INTRODUCTION:Pandemics are known to affect mental health of the general population and various at-risk groups like healthcare workers, students and people with chronic medical diseases. However, not much is known of the mental health of people with pre-existing mental illness during a pandemic. This systematic review and meta-analysis investigates, whether people with pre-existing mental illness experience an increase in mental health symptoms and experience more hospitalizations during a pandemic. MATERIALS AND METHODS:A systematic search was conducted in the EMBASE, OVID-MEDLINE and PsycINFO databases to identify potentially eligible studies. Data were extracted independently and continuous data were used in calculating pooled effect sizes of standardized mean difference (SMD) using the random-effects model. RESULTS:Of 1791 records reviewed 15 studies were included. People with pre-existing mental illness have significantly higher psychiatric symptoms, anxiety symptoms and depressive symptoms compared to controls during a pandemic with pooled effect sizes (SMD) of 0.593 (95% confidence interval (CI) 0.46 to 0.72), 0.616 (95% CI 0.49 to 0.73) and 0.597 (95% CI 0.38 to 0.80) respectively. Studies also found a reduction in psychiatric hospitalizations and utilization of psychiatric services during pandemics. CONCLUSION:The review highlights the need for mental health services to address the increased mental health symptoms in people with pre-existing mental illnesses during a pandemic. Future research should focus on better designed controlled studies of discrete illness groups, so as to provide a robust basis for policy makers to plan appropriate level of support and care for people with mental illness during a pandemic.
PurposeThe purpose of this paper is to compare levels of psychological distress in 2001 and 2010 in eight countries of the former Soviet Union and to explore how these changes vary for different population groups.Design/methodology/approachData were collected using two related studies from 2001 (n=14,242) and 2010 (n=15,081). Both studies consisted of nationally representative cross‐sectional household surveys in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine using a standardized questionnaire. Psychological distress was measured using a 12 item instrument, with scores of 10‐12 indicating high psychological distress. Changes in prevalence of high psychological distress were measured between 2001 and 2010 by country, gender, age group, educational level, disability status, personal support and household economic status using descriptive and prevalence rate ratio analysis.FindingsLevels of high psychological distress decreased from 8.7 per cent in 2001 to 4.9 per cent in 2010 for the whole study region (4.5 per cent to 2.8 per cent for men; 12.0 per cent to 6.5 per cent for women). All study countries recorded decreases in high psychological distress. The adjusted relative rate ratios indicate the observed decreases have not been experienced by men, older age groups, less educated respondents, those with a disabling health condition, low levels of support and bad household economic status.Originality/valueThe study shows decreases in levels of high psychological distress in the study countries, but that decreases were less for socially and economically marginalised populations. This highlights the cycle of poverty, social exclusion and poor mental health in the region. Despite decreases of psychological distress among women, they continue to bear a significantly higher burden than men.
Although it is well recognised that the collapse of the Soviet Union and the subsequent widespread social and economic changes impacted on the levels and distribution of physical health, there is very limited evidence on the social patterning of mental health in the countries that emerged. The aim of this paper is to assess levels of psychological distress and describe its demographic, social and economic correlates in eight former Soviet countries.Cross‐sectional surveys using multi‐stage random sampling were conducted in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine. A standardised questionnaire was used for all countries, including the main outcome for this study of psychological distress, which consisted of 12 items on symptoms of psychological distress. Respondents who repor ted 10‐12 of the symptoms were considered to have a high psychological distress score. Multivariate logistic regression analysis was then used to investigate how demographic, social and economic factors were associated with a high psychological distress score.High psychological distress in seven of the eight countries ranges from 3.8% in Kazakhstan to 10% in Ukraine but was substantially higher (21.7%) in Armenia. Factors associated with psychological distress in the multivariate analysis included: being female; increasing age; incomplete secondary education; being disabled; experiencing two or more stressful events in the past year; lack of trust in people; lack of personal suppor t in crisis; being unemployed; and poor household economic situation.The study contributes evidence on the association of impoverishment and social isolation on psychological distress in countries of the former Soviet Union and highlights the impor tance of exploring ways of improving mental health by addressing its social determinants.
Reports produced in response to the need for health technology assessment (HTA) vary greatly in the methods they use, depending on the decision-maker's needs, the technology's characteristics and the resources available. HTA reports vary from the brief, such as 'vignettes' produced when a new technology emerges, to the exhaustive, such as 'Cochrane reviews' synthesising a mature evidence base. They may address a wide range of different questions. 'Classic HTAs', typically those reports prepared to support NICE appraisal decisions, seek to use scientifically rigorous methods to address a focused policy question. These are based on systematic reviews of the effectiveness evidence but this is often fed into economic models, in order to generate estimates of cost-effectiveness. Future developments in HTA responses will reflect both the embedding of systematic methods and a growing responsiveness to customer needs.
BACKGROUND:The aim of the study was to provide a critical and comprehensive overview of the published peer-reviewed evidence relating to community pharmacy-based activity in the reduction of risk behaviours and risk factors for coronary heart disease (CHD). METHOD:Electronic databases were searched from 1 January 1990 to 1 February 2001. Hand searches for the same period were undertaken of specific journals and proceedings of peer-reviewed conference abstracts. Data abstracted from publications included: participants/setting; study designs intervention including training); outcome measures; key findings. RESULTS:Four randomized controlled trials (RCTs) were identified, two in smoking cessation and two in lipid management. All met review criteria and were included. Two (RCTs) involving 976 subjects and three non-randomized experimental studies were identified that evaluated the effectiveness of community pharmacy advice in smoking cessation. Two controlled trials and one before-and-after study investigated the effect of training on pharmacists' smoking cessation advice. One attitudinal survey collected data on reactive and proactive smoking cessation advice-giving by community pharmacists. Two RCTs involving 642 subjects, and two observational studies were identified for community pharmacy-based lipid management. The published studies provided evidence of clinical and cost-effectiveness of community pharmacy services from UK RCTs in smoking cessation, and from US and Canadian RCTs in lipid management in the prevention of heart disease. Although the role of the community pharmacy in disease detection and case finding has been widely discussed, only a small number of studies was found. The findings indicated that further investigation is warranted in these areas. CONCLUSION:The peer-reviewed literature demonstrates the contribution of community pharmacy-based services to the reduction of risk behaviours and risk factors for CHD. The evidence supports the wider provision of smoking cessation and lipid management through community pharmacies. Health commissioners and planners can use the findings of this review to incorporate community pharmacy based health development activities into local health services. Further research is needed into the contribution of community pharmacy to disease detection and case finding as part of local public health strategies.
In August 2000, health authorities in England and Wales became statutory consultees for permits issued to industry by the Environment Agency as part of the implementation of EU directives. This responsibility has since been delegated to Primary Care Trusts. To assess health authority responses to applications made under the Integrated Pollution Prevention and Control (IPPC) regulations, we collected data from public registers during the first 12 months of this new regulatory regime. There was evidence of 27 applications, of which 59 per cent had substantive comments from health authorities. There was wide variation in the length and content. Responses were from Consultants in Communicable Disease Control (57 per cent) or Directors of Public Health (43 per cent). Only two health authorities had a dedicated resource for responding to IPPC applications. Capacity and capability are lacking and require resources invested for consistent, effective public health input to the process of permitting potentially polluting industries.
BACKGROUNDThe aims of this study were to develop ischaemic heart disease (IHD) registers in three primary care groups (PCGs) in SW London; to determine what proportion of patients with IHD were already identified; and to estimate the workload in producing an IHD disease register.METHODSA population-based cross-sectional study was carried out in 46 out of 49 general practices in three PCGs in SW London, using computerized and paper medical records. Outcome measures were proportion of patients with IHD on existing disease registers, and workload and cost of producing complete registers.RESULTSOf 3803 patients with a pre-existing IHD Read code, 570 (15 per cent) were found to have no evidence of IHD, leaving 3233 patients with confirmed or probable IHD. A search of 7726 patients prescribed one of five cardiovascular drugs but not already coded as having IHD identified a further 1447 confirmed or probable cases. On average, coders spent 4.9 hours per 1000 list size verifying IHD cases or finding uncoded cases. Each additional IHD case required about 0.68 hours (41 minutes) of coder's time to identify and one case of IHD was identified or confirmed for about every five sets of notes examined. The cost of each additional case identified was about pounds sterling 10.20. At practice level, there was a wide variation in the proportion of IHD patients already on the register or wrongly coded as having IHD.CONCLUSIONSA centralized search programme can identify patients with IHD efficiently and at relatively low cost. As the identification of cases is an essential first step in implementing effective secondary prevention, other primary care trusts may also find this method useful in improving the management of patients with IHD.
Background Data are available on the prevalence of smoking states (never, current and ex). However, data on behaviour change rates (starting - never to current, quitting - current to ex and lapsing - ex to current) are not readily available and cannot be simply derived from or related to prevalence data.Method A model was constructed to relate prevalence of smoking states to behaviour change rates. It was populated with prevalence of smoking status taken from the General Household Survey together with population structure, age-and sex-specific death rates, and birth rates for England and Wales. This model could be used to calculate past behaviour change given observed prevalence of smoking states or future prevalence of smoking given predicted rates of behaviour change.Results To fit data it was necessary to assume that as they age some ex smokers reclassify themselves as never smokers. In the age band 16-19 years about 9 per cent of never smokers start smoking, and about 5 percent of current smokers quit. In the age band 20-24 years the corresponding figures for starting are about 4 per cent in males and 2 per cent in females, and for quitting about 2 per cent in both. In older age bands the percentages starting are zero or less than zero (indicating reclassifying), and the percentage quitting rises with age. Net lapsing (shift from ex to current) occurred very infrequently and is quantitatively unimportant. If the current starting, quitting and lapsing rates are maintained the Smoking kills target will not be met. Future prevalence of smoking under different scenarios is examined.Conclusion The model is useful in calculating the proportions changing smoking state from serial cross-sectional data on prevalence and for predicting future prevalence.
BACKGROUND:Approximately 110,000 people in the United Kingdom are affected with familial hypercholesterolaemia (FH). At least 75 per cent are undiagnosed. Treatment with statins is effective but effective primary prevention requires early diagnosis. The best strategy to achieve this is unclear. This paper compares the costs and benefits over a 10 year period of two strategies found in our previous modelling: population screening of 16-year-olds or tracing family members of affected patients.METHODS:Computer modelling of time-limited data was conducted. The number available for screening and the potential new cases in England and Wales aged 16-54 years were estimated. The costs (of screening and treatment) and benefits (deaths averted) that might be accrued over 10 years were assessed.RESULTS:Screening 16-year-olds results in 470 new diagnoses, and over 10 subsequent years averts 11.7 deaths at a cost of 6,176,648 pounds sterling, giving a cost per case identified and treated of 13,141 pounds sterling (including a 10 year drug cost of 1,584,918 pounds sterling). By contrast, screening first-degree relatives of known uases results in 13,248 new diagnoses, 560 deaths averted over 10 years, at a cost of 46,430,681 pounds sterling giving a cost per case identified and treated of 3,505 pounds sterling (including 10 year drug cost of 44,645,760 pounds sterling). The cost per death averted would be 3,187 pounds sterling.CONCLUSIONS:Although the two approaches appear similar in cost-effectiveness over a lifetime, the shorter-term (10 year) cost-effectiveness clearly favours family tracing. This represents good value for money compared with common medical interventions, and suggests that pilot FH family tracing programmes should be conducted.
BACKGROUNDThe aim of the study was to investigate the feasibility of monitoring older people's health by measuring active life expectancy among older people with and without diabetes using routinely collected primary care data.METHODSThe study comprised the first five rounds of a routine health assessment of those aged 75 years and over belonging to a large Midlands general practice (list size 32,500). A nurse carried out the health assessments in the participant's home. Being active was defined as the ability to perform (without difficulty, help or use of aids) at least six of seven activities of daily living (ADLs). Mortality data were collected through the practice register together with regular linkage to information from the Office for National Statistics. Period health expectancies were calculated for those known or found to be diabetic through the health assessments and for non-diabetic individuals.RESULTSCalculation of active life expectancies (ALE) was based on 2,474 persons (212 with and 2,262 without diabetes). At all ages, people with diabetes had lower life expectancy and spent fewer years active. The proportion of remaining life spent active was, however, similar for both groups at younger ages, but by age 85 years people with diabetes spent only 32 per cent of remaining life active compared with 42 per cent for those without diabetes.CONCLUSIONAnnual health assessments of the over-75s in primary care together with linkage to mortality data provide a feasible method of monitoring older people's health, particularly for subgroups at greater risk of disability. At Strategic Health Authority or Primary Care Trust level these methods can monitor health needs, highlight health inequalities and evaluate intervention strategies.
BACKGROUND This study examines a cohort in which individuals of privileged socio-economic position report greater psychological stress. We have previously shown in this cohort that stress is unrelated to coronary heart disease as measured by hospital discharge diagnosis and cause-specific death. In contrast, stress and hospitalization for cardiovascular conditions not requiring mandatory admission were associated. We hypothesized that psychosocial factors, in particular reporting tendency, are the likely mediator of this association, and the present study considers this further. METHODS A total of 5,596 men underwent a health screening during which they completed the Reeder Stress Inventory. Details of hospital admissions were retrieved from the Scottish Morbidity Records over a 21 year follow-up. Relationships between stress and admission were evaluated using proportional hazards regression. RESULTS Compared with low stress, reported high stress was found to be associated with increased numbers of admissions for each of three most common cardiovascular causes of non-mandatory admission: adjusted hazard ratios were 3.43 for essential hypertension (95 per cent confidence interval (CI) 1.36-8.65), 1.91 for lower limb varicose veins (95 per cent CI 1.12-3.24), and 2.01 for haemorrhoids (95 per cent CI 1.16-3.51). Stress and blood pressure at baseline were not associated. CONCLUSION The association between stress and admissions as a result of hypertension appears unlikely to be mediated by blood pressure. More likely is a mechanism based upon the reporting of symptoms, or the recording of discharge diagnoses. There is no obvious medical explanation for associations between stress and hospitalization as a result of varicose veins or haemorrhoids, and again it is likely that psychosocial factors provide the mechanism.
BACKGROUND:Little is known about the utilization of NHS Direct by disadvantaged groups, in spite of the service aiming to be 'accessible to all'. This study investigates the relationship between use of NHS Direct and deprivation in one predominantly disadvantaged area.METHODS:Ward-level call rates to NHS Direct South East London over a 6 month period were calculated using postcode data. Jarman and Townsend scores were used as a proxy of deprivation in each ward. We performed negative binomial regression to investigate the relationship between deprivation score and rate of calls to NHS Direct.RESULTS:There was a significant, non-linear (quadratic) effect of deprivation score on call rates; call rates were lower in both the most affluent and most deprived wards.CONCLUSION:Calls to NHS Direct rise with increasing deprivation until, at extreme levels of deprivation, they subsequently decline. This challenges assumptions that NHS Direct is not utilized in deprived areas.
