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  1. Call for public health rethink

    Britain needs a "radical upgrade" to its approach to researching public health, leading scientists say today.

    The rethink should ensure the public has more control over its health, according to a report from the Academy of the Medical Sciences.

    The academy says public health is shaped by genes, food, places, transport, air and "where we learn and work."

    It calls for a new breed of researchers to break the traditional boundaries of biomedical and public health research.

    It says that health and social care professionals will need the skills to tackle the factors that cause health problems.

    Professor Dame Anne Johnson, who led a working group that produced the report, said: "Public health measures such as smoke-free and clean air legislation, safer food and workplaces, and vaccination have resulted in major advances in the health of the public. However society is evolving rapidly and new challenges are emerging that require a change in our understanding of public health.

    "We need a public health system, and the research to support it, that takes account of the wide range of interacting factors that affect health to develop effective prevention measures that result in a healthier, fairer future for all.

    “The health of the public shouldn’t just be at the heart of Department of Health policies - it should be at the heart of all government policies.”

    The Royal College of Physicians welcomed the call for stronger collaboration between medical organisations to help improve the nation’s health.

    RCP academic vice president, Professor Margaret Johnson, said: “The RCP has a strong history of improving public health, with the most recent achievement being the ban on smoking in cars with children.

    “As such, the recommendation in this report for greater co-operation and collaboration between sectors in order to improve the nation’s health are extremely welcome - as we know that research and long term public health successes are best achieved in partnership with others.”

    She said the report’s recommendation to help physicians access public health research throughout their career, reflected the conclusions in its own 2016 report, ‘Research for all’.

    “We strongly agree that if we are to see innovation in this area physicians must be given the time, funding and support to actively engage in research,” continued Prof Johnson.

    “We will work with the Academy of Medical Sciences to ensure such skills are utilised for the benefit of public health research in the future. Finally, we must not forget that though research and legislative change are important factors in improving the health of the public, we need to ensure that we engage the public and patient groups if we are to achieve sustainable change.”

  2. WHO map reveals extent of global air pollution

    Almost all of the world’s population lives in areas where air quality exceeds limits set by the World Health Organization (WHO), a new report by the global body out today (27 September, 2016) has revealed.

    An air quality model, which is the most detailed outdoor – or ambient – air pollution-related health data, by country, ever reported by WHO, shows that 92% of the global population live in towns and cities where air pollution is prevalent.

    The interactive maps are based on data from satellite measurements, air transport models and ground station monitors for more than 3,000 rural and urban locations.

    Developed by WHO with the University of Bath, England, the model has carefully calibrated data from satellite and ground stations and national air pollution exposures were analysed against population and air pollution levels at a grid resolution of about 10 km x 10 km.

    Dr Maria Neira, WHO director, Department of Public Health, Environmental and Social Determinants of Health, said the new WHO model was a “big step forward towards even more confident estimates of the huge global burden of more than 6 million deaths”.

    “More and more cities are monitoring air pollution now, satellite data is more comprehensive, and we are getting better at refining the related health estimates,” she added.

    Dr Flavia Bustreo, assistant director general at WHO, added: “The new WHO model shows countries where the air pollution danger spots are, and provides a baseline for monitoring progress in combating it.

    “Air pollution continues to take a toll on the health of the most vulnerable populations - women, children and the older adults. For people to be healthy, they must breathe clean air from their first breath to their last.”

    Approximately three million deaths a year are linked to exposure to outdoor air pollution, while in 2012, an estimated 6.5 million deaths – 11.6% of all global deaths – were linked to both indoor and outdoor air pollution.

    Just under 90% of deaths that are linked to air-pollution happen in low- and middle-income countries, with nearly two thirds in WHO’s South-East Asia and Western Pacific regions.

    The interactive map provides information on population-weighted exposure to particulate matter of an aerodynamic diameter of less than 2.5 micrometres (PM2.5) for all countries. The map also indicates data on monitoring stations for PM10 and PM2.5values for about 3000 cities and towns.

    Dr Neira said action to tackle air pollution cannot come soon enough.

    “Solutions exist with sustainable transport in cities, solid waste management, access to clean household fuels and cook-stoves, as well as renewable energies and industrial emissions reductions,” she added.

  3. Too few improvements in neo-natal care

    Neonatal units should form partnerships with other hospitals to improve standards of care for very sick babies, according to the Royal College of Paediatrics and Child Health.

    The call follows the publication of the latest National Neonatal Audit Programme report (NNAP), published today ( 27 September, 2016) by the college.

    This found that very little or no improvement had been made over the last year in meeting several important care standards.

    The report found there had been no progress in some areas of care, including ensuring that babies’ eyes were screened to minimise risk of premature visual loss and their temperature management. The report also found that many parents did not receive timely consultation with a senior member of staff.

    NNAP has launched an online reporting tool alongside the report, which neonatal units can use to identify good practice and form links with other units.

    The report assessed 95,325 admissions of babies across 179 neonatal units in England, Wales and for the first time this year, Scotland, and found that hypothermia is a common problem, with 28% of babies born at less than 32 weeks gestation having a temperature below the recommended range of 36.5-37.5 degrees.

    It also found that 52% of units maintained the recommended temperature of babies born at under 29 weeks – up from 51% in 2014 – and that more than one in 20 babies did not receive retinopathy of prematurity screening at the recommended time. This was unchanged from 2014.

    A total of 12% of parents did not have a recorded consultation with a senior member of staff within 24 hours of their baby’s admission to the neonatal unit. The report found that adherence to this standard varies from 54 to 100%. Just over a quarter (27%) of units achieved a 100% rate of timely consultation.

    The report also found that 58% of babies delivered at less than 33 weeks gestation were being fed with their mother’s milk when they were discharged from neonatal care, a figure that has remained stable since 2012.

    Dr Sam Oddie, clinical lead for the National Neonatal Audit Programme (NNAP) and member of the RCPCH said: “Some units are doing remarkably well when it comes to meeting the care standards measured by the NNAP; however there are others that are simply not delivering on these yet. These units need to be looking at improving this.

    “100% of babies should have their temperature taken within an hour of birth and the fact this isn’t happening is very concerning. If not monitored closely, low admission temperature can lead to hypothermia and severe illness, so getting this right is essential.”

    He also said he wanted to see the figure on doctors speaking to parents improve quickly.

    “When a baby is admitted to a neonatal unit, it can be a daunting time for parents,” he said. “Having a doctor speak to them early about what is happening and the support on offer to them is extremely important.

    “27% of units did this for all their families, showing that there is no excuse for not providing this key element of support for parents. This is something I hope to see improved very quickly.”

    The NNAP found that there had been greater improvements in recording vital developmental checks at age two, with 60% of babies born at 30 weeks gestation having their two year follow-up appointment, compared with 54% recorded in 2014.

    Dr Sam Oddie added: “Babies born prematurely do not always reach key developmental milestones so these checks at age two provide a valuable opportunity to identify any potential issues early.”

    The NNAP is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and is funded by NHS England, the Welsh Government and the Scottish Government.

    A full breakdown of the 2015 data from the NNAP can be found on an interactive reporting tool available on the NNAP web pages at [www.rcpch.ac.uk/nnap].

  4. Phase I trial expectations ‘unrealistic’

    Cancer patients who are considering participating in phase I clinical trials have “unrealistic expectations” of the benefits, a new study reports.

    The research by The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, which explored patients’ motivations for considering phase I trials and assessed their expectations both before and after they consulted with clinicians, found that almost half thought their tumours would shrink.

    The revelation, published in Cancer, demonstrate the challenges facing patients and healthcare professionals during their interactions in phase I studies, say the authors.

    A total of 396 patients who were considering participating in a phase I clinical trial completed questionnaires prior to being seen by a doctor, and 301 completed an abbreviated follow-up questionnaire after consultation with clinicians.

    Dr Udai Banerji, who led the research, and team found that when the patients were asked about the potential personal benefit of participating, 43% predicted tumour shrinkage in the initial questionnaire.

    Following a consultation, this increased to 47%, which shows that existing methods of communication did not lessen patients’ pre-consultation expectations of benefit, he said.

    Overall, patients were keen to consider trials, with 72% of pre- and 84% of post-clinic patients willing to enrol.

    “There is a positive message in this, which is that 84% of patients are willing to participate in phase I oncology studies after a discussion with clinical and nursing staff who lay out the conservative estimates of benefit and requirements of hospital visits.,” said Dr Banerji.

    “This is good for current and future patients and cancer medicine in general. The high percentage of patients expecting their tumours to shrink was a sobering finding. This creates a challenge for healthcare professionals to manage expectations but to do so without being patronising or dismissing human hope.”

    The results also demonstrate the need to improve patient information and consent forms, he added.

    Dolly S, Kalaitzaki E, Puglisi M et al. A study of the motivations and expectations of patients seen in phase I oncology clinics. Cancer 26 September 2016; doi: 10.1002/cncr.30235

 

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