Effectiveness of interventions to reduce homelessness

This review assesses the effectiveness of interventions combining housing and case management as a means to reduce homelessness and increase residential stability for individuals who are homeless, or at risk of becoming homeless | Campbell Collaboration

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Image source: http://www.campbellcollaboration.org

Authors found that a range of housing programs and case management interventions appear to reduce homelessness and improve housing stability, compared to usual services. The findings showed no indication of housing programs or case management resulting in poorer outcomes for homeless or at-risk individuals than usual services.

Full document: Effectiveness of interventions to reduce homelessness: a systematic review and meta-analysis | Campbell Collaboration | 2018 (3)

Australian study finds not exercising increases depressive symptoms- especially for women

The principle that regular exercise improves depressive symptoms (DS) might be well-established, but the effects of discontinuing exercise on depression are overlooked in research, according to  Australian scientists.  They conducted a systematic review to examine the relationship between depression and stopping exercising.  The researchers  discovered that no studies had considered the effects of regular exercise on major depressive disorder (MDD), but that ceasing exercise increases DS. (via Science Direct)

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Key findings:

Female participants were more likely to experience worsening of depressive symptoms than males following cessation of exercise

DS arose without changes in neurotrophic or immune biological markers

As a result of their findings, the researchers call for high-quality trials in healthy adults and patients with depression are needed.

Abstract

Background

Regular exercise in adults improves depressive symptoms (DS) and major depressive disorder (MDD), however the clinical effects of ceasing exercise are largely unknown.

Methods

Seven databases were searched from inception to December 2017. Eligibility criteria included English language studies investigating the effects of ceasing exercise on DS or MDD in regularly active adults with or without prior DS or MDD. Blood based markers related to exercise cessation (EC) were assessed, if recorded. Studies investigating exercise follow-up periods were excluded.

Results

No studies investigated EC in MDD. Six studies including two RCTS and three studies investigating neurogenic and immune biological markers associated with DS met inclusion criteria (152 healthy adults, females n = 50/32.89%). Compared to baseline, EC increased DS after three days, one week, and two weeks. Female participants had significantly more DS than male participants. Following EC, no changes in brain derived neurotrophic factor (BDNF) or tumour necrosis factor alpha (TNF) were evident, however C-reactive protein (CRP) at week one and interleukin 6 (IL6) at week two were reduced.

Limitations

Quality concerns including risks of attrition and reporting bias limit our confidence in these results.

Conclusions

Ceasing regular exercise increases DS in healthy adults, with greater DS in females than males. Contrary to the cytokine/inflammatory hypothesis of depression, DS were associated with reduced CRP and IL6 and without increased TNF. High quality trials are needed to extend this field of research in both healthy and MDD populations.
Full reference: Morgan,  J., A.,  Olagunju, J. A., Corrigan, F.,   Baune, B.T. | 2018  |  Does ceasing exercise induce depressive symptoms? A systematic review of experimental trials including immunological and neurogenic markers | Journal of Affective Disorders | Vol. 234 | P. 180 -92 |  DOI: 10.1016/j.jad.2018.02.058

 

Avoidable Lifestyle factors implicated in 2,500 cancer cases a week that could be prevented

Cancer Research UK  |  March 2018 | More than 2,500 cancer cases a week could be avoided

Cancer Research UK has published findings which demonstrate that almost 4 in 10 ( 37.7 per cent) of cancers could have been prevented. The landmark study highlights that many lifestyle factors could contribute to an individual’s risk of developing cancer.  The study identifies 135, 500 cases of cancer a year in the UK that could be prevented through lifestyle changes. The research findings have been published this month in the British Journal of Cancer  (the full abstract at the end of the post).

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Image source: cancerresearchuk.org

While smoking was to blame for the largest percentage of preventable cancer cases, using data from 2015 the researchers observed,  tobacco smoke caused around 32,200 cases of cancer in men (17.7% of all male cancer cases) and around 22,000 (12.4%) in women.

Obesity is the second highest contributory risk to developing cancer: around 22,800 (6.3%) cases of cancer a year are down to being overweight or obese. This is equivalent to around 13,200 (7.5%) cases of cancer in women and around 9,600 (5.2%) in men. The results imply that 5% (1 in 20) cancer cases might possibly be prevented by maintaining a health weight. Obesity has been linked to 13 different types of cancer, such as cancers of the bowel, breast and kidney.

The third greatest factor in preventable cancers was overexposure to UV radiation from the sun and sunbeds, associated with around 13,600 cases of melanoma skin cancer a year, 3.8% of all cancer cases.

Other preventable lifestyle risks outlined in the study were eating too little fibre causing around 11,900 cases equivalent to 3.3% each, drinking too much alcohol (attributed to causing 11,700 cases or 3.3% each.

In repsonse to the findings of the research, Sir Harpal Kumar, Cancer Research UK’s chief executive, said: “Leading a healthy life doesn’t guarantee that a person won’t get cancer, but it can stack the odds in your favour. These figures show that we each can take positive steps to help reduce our individual risk of the disease.” (Cancer Research UK)

Full press release from Cancer Research UK here 

Full reference: Brown, K. F., et al   | 2018 |  The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015  |British Journal of Cancer | doi:10.1038/s41416-018-0029-6

Abstract

Background

Changing population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them.

Methods

Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country.

Results

Nearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors.

Conclusion

Tobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels—both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable ‘lifestyle’ factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.

 

Blueberry muffins have more sugar than a can of coke

Obesity Health Alliance  |  2018  |  Warning over blueberry muffin hidden sugar content – with leading brands containing up to 10 teaspoons of sugar; more than a can of Coke

Action on Sugar and the Obesity Health Alliance (OHA) have released figures highlighting the amount of sugar in blueberry muffins. Their data not only shows the ‘hidden sugar’ in the treat, but it also underlines the variation in sugar content in the muffins sold across retail outlets in the UK.  Some of these muffins contain as much as 10 teaspoons (tsps) of sugar and those with the least sugar contained 3 tsps.

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Their analysis shows that  muffins purchased at railways station shops had more sugar (19%) and were over a third  (32%) than those available pre-packaged in supermarkets.  While,  just under two thirds 61% of all the muffins included in the survey  contained six teaspoons of sugar or more, which is the upper daily limit  for a child aged 7-10 years.

Caroline Cerny, Obesity Health Alliance Lead, said:

“We may think grabbing a blueberry muffin is a reasonably healthy option for a snack on the go compared to other cakes or a chocolate bar – yet the figures suggest otherwise.  There is huge variation in both the size of muffins and the sugar content; and with limited nutrition labelling it’s all too easy to eat a huge amount of sugar in just one serving.”

Action on Obesity are calling on the government to introduce warning labels to be mandatory on all food products, not just those sold ready packaged in supermarkets.

The full release is available at Obesity  Health Alliance, Warning over blueberry muffin hidden sugar content – with leading brands containing up to 10 teaspoons of sugar; more than a can of Coke
In the media BBC News A blueberry muffin ‘could have day’s worth of sugar’

The Prioritisation Framework: making the most of your budget

A flexible tool to support local authorities make transparent, evidence-based spending decisions across public health programmes | Public Health England

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Local public health teams are facing increasingly complex and challenging decisions over what services to invest in and disinvest from. The Prioritisation Framework is designed to help local authorities conduct a systematic prioritisation exercise, by greatly reducing the burden and complexity of the task.

The approach is based on Multi Criteria Decision Analysis, a recognised decision support technique which has been successfully used in a variety of contexts.

Throughout the tool users are provided with extensive guidance and links to other relevant resources. A supporting materials pack is available from the PHE Health Economics team at healtheconomics@phe.gov.uk.

A call for action against sepsis

NHS RightCare has produced a call to action video with former National Medical Director Professor Sir Bruce Keogh to address sepsis. 

This video calls for all commissioners, clinicians and health economies in England to come together to address and reduce the variation found in the care of sepsis for all patients with the aim of improving outcomes and quality of life.

In spring 2018, NHS RightCare will publish a full scenario detailing a sub-optimal, but realistic, care pathway against an optimal pathway and the measures that can be applied to improve identification, treatment and outcomes.