Shared decision-making interventions: An overview and a meta-analysis of their impact on vaccine uptake.

BACKGROUND: The interest in shared decision making (SDM) and the use of patient decision aids have increased significantly. Research indicates that this approach has benefits, and yet, implementation remains a challenge. To illustrate this development, we focus on vaccine hesitancy which has become a serious public health challenge during the COVID-19 pandemic. Various strategies have been used in healthcare, with limited success, to help patients overcome vaccine hesitancy. It is unclear whether SDM interventions can increase vaccination rates. AIMS: Our aim was two-fold: to provide an overview of SDM and the use of patient decision aids and to determine the effect of SDM interventions on vaccine uptake. METHODS: To provide an overview, we drew on our knowledge of the field and summarized the most recent systematic reviews. We examined the impact on vaccine hesitancy by searching for randomized controlled trials (RCTs) of SDM interventions, conducted a meta-analysis and calculated a pooled odds ratio. Additional outcomes were reported in a narrative synthesis. RESULTS: SDM is viewed as the pinnacle of patient-centred care, supported by an ethical imperative and by empirical evidence of benefits. We found 10 RCTs that met our inclusion criteria. SDM interventions significantly increased vaccine uptake compared to control groups (odds ratio = 1.45; 95% confidence interval [1.17-1.80]; p < 0.01). Some RCTs also reported significantly decreased decisional conflict and increased decision confidence. CONCLUSION: Future healthcare delivery systems will need to consider how to support the implementation of SDM. Interventions designed to facilitate this approach can represent a helpful, ethically defensible, strategy to increase vaccination rates.

Community Alcohol Partnerships with the alcohol industry: what is their purpose and are they effective in reducing alcohol harms?

Background: Local initiatives to reduce alcohol harms are common. One UK approach, Community Alcohol Partnerships (CAPs), involves partnerships between the alcohol industry and local government, focussing on alcohol misuse and anti-social behaviour (ASB) among young people. This study aimed to assess the evidence of effectiveness of CAPs. Methods: We searched CAP websites and documents, and databases, and contacted CAPs to identify evaluations and summarize their findings. We appraised these against four methodological criteria: (i) reporting of pre-post data; (ii) use of comparison area(s); (iii) length of follow-up; and (iv) baseline comparability of comparison and intervention areas. Results: Out of 88 CAPs, we found three CAP evaluations which used controlled designs or comparison areas, and further data on 10 other CAPs. The most robust evaluations found little change in ASB, though few data were presented. While CAPs appear to affect public perceptions of ASB, this is not a measure of the effectiveness of CAPs. Conclusions: Despite industry claims, the few existing evaluations do not provide convincing evidence that CAPs are effective in reducing alcohol harms or ASB. Their main role may be as an alcohol industry corporate social responsibility measure which is intended to limit the reputational damage associated with alcohol-related ASB.

Provision of information to consumers about the calorie content of alcoholic drinks: did the Responsibility Deal pledge by alcohol retailers and producers increase the availability of calorie information?

OBJECTIVES: Alcohol is a significant source of dietary calories and is a contributor to obesity. Industry pledges to provide calorie information to consumers have been cited as reasons for not introducing mandatory ingredient labelling. As part of the Public Health Responsibility Deal (RD) in England, alcohol retailers and producers committed to providing consumers with information on the calorie content of alcoholic drinks. This study examines what was achieved following this commitment and considers the implications for current industry commitments to provide information on alcohol calories. STUDY DESIGN: Analysis of RD pledge delivery plans and progress reports. Assessment of calorie information in supermarkets and in online stores. METHODS: (i) Analysis of the content of pledge delivery plans and annual progress reports of RD signatories to determine what action they had committed to, and had taken, to provide calorie information. (ii) Analysis of the availability of calorie information on product labels; in UK supermarkets; and on online shopping sites and websites. RESULTS: No information was provided in any of 55 stores chosen to represent all the main UK supermarkets. Calorie information was not routinely provided on supermarkets' websites, or on product labels. CONCLUSIONS: One of the stated purposes of the RD was to provide consumers with the information to make informed health-related choices, including providing information on the calorie content of alcoholic drinks. This study indicates that this did not take place to any significant extent. The voluntary implementation of alcohol calorie labelling by industry needs to continue to be carefully monitored to determine whether and how it is done.

An evaluation of a public-private partnership to reduce artificial trans fatty acids in England, 2011-16.

Background: The Public Health Responsibility Deal (RD) is a public-private partnership in England involving voluntary pledges between government, and business and other public organizations to improve public health. One such voluntary pledge refers to the reduction of trans fatty acids (TFAs) in the food supply in England by either pledging not to use artificial TFAs or pledging artificial TFA removal. This paper evaluates the RD's effectiveness at encouraging signatory organizations to remove artificially produced TFAs from their products. Methods: We analysed publically available data submitted by RD signatory organizations. We analysed their plans and progress towards achieving the TFAs pledge, comparing 2015 progress reports against their delivery plans. We also assessed the extent to which TFAs reductions beyond pre-2011 levels could be attributed to the RD. Results: Voluntary reformulation via the RD has had limited added value, because the first part of the trans fat pledge simply requires organizations to confirm that they do not use TFAs and the second part, that has the potential to reduce use, has failed to attract the participation of food producers, particularly those producing fast foods and takeaways, where most remaining use of artificial TFAs is located. Conclusions: The contribution of the RD TFAs pledges in reducing artificial TFAs from England's food supply beyond pre-2011 levels appears to be negligible. This research has wider implications for the growing international evidence base voluntary food policy, and offers insights for other countries currently undertaking work to remove TFAs from their food supply.

Getting England to be more physically active: are the Public Health Responsibility Deal's physical activity pledges the answer?

BACKGROUND: The Public Health Responsibility Deal (RD) in England is a public-private partnership involving voluntary pledges between government, industry, and other organisations to improve public health by addressing alcohol, food, health at work, and physical activity. This paper analyses the RD physical activity (PA) pledges in terms of the evidence of their potential effectiveness, and the likelihood that they have motivated actions among organisations that would not otherwise have taken place. METHODS: We systematically reviewed evidence of the effectiveness of interventions proposed in four PA pledges of the RD, namely, those on physical activity in the community; physical activity guidelines; active travel; and physical activity in the workplace. We then analysed publically available data on RD signatory organisations' plans and progress towards achieving the physical activity pledges, and assessed the extent to which activities among organisations could be attributed to the RD. RESULTS: Where combined with environmental approaches, interventions such as mass media campaigns to communicate the benefits of physical activity, active travel in children and adults, and workplace-related interventions could in principle be effective, if fully implemented. However, most activities proposed by each PA pledge involved providing information or enabling choice, which has limited effectiveness. Moreover, it was difficult to establish the extent of implementation of pledges within organisations, given that progress reports were mostly unavailable, and, where provided, it was difficult to ascertain their relevance to the RD pledges. Finally, 15 % of interventions listed in organisations' delivery plans were judged to be the result of participation in the RD, meaning that most actions taken by organisations were likely already under way, regardless of the RD. CONCLUSIONS: Irrespective of the nature of a public health policy to encourage physical activity, targets need to be evidence-based, well-defined, measurable and encourage organisations to go beyond business as usual. RD physical activity targets do not adequately fulfill these criteria.

Scald risk in social housing can be reduced through thermostatic control system without increasing Legionella risk: a cluster randomised trial.

OBJECTIVE: To quantify the effects of a thermostatic control system in social (public) housing on the prevalence of dangerous (>60°C) water temperatures and on fuel consumption. DESIGN: Pair-matched double-blind cluster randomised controlled trial. SETTING: Social housing in a deprived inner-London borough. PARTICIPANTS: 150 households recruited as clusters from 22 social housing estates. Four small estates were combined into two clusters (resulting in a total of 10 pairs of clusters). INTERVENTION: Social housing estate boiler houses were randomised to a thermostatic control sterilisation programme (heating water to 65°C during 00:00-06:00 h and to 50°C from 06:00 to 00:00 h daily) or to standard control (constant temperature 65°C). MAIN OUTCOME MEASURES: Water temperature over 60°C ('dangerous') after running taps for 1 min and daily fuel consumption (cubic feet of gas). RESULTS: 10 clusters (80 households) were allocated to the sterilisation programme and 10 clusters (70 households) to control, of which 73 and 67 households, respectively, were analysed. Prevalence of dangerous (>60°C) hot water temperatures at 1 min was significantly reduced with the sterilisation programme (mean of cluster prevalence 1% in sterilisation programme group vs 34% in control group; absolute difference 33%, 95% CI 12% to 54%; p=0.006). Prevalence of high (>55°C) hot water temperatures at 1 min was significantly reduced (31% sterilisation vs 59% control; absolute difference 28%, 95% CI 9% to 47%; p=0.009). Gas consumption per day reduced more in the control group than in the sterilisation programme group, although not statistically significantly (p=0.125). CONCLUSIONS: The thermostatic control with daily sterilisation was effective in capping hot water temperatures and therefore reduced scald risk. Although expected to save energy, fuel consumption was increased relative to the control group. Trial registration ClinicalTrials.gov ID: NCT00874692.

A review of decision support technologies for amniocentesis.

BACKGROUND: There is an increasing interest in designing decision tools [decision support technologies (DSTs)] that support patients when they have to decide about health matters. The purpose of this review was to describe and evaluate existing DSTs for amniocentesis testing. METHODS: Ten medical and psychological databases were searched up to January 2008 and key authors and organizations contacted to identify DSTs for amniocentesis (published or otherwise). DSTs that described amniocentesis testing were included. RESULTS: Six DSTs met the inclusion criteria and were evaluated using the International Patient Decision Aids Standards Instrument. The evaluation suggested that most DSTs provided a satisfactory level of information on the index decision and, on the specific features of a diagnostic test; provided structured guidance in making a decision; were based on scientific evidence and disclosed the funding sources and authors' credentials. However, most DSTs failed to communicate probabilistic information, to clarify patient values and use plain language. The majority of DSTs did not use a systematic development process. Furthermore, the DSTs' evaluation often lacked scientific rigour. In most cases, neither the quality nor the effectiveness of the DST could be inferred from the evaluations. CONCLUSIONS: The review highlights variations in the development, evaluation and quality of existing DSTs for amniocentesis. We do not know what impact DSTs may have when implemented in clinical settings. Decisions in this context have high stakes and strong emotional impacts. It is important to ensure that DSTs achieve high standards.

Training primary health care workers about drugs: a national survey of UK trainers' perceptions towards training.

Reports have consistently shown that non-specialist drug workers (whose working role is not specifically concentrated on dealing with drug-related issues) are reluctant to work with drug users. A number of explanations have been offered to account for this unwillingness including attitudinal factors, occupational constraints and a lack of motivation to learn about drug-related issues. Previously, it has been shown that training affects commitment to working with substance misusers, although failure to attract particular professional groups (e.g. general practitioners) into training courses has also been reported. No previous research has examined the views of trainers about training primary health care and health-related workers. This study of a (non-probability) sample of UK drug trainers (n = 145) assessed training activity for different health care workers, and trainers' differential perceptions of training needs and methods. GPs were the group least likely to become trained about drug issues. Training in attitudes towards drug using individuals was perceived to be more important than either skills or knowledge training for GPs, practice nurses, other nurses and probation officers. Experiential training methods were perceived to be more important than a didactic approach for training all health groups except GPs for whom lecture type instruction was believed to be equally appropriate. Seventy-nine percent of subjects reported providing training across drugs in alcohol or drugs, alcohol and tobacco. Most trainers who stated that certain professions required independent training believed that GPs should be trained separately from other groups.

General practice involvement in the management of alcohol misuse: dynamics and resistances.

While there is a growing body of empirical evidence to suggest that the types of interventions which General Practitioners (GPs) could offer patients with potential or established alcohol problems are effective, there are still, in practice, many barriers to the treatment of alcohol problems in the primary care setting. These barriers are both practical and attitudinal in nature and stem from GPs, patients, the operational practices, and the ethos of the primary healthcare system itself. GPs, for example, may have difficulty arriving at a diagnosis of alcohol problems. Many believe that they have neither the skills nor the expertise required to deal with such problems. Patients are often reluctant to seek help for alcohol problems and may question the appropriateness of GP treatment. Situational barriers include the already heavy workload of the GP. Barriers such as these are reviewed and recommendations about the ways in which they might be overcome are outlined.

Simultaneous assessment of the opiate-induced modifications in the vertical and horizontal components of locomotor activity in mice.

The effects of some opiates on the horizontal and vertical components of locomotor activity in mice were measured in actometers fitted with photoelectric cells counting horizontal displacements and the striding over a low partition wall. Morphine and fentanyl, used at low doses which did not modify the horizontal locomotor activity, decreased the striding over of the partition wall. Such a dissociation was not observed with either kappa or sigma agonists which affected in the same way the two components of the locomotor activity: both components were inhibited by kappa agonists and slightly stimulated by the sigma agonist SKF 10047. Although the opiate-induced inhibition of the striding over was induced by low doses of morphine, relatively high doses of naloxone were necessary for its antagonism. This apparently difficult antagonism could result in fact from the sedation which appeared when morphine was associated with naloxone.