Sun-safe behaviours, personal risk, level of concern, and knowledge about cutaneous melanoma in italy: time for social marketing?

INTRODUCTION: The incidence of cutaneous melanoma is increasing, although 80-95% of all deaths caused by melanoma can be avoided through protective behaviours. There is evidence that social marketing as an approach in public health can improve health-related behaviours and encourage sun-safe behaviours. METHODS: A multicentre survey was conducted to collect and compare data about cutaneous melanoma risk, knowledge, concern, and protective behaviours across Northern, Central, and Southern Italy, and explore how these data could potentially inform a social marketing intervention to improve sun-safe behaviours. Data were analysed using descriptive and inferential statistics. RESULTS: A total of 1,028 questionnaires were collected. Apart from 'Personal Risk' no statistically significant differences were found between the three regions. About 30% (n = 344) of the total sample had high levels of personal risk, and low levels of concern and protective behaviour, and over 70% (n = 711) gave priority to sun tanning. The worst scores were related to knowledge about melanoma (30% wrong answers, and over 40% 'don't know'). Protective behaviour was moderately correlated with age (p = 0.03). Personal risk was significantly higher in women (10.84 vs 10.05), and lower in individuals with a degree (9.46 vs 11.38; p < 0.001). CONCLUSIONS: Over 70% of our sample gave priority to sun tanning, which combined with low levels of concern and knowledge about melanoma, and high levels of personal risk, confirm that much still needs to be done in terms of melanoma prevention, but all these are aspects that could be effectively addressed through social marketing interventions.

Can lay health trainers increase uptake of NHS Health Checks in hard-to-reach populations? A mixed-method pilot evaluation.

BACKGROUND: The NHS Health Check Programme was launched in England in 2009, offering a vascular risk assessment to people aged 40-74 years without established disease. Socio-economic deprivation is associated with higher risk of cardiovascular disease and lower uptake of screening. We evaluated the potential impact of a community-based health check service that sought to address health inequalities through the involvement of lay health trainers. METHODS: Key stakeholder discussions (n = 20), secondary analysis of client monitoring data (n = 774) and patient experience questionnaires (n = 181). RESULTS: The health check programme was perceived as an effective way of engaging people in conversations about their health. More than half (57.6%) of clients were aged under 50 years and a similar proportion (60.5%) were from socio-economically deprived areas. Only 32.7% from the least affluent areas completed a full health check in comparison with 44.4% from more affluent areas. Eligible men were more likely than eligible women to complete a health check (59.4 versus 33.8%). CONCLUSIONS: A community-based, health trainer-led approach may add value by offering an acceptable alternative to health checks delivered in primary care settings. The service appeared to be particularly successful in engaging men and younger age groups. However, there exists the potential for intervention-generated inequalities.

Getting the balance right: qualitative evaluation of a holistic weight management intervention to address childhood obesity.

BACKGROUND: Childhood obesity is linked to a range of health and social problems. Solutions include the delivery of appropriate weight management interventions for those aged 16 and under. The 'Balance It! Getting the Balance Right' programme appears to be effective for those who complete the intervention, but the non-completion rate remains high. A qualitative evaluation was undertaken to explore the views of key stakeholders in the programme and identify possible reasons for non-completion. METHODS: Semi-structured interviews were conducted with a purposive sample of 16 NHS and local authority staff, and with 20 children (aged 4-16 years) and their families. A mosaic methodology was used, involving visual and verbal techniques employed to enable children of all ages to take an active role in expressing their opinions. RESULTS: Key themes included the challenges of approaching overweight children; positive outcomes for some families; and issues relating to communication and coordination. Participants spoke positively about the multi-disciplinary approach of 'Balance It!', but felt it could better meet the needs of its target population. CONCLUSIONS: Structured interventions help to ensure consistency and coherence in terms of approaches to childhood overweight and obesity. Whole family approaches may be most effective in enhancing the user experience.

A retrospective study examining thrombolysis for occluded femoro-popliteal grafts - is it worthwhile?

AIM: To assess the effectiveness of catheter directed thrombolysis (CDT) in the treatment of acute graft occlusion. METHODS: Tissue prothrombin activator (rt-PA) was the sole agent used for thrombolysis. This was infused through a 4F straight 65 cm catheter placed under ultrasound guidance. Following a pre-CDT angiogram, a catheter was placed just proximal to the distal anastomosis. An infusion of rt-PA was given over 24 h. An assessment of acute clinical success, limb salvage rates, patency rates and complication rates were made over a period of one year. RESULTS: 80% (20/25) of grafts were successfully reopened immediately. 4/5 (80%) of the unsuccessful CDT cases required amputation within a few weeks. 60% (12/20) of successful CDT cases had an underlying stenotic lesion which required angioplasty. Limb salvage rate was 72% (18/25) at 12 months. There was no CDT related mortality. Secondary patency rate at 9 months was 76% (13/17). CONCLUSION: CDT can achieve reasonable results in this group of challenging patients and may be seen as a useful accessory in the vascular toolkit. However, precise indications for its use need further clarification.

An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health.

BACKGROUND: There is a need to identify and analyse the range of models developed to date for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and cost-effectiveness in improving the health and well-being of individuals and communities in the UK, with particular reference to the reduction of inequalities. OBJECTIVES: To identify the component intervention techniques of lifestyle advisors (LAs) in the UK and similar contexts, and the outcomes of HRLA interventions. DATA SOURCES: Stakeholder views, secondary analysis of the National Survey of Health Trainer Activity, telephone survey of health trainer leads/coordinators. A search of a range of electronic databases was undertaken [including the Applied Social Sciences Index and Abstracts (ASSIA), EMBASE, NHS Economic Evaluation Database (NHS EED), MEDLINE, Psyc INFO, etc.], as well searching relevant journals and reference lists, conducted from inception to September 2008. REVIEW METHODS: Identified studies were scanned by two reviewers and those meeting the following criteria were included: studies carrying out an evaluation of HRLA; those taking place in developed countries similar to the UK context; those looking at adult groups; interventions with the explicit aim of health improvement; interventions that involved paid or voluntary work with an individual or group of peers acting in an advisory role; advice delivered by post, online or electronically; training, support or counselling delivered to patients, communities or members of the public. After quality assessment, studies were selected for inclusion in the review. Data were abstracted from each study according to an agreed procedure and narrative, and realist and economic approaches were used to synthesise the data. Cost-effectiveness analysis of interventions was undertaken. RESULTS: In total, 269 studies were identified but 243 were excluded. The 26 included studies addressing chronic care, mental health, breastfeeding, smoking, diet and physical activity, screening and human immunodeficiency virus (HIV) infection prevention. Overall, there was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life (QoL), and thus uncertainty about the interventions' cost-effectiveness. However, the economic analysis showed that LA interventions were cost-effective in chronic care and smoking cessation, inconclusive for breastfeeding and mental health and not cost-effective for screening uptake and diet/physical activity. LA interventions for HIV prevention were cost-effective, but not in a UK context. LIMITATIONS: The wide variety of LA models, delivery settings and target populations prevented the reviewers from establishing firm causal relationships between intervention mode and study outcomes. CONCLUSIONS: Evidence was variable, giving only limited support to LAs having a positive impact on health knowledge, behaviours and outcomes. Levels of acceptability appeared to be high. LAs acted as translational agents, sometimes removing barriers to prescribed behaviour or helping to create facilitative social environments. Reporting of processes of accessing or capitalising on indigenous knowledge was limited. Ambiguity was apparent with respect to the role and impact of lay and peer characteristics of the interventions. A future programme of research on HRLA could benefit from further emphasis on identification of needs, the broadening of population focus and intervention aims, the measurement of outcomes and the reviewing of evidence. FUNDING: This study was funded by the Health Technology Assessment programme of the National Institute for Health Research.

CPR degradation diagram.

During untreated ventricular fibrillation (VF), before CPR is applied, different bodily systems deteriorate at different rates. This paper describes the times when the EEG disappears, when respiratory arrest occurs, and when PD-PEA occurs. It also describes the frequency of VF waves over a 7-min period and how the frequency increases with good CPR.

How much lung ventilation is obtained with only chest-compression CPR?

The objective of this 14-pig study was designed to determine the amount of lung ventilation obtainable by only rhythmic chest compression (100/min, 100 lbs). Tidal volume (TV), dead space (DS), and respiration rate (R) were measured with normal breathing and with rhythmic chest compression during ventricular fibrillation. The ratio of TV/DS was calculated in both cases. For normal breathing the ratio was 2.54 +/- 0.68; for chest compression breathing the ratio was 0.80 +/- 0.07. Minute alveolar ventilation (TV - DS)R was computed for both cases. With spontaneous breathing, the minute alveolar volume was 5.48 +/- 2.1 l/min. With only chest-compression breathing, the alveolar ventilation was -1.49 +/- 0.64 l/min. The negative minute alveolar volume and fractional ratio reveals that TV was less than the dead space indicating that chest-compression alone does not ventilate the lungs.

Nonpulsatile and noninvasive transmittance and reflectance tissue-bed oximetry.

A new optical device was developed that measures blood pressure noninvasively, in small human subjects (neonates and premature infants) and small animals (Roeder RAR. Transducer for indirect measurement of blood pressure in small human subjects and animals, Purdue University, BME; 2003.: xi, 50 p.). The ability of this device to measure oxygen saturation enhances its value. The objective of this research was to add the ability to obtain SaO(2) from the same device and to obtain the calibration curve. Another objective was to determine which measurement method (transmittance or reflectance) is preferable. This new oximeter is unlike the conventional pulse oximeter in that it does not require a pulse, making it ideal for measuring oxygen saturation noninvasively in small human subjects with small amplitude pulses or without a pulse. A study was performed in 11 pigs, ranging in weight 20-27 kg. The pig tail was used as the measuring site for %SaO(2) measurements. Arterial blood samples were obtained from the femoral artery and oxygen saturation was measured with a blood-gas analyzer. A small blood-pressure cuff was used to render the optical path bloodless. A comparison of the transmittance and reflectance methods for measuring oxygen saturation was made. %SaO(2) measurements ranged from 4% to 100%. It was found that both the transmittance and reflectance methods can be used to measure %SaO(2) reliably in situations with or without a pulse.