Evidence-based decision-making in a climate of political expediency: insights from local government.

AIMS: Local authorities in England are responsible for public health and health promotion. This article sought to explore how research and decision-making co-exist in a local authority in England. METHODS: An Embedded Researcher was based within the local authority and used qualitative methodology to address the research aim. Interviews and focus groups were employed to ascertain a range of stakeholder views in the local authority. All transcripts were coded on NVivo 12 by the Embedded Researcher and two members of the research team cross-checked a sample for coding accuracy. Data were analysed using framework analysis. RESULTS: The data suggest several barriers to using research to inform decision-making in health promotion and public health. The study shows that research is valued in local authorities, but not always privileged - this is due to cultural factors and practical political reasons which often means that decisions need to be made expediently. Participants outlined a juxtaposition between academic credibility; timeliness to complete the research and the financial cost associated with it; against the independence and credibility that independent academics could bring. CONCLUSION: Policy formulation and delivery is an integral aspect of health promotion and critical to achieving improved population health and reductions in health inequalities. However, there exists tensions between gathering research evidence and making research-informed decisions. The article concludes by advocating the use of Embedded Researchers to fully understand how research is gathered and used to support public health and health promotion policymaking.

Emerging lessons from the commissioning and delivery of a gambling treatment service.

OBJECTIVES: Gambling is a public health concern, given the multiplicity of harms for individuals, families and communities. This article reports on the commissioning and delivery of a problem gambling treatment service in a metropolitan area in England, where the concentration of problem gambling is often higher than the national average. STUDY DESIGN: This is a cross-sectional study, using purposively sampled 'experts' and stakeholders involved in the conception and set-up of the service. METHODS: Individual semistructured interviews were used to ascertain the depth of information required to fully appreciate the nuances and complexities of the service. Eight participants took part in the interviews, with an additional respondent providing written comments in relation to the interview schedule as a workaround to accommodate the organisational impacts of COVID-19. RESULTS: The article identifies several factors contributing to the successful delivery of the service. Well-managed collaborative provision with expertise from across sectors is critical, but this needs to be balanced against the challenges faced by bridging cultural variances in practice and language. Adopting evidence-based models of delivery was central to practice, and moreover, geographical location is a key consideration to encourage access for those facing gambling problems and discourage feelings of stigma. CONCLUSIONS: This article offers a unique contribution to understanding more about the provision of gambling treatment services. This is crucial, given that a greater number of people face challenges as a consequence of gambling harms, and such services should be seen part of forming a coherent public health response.

Does perfusion matter? Preoperative prediction of incisional hernia development.

PURPOSE: Incisional hernias complicate 12-15% of general surgery cases with higher rates reported after laparotomy for aortoiliac occlusive disease (10-17%) and aneurysmal disease (17-38%). We hypothesize that inadequate perfusion of the abdominal wall promotes future hernia development. METHODS: Thirty-eight patients undergoing midline laparotomy or thoracoabdominal approach for aortic disease with at least 2 years of follow-up were included in the study. Preoperative imaging was reviewed to assess vessel patency, contributing to the abdominal wall perfusion. Patency of the superior epigastric artery was determined at the T10 level, the inferior epigastric artery at the L4 level, and the deep circumflex iliac artery at the anterior superior iliac spine. Lumbar arteries were considered patent if they were seen branching from the aorta. Clinic notes and hospital medical records were reviewed to evaluate the hernia development post-procedure. RESULTS: Thirteen patients (34%) developed an incisional hernia. Absent flow from bilateral superior epigastric arteries or absent flow from ipsilateral superior and inferior epigastric arteries was found to be predictive of hernia development (P = 0.013, 0.011, respectively). There was no association identified with perfusion from the lumbar or deep circumflex iliac arteries. CONCLUSIONS: Absent patency of the abdominal wall vasculature is a novel risk factor for incisional hernia development in the setting of aortic disease. Preoperative assessment of perfusion may convey the risk of hernia development and may be a tool to guide measures such as prophylactic mesh placement to reduce the future risk of incisional hernia.

The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study.

We have studied the effect of shortening of the femoral neck and varus collapse on the functional capacity and quality of life of patients who had undergone fixation of an isolated intracapsular fracture of the hip with cancellous screws. After screening 660 patients at four university medical centres, 70 patients with a mean age of 71 years (20 to 90) met the inclusion criteria. Overall, 66% (46 of 70) of the fractures healed with > 5 mm of shortening and 39% (27 of 70) with > 5 degrees of varus. Patients with severe shortening of the femoral neck had significantly lower short form-36 questionnaire (SF-36) physical functioning scores (no/mild (<5 mm) vs severe shortening (> 10 mm); 74 vs 42 points, p < 0.001). A similar effect was noted with moderate shortening, suggesting a gradient effect (no/mild (< 5 mm) vs moderate shortening (5 to 10 mm); 74 vs 53 points, p = 0.011). Varus collapse correlated moderately with the occurrence of shortening (r = 0.66, p < 0.001). Shortening also resulted in a significantly lower EuroQol questionnaire (EQ5D) index scores (p = 0.05). In a regression analysis shortening of the femoral neck was the only significant variable predictive of a low SF-36 physical functioning score (p < 0.001).

Isolamento no território federal do Amapá de um vírus nôvo relacionado sorològicamente aos agentes responsáveis pelas febres hemorrágicas da Argentina e da Bolívia / Isolation in the Federal Territory of Amapá of a new virus serologically related to the agents responsible for hemorrhagic fever in Argentina and Bolivia

Um nôvo membro do grupo Tacaribe, o vírus Amapari, tem sido inoculado repetidas vêzes das vísceras e sangue de Oryzomys e Neacomys, capturados em SN, Território Federal do Amapá. Um único isolamento foi obtido da urina das crias e de ectoparasitos dêsses animais. Os autores analisam algumas implicações ecológicas, bem como do ponto de vista de patogenicidade humana do referido agente. Referem, ainda, a importância da prova de FC’ como recurso de grande valor no isolamento dêste vírus, uma vez que os camundongos inoculados com os espécimens provenientes de animais infectados freqüentemente desenvolvem infecção inaparente.

A new member of the Tacaribe group, Amapari virus, has been repeatedly isolated from the viscera and blood of rodents belonging to the genera Oryzomys and Neacomys captured in the Serra do Navio region, Federal Territory of Amapá, Brazil. Single isolations were also obtained from the urine, young, and ectoparasites of these animals. The authors discuss certain aspects of the epizootiology of the above mentioned virus, with special reference to its pathogenicity in man. They also refer the importance of FC’ test as a tool of great value for isolation of this virus, since mice inoculated with specimens obtained from infected animals frequently develop inapparent infection.

Global surveillance of emerging diseases: the ProMED-mail perspective.

The Internet is changing the way global disease surveillance is conducted. Countries and international organizations are increasingly placing their outbreak reports on the Internet, which speeds up distribution and therefore prevention and control. The World Health Organization (WHO) has recognized the value of nongovernmental organizations and the media in reporting outbreaks, which it then attempts to verify through its country offices. However, WHO and other official sources are constrained in their reporting by the need for bureaucratic clearance. ProMED-mail has no such constraints, and posts outbreak reports 7 days a week. It is moderated by infectious disease specialists who add relevant comments. Thus, ProMED-mail complements official sources and provides early warning of outbreaks. Its network is more than 20,000 people in over 150 countries, who place their computers and time at the network's disposal and report on outbreaks of which they have knowledge. Regions and countries could benefit from adopting the ProMED-mail approach to complement their own disease surveillance systems.

Emerging infectious diseases and risk to the traveler.

This article examines the relationship between travel and emerging infections. The authors begin with an overview of disease emergence and follow with a brief infection-by-infection examination of selected emerging pathogens of particular relevance to travelers and the medical care providers who counsel them. Emphasis is given to those agents that clearly have emerged as significant new or increased risk to travelers; or are of sufficiently new interest, even in the face of inadequate data in travelers, to be of potential immediate concern. The authors also discuss several novel pathogens, such as Ebola virus, that are clearly of insignificant or minimal risk to travelers, but are the subject of frequent questions from patients requesting pre-travel advice from medical providers.

The role of computer networking in investigating unusual disease outbreaks and allegations of biological and toxin weapons use.

Computer networking can aid in the epidemiological investigation of unusual disease outbreaks and possible uses of biological weapons. Exchange of computerized data over the Internet has many advantages in facilitating the investigation of the source of a disease outbreak. It is especially useful in the investigation of suspected or alleged releases of biological weapons. Computer networking through the Internet a fosters a truly global disease outbreak early warning system in which both government and non-government sources are contributing. Such information exchange is of great potential benefit to the Biological Weapons Convention and the attempts to develop a verification protocol.

Preparation for emergency relief after biological warfare.

Upon invitation by the World Health Organization during the Gulf War, a task force "Scorpio" independent from the nations involved in the armed conflict was formed whose task was to determine whether, which and to what extent biological warfare agents had been used. risk assessment concluded that anthrax and Clostridium botulinum toxin were the major risks. The 21 civilian experts had rapidly to decide on the doctrine of operation, to assemble material which could be used and to be immunized or protected otherwise against the potential risks. Biological warfare agents may be used anywhere any time, be it by terrorists or during open or clandestine hostilities. The general population cannot rely on the military to take care of civilian relief, thus international and national organizations may wish to establish similar task forces basing on the "Scorpio" model on a national or regional basis.