Simulated versus traditional therapeutic radiography placements: A randomised controlled trial.

INTRODUCTION: Clinical placements provide rich learning environments for health professional pre-registration education but add significant workload pressure to clinical departments. Advances in simulation approaches mean that many aspects of students' clinical learning can be undertaken in the academic environment. There is, however, little data identifying specific pedagogical gains afforded by simulation compared to clinical placement. This study measured the impact of a comprehensive integrated simulation placement on student clinical skill acquisition. METHODS: A virtual department was developed using a range of simulation equipment and software, with actors and service users providing a range of patients for students to engage with. A cohort of 29 first-year undergraduate therapeutic radiography students were randomly assigned to either simulated or conventional clinical placement. Clinical skills assessment scores provided by a blinded assessor were then compared. RESULTS: Mean overall assessment scores for each cohort were within 3% of each other. The simulation cohort had over 10% higher "communication" scores than the traditional group (p = 0.028). The ability to gain both technical and interpersonal skills simultaneously improved learning compared to clinical placement. Students valued the structured approach of the simulated placement and the opportunity to practice techniques in a safe unpressured environment. CONCLUSION: An integrated simulated placement can help students to achieve clinical learning outcomes and lead to improved interpersonal skills. IMPLICATIONS FOR PRACTICE: Use of blended simulation resources can enable students to acquire technical, procedural and interpersonal skills which in turn may enable reduction of overall clinical placement time and departmental training burden.

Evaluating the perceptions of the transgender and non-binary communities of pelvic radiotherapy side effect information booklets.

INTRODUCTION: Patients undergoing radiotherapy for pelvic cancers will often experience acute and late toxicity which can result in symptoms which have a significant impact on psychosocial functioning and quality of life. Having written information regarding these symptoms enables informed decision-making and ongoing support. Transgender and non-binary communities are a marginalised but steadily growing subsection of the radiotherapy patient population yet their needs differ from those of the general population. This study aimed to evaluate the relevance of the pelvic radiotherapy patient information booklets with regard to this communities. METHODS: An online survey was distributed via social media to evaluate the perceptions of these communities of four commonly distributed pelvic radiotherapy information booklets. RESULTS: There were 19 full responses and most participants expressed discomfort regarding being provided with (11/19) or picking up (10/19) the booklets. Although most (11/19) agreed that the material in the booklets was relevant, the same number felt that the wording was not. Some of the language and assumptions made regarding the transgender and non-binary communities were incorrect and had the potential to cause distress. CONCLUSION: The importance of providing guidance and support to these communities was identified. IMPLICATIONS FOR PRACTICE: Further research is required to establish how best to provide inclusive patient information for transgender and non-binary individuals.

A guide to architecture for the public health workforce.

BACKGROUND: Public health and environmental challenges facing the world in the 21st century, including the ageing population, increasing urbanisation, rise of non-communicable diseases and climate instability, require an interdisciplinary response. A significant proportion of the population's time is spent indoors, be it at home, school, work or in leisure time; the work of an architect can cover all of these sectors, but their role in health and well-being remains an under explored area. OBJECTIVE: This article examines the architecture profession's potential to contribute to improved health and well-being of the population through healthier buildings and places. METHODOLOGY: This short communication adopts a descriptive approach. First, it maps the remit, skills and influence of the architecture profession and applies this to a well-accepted public health model, the prevention pyramid. Second, it uses themes identified by the Royal Society for Public Health to discuss ways to improve engagement with the architecture profession as part of the wider public health workforce. RESULTS: This article finds that the remit, skills and potential influence of architects places them in a key position to improve the health and well-being of the population. Despite this, there has been relatively little engagement between public health and this profession. Much more attention to date has been on integrating the planning sector with public health. CONCLUSION: Opportunities for improved engagement exist through partnership working, incorporating health into both undergraduate and postgraduate education and continuing professional development training, building the evidence base and developing architecture and health-related policy and legislation.

Built and natural environment planning principles for promoting health: an umbrella review.

BACKGROUND: The built and natural environment and health are inextricably linked. However, there is considerable debate surrounding the strength and quality of the evidence base underpinning principles of good practice for built and natural environment design in promoting health. This umbrella review aimed to assess relationships between the built and natural environment and health, concentrating on five topic areas: neighbourhood design, housing, food environment, natural and sustainable environment, and transport. METHODS: A structured search was conducted for quantitative systematic reviews and stakeholder reviews published between January 2005 and April 2016. Seven databases and the websites of 15 relevant and respected stakeholder organisations known to publish review-level documentation were searched. Searches were limited to English-language publications and duplicate references were removed. Evidence quality and strength was appraised using validated techniques. Findings were used to develop a diagram for each topic area, illustrating relationships between built and natural environment planning principles and health-related outcomes. RESULTS: A total of 117 systematic reviews and review-level documents were eligible for inclusion. The quality of evidence was mixed; much of the evidence examined relied on findings from cross-sectional studies, making it difficult to draw clear causal links between built environment exposures and health-related impacts and outcomes. Fourteen actionable planning principles associated with positive health-related outcomes were identified across the five topic areas. For example, neighbourhoods that enhanced walkability, were complete and compact in design, and those which enhanced connectivity through safe and efficient infrastructure were associated with better health-related outcomes relating to physical activity, social engagement, mental health, perceptions of crime, and road traffic collisions. Evidence for the effectiveness of planning principles across different topic areas and on reducing health inequalities was sparse and inconclusive. CONCLUSIONS: Findings provide an up-to-date overview of relationships between the built and natural environment and health and present logical, evidence-based messages to aid communication between public health and planning professionals.

Employability and career experiences of international graduates of MSc Public Health: a mixed methods study.

OBJECTIVES: This article aims to describe the public health career experiences of international graduates of a Master of Science in Public Health (MSc PH) programme and to contribute to developing the evidence base on international public health workforce capacity development. STUDY DESIGN: A sequential mixed methods study was conducted between January 2017 and April 2017. METHODS: Ninety-seven international graduates of one UK university's MSc PH programme were invited to take part in an online survey followed by semistructured interviews, for respondents who consented to be interviewed. We computed the descriptive statistics of the quantitative data obtained, and qualitative data were thematically analysed. RESULTS: The response rate was 48.5%. Most respondents (63%) were employed by various agencies within 1 year after graduation. Others (15%) were at different stages of doctor of philosophy studies. Respondents reported enhanced roles after graduation in areas such as public health policy analysis (74%); planning, implementation and evaluation of public health interventions (74%); leadership roles (72%); and research (70%). The common perceived skills that were relevant to the respondents' present jobs were critical analysis (87%), multidisciplinary thinking (86%), demonstrating public health leadership skills (84%) and research (77%). Almost all respondents (90%) were confident in conducting research. Respondents recommended the provision of longer public health placement opportunities, elective courses on project management and advanced statistics, and 'internationalisation' of the programme's curriculum. CONCLUSIONS: The study has revealed the relevance of higher education in public health in developing the career prospects and skills of graduates. International graduates of this MSc PH programme were satisfied with the relevance and impact of the skills they acquired during their studies. The outcomes of this study can be used for curriculum reformation. Employers' perspectives of the capabilities of these graduates, however, need further consideration.

Engaging a wider public health workforce for the future: a public health practitioner in residence approach.

This paper outlines and assesses a project that sought to use a studio residency (a public health practitioner in residence) as a vehicle to introduce public health issues and concepts into the curricula of a studio cohort of fifth and sixth year architecture students. The practitioner delivered workshops, group tutorials and one-to-one guidance on individual design projects whose aim was to improve the health and well-being of the local population. Students reported being enthused by the practitioner and developed a broader understanding of their role as future architects in the promotion and protection of the health of the public. The public health practitioner in residence model may offer an exciting way of educating and inspiring the future wider public health workforce in the built environment design focused professions. Such an approach could transform the way in which such professionals construct their societal role in terms of their future impact on population health and their contribution as members of the wider public health workforce.

Evaluating social and behavioural impacts of English smoke-free legislation in different ethnic and age groups: implications for reducing smoking-related health inequalities.

OBJECTIVE: To explore social and behavioural impacts of English smoke-free legislation (SFL) in different ethnic groups. DESIGN: A longitudinal, qualitative panel study of smokers using in-depth interviews conducted before and after introduction of SFL. PARTICIPANTS: A purposive sample of 32 smokers selected from three ethnic groups in deprived London neighbourhoods with approximately equal numbers of younger and older, male and female respondents. RESULTS: SFL has had positive impacts with half smoking less and three quitting. Although there were no apparent differences in smoking and quitting behaviours between groups, there were notable differences in the social impacts of SFL. The greatest negative impacts were in smokers over 60 years, potentially increasing their social isolation, and on young Somali women whose smoking was driven more underground. In contrast, most other young adult smokers felt relatively unaffected by SFL, describing unexpected social benefits. Although there was high compliance, reports of illegal smoking were more frequent among young, ethnic minority smokers, with descriptions of venues involved suggesting they are ethnically distinct and well hidden. Half of respondents reported stopping smoking in their own homes after SFL, but almost all were Somali or Turkish. White respondents tended to report increases in home smoking. DISCUSSION: Although our study suggests that SFL can lead to reductions in tobacco consumption, it also shows that impacts vary by ethnicity, age and sex. This study highlights the importance of understanding the meaning of smoking in different social contexts so future tobacco control interventions can be developed to reduce health and social inequalities.

Rhetoric or reality? A systematic review of the impact of participatory approaches by UK public health units on health and social outcomes.

BACKGROUND: There has been a philosophical commitment to participation in public health since the 1970s. UK policy rhetoric on participation in public health has been particularly marked since 1997. It is less clear that participatory approaches have been pursued by UK public health units in practice. METHODS: A systematic review was undertaken of all studies using any recognized research methodology from 1974 to 2007 reporting on health and social outcomes of participatory approaches by UK public health units. Seventeen electronic databases were searched and inclusion/exclusion criteria and quality appraisal criteria applied. RESULTS: Five thousand and four hundred and fifty-one references were identified, reduced to 2155 once duplicates were removed. Only eight papers covering seven studies were relevant and included in the analysis. Only two studies met more than half of the relevant quality appraisal criteria. The studies fell into two distinct groups: four used qualitative methods to illustrate the complexities of effective community participation; three claimed success for their participative initiative without providing adequate evidence to substantiate such claims. CONCLUSIONS: This systematic review demonstrates that there is very little evidence in the peer-reviewed literature of participatory approaches by UK public health units or of such approaches having any noteworthy impact on health and social outcomes.

Teaching Public Health Networks in England: an innovative approach to building public health capacity and capability.

This paper examines the development and achievements of the Teaching Public Health Networks (TPHNs) in England; an initiative that aimed to catalyse collaborative working between the public health workforce and further and higher education, to enhance public health knowledge in the wider workforce with a view to enhancing capacity to tackle inequalities and meeting public health targets. This paper highlights activities under three outcomes: mobilizing resources, people, money and materials; building capacity through training and infrastructure development; and raising public and political awareness. The TPHN approach is shown to have led to innovative developments in public health education and training, including engagement with professionals that have not previously had exposure to public health. This paper aims to disseminate the learning from this complex public health initiative, now in its third year of development, and to share examples of good practice. It is hoped that other countries can use the TPHN approach as a model to address the various common and country-specific challenges in public health workforce development.

Attitudes towards second hand smoke amongst a highly exposed workforce: survey of London casino workers.

STUDY OBJECTIVE: To examine knowledge, attitudes and experiences of London casino workers regarding exposure to second hand smoke (SHS) in the workplace. DESIGN: Postal survey of 1568 London casino workers in 25 casinos who were members of the TGWU or GMB Trade Unions. MAIN RESULTS: Of the workers, 559 responded to the survey (36% response), 22% of whom were current smokers. Of the respondents, 71% report being nearly always exposed to heavy levels of SHS at work, and most (65%) want all working areas in their casino to be smoke-free. The majority (78%) are bothered by SHS at work, while 91% have wanted to move away from where they are working because of it. Fifty-seven per cent believe their health has suffered as a result of SHS. Of the workers who smoke at work, 59% believe that they would try to quit smoking if no one was allowed to smoke in the casino. CONCLUSIONS: The majority of responders are bothered by SHS, and many are concerned about the health impacts. Most want all working areas in their casino to be smoke-free. Despite difficulties in generalizing from this limited sample, these findings add weight to the argument that the legislation on smoking in public places in England should encompass all workplaces, without exemption.

The Living Tomorrow Project: how Philip Morris has used a Belgian tourist attraction to promote ventilation approaches to the control of second hand smoke.

STUDY OBJECTIVE: To examine the involvement of Philip Morris in Living Tomorrow 2 and determine the rationale behind its involvement. DESIGN: Research was conducted through a web based search of internal tobacco industry documents made publicly available through litigation. MAIN RESULTS: For approximately 1,000,000 euros Philip Morris (now Altria) became a co-initiator of Living Tomorrow 2, a tourist complex in Belgium that aims to demonstrate how we will be living in the future. In addition to promoting the company and its grocery products, Philip Morris is using the complex and its website to promote ventilation as a means of accommodating smokers and non-smokers in the indoor environment. Particular emphasis was placed on the bar and restaurant areas. Despite the rationale for its involvement, Philip Morris fails to acknowledge its role as a cigarette manufacturer. As a form of corporate sponsorship Philip Morris thought its involvement could evade any European tobacco advertising ban. CONCLUSIONS: Philip Morris is using a tourist attraction to promote its views on control of second hand smoke (SHS) and accommodation of smokers and non-smokers in the indoor environment. However, ventilation does not deal with the health effects of SHS. Policymakers must be cognisant of the devious tactics the industry employs to promote its own agenda, especially in relation to indoor air quality and smoking in public places. Tobacco control legislation should be continually modified and strengthened in response to the changing activities of the tobacco industry as it strives to evade existing legislation and deter the advent of new legislation.

Adenovirus-induced inclusion body hepatitis in four-day-old broiler breeders.

Two separate parent broiler flocks originating from the same grandparent flock experienced mortalities of 23% and 40%, respectively, in chicks between 1 and 14 days of age. Chicks affected at 4 days of age had tremors, depression, and hypoglycemia. They had pale yellow, swollen, friable livers. Pancreata were discolored and hemorrhagic. Spleens were swollen and sightly darkened. Microscopic lesions consisted of multifocal areas of acute hepatic and pancreatic necrosis with numerous basophilic intranuclear inclusions with karyomegaly. Splenic sections had severe lymphoid depletion and reticular cell and macrophage hyperplasia. An adenovirus from affected livers was isolated in chicken embryo liver cells. Serologic evidence suggests that the grandparent flock began egg production seronegative to adenovirus antibodies, was exposed during production, and, subsequently, shed adenovirus vertically to its progeny. The clinical syndrome was reproduced by injecting the isolated adenovirus into 1-day-old antibody-negative chicks. Histologic lesions in the experimentally reproduced disease cases were identical to those in the naturally occurring cases.

Tuberculosis epidemiology in Croydon.

A survey of tuberculosis in Croydon between 1988 and 1991, using Chest Clinic health visitor records, showed that the disease occurred most frequently in those of Indian Sub-Continent (ISC) ethnic origin. Of the 222 cases during the 4-year period, 65% were of ISC ethnic origin, 22% were Caucasian and 11% Afro-Caribbean. Non-Caucasian cases were younger (P < 0.0001), and more likely to be female (P = 0.064) or present with non-pulmonary disease (P = 0.064). One-quarter of ISC patients developed active tuberculosis more than 15 years after immigration into the UK. Only seven cases were children. The contact tracing procedure resulted in three additional cases, all of whom were contacts of smear-positive index cases. There were significantly fewer Heaf or radiologically positive contacts of non-smear positive pulmonary, or non-pulmonary index cases (P = 0.0002). The value of the current contact tracing system is discussed.

A novel variety of the Dantu gene complex (DantuMD) detected in a Caucasian.

The first Caucasian (MD) shown to exhibit the low-frequency MNSs system antigen, Dantu was detected due to an increased tendency of erythrocytes to be aggregated by substances that promote red cell agglutination. The donor was found to exhibit a novel variety of the Dantu gene complex (DantuMD), as judged from biochemical, immunochemical, and serological studies. The glycophorin (GP) A level of MD's erythrocyte membranes were slightly decreased (about 17%) but GP B was not significantly different from normal. GP A and GP B of MD's cells were shown to carry M and N or S and s antigens, respectively, indicating that MD exhibits two genes encoding GP A and two genes encoding GP B. MD's cells contain a Dantu-, N- and s-specific GP B-GP A hybrid GP (molar ratio to GP A approx. 0.6:1.0). Partial amino-acid sequence analysis indicates that the structure of this molecule is rather similar to, or completely identical with, that of the hybrid GP in DantuNE erythrocytes. The residues 1-39 or 40-99 of the latter molecule correspond to the residues 1-39 of s-specific GP B and the residues 72-131 of GP A, respectively. Statistical evidence suggests that MD exhibits a single gene encoding the hybrid GP. Thus, MD appears to be heterozygous for a typical anti-Lepore type gene complex that seems to comprise genes for GP A, GP B, and the GP B-GP A hybrid. The diminished GP A level and a decreased galactose-oxidase labelling of the major membrane protein (anion channel protein, band 3) in MD's cells is in accordance with previous data suggesting that band 3 might form a complex with GP A and the Dantu-specific hybrid GP. This complex formation may be necessary for optimum incorporation of the latter molecules into the membrane.