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Learning together to promote mental health and well-being in English secondary schools: LTMH study refinement and feasibility evaluation, a comprehensive synopsis.
Get PDFBACKGROUND: Young people's mental health worsened during and since the coronavirus disease discovered in 2019 pandemic. School environments play a key role in young people's mental health. Learning Together for Mental Health is a whole-school intervention aiming to promote mental health in secondary schools, adapted from the previous Learning Together intervention which was found effective in reducing bullying and promoting mental health. OBJECTIVE: To adapt Learning Together to increase focus on mental health so producing the Learning Together for Mental Health intervention and evaluate the appropriateness of conducting a Phase III trial of the Learning Together for Mental Health intervention regarding pre-defined progression criteria relating to the intervention and trial methods, and assessing intervention feasibility, reach and acceptability, feasibility of trial measures and procedures, potential mechanisms and possible harms. DESIGN AND METHODS: We conducted a feasibility study with baseline and follow-up surveys, process evaluation and economic-evaluation feasibility-testing. SETTING AND PARTICIPANTS: One school participated in intervention adaptation. Our feasibility study included four state, mixed-sex secondary schools in southern England (one of which dropped out after baselines and was replaced with another). We recruited 640 year-7 (age 11-12) students at baseline survey and 566 year-10 (age 14-15) students at 12-month follow-up. Baseline and follow-up participants were different groups, as the focus was assessing feasibility for the age groups to be surveyed at baseline and follow-up in a Phase III randomised controlled trial. Twenty staff, 27 year-8 (age 12-13) students and 22 year-10 students participated in qualitative research as did two trainers and one external facilitator. INTERVENTIONS: As part of our feasibility study, all schools received the Learning Together for Mental Health intervention for one academic school year. MAIN OUTCOME MEASURES: Pre-defined criteria for progression to a Phase III trial. RESULTS: The intervention was successfully adapted from the previous intervention using public involvement. The trial met all criteria for progression to Phase III. The all-staff and in-depth restorative practice training were implemented with fidelity in all schools and all schools had at least two staff trained in-depth in restorative practice. Curriculum training was delivered with fidelity in three of four schools. The response rate to the baseline (needs) survey across the three participating schools was 79%. Progression required at least two schools to have delivered the curriculum with at least 50% fidelity, which was achieved; one of the two schools which delivered the curriculum reported over 80% fidelity and the other school reported over 75% fidelity. All students and staff across all four schools who completed the action group survey and 93% of senior leadership team members who completed the senior leadership team survey reported that Learning Together for mental health was a good way to promote student Mental Health. Potential mechanisms of action involve promoting student sense of school belonging and practical reasoning and skills. No harms were reported. Trial measures and procedures were feasible and acceptable to implement. Intervention and trial refinement are suggested. LIMITATIONS: Our study involved a small, purposive sample of schools and students which are not representative of those in England. CONCLUSIONS: With some minor amendments, Learning Together for Mental Health should be subject to a future Phase III trial of effectiveness. FUTURE WORK: The intervention should be refined by making the curriculum optional and improving materials. FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131594
Effective coverage of maternal, neonatal and child health services based on District Health Information System 2 (DHIS2) data in Ethiopia: a mixed-methods study.
No full textOBJECTIVE: Our objective was to assess the feasibility of using the routine health information system data source, District Health Information System (DHIS2) to measure the effective coverage of selected health service indicators in Ethiopia and to explore stakeholder perceptions of those measures. DESIGN: We conducted a mixed-methods study. We mapped the availability of data elements in DHIS2 between July 2022 and June 2023 for five indicators (four or more antenatal care visits (ANC4+), skilled birth attendance, postnatal care, sick child care and child nutrition care). We defined effective coverage cascade steps for each indicator, assessed data quality and analysed data using STATA V.17. Finally, qualitative interviews were conducted with 15 key stakeholders, and the data were analysed thematically for reflections on the DHIS2 output. SETTING: The data were captured from all public health facilities of 11 regions and 2 administrative cities in Ethiopia. RESULTS: There was better availability of data elements for maternal healthcare than for child healthcare. It was possible to estimate the intervention-adjusted coverage of ANC4+ (16% nationally) and the process-quality-adjusted coverage of skilled birth attendance (19% nationally). Postnatal care, sick child care and child nutrition indicators lacked data across multiple cascade steps. The quality of data for effective coverage measurement differed by region. The key informants expressed concerns about the adequacy and appropriateness of DHIS2 data for this analysis. While all acknowledged its potential for decision-making, respondents emphasised the need for standardised methods and data sources to enhance comparability and acceptability of the findings. CONCLUSIONS: The findings underscore the need for system-level improvement of data availability and quality, and adoption of a standardised approach to calculating effective coverage using DHIS2. There was a concern that the findings may not be accepted by policymakers; however, the local level granularity made possible through DHIS2 was appreciated
Evaluating the impact of capitation funding top-up payments in primary care.
Get PDFBACKGROUND: Capitation payments account for approximately half of core funding for General Practitioner (GP) practices in England, allocated via the Global Sum Allocation (‘Carr-Hill’) formula. The formula has not been updated since 2004 and lacks adjustments for clinical diagnoses, patient communication difficulties, and deprivation which are factors known to influence workload and health outcomes. In July 2021, Leicester, Leicestershire, and Rutland (LLR) Integrated Care Board introduced the Health Equity Payment (HEP), a top-up funding scheme based on a locally developed formula incorporating these additional factors.
METHOD: We conducted a retrospective observational study using national public data to evaluate the impact of HEP between July 2021 and April 2023. Practices receiving HEP were matched to similar practices outside LLR using Genetic Matching on demographics, disease prevalence, and baseline outcomes. Seven outcomes were assessed: three patient experience measures from the GP Patient Survey, three staffing metrics (GP, nurse, and administrative full-time equivalents per 1000 weighted patients), and Quality and Outcomes Framework (QOF) achievement. Causal effects were estimated using doubly robust regression models with g-computation to estimate the average treatment effect.
RESULTS: Sixty-two LLR practices received HEP and were matched to 62 control practices. Practices receiving HEP achieved a 3.2% point higher QOF score (95% CI: 0.5 to 5.9; p = 0.02) compared to controls. No statistically significant differences were found in patient experience or staffing outcomes. Sensitivity analyses confirmed robustness to alternative time periods and outcome specifications but revealed sensitivity to missing staffing data from atypical practices.
DISCUSSION: This study provides the first causal evaluation of a capitation funding model incorporating clinical and sociodemographic factors in England. The modest improvement in QOF achievement suggests that targeted funding could be linked to enhanced care quality. The absence of effects on staffing and patient experience may reflect data limitations, short follow-up, or heterogeneity in how funds were used. These findings provide the the first evidence that locally tailored funding models could address inequalities in primary care provision and inform ongoing national reviews of the general practice capitation funding.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-025-03136-x
Are hospital management practices associated with enhanced quality of care for small and sick newborns? A nationwide cross-sectional study using linked inpatient admission records in Malawi.
Get PDFBACKGROUND: Improved quality of care is fundamental for reducing patient mortality and building sustainable health systems. Currently, there is a lack of research on the role of hospital management in improving the quality of care and health outcomes, particularly in low-income settings. METHODS: We examined associations between hospital management practices and neonatal quality of care in Malawi. We adapted the World Management Survey tool to measure 28 management practices across five domains - delivery of clinical care in the neonatal unit, human resource management, target setting, finances, and governance. In April 2022, we administered the tool to five clinical and administrative managers in each of the 36 central and first-level referral hospitals (n = 180 interviews). Further, we calculated a hospital-level management score (1 - poor, 5 - excellent) and linked these data to records of 20 831 neonatal admissions (February-July 2022). Our primary outcome was in-hospital neonatal mortality, and secondary outcomes included 14 clinical quality indicators. We examined associations between hospital-level management scores and individual-level patient outcomes using a multilevel mixed-effects Poisson regression. RESULTS: The mean hospital-level management score across the 36 hospitals was 3.35 (standard deviation = 0.4). Among 20 831 neonatal admissions, 2590 (12.4%; 95% confidence interval (CI) = 11.9-12.8) died, representing a mortality rate of 27.2 deaths per 1000 person-days. We found no relationship between the management score and in-hospital neonatal mortality (adjusted incidence rate ratio per unit increase in the score = 1.08; 95% CI = 0.81-1.44). Five management domains were not associated with mortality, and we found limited evidence that management practice scores were positively associated with quality of clinical care. CONCLUSIONS: This study presents novel, national evidence on the association between hospital management practices and neonatal mortality in a low-income country, with complementary data on quality of clinical care. We found no evidence that hospital management practices were associated with neonatal mortality and limited evidence of an association with the quality of clinical care. Rigorous impact evaluations of targeted management interventions, with embedded process evaluations, could address potential confounders and help understand how and under what circumstances management improvements could translate into better quality of care
Alcohol use disorder increases risk of major adverse limb events following lower-extremity revascularization for chronic limb-threatening ischemia
Get PDFObjective: One in four patients with chronic limb-threatening ischemia (CLTI) undergo major amputation. Despite an established pathophysiological link between excessive alcohol consumption and adverse cardiovascular outcomes, the prevalence and impact of alcohol use disorder (AUD) among adult patients with CLTI has not been investigated. To address this gap, we sought to evaluate the association between AUD and major adverse limb events (MALE) among adults undergoing lower extremity revascularization for CLTI.
Methods: Data were abstracted via Structured Query Language server queries of inpatient and outpatient electronic health records of the UPMC multi-hospital, unified health care system. We included index revascularization (endovascular or open) among adults with CLTI (2016- 2024). Validated International Clinical Diagnosis (ICD-10-CM) codes defined AUD. One-year outcomes of MALE (primary), major amputation, and major revascularization were compared with Fine Gray regression risk-adjusted for competing mortality. Cumulative hazard curves and Cox modeling assessed these outcomes alongside one-year mortality in sensitivity analyses. Multivariable regression was clustered by hospital and generated subdistribution (sHR) or adjusted hazard ratios (aHR) with 95% confidence intervals (Cl) for Fine Gray or Cox modeling, respectively.
Results: Among 3,744 patients with CLTI undergoing revascularization (mean age 69.8 ± 11.7 years; 61.0% male), 183 (4.9%) had an AUD diagnosis. Patients with an AUD diagnosis were more frequently male (84.2% vs. 59.8%; p<.001) and concurrent tobacco users (56.3% vs. 26.4%; p<.001). AUD correlated with an increased risk of one-year MALE (35.6% vs 27.2%, p=.002). In Fine Gray competing-mortality risk regression, AUD was independently associated with increased risk MALE (sHR=1.29, 95% CI 1.03–1.63, p=.029). While major revascularization failed to reach significance (sHR=1.14, 95% CI 0.89–1.47, p=.295), AUD conferred higher one-year risk of major amputation (sHR=1.94, 95% CI 1.65–2.36, p<.001) and mortality (aHR=1.51, 95% CI 1.09–2.09, p=.013).
Conclusion: An AUD diagnosis independently conferred greater risk of MALE and mortality among adults undergoing index lower extremity revascularization for CLTI. These findings underscore the potential value of preoperative identification of AUD to refine risk stratification in this vulnerable, understudied population
Prediction of genetic relatedness of Escherichia coli using neighbor typing: a tool for rapid outbreak detection.
Get PDFIdentifying the genetic relatedness of resistant bacterial pathogens in healthcare settings can help identify undetected transmission events and outbreaks. However, current methods are time- and resource-intensive. We evaluated a rapid neighbor typing method paired with long-read sequencing for assessment of genetic relatedness. Utilizing a data set of primary clinical samples and published isolate data from two outbreaks of Escherichia coli, we applied genomic neighbor typing of long-read sequence data to rapidly estimate genetic relatedness. We assessed the correlation between neighbor typing predicted genetic distance and pairwise genetic distance from short-read draft whole genomes for all sample pairs. Predicted genetic trees using neighbor typing were compared to reference genetic trees generated using mash distances and maximum-likelihood (ML) methods to assess the extent of agreement, along with metrics of cluster similarity (cluster comparability and Baker's gamma index [BGI]) and tree topology similarity (generalized Robinson-Foulds [GRF] metric). For all three data sets, we found strong correlations between the reference methods and predicted genetic distances (Spearman's rho = 0.75-0.95, P < 0.001), which improved when using a lineage score-informed approach (Spearman's rho = 0.93-0.94, P < 0.001). Predicted genetic trees and clusters from neighbor typing were comparable to those generated using either mashtree or an ML method, with a range of cluster comparability of 85.8-99.5%, BGIs of 0.8-0.95, and GRF values of 0.34-0.8. Pairing the neighbor typing method with long-read sequencing can enable accurate predictions of the relatedness of E. coli samples and isolates, and could potentially be used as a rapid outbreak surveillance tool
Measuring and assessing corruption in public health systems in low- and middle-income countries: a scoping review of methods.
No full textCorruption in health systems has serious implications for health outcomes and equitable care. Although various methods exist to measure it, their application, purpose, effectiveness, and context have not yet been systematically consolidated to enable learning. We conducted a scoping review to identify empirical approaches used to measure health-sector corruption globally, with a focus on low- and middle-income countries. We examined the opportunities and challenges of these methods and developed a typology to guide future research. We searched Econlit, Embase, Global Health, Medline, Social Policy and Practice, Web of Science, and websites of international organisations focused on corruption research. Reference lists of included studies were also hand-searched. Two rounds of searches were conducted: first for studies published between 2000 and 2022, then for earlier publications dating back to 1993. Thirty-seven studies were narratively synthesised. Common methods included surveys, interviews, focus groups, and audits. Surveys were more common before 2000. Ethnography, investigative journalism, co-production, and crowdsourcing-though previously recommended-were rarely used or reported in the literature. Often, measuring corruption was not the primary aim, and methods were poorly described. Many lacked a clear definition of corruption or a theoretical grounding. Our review and typology highlight trade-offs between rigour, feasibility, and utility. As demand for evidence in this field grows, consensus on corruption definitions and sub-types is needed to guide study design and improve comparability across contexts. Promising directions include theory-informed mixed methods, context-sensitive designs, qualitative pilots, and interdisciplinary approaches
Towards an African-led model for strengthening capacity in medical statistics and epidemiology in sub-Saharan Africa: an equitable partnership approach.
Get PDFThe demand for expertise in applied medical statistics and epidemiology in Africa exceeds the supply [1, 2] and it is rapidly increasing, with large-scale data sources such as electronic health
records, bioimaging, genomics, social media, geospatial data,
mobile phones, and wearable technology. In parallel, the expansion of statistical methods and tools (such as machine learning)
means that it is essential to increase the number of people who
are trained to analyse available data and stay abreast of methodological and technological advances for improving health in
Africa. Rigorous study design and analysis are essential elements of good research and require well-trained, experienced
statisticians who are integrated into research teams; a common
misconception is that statisticians are only needed to analyse
data rather than being an integral part of the research process
Pipes as an engagement tool: qualitative findings from a crack equipment and harm reduction training intervention in England.
Get PDFBACKGROUND: Crack cocaine use is increasingly prevalent in England, yet drug services are poorly equipped to support the needs of this population. Provision of stimulant inhalation equipment is prohibited, and workforce crack-related harm reduction knowledge is generally low. The Safe Inhalation Pipe Provision (SIPP) project piloted a crack inhalation equipment and training intervention in England. This paper explores how and in what way crack training and equipment provision influences engagement with drug service providers. METHODS: SIPP is a mixed-method study, comprising a before-and-after survey, service monitoring data, qualitative interviews, focus groups, and observations. Here we report qualitative data generated with people who use crack and providers at three intervention and three comparison group sites. We conducted a thematic analysis and report themes specific to contact and engagement with drug services. RESULTS: Prior to intervention implementation, little adequate crack-specific support was identified. SIPP equipment provision facilitated increased contact and/or disclosure of crack use with services. Workforce training enhanced communication and relationship-building opportunities, enabling disclosure of additional need and commensurate provision or linkage to health and social supports. The capacity for contact to facilitate engagement was impacted by organisational and structural constraints, and for some populations barriers to access remain entrenched. CONCLUSIONS: Provision of crack inhalation equipment can facilitate new contacts with services among a highly marginalised population. Complementary workforce training helps to enable relationship building and engagement opportunity. Additional methods of provision, including through peer networks, are required to support people for whom barriers to service access remain. TRIAL REGISTRATION: ISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454
Health improvement and inequality in local authority green infrastructure strategies in England: a policy review.
Get PDFINTRODUCTION: Green spaces are increasingly recognized as critical to public health. This study examines English local planning authorities' green infrastructure strategies, evaluating how health improvement and inequality reduction goals are integrated.
METHODS: A quantitative content analysis was conducted on publicly accessible green infrastructure strategy documents. Of 305 potential authorities, 133 (44%) were included based on eligibility criteria. Only strategies published from 2012 onwards were included. Data were coded across themes: health policy and actors, health outcomes, demographics and inequalities, environmental change and health. A scoring system quantified consideration of health and inequality, with descriptive statistics summarizing thematic presence, frequency, regional variation, and temporal trends.
RESULTS: The integration of health and inequality varied substantially. Most strategies referenced general health outcomes, but fewer detailed actions targeting health inequalities or specific demographic groups. Regional differences were observed, and methods for monitoring health impacts were limited.
CONCLUSION: Local green infrastructure strategies in England increasingly recognize their health improvement potential, but inconsistent integration of health and inequality may limit impact. Stronger collaboration between planning and public health is needed to create equitable, accessible, health-promoting environments. Future research should explore longitudinal health impacts and identify best practices for integrating health equity in spatial planning