Brendan Walsh

The importance of socio-economic variables in cancer screening participation: a comparison between population-based and opportunistic screening in the EU-15.

OBJECTIVESnTo investigate differences in participation with breast and cervical cancer screening related to individual socio-economic characteristics, across population-based versus opportunistic screening programmes.nnnMETHODSnData from Eurobarometer 66.2 Health in the European Union 2006 on self-reported breast and cervical cancer screening participation in the preceding 12 months within the EU 15 was obtained The sample was restricted to those eligible for screening based on the screening age within each country. Observations for 2214 and 5025 individuals respectively for breast and cervical cancer screening were available. Data on marital status, self-reported health, socio-economic group and years of education were also available. Screening programmes were categorised as population-based or opportunistic and logistic regression analysis used to examine the relationship between participation, individual characteristics and programme type.nnnRESULTSnDifferences in participation related to socio-economic status were observed in opportunistic screening programmes for breast cancer (OR=0.63* and OR=0.51**) and cervical cancer (OR=0.75** and OR=0.64**). Differences related to socio-economic characteristics were not found with respect to participation in population-based programmes.nnnCONCLUSIONSnIn opportunistic programmes, differences in participation across socio-economic groups are evident in respect of both breast and cervical cancer screening. These differences may have implications for treatment and outcomes across socio-economic groups. Such differences were not evident in population-based programmes.

Decomposing socioeconomic inequalities in childhood obesity: evidence from Ireland.

The objective of this paper is to quantify and decompose the socioeconomic gradient in childhood obesity in the Republic of Ireland. The analysis is performed using data from the first wave of the Growing Up in Ireland survey, a nationally representative survey of 8568 nine-year-old children conducted in 2007 and 2008. We estimate concentration indices to quantify the extent of the socioeconomic gradient in childhood obesity and undertake a subsequent decomposition analysis to pinpoint the key factors underpinning the observed inequalities. Overall the results confirm a strong socioeconomic gradient in childhood obesity in the Republic of Ireland. Concentration indices of obesity (CI=-0.168) and overweight/obese (CI=-0.057) show that the gradient is more pronounced in obese children, while results from the decomposition analysis suggest that the majority of the inequality in childhood obesity is explained by parental level variables. Our findings suggest that addressing childhood obesity inequalities requires coordinated policy responses at both the child and parental level.

Cost of care for cancer patients in England: evidence from population-based patient-level data.

Background:Health systems are facing the challenge of providing care to an increasing population of patients with cancer. However, evidence on costs is limited due to the lack of large longitudinal databases.Methods:We matched cost of care data to population-based, patient-level data on cancer patients in England. We conducted a retrospective cohort study including all patients age 18 and over with a diagnosis of colorectal (275u2009985 patients), breast (359u2009771), prostate (286u2009426) and lung cancer (283u2009940) in England between 2001 and 2010. Incidence costs, prevalence costs, and phase of care costs were estimated separately for patients age 18–64 and ⩾65. Costs of care were compared by patients staging, before and after diagnosis, and with a comparison population without cancer.Results:Incidence costs in the first year of diagnosis are noticeably higher in patients age 18–64 than age ⩾65 across all examined cancers. A lower stage diagnosis is associated with larger cost savings for colorectal and breast cancer in both age groups. The additional costs of care because of the main four cancers amounts to £1.5 billion in 2010, namely 3.0% of the total cost of hospital care.Conclusions:Population-based, patient-level data can be used to provide new evidence on the cost of cancer in England. Early diagnosis and cancer prevention have scope for achieving large cost savings for the health system.

The role of private medical insurance in socioeconomic inequalities in cancer screening uptake in the Republic of Ireland

Screening is seen by many as a key element in cancer control strategies. Differences in uptake of screening related to socio-economic status exist and may contribute to differences in morbidity and mortality across socio-economic groups. Although a number of factors are likely to underlie differential uptake, differential access to subsequent diagnostic tests and/or treatment may have a pivotal role. This study examines differences in the uptake of cancer screening in Ireland related to socio-economic status. Data were extracted from SLÁN 2007 concerning uptake of breast, cervical, colorectal and prostate cancer screening in the preceding 12 months. Concentration indices were calculated and decomposed. Particular emphasis was placed in the decomposition upon the impact of private health insurance, evidenced in other work to impact on access to care within the mixed public-private Irish health system. This study found that significant differences related to socio-economic status exist with respect to uptake of cancer screening and that the main determinant of difference for breast, colorectal and prostate cancer screening was possession of private insurance. This may have profound implications for the design of cancer control strategies in countries where private insurance has a significant role, even where screening services are publicly funded and population based.

An examination of variations in the uptake of prostate cancer screening within and between the countries of the EU-27

OBJECTIVESnProstate specific antigen (PSA) testing as a part of a prostate cancer control strategy is the subject of much debate. This paper examines variations in the uptake of PSA testing across Europe and the role of individual and contextual variables in explaining this variation.nnnMETHODSnData were taken from Eurobarometer 66.2 Health in the European Union 2006 on self-reported uptake of screening. Data related to men across the EU-27 and Croatia, aged 40 and over (N=6986). A logistic regression analysis examines the role of individual characteristics across and within the countries.nnnRESULTSnA range of individual characteristics were found to be statistically significant predictors of uptake including education, marital status, and smoking status. Socio-economic status (SES) was also a statistically significant predictor of the likelihood of screening. Variation across countries in uptake was evident; importantly a significant role was accorded primary care in explaining variation in uptake.nnnCONCLUSIONnUptake of PSA testing varies considerably within and across European countries. Differences within states relate to the characteristics of individuals offered tests and differences between states, to the system of primary care in operation. Given the significant welfare losses implicit in the evident variations the role of primary care warrants further investigation.

The role of private medical insurance in socio-economic inequalities in cancer screening uptake in Ireland.

Screening is seen by many as a key element in cancer control strategies. Differences in uptake of screening related to socio-economic status exist and may contribute to differences in morbidity and mortality across socio-economic groups. Although a number of factors are likely to underlie differential uptake, differential access to subsequent diagnostic tests and/or treatment may have a pivotal role. This study examines differences in the uptake of cancer screening in Ireland related to socio-economic status. Data were extracted from SLÁN 2007 concerning uptake of breast, cervical, colorectal and prostate cancer screening in the preceding 12 months. Concentration indices were calculated and decomposed. Particular emphasis was placed in the decomposition upon the impact of private health insurance, evidenced in other work to impact on access to care within the mixed public-private Irish health system. This study found that significant differences related to socio-economic status exist with respect to uptake of cancer screening and that the main determinant of difference for breast, colorectal and prostate cancer screening was possession of private insurance. This may have profound implications for the design of cancer control strategies in countries where private insurance has a significant role, even where screening services are publicly funded and population based.

Prostate cancer screening practices in the Republic of Ireland: the determinants of uptake.

Objectives: The objectives of this paper are to analyse the determinants of prostate cancer screening uptake in the Republic of Ireland and to compare the role of non-need factors in uptake of screening among those in and outside the age range recommended as cost-effective for screening according to the European Randomised Study of Screening for Prostate Cancer (ERSPC). Methods: The investigation combined a logistic regression analysis of uptake, with an estimation of income-related concentration indices and decomposition of the indices using data collected as part of the Survey of Lifestyle and Nutrition (SLAN) 2007. Comparisons were made across groups differentiated by age in terms of the expected value of the prostate cancer screening. Results: Uptake of prostate screening in men 40 years and over in the preceding 12 months was approximately 24%. Uptake was higher among those in age groups that are perceived to receive most benefit from a Prostate Specific Antigen (PSA) test based on the findings of the ERSPC trial. Screening is highest in those with highest socioeconomic status and educational attainment, and who also hold private insurance cover. The largest socioeconomic inequality is observed for men over 70 years of age (0.2298). The smallest inequality was observed for those aged 55-69 (0.1573). Decomposition of the concentration indices shows that possession of private insurance is the largest determinant of inequality among those aged 55-69 (36%) and remains a significant determinant for those aged 40-54 (26%) and those aged 70 and over (17%). Conclusions: There are high levels of prostate cancer screening uptake and significant income-related inequality in uptake in the Republic of Ireland. Given that the merits of prostate cancer screening overall and across different age groups are the subject of debate, the high levels of screening and income-related inequalities in uptake warrant closer attention and identification of potential policy responses.

Since The Start Of The Vaccines For Children Program, Uptake Has Increased, And Most Disparities Have Decreased.

The Vaccines for Children program is a US government intervention aimed at increasing vaccination uptake by removing financial barriers that may prevent US children from accessing vaccinations. This study examined the impact that this intervention had on race and ethnicity-related and income-related disparities for diphtheria-tetanus-acellular pertussis, measles-mumps-rubella, and polio vaccinations, using data from the National Immunization Survey, 1995-2013. Vaccination rates increased across all races, ethnicities, and income groups following the introduction of the Vaccines for Children program. Disparities among race and ethnic groups narrowed considerably over time since the introduction of the vaccine program, although income-related disparities changed at different rates within racial and ethnic groups and in some cases increased. Government interventions aimed solely at reducing certain financial barriers to vaccination may fail to address other important aspects of cost or perceived benefits that influence vaccination uptake, especially among poorer children.

Impact of laparoscopic versus open surgery on hospital costs for colon cancer: a population-based retrospective cohort study

Objective Laparoscopy is increasingly being used as an alternative to open surgery in the treatment of patients with colon cancer. The study objective is to estimate the difference in hospital costs between laparoscopic and open colon cancer surgery. Design Population-based retrospective cohort study. Settings All acute hospitals of the National Health System in England. Population A total of 55u2005358 patients aged 30 and over with a primary diagnosis of colon cancer admitted for planned (elective) open or laparoscopic major resection between April 2006 and March 2013. Primary outcomes Inpatient hospital costs during index admission and after 30 and 90u2005days following the index admission. Results Propensity score matching was used to create comparable exposed and control groups. The hospital cost of an index admission was estimated to be £1933 (95% CI 1834 to 2027; p<0.01) lower among patients who underwent laparoscopic resection. After including the first unplanned readmission following index admission, laparoscopy was £2107 (95% CI 2000 to 2215; p<0.01) less expensive at 30u2005days and £2202 (95% CI 2092 to 2316; p<0.01) less expensive at 90u2005days. The difference in cost was explained by shorter hospital stay and lower readmission rates in patients undergoing minimal access surgery. The use of laparoscopic colon cancer surgery increased 4-fold between 2006 and 2012 resulting in a total cost saving in excess of £29.3 million for the National Health Service (NHS). Conclusions Laparoscopy is associated with lower hospital costs than open surgery in elective patients with colon cancer suitable for both interventions.

The effect of a training programme on school nurses’ knowledge, attitudes, and depression recognition skills: The QUEST cluster randomised controlled trial

BACKGROUNDnMental health problems in children and young people are a vital public health issue. Only 25% of British school children with diagnosed mental health problems have specialist mental health services contact; front-line staff such as school nurses play a vital role in identifying and managing these problems, and accessing additional services for children, but there appears limited specific training and support for this aspect of their role.nnnOBJECTIVESnTo evaluate the effectiveness of a bespoke short training programme, which incorporated interactive and didactic teaching with printed and electronic resources. Hypothesized outcomes were improvements in school nurses knowledge, attitudes, and recognition skills for depression.nnnDESIGNnA cluster-randomised controlled trial.nnnPARTICIPANTS AND SETTINGn146 school nurses from 13 Primary Care Trusts (PCTs) in London were randomly allocated to receive the training programme.nnnMETHODSnSchool nurses from 7 PCTs (nu202f=u202f81) were randomly allocated to receive the training intervention and from 6 PCTs (nu202f=u202f65) for waiting list control. Depression detection was measured by response to vignettes, attitudes measured with the Depression Attitude Questionnaire, and knowledge by the QUEST knowledge measure. These outcomes were measured at baseline and (following training) 3 months and nine months later, after which nurses in the control group received the training programme.nnnRESULTSnAt 3 months, 115 nurses completed outcome measures. Training was associated with significant improvements in the specificity of depression judgements (52.0% for the intervention group and 47.2% for the control group, Pu202f=u202f0.039), and there was a non-significant increase in sensitivity (64.5% compared to 61.5% Pu202f=u202f0.25). Nurses knowledge about depression improved (standardised mean differenceu202f=u202f0.97 [95% CI 0.58 to 1.35], Pu202f<u202f0.001); and confidence about their professional role in relation to depression increased. There was also a significant change in optimism about depression outcomes, but no change in tendency to defer depression management to specialists. At 9-month follow-up, improved specificity in depression identification and improved knowledge were maintained.nnnCONCLUSIONSnThis school nurse development programme, designed to convey best practice for the identification and care of depression, delivered significant improvements in some aspects of depression recognition and understanding, and was associated with increased confidence in working with young people experiencing mental health problems.