Kerryn Husk

Indoor fungal diversity and asthma: A meta-analysis and systematic review of risk factors

BACKGROUND Indoor dampness increases the risk of indoor fungal growth. A complex interaction between occupant behaviors and the built environment are thought to affect indoor fungal concentrations and species diversity, which are believed to increase the risk of having asthma, exacerbation of asthma symptoms, or both. To date, no systematic review has investigated this relationship. OBJECTIVE This review aims to assess the relationship between exposure to indoor fungi identified to the genera or species level on asthma outcomes in children and adults. METHODS Ten databases were systematically searched on April 18, 2013, and limited to articles published since 1990. Reference lists were independently screened by 2 reviewers, and authors were contacted to identify relevant articles. Data were extracted from included studies meeting our eligibility criteria by 2 reviewers and quality assessed by using the Newcastle-Ottawa scale designed for assessment of case-control and cohort studies. RESULTS Cladosporium, Alternaria, Aspergillus, and Penicillium species were found to be present in higher concentrations in homes of asthmatic participants. Exposure to Penicillium, Aspergillus, and Cladosporium species were found to be associated with increased risk of reporting asthma symptoms by a limited number of studies. The presence of Cladosporium, Alternaria, Aspergillus, and Penicillium species increased the exacerbation of current asthma symptoms by 36% to 48% compared with those exposed to lower concentrations of these fungi, as shown by using random-effect estimates. Studies were of medium quality and showed medium-high heterogeneity, but evidence concerning the specific role of fungal species was limited. CONCLUSION Longitudinal studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

Beyond greenspace: an ecological study of population general health and indicators of natural environment type and quality

BackgroundMany studies suggest that exposure to natural environments (‘greenspace’) enhances human health and wellbeing. Benefits potentially arise via several mechanisms including stress reduction, opportunity and motivation for physical activity, and reduced air pollution exposure. However, the evidence is mixed and sometimes inconclusive. One explanation may be that “greenspace” is typically treated as a homogenous environment type. However, recent research has revealed that different types and qualities of natural environments may influence health and wellbeing to different extents.MethodsThis ecological study explores this issue further using data on land cover type, bird species richness, water quality and protected or designated status to create small-area environmental indicators across Great Britain. Associations between these indicators and age/sex standardised prevalence of both good and bad health from the 2011 Census were assessed using linear regression models. Models were adjusted for indicators of socio-economic deprivation and rurality, and also investigated effect modification by these contextual characteristics.ResultsPositive associations were observed between good health prevalence and the density of the greenspace types, “broadleaf woodland”, “arable and horticulture”, “improved grassland”, “saltwater” and “coastal”, after adjusting for potential confounders. Inverse associations with bad health prevalence were observed for the same greenspace types, with the exception of “saltwater”. Land cover diversity and density of protected/designated areas were also associated with good and bad health in the predicted manner. Bird species richness (an indicator of local biodiversity) was only associated with good health prevalence. Surface water quality, an indicator of general local environmental condition, was associated with good and bad health prevalence contrary to the manner expected, with poorer water quality associated with better population health. Effect modification by income deprivation and urban/rural status was observed for several of the indicators.ConclusionsThe findings indicate that the type, quality and context of ‘greenspace’ should be considered in the assessment of relationships between greenspace and human health and wellbeing. Opportunities exist to further integrate approaches from ecosystem services and public health perspectives to maximise opportunities to inform policies for health and environmental improvement and protection.

Controlling pre‐loaders: alcohol related violence in an English night time economy

Purpose – The aim of this paper is to focus on the impact of alcohol pre‐loading on behaviour in the night time economy (NTE).Design/methodology/approach – The project was commissioned by Devon and Cornwall Police. During the course of six months in late 2010/early 2011, 597 arrestees were asked a series of questions relating to their drinking patterns on the evening prior to their arrest.Findings – The research shows that there is a shift from the traditional “pub‐club” drinking pattern to a “home‐pub‐club” pattern where excessive early evening drinking is occurring in the private sphere in the absence of external control. Moreover, pre‐loading has become a key aspect in the drinking patterns of many of the NTE population with around 50 per cent of people drinking significant quantities of alcohol prior to entering the NTE. It also demonstrates that those that pre‐load self‐report higher levels of drinking and thus higher levels of intoxication than those that do not.Research limitations/implications – F...

“I don’t really like the pub […]”: reflections on young people and pre-loading alcohol

Purpose – Recent research (Barton and Husk, 2012) suggested that in the UK we are seeing a shift from the traditional “pub-club” drinking pattern to a “home-pub-club” pattern. In the latter model often excessive early evening drinking is occurring in the private sphere in the absence of external control, leading to problems when the drinkers enter the public sphere. Moreover, pre-loading has become a key aspect in the drinking patterns of many of the Night Time Economy (NTE) population with around 60-70 per cent of people drinking some alcohol prior to going out. In the previous work (Barton and Husk, 2012) 50 per cent of people were drinking significant quantities of alcohol prior to entering the NTE. The paper aims to discuss these issues. Design/methodology/approach – However, whilst these statistics give a general overview of patterns of drinking, they fail to provide the depth required to uncover potential mechanisms. It is generally assumed that the driving force behind this cultural shift in alcoho...

Can we, should we, measure ethnicity?

This paper discusses some of the methodological issues in the measurement of ethnicity in the social survey. Measurement encounters two sets of interrelated problems: those of the definition and nature of ethnicity as a social phenomenon and its individual subjective experience and those of the derivation of valid and reliable categories. Commonly used single-item measures fail to capture many ethnic groups and may be of limited value. Extending categories in these will capture more groups, but can be unwieldy and produce small cell counts, whereas multiple measures can be more successful, but are practically less viable in general surveys. We conclude that whilst these difficulties are probably insurmountable, a strategy that is sensitive to the presence of ethnic groups in particular localities is a way forward, but this should also be part of a more sociologically nuanced approach to the collection of ethnic data.

What approaches to social prescribing work, for whom, and in what circumstances? A protocol for a realist review

BackgroundThe use of non-drug, non-health-service interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve their health and well-being. Interventions typically involve accessing activities run by the third sector or community agencies and may also be described as non-medical referral, community referral or social prescribing. To be effective, patients need to be “transferred” from the primary care setting into the community and to maintain their participation in activities. However, it is not currently known how and why these approaches enable which people under what circumstances to reach community services that may benefit their health and well-being.MethodsDatabase searches and extensive searching of grey sources will be carried out in an attempt to find evidence associated with referral and retention in social prescribing. After initial scoping searches, two main phases of searching will be conducted: (a) will focus on the identification of programme theories to illustrate how approaches to social prescribing work for different people and in different contexts and (b) will consist of targeted searches to locate evidence to refine these candidate theories into configurations of the contexts in which populations and the main mechanisms outcomes are achieved. Inclusion criteria will initially be broad in order to develop a clear picture of the ways in which social prescriptions might operate but may iteratively become more focused in response to initially identified evidence, for example, in terms of the population group.An expert advisory group consisting of professionals working in a range of organisations involved in social prescribing will be convened to check the approaches in the review and provide real-life experience of social prescribing. Findings from the review will be disseminated to commissioners, published in a peer-reviewed journal and used to help refine an intervention model for an outdoor nature-based group intervention.DiscussionThis realist review will explore why mechanisms of social prescribing work, for what groups of people and their impact on enrolment, attendance and adherence to programmes. The use of realist approaches to detail the social prescribing process is novel and will offer insights into effective transfer of patients.Systematic review registrationPROSPERO CRD42016039491

What are the health and well-being impacts of community gardening for adults and children: a mixed method systematic review protocol

BackgroundCommunity gardening is defined by its shared nature; gardeners work collectively to manage a garden for shared benefit. Although communal gardening activities, and recognition of their perceived benefits have a long history, it is in recent years that interest has developed in assessing the potential of the approach to address many of the threats to health and wellbeing faced by global populations. Community gardening may address chronic and non-communicable disease through the provision of opportunities for physical activity, improved nutrition and reduced stress. Participation in the gardening activities may improve wellbeing through increased social contact, culturally valued activities and mitigation of food poverty. The benefits of community gardening are argued to extend beyond the participants themselves through more coherent and cohesive communities, improved physical environments and the sharing of the products of the labour. While there are many claims made and an emerging body of research, no previous systematic review has sought to identify and synthesise the evidence in a global context.MethodsThe objectives of the mixed method systematic review are to understand the health and wellbeing impacts of active participation in community gardening. Both quantitative and qualitative evidence will be sought using a broad and diverse search strategy to address the four review questions:1) does active involvement in community gardening lead to improved health or wellbeing;2) if so, how does active involvement in community gardening affect health and wellbeing;3) are there different impacts for different population groups (for instance according to age, socio-economic status or sex); and4) do different types of community gardening (for example producing vegetables or a flower garden) or in different contexts have different types of impacts?A theoretical framework, informed by an initial theory of change model, will illustrate the outcomes of participation and any mechanisms of action (i.e. how such impacts are achieved). The synthesis will be sensitive to factors which may affect the impacts, such as the context of the activities, the demographics of participants, and the implementation and specifics of the community gardening interventions.

Understanding how environmental enhancement and conservation activities may benefit health and wellbeing: a systematic review

BackgroundAction taken to enhance or conserve outdoor environments may benefit health and wellbeing through the process of participation but also through improving the environment. There is interest, amongst both health and environmental organisations, in using such activities as health promotion interventions.The objective of this systematic review was to investigate the health and wellbeing impacts of participation in environmental enhancement and conservation activities and to understand how these activities may be beneficial, to whom and in what circumstances or contexts.MethodsA theory-led mixed-method systematic review was used to assess evidence of effect and to identify pathways to change (protocol: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010351/full). Due to the multi-disciplinary, dispersed and disparate body of evidence an extensive multi-stage search strategy was devised and undertaken. Twenty-seven databases and multiple sources of grey literature were searched and over 200 relevant organisations were contacted. The heterogenous evidence was synthesised using a narrative approach and a conceptual model was developed to illustrate the mechanisms of effect. Due to the limited nature of the evidence additional higher order evidence was sought to assess the plausibility of the proposed mechanisms of effect through which health and wellbeing may accrue.ResultsThe majority of the quantitative evidence (13 studies; all poor quality and lower-order study designs) was inconclusive, though a small number of positive and negative associations were observed. The qualitative evidence (13 studies; 10 poor quality, 3 good) indicated that the activities were perceived to have value to health and wellbeing through a number of key mechanisms; including exposure to natural environments, achievement, enjoyment and social contact. Additional high level evidence indicated that these pathways were plausible.ConclusionsDespite interest in the use of environmental enhancement activities as a health intervention there is currently little direct evidence of effect, this is primarily due to a lack of robust study designs. Further rigorous research is needed to understand the potential of the activities to benefit health and environment.

Physical activity and the prevention, reduction, and treatment of alcohol and/or substance use across the lifespan (The PHASE review): protocol for a systematic review

BackgroundAlcohol and substance use results in significant human and economic cost globally and is associated with economic costs of £21 billion and £15billion within the UK, respectively, and trends for use are not improving. Pharmacological interventions are well researched, but relapse rates across interventions for substance and alcohol use disorders are as high as 60–90%. Physical activity may offer an alternative or adjunct approach to reducing rates of alcohol and substance use that is associated with few adverse side effects, is easily accessible, and is potentially cost-effective. Through psychological, behavioural, and physiological mechanisms, physical activity may offer benefits in the prevention, reduction, and treatment of alcohol and substance use across the lifespan. Whilst physical activity is widely advocated as offering benefit, no systematic review exists of physical activity (in all forms) and its effects on all levels of alcohol and substance use across all ages to help inform policymakers, service providers, and commissioners.MethodsThe objectives of this mixed methods systematic review are to describe and evaluate the quantitative and qualitative research obtained by a diverse search strategy on the impact of physical activity and its potential to:1.Reduce the risk of progression to alcohol and/or substance use (PREVENTION)2.Support individuals to reduce alcohol and/or substance use for harm reduction (REDUCTION), and3.Promote abstinence and relapse prevention during and after treatment for an alcohol and/or substance use disorder (TREATMENT).With the input of key stakeholders, we aim to assess how what we know can be translated into policy and practice. Quantitative, qualitative, service evaluations, and economic analyses will be brought together in a final narrative synthesis that will describe the potential benefits of physical activity for whom, in what conditions, and in what form.DiscussionThis review will provide details of what is known about physical activity and the prevention, reduction, and treatment of alcohol and/or substance use. The synthesised findings will be disseminated to policymakers, service providers, and commissioners in the UK.Systematic review registrationPROSPERO number: CRD42017079322.

Interventions for reducing unplanned paediatric admissions: an observational study in one hospital

Objective Evidence on how best to intervene to improve paediatric acute care and therefore reduce unplanned hospital admissions is weak. We describe service evaluation work at one hospital to assess interventions at critical clinical and service decision points. Design We conducted an observational study using routine daily-collected data (April 2009–December 2015) from a medium-sized district general hospital in south-west UK, using before-and-after comparisons of admissions-related data to evaluate two interventions implemented in April and November 2014, respectively: (1) an advice and guidance (A&G) phone line, where a senior paediatrician is available for general practitioners (GPs) and emergency department (ED) and (2) a Short Stay Paediatric Assessment Unit (SSPAU). We analysed data on all admitted children (<18 years) in the catchment area (population estimate 27 740 in 2015). Outcomes were GP-referred attendances, ward admissions, less than 1 day admissions and length of stay. Results A&G phone line was associated with a reduction in the mean number of less than 1 day admissions per month (difference in means before and after intervention −16.6 (95% CI −0.2 to −32.9)) and an increase in overall monthly bed-days (difference 72.5 (95% CI 21.0 to 124.0)), but there was little evidence of a change in GP-referred attendances or ward admissions. SSPAU was associated with a reduction in the mean number of monthly ward admissions (difference −34.6 (95% CI –21.3 to −48.0)) and less than 1 day admissions (difference in means −21.7 (95% CI −8.4 to −35.1)) and a reduction in the mean number of overall bed-days per month (difference −50.2 (95% CI −12.1 to −88.3)). Conclusions Interventions for reducing time taken to senior clinician review may be effective in better managing paediatric acute care. Further work should explore results by age, condition and injury/illness status.