Suchergebnisse

In 2014, Welsh Government launched the Wales We Want National Conversation. It asked the people of Wales to say what was important to them about the country they live in and what direction it should take. The response was remarkable and involved thousands of people across the country. The conversation led to the world leading Well-being of Future Generations legislation which now enshrines the principles of collaboration, prevention and involving the people of Wales in how our public services work. Public Health Wales is now developing its long-term ambitions on how it will protect and improve the health of our nation over the next 12 years. Embracing the principles set out in the Well-being of Future Generations (Wales) Act 2015, we wanted to hear directly from the public about what are the major challenges to health in Wales and how they would like them addressed. We asked 1,001 individuals who represented the different ages, genders and levels of deprivation across Wales to participate in Stay Well in Wales; a nationally representative survey about what we all think could help us live healthier, happier and longer lives. This report sets out what Wales thinks should be done to improve the health of its residents. This is a first for Wales and something that most countries in the world are yet to accomplish. Like the Wales We Want Conversation, the views expressed in Stay Well in Wales have proved to be rich, informed and strongly supportive of investing in a healthier future for our nation. At Public Health Wales, we aim to use this knowledge to help set aspirations for the next decade and beyond and help deliver a Wales with health, opportunity and prosperity for all.

Abstract Background Governments aim to increase treatment participation by problematic drug users. In the UK this has been achieved by fiscal investment, an expanded workforce, reduced waiting times and coercive measures (usually criminal justice (CJ) led). No assessment of these measures on treatment outcomes has been made. Using established monitoring systems we assessed trends in 'dropped out' and 'discharged drug free' (DDF), since the launch of the national drug strategy, and rates of treatment re-presentation for these cohorts. Methods A longitudinal dataset of drug users (1997 to 2004/05, n = 26,415) was used to identify people who dropped out of, and were DDF from, services for years 1998 to 2001/02, and re-presentations of these people in years to 2004/05. Trends in drop out and DDF, baseline comparisons of those DDF and those who dropped out and outcome comparisons for those referred from the CJ system versus other routes of referral were examined using chi square. Logistic regression analyses identified variables predicting drop out versus DDF and subsequent re-presentation versus no re-presentation. Results The proportion of individuals dropping out has increased from 7.2% in 1998 to 9.6% in 2001/02 (P < 0.001). The proportion DDF has fallen from 5.8% to 3.5% (P < 0.001). Drop out was more likely in later years, by those of younger age and by CJ referrals. The proportion re-presenting to treatment in the following year increased from 27.8% in 1998 to 44.5% in 2001/02 (P < 0.001) for those DDF, and from 22.9% to 48.6% (P < 0.001) for those who dropped out. Older age and prior treatment experience predicted re-presentation. Outcome (drop out or DDF) did not predict re-presentation. Conclusion Increasing numbers in treatment is associated with an increased proportion dropping out and an ever-smaller proportion DDF. Rates of drop out are significantly higher for those coerced into treatment via the CJ system. Rates of re-presentation are similar for those dropping out and those DDF. Encouragingly, those who need to re-engage with treatment, particularly those who drop out, are doing so more quickly. The impact of coercion on treatment outcomes and the appropriateness of aftercare provision require further consideration.

BackgroundEstimates show that only half of adults in Wales meet the UK recommend guidelines for physical activity. In 2015, the financial burden of physical inactivity to the Welsh NHS was estimated to be £35 million. Workplace interventions promoting physical activity can result in positive outcomes for employee health, wellbeing, productivity, job satisfaction and reduced absenteeism. However, the majority of such interventions are prescriptive in the type/duration of physical activity to be completed. In response to Welsh public opinion that employers should do more to help improve the health of their workforce, Public Health Wales (PHW) developed the Time to Move initiative - a 12-month pilot providing employees the opportunity to use one hour (pro rata) of paid work time per week for physical activity of their choice.
MethodsThe Time to Move initiative was evaluated using a pre-experimental time series design. Data were collected using online questionnaires at baseline (June-August 2018), mid-initiative (Dec 2018) and 12-months post-initiative (June–Aug 2019). All measures were self-reported and included physical activity (MET-minutes/week), general health (0, poor – 100, good) and mental well-being (SWEMWBS), job satisfaction (1, very dissatisfied – 5, very satisfied) and participant demographics (e.g. age, gender, pay band).
Findings625 participants completed measures at 12-months post-initiative (72.8% of baseline sample), representing just over a third of all PHW employees. Of those completing all relevant measures, 57.7% reported increased physical activity levels at 12-months compared to baseline (30.6% decreased; 11.6% no change). 75.3% of the sample met UK physical activity guidelines at 12-months compared to 58.8% at baseline. Individuals with the lowest reported levels of physical activity at baseline (n=223) made the greatest improvements - increasing their weekly moderate physical activity by >2.5 hours. Those with moderate activity (n=269) increased by 58 minutes/week and those with high activity levels (n=50) decreased by >4 hours/week. Overall, a small but statistically significant improvement was seen in mental well-being over the study period (mean scores, 22.4 baseline, 23.2 12-months), with participants with categorised as having low mental well-being at baseline benefitting the most. For self-reported health, 34.7% increased their rating (change of at least 10 points), 54.6% had no change and 10.7% declined. The proportion very/quite satisfied with their job increased from 64.4% to 72.0%, with 33.4% of individuals reporting increased job satisfaction (19.6% decreased).
ConclusionsThe Time to Move initiative demonstrates how organisations can encourage and enable their employees to improve their health. Evaluation findings indicate that the provision of paid time to engage in physical activity resulted in positive outcomes for many employees. However, understanding of the impact of the intervention over a longer-period of time is required, including how continued participation may have been impacted by COVID-19-related restrictions.

Policy in all sectors affects health, through multiple pathways and determinants. Health in all policies (HiAP) is an approach that seeks to identify and influence the health and equity impacts of policy decisions, to enhance health benefits and avoid harm. This usually involves the use of health impact assessment or health lens analysis. There is growing international experience in these approaches, and some countries have cross-sectoral governance structures that prioritize the assessment of the policies that are most likely to affect health. The fundamental elements of HiAP are inter-sectoral collaboration, policy influence, and holistic consideration of the range of health determinants affected by a policy area or proposal. HiAP requires public health professionals to invest time to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity. With commitment, political will and tools such as the health impact assessment, it provides a powerful approach to integrated policymaking that promotes health, well-being, and equity. The COVID-19 pandemic has raised the profile of public health and highlighted the links between health and other policy areas. This paper describes the rationale for, and principles underpinning, HiAP mechanisms, including HIA, experiences, challenges and opportunities for the future.

<i>Aim:</i> To examine the contributions of international holiday resorts and visitors' nationality to recruitment, relapse into, and escalation in frequency of recreational drug use. <i>Methods:</i> Retrospective design surveying British, German and Spanish (n = 3,003) holidaymakers aged 16–35 visiting Ibiza or Majorca (Spain). <i>Results:</i> Individuals' drug use in international resorts was related to use at home, holiday destination and nationality. While visiting Ibiza, 7.2% of British tourists tried ecstasy for the first time with similar recruitment amongst Spanish (8.6%) but not Germans (1.8%) or those visiting Majorca (0.8, 1.5 and 1.2%, respectively). Recruitment into cocaine use was associated with being Spanish, male, visiting Ibiza and drunkenness. One in 5 British holidaymakers visiting Ibiza tried at least one new drug. British and Spanish were most likely to relapse into using a drug after at least 12 months' abstinence; 6.8% of British (1.3% German, 2.9% Spanish) relapsed into using at least one drug. Across nationalities, substance use frequency increased on holiday. <i>Conclusions:</i> International nightlife resorts are major sources of recruitment, relapse and escalation in drug use. Such resorts contribute to the international spread of drug cultures but have been largely ignored as settings for interventions to tackle drugs.

BACKGROUND: Health Impact Assessment (HIA) is promoted as a decision-informing tool by public health and governmental agencies. HIA is beneficial when carried out as part of policy development but is also valuable as a methodology when a policy is being implemented to identify and understand the wider health and well-being impacts of policy decisions, particularly when a decision needs to be taken rapidly to protect the population. This paper focusses on a HIA of the 'Staying at Home and Social Distancing Policy' or 'lockdown' in response to the COVID-19 pandemic in Wales conducted by the Welsh national public health institute. It describes the process and findings, captures the learning and discusses how the process has been used to better understand the wider health and well-being impacts of policy decisions beyond direct health harm. It also examines the role of public health institutes in promoting and using HIA. METHODS: A HIA was conducted following a standard HIA five step process. A literature review was undertaken alongside 15 qualitative semi-structured interviews with key stakeholders, and relevant health and demographic data were collated. The results were triangulated and analysed to form a holistic assessment of the policy decision and its impacts. RESULTS: A wide range of major health and well-being impacts of the lockdown in Wales were identified across the determinants of health, which included positive and negative social, economic, environmental and mental well-being impacts beyond the impact on direct health. Populations affected included children and young people, those on low incomes and women as well as those whose health has been directly impacted by COVID-19 such as older people. The work highlighted the benefit that HIA can bring in emphasizing impacts which can inform policy and shared learning with others. CONCLUSION: HIA is a largely underused tool to understand the impact of policy and political decisions, particularly when a decision has been taken at speed. This case study ...

BackgroundHealth Impact Assessment (HIA) is promoted as a decision-informing tool by public health and governmental agencies. HIA is beneficial when carried out as part of policy development but is also valuable as a methodology when a policy is being implemented to identify and understand the wider health and well-being impacts of policy decisions, particularly when a decision needs to be taken rapidly to protect the population. This paper focusses on a HIA of the 'Staying at Home and Social Distancing Policy' or 'lockdown' in response to the COVID-19 pandemic in Wales conducted by the Welsh national public health institute. It describes the process and findings, captures the learning and discusses how the process has been used to better understand the wider health and well-being impacts of policy decisions beyond direct health harm. It also examines the role of public health institutes in promoting and using HIA.MethodsA HIA was conducted following a standard HIA five step process. A literature review was undertaken alongside 15 qualitative semi-structured interviews with key stakeholders, and relevant health and demographic data were collated. The results were triangulated and analysed to form a holistic assessment of the policy decision and its impacts.ResultsA wide range of major health and well-being impacts of the lockdown in Wales were identified across the determinants of health, which included positive and negative social, economic, environmental and mental well-being impacts beyond the impact on direct health. Populations affected included children and young people, those on low incomes and women as well as those whose health has been directly impacted by COVID-19 such as older people. The work highlighted the benefit that HIA can bring in emphasizing impacts which can inform policy and shared learning with others.ConclusionHIA is a largely underused tool to understand the impact of policy and political decisions, particularly when a decision has been taken at speed. This case study highlights how HIA ...

AIMS: To estimate the association between implementation of a community-based multi-component intervention (Drink Less Enjoy More) and sales of alcohol to pseudo-intoxicated patrons and nightlife patron awareness of associated legislation. DESIGN: Cross-sectional pre-intervention and follow-up measurements including alcohol test purchases (using pseudo-intoxicated patrons) in licensed premises (stratified random sample; 2013, 2015) and a survey with nightlife patrons (convenience sample; 2014, 2015). SETTING: One UK municipality with a large night-time economy. PARTICIPANTS: Licensed premises (pre=73; follow-up=100); nightlife patrons (pre=214; follow-up=202). INTERVENTION: The Drink Less Enjoy More intervention included three interacting components: community mobilisation and awareness raising; responsible bar server training; and active law enforcement of existing legislation prohibiting sales of alcohol to, and purchasing of alcohol for, a person who appears to be alcohol intoxicated: 'intoxicated', herein for economy. MEASUREMENTS: The primary outcomes were alcohol service refusal to pseudo-intoxicated patrons and nightlife patron knowledge of alcohol legislation (illegal to sell alcohol to, and purchase alcohol for, intoxicated people), adjusted for potential confounders including characteristics of the area, venue, test purchase, and nightlife patron. FINDINGS: Pre-intervention, 16.4% of alcohol sales were refused, compared with 74.0% at follow-up (p<0.00l). In adjusted analyses, the odds of service refusal were higher at follow-up (adjusted odds ratio [AOR] 14.6, p<0.001). Service refusal was also associated with server gender and patron drunkenness within the venue. Amongst drinkers, accurate awareness of alcohol legislation was higher at follow-up (sales: pre, 44.5%; follow-up, 66.0%; p<0.001 / purchase: pre, 32.5%; follow-up, 56.0%; p<0.001). In adjusted analyses, knowledge of legislation was higher at follow-up (sales: AOR 2.7, p<0.001; purchasing: AOR 2.7, p<0.001). Knowledge of legislation was also associated with participant age (purchasing) and expectations of intoxication (sales). CONCLUSION: A community-based multi-component intervention concerning alcohol sales legislation in the UK was associated with a reduction in sales of alcohol to pseudo-intoxicated patrons in on-licensed premises in a UK nightlife setting and an improvement in nightlife patron awareness of associated legislation.

Objective: To examine factors associated with suffering harm from another person'fs alcohol consumption and explore how suffering such harms relate to feelings of safety in nightlife. Design: Cross-sectional opportunistic survey (Global Drug Survey) using an online anonymous questionnaire in 11 languages promoted through newspapers, magazines and social media. Subjects: Individuals (participating November 2014.January 2015) aged 18.34 years, reporting alcohol consumption in the past 12 months and resident in a country providing .250 respondents (n=21 countries; 63 725 respondents). Main outcome measures: Harms suffered due to others'f drinking in the past 12 months, feelings of safety on nights out (on the way out, in bars/pubs, in nightclubs and when travelling home) and knowledge of over-serving laws and their implementation. Results: In the past 12 months, 40% of respondents suffered at least one aggressive (physical, verbal or sexual assault) harm and 59.5% any harm caused by someone drunk. Suffering each category of harm was higher in younger respondents and those with more harmful alcohol consumption patterns. Men were more likely than women to have suffered physical assault (9.2% vs 4.7; p0.001), with women much more likely to suffer sexual assault or harassment (15.3% vs 2.5%; p0.001). Women were more likely to feel unsafe in all nightlife settings, with 40.8% typically feeling unsafe on the way home. In all settings, feeling unsafe increased with experiencing more categories of aggressive harm by a drunk person. Only 25.7% of respondents resident in countries with restrictions on selling alcohol to drunks knew about such laws and 75.8% believed that drunks usually get served alcohol. Conclusions: Harms from others'f drinking are a threat to people'fs health and well-being. Public health bodies must ensure that such harms are reflected in measures of the societal costs of alcohol, and must advocate for the enforcement of legislation designed to reduce such harms.

<i>Aims:</i> Given the importance of party people as innovators and early adaptors in the diffusion of substance use, and given the lack of longitudinal scope in studies of the nightlife scene, we explored changes in illicit drug use among young people participating in the nightlife scene in Flanders. <i>Methods:</i> A survey among party people selected at dance events, rock festivals and clubs was held in the summer of 2003 and repeated in 2005, 2007 and 2009. In total, 2,812 respondents filled in a questionnaire on the use of cannabis, ecstasy, cocaine, amphetamines, GHB and ketamine. <i>Results:</i> The results of the multiple logistic regression analyses show that in the group of frequent pub visitors, the predicting probability of cannabis use increased over time, while the gap in drug use between dance music lovers and non-lovers of dance music narrowed. For cocaine use during the last year, an increase was found related to the housing situation (alone or with parents) of respondents. While the odds of using ecstasy decreased over the years, the odds of using GHB increased. <i>Conclusion:</i> We can conclude that monitoring emerging trends, which can be quickly observed in the nightlife scene, provides meaningful information for anticipating possible trends.