Search

The purpose of syndromic surveillance is to provide early warning of public health incidents, real-time situational awareness during incidents and emergencies, and reassurance of the lack of impact on the population, particularly during mass gatherings. The United Kingdom Health Security Agency (UKHSA) currently coordinates a real-time syndromic surveillance service that encompasses 6 national syndromic surveillance systems reporting on daily health care usage across England. Each working day, UKHSA analyzes syndromic data from over 200,000 daily patient encounters with the National Health Service, monitoring over 140 unique syndromic indicators, risk assessing over 50 daily statistical exceedances, and taking and recommending public health action on these daily. This English syndromic surveillance service had its origins as a small exploratory pilot in a single region of England in 1999 involving a new pilot telehealth service, initially reporting only on "cold or flu" calls. This pilot showed the value of syndromic surveillance in England, providing advanced warning of the start of seasonal influenza activity over existing laboratory-based surveillance systems. Since this initial pilot, a program of real-time syndromic surveillance has evolved from the single-system, -region, -indicator pilot (using manual data transfer methods) to an all-hazard, multisystem, automated national service. The suite of systems now monitors a wide range of syndromes, from acute respiratory illness to diarrhea to cardiac conditions, and is widely used in routine public health surveillance and for monitoring seasonal respiratory disease and incidents such as the COVID-19 pandemic. Here, we describe the 25-year evolution of the English syndromic surveillance system, focusing on the expansion and improvements in data sources and data management, the technological and digital enablers, and novel methods of data analytics and visualization. [ABSTRACT FROM AUTHOR]

Thirty-five children's trust pathfinders, local cross-sector partnerships, were introduced across England in 2003 to promote greater integration in children's services. Using administrative performance data, this paper tracks yearly trends in child service outputs and child well-being outcomes from 1997 to 2004 in these local areas, including the period before their introduction. Professional perceptions of change in child outcomes are also presented. Time series regression analysis shows there was a general improvement in England in these selected performance indicators prior to the introduction of children's trusts pathfinders. Children's trust pathfinder areas initially focusing on "all children" in their local area, rather than selected groups of children, showed the most progress. There was no consistent quantitative evidence for better outcomes in more integrated areas, however, 25 of the 35 survey respondents provided locally specific examples of children's trust pathfinder arrangements improving outcomes for children and young people.

Introduction Climate change is likely to affect allergic disease (Smith et al. 2014), and the view of clinical experts is that these diseases will increase under climate change (Bielory et [...], BACKGROUND: Globally, pollen allergy is a major public health problem, but a fundamental unknown is the likely impact of climate change. To our knowledge, this is the first study to quantify the consequences of climate change upon pollen allergy in humans. OBJECTIVES: We produced quantitative estimates of the potential impact of climate change upon pollen allergy in humans, focusing upon common ragweed (Ambrosia artemisiifolia) in Europe. METHODS: A process-based model estimated the change in ragweed's range under climate change. A second model simulated current and future ragweed pollen levels. These findings were translated into health burdens using a dose-response curve generated from a systematic review and from current and future population data. Models considered two different suites of regional climate/ pollen models, two greenhouse gas emissions scenarios [Representative Concentration Pathways (RCPs) 4.5 and 8.5], and three different plant invasion scenarios. RESULTS: Our primary estimates indicated that sensitization to ragweed will more than double in Europe, from 33 to 77 million people, by 2041-2060. According to our projections, sensitization will increase in countries with an existing ragweed problem (e.g., Hungary, the Balkans), but the greatest proportional increases will occur where sensitization is uncommon (e.g., Germany, Poland, France). Higher pollen concentrations and a longer pollen season may also increase the severity of symptoms. Our model projections were driven predominantly by changes in climate (66%) but were also influenced by current trends in the spread of this invasive plant species. Assumptions about the rate at which ragweed spreads throughout Europe had a large influence upon the results. CONCLUSIONS: Our quantitative estimates indicate that ragweed pollen allergy will become a common health problem across Europe, expanding into areas where it is currently uncommon. Control of ragweed spread may be an important adaptation strategy in response to climate change. http://dx.doi.org/10.1289/EHP173

We examine the relative importance of both objective and perceived environmental features for physical activity in older English adults. Self-reported physical activity levels of 8,281 older adults were used to compute volumes of outdoor recreational and commuting activity. Perceptions of neighborhood environment supportiveness were drawn from a questionnaire survey and a geographical information system was used to derive objective measures. Negative binominal regression models were fitted to examine associations. Perceptions of neighborhood environment were more associated with outdoor recreational activity (over 10% change per standard deviation) than objective measures (5–8% change). Commuting activity was associated with several objective measures (up to 16% change). We identified different environmental determinants of recreational and commuting activity in older adults. Perceptions of environmental supportiveness for recreational activity appear more important than actual neighborhood characteristics. Understanding how older people perceive neighborhoods might be key to encouraging outdoor recreational activity. [ABSTRACT FROM AUTHOR]

Abstract Background Activity levels are known to decline with age and there is growing evidence of associations between the school environment and physical activity. In this study we investigated how objectively measured one-year changes in physical activity may be associated with school-related factors in 9- to 10-year-old British children. Methods Data were analysed from 839 children attending 89 schools in the SPEEDY (Sport, Physical Activity, and Eating behaviours: Environmental Determinants in Young People) study. Outcomes variables were one year changes in objectively measured sedentary, moderate, and vigorous physical activity, with baseline measures taken when the children were 9–10 years old. School characteristics hypothesised to be associated with change in physical activity were identified from questionnaires, grounds audits, and computer mapping. Associations were examined using simple and multivariable multilevel regression models for both school (9 am – 3 pm) and travel (8–9 am and 3–4 pm) time. Results Significant associations during school time included the length of the morning break which was found to be supportive of moderate (β coefficient: 0.68 [p: 0.003]) and vigorous (β coefficient: 0.52 [p: 0.002]) activities and helps to prevent adverse changes in sedentary time (β coefficient: -2.52 [p: 0.001]). During travel time, positive associations were found between the presence of safe places to cross roads around the school and changes in moderate (β coefficient: 0.83 [p:0.022]) and vigorous (β coefficient: 0.56 [p:0.001]) activity, as well as sedentary time (β coefficient: -1.61 [p:0.005]). Conclusion This study suggests that having longer morning school breaks and providing road safety features such as cycling infrastructure, a crossing guard, and safe places for children to cross the road may have a role to play in supporting the maintenance of moderate and vigorous activity behaviours, and preventing the development of sedentary behaviours in children.

Environ Health Perspect 125(3):385-391 (2017), http://dx.doi.org/10.1289/EHP173 In the list of authors, the eighth author's last name was misspelled as 'Solomon.' The correct spelling is Fabien Solmon. The authors regret the [...]

Purpose. Little is known about school environmental factors that promote or inhibit activity, especially from studies using objective measures in large representative samples. We therefore aimed to study associations between activity intensities and physical and social school environmental factors. Methods. A population-based sample of 1 908 British children (SPEEDY study), mean age 10.3 years (Standard deviation [SD]: 0.3), recruited from 92 schools across Norfolk, UK, with valid activity data (assessed with Actigraph accelerometers). Outcome measures were school-based (8 am-4 pm on weekdays) time (in minutes) spent in sedentary (<100 counts/min), moderate (2 000-3 999 counts/min) and vigorous (≥4 000 counts/min) activity. A total of 40 school physical and social environmental factors were assessed. Multivariable multilevel linear regression analyses adjusted for children's sex and body mass index were conducted; interactions with sex were investigated. Results. Availability of a 'Park and Stride' scheme was negatively associated with sedentary minutes (−7.74; 95% CI: −14.8; −0.70). Minutes of moderate activity were associated with the availability of a lollypop person (1.33, 95% CI: 0.35; 2.62) and objectively-assessed walking provision (1.70, 95% CI: 0.85; 2.56). The number of sports facilities of at least medium quality (0.47, 95% CI: 0.16; 0.79), not having a policy on physical activity (−2.28, 95% CI: −3.62; −0.95), and, in boys only, provision of pedestrian training (1.89; 95% CI: 0.77; 3.01) were associated with minutes of vigorous activity. Conclusions. Only a small number of school-level factors were associated with children's objectively-measured physical activity intensity, giving few pointers for potential future intervention efforts. Further research should focus on using objective measures to elucidate what factors may explain the school-level variance in activity levels. [ABSTRACT FROM AUTHOR]