Public Health Wales

BackgroundOlder adults make up the largest proportion of nonusers of the internet. With the increasing digitalization of services, it is important to identify what interventions are effective at reducing digital exclusion in older adults.ObjectiveWe aimed to identify what evidence exists on the effectiveness of interventions to address digital exclusion in older adults.MethodsThis rapid review assessed the effectiveness of interventions to address digital exclusion in older adults aged 60 years or older. Searches were conducted in November 2023 across a range of databases and used supplementary search methods. Searches were limited to comparative studies published from 2018 onward in English. Data were analyzed using a narrative synthesis approach.ResultsA total of 21 studies were included that aimed to increase a range of digital literacy skills. Sample sizes ranged from 5 to 381. Intervention approaches varied considerably and were often multicomponent and undertaken in a variety of settings. There is evidence to suggest that a range of interventions can reduce physical, personal, and perceptual barriers and improve older adults’ skills, knowledge, digital literacy, and perceived self-efficacy, reduce technophobia, and increase use of technology. Importantly, findings indicated improvements among a range of subpopulations, including those living in rural areas, at risk of social isolation, who are homebound, of lower socioeconomic groups, and individuals with visual impairment. To achieve improved and sustained digital inclusion in older adults, evidence suggests it may be important to ensure structural barriers, such as access to the internet and affordability of devices, are removed. However, all studies contained methodological limitations and may not be adequately powered to determine effectiveness.ConclusionsThe evidence shows the potential benefits of interventions aimed at improving a range of digital skills and increasing technology use in older adults, which could help to address digital exclusion. The findings of this rapid review can inform the development and delivery of future interventions. However, it is important to consider the context in which the included interventions were used and the lack of certainty of the findings. This review also identified a lack of high-quality evidence, as all studies identified contained methodological limitations and may not have been adequately powered to determine effectiveness. In addition, consideration should also be given to those who do not wish to engage with the online world to ensure they are not left behind.

To review practice in Wales for engaging men and boys in violence prevention and examine how public health can support effective and coordinated efforts as part of a whole system approach. A mixed-methods study combining a national mapping survey and qualitative focus group research. A mapping survey (n=36) was conducted to identify programmes across Wales aimed at engaging men and boys in violence prevention. In addition, a focus group was held with leads from eight 'Test and Learn' pilot projects. Data were analysed thematically to identify key enablers, barriers, and features of promising practice. Programmes varied in focus, target age group, geographical reach, and tier of prevention. Practitioners highlighted the effectiveness of trauma-informed, strengths-based, and culturally relevant approaches. Staff empathy, relationships and coproduction were identified as critical success factors. However, the review also found limited evidence of strategic coordination, evaluation, or long-term investment in this area. Engaging men and boys in violence prevention is vital to addressing the gendered dynamics of perpetration and maximising opportunities for prevention. This research reveals a developing landscape of interventions that, while showing promising elements of trauma-informed, strengths-based practice, remains fragmented and inconsistent in its strategic coordination and evaluation. Realising the full potential of this approach will require public health leadership to move beyond individual behaviour change towards a whole-system approach that addresses the structural drivers of gendered violence.

BackgroundCommunity pharmacists are the most publicly accessible health professionals in high-income countries. There is increasing interest in conducting randomised controlled trials (RCT)—the benchmark of original evidence in the medical field—in community pharmacies. However, little evidence exists examining the challenges and opportunities of conducting RCTs in pharmacies, particularly with respect to project management. In this work, we aim to provide a narrative of lessons learned in conducting two RCTs in community pharmacies in two high-income countries.MethodsWe retrospectively reviewed multiple data sources including administrative and trial activity records. We conducted face-to-face and online sessions to create a list of lessons learned from our experiences and created a stakeholder map for the trials examined. We framed our findings using the Project Managements Institute’s model of the project life cycle, and descriptive statistics were used to estimate the outcomes reported.ResultsNinety-six pharmacies were recruited. Across the project phases, seven high-level tasks within Initiation; 30 within Planning, 43 within Execution/Monitoring and Controlling, and 14 in Closure, were identified. Recruitment of pharmacies, developing documentation for trial drug supply, participant recruitment, and negotiation with pharmacy contracting bodies took longest to complete. Eight key stakeholder groups were identified, including public services/agencies; community pharmacies, communications actors; funders/sponsors; universities/research institutes; healthcare providers; suppliers; and regulators. Thirty lessons were identified, most critically across engaging and managing stakeholders; selecting and supporting trial sites; streamlining trial processes to minimise burden; optimising data collection and accuracy; and considering pharmacy constraints and costs.ConclusionsConducting RCTs in community pharmacies presents unique challenges across the project life cycle. Key lessons include the importance of early planning, streamlining processes to reduce staff burden, and addressing pharmacy constraints. The complexity of the work necessitates dedicated and well-resourced trial management staff to enhance stakeholder management and offer tailored supports where required.Trial registration.Not applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09196-9.

Stained microscopy of fecal smears was the cornerstone of Cryptosporidium diagnosis for many years and provides a low-cost method for detecting oocysts. The development and commercialization of improved enzyme immunosorbent assays (EIAs) for coproantigen detection provided an automatable method for mass testing and rapid diagnostics when incorporated onto a cartridge format. Similarly, immunochromatographic lateral flow (ICLF) assays enable rapid diagnostics. Nevertheless, it is important that positive reactions by EIAs or ICLF assays are confirmed. Here, we describe microscopical methods using tinctorial stains for the diagnosis of acute cryptosporidiosis and using immunofluorescent reagents for diagnosis or for confirmation of EIA- or ICLF-positive reactions.

The gp60 gene has been widely used to subtype Cryptosporidium for many years. Predominantly, this has involved nested polymerase chain reaction (PCR) amplification, gel electrophoresis, and Sanger sequencing of the amplicons. However, laboratories may no longer have gel electrophoresis capability, and during outbreak investigations a more timely approach may be required. Here, we describe a real-time PCR assay combined with high-resolution melt curve analysis that streamlines the PCR detection of gp60 amplicons of Cryptosporidium parvum and Cryptosporidium hominis for sequencing during public health investigations.

Hospital-Based Violence Intervention Programs (HVIPs), based in Emergency Departments (EDs), have been proposed as a public health response to violence. These programs address the underlying reasons why patients are exposed to violence. In addressing any underlying modifiable risks and vulnerabilities HVIPs can reduce patients' exposure to violence and therefore subsequent unplanned attendance into ED. The objectives of this study are to (1) assess whether patient involvement with a HVIP reduces the likelihood of unscheduled ED reattendance, (2) determine whether the presence of the HVIP improves ascertainment of violence in ED attendances, and (3) derive the costs of the HVIP and compare those to the benefits of the intervention and understand whether the HVIP represents value for money from a health service perspective. If an effect is observed, then models will estimate the health impacts, costs and potential savings over a longer time (eg, 10 years) period and for a national roll-out. ED patients are eligible for inclusion in the evaluation if they are normally resident in Wales, United Kingdom, aged 11 years and older. A controlled longitudinal natural experiment will be undertaken. The primary outcome is derived from the Emergency Department Dataset, routinely collected for all EDs in Wales, and is subsequent unplanned ED attendance. Case patients will be matched to control patients attending EDs without an HVIP. Analysis will derive the hazard rate for subsequent unplanned ED attendances using recurrent event analysis. The total monthly count of patients identified as attending because of violence in intervention EDs will be compared to the total count of Welsh control EDs in an interrupted time-series analysis to determine whether HVIPS increase violence ascertainment. To determine whether referral, versus no referral, to the HVIP represents value for money, we will undertake a cost-effectiveness analysis from the perspective of the National Health Service. The approval to access and analyze data housed in the Secure Anonymized Information Linkage (SAIL) databank, an ISO (International Organization for Standardization) 27001 certified and UK Statistics Authority accredited secure data environment, was granted by the SAIL independent Information Governance Review Panel (Ref: 1421). Findings will be presented at local, national, and international conferences and disseminated by peer-reviewed publication. Design inputs arising from public patient involvement and engagement (PPIE) are reported. As a protocol, no further results are available. Novel methods are developed to provide the first robust evaluation of Emergency Department Violence Intervention Programs (EDVIPs). ISRCTN Registry ISRCTN68945844; https://www.isrctn.com/ISRCTN68945844?q=68945844&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10. PRR1-10.2196/86247.

BackgroundMeasuring the broader health impacts and social value of public health initiatives is crucial for demonstrating value and securing sustainable funding. This research investigates the use of Health Impact Assessment (HIA) and Social Return on Investment (SROI) as tools to highlight the potential social, economic, and health outcomes of public health investments. The study focuses on integrating these tools to create more comprehensive evaluations and support policy decisions that foster a Well-being Economy.MethodsThe research employed a mixed-methods approach, including systematic scoping reviews of peer-reviewed and grey literature to assess the application of HIA and SROI in public health. In-depth case studies, expert interviews, and a national survey of Public Health Institutes (PHIs) provided additional insights. The study also explored the practical integration of HIA and SROI, including a case study of a self-administered service for Sexually Transmitted Infections.FindingsThe findings reveal that while HIA and SROI are typically used independently, their combined use can offer a more holistic view. However, challenges remain in standardising methodologies, particularly in stakeholder engagement and outcome valuation. The research identified key barriers, such as limited resources and a lack of expertise in PHIs, hindering the full potential of these frameworks. A case study demonstrated the practical application of both frameworks.ConclusionsThis research promotes the value of integrating HIA and SROI and emphasises the importance of fostering greater awareness and understanding of these frameworks. The research provides practical recommendations for advancing the use of HIA and SROI, including policy levers, workforce development, and standardised practices. The findings advocate for a Well-being Economy, where the value of public health is recognised beyond financial returns, fostering long-term investment.Key messages• Using both Health Impact Assessment and Social Return on Investment provides a comprehensive evaluation of public health initiatives, capturing both health outcomes and broader social value.• To capture the wider impacts and social value of investment in public health, greater awareness, standardised practices, and policy levers are essential for securing long-term investment.

Ageing is a complex sociocultural and physiological process characterised by declines in nutritional and functional status and the immune response. The ageing immune system is plagued by both quantitative and qualitative deficits in the innate and adaptive immune system characterised by reduced responsiveness to de novo antigens and vaccines, along with low-level inflammation which is modulated by nutrition. In this short review, we will highlight the vicious cycle of infection and malnutrition, which is prevalent in the elderly. In doing so we will highlight the relevant contributions of both macronutrient and micronutrient deficiency to immune system dysfunction highlighting the need to research and modify nutrition in the elderly to improve health-related outcomes and protect healthcare systems from anticipated rises in the ageing population.

Improving oral health in patients with acutely dysphagic stroke is a plausible approach to prevent pneumonia. We aimed to determine whether a phase 3, definitive trial of oral health care (OHC) treatments, supported by staff education and training, is feasible in stroke unit care. The CHOSEN (Chlorhexidine or Toothpaste, Manual or Powered Brushing to prevent Pneumonia Complicating Stroke) trial was conducted and reported in line with the Consolidated Standards of Reporting Trials 2010 statement extended to feasibility trials. We aimed to recruit 120 participants with acute stroke and dysphagia within 24 hours of admission, from 4 stroke units in the northwest of England, randomized (1:1:1:1) to 1 of 4 OHC treatments: manual toothbrush or powered toothbrush with either nonfoaming toothpaste or chlorhexidine 1% gel. Stroke unit nursing staff received standardized education and training. Feasibility was assessed using a priori criteria. Between January 2022 and end of January 2023, 626 patients were screened. A total of 101 participants (median age, 73 [interquartile range, 62-80] years; median National Institutes of Health Stroke Scale score, 10 [interquartile range, 5-18]; 44% women) were enrolled (77% of eligible patients approached). Adherence was 91%, with no substantial difference between the OHC treatments, and 88% completed follow-up. There were 19 serious adverse events but no marked differences between allocated OHC treatments. In exploratory secondary analyses, again there were no substantial differences in survival, incident pneumonia, modified Rankin Scale score, or quality of life at 3 months between the OHC treatment allocations. OHC treatments incorporating chlorhexidine and powered brushing and supported by standardized staff training appeared feasible and safe in patients with acutely dysphagic stroke. Progression criteria were met for a definitive trial of efficacy and cost effectiveness. URL: https://doi.org/10.1186/ISRCTN52421361; Unique identifier: ISRCTN52421361.