Using real-time syndromic surveillance to monitor the health effects of air pollution

ObjectiveTo explore the utility of syndromic surveillance systems for detecting and monitoring the impact of air pollution incidents on health-care seeking behaviour in England between 2012 and 2017.IntroductionThe negative effect of air pollution on human health is well documented illustrating increased risk of respiratory, cardiac and other health conditions. [1] Currently, during air pollution episodes Public Health England (PHE) syndromic surveillance systems [2] provide a near real-time analysis of the health impact of poor air quality. In England, syndromic surveillance has previously been used on an ad hoc basis to monitor health impact; this has usually happened during widespread national air pollution episodes where the air pollution index has reached ‘High’ or ‘Very High’ levels on the UK Daily Air Quality Index (DAQI). [3-5]We now aim to undertake a more systematic approach to understanding the utility of syndromic surveillance for monitoring the health impact of air pollution. This would improve our understanding of the sensitivity and specificity of syndromic surveillance systems for contributing to the public health response to acute air pollution incidents; form a baseline for future interventions; assess whether syndromic surveillance systems provide a useful tool for public health alerting; enable us to explore which pollutants drive changes in health-care seeking behaviour; and add to the knowledge base.MethodsThe systematic approach will involve accessing historical data for air pollution incidents and syndromic surveillance data over the period 2012-17 across England. We will use PM10, PM2.5, ozone, NO2 , SO2 and DAQI data to define air pollution periods, and historical syndromic surveillance system data for respiratory syndromes (asthma, difficulty breathing, wheeze, cough, bronchitis, sore throat and allergic rhinitis), cardiac (all cardiovascular and myocardial infarction) and eye irritation/conjunctivitis syndromes. We will use regression modelling and cross-correlation analyses to determine the effects of air pollution, weather and pollen upon these syndromes and thus provide evidence of the sensitivity of these systems. Historical data on additional environmental variables including temperature and precipitation, humidity and thunderstorm activity, pollen and fungal spores will be accounted for in the regression models, as well as data on influenza and respiratory syncytial virus (RSV) laboratory reports. We will include sub-national geographies and age/gender analyses in the study depending on the data availability and suitability.ResultsInitial results presented will include the preliminary descriptive epidemiology with a focus on asthma and the impact of air pollution incidents on health-care seeking behaviour using data from the PHE national syndromic surveillance systems.ConclusionsWe aim to demonstrate an innovative use of syndromic surveillance data to explore the impact of air pollution incidents on health-care seeking behaviour in England, in turn improving our understanding of the sensitivity and specificity of these systems for detecting the impact of air pollution incidents and to contribute to the knowledge base. This understanding will improve the public health response to future incidents.References1. World Health Organization (WHO). Preventing disease through healthy environments. Exposure to air pollution: A major public health concern. (http://www.who.int/ipcs/features/air_pollution.pdf). Accessed 28/09/20172. Public Health England. Syndromic surveillance: systems and analyses. (https://www.gov.uk/government/collections/syndromic-surveillance-systems-and-analyses). Accessed 20/09/20173. Department for Environment Food and Rural Affairs (Defra). Daily Air Quality Index (DAQI). (https://uk-air.defra.gov.uk/air-pollution/daqi). Accessed 28/06/20174. Smith GE, et al. Using real-time syndromic surveillance systems to help explore the acute impact of the air pollution incident of March/April 2014 in England. Environ Res 2015; 136: 500-504.5. Elliot AJ, et al. Monitoring the effect of air pollution episodes on health care consultations and ambulance call-outs in England during March/April 2014: A retrospective observational analysis. Environ Pollut 2016; 214: 903-911.

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Is it me? The impact of patient–physician interactions on lupus patients’ psychological well-being, cognition and health-care-seeking behaviour

Rheumatology Advances in Practice ◽

10.1093/rap/rkaa037 ◽

2020 ◽

Vol 4 (2) ◽

Cited By ~ 1

Author(s):

Melanie Sloan ◽

Felix Naughton ◽

Rupert Harwood ◽

Elliott Lever ◽

David D’Cruz ◽

...

Keyword(s):

Health Care ◽

Well Being ◽

Medical Decision ◽

Health Care Seeking ◽

Care Seeking ◽

Psychological Well Being ◽

Health Care Seeking Behaviour ◽

Patient Reported ◽

The Impact ◽

Care Seeking Behaviour

Abstract Objective The aim was to explore the impact of patient–physician interactions, pre- and post-diagnosis, on lupus and UCTD patients’ psychological well-being, cognition and health-care-seeking behaviour. Methods Participants were purposively sampled from the 233 responses to a survey on patient experiences of medical support. Twenty-one semi-structured interviews were conducted and themes generated using thematic analysis. Results The study identified six principal themes: (i) the impact of the diagnostic journey; (ii) the influence of key physician(s) on patient trust and security, with most participants reporting at least one positive medical relationship; (iii) disparities in patient–physician priorities, with patients desiring more support with quality-of-life concerns; (iv) persisting insecurity and distrust, which was prevalent and largely influenced by previous and anticipated disproportionate (often perceived as dismissive) physician responses to symptoms and experiences of widespread inadequate physician knowledge of systemic autoimmune diseases; (v) changes to health-care-seeking behaviours, such as curtailing help-seeking or under-reporting symptoms; and (vi) empowerment, including shared medical decision-making and knowledge acquisition, which can mitigate insecurity and improve care. Conclusion Negative medical interactions pre- and post-diagnosis can cause a loss of self-confidence and a loss of confidence and trust in the medical profession. This insecurity can persist even in subsequent positive medical relationships and should be addressed. Key physicians implementing empowering and security-inducing strategies, including being available in times of health crises and validating patient-reported symptoms, might lead to more trusting medical relationships and positive health-care-seeking behaviour.

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‘It still leaves me sixty dollars out of pocket’: experiences of diabetes medical care among low-income earners in Perth

Australian Journal of Primary Health ◽

10.1071/py12096 ◽

2014 ◽

Vol 20 (2) ◽

pp. 143 ◽

Cited By ~ 6

Author(s):

Beatriz Cuesta-Briand ◽

Sherry Saggers ◽

Alexandra McManus

Keyword(s):

Health Care ◽

Low Income ◽

Health Care Seeking ◽

Care Seeking ◽

Indigenous Status ◽

Experience Of Care ◽

Lack Of Information ◽

Health Care Seeking Behaviour ◽

The Impact ◽

Care Seeking Behaviour

Diabetes prevalence is increasing in Australia, and there are stark inequities in prevalence and clinical outcomes experienced by Indigenous people and low socioeconomic groups compared with non-Indigenous and socioeconomically advantaged groups. This paper explores the impact of Indigenous status and socioeconomic disadvantage on the experience of diabetes care in the primary health setting. Data were collected through focus groups and interviews. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from disadvantaged areas in Perth, Australia. Data analysis was mainly deductive and based on a conceptual framework for the relationship between socioeconomic position and diabetes health outcomes. Most participants reported accessing general practitioners regularly; however, evidence of access to dietitians and podiatrists was very limited. Perceived need, cost, lack of information on available services and previous negative experiences influenced health care-seeking behaviour. Complexity and lack of coordination characterised the model of care reported by most participants. In contrast, Indigenous participants accessing an Aboriginal community-controlled health organisation reported a more accessible and coordinated experience of care. Our analysis suggests that Indigenous and socioeconomically disadvantaged people tailor their health care-seeking behaviour to the limitations imposed by their income and disadvantaged circumstances. To reduce inequities in care experiences, diabetes services in primary care need to be accessible and responsive to the needs of such groups in the community.

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Spike in asthma healthcare presentations in eastern England during June 2021: a retrospective observational study using syndromic surveillance data

10.1101/2021.10.26.21264613 ◽

2021 ◽

Author(s):

Alex J Elliot ◽

Christopher Bennett ◽

Helen E Hughes ◽

Roger A Morbey ◽

Dan Todkill ◽

...

Keyword(s):

Health Care ◽

Syndromic Surveillance ◽

Healthcare Services ◽

Thunderstorm Activity ◽

Surveillance Systems ◽

Care Seeking ◽

Health Care Seeking Behaviour ◽

Difficulty Breathing ◽

Online Assessments ◽

Care Seeking Behaviour

Background Thunderstorm asthma is often characterised by a sudden surge in patients presenting with exacerbated symptoms of asthma linked to thunderstorm activity. On 17 June 2021, Public Health England (PHE) observed a large spike in health care seeking behaviour by patients presenting with asthma and difficulty breathing symptoms across parts of England. Objectives To describe the epidemiology of the observed asthma spike and explore available meteorological and environmental data to understand potential causes of this episode. Design A retrospective observational study was conducted of patient visits to health care services in England as monitored through surveillance systems routinely operated by PHE. The number of presentations during the asthma event was compared to expected levels for the overall population and across specific regions. Setting Healthcare services in England. Main outcome measures Number of patients presenting to healthcare services for asthma- and difficulty breathing-type symptoms. Results Spikes in asthma and difficulty breathing were detected across several PHE syndromic surveillance systems. Across affected areas ED attendances for asthma increased by 560% on 17 June compared to the average number of weekday daily attendances during the previous 4 weeks. GP out of hours contacts increased by 422%, NHS 111 calls 193%, NHS 111 online assessments 581% and ambulance call outs 54%. Increases were particularly noted in patient age groups 5-14 and 15-44 years. In non-affected regions, increases were small (<10%) or decreased, except for NHS 111 online assessments where there was an increase of 39%. A review of the meteorological conditions showed several localised, weak or moderate thunderstorms specifically across parts of South East England on the night of June 16. Conclusions An unprecedented episode of asthma was recorded in England, characterised by significant surges in health care seeking behaviour. However, the links to meteorologically defined thunderstorm activity were not as clear as previous episodes, with less evidence of severe thunderstorm activity in those areas affected, prompting further discussion about the causes of these events and implications for public health management of the risk.

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Knowledge and Health Care Seeking Behaviour About Neonatal Danger Signs Among Mothers Visiting Immunization Unit in Public Health Facilities of Debre Markos Town Northwest Ethiopia, June 2016

10.7176/jmpb/52-05 ◽

2018 ◽

Keyword(s):

Public Health ◽

Health Care ◽

Northwest Ethiopia ◽

Health Facilities ◽

Health Care Seeking ◽

Care Seeking ◽

Public Health Facilities ◽

Danger Signs ◽

Health Care Seeking Behaviour ◽

Care Seeking Behaviour

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Prevalence and health care seeking behaviour for sexually transmitted infections among in-school adolescents in Ado-Ekiti, South-Western Nigeria

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2016-0011 ◽

2016 ◽

Vol 29 (6) ◽

Author(s):

Patrick T. Adegun ◽

Eyitope O. Amu

Keyword(s):

Health Care ◽

Sexually Transmitted Infections ◽

Health Care Seeking ◽

Care Seeking ◽

Self Medication ◽

Cross Sectional ◽

Sexually Transmitted ◽

Stomach Pain ◽

Health Care Seeking Behaviour ◽

Care Seeking Behaviour

Abstract Background: In Nigeria, adolescents are highly vulnerable to sexually transmitted infections (STIs) which have the potential of jeopardising their future reproductive lives if poorly treated. Objective: To determine the prevalence and health care seeking behaviour for STIs among secondary school adolescents in Ado, South-Western Nigeria. Subjects: Male and female adolescents aged 10–19 years. Methods: The study employed a descriptive cross-sectional design. A pre-tested, self-administered, semi-structured questionnaire was used to elicit information from 560 adolescents selected from public and private secondary schools in Ado Local Government Area (LGA) of Ekiti State, using a multistage sampling technique. The data were analyzed using descriptive and inferential statistics. Analyzed data were presented in the form of tables and charts. Results: Two hundred and fifty-one (47.1%) respondents had previous symptoms of STIs. The commonest symptoms among the males were penile discharge (30.5%), painful micturition (30.5%) and stomach pain with swollen testes (25.4%). The commonest symptoms among the females were genital itching (27.6%), genital sores (14.1%) and painful micturition (13.1%). Only 26.7% sought treatment from a health facility; 37.0% did nothing; 15.9% went to patent medicine stores, 10.0% used herbs; the rest did self-medication or prayed. Conclusion: The prevalence of STI symptoms among adolescents in Ado-Ekiti is high but their health care seeking behaviour is poor. Health education about the dangers of untreated STI and the importance of seeking treatment early, targeted at adolescents, should be intensified.

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