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Objectives: The aim of this paper is to examine the way in which nurses manage patients who refuse nursing care procedures. Design: This paper reports on a qualitative study which was undertaken to explore the way in which nurses obtain consent prior to nursing care procedures. Focus groups were carried out to obtain background data concerning how consent is obtained. Critical incidents were collected through in depth interviews as a means of focusing on specific incidents in clinical practice. Setting: Two teaching hospitals in England. Participants: Purposive sample of qualified nurses. Results: When a patient refuses nursing care, nurses respond by giving information until the Patient finally accedes to the procedure. Nurses will go to great lengths to achieve patients' agreement to the procedure, but the extent to which the agreement remains voluntary cannot be ascertained by the data collected in this study. If the patient does not eventually agree to a procedure, there is evidence that nurses will administer the care in the absence of consent. Conclusions: Nurses are concerned to obtain the patient's consent prior to the administration of nursing care but if this cannot be achieved do not regard obtaining consent as an absolute requirement. Consent is preferred, but not considered essential. Nurses have some understanding of the principles of informed consent but do not apply them to everyday clinical nursing practice. [ABSTRACT FROM AUTHOR]

Since Bennett, Draper, and Frith published a paper in the Journal of Medical Ethics in 2000 considering the possible criminalization of HIV transmission, an important legal development has taken place. February 2001 saw the first successful United Kingdom prosecution for the sexual transmission of disease for over a century, when Stephen Kelly was convicted in Glasgow of recklessly injuring his former girlfriend by infecting her with HIV. Whether English criminal law (as opposed to Scots law) can apply criminal penalties in such a case, however, still remains uncertain. This paper, in addition to providing some background to the Kelly case, briefly explores the current possibilities for prosecution under English law. It then proceeds to outline and comment on the issues relevant to criminalization, responding in part to points made by Bennett, Draper, and Frith and also by Bird and Leigh Brown in a recent article in the BMJ. [ABSTRACT FROM AUTHOR]

While the decision of the House of Lords in Re F in [1990] clarified somewhat the law concerning the treatment of the mentally incapacitated adult, many uncertainties remained. This paper explores proposals discussed in a recent government green paper for reform of the law in an area involving many difficult ethical dilemmas. [ABSTRACT FROM AUTHOR]

In this article, the author focuses on the impact of the British National Health Service (NHS) health care guidelines restraints on clinical commissioning groups (CCGs) in England. He informs that four CCGs have implemented the National Institute for Health and Care Excellence (NICE) guideline for in vitro fertilisation and the general practitioner (GP) referral service management guideline has restricted the flow of patients in CCGs. It states that a white paper released by the NHS in 2010 has revealed that NHS has planned to abolish primary health care trusts. It also mentions that the guidelines have impacted both the budget and responsibilities of CCGs. INSETS: BOX 1: CCGS FAIL TO IMPLEMENT NICE GUIDANCE ON IVF;BOX 2: CLOSING THE GATES¿NEW REFERRAL MANAGEMENT SYSTEMS;COMMISSIONING GROUPS ¿ HOW THEY CAME INTO BEING;BOX 3: FAMILY DOCTOR¿PATIENTS¿ ADVOCATE OR GUARDIAN OF THE PUBLIC

Background In 2008, the Healthy Community Challenge Fund commissioned nine 'healthy towns' in England to implement and evaluate community-based environmental interventions to prevent obesity. This paper examines the role of evidence in informing intervention development, innovation and the potential for programmes to contribute to the evidence base on the effectiveness of interventions that tackle population obesity. Method Twenty qualitative interviews with local programme stakeholders and national policy actors were conducted. Interview transcripts were coded and thematically analysed. Initial analyses were guided by research questions regarding the nature and role of evidence in the development and implementation of the healthy towns programme and the capacity for evidence generation to inform future intervention design, policy and practice. Findings Stakeholders relied on local anecdotal and observational evidence to guide programme development. While the programme was considered an opportunity to trial new and innovative approaches, the requirement to predict likely health impacts and adopt evidence-based practice was viewed contradictory to this aim. Stakeholders believed there were missed opportunities to add to the existing empirical evidence base due to a lack of clarity and planning, particularly around timing, in local and national evaluations. Conclusions A strong emphasis on relying on existing evidence-based practice and producing positive impacts and outcomes may have impeded the opportunity to implement truly innovative programmes because of fear of failure. Building more time for development, implementation and evaluation into future initiatives would maximise the use and generation of robust and relevant evidence for public health policy and practice. [ABSTRACT FROM AUTHOR]

Background Although long-term trends in local labour market conditions are likely to influence health, few studies have assessed whether this is so. This paper examines whether (1) trends in local employment rates have relevance for mortality and morbidity outcomes in England and (2) trends are stronger predictors of these outcomes than employment rates measured at one point in time. Methods Using latent class growth models, local areas were classified into eight groups following distinct trends in employment rates between 1981 and 2008. Areas were also categorised in 'octile' groups by rank of employment rates in 2001. These area groupings were linked to a sample of 207 959 individuals from the Office of National Statistics Longitudinal Study. Associations between area groupings and risk of all-cause mortality and of reporting a limiting long-term illness at the end of the period were measured using logistic regression. Models were adjusted for individuals' socio-demographic characteristics measured in 1981 and for their residential mobility between 1981 and 2001. Results Compared to areas with continuously high employment rates over the period, risk of mortality and morbidity was higher in areas with persistently low or declining employment rates. Findings suggest that longterm trends in local employment rates are useful as predictors of mortality and morbidity differences. These are not so clearly distinguished by only considering employment rates at one point in time. Conclusion Poor health outcomes are associated with long-term economic disadvantage in some areas of England, reflected in employment rates, underlining the importance of efforts to improve health in areas with especially 'deep-seated' deprivation. [ABSTRACT FROM AUTHOR]

Background The WHO International Classification of Functioning, Disability and Health (ICF) is now the dominant model for exploring the social consequences of a health condition. This paper investigates the association of the different ICF disability domains with mortality. Methods Data are from the British Women Heart and Health Study, a large (n=4157) prospectively studied cohort of women randomly selected from 23 towns aged 64-83 years in 2003. Scores were calculated to describe the cumulative load of impairments, limitations and restrictions within each ICF domain. Cox proportional hazards regression was used to calculate mortality HRs per unit score increase within each ICF domain. Adjustments were made for age, town, living status, socioeconomic status, lifestyle behaviours and health conditions. Results Each ICF domain was associated with mortality after controlling for lifestyle factors and health conditions. However, only complex activities (HR=1.09, 95% CI 1.01 to 1.18) and participation (HR=1.10, 95% CI 1.04 to 1.16) were independent predictors of mortality following adjustment for all other disability domains and potential confounders. Conclusions Results suggest that difficulties with complex activities or social participation could be used to identify and target women at high risk of dying. Interventions to facilitate complex activities or improve social participation may help to delay mortality in elderly women. [ABSTRACT FROM AUTHOR]

Background In recent decades, labour market participation has fallen in men, with large amounts of this decline accounted for by increases in permanent sickness. There is speculation that the rising numbers of permanently sick incorporate more people with less severe conditions than was previously the case. This paper examines the relationship between labour market position and subsequent mortality around State Pension Age. Methods Using linked census and death records in the ONS Longitudinal Study, samples of men aged 55-69 and women aged 50-64 were selected from each decennial census, 1971-2001 and their health followed up. Differences between the employed, unemployed and economically inactive in age-specific death rates, Standardised Mortality Ratios and odds of reporting limiting long-term illness were examined. Results Labour market activity in late middle age has changed since 1971. For example, the proportion of men employed at ages 60-64 years has fallen by 39%, and the proportion permanently sick has more than doubled. Despite this change, there has been stability in the RR of mortality between labour market positions. Working people have the lowest risk of premature death, while, relative to working people, the permanently sick continue to have mortalities around three times higher among men and four to five times higher among women. Conclusion The evidence does not support the notion that the permanently sick are becoming less seriously ill. The persistence of the group's raised mortality suggests that measures aimed at encouraging later life employment should ensure provision of work environments suitable for people with chronic illnesses. [ABSTRACT FROM AUTHOR]

England was the first European country to pursue a systematic policy to reduce socio-economic inequalities in health. This paper assesses whether this strategy has worked, and what lessons can be learnt. A review of documents was conducted, as well as an analysis of entry-points chosen, specific policies chosen, implementation of these policies, changes in intermediate outcomes, and changes in final health outcomes. Despite some partial successes, the strategy failed to reach its own targets, that is, a 10% reduction in inequalities in life expectancy and infant mortality. This is due to the fact that it did not address the most relevant entry-points, did not use effective policies and was not delivered at a large enough scale for achieving population-wide impacts. Health inequalities can only be reduced substantially if governments have a democratic mandate to make the necessary policy changes, if demonstrably effective policies can be developed, and if these policies are implemented on the scale needed to reach the overall targets. [ABSTRACT FROM AUTHOR]

Objectives To explore similarities and differences in policy content and the political context of the three main English government reports on health inequalities: the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010). Methods Thematic policy and context analysis of the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010) in terms of: (i) underpinningtheoretical principles; (ii) policy recommendations; (iii) the political contexts in which each was released; and (iv) their actual or potential influence on research and policy. Results There were great similarities and very few differences in terms of both the theoretical principles guiding the recommendations of these reports and the focus of the recommendations themselves. However, there were clear differences in terms of the political contexts of each report, as well as their subsequent impacts on research and policy. Conclusion The paper calls into question the progress of health inequalities research, the use of evidence and of the links between research, politics and policy. [ABSTRACT FROM AUTHOR]

Objective: NHS stop smoking services are expected to play a key part in achieving the infant mortality and life expectancy health inequality targets in England by reducing smoking prevalence in deprived areas. This paper assesses the extent to which services have made a contribution to reducing inequalities in smoking between 2003-4 and 2005-6. Methods: Synthetic estimates of baseline smoking prevalence data were compared with national monitoring data about the numbers of smokers in receipt of services and the proportion who self report quilting at four weeks. The social distribution of service recipients and quitters was compared with estimates of smoking prevalence to assess impact on inequalities. Comparisons were made between officially designated disadvantaged areas (the Spearhead Group) and others. Results: Short-term cessation rates were lower in disadvantaged areas (52.6%) than elsewhere (57.9%) (p<0.001), but the proportion of smokers being treated was higher (16.7% compared with 13.4%) (p<0.001). The net effect was that a higher proportion of smokers in the most disadvantaged areas reported success (8.8%) than in more advantaged areas (7.8%) (p<0.001). Using the evidence-based assumption that three-quarters of short-term quitters will relapse within one year, the absolute and relative rate gaps in smoking prevalence between Spearhead areas and others are estimated to fall by small but for Health, University significant amounts from 5.2 and 1.215 (CIs: 1.216 to 1.213) to 5.0 and 1.212 (CIs: 1.213 to 1.210) between 2003-4 and 2005-6. Conclusion: NHS stop smoking services have probably made a modest contribution to reducing inequalities in smoking prevalence. To achieve government targets, however, requires both the development of more innovative cessation interventions for the most addicted smokers and action to ensure that other aspects of tobacco control policy make a larger contribution to inequality goals. [ABSTRACT FROM AUTHOR]

This paper examines the law relating to healthcare resource allocation in England. The National Health Service (NHS) Act 1977 does not impose an absolute duty to provide specified healthcare services. The courts will only interfere with a resource allocation decision made by an NHS body if that decision is frankly irrational (or where the decision infringes the principle of proportionality when a right under the European Convention on Human Rights (ECHR) is engaged). Such irrationality is very difficult to establish. The ECHR has made no significant contribution to domestic English law in the arena of healthcare provision. The decision of the European Court in the Yvonne Watts case establishes that, in relation to the question of entitlement to seek treatment abroad at the expense of the NHS, a clinical judgment about the urgency of treatment trumps an administrative decision about waiting list targets. That decision goes against the grain of domestic law about healthcare allocation, but is not likely to have wide ramifications in domestic law. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the determinants of self rated health (SRH) in men and women in the British Whitehall II study and the French Gazel cohort study. Methods: The cross sectional analyses reported in this paper use data from wave 1 of the Whitehall II study (1985-88) and wave 2 of the Gazel study (1990). Determinants were either self reported or obtained through medical screening and employer's records. The Whitehall II study is based on 20 civil service departments located in London. The Gazel study is based on employees of France's national gas and electricity company (EDF-GDF). SRH data were available on 6889 men and 3403 women in Whitehall II and 13 008 men and 4688 women in Gazel. Results: Correlation analysis was used to identify determinants of SRH from 35 measures in Whitehall II and 33 in Gazel. Stepwise multiple regressions identified five determinants (symptom score, sickness absence, longstanding illness, minor psychiatric morbidity, number of recurring health problems) in Whitehall II, explaining 34.7% of the variance in SRH. In Gazel, four measures (physical tiredness, number of health problems in the past year, physical mobility, number of prescription drugs used) explained 41.4% of the variance in SRH. Conclusion: Measures of mental and physical health status contribute most to the SRH construct. The part played by age, early life factors, family history, sociodemographic variables, psychosocial factors, and health behaviours in these two occupational cohorts is modest. [ABSTRACT FROM AUTHOR]

It is impossible to be certain, but it is estimated that each year in England and Wales there may be about 30-40 infant deaths from covert homicide, which represents about 10% of the current annual total of sudden unexpected deaths in infancy. This paper reviews the features that have been suggested as possible indicators of covert homicide, describes the difficulties in its identification and the need for better evidence, and emphasizes the importance of thorough medical investigation of all sudden infant deaths. [ABSTRACT FROM AUTHOR]

Objective: To discover the importance of social sources of tobacco to young people as opposed to commercial sources; to describe the peer market for cigarettes in schools and the consequences for young people of their involvement in it. Study design: Cross sectional questionnaire survey, one-to-one interviews, and focus groups. Setting: Seven schools in Birmingham, UK. Subjects: All students in two randomly selected classes from each school completed the questionnaire, and never smokers, occasional smokers, and regular smokers were interviewed. Results: Two thirds of occasional smokers and one quarter of regular smokers obtained cigarettes socially, mostly for free. A few smokers regularly bought their cigarettes from others. Among friendship groups, both smokers and non-smokers were involved in the exchange of cigarettes, often for money, which is a common activity. A few young people use the selling of cigarettes to fund their own smoking. Some young people, smokers and non-smokers, are involved in semi-commercial selling of cigarettes. All school students ore aware of where to purchase cigarettes from non-friends, which is only used "in emergency" because of the high price. One school had a strong punishment policy for students caught with cigarettes. In this school, more people bought singles from the peer market and the price was higher. Conclusions: The passing and selling of cigarettes in school is a common activity, which from the young persons perspective, ensures that all share cross counter purchases. A few people are prepared to use the peer market for monetary gain and it appears to be responsive to external conditions. The peer market might mean that efforts to control illegal sales of cigarettes are not as effective as hoped. INSET: What this paper adds.. [ABSTRACT FROM AUTHOR]

Each of the following papers gives an account of a different UK clinical ethics committee. The committees vary in the length of time they have been established, and also in the main focus of their work. The accounts discuss the development of the committees and some of the ethical problems that have been brought to them. The issues raised will be relevant for other National Health Service (NHS) trusts in the UK that wish to set up such a committee. (Journal of Medical Ethics 2001 ;27 suppl I:i9-i17) [ABSTRACT FROM AUTHOR]

Equipoise is widely regarded to be an essential prerequisite for the ethical conduct of a randomised controlled trial There are some circumstances however, under which it is acceptable to conduct a randomised controlled trial (RCT) in the absence of equipoise. Limited access to the preferred intervention is one such circumstance. In this paper we present an example of a randomised trial in which access to the preferred intervention, preschool education, was severely limited by resource constraints. The ethical issues that arise when conducting randomised trials in health care are considered in the context of trials of social interventions. In health, education and social welfare, effective interventions are frequently limited due to budgetary constraints. Explicit acknowledgement of the need to ration interventions, and the use of random allocation to do this even in the absence of equipoise, would facilitate learning more about the effects of these interventions. [ABSTRACT FROM AUTHOR]

A negative image of community care prevails. This method of care is perceived to be a relatively novel phenomenon and has received mixed media coverage. The negative image of community care has led to the growing belief that this care method has failed. This failure has largely been ascribed to the lack of powers available to control patients in the community and to the method's relative novelty. However, this paper contends that there are two flaws to the above assertion: first, community care is far from new, and second, the inherent problem is not the lack of powers available to control patients in the community, but, essentially, the absence of a secure and stable environment within the community. [ABSTRACT FROM AUTHOR]

This paper addresses ethical concerns emanating from the practice of using patients for health care education. It shows how some of the ways that patients are used in educational strategies to bridge theory-practice gaps can cause harm to patients and patient-practitioner relationships, thus failing to meet acceptable standards of professional practice. This will continue unless there is increased awareness of the need for protection of human rights in teaching situations. Unnecessary exposure of patients, failing to obtain explicit consent, causing harm to vulnerable or disadvantaged groups and inappropriate use of information, though normally regarded as unacceptable professional practices, may go unrecognised in meeting educational needs, widening rather than narrowing theory-practice gaps. [ABSTRACT FROM AUTHOR]

During a two-year study of a developmental surveillance programme covering all children under 5 in a Large general practice in the south of England, 2157 children were examined, including 382 newborn babies seen at home. Suspected disorders--excluding those found during non-routine consultations--were discovered in 232 children (15% of boys and 11% of girls), of whom 171 (104 boys and 67 girls) were referred to specialist agencies.
The number and nature of the disorders show that routine surveillance on the lines proposed by the Court Committee is worth while. Nevertheless, such programmes could not be started on a national scale without increased resources for the specialist services to which more children would need to be referred.
In this paper we indicate the rate of suspected (not necessarily confirmed) abnormalities detected by our examinations, and discuss the implications for the work load of the specialist services. Such estimates are an essential preliminary to setting up any nationwide surveillance programme on the lines of the Court Report's recommendations. [ABSTRACT FROM AUTHOR]

Much of postmodern philosophy questions the assumptions of Modernity, that period in the history of the Western world since the Enlightment. These assumptions are that truth is discoverable through human reason; that certain knowledge is possible; and furthermore, that such knowledge will provide a basis for the ineluctable progress of Mankind. The Enlightenment project is underwritten by the conviction that knowledge gained through the scientific method is secure. In so far as biomedicine inherits these assumptions it becomes fair game for postmodern deconstruction. Today, perhaps more than ever, plural values compete, and contradictory approaches to health, for instance, garner support and acquire supremacy through consumer choice and media manipulation rather than evidence-based science. Many doctors feel a tension between meeting the needs of the patient face to face, and working towards the broader health needs of the public at large. But if the very foundations of medical science are questioned, by patients, or by doctors themselves, wherein lies the value of their work? This paper examines the issues that the anti-foundationalist thrust of postmodernism raises, in the light of a case of mild hypertension. The strict application of medical protocol, derived from a nomothetic, statistical perspective, seems unlikely to furnish value in the treatment of an individual. The anything goes, consumerist approach, however, fares no better. The author argues that whilst value cannot depend on any rationally predetermined parameters, it can be rescued, and emerges from the process of the meeting with the patient. [ABSTRACT FROM AUTHOR]

Background: The Home Office has recently published estimates which, for the first time, provide a "robust national estimate" of the number of problematic drug users in England. The 2004/05 and 2005/06 estimates are the highest estimates ever produced for England and coincide with the highest ever government annual expenditure on combating illicit drug use. Methods and Results: Review of a range of data sources that indicate a downward trend in problematic drug use in recent years. Conclusions: The validity of the estimates is important for drug policy, and the paper considers the implications of both increasing and decreasing levels of problematic drug use. [ABSTRACT FROM AUTHOR]

The article presents comments on a paper by researcher N. Khairulddin and colleagues titled "Emergence of Methicillin Resistant Staphylococcus Aureus," published in the April 2004 issue of the journal "Archives of Disease in Childhood." Khairulddiri and colleagues reported the proportion of bacteraemias with Staphylococcus aureus in children in England and Wales that were due to Methicillin Resistant Staphylococcus Aureus (MRSA.), which increased from 0.9% to 13.1% between 1990 and 2000. The author and researchers point out that there is an urgent need for a national review of MRSA in children, both to establish the extent of the current problem and to implement infection control measures.

At the beginning of 2000 several clinics in Cambridgeshire and Suffolk, both in England, saw an increase in new cases of infectious syphilis. This cluster of cases was unusual in that unlike other clusters reported in Great Britain it involved transmission of syphilis locally by heterosexual sex among predominantly white middle aged individuals, some of whom had met their sexual contacts through Internet chat rooms. This cluster of cases was reported initially in the journal "Communicable Diseases Review." At least two other papers have been submitted for publication on this cluster. There are a number of lessons that can be learnt from the experience in Cambridgeshire.

Highlights the international congress on transcultural psychiatry held in Great Britain. Sponsorship of World Federation for Mental Health and the University of Bradford; Details of the papers presented in the conference; Training of psychiatrists relative to survey instrument management.

The article summarizes a study evaluating the relation between high ambient temperatures with the changes in the risk of myocardial infarction on an hourly timescale. Paper-adds including data at an hourly temporal resolution from 11 conurbations in England and Wales showed that higher temperatures were associated with increased risk of myocardial infarction, with reductions in risk at longer lags being consistent with heat, in the six hours after exposure, above a threshold of 20°C.

Objective Reducing geographic inequalities in survival from cancer in England was a key aim of the Calman-Hine Report (1995) and the NHS Cancer Plan (2000). In this paper we assess whether regional differences have diminished following these policy developments by analysing the trend in one-year relative survival from six cancers in the 28 Cancer Networks of England. Methods We estimated population-based relative survival at one year for 1.4 million patients who were diagnosed with cancer of the breast (women), cervix, stomach, oesophagus, lung or colon in England during 1991-2006 and followed up to 31 December 2007. Relative survival is the ratio of the observed survival of cancer patients relative to the expected mortality in the general population (background mortality) and it can be interpreted as the survival of cancer patients after other causes of death have been taken into account. Background mortality was estimated by age, sex, calendar year, deprivation category and Government Office Region. Age-standardised relative survival was estimated by Cancer Network in three calendar periods: 1991–1995, 1996–2000 and 2001–2006. Funnel plots were used to display spatial and temporal variation in survival. The number of Cancer Network, sex and age combinations that were outside of the 99.8% control limits of the England-wide estimate of relative survival was charted over time. Results One-year relative survival improved over time for all patients except those diagnosed with cervical cancer. There were large regional differences in relative survival for each of the six cancers. Cancer Networks that were low-survival outliers across several cancers were clustered across Northern England and the Midlands. The north-south divide became less marked over time although the overall number of lower outliers compared to the national value remained stable. Conclusion Policy changes over the past two decades coincided with improved relative survival, without seeing an increase in regional disparity. The north-south divide in the distribution of low-survival Cancer Networks became less pronounced over time but regional disparities persist. Further methodological development is needed to obtain more robust estimates of age-standardised relative survival for small populations, in order to monitor these regional trends. [ABSTRACT FROM PUBLISHER]

Background There are few data sets that provide detailed population health data at a geographic scale below Government Office Region, and few estimates at a finer scale are validated against real-world data. The focus of the paper is on testing the validity of a methodological approach to create small area population health profiles that may be used in academic and policy research to explore the spatial patterning of health, and repeated as new data become available. The objectives of the study are to 1) simulate estimates of common mental disorders (CMD) in adults at a small area-level and 2) to validate estimates against small area health and socio-economic measures. Methods A deterministic reweighting methodology assigns probabilities of respondents from the 2004–6 annual Health Survey for England (HSE) to live in small areas (Lower Super Output Areas, or LSOAs) based on matching sociodemographic attributes available in both the HSE and the 2001 Population Census. These attributes are chosen because they are strong predictors of CMD (measured by GHQ-12). Gender, social class, economic activity and marital status were used to create estimates of people reporting CMD for each LSOA. These estimates were correlated to LSOA indicators composing the “health domain” of the Index of Multiple Deprivation 2007 (IMD2007) and to other socio-economic information. LSOA estimates were then aggregated at the Local Authority (LA) level and proportions of people reporting CMD were computed; these were then compared to observed prevalence of CMD at the LA level (based on 30 304 HSE respondents nested in 352 LA). Results LSOA CMD estimates were correlated at 0.68 (p<0.001) with adults suffering from mood or anxiety disorders and at 0.83 (p<0.001) with comparative illness and disability ratio. Significant positive correlations between CMD estimates and overall, and domain specific, scores of the IMD2007 were observed. In 90.6% of LA, discrepancies between microsimulated and observed prevalence of CMD were less than 10%. LA where discrepancies were greater than 10% were mostly characterised by small HSE sample size, which may explain why estimates were more inaccurate in these localities. Conclusion The findings indicate that spatial microsimulation might be an appropriate methodological approach for replicating social and demographic patterns of mental health in order to create a small-scale spatial data set. The validation of simulated area-based estimates of mental health presents a viable and cost-effective alternative to local level surveys. [ABSTRACT FROM PUBLISHER]

Objectives Emergency Department (ED) use is known to be related to both socio-economic deprivation and distance to hospital. However, hospitals are often located in urban areas close to deprived populations. The objective of this study is to investigate the relationship between distance and attendance at EDs, net of deprivation. Method Multiple linear regression models were used to explore the relationship between deprivation and distance to hospital with age-sex standardised ED attendance rates at neighbourhood level. Distance to a Minor Injury Unit (MIU) was also included. Interaction between distance and deprivation was investigated. Separate models for children and adults were used because some populations had access to a dedicated children's ED. Setting The Government Office Region of the West Midlands, in central England (population 5.4 million). Population Attendances of West Midlands residents to EDs in acute hospitals in financial year 2007/08 (n=1 465 355) within 3482 Lower Level Super Output Areas (LSOA), each containing approximately 1600 residents. Outcome Measures The response variable was the directly age-sex standardised ED attendance rate for each LSOA (square-root transformed). Predictor variables were distance from LSOA centroid to nearest ED and nearest MIU in kilometres and income deprivation score (high score=high deprivation). Results There was a significant positive relationship between attendance and deprivation, β coefficient=0.96 (p<0.001) in adults and 0.68 (p<0.001) in children. There was a significant negative relationship between attendance and distance, the β coefficient=−0.24 (p<0.001) in adults and −0.37 (p<0.001) in children. Child attendance appeared more sensitive to distance than adult attendance but less sensitive to deprivation. Attendance in deprived neighbourhoods was more sensitive to distance than in less deprived ones. For adults, at the third quartile of deprivation, √ attendance rate=−0.32 per km +19.50 compared to −0.18 per km +15.86 at the fist quartile. For children, at the third quartile of deprivation, √ attendance rate=−0.49 per km +21.30 compared to −0.30 per km +17.95 at the first quartile. The paper goes on to describe the models in greater detail, (including the effect of MIUs). Conclusion Attendance at EDs is sensitive to income deprivation at neighbourhood level but distance from hospital appears to modify this relationship differently in deprived areas than in affluent ones. Also, children's attendance appears to be more sensitive to distance than that of adults. This is useful to understand when comparing ED attendance between and within populations. [ABSTRACT FROM PUBLISHER]

Background Reducing childhood obesity is a key UK government target. Obesogenic environments are one of the major explanations for the rising prevalence and thus a constructive focus for preventive strategies. Spatial analysis techniques are used to provide more information about obesity at the neighbourhood level in order to help to shape local obesity-prevention policies. Methods Childhood obesity was defined by body mass index, using cross-sectional height and weight data for children aged 3-13…years (obesity>98th centile; British reference dataset). Relationships between childhood obesity and 12 simulated obesogenic variables were assessed using geographically weighted regression. These results were applied to three wards with different socio-economic backgrounds, tailoring local obesity-prevention policy. Results The spatial distribution of childhood obesity varied, with high prevalence in deprived and affluent areas. Key local covariates strongly associated with childhood obesity differed: in the affluent ward, they were perceived neighbourhood safety and fruit and vegetable consumption; in the deprived ward, expenditure on food, purchasing school meals, multiple television ownership and internet access; in all wards, perceived access to supermarkets and leisure facilities. Accordingly, different interventions/strategies may be more appropriate/effective in different areas. Conclusions These analyses identify the covariates with the strongest local relationships with obesity and suggest how policy can be tailored to the specific needs of each micro-area: solutions need to be tailored to the locality to be most effective. This paper demonstrates the importance of small-area analysis in order to provide health planners with detailed information that may help them to prioritise interventions for maximum benefit. [ABSTRACT FROM AUTHOR]

The article focuses on whether terminally ill children with chronic conditions are being admitted and die in intensive care units (ICU) during the final acute phase of their illness in London, England. Based on the paper from the Great Ormond Street Hospital for Children, a total of 1127 children died in the hospital during a 7-year period, specifically from 1997-2004. It is stated that the chief diagnostic categories of the children were congenital malformations, perinatal conditions, cardiovascular diseases and neoplasm. In details, 86 percent of the death of the children occurred in the ICU with a significant trend of 80 percent deaths on ICU in 1997-1998 and 91 percent in 2003-2004.