41 results
Search Results
2. Barriers and delays in access to abortion care: a cross-sectional study of people traveling to obtain care in England and the Netherlands from European countries where abortion is legal on broad grounds.
- Author
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Wollum, Alexandra, De Zordo, Silvia, Zanini, Giulia, Mishtal, Joanna, Garnsey, Camille, and Gerdts, Caitlin
- Subjects
ABORTION laws ,HEALTH policy ,HEALTH services accessibility ,CONFIDENCE intervals ,TRAVEL ,CROSS-sectional method ,FIRST trimester of pregnancy ,MEDICAL care costs ,CLINICS ,COMPARATIVE studies ,DESCRIPTIVE statistics ,SOCIAL classes ,RESEARCH funding ,ODDS ratio ,PROPORTIONAL hazards models - Abstract
Introduction: This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. Methodology: We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. Results: Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21–0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. Discussion: These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care. Plain Language Summary: This paper explores delays in accessing abortion care associated with financial and medical system barriers. We focus on residents of countries in Europe where abortion is available on broad grounds in the first trimester seeking abortion care outside of their country of residence. This study demonstrates an association between difficulty covering abortion costs for people facing financial insecurity and in-country care seeking and delays in accessing abortion abroad. Policy barriers, medical system barriers, as well as financial barriers may interact to delay access to care for people in European countries with broad grounds for abortion access in the first trimester but restrictions thereafter, especially for people later in pregnancy. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
3. Cross-country abortion travel to England and Wales: results from a cross-sectional survey exploring people's experiences crossing borders to obtain care.
- Author
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Garnsey, Camille, Zanini, Giulia, De Zordo, Silvia, Mishtal, Joanna, Wollum, Alexandra, and Gerdts, Caitlin
- Subjects
PREGNANCY & psychology ,HEALTH services accessibility ,RESEARCH methodology ,CROSS-sectional method ,TRAVEL ,ABORTION ,MEDICAL care costs ,SOCIOECONOMIC factors ,MEDICAL tourism - Abstract
Background: The laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019. Methods: We recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts. Results: Over a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult. Conclusions: This analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities. Plain language summary: In Europe, people who live in countries where abortion is severely restricted or illegal altogether lack access to abortion care entirely, but even people who live in countries with more liberal laws face barriers due to gestational age limits, waiting periods, and a lack of trained and willing providers. Existing evidence suggests that restrictions and barriers compel people from both countries with restrictive laws as well as those from countries with more liberal laws to travel outside of their home country for abortion services. England and Wales are common destinations for people traveling within Europe to obtain abortion services, but little is known about the experiences of these travelers. We surveyed individuals who had traveled from another country to seek abortion services in England or Wales. Our analysis documents that many participants contemplated getting an abortion and sought care in their home countries before traveling. Likewise, many participants indicated that they would have preferred to have obtained an abortion earlier in their pregnancy, and referenced scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. A majority of participants indicated that covering the costs of their abortion, and the costs of travel was difficult, and that the travel experience in its entirety was difficult. Our findings document the reasons for, and burdens associated with abortion travel and highlight the need to expand access to abortion across Europe via the elimination of all legal restrictions and impediments. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
4. Cluster Sampling Bias in Government-Sponsored Evaluations: A Correlational Study of Employment and Welfare Pilots in England.
- Author
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Vaganay, Arnaud
- Subjects
EMPLOYMENT ,LABOR market ,CLUSTER sampling ,EMPIRICAL research - Abstract
For pilot or experimental employment programme results to apply beyond their test bed, researchers must select ‘clusters’ (i.e. the job centres delivering the new intervention) that are reasonably representative of the whole territory. More specifically, this requirement must account for conditions that could artificially inflate the effect of a programme, such as the fluidity of the local labour market or the performance of the local job centre. Failure to achieve representativeness results in Cluster Sampling Bias (CSB). This paper makes three contributions to the literature. Theoretically, it approaches the notion of CSB as a human behaviour. It offers a comprehensive theory, whereby researchers with limited resources and conflicting priorities tend to oversample ‘effect-enhancing’ clusters when piloting a new intervention. Methodologically, it advocates for a ‘narrow and deep’ scope, as opposed to the ‘wide and shallow’ scope, which has prevailed so far. The PILOT-2 dataset was developed to test this idea. Empirically, it provides evidence on the prevalence of CSB. In conditions similar to the PILOT-2 case study, investigators (1) do not sample clusters with a view to maximise generalisability; (2) do not oversample ‘effect-enhancing’ clusters; (3) consistently oversample some clusters, including those with higher-than-average client caseloads; and (4) report their sampling decisions in an inconsistent and generally poor manner. In conclusion, although CSB is prevalent, it is still unclear whether it is intentional and meant to mislead stakeholders about the expected effect of the intervention or due to higher-level constraints or other considerations. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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5. Vivendo à margem da lei: histórias de brasileiros em situação irregular no contexto europeu.
- Author
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Proença Lara, Glaucia Muniz
- Subjects
- *
DISCOURSE analysis , *ENUNCIATION , *WORK environment , *SEMANTICS , *VOCABULARY , *SIMILARITY (Psychology) , *MENTAL representation - Abstract
This paper examines and compares, in the light of French Discourse Analysis, four life stories - collected through interviews - that were produced by Brazilian migrants that live illegally in France or in England. The main objective is to find out the discursive representations (of themselves, of the others, of the world) constructed by such individuals in their narratives and, at the same time, verify if and how their irregular situation interferes with their routine in the new country. In order to analyze and compare the four stories, some categories that integrate Maingueneau's Global Semantics (2005) were used: themes, vocabulary, enunciative deixis and enunciation mode. If the results reveal differences in the way of telling and evaluating the migratory experience, they also allow us to apprehend similarities, such as the primarily economic motivation to migrate, the difficulties (cultural, linguistic etc.) faced especially when arriving in the destination country and the precarious working conditions to which Brazilian migrants are submitted due to being in an irregular situation. Even though two of the interviewed subjetcts have preferred to be silent on this issue, their opinions can be implicitly identified. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
6. ‘We’re passengers sailing in the same ship, but we have our own berths to sleep in’: Evaluating patient and public involvement within a regional research programme: An action research project informed by Normalisation Process Theory.
- Author
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Keenan, Julia, Poland, Fiona, Boote, Jonathan, Howe, Amanda, Wythe, Helena, Varley, Anna, Vicary, Penny, Irvine, Lisa, and Wellings, Amander
- Subjects
ACTION research ,SOCIAL science research ,SAILING ships ,THEORY ,PUBLIC health research ,MARINE terminals - Abstract
Background: Patient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI. Methods: We purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation. Results: We interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI. Conclusion: Combining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
7. The human geography of Twitter: Quantifying regional identity and inter-region communication in England and Wales.
- Author
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Arthur, Rudy and Williams, Hywel T. P.
- Subjects
SOCIAL sciences education ,SOCIAL movements ,INTERNET friendship ,SOCIAL interaction ,SOCIAL networks ,FRIENDSHIP ,HUMAN geography - Abstract
Given the centrality of regions in social movements, politics and public administration, here we aim to quantitatively study regional identity, cross-region communication and sentiment. This paper presents a new methodology to study social interaction within and between social-geographic regions, and then applies the methodology to a case study of England and Wales. We use a social network, built from geo-located Twitter data, to identify contiguous geographical regions with a shared social identity and then investigate patterns of communication within and between them. In contrast to other approaches (e.g. using phone call data records or online friendship networks), use of Twitter data provides message contents as well as social connections. This allows us to investigate not only the volume of communication between locations, but also the sentiment and vocabulary used in the messages. For example, our case study shows: a significant dialect difference between England and Wales; that regions tend to be more positive about themselves than about others, with the South being more ‘self-regarding’ than the North; and that people talk politics much more between regions than within. This study demonstrates how social media can be used to quantify regional identity and inter-region communications and sentiment, exposing these previously hard-to-observe geographic concepts to analysis. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
8. Soil health pilot study in England: Outcomes from an on-farm earthworm survey.
- Author
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Stroud, Jacqueline L.
- Subjects
EARTHWORMS ,SOIL management ,FOOD production - Abstract
Earthworms are primary candidates for national soil health monitoring as they are ecosystem engineers that benefit both food production and ecosystem services associated with soil security. Supporting farmers to monitor soil health could help to achieve the policy aspiration of sustainable soils by 2030 in England; however, little is known about how to overcome participation barriers, appropriate methodologies (practical, cost-effective, usefulness) or training needs. This paper presents the results from a pilot #60minworms study which mobilised farmers to assess over >1300 ha farmland soils in spring 2018. The results interpretation framework is based on the presence of earthworms from each of the three ecological groups at each observation (20 x 20 cm x 20 cm pit) and spatially across a field (10 soil pits). Results showed that most fields have basic earthworm presence and abundance, but 42% fields may be over-worked as indicated by absence/rarity of epigeic and/or anecic earthworms. Tillage had a negative impact (p < 0.05) on earthworm populations and organic matter management did not mitigate tillage impacts. In terms of farmer participation, Twitter and Farmers Weekly magazine were highly effective channels for recruitment. Direct feedback from participants included excellent scores in trust, value and satisfaction of the protocol (e.g. 100% would do the test again) and 57% would use their worm survey results to change their soil management practices. A key training need in terms of earthworm identification skills was reported. The trade-off between data quality, participation rates and fieldwork costs suggests there is potential to streamline the protocol further to #30minworms (5 pits), incurring farmer fieldwork costs of approximately £1.48 ha
-1 . At national scales, £14 million pounds across 4.7 M ha-1 in fieldwork costs per survey could be saved by farmer participation. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
9. Vivendo à margem da lei: histórias de brasileiros em situação irregular no contexto europeu.
- Author
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Muniz Proença Lara, Glaucia
- Subjects
- *
DISCOURSE analysis , *ENUNCIATION , *SEMANTICS , *VOCABULARY - Abstract
This paper examines and compares, in the light of French Discourse Analysis, four life stories -- collected through interviews -- that were produced by Brazilian migrants that live illegally in France or in England. The main objective is to find out the discursive representations (of themselves, of the others, of the world) constructed by such individuals in their narratives and, at the same time, verify if and how their irregular situation interferes with their routine in the new country. In order to analyze and compare the four stories, some categories that integrate Maingueneau's Global Semantics (2005) were used: themes, vocabulary, enunciative deixis and enunciation mode. If the results reveal differences in the way of telling and evaluating the migratory experience, they also allow us to apprehend similarities, such as the primarily economic motivation to migrate, the difficulties (cultural, linguistic etc.) faced especially when arriving in the destination country and the precarious working conditions to which Brazilian migrants are submitted due to being in an irregular situation. Even though two of the interviewed subjetcts have preferred to be silent on this issue, their opinions can be implicitly identified. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
10. Comparison of Statistical Algorithms for the Detection of Infectious Disease Outbreaks in Large Multiple Surveillance Systems.
- Author
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Enki, Doyo G., Garthwaite, Paul H., Farrington, C. Paddy, Noufaily, Angela, Andrews, Nick J., and Charlett, Andre
- Subjects
COMMUNICABLE disease diagnosis ,COMMUNICABLE diseases ,MATHEMATICAL models ,ALGORITHMS ,APPLIED mathematics ,EPIDEMICS - Abstract
A large-scale multiple surveillance system for infectious disease outbreaks has been in operation in England and Wales since the early 1990s. Changes to the statistical algorithm at the heart of the system were proposed and the purpose of this paper is to compare two new algorithms with the original algorithm. Test data to evaluate performance are created from weekly counts of the number of cases of each of more than 2000 diseases over a twenty-year period. The time series of each disease is separated into one series giving the baseline (background) disease incidence and a second series giving disease outbreaks. One series is shifted forward by twelve months and the two are then recombined, giving a realistic series in which it is known where outbreaks have been added. The metrics used to evaluate performance include a scoring rule that appropriately balances sensitivity against specificity and is sensitive to variation in probabilities near 1. In the context of disease surveillance, a scoring rule can be adapted to reflect the size of outbreaks and this was done. Results indicate that the two new algorithms are comparable to each other and better than the algorithm they were designed to replace. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
11. The Self-Reported Oral Health Status and Dental Attendance of Smokers and Non-Smokers in England.
- Author
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Csikar, Julia, Kang, Jing, Wyborn, Ceri, Dyer, Tom A., Marshman, Zoe, and Godson, Jenny
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DENTAL care ,HEALTH of cigarette smokers ,SELF-evaluation ,HEALTH status indicators ,ORAL cancer risk factors - Abstract
Smoking has been identified as the second greatest risk factor for global death and disability and has impacts on the oral cavity from aesthetic changes to fatal diseases such as oral cancer. The paper presents a secondary analysis of the National Adult Dental Health Survey (2009). The analysis used descriptive statistics, bivariate analyses and logistic regression models to report the self-reported oral health status and dental attendance of smokers and non-smokers in England. Of the 9,657 participants, 21% reported they were currently smoking. When compared with smokers; non-smokers were more likely to report ‘good oral health’ (75% versus 57% respectively, p<0.05). Smokers were twice as likely to attend the dentist symptomatically (OR = 2.27, CI = 2.02–2.55) compared with non-smoker regardless the deprivation status. Smokers were more likely to attend symptomatically in the most deprived quintiles (OR = 1.99, CI = 1.57–2.52) and perceive they had poorer oral health (OR = 1.77, CI = 1.42–2.20). The present research is consistent with earlier sub-national research and should be considered when planning early diagnosis and management strategies for smoking-related conditions, considering the potential impact dental teams might have on smoking rates. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
12. Consumer privacy issues in mobile commerce: a comparative study of British, French and Romanian consumers.
- Author
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Gurău, Călin and Ranchhod, Ashok
- Subjects
CONSUMERS ,SENSORY perception ,PRIVACY ,RIGHT of privacy - Abstract
Purpose - This paper aims on one hand to provide a comparison of mobile consumers' perceptions regarding privacy issues in three different national and cultural contexts (England, France and Romania), and on the other hand, to investigate the strategic approach taken by respondents for protecting their privacy. Design/methodology/approach - Both secondary and primary data are collected and analysed. Secondary data collection focuses on the topic of consumer privacy issues in mobile commerce. Primary data collection was realised between March-June 2008, when 300 mobile device users answered to a face-to-face questionnaire, in each of the three investigated countries. Findings - Both the country of origin and the personal profile of users, are influencing their perception regarding privacy threats in the mobile commerce environment, as well as the privacy protection strategy they adopt, Research limitations/implications - This study has an exploratory approach, the results being mostly descriptive. The findings can provide a useful insight for marketers, legislators and consumers regarding the privacy related concerns and behaviours in the mobile commerce environment. Originality/value - This study realises a multi-country comparative analysis regarding the perceptions of mobile device users, and investigates the influence of their profile on the personal privacy protection strategy adopted in the mobile commerce environment. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
13. The Burden of Respiratory Disease from Formaldehyde, Damp and Mould in English Housing.
- Author
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Clark, Sierra N., Lam, Holly C. Y., Goode, Emma-Jane, Marczylo, Emma L., Exley, Karen S., and Dimitroulopoulou, Sani
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INDOOR air pollution ,FORMALDEHYDE ,RESPIRATORY diseases ,INDOOR air quality ,OCCUPATIONAL exposure ,ETHNICITY ,ASTHMA in children - Abstract
Quantifying the burden of disease from exposure to poor indoor air pollution can support policy development. In England, there is current regulatory and public attention on the health implications of residential exposure to formaldehyde, damp and mould. However, there is scarce information on these health impacts at the population scale. As such, we assessed the burden of key respiratory diseases from residential formaldehyde, damp and/or mould for the English population aged 0–14 and 15–49. We obtained data on the percentage of dwellings affected by damp and/or mould from the English Housing Survey and estimated the distribution of residential formaldehyde concentrations (annual average (μg/m
3 )) by pooling data from monitoring studies conducted in England. Exposures were combined with epidemiological relationships and national health data to estimate Population Attributable Fractions (PAFs), disease incidence, and Disability Adjusted Life Years (DALYs) lost associated with residential formaldehyde or damp and/or mould exposure in England. We made estimates for the year 2019 but also looked back several years in time. Exposure to formaldehyde was associated with approximately 4000 new cases of childhood asthma (~800 DALYs lost) in 2019, though the estimates were sensitive to the placement of the lower exposure threshold. Exposure to damp and/or mould was associated with approximately 5000 new cases of asthma (~2200 DALYs) and approximately 8500 lower respiratory infections (~600 DALYs) among children and adults in 2019, though the PAFs were unequally distributed across dwellings based on income and ethnicity. Alternative data sources suggest that the percentage of dwellings affected by damp and/or mould may even be higher, resulting in a possible 3–8-fold greater number of cases and DALYs. Our assessment emphasizes a potential respiratory health burden in England associated with residential formaldehyde as well as damp and/or mould, further highlighting the public health importance of good indoor air quality and good quality housing. [ABSTRACT FROM AUTHOR]- Published
- 2023
- Full Text
- View/download PDF
14. Large differences in the organization of palliative care in nursing homes in six European countries: findings from the PACE cross-sectional study.
- Author
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Honinx, E., Van den Block, L., Piers, R., Onwuteaka-Philipsen, B. D., Payne, S., Szczerbińska, K., Gambassi, G., Kylänen, M., Deliens, L., Smets, T., on behalf of PACE, Gatsolaeva, Yuliana, Miranda, Rose, Pivodic, Lara, Tanghe, Marc, van Hout, Hein, Pasman, Roeline H. R. W., Oosterveld-Vlug, Mariska, Piers, Ruth, and Wichmann, Anne B.
- Subjects
MEDICAL quality control ,MEETINGS ,HEALTH services administration ,HEALTH services accessibility ,MEDICAL care ,NURSING care facilities ,QUALITY assurance ,HEALTH care teams ,DESCRIPTIVE statistics ,CHI-squared test ,QUESTIONNAIRES ,STATISTICAL sampling ,STATISTICAL correlation ,PALLIATIVE treatment ,SECONDARY analysis - Abstract
Background: To be able to provide high-quality palliative care, there need to be a number of organizational structures available in the nursing homes. It is unclear to what extent such structures are actually present in nursing homes in Europe. We aim to examine structural indicators for quality of palliative care in nursing homes in Europe and to evaluate the differences in terms of availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives. Methods: A PACE cross-sectional study (2015) of nursing homes in Belgium, England, Finland, Italy, the Netherlands and Poland. Nursing homes (N = 322) were selected in each country via proportional stratified random sampling. Nursing home administrators (N = 305) filled in structured questionnaires on nursing home characteristics. Organization of palliative care was measured using 13 of the previously defined IMPACT structural indicators for quality of palliative care covering four domains: availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives. We calculated structural indicator scores for each country and computed differences in indicator scores between the six countries. Pearson's Chi-square test was used to compute the p-value of each difference. Results: The availability of specialist palliative care teams in nursing homes was limited (6.1–48.7%). In Finland, Poland and Italy, specialist advice was also less often available (35.6–46.9%). Up to 49% of the nursing homes did not provide a dedicated contact person who maintained regular contact with the resident and relatives. The 24/7 availability of opioids for all nursing home residents was low in Poland (37.5%). Conclusions: This study found a large heterogeneity between countries in the organization of palliative care in nursing homes, although a common challenge is ensuring sufficient structural access to specialist palliative care services. Policymakers and health and palliative care organizations can use these structural indicators to identify areas for improvement in the organization of palliative care. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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15. Estimated impact of revising the 13-valent pneumococcal conjugate vaccine schedule from 2+1 to 1+1 in England and Wales: A modelling study.
- Author
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Choi, Yoon Hong, Andrews, Nick, and Miller, Elizabeth
- Subjects
PNEUMOCOCCAL vaccines ,PNEUMOCOCCAL pneumonia ,PRIME numbers ,COMMUNITY-acquired pneumonia ,HERD immunity - Abstract
Background: In October 2017, the United Kingdom Joint Committee on Vaccination and Immunisation (JCVI) recommended removal of one primary dose of the 13-valent pneumococcal conjugate vaccine (PCV13) from the existing 2+1 schedule (2, 4, 12 months). We conducted a mathematical modelling study to investigate the potential impact of a 1+1 (3, 12 month) schedule on invasive pneumococcal disease (IPD) and pneumococcal community-acquired pneumonia (CAP). Our results and those from a 1+1 immunogenicity study formed the key evidence reviewed by JCVI.Methods and Findings: We developed age-structured, dynamic, deterministic models of pneumococcal transmission in England and Wales to describe the impact on IPD of 7-valent PCV (PCV7; introduced in 2006) and PCV13 (introduced in 2010). Key transmission and vaccine parameters were estimated by fitting to carriage data from 2001/2002 and post-PCV IPD data to 2015, using vaccine coverage, mixing patterns between ages, and population data. We considered various models to investigate potential reasons for the rapid increase in non-PCV13 (non-vaccine serotype [NVT]) IPD cases since 2014. After searching a large parameter space, 500 parameter sets were identified with a likelihood statistically close to the maximum and these used to predict future cases (median, prediction range from 500 parameter sets). Our findings indicated that the emergence of individual NVTs with higher virulence resulting from ongoing replacement was likely responsible; the NVT increase was predicted to plateau from 2020. Long-term simulation results suggest that changing to a 1+1 schedule would have little overall impact, as the small increase in vaccine-type IPD would be offset by a reduction in NVT IPD. Our results were robust to changes in vaccine assumptions in a sensitivity analysis. Under the base case scenario, a change to a 1+1 schedule in 2018 was predicted to produce 31 (6, 76) additional IPD cases over five years and 83 (-10, 242) additional pneumococcal-CAP cases, with together 8 (-2, 24) additional deaths, none in children under 15 years. Long-term continuation with the 2+1 schedule, or changing to a 1+1, was predicted to sustain current reductions in IPD cases in under-64-year-olds, but cases in 65+-year-olds would continue to increase because of the effects of an aging population. Limitations of our model include difficulty in fitting to past trends in NVT IPD in some age groups and inherent uncertainty about future NVT behaviour, sparse data for defining the mixing matrix in 65+-year-olds, and the methodological challenge of defining uncertainty on predictions.Conclusions: Our findings suggest that, with the current mature status of the PCV programme in England and Wales, removing one primary dose in the first year of life would have little impact on IPD or pneumococcal CAP cases or associated deaths at any age. A reduction in the number of priming doses would improve programmatic efficiency and facilitate the introduction of new vaccines by reducing the number of coadministered vaccines given at 2 and 4 months of age in the current UK schedule. Our findings should not be applied to other settings with different pneumococcal epidemiology or with immature programmes and poor herd immunity. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
16. Public responses to volunteer community care: Propositions for old age and end of life.
- Author
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Tapp, Alan, Nancarrow, Clive, Morey, Yvette, Warren, Stella, Bowtell, Nicola, and Verne, Julia
- Subjects
TRAINING of volunteers ,AGE ,OLD age ,DEATH ,MEDICAL personnel ,FRAIL elderly - Abstract
Background: Funding shortages and an ageing population have increased pressures on state or insurance funded end of life care for older people. Across the world, policy debate has arisen about the potential role volunteers can play, working alongside health and social care professionals in the community to support and care for the ageing and dying. Aims: The authors examined self-reported levels of care for the elderly by the public in England, and public opinions of community volunteering concepts to care for the elderly at the end of life. In particular, claimed willingness to help and to be helped by local people was surveyed. Methods: A sample of 3,590 adults in England aged 45 or more from an online access panel responded to a questionnaire in late 2017. The survey data was weighted to be representative of the population within this age band. Key literature and formative qualitative research informed the design of the survey questionnaire, which was further refined after piloting. Results: Preferences for different models of community volunteering were elicited. There was a preference for ‘formal’ models with increased wariness of ‘informal’ features. Whilst 32% of adults said they ‘might join’ depending on whom the group helped, unsurprisingly more personal and demanding types of help significantly reduced the claimed willingness to help. Finally, willingness to help (or be helped) by local community carers or volunteers was regarded as less attractive than care being provided by personal family, close friends or indeed health and care professionals. Conclusion: Findings suggest that if community volunteering to care for elderly people at the end of life in England is to expand it may require considerable attention to the model including training for volunteers and protections for patients and volunteers as well as public education and promotion. Currently, in England, there is a clear preference for non-medical care to be delivered by close family or social care professionals, with volunteer community care regarded only as a back-up option. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
17. Perceived discrimination, health and wellbeing among middle-aged and older lesbian, gay and bisexual people: A prospective study.
- Author
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Jackson, Sarah E., Hackett, Ruth A., Grabovac, Igor, Smith, Lee, and Steptoe, Andrew
- Subjects
RACE discrimination ,PERCEIVED discrimination ,HEALTH of LGBTQ+ people ,HOMOPHOBIA ,GAY people ,MIDDLE-aged persons ,QUALITY of life - Abstract
Objective: To examine cross-sectional and prospective associations between perceived discrimination in daily life (based on a range of attributes), sexual orientation discrimination, and health and wellbeing in middle-aged and older lesbian, gay and bisexual (LGB) people. Methods: Data were from 304 LGB men and women aged 41–85 years participating in the English Longitudinal Study of Ageing. Perceived discrimination in daily life was reported in 2010/11. Participants could attribute their discrimination experience to characteristics including age, sex, race, physical disability, and sexual orientation. Self-rated health, limiting long-standing illness, depressive symptoms, quality of life, life satisfaction and loneliness were assessed in 2010/11 and 2016/17. Analyses adjusted for age, sex, ethnicity, partnership status and socioeconomic position. Results: Perceived discrimination in daily life was reported by 144 (47.4%) participants. Cross-sectionally, perceived discrimination in daily life was associated with increased odds of depressive symptoms (OR = 2.30, 95% CI 1.02 to 5.21), loneliness (OR = 3.37, 95% CI 1.60 to 7.10) and lower quality of life (B = -3.31, 95% CI -5.49 to -1.12). Prospectively, perceived discrimination in daily life was associated with increased odds of loneliness (OR = 3.12, 95% CI 1.08 to 8.99) and lower quality of life (B = -2.08, 95% CI -3.85 to -0.31) and life satisfaction (B = -1.92, 95% CI -3.44 to -0.39) over six-year follow-up. Effect sizes were consistently larger for participants who attributed experiences of discrimination to their sexual orientation compared with those who attributed experiences of discrimination to other reasons (e.g. age, sex, race). Conclusion: These results provide cross-sectional and prospective evidence of associations between perceived discrimination in daily life and health and wellbeing outcomes in middle-aged and older LGB adults in England. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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18. Relationship between living alone and common mental disorders in the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys.
- Author
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Jacob, Louis, Haro, Josep Maria, and Koyanagi, Ai
- Subjects
MULTIVARIABLE testing ,LIVING alone ,MEDIATION (Statistics) ,MENTAL illness ,LOGISTIC regression analysis ,DISEASES ,MEDIATION ,ODDS ratio - Abstract
Given the high prevalence of common mental disorders (CMDs) and individuals living alone in the United Kingdom, the goal of this study using English nationally representative data was to examine the association between living alone and CMDs, and to identify potential mediating factors of this association. The data were drawn from the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. CMDs were assessed using the Clinical Interview Schedule-Revised (CIS-R), a questionnaire focusing on past week neurotic symptoms. The presence of CMDs was defined as a CIS-R total score of 12 and above. Multivariable logistic regression and mediation analyses were conducted to analyze the association between living alone and CMDs, and to identify mediators in this association. The prevalence of CMDs was higher in individuals living alone than in those not living alone in all survey years. Multivariable analysis showed a positive association between living alone and CMDs in all survey years (1993: odds ratio [OR] = 1.69; 2000: OR = 1.63; and 2007: OR = 1.88). Overall, loneliness explained 84% of the living alone-CMD association. Living alone was positively associated with CMDs. Interventions addressing loneliness among individuals living alone may be particularly important for the mental wellbeing of this vulnerable population. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
19. Exploring women’s preferences for birth settings in England: A discrete choice experiment.
- Author
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Fletcher, Benjamin Rupert, Rowe, Rachel, Hollowell, Jennifer, Scanlon, Miranda, Hinton, Lisa, and Rivero-Arias, Oliver
- Subjects
CHILDBIRTH at home ,LABOR (Obstetrics) ,PREGNANT women ,CONSUMER preferences ,CONTINUUM of care - Abstract
Objective: To explore pregnant women’s preferences for birth setting in England. Design: Labelled discrete choice experiment (DCE). Setting: Online survey. Sample: Pregnant women recruited through social media and an online panel. Methods: We developed a DCE to assess women’s preferences for four hypothetical birth settings based on seven attributes: reputation, continuity of care, distance from home, time to see a doctor, partner able to stay overnight, chance of straightforward birth and safety for baby. We used a mixed logit model, with setting modelled as an alternative-specific constant, and conducted a scenario analysis to evaluate the impact of changes in attribute levels on uptake of birth settings. Main outcome measures: Women’s preferences for birth setting. Results: 257 pregnant women completed the DCE. All birth setting attributes, except ‘time to see doctor’, were significant in women’s choice (p<0.05). There was significant heterogeneity in preferences for some attributes. Changes to levels for ‘safety for the baby’ and ‘partner able to stay overnight’ were associated with larger changes from baseline uptake of birth setting. If the preferences identified were translated into the real-world context up to a third of those who reported planning birth in an obstetric unit might choose a midwifery unit assuming universal access to all settings, and knowledge of the differences between settings. Conclusions: We found that ‘safety for the baby’, ‘chance of a straightforward birth’ and ‘can the woman’s partner stay overnight following birth’ were particularly important in women’s preferences for hypothetical birth setting. If all birth settings were available to women and they were aware of the differences between them, it is likely that more low risk women who currently plan birth in OUs might choose a midwifery unit. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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20. A macroeconomic assessment of the impact of medical research expenditure: A case study of NIHR Biomedical Research Centres.
- Author
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Smith, Joel B. E., Channon, Keith, Kiparoglou, Vasiliki, Forbes, John F., and Gray, Alastair M.
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MEDICAL research ,GROWTH industries ,CASE studies ,INPUT-output analysis ,TRANSLATIONAL research ,JOB creation ,PUBLIC health research - Abstract
Quantifying the value of investment in medical research can inform decision-making on the prioritisation of research programmes. Existing methodologies to estimate the rate of return of medical research are inappropriate for early-phase translational research due to censoring of health benefits and time lags. A strategy to improve the process of translational research for patient benefit has been initiated as part of the UK National Institute for Health Research (NIHR) investment in Biomedical Research Centres (BRCs) in England. By providing a platform for partnership between universities, NHS trusts and industry, successful BRCs should reduce time lags within translational research whilst also providing an impetus for local economic growth through industry collaboration. We present a novel contribution in the assessment of early-phase biomedical research by estimating the impact of the Oxford Biomedical Research Centre (OxBRC) on income and job creation following the initial NIHR investment. We adopt a macroeconomic assessment approach using Input-Output Analysis to estimate the value of medical research in terms of income and job creation during the early pathway towards translational biomedical research. Inter-industry linkages are assessed by building a model economy for the South East England region to estimate the return on investment of the OxBRC. The results from the input-output model estimate that the return on investment in biomedical research within the OxBRC is 46%. Each £1 invested in the OxBRC generates an additional £0.46 through income and job creation alone. Multiplicative employment effects following a marginal investment in the OxBRC of £98m during the period 2007-2017 result in an estimated additional 196 full time equivalent positions being created within the local economy on top of direct employment within OxBRC. Results from input-output analyses can be used to inform the prioritisation of biomedical research programmes when compared against national minimum thresholds of investment. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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21. Impact of a progressive stepped care approach in an improving access to psychological therapies service: An observational study.
- Author
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Boyd, Lisa, Baker, Emma, and Reilly, Joe
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SCIENTIFIC observation ,STATISTICAL hypothesis testing ,BIBLIOTHERAPY - Abstract
England’s national Improving Access to Psychological Therapies (IAPT) programme advocates stepped care as its organizational delivery of psychological therapies to common mental health problems. There is limited evidence regarding the efficacy of stepped care as a service delivery model, heterogeneity of definition and differences in model implementation in both research and routine practice, hence outcome comparison in terms of effectiveness of model is difficult. Despite sound evidence of the efficacy of low intensity interventions there appears to be a perpetuation of the notion that severity and complexity should only be treated by a high intensity intervention through the continuation of a stratified care model. Yet no psychotherapy treatment is found to be more superior to another, and not enough is known about what works for whom to aid the matching of treatment decision. In the absence of understanding precise treatment factors optimal for recovery, it may be useful to better understand the impact of a service delivery model, and whether different models achieve different outcomes. This study aims to contribute to the discussion regarding the stepped care definition and delivery, and explores the impact on clinical outcomes where different types of stepped care have been implemented within the same service. An observational cohort study analysed retrospective data (n = 16,723) over a 4 year period, in a single IAPT service, where delivery changed from one type of stepped care model to another. We compared the outcomes of treatment completers with a stratified care model and a progression care model. We also explored the assumption that patients who score severe on psychological measures, and therefore are potentially complex, would achieve better outcomes in a stratified model. Outcomes in each model type were compared, alongside baseline factor variables. A significant association was observed between a recovery outcome and model type, with patients 1.5 times more likely to recover in the progression delivery model. The potential implications are that with a progression stepped care model of service delivery, more patients can be treated with a lower intensity intervention, even with initial severe presentations, ensuring that only those that need high intensity CBT or equivalent are stepped up. This could provide services with an effective clinical model that is efficient and potentially more cost effective. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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22. The relative age effect in European elite soccer: A practical guide to Poisson regression modelling.
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Doyle, John R. and Bottomley, Paul A.
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POISSON regression ,REGRESSION analysis ,PHYSICAL sciences ,SOCCER ,SOCIAL sciences ,AGE discrimination in employment - Abstract
Many disciplines of scholarship are interested in the Relative Age Effect (RAE), whereby age-banding confers advantages on older members of the cohort over younger ones. Most research does not test this relationship in a manner consistent with theory (which requires a decline in frequency across the cohort year), instead resorting to non-parametric, non-directional approaches. In this article, the authors address this disconnect, provide an overview of the benefits associated with Poisson regression modelling, and two managerially useful measures for quantifying RAE bias, namely the Indices of Discrimination and Wastage. In a tutorial-like exposition, applications and extensions of this approach are illustrated using data on professional soccer players competing in the top two tiers of the “Big Five” European football leagues in the search to identify paragon clubs, leagues, and countries from which others may learn to mitigate this form of age-discrimination in the talent identification process. As with OLS regression, Poisson regression may include more than one independent variable. In this way we test competing explanations of RAE; control for unwanted sources of covariation; model interaction effects (that different clubs and countries may not all be subject to RAE to the same degree); and test for non-monotonic versions of RAE suggested in the literature. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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23. A systematic review of the outcome data supporting the Healthy Living Pharmacy concept and lessons from its implementation.
- Author
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Nazar, Zachariah Jamal, Nazar, Hamde, White, Simon, and Rutter, Paul
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META-analysis - Abstract
Background: The Healthy Living Pharmacy (HLP) project, launched in England, UK in 2009 was a novel approach of introducing public health services within community pharmacy to tackle local health inequalities. A national roll-out followed a reported successful pilot; subsequent local evaluations ensued. Objectives: To summarise reported outcomes and investigate contextual factors that indicate the presence, absence and maturity of implementation determinants, thus offering useful lessons to stakeholders in implementing future initiatives to achieve successful outcomes. Methods: A systematic review was conducted to identify all publications reporting on the HLP project. All HLP articles and conference abstracts were considered for inclusion and were assessed for methodological quality. The Consolidated Framework for Implementation Research (CFIR) was utilised to identify potential implementation determinants reported. Each article was then analysed to identify reported economic, humanistic or clinical outcomes. Results: The review included six peer-reviewed journal articles and 12 conference abstracts. Joanna Briggs Institute Qualitative Assessment and Review Instrument indicated deficiencies in methodological quality. Through adoption of the CFIR framework, the implementation determinants relevant to the implementation of HLP into community pharmacy were identified. A resonating issue emerged in that the absence of adopting an evidence-based implementation process limited the ability to capture meaningful outcome data. This resulted in a lack of evidence to support sustainability and the failure to address many of the well cited barriers, e.g. lack of awareness amongst patients, public and other healthcare professionals, and weak support for future investment in resource for training and dissemination. Conclusions: Healthcare systems are increasingly called on to adopt evidence-based interventions that improve quality, control costs, and maximize value, thus offering opportunity to accelerate the implementation of clinical pharmacy services and programs aimed at improving patient care. Interventions, such as the HLP project require focused efforts on implementation and evaluation of those implementation efforts to produce effective and lasting changes in complex health care systems. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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24. Associations between socio-economic factors and alcohol consumption: A population survey of adults in England.
- Author
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Beard, Emma, Brown, Jamie, West, Robert, Kaner, Eileen, Meier, Petra, and Michie, Susan
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ALCOHOL drinking ,ADULT attitudes ,DEMOGRAPHIC surveys ,SOCIOECONOMICS - Abstract
Aim: To gain a better understanding of the complex relationships of different measures of social position, educational level and income with alcohol consumption in England. Method: Between March 2014 and April 2018 data were collected on n = 57,807 alcohol drinkers in England taking part in the Alcohol Toolkit Study (ATS). Respondents completed the AUDIT-C measure of frequency of alcohol consumption, amount consumed on a typical day and binge drinking frequency. The first two questions were used to derive a secondary measure of quantity: average weekly unit consumption. Socio-economic factors measured were: social-grade (based on occupation), employment status, educational qualifications, home and car ownership and income. Models were constructed using ridge regression to assess the contribution of each predictor taking account of high collinearity. Models were adjusted for age, gender and ethnicity. Results: The strongest predictor of frequency of alcohol consumption was social-grade. Those in the two lowest occupational categories of social grade (e.g. semi-skilled and unskilled manual workers, and unemployed, pensioners, casual workers) has fewer drinking occasions than those in professional-managerial occupations (β = -0.29, 95%CI -0.34 to -0.25; β = -0.31, 95%CI -0.33 to -0.29). The strongest predictor of consumed volume and binge drinking frequency was lower educational attainment: those whose highest qualification was an A-level (i.e. college/high school qualification) drank substantially more on a typical day (β = 0.28, 95%CI 0.25 to 0.31) and had a higher weekly unit intake (β = 3.55, 95%CI 3.04 to 4.05) than those with a university qualification. They also reported a higher frequency of binge drinking (β = 0.11, 95%CI 0.09 to 0.14). Housing tenure was a strong predictor of all drinking outcomes, while employment status and car ownership were the weakest predictors of most outcomes. Conclusion: Social-grade and educational attainment appear to be the strongest socioeconomic predictors of alcohol consumption indices in England, followed closely by housing tenure. Employment status and car ownership have the lowest predictive power. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
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25. DIY HIV prevention: Formative qualitative research with men who have sex with men who source PrEP outside of clinical trials.
- Author
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Paparini, Sara, Nutland, Will, Rhodes, Tim, Nguyen, Vinh-Kim, and Anderson, Jane
- Subjects
HIV prevention ,DO-it-yourself work ,GENERIC drugs ,QUALITATIVE research ,NATIONAL health services ,CLINICAL trials ,EMTRICITABINE-tenofovir ,PRE-exposure prophylaxis - Abstract
Pre-exposure prophylaxis (PrEP) with antiretroviral medication is an effective, evidence-based option for HIV prevention. In England, issues of cost-effectiveness and of responsibility for commissioning prevention services have so far led National Health Service (NHS) England to decide not to commission PrEP. Given the significant lag between the awareness of PrEP efficacy and the opportunity to obtain PrEP through traditional health care routes, many gay and other men who have sex with men (MSM) have turned to ‘DIY PrEP’, purchasing generic formulations of PrEP for themselves on the internet or via other alternative routes. However, there is very little research on DIY PrEP practices and no qualitative study with DIY PrEP users in the UK. A formative qualitative study was conducted in 2017 to inform the development of an intervention (PrEP Club) to support DIY PrEP users and improve the safety and experience of this prevention strategy. Focus groups were held with 20 MSM who are based in London and are obtaining PrEP through means other than clinical trials, to explore their accounts of sourcing and using PrEP and the experiential meanings of these. In this article, we report findings from this first, formative study and present the different practices involved in finding out about PrEP, buying it and ascertaining legitimacy of sellers and products. We reflect on the uncertainties participants described related to actually using PrEP, including deciding on drug dosing and monitoring their health. Finally, we present the results of the discussions participants had about the kind of support they had received, the help they would have liked, and their views on proposed interventions to support DIY PrEP users, such as PrEP Club. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
26. Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035.
- Author
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Pimpin, Laura, Retat, Lise, Fecht, Daniela, de Preux, Laure, Sassi, Franco, Gulliver, John, Belloni, Annalisa, Ferguson, Brian, Corbould, Emily, Jaccard, Abbygail, and Webber, Laura
- Subjects
AIR pollution ,HEALTH ,NON-communicable diseases ,MEDICAL care costs ,PARTICULATE matter ,NITROGEN dioxide ,PUBLIC health ,AIR pollution prevention ,COMPARATIVE studies ,COMPUTER simulation ,ENVIRONMENTAL monitoring ,FORECASTING ,RESEARCH methodology ,MEDICAL cooperation ,NATIONAL health services ,NITRIC oxide ,RESEARCH ,RISK assessment ,SOCIAL case work ,TIME ,EVALUATION research ,DISEASE incidence ,STATISTICAL models ,INHALATION injuries ,ECONOMICS - Abstract
Background: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England.Method and Findings: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data.Conclusions: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status. [ABSTRACT FROM AUTHOR]- Published
- 2018
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27. Predictors of and reasons for attempts to reduce alcohol intake: A population survey of adults in England.
- Author
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Beard, Emma, Brown, Jamie, Kaner, Eileen, West, Robert, and Michie, Susan
- Subjects
PREVENTION of alcoholism ,PUBLIC health ,MEDICAL economics ,HEALTH of adults ,BODY weight - Abstract
Objective: This study aimed to assess the predictors among high-risk drinkers in England of attempts to reduce alcohol consumption, the reasons given for these attempts and the association between the various reasons and alcohol consumption. Method: Data came from 2,800 high-risk drinkers taking part in the Alcohol Toolkit Study (ATS) between March 2014 and November 2016 who were attempting to reduce their alcohol consumption. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and were asked questions regarding their socio-demographic characteristics, attempts to cut down and reasons for doing so. Results: Those cutting down were significantly older (OR 1.01, p<0.001), were more likely to be female (OR 1.32, p<0.05), had higher AUDIT-C scores (OR 1.12, p<0. 001), were less likely to be of white ethnicity (OR 0.64, p<0. 001), and were more likely to reside in the South of England (OR 1.34, p<0. 001). They were also more likely to be of higher occupationally-based social-grades (p<0. 001). The main reported reasons for reducing consumption were: fitness (22.5%), weight loss (20.4%), future health (20.4%), advice from a health-care professional (7.9%) and cost (7.6%). Those reporting the followings reasons for cutting down had higher AUDIT-C scores than those who did not report these reasons: a concern about further health problems (β 0.20, p<0.05), advice from a doctor/health worker (β 0.38, p<0.05), that drinking was too expensive (β 0.42, p<0.01) and detoxification (β 0.42, p<0.01). Lower AUDIT-C scores were noted among those who reported that they knew someone who was cutting down (β -0.67, p<0.05), that there was no reason (β -0.36, p<0.05), or they didn’t know why they were cutting down (β -0.25, p<0.05). Conclusions: Around a fifth of high-risk drinkers in England report trying to reduce their drinking, particularly older, high-socioeconomic female drinkers from the south of England. Attempts to cut down appear to be driven by a desire to improve health, advice from others and cutting down on the cost of drinking. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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28. Chlamydia trachomatis Pgp3 Antibody Population Seroprevalence before and during an Era of Widespread Opportunistic Chlamydia Screening in England (1994-2012).
- Author
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Woodhall, Sarah C., Wills, Gillian S., Horner, Patrick J., Craig, Rachel, Mindell, Jennifer S., Murphy, Gary, McClure, Myra O., Soldan, Kate, Nardone, Anthony, and Johnson, Anne M.
- Subjects
CHLAMYDIA trachomatis ,SEROPREVALENCE ,OPPORTUNISTIC infections ,PUBLIC health ,HEALTH surveys ,DIAGNOSIS - Abstract
Background: Opportunistic chlamydia screening of <25 year-olds was nationally-implemented in England in 2008 but its impact on chlamydia transmission is poorly understood. We undertook a population-based seroprevalence study to explore the impact of screening on cumulative incidence of chlamydia, as measured by C.trachomatis-specific antibody. Methods: Anonymised sera from participants in the nationally-representative Health Surveys for England (HSE) were tested for C.trachomatis antibodies using two novel Pgp3 enzyme-linked immunosorbent assays (ELISAs) as a marker of past infection. Determinants of being seropositive were explored using logistic regression among 16–44 year-old women and men in 2010 and 2012 (years when sexual behaviour questions were included in the survey) (n = 1,402 women; 1,119 men). Seroprevalence trends among 16–24 year-old women (n = 3,361) were investigated over ten time points from 1994–2012. Results: In HSE2010/2012, Pgp3 seroprevalence among 16–44 year-olds was 24.4% (95%CI 22.0–27.1) in women and 13.9% (11.8–16.2) in men. Seroprevalence increased with age (up to 33.5% [27.5–40.2] in 30–34 year-old women, 18.7% [13.4–25.6] in 35–39 year-old men); years since first sex; number of lifetime sexual partners; and younger age at first sex. 76.7% of seropositive 16–24 year-olds had never been diagnosed with chlamydia. Among 16–24 year-old women, a non-significant decline in seroprevalence was observed from 2008–2012 (prevalence ratio per year: 0.94 [0.84–1.05]). Conclusion: Our application of Pgp3 ELISAs demonstrates a high lifetime risk of chlamydia infection among women and a large proportion of undiagnosed infections. A decrease in age-specific cumulative incidence following national implementation of opportunistic chlamydia screening has not yet been demonstrated. We propose these assays be used to assess impact of chlamydia control programmes. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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29. An evaluation of equity and equality in physical activity policies in four European countries.
- Author
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Hämäläinen, Riitta-Maija, Sandu, Petru, Syed, Ahmed M., and Jakobsen, Mette W.
- Subjects
CONTENT analysis ,HEALTH services accessibility ,HEALTH status indicators ,INTERVIEWING ,HEALTH policy ,POLICY sciences ,SOCIAL justice ,EVALUATION research ,PHYSICAL activity - Abstract
Background: There is strong research evidence on the importance of health equity and equality for wellbeing in societies. As chronic non-communicable diseases are widespread, the positive impact of physical activity (PA) on health has gained importance. However, PA at the population level is far from optimal. PA depends not only on individual factors, but also on policies for PA in sport, health, transport, education and other sectors, on social and cultural factors, and on the environment. Addressing health inequalities and inequities in PA promotion policies could benefit from policy development processes based on partnership and collaboration between various sectors, researchers, practitioners and policy makers (= cross-sectoral, evidence-informed policy making). The objective of this article is to describe how equity and equality was addressed in PA policies in four EU member states (Denmark, Finland, Romania and England), who were partners in the REPOPA project (www.repopa.eu, EC/FP7/Health Research/GA 281532). Methods: Content analysis of 14 PA policies and 61 interviews were undertaken between 2012 and 2013 with stakeholders involved in developing PA policies in partner countries. Results: Even though specific population subgroups were mentioned in the policy documents analysed, they were not necessarily defined as vulnerable populations nor was there a mention of additional emphasis to support such groups from being marginalised by the policy due to inequity or inequality. There were no clear objectives and activities in the analysed policies suggesting commitment of additional resources in favour of such groups. Addressing equity and equality were often not included in the core aims of the policies analysed; these aspects were mentioned in the background of the policy documents analysed, without being explicitly stated in the aims or activities of the policies. In order to tackle health inequities and inequalities and their consequences on the health status of different population subgroups, a more instrumental approach to health equality and equity in PA promotion policies is needed. Policies should include aims to address health inequalities and inequities as fundamental objectives and also consider opportunities to allocate resources to reduce them for identified groups in this regard: the socially excluded, the remote, and the poor. Conclusions: The inclusion of aspects related to health inequalities and inequities in PA policies needs monitoring, evaluation and transparent accountability if we are to see the best gains in health of socially disadvantaged group. To tackle health inequities and inequalities governance structures need to take into consideration proportionate universalism. Thus, to achieve change in the social determinants of health, policy makers should pay attention to PA and proportionally invest for universal access to PA services. PA promotion advocates should develop a deeper awareness of political and policy structures and require more equity and equality in PA policies from those who they seek to influence, within specific settings for policy making and developing the policy agenda. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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30. Water Quality Is a Poor Predictor of Recreational Hotspots in England.
- Author
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Ziv, Guy, Mullin, Karen, Boeuf, Blandine, Fincham, William, Taylor, Nigel, Villalobos-Jiménez, Giovanna, von Vittorelli, Laura, Wolf, Christine, Fritsch, Oliver, Strauch, Michael, Seppelt, Ralf, Volk, Martin, and Beckmann, Michael
- Subjects
WATER quality ,ECOSYSTEM services ,HYDROLOGY ,BIOMECHANICS ,WATER temperature - Abstract
Maintaining and improving water quality is key to the protection and restoration of aquatic ecosystems, which provide important benefits to society. In Europe, the Water Framework Directive (WFD) defines water quality based on a set of biological, hydro-morphological and chemical targets, and aims to reach good quality conditions in all river bodies by the year 2027. While recently it has been argued that achieving these goals will deliver and enhance ecosystem services, in particular recreational services, there is little empirical evidence demonstrating so. Here we test the hypothesis that good water quality is associated with increased utilization of recreational services, combining four surveys covering walking, boating, fishing and swimming visits, together with water quality data for all water bodies in eight River Basin Districts (RBDs) in England. We compared the percentage of visits in areas of good water quality to a set of null models accounting for population density, income, age distribution, travel distance, public access, and substitutability. We expect such association to be positive, at least for fishing (which relies on fish stocks) and swimming (with direct contact to water). We also test if these services have stronger association with water quality relative to boating and walking alongside rivers, canals or lakeshores. In only two of eight RBDs (Northumbria and Anglian) were both criteria met (positive association, strongest for fishing and swimming) when comparing to at least one of the null models. This conclusion is robust to variations in dataset size. Our study suggests that achieving the WFD water quality goals may not enhance recreational ecosystem services, and calls for further empirical research on the connection between water quality and ecosystem services. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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31. Modelling Neonatal Care Pathways for Babies Born Preterm: An Application of Multistate Modelling.
- Author
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Seaton, Sarah E., Barker, Lisa, Draper, Elizabeth S., Abrams, Keith R., Modi, Neena, Manktelow, Bradley N., and null, null
- Subjects
PREMATURE infants -- Hospital care ,NEONATAL intensive care ,INFANT mortality ,LENGTH of stay in hospitals ,MATHEMATICAL models - Abstract
Modelling length of stay in neonatal care is vital to inform service planning and the counselling of parents. Preterm babies, at the highest risk of mortality, can have long stays in neonatal care and require high resource use. Previous work has incorporated babies that die into length of stay estimates, but this still overlooks the levels of care required during their stay. This work incorporates all babies, and the levels of care they require, into length of stay estimates. Data were obtained from the National Neonatal Research Database for singleton babies born at 24–31 weeks gestational age discharged from a neonatal unit in England from 2011 to 2014. A Cox multistate model, adjusted for gestational age, was used to consider a baby’s two competing outcomes: death or discharge from neonatal care, whilst also considering the different levels of care required: intensive care; high dependency care and special care. The probabilities of receiving each of the levels of care, or having died or been discharged from neonatal care are presented graphically overall and adjusted for gestational age. Stacked predicted probabilities produced for each week of gestational age provide a useful tool for clinicians when counselling parents about length of stay and for commissioners when considering allocation of resources. Multistate modelling provides a useful method for describing the entire neonatal care pathway, where rates of in-unit mortality can be high. For a healthcare service focussed on costs, it is important to consider all babies that contribute towards workload, and the levels of care they require. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
32. Regional Variation in Acute Kidney Injury Requiring Dialysis in the English National Health Service from 2000 to 2015 – A National Epidemiological Study.
- Author
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Kolhe, Nitin V., Fluck, Richard J., Muirhead, Andrew W., and Taal, Maarten W.
- Subjects
KIDNEY injuries ,HEMODIALYSIS ,EPIDEMIOLOGY ,SOCIODEMOGRAPHIC factors - Abstract
Background: The absence of effective interventions in presence of increasing national incidence and case-fatality in acute kidney injury requiring dialysis (AKI-D) warrants a study of regional variation to explore any potential for improvement. We therefore studied regional variation in the epidemiology of AKI-D in English National Health Service over a period of 15 years. Method: We analysed Hospital Episode Statistics data for all patients with a diagnosis of AKI-D, using ICD-10-CM codes, in English regions between 2000 and 2015 to study temporal changes in regional incidence and case-fatality. Results: Of 203,758,879 completed discharges between 1
st April 2000 and 31st March 2015, we identified 54,252 patients who had AKI-D in the nine regions of England. The population incidence of AKI-D increased variably in all regions over 15 years; however, the regional variation decreased from 3·3-fold to 1·3-fold (p<0·01). In a multivariable adjusted model, using London as the reference, in the period of 2000–2005, the North East (odd ratio (OR) 1·38; 95%CI 1·01, 1·90), East Midlands (OR 1·38; 95%CI 1·01, 1·90) and West Midlands (OR 1·38; 95%CI 1·01, 1·90) had higher odds for death, while East of England had lower odds for death (OR 0·66; 95% CI 0·49, 0·90). The North East had higher OR in all three five-year periods as compared to the other eight regions. Adjusted case-fatality showed significant variability with temporary improvement in some regions but overall there was no significant improvement in any region over 15 years. Conclusions: We observed considerable regional variation in the epidemiology of AKI-D that was not entirely attributable to variations in demographic or other identifiable clinical factors. These observations make a compelling case for further research to elucidate the reasons and identify interventions to reduce the incidence and case-fatality in all regions. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
33. Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England.
- Author
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Beard, Emma, Brown, Jamie, West, Robert, Angus, Colin, Brennan, Alan, Holmes, John, Kaner, Eileen, Meier, Petra, and Michie, Susan
- Subjects
ALCOHOL drinking & health ,ALCOHOL-induced disorders ,HEALTH of adults ,HEALTH surveys ,SOCIAL status - Abstract
Background: The Alcohol Harm Paradox refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. Thus this study assessed socioeconomic patterning of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age. Method: Data were used from the Alcohol Toolkit Study between March and September 2015 on 31,878 adults (16+) living in England. Participants completed the AUDIT which includes alcohol consumption, harm and dependence modules. SES was measured via qualifications, employment, home and car ownership, income and social-grade, plus a composite of these measures. The composite score was coded such that higher scores reflected greater social-disadvantage. Results: We observed the Alcohol Harm Paradox for the composite SES measure, with a linear negative relationship between SES and AUDIT-Consumption scores (β = -0.036, p<0.001) and a positive relationship between lower SES and AUDIT-Harm (β = 0.022, p<0.001) and AUDIT-Dependence (β = 0.024, p<0.001) scores. Individual measures of SES displayed different, and non-linear, relationships with AUDIT modules. For example, social-grade and income had a u-shaped relationship with AUDIT-Consumption scores while education had an inverse u-shaped relationship. Almost all measures displayed an exponential relationship with AUDIT-Dependence and AUDIT-Harm scores. We identified moderating effects from age and gender, with AUDIT-Dependence scores increasing more steeply with lower SES in men and both AUDIT-Harm and AUDIT-Dependence scores increasing more steeply with lower SES in younger age groups. Conclusion: Different SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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- View/download PDF
34. Did the English strategy reduce inequalities in health? A difference-in-difference analysis comparing England with three other European countries.
- Author
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Yannan Hu, van Lenthe, Frank J., Judge, Ken, Lahelma, Eero, Costa, Giuseppe, de Gelder, Rianne, Mackenbach, Johan P., and Hu, Yannan
- Subjects
HEALTH education ,EQUALITY ,HEALTH policy ,HEALTH status indicators ,SOCIOECONOMICS ,CHRONIC diseases ,COMPARATIVE studies ,HEALTH ,HEALTH promotion ,RESEARCH methodology ,MEDICAL care ,MEDICAL cooperation ,OBESITY ,RESEARCH ,RESEARCH funding ,SMOKING ,SURVEYS ,ETHNOLOGY research ,SOCIOECONOMIC factors ,EVALUATION research ,HEALTH equity ,EVALUATION of human services programs ,SELF diagnosis - Abstract
Background: Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme.Methods: Data were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000-2010 were more favourable as compared to the period 1990-2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position.Results: After the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000-2010 in England were not more favourable than those observed in the period 1990-2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries.Conclusions: In this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
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35. The impact of increasing income inequalities on educational inequalities in mortality - An analysis of six European countries.
- Author
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Hoffmann, Rasmus, Yannan Hu, de Gelder, Rianne, Menvielle, Gwenn, Bopp, Matthias, and Mackenbach, Johan P.
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MORTALITY ,CAUSES of death ,INCOME ,LONGITUDINAL method ,REGRESSION analysis ,TIME ,SOCIOECONOMIC factors ,EDUCATIONAL attainment ,HEALTH equity - Abstract
Background: Over the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities. Methods: We collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35-79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality. Results: The general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance. Conclusions: We find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important determinant of mortality in this European context of high-income countries. This study contributes to the discussion on income inequality as entry point to tackle health inequalities. More research is needed to test the common and plausible assumption that increasing income inequality leads to more health inequality, and that one needs to act against the former to avoid the latter. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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- View/download PDF
36. Cost-Effectiveness of Vaccinating Immunocompetent ≥65 Year Olds with the 13-Valent Pneumococcal Conjugate Vaccine in England.
- Author
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van Hoek, Albert Jan and Miller, Elizabeth
- Subjects
PNEUMOCOCCAL vaccines ,IMMUNOCOMPETENT cells ,BIOCONJUGATES ,COST effectiveness ,CLINICAL trials - Abstract
Background: Recently a large clinical trial showed that the use of 13-valent pneumococcal conjugate vaccine (PCV13) among immunocompetent individuals aged 65 years and over was safe and efficacious. The aim of this study was to assess the cost-effectiveness of vaccinating immunocompetent 65 year olds with PCV13 vaccine in England. England is a country with universal childhood pneumococcal conjugate vaccination programme in place (7-valent (PCV7) since 2006 and PCV13 since 2010), as well as a 23-valent pneumococcal polysaccharide (PPV23) vaccination programme targeting clinical risk-groups and those ≥65 years. Method: A static cohort cost-effectiveness model was developed to follow a cohort of 65 year olds until death, which will be vaccinated in the autumn of 2016 with PCV13. Sensitivity analysis was performed to test the robustness of the results. Results: The childhood vaccination programme with PCV7 has induced herd protection among older unvaccinated age groups, with a resultant low residual disease burden caused by PCV7 vaccine types. We show similar herd protection effects for the 6 additional serotypes included in PCV13, and project a new low post-introduction equilibrium of vaccine-type disease in 2018/19. Applying these incidence projections for both invasive disease and community-acquired pneumonia (CAP), and using recent measures of vaccine efficacy against these endpoints for ≥65 year olds, we estimate that vaccination of a cohort of immunocompetent 65 year olds with PCV13 would directly prevent 26 cases of IPD, 69 cases of CAP and 15 deaths. The associated cost-effectiveness ratio is £257,771 per QALY gained (using list price of £49.10 per dose and £7.51 administration costs) and is therefore considered not cost-effective. To obtain a cost-effective programme the price per dose would need to be negative. The results were sensitive to disease incidence, waning vaccine protection and case fatality rate; despite this, the overall conclusion was robust. Conclusions: Vaccinating immunocompetent individuals aged ≥65 years with PCV13 is efficacious. However the absolute incidence of vaccine-type disease will likely become very low due to wider benefits of the childhood PCV13 vaccination programme, such that a specific PCV13 vaccination programme targeting the immunocompetent elderly would not be cost-effective. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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- View/download PDF
37. Family Caregivers Who Would Be Unwilling to Provide Care at the End of Life Again: Findings from the Health Survey for England Population Survey.
- Author
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Johnson, Miriam J., Allgar, Victoria, Macleod, Una, Jones, Annie, Oliver, Steven, and Currow, David
- Subjects
CAREGIVERS ,FAMILY medicine ,TERMINAL care ,HEALTH surveys ,POPULATION health - Abstract
Background: Family caregivers provide significant care at the end of life. We aimed to describe caregiver characteristics, and of those unwilling to repeat this role under the same circumstances. Methods: Observational study of adults in private households (Health Survey for England [HSE]). Caregiving questions included: whether someone close to them died within past 5 years; relationship to the deceased; provision, intensity and duration of care; supportive/palliative care services used; willingness to care again; able to carry on with life. Comparison between those willing to care again or not used univariable analyses and an exploratory multiple logistic regression. A descriptive comparison with Health Omnibus Survey (Australia) data was conducted. Findings: HSE response was 64%. 2167/8861 (25%) respondents had someone close to them die in the previous 5 years. Some level of personal care was provided by 645/8861 (7.3%). 57/632 (9%) former caregivers would be unwilling to provide care again irrespective of time since the death, duration of care, education and income. Younger age (≤65; odds ratio [OR] 2.79; 95% CI 136, 5.74) and use of palliative care services (odds ratio: 1.95, 95% CI: 1.09, 3.48) showed greater willingness to provide care again. Apart from use of palliative care services, findings were remarkably similar to the Australian data. Conclusions: A significant group of caregivers would be unwilling to provide care again. Older people and those who had not used palliative care services were more likely to be unwilling to care again. Barriers preventing access for disadvantaged groups need to be overcome. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
38. The Three-Dimensional Morphology of Simulated and Observed Convective Storms over Southern England.
- Author
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Stein, Thorwald H. M., Hogan, Robin J., Hanley, Kirsty E., Nicol, John C., Lean, Humphrey W., Plant, Robert S., Clark, Peter A., and Halliwell, Carol E.
- Subjects
STORMS ,CONVECTIVE boundary layer (Meteorology) ,ICING (Meteorology) ,RAINFALL ,MATHEMATICAL models - Abstract
A set of high-resolution radar observations of convective storms has been collected to evaluate such storms in the Met Office Unified Model during the Dynamical and Microphysical Evolution of Convective Storms (DYMECS) project. The 3-GHz Chilbolton Advanced Meteorological Radar was set up with a scan-scheduling algorithm to automatically track convective storms identified in real time from the operational rainfall radar network. More than 1000 storm observations gathered over 15 days in 2011 and 2012 are used to evaluate the model under various synoptic conditions supporting convection. In terms of the detailed three-dimensional morphology, storms in the 1500-m grid length simulations are shown to produce horizontal structures a factor of 1.5-2 wider compared to radar observations. A set of nested model runs at grid lengths down to 100 m show that the models converge in terms of storm width, but the storm structures in the simulations with the smallest grid lengths are too narrow and too intense compared to the radar observations. The modeled storms were surrounded by a region of drizzle without ice reflectivities above 0 dB Z aloft, which was related to the dominance of ice crystals and was improved by allowing only aggregates as an ice particle habit. Simulations with graupel outperformed the standard configuration for heavy-rain profiles, but the storm structures were a factor of 2 too wide and the convective cores 2 km too deep. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
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39. Invited Commentary: The Search for Explanations of the American Health Disadvantage Relative to the English.
- Author
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Avendano, Mauricio and Kawachi, Ichiro
- Subjects
HYPOTHESIS ,HEALTH status indicators ,HUMAN life cycle ,LIFE expectancy ,POVERTY ,SOCIAL justice ,SOCIAL security ,GOVERNMENT policy - Abstract
Although Americans make up just 5% of the world's population, they represent more than half of every medical dollar expended on the planet. Yet, American life expectancy appears near the bottom of rankings by the Organization for Economic Cooperation and Development, and American adults live in poorer health than most Europeans. In this issue of the Journal, Martinson et al. (Am J Epidemiol. 2011;173(8):870) provide us with further evidence of the generality of this phenomenon, showing a pattern of poorer health in the United States relative to England across the entire life course. Recent research points at single risk factors such as smoking as potential explanations, but such hypotheses are of limited scope to explain the pervasive US health disadvantage across the entire life course. In this commentary, a potentially promising line of inquiry based upon differences in social policy contexts is proposed. Life in the United States can be distinguished from that of the rest of the member countries of the Organization for Economic Cooperation and Development in terms of the weakness of its social safety nets, the magnitude of social inequalities, and the harshness of poverty. The authors argue that broadening the scope of their inquiry to include the social and policy contexts of nations might help to solve the puzzle of the US health disadvantage. [ABSTRACT FROM PUBLISHER]
- Published
- 2011
- Full Text
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40. A SPALACOLESTINE SPALACOTHERIID (MAMMALIA, TRECHNOTHERIA) FROM THE EARLY CRETACEOUS (BARREMIAN) OF SOUTHERN ENGLAND AND ITS BEARING ON SPALACOTHERIID EVOLUTION.
- Author
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SWEETMAN, STEVEN C.
- Subjects
MAMMALS ,FOSSILS ,CRETACEOUS stratigraphic geology ,ANIMALS - Abstract
Bulk screening of Early Cretaceous (Barremian) Wealden Group strata of the Wessex Formation exposed on the south-west and south-east coasts of the Isle of Wight, southern England, has resulted in the recovery of fragmentary remains pertaining to a new spalacolestine spalacotheriid mammal, Yaverlestes gassoni gen. et sp. nov. These represent the first European record of the Spalacolestinae. The remains comprise a dentulous incomplete dentary and isolated upper and lower molariforms, the former representing the most substantial mammal remains yet recovered from the Wealden Group. Hitherto, six species of spalacotheriid mammal were known from the Lower Cretaceous of Europe. All are referred to the genus Spalacotherium but in the case of taxa diagnosed on the basis of isolated lower teeth and other specimens where the post-canine dentition is incompletely known, it is now evident that these referrals should be treated with caution. Furthermore, the new Wessex Formation spalacotheriid and recently described spalacotheriids from the ?Barremian of Japan, and the Barremian and Aptian of China exhibit combinations of characters that suggest that spalacotheriids were more diverse and that their evolution was more complex than previously recognized. The systematic position of an isolated tooth from the basal Cretaceous Lourinhã Formation of Portugal is discussed and the tooth reassigned to the Spalacotheriidae. Together with the new Wessex Formation taxon, eight species are now known from the Lower Cretaceous of Europe. The discovery of a spalacolestine in the Barremian Wessex Formation supports the concept of faunal interchange between Europe, Asia and North America during the Early Cretaceous. It also supports derivation of North American spalacotheriids from a European or Eurasian ancestor. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
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41. SYSTEMATICS AND TAXONOMY OF EOCENE TOMISTOMINE CROCODYLIANS FROM BRITAIN AND NORTHERN EUROPE.
- Author
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Brochu, Christopher A.
- Subjects
CROCODILIANS ,EOCENE stratigraphic geology ,HUMERUS ,TAXONOMY - Abstract
The holotype of Dollosuchus dixoni (Owen) from the Early–Middle Eocene Bracklesham Beds of England is a set of mandibular fragments that cannot be distinguished from corresponding parts of other longirostrine crocodylians. An isolated humerus from the Bracklesham Beds is consistent with a gavialoid, but it cannot be referred to the holotype of D. dixoni. The name Dollosuchoides densmorei is established for the well-preserved skull and skeleton of a tomistomine from the Middle Eocene of Belgium that had been referred to D. dixoni. It can be clearly distinguished from the basal tomistomine ‘ Crocodilus’ spenceri Buckland from the Lower Eocene of England, which cannot be referred to Dollosuchoides and is provisionally referred to Kentisuchus Mook. Although basal within Tomistominae, Dollosuchoides is more closely related to Tomistoma than to Kentisuchus. [ABSTRACT FROM AUTHOR]
- Published
- 2007
- Full Text
- View/download PDF
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