1,721,801 research outputs found
The inter-relationships between three proxies of health care need at the small area level: an urban/rural comparison
No full textStudy objective: To examine the relations between geographical variations in mortality, morbidity, and deprivation at the small area level in the south west of England and to assess whether these relations vary between urban and rural areas. Design: A geographically based cross sectional study using 1991 census data on premature limiting long term illness (LLTI) and socioeconomic characteristics, and 1991–1996 data on all cause premature mortality. The interrelations between the three widely used proxies of health care need are examined using correlation coefficients and scatterplots. The distribution of standardised LLTI residuals from a regression analysis on mortality are mapped and compared with the distribution of urban and rural areas. Multilevel Poisson modelling investigates whether customised deprivation profiles improve upon a generic deprivation index in explaining the spatial variation in morbidity and mortality after controlling for age and sex. These relations are examined separately for urban, fringe, and rural areas. Setting: Nine counties in the south west of England. Participants: Those aged between 0–64 who reported having a LLTI in the 1991 census, and those who died during 1991–1996 aged 0–74. Main results: Relations between both health outcomes and generic deprivation indices are stronger in urban than rural areas. The replacement of generic with customised indices is an improvement in all area types, especially for LLTI in rural areas. The relation between mortality and morbidity is stronger in urban than rural areas, with levels of LLTI appearing to be greater in rural areas than would be predicted from mortality rates. Despite the weak direct relations between mortality and morbidity, there are strong relations between the customised deprivation indices computed to predict these outcomes in all area types. Conclusions: The improvement of the customised deprivation indices over the generic indices, and the similarity between the mortality and morbidity customised indices within area types highlights the importance of modelling urban and rural areas separately. Stronger relations between mortality and morbidity have been revealed at the local authority level in previous research providing empirical evidence that the inadequacy of mortality as a proxy for morbidity becomes more marked at lower levels of aggregation, especially in rural areas. Higher levels of LLTI than expected in rural areas may reflect different perceptions or differing patterns of illness. The stronger relations between the three proxies in urban than rural areas suggests that the choice of indicator will have less impact in urban than rural areas and strengthens the argument to develop better measures of health care need in rural areas
Liver function tests: defining what's normal
No full textChronic liver disease and hepatocellular carcinoma are major worldwide public health problems in countries with endemically high levels of viral hepatitis (B and C).1 However, even in western countries chronic liver disease is an emerging problem, due not only to viral hepatitis but also to the effects of lifestyle factors such as heavy alcohol consumption and obesity
Renal services for people with diabetes in the UK
No full textDiabetic nephropathy is a serious complication of diabetes that can lead to endstage renal failure (ESRF). It is now the most common cause of ESRF in patients accepted onto renal replacement therapy (RRT) programmes in the UK. Rates of diabetic ESRF are more common in ethnic minority populations. The risk of developing diabetic ESRF is higher in Type 1 diabetes but in absolute terms more patients with Type 2 diabetes develop ESRF and are treated. There is still unmet need for RRT amongst patients with diabetes who develop ESRF. The shortage of organ donors, especially amongst ethnic minorities, means that dialysis is the mainstay of treatment in patients with diabetes and ESRF. This is now largely hospital haemodialysis with an increasing proportion being delivered in satellite units. Demand for RRT from patients with diabetes will increase due to demographic change and the increasing prevalence of diabetes, particularly Type 2, in the population. To meet this challenge closer liaison between those primarily caring for patients with diabetes (primary care physicians and diabetologists) and nephrologists is required to ensure effective surveillance of renal function, to increase early referral and to agree protocols of subsequent care. Continued expansion of high-quality RRT is needed that ensures equity of access with particular targeting in areas with large ethnic minority populations. A national priority must be an increase in the kidney transplant rate
A multilevel analysis of the effects of rurality and social deprivation on premature limiting long term illness
No full textSTUDY OBJECTIVE---To examine the geographical variation in self perceived morbidity in the south west of England, and assess the associations with rurality and social deprivation.DESIGN---A geographically based cross sectional study using 1991 census data on premature Limiting Long Term Illness (LLTI). The urban-rural and intra-rural variation in standardised premature LLTI ratios is described, and correlation and regression analyses explore how well this is explained by generic deprivation indices. Multilevel Poisson modelling investigates whether Customised Deprivation Profiles (CDPs) and area characteristics improve upon the generic indices.SETTING---Nine counties in the south west of EnglandPARTICIPANTS---The population of the south west enumerated in the 1991 census.MAIN RESULTS---Intra-rural variation is apparent, with higher rates of premature LLTI in remoter areas. Together with high rates in urban areas and lower rates in the semi-rural areas this indicates the existence of a U shaped relation with rurality. The generic deprivation indices have strong positive relations with premature LLTI in urban areas, but these are a lot weaker in semi-rural and rural locations. CDPs improve upon the generic indices, especially in the rural settings. A substantial reduction in unexplained variation in rural areas is seen after controlling for the level of local isolation, with higher isolation, at the wider geographical scale, being related to higher levels of LLTI.CONCLUSIONS---This study highlights the need to treat rural areas as heterogeneous, although this has not been the tendency in health research. Generic deprivation indices are unlikely to be a true reflection of levels of deprivation in rural environments. The importance of CDPs that are specific to the area type and health outcome is emphasised. The significance of physical isolation suggests that accessibility to public and health services may be an important issue, and requires further research
A multifaceted approach to tailor antibiotic use in adults presenting to primary care with symptoms of acute rhinosinusitis and sore throat
No full textThis research project addresses three key objectives, to identify:
1) subgroups of adults presenting to primary care with symptoms of acute rhinosinusitis that are most likely to benefit from antibiotics, using novel individual participant data meta-analytic methods including multivariable, risk-based analysis (WP 1.1);
2) specific diagnostic criteria that predict antibiotic benefit in adults presenting to primary care with symptoms of acute rhinosinusitis, using diagnostic individual participant data meta-analysis to develop and validate a simple prediction model that will identify those patients likely to have a positive CT scan (WP 1.2);
3) subgroups of adults presenting to primary care with symptoms of sore throat that are most likely to benefit from antibiotics, using both conventional and novel IPD meta-analytic methods (WP 2)
The Index of Multiple Deprivation 2000 and accessibility effects on health
No full textStudy objective: To investigate whether the Index of Multiple Deprivation 2000 (IMD) is more strongly related to inequalities in health in rural areas than traditional deprivation indices. To explore the contribution of the IMD domain "geographical access to services" to understanding rural health variations. Design: A geographically based cross sectional study. Setting: Nine counties in the south west region of England. Participants: All those aged below 65 who reported a limiting long term illness in the 1991 census, and all those who died during 1991–96, aged less than 65 years. Main results: The IMD is comparable with the Townsend score in its overall correlation with premature mortality (r2 = 0.44 v 0.53) and morbidity (r2 = 0.79 v 0.76). Correlation between the Townsend score and population health is weak in rural areas but the IMD maintains a strong correlation with rates of morbidity (r2 = 0.70). The "geographical access to services" domain of the IMD is not strongly correlated with rates of morbidity in rural areas (r2 = 0.04), and in urban areas displays a negative correlation (r2 = -0.47). Conclusions: The IMD has a strong relation with health in both rural and urban areas. This is likely to be the result of the inclusion of data in the IMD on the numbers of people claiming benefits related to ill health and disability. The domain "geographical access to services" is not associated with health in rural areas, although it displays some association in urban areas. This domain is potentially important but, as yet, inadequately specified in the IMD for the purposes of health research
Comparison of two screening strategies for haemochromatosis: a pilot study investigating uptake, feasibility and cost
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