14 research outputs found
Why poor quality of ethnicity data should not preclude its use for identifying disparities in health and healthcare
No full textBackground: Data of quality are needed to identify ethnic disparities in health and healthcare and to meet the challenges in governance of race relations. Yet concerns over completeness, accuracy and timeliness have been long-standing and inhibitive with respect to the analytical use of the data.
Aims: To identify incompleteness of ethnicity data across routine health and healthcare datasets and to investigate the utility of analytical strategies for using data that is of suboptimal quality.
Methods: An analysis by government office regions of ethnicity data incompleteness in routine datasets and a comprehensive review and evaluation of the literature on appropriate analytical strategies to address the use of such data.
Results: There is only limited availability of ethnically coded routine datasets on health and healthcare, with substantial variability in valid ethnic coding: although a few have high levels of completeness, the majority are poor (notably hospital episode statistics, drug treatment data and non-medical workforce). In addition, there is also a more than twofold regional difference in quality. Organisational factors seem to be the main contributor to the differentials, and these are amenable-yet, in practice, difficult-to change. This article discusses the strengths and limitations of a variety of analytical strategies for using data of suboptimal quality and explores how they may answer important unresolved questions in relation to ethnic inequalities.
Conclusions: Only by using the data, even when of suboptimal quality, and remaining close to it can healthcare organisations drive up quality
Self-care in primary care: findings from a longitudinal comparison study.
No full textTo examine the effects of self-care training workshops for primary healthcare workers on frequently attending patients
Income-Related Health Inequalities in Korea
No full textData from the 2001 Korean National Health and Nutrition Examination Survey and the ill health concentration index (CI) were used to examine income-related health inequalities among Koreans. Participants (>19 years old) were requested to provide information regarding monthly household income, expenditures, subjective living conditions, and health status. Ill health was determined both subjectively through self-rated health (SRH) scores and objectively through the number of diseases (ND). At the individual level, the CIs for SRH and ND were -0.147 and -0.093, respectively; age–gender adjusted CIs were -0.065 and -0.071, respectively. These values remained unchanged when estimating CI for grouped data. These results indicate that ill health was more pronounced among lower income groups in Korea. However, avoidable health inequality in Korea was smaller than in the United Kingdom and the United States, larger than in Sweden, Eastern Germany, Finland, and Western Germany, and roughly equal to the Netherlands, Spain, and Switzerland
Primary care in accident and emergency departments : the cost effectiveness and applicability of a new model of care.
No full textThe thesis describes the development, research and evaluation of the applicability of a new
model of care that involves GPs being employed on a sessional basis in A&E departments to
treat patients attending with primary care needs. The main aim of the study was to research its
cost and clinical effectiveness.
A multi-faceted approach was taken to include consideration of patients' needs and preferences,
professional concerns, organisational and structural issues within the health service, and
planning and policy issues. Clinical, sociological, epidemiological, and economic perspectives
are drawn upon, reflecting the context of the service development and to provide a firm base
for discussion about the generalisability and applicability of the findings.
The first two chapters provide a detailed review of the epidemiological, sociological,
clinical, and organisational literature relating to the primary care/A&E interface. The
incentives and disincentives that may act to increase or reduce demand and supply are
explored, in addition to issues relating to the 'appropriateness' of demand, the
organisational culture of A&E departments, and strategies used to curtail or cope with
demand. The demand for primary care at A&E departments appears to cross national
boundaries and hence, literature from other countries (particularly the USA) is included
and its applicability to the UK considered. Relevant literature relating to the quality of A&E
care, patient satisfaction, and the costing of care is also discussed.
The main study was a prospective controlled trial that was conducted at King's College
Hospital. This compared process variables, clinical outcome and costs of 'primary care'
consultations performed by senior house officers (SHOs), registrars, and general
practitioners working three-hour sessions in A&E. A new system of nurse triage was
implemented to allow the prospective identification of patients presenting with primary care
needs. A total of 27 SHOs, three registrars and one senior registrar were included, and the
patient sample comprised 1702 patients seen by GPs, 2382 by SHOs, and 557 by registrars or
the senior registrar. GPs were found to practice considerably less interventionist care than
A&E medical staff, and the resource implications were substantial.
The findings are discussed critically, and their applicability is considered drawing on empirical
data from recent evaluations of A&E Primary Care Service developments in other parts of
London. The policy and service implications of the study are considered and further research
needs identified
Adult palliative day-care services : an investigation of the factors influencing access to services using the case of a cancer network in the United Kingdom
No full textBackground: Literature indicates underutilization of Palliative Care Services in the UK, with possible
inequalities of access. These trends in underutilization are seen in Adult-Palliative Day-Care (APDC),
a Specialist Palliative Care Service delivered in the outpatient setting. However, gaps in knowledge
remain regarding if underutilization in APDC is real, and the identity and nature of the factors which
determine access.
Aim: The overall research question was “What are the factors which act to determine access to
APDC?”. Five sub-questions for exploration in the context of access were formulated relating to the:
perceived health care needs of users; the benefits of using APDC, and understandings of the role of
APDC as a palliative care service.
Methods: The study site was a cancer network in the Midlands of England which covered rural and
urban areas. It contained 5 APDC units, 3 Primary Care Trusts, and 3 Acute Care Trusts. Fifty semistructured
in-depth interviews were conducted with: 19 providers of APDC; 13 health professional
referrers; 11 palliative care patients who had used the service; and 7 of their carers. The reasons for
non-attendance for 149 patients who were referred to day-care but did not attend were also analysed.
Thematic analysis with constant comparison and content analysis were used to analyse transcripts and
document data respectively.
Results: Eighteen determinants of access were identified arising out of the characteristics of the:
potential service user (2), the health service or organization (9), and from interactions between
potential service users, the family, the wider society, and the health service (7). The study found that
utilization measures in APDC may not be accurately representing service use, as APDC units maybe
functioning at their maximum capacity while current calculation methods report underutilization.
Conclusion: New insights into accessing APDC are presented which and may have applications for
future policy and research
Interactions between mycophagous nematodes, mycorrhizal and other soil fungi
No full textThe hypothesis that mycophagous nematodes feed on the mycelia of VAM fungi and consequently reduce the spread of vesicular-arbuscular mycorrhizal (VAM) infection in plant roots and the growth response of plants to this infection was investigated in experiments carried out under controlled
environmental conditions.
Preliminary experiments indicated that nematodes might be able to reduce VAM infection by Glomus clarum if they were added to soil at the same time as the fungal inoculum. However, nematodes did not affect the growth response of red clover to VAM infection even though there was an indication that nematodes may directly affect plant growth possibly by causing damage to root hairs which could
facilitate the entry of pathogens. There seemed to be little effect of mycorrhizal status on the numbers of
nematodes which could be recovered from the growth medium. The two standard methods used to extract nematodes in these preliminary experiments were found to give low and variable recoveries. A method which gave greater and less variable recoveries was developed and the conditions for its successful use were defined.
The four species of nematodes used in this study differed in their ability to reduce the growth of a range of fungi and in their ability to increase in number as a result of feeding on these fungi. Both experimental data and a mathematical model, which was developed subsequently, showed that the suitability of a fungus as a source of nutrition could be measured by the increase in numbers of
nematodes and the reduction in weight of mycelium as a result of grazing. The model therefore provided a rationale for ranking different fungi in terms of their suitability as hosts for a given species of nematode.
Of the four species of nematodes, A phelenchus avenae was the most damaging to the growth of a range of fungi. However, when added at the same time as, or later than, the VAM inoculum, A. avenae had no effect on the spread of VAM infection or on the response of plants to VAM infection. The
numbers of A. avenae recovered were similar in non-mycorrhizal and mycorrhizal treatments. A mathematical model was developed which simulated the spread of VAM infection and the change in numbers of nematodes with time. Close agreement between predictions of the model and experimental results was only achieved if it was assumed that the nematodes were not capable of feeding on the VAM
fungus.
Aphelencholdes composticola multiplied most when cultured in agar plates but grew poorly when cultured on its own in soil. When organic material (bran) colonized either by Agaricus bisporus (the nematodes preferred host) or by volunteer fungi was introduced into soil, the numbers of A. composticola increased by up to one hundred times. Neither VAM infection by G. clarum nor the mycorrhizal responses of the plant were affected by these high numbers of A. composticola, by the introduction of bran alone or by bran colonized by A. bisporus. In soil without added bran or saprotrophic fungi numbers of A. composticola were not affected by the presence of G. clarum, indicating that the available food sources in unamended soil were sparse. Mycorrhizal plants appeared to benefit more than non-mycorrhizal plants from the mineralization of phosphorus by the saprotrophic fungi.
Factors which may determine the suitability of some fungi as food sources for mycophagous nematodes are discussed. The possibility that VAM fungi are immune to grazing by these nematodes is considered. Ways in which mycophagous nematodes may influence the growth of plants are also
discussed
Study of final state photons in hadronic Z0 decay and limits on new phenomena
No full textThe differential cross section for final state radiation from primary quarks is obtained from a study of isolated energetic photons produced in the reaction e+e-→Z0→hadrons+γ, as measured in the DELPHI detector at the CERN LEP collider. When combined with the measurement of the total hadronic width of the Z0, the observed rate determines the electroweak coupling constants of up and down type quarks, i.e. {Mathematical expression} No evidence is seen for additional photon production from anomalous decays of the Z0 or from decays of new particles. This measurement leads to upper limits on the production cross section times branching fraction of (a) the Higgs boson in the reaction e+e-→Z0→H +γ, H→hadrons, (b) an excited quark, q*→q+γ, and (c) the contribution of an anomalous decay of the Z0 into a photon and hadrons. These limits, all at the 95% confidence level, vary from 3 to 10pb as the mass of the intermediate state (H, q* or Z*) varies from 10 GeV/c2 to 80 GeV/c2. © 1992 Springer-Verlag0SCOPUS: ar.jinfo:eu-repo/semantics/publishe
The reaction e+ e- ---> gamma gamma (gamma) at Z0 energies
No full textThe total and differential cross-sections for the reaction e+e- → γγ(γ) are measured at centre of mass energies around 91 GeV using an integrated luminosity of 4.7 pb-1. The aggreement with QED prediction is good. Consequently there is no evidence for non-standard channels which would have the same experimental signature. The lower limits on the QED cuttoff parameters are Λ+ > 113 GeV and Λ- > 95 GeV. An upper limit on the effective coupling between a possible excited electron and the gamma is derived. At 95% confidence level the branching ratios for Z0 decay into π0γ, ηψ and γγγ are below 1.5 × 10-4, 2.8 × 10-4 and 1.4 × 10-4 respectively.0info:eu-repo/semantics/publishe
Towards 2022: What are prevention and risk reduction in Alzheimer’s disease?
No full textThe increase in life expectancy has led in recent years to neurodegenerative pathologies, such as Alzheimer’s disease, that were strange in the last century, now become so frequent that there is talk of a new epidemic. It is estimated that approximately 50000000 patients suffer dementia around the world (World Health OrganizationWHO, 2012). Alzheimer’s disease is the most common dementia, and brain pathology begin up to 25 years before the first clinical symptoms appear (Bateman et al., 2012). Thus, Alzheimer currently has five stages, the pre-symptomatic, the mild cognitive impairment, and the mild, moderate and severe dementia. Since the original description in 1904 by Alois Alzheimer, the disease could only be definitively diagnosed by neuropathological, and the clinical diagnosis was only probable or possible (NINCDS ADRDA, McKhan et al., 1984). In recent years, more detailed knowledge of structural neuroimaging (hippocampal volume by MRI), metabolic (FDG-PET), molecular (amyloid PET), and cerebrospinal fluid studies (Aβ42, tau and f-tau) make it possible to diagnose Dementia due to Alzheimer’s disease while the patient is alive (McKhan et al., 2011) and even at pre-symptomatic stage of the disease (Sperling et al, 2011)
