1,721,049 research outputs found
The costs associated with the public health management of a cluster of meningococcal infection in England
No full textThe human and public health costs of meningococcal disease are substantial, with 201 cases reported in England between April and June 2013. It is estimated that serogroup B accounts for 85–90% of all cases of meningococcal disease. A vaccine against serogroup B meningococcal disease was approved by the European Medicines Agency in November 2012. In March 2014 the UK Joint Committee on Vaccination and Immunisation recommended that the vaccine be offered to babies at 2, 4 and 12 months of age, provided it can be procured at a cost effective price.Using a real cluster of two cases of meningococcal infection in the UK, we estimate that the cost of managing two cases was 17 times more than the cost of managing a single case (£5584.39 versus £317.72, respectively). We recommend that vaccine cost effectiveness models should take a full account of the costs involved in managing cases and clusters of meningococcal disease
Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial
No full textObjective: To establish the cost effectiveness of nurse led secondary prevention clinics for coronary heart disease based on four years' follow up of a randomised controlled trial. Design: Cost effectiveness analysis. Setting: 19 general practices in north east Scotland. Participants: 1343 patients (673 in intervention group and 670 in control group, as originally randomised) aged under 80 years with a diagnosis of coronary heart disease but without terminal illness or dementia and not housebound. Intervention: Nurse led clinics to promote medical and lifestyle components of secondary prevention. Main outcome measures: Costs of clinics; overall costs to health service; and cost per life year and per quality adjusted life year (QALY) gained, expressed as incremental gain in intervention group compared with control group. Results: The cost of the intervention (clinics and drugs) was £136 ($254; 195) per patient higher (1998-9 prices) in the intervention group, but the difference in other NHS costs, although lower for the intervention group, was not statistically significant. Overall, 28 fewer deaths occurred in the intervention group leading to a gain in mean life years per patient of 0.110 and of 0.124 QALYs. The incremental cost per life year saved was £1236 and that per QALY was £1097. Conclusion: Nurse led clinics for the secondary prevention of coronary heart disease in primary care seem to be cost effective compared with most interventions in health care, with the main gains in life years saved
Exploring the complex pathways among specific types of technology, self-reported sleep duration and body mass index in UK adolescents
No full textObjective: To examine the independent associations between sleep duration, four technology types (computer use, mobile telephones, TV viewing and video gaming) and body mass index (BMI) z-score. We propose a theoretical path model showing direct effects of four technology types on BMI z-score and sleep duration as well as the indirect effects of each technology on BMI z-score while considering sleep duration as a mediator.Methods: Consenting adolescents (n=632; 63.9% girls, aged 11-18 years) were recruited to the Midlands Adolescent Schools sleep Education Study. The School Sleep Habits Survey (SSHS) and Technology Use Questionnaire (TUQ) were administered. Objective measures of height (cm) and weight (kg) were obtained for BMI z-score calculation.Results: Weekday use of all technology types was significantly associated with reduced weekday sleep duration after adjustment (? (computer use)=-0.38, P<0.01; ? (mobile telephone)=-0.27, P<0.01; ? (TV viewing)=-0.35, P<0.01; and ? (video gaming)=-0.39, P<0.01). Use of all technology types, with the exception of mobile telephones, was significantly associated with increased BMI z-score after adjustment (? (computer use)=0.26, P<0.01; ? (TV viewing)=0.31, P<0.01; and ? (video gaming)=0.40, P<0.01). Our path model shows that weekday sleep duration was significantly and negatively associated with BMI z-score (?=-0.40, P<0.01).Conclusion: Weekday sleep duration potentially mediates the effects of some technologies on BMI z-score. If confirmed, improving sleep through better management of technology use could be an achievable intervention for attenuating obesity
Characteristics and impact of Long Covid: findings from an online survey
No full textBackground: Long Covid is a public health concern that needs defining, quantifying, and describing. We aimed to explore the initial and ongoing symptoms of Long Covid following SARS-CoV-2 infection and describe its impact on daily life. Methods: We collected self-reported data through an online survey using convenience non-probability sampling. The survey enrolled adults who reported lab-confirmed (PCR or antibody) or suspected COVID-19 who were not hospitalised in the first two weeks of illness. This analysis was restricted to those with self-reported Long Covid. Univariate comparisons between those with and without confirmed COVID-19 infection were carried out and agglomerative hierarchical clustering was used to identify specific symptom clusters, and their demographic and functional correlates. Results: We analysed data from 2550 participants with a median duration of illness of 7.6 months (interquartile range (IQR) 7.1-7.9). 26.5% reported lab-confirmation of infection. The mean age was 46.5 years (standard deviation 11 years) with 82.8% females and 79.9% of participants based in the UK. 89.5% described their health as good, very good or excellent before COVID-19. The most common initial symptoms that persisted were exhaustion, chest pressure/tightness, shortness of breath and headache. Cognitive dysfunction and palpitations became more prevalent later in the illness. Most participants described fluctuating (57.7%) or relapsing symptoms (17.6%). Physical activity, stress, and sleep disturbance commonly triggered symptoms. A third (32%) reported they were unable to live alone without any assistance at six weeks from start of illness. 16.9% reported being unable to work solely due to COVID-19 illness. 37.0% reported loss of income due to illness, and 64.4% said they were unable to perform usual activities/duties.Acute systems clustered broadly into two groups: a majority cluster (n=2235, 88%) with cardiopulmonary predominant symptoms, and a minority cluster (n=305, 12%) with multisystem symptoms. Similarly, ongoing symptoms broadly clustered in two groups; a majority cluster (n=2243, 88.8%) exhibiting mainly cardiopulmonary, cognitive symptoms and exhaustion, and a minority cluster (n=283, 11.2%) exhibiting more multisystem symptoms. Belonging to the more severe multisystem cluster was associated with more severe functional impact, lower income, younger age, being female, worse baseline health, and inadequate rest in the first two weeks of the illness, with no major differences in the cluster patterns when restricting analysis to the lab-confirmed subgroup. Conclusion: This is an exploratory survey of Long Covid characteristics. Whilst this is a non-representative population sample, it highlights the heterogeneity of persistent symptoms, and the significant functional impact of prolonged illness following confirmed or suspected SARS-CoV-2 infection. To study prevalence, predictors and prognosis, research is needed in a representative population sample using standardised case definitions. <br/
Patient factors influencing the prescribing of lipid lowering drugs for primary prevention of cardiovascular disease in UK general practice: a national retrospective cohort study
Full text linkBACKGROUND: Guidelines indicate eligibility for lipid lowering drugs, but it is not known to what extent GPs' follow guidelines in routine clinical practice or whether additional clinical factors systematically influence their prescribing decisions. METHODS: A retrospective cohort analysis was undertaken using electronic primary care records from 421 UK general practices. At baseline (May 2008) patients were aged 30 to 74 years, free from cardiovascular disease and not taking lipid lowering drugs. The outcome was prescription of a lipid lowering drug within the next two years. The proportions of eligible and ineligible patients prescribed lipid lowering drugs were reported and multivariable logistic regression models were used to investigate associations between age, sex, cardiovascular risk factors and prescribing. RESULTS: Of 365,718 patients with complete data, 13.8% (50,558) were prescribed lipid lowering drugs: 28.5% (21,101/74,137) of those eligible and 10.1% (29,457/291,581) of those ineligible. Only 41.7% (21,101/50,558) of those prescribed lipid lowering drugs were eligible. In multivariable analysis prescribing was most strongly associated with increasing age (OR for age ≥ 65 years 4.21; 95% CI 4.05-4.39); diabetes (OR 4.49; 95% CI 4.35-4.64); total cholesterol level ≥ 7 mmol/L (OR 2.20; 95% CI 2.12-2.29); and ≥ 4 blood pressure measurements in the past year (OR 4.24; 95% CI 4.06-4.42). The predictors were similar in eligible and ineligible patients. CONCLUSIONS: Most lipid lowering drugs for primary prevention are prescribed to ineligible patients. There is underuse of lipid lowering drugs in eligible patients
The feasibility and acceptability of assessing and managing sarcopenia and frailty among older people with upper limb fracture
No full textBackground: Sarcopenia and frailty are associated with increased risk of falls and fractures. This study evaluated the feasibility of assessing sarcopenia and frailty among older people attending fracture clinics.Methods: Patients aged 65+ years with an arm fracture attending fracture clinics in one UK city were recruited. Sarcopenia was assessed using gait speed, grip strength, skeletal muscle mass index SMI, SARC-F questionnaire, the European Working Group on Sarcopenia in Older People (EWGSOP) I and II criteria. Frailty was assessed using Fried Frailty Phenotype (FFP), FRAIL scale, PRISMA-7, electronic Frailty Index (e-FI), Clinical Frailty Score (CFS), and Study of Osteoporotic Fracture (SOF). The sensitivity and specificity of each tool was calculated against the EWGSOP II criteria (sarcopenia) and FFP (frailty). Patients identified to have either condition were referred for Comprehensive Geriatric Assessment (CGA). Interviews with 13 patients and nine staff explored the acceptability of this process.Results: 100 patients (Mean age 75 years) were recruited. Most sarcopenia and frailty assessments were quick with complete data collection and were acceptable to patients and staff. Sarcopenia was identified among 4% -39% participants depending on the tool and frailty among 9-25%. Both conditions were more common among men than women with all tools. The SARC-F and PRISMA-7 had the best sensitivity (100% and 93% respectively) and specificity (96% and 87%). CGA among 80% of referred participants led to three interventions per participant (e.g. medication changes, investigations). Conclusions: SARC-F and PRISMA-7 are recommended for use in fracture clinics to screen for sarcopenia and frailty
Treatment burden for patients with multimorbidity: cross-sectional study with exploration of a single-item measure
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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