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Holleyman RJ, Barnard S, Bauer-Staeb C, Hughes A, Dunn S, Fox S, Newton JN, Fitzpatrick J, Waller Z, Deehan DJ, Charlett A, Gregson CL, Wilson R, Fryers P, Goldblatt P, Burton P. Adjusting expected deaths for mortality displacement during the COVID-19 pandemic: a model based counterfactual approach at the level of individuals. BMC Med Res Methodol 2023; 23:241. [PMID: 37853353 PMCID: PMC10585864 DOI: 10.1186/s12874-023-01984-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/23/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Near-real time surveillance of excess mortality has been an essential tool during the COVID-19 pandemic. It remains critical for monitoring mortality as the pandemic wanes, to detect fluctuations in the death rate associated both with the longer-term impact of the pandemic (e.g. infection, containment measures and reduced service provision by the health and other systems) and the responses that followed (e.g. curtailment of containment measures, vaccination and the response of health and other systems to backlogs). Following the relaxing of social distancing regimes and reduction in the availability of testing, across many countries, it becomes critical to measure the impact of COVID-19 infection. However, prolonged periods of mortality in excess of the expected across entire populations has raised doubts over the validity of using unadjusted historic estimates of mortality to calculate the expected numbers of deaths that form the baseline for computing numbers of excess deaths because many individuals died earlier than they would otherwise have done: i.e. their mortality was displaced earlier in time to occur during the pandemic rather than when historic rates predicted. This is also often termed "harvesting" in the literature. METHODS We present a novel Cox-regression-based methodology using time-dependent covariates to estimate the profile of the increased risk of death across time in individuals who contracted COVID-19 among a population of hip fracture patients in England (N = 98,365). We use these hazards to simulate a distribution of survival times, in the presence of a COVID-19 positive test, and then calculate survival times based on hazard rates without a positive test and use the difference between the medians of these distributions to estimate the number of days a death has been displaced. This methodology is applied at the individual level, rather than the population level to provide a better understanding of the impact of a positive COVID-19 test on the mortality of groups with different vulnerabilities conferred by sociodemographic and health characteristics. Finally, we apply the mortality displacement estimates to adjust estimates of excess mortality using a "ball and urn" model. RESULTS Among the exemplar population we present an end-to-end application of our methodology to estimate the extent of mortality displacement. A greater proportion of older, male and frailer individuals were subject to significant displacement while the magnitude of displacement was higher in younger females and in individuals with lower frailty: groups who, in the absence of COVID-19, should have had a substantial life expectancy. CONCLUSION Our results indicate that calculating the expected number of deaths following the first wave of the pandemic in England based solely on historical trends results in an overestimate, and excess mortality will therefore be underestimated. Our findings, using this exemplar dataset are conditional on having experienced a hip fracture, which is not generalisable to the general population. Fractures that impede mobility in the weeks that follow the accident/surgery considerably shorten life expectancy and are in themselves markers of significant frailty. It is therefore important to apply these novel methods to the general population, among whom we anticipate strong patterns in mortality displacement - both in its length and prevalence - by age, sex, frailty and types of comorbidities. This counterfactual method may also be used to investigate a wider range of disruptive population health events. This has important implications for public health monitoring and the interpretation of public health data in England and globally.
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Affiliation(s)
- Richard James Holleyman
- UK Health Security Agency, Wellington House; 133-155 Waterloo Road, London, SE1 8UG, UK.
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK.
| | - Sharmani Barnard
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Clarissa Bauer-Staeb
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Andrew Hughes
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Samantha Dunn
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Sebastian Fox
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - John N Newton
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Justine Fitzpatrick
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Zachary Waller
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - David John Deehan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
| | - Andre Charlett
- UK Health Security Agency, Wellington House; 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU, UK
| | - Rebecca Wilson
- Department of Public Health, Policy and Systems, University of Liverpool Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL, UK
| | - Paul Fryers
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Peter Goldblatt
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
- Department of Epidemiology & Public Health, UCL Institute of Health Equity, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Paul Burton
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
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2
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Yu D, Jordan KP, Wilkie R, Bailey J, Fitzpatrick J, Ali N, Niblett P, Peat G. Persistent inequalities in consultation incidence and prevalence of low back pain and osteoarthritis in England between 2004 and 2019. Rheumatol Adv Pract 2022; 7:rkac106. [PMID: 36601519 PMCID: PMC9800855 DOI: 10.1093/rap/rkac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
Objective We wanted to determine whether socioeconomic inequalities in primary care consultation rates for two major, disabling musculoskeletal conditions in England narrowed or widened between 2004 and 2019. Methods We analysed data from Clinical Practice Research Datalink Aurum, a national general practice electronic health records database, linked to national deprivation ranking of each patient's registered residential postcode. For each year, we estimated the age- and sex-standardized consultation incidence and prevalence for low back pain and OA for the most deprived 10% of neighbourhoods through to the least deprived 10%. We then calculated the slope index of inequality and relative index of inequality overall and by sex, age group and geographical region. Results Inequalities in low back pain incidence and prevalence over socioeconomic status widened between 2004 and 2013 and stabilized between 2014 and 2019. Inequalities in OA incidence remained stable over socioeconomic status within the study period, whereas inequalities in OA prevalence widened markedly over socioeconomic status between 2004 and 2019. The widest gap in low back pain incidence and prevalence over socioeconomic status was observed in populations resident in northern English regions and London and in those of working age, peaking at 45-54 years. Conclusion We found persistent, and generally increasing, socioeconomic inequalities in the rate of adults presenting to primary care in England with low back pain and OA between 2004 and 2019.
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Affiliation(s)
- Dahai Yu
- Correspondence: Dahai Yu, Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, Staffordshire ST5 5BG, UK. E-mail:
| | - Kelvin P Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Ross Wilkie
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - James Bailey
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Justine Fitzpatrick
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - Nuzhat Ali
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - Paul Niblett
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK,Department of Allied Health Professions, College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield, UK
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Butler E, Walsh JE, Grogan S, Lyons C, Whalley D, Fitzpatrick J, Gallagher L, Dockery F. 348 WHAT IS THE OLDER PATIENT’S VIEW ON RECEIVING DETAILED MEDICAL LETTERS? Age Ageing 2022. [DOI: 10.1093/ageing/afac218.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sending copies of clinic letters to patients involves additional work for medical staff in formatting letters, administrative staff in printing and posting and is an added cost to the healthcare service. Though seen largely as good practice in some specialities, it is not done routinely in Geriatric medical services. We introduced this practice as standard in our service and wished to evaluate whether from the patient perspective, it is worthwhile.
Methods
We sent a questionnaire to n=80 older patients who were evaluated in the home setting (by the Integrated Care Team for Older People – ICTOP) or recently attended CGA (Comprehensive Geriatric Assessment) clinic or FLS (Fracture Liaison Service) clinic. We asked their opinion on the detailed medical letter sent to their General Practitioner (GP), which they received a copy of. The questionnaire could be completed by patient/carer/relative, and returned anonymously.
Results
N=30/80 were returned. Two said they found the letter difficult to understand; 1/30 said the letter caused them to worry but all said they still preferred that they had received it. N= 2 said they would like to have contributed to the letter for accuracy. All said they felt they should receive copies of all their medical correspondence. Free text comments showed overwhelming support for the process, in allowing them to self-manage their health, enhance communication with other healthcare professionals and was a useful document to refer back to when they are trying to process information during short consultations.
Conclusion
Though a small survey and limited by low response rate, older people expressed high levels of satisfaction in receiving copies of medical letters about their health. It supports the ongoing practice and should be adopted widely.
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Affiliation(s)
- E Butler
- Beaumont Hospital , Dublin, Ireland
| | - JE Walsh
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| | - S Grogan
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| | - C Lyons
- Beaumont Hospital , Dublin, Ireland
| | - D Whalley
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
| | | | | | - F Dockery
- Beaumont Hospital , Dublin, Ireland
- Integrated Care Team for Older People, North Dublin , Dublin, Ireland
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Iyengar KP, Azzopardi CA, Fitzpatrick J, Hill T, Haleem S, Panchal H, Botchu R. Calcaneal offset index to measure hindfoot alignment in pes planus. Skeletal Radiol 2022; 51:1631-1637. [PMID: 35146553 DOI: 10.1007/s00256-022-04011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pes planus is a common three-dimensional (3D) deformity characterised by forefoot abduction, the collapse of the medial longitudinal arch, and hindfoot valgus. Several radiological measurements such as anteroposterior talocalcaneal angle (Kite's) and 'Calcaneal pitch angle' (CPA) exist to calculate the degree of hindfoot alignment in these patients with variable intra- and interobserver reliability. OBJECTIVE To describe a new radiological ancillary method of measuring hindfoot alignment, the calcaneal offset index (COI). MATERIAL AND METHODS Anteroposterior (mortise) and lateral view weight-bearing (WB) ankle radiographs of 200 consecutive patients referred for foot and ankle pain were reviewed. Demographic details, clinical indication, and COI calculation were undertaken on the mortise view along with the measurement of CPA for each patient. A one-way analysis of variance (ANOVA) was performed. Intraclass correlation coefficient (ICC) analysis was evaluated to assess the intraclass reliability between observers. RESULTS There was a female preponderance of 2:1 in the study population with a mean age of 51.21 years (13-86 years). The calcaneal offset was increased in pes planus (hindfoot valgus). The p-value was 0.00023 on ANOVA. The COI gave an excellent interobserver correlation with ICC of 0.9 and moderate intraobserver reliability on the ICC analysis of 0.55. CONCLUSION The COI can be an additional index of measuring hindfoot alignment in patients with pes planus. Contrary to the traditional angular measurements, this linear transverse plane measure is easier to calculate and reproducible. COI measurement has shown moderate intraobserver reliability but excellent interobserver reliability.
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Affiliation(s)
- K P Iyengar
- Departments of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK
| | - C A Azzopardi
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK
| | - J Fitzpatrick
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK
| | - T Hill
- Departments of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK
| | - S Haleem
- Departments of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - H Panchal
- Sanyapixel Diagnostics, Ahmedabad, India
| | - R Botchu
- Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK.
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Fitzpatrick J. 1. Livestock Science Matters for Human and Planetary Health. Animal - science proceedings 2022. [PMCID: PMC9090130 DOI: 10.1016/j.anscip.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Yu D, Missen M, Jordan KP, Edwards JJ, Bailey J, Wilkie R, Fitzpatrick J, Ali N, Niblett P, Peat G. Trends in the Annual Consultation Incidence and Prevalence of Low Back Pain and Osteoarthritis in England from 2000 to 2019: Comparative Estimates from Two Clinical Practice Databases. Clin Epidemiol 2022; 14:179-189. [PMID: 35210865 PMCID: PMC8860349 DOI: 10.2147/clep.s337323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare estimates of annual person-consulting incidence and prevalence of low back pain (LBP) and osteoarthritis for two national English electronic health record databases (Clinical Practice Research Datalink (CPRD) Aurum and CPRD GOLD). Patients and Methods Retrospective, population-based, longitudinal cohort study. LBP and osteoarthritis cases were defined using established codelists in people aged ≥15 and ≥45 years, respectively. Incident cases were new recorded cases in a given calendar year with no relevant consultation in the previous 3 years (denominator = exact person-time in the same calendar year for the at-risk population). Prevalent cases were individuals with ≥1 consultation for the condition of interest recorded in a given calendar year, irrespective of prior consultations for the same condition (denominator = all patients with complete registration history in the previous 3 years). We estimated age-sex standardised incidence and annual (12-month period) prevalence for both conditions in 2000–2019, overall, and by sex, age group, and region. Results Standardised incidence and prevalence of LBP from Aurum were lower than those from GOLD until 2014, after which estimates were similar. Both databases showed recent declines in incidence and prevalence of LBP: declines began earlier in GOLD (after 2012–2014) than Aurum (after 2014–2015). Standardised incidence (after 2011) and prevalence of osteoarthritis (after 2003) were higher in Aurum than GOLD and showed different trends: incidence and prevalence were stable or increasing in Aurum, decreasing in GOLD. Stratified estimates in CPRD Aurum suggested consistently higher occurrence among women, older age groups, and those living in the north of England. Conclusion Comparative analyses of two English databases produced conflicting estimates and trends for two common musculoskeletal conditions. Aurum estimates appeared more consistent with external sources and may be useful for monitoring population musculoskeletal health and healthcare demand, but they remain sensitive to analytic decisions and data quality.
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Affiliation(s)
- Dahai Yu
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
- Correspondence: Dahai Yu, Email
| | - Matthew Missen
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Kelvin P Jordan
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - John J Edwards
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - James Bailey
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Ross Wilkie
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Justine Fitzpatrick
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Nuzhat Ali
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Paul Niblett
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - George Peat
- Primary Care Centre versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
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Barnard S, Fryers P, Fitzpatrick J, Fox S, Waller Z, Baker A, Burton P, Newton J, Doyle Y, Goldblatt P. Inequalities in excess premature mortality in England during the COVID-19 pandemic: a cross-sectional analysis of cumulative excess mortality by area deprivation and ethnicity. BMJ Open 2021; 11:e052646. [PMID: 34949618 PMCID: PMC8710653 DOI: 10.1136/bmjopen-2021-052646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To examine magnitude of the impact of the COVID-19 pandemic on inequalities in premature mortality in England by deprivation and ethnicity. DESIGN A statistical model to estimate increased mortality in population subgroups during the COVID-19 pandemic by comparing observed with expected mortality in each group based on trends over the previous 5 years. SETTING Information on deaths registered in England since 2015 was used, including age, sex, area of residence and cause of death. Ethnicity was obtained from Hospital Episode Statistics records linked to death data. PARTICIPANTS Population study of England, including all 569 824 deaths from all causes registered between 21 March 2020 and 26 February 2021. MAIN OUTCOME MEASURES Excess mortality in each subgroup over and above the number expected based on trends in mortality in that group over the previous 5 years. RESULTS The gradient in excess mortality by area deprivation was greater in the under 75s (the most deprived areas had 1.25 times as many deaths as expected, least deprived 1.14) than in all ages (most deprived had 1.24 times as many deaths as expected, least deprived 1.20). Among the black and Asian groups, all area deprivation quintiles had significantly larger excesses than white groups in the most deprived quintiles and there were no clear gradients across quintiles. Among the white group, only those in the most deprived quintile had more excess deaths than deaths directly involving COVID-19. CONCLUSION The COVID-19 pandemic has widened inequalities in premature mortality by area deprivation. Among those under 75, the direct and indirect effects of the pandemic on deaths have disproportionately impacted ethnic minority groups irrespective of area deprivation, and the white group the most deprived areas. Statistics limited to deaths directly involving COVID-19 understate the pandemic's impact on inequalities by area deprivation and ethnic group at younger ages.
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Affiliation(s)
- Sharmani Barnard
- Health Intelligence, Public Health England, London, UK
- ARC Centre of Excellence for Children and Families over the Life Course (Life Course Centre), Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Paul Fryers
- Health Intelligence, Public Health England, London, UK
| | | | - Sebastian Fox
- Health Intelligence, Public Health England, London, UK
| | | | - Allan Baker
- Health Intelligence, Public Health England, London, UK
| | - Paul Burton
- Health Intelligence, Public Health England, London, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Newton
- Health Intelligence, Public Health England, London, UK
| | - Yvonne Doyle
- Health Intelligence, Public Health England, London, UK
| | - Peter Goldblatt
- Health Intelligence, Public Health England, London, UK
- UCL Institute of Health Equity, University College London, London, UK
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Lomas J, Brown N, Fitzpatrick J, Fryers P, Barnard S. Comparison of all-cause mortality in England with Europe and the USA: January 2020 to February 2021. Eur J Public Health 2021. [PMCID: PMC8574263 DOI: 10.1093/eurpub/ckab165.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Assessing mortality during the COVID-19 pandemic is vital for informing public health strategies and policy decision making. All-cause excess mortality provides an objective measure of the impact of the pandemic including both the direct and indirect effects. Our study considers the burden of mortality in the UK, Europe and the USA. We examine variation between countries, by age and sex. We explore the extent to which this variation is associated with COVID-19 case rates and other population characteristics. Methods The study is a secondary analysis of routine administrative population and mortality data. Weekly death occurrences and population estimates were obtained from Eurostat and national statistical agencies. Contextual information on COVID-19 case rates, population-level risk factors and healthcare were obtained from various open-source databases. Weekly age-standardised mortality rates (ASMRs) were calculated and presented relative to a baseline average from the preceding 5-year period. Relative cumulative (rc) ASMRs were then calculated to provide a comparable assessment of excess mortality at a point in time. Results Preliminary results show that, by end of the analysis period, England had an overall rcASMR of 10.09%. Higher excess mortality was identified for some countries (eg USA 14.58%) and lower - even below average mortality - for others (eg Norway -6.8%). Under 65 rcASMR showed substantial variation between countries. Cumulative COVID-19 case rates showed a moderate effect size (R2 = 0.51) when used to explain the proportion of variation observed between rcASMRs. Other population factors showed a smaller effect. Conclusions The burden of mortality experienced between countries and populations over the COVID-19 pandemic period has shown significant variation. Factors which may have contributed to the position of some countries should be further explored in order to inform ongoing management of Covid-19 and future pandemic events. Key messages Significant variation in all-cause excess mortality has been identified across the COVID-19 pandemic period between nations and particularly in younger age groups. COVID-19 case rates are associated with relative cumulative all-cause excess mortality among the nations assessed.
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Affiliation(s)
- J Lomas
- Public Health England, London, UK
| | - N Brown
- Public Health England, London, UK
| | | | - P Fryers
- Public Health England, London, UK
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Fryers PT, Barnard S, Burton PR, Fox S, Waller Z, Fitzpatrick J. Excess mortality in England during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574561 DOI: 10.1093/eurpub/ckab164.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Excess mortality monitoring is not dependent on completeness or consistency of coding of causes of death and captures deaths caused directly and indirectly by COVID-19. It takes account of existing inequalities in the baseline rates and shows the additional impact of COVID-19. We report weekly on excess mortality by age, gender, geographical area, deprivation, and ethnicity.
Methods
A quasi-Poisson model was fitted to deaths data for 2015-2019 to estimate expected mortality in population sub-groups each week during the COVID-19 pandemic. This was compared with observed mortality reported each week. Information on deaths registered was obtained from death certificates. Ethnicity was obtained from hospital records linked to deaths data.
Results
Early in the pandemic, excess deaths exceeded official reported COVID-19 deaths every week. Throughout the pandemic there were stark inequalities in excess death rates. Based on data from 21 March 2020 to 9 April 2021, people living in the most deprived areas in England experienced more excess (1.21 times; 95% CI 1.21-1.22) compared with people living in the least deprived areas (1.17; 1.16-1.18). Black (1.56; 1.53-1.58) and Asian groups (1.55; 1.53-1.56) experienced more excess than the White group (1.16; 1.16-1.17). There was wide variation between English regions.
Conclusions
Reporting overall excess mortality early in the pandemic is important to inform policy makers and public about the true scale of the death toll when coding is inconsistent and developing. This approach has highlighted the large increases in already established inequalities in mortality. It provides rapid surveillance of developing disparities for national and local decision makers. It has been used to inform policy around reducing disparities and to revise messaging to encourage hospital attendance for non- COVID-19 health problems.
Key messages
Excess deaths from all causes is a robust measure of overall impact, unaffected by coding consistency. COVID-19 has dramatically worsened established inequalities between ethnic groups and deprivation groups.
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Affiliation(s)
- PT Fryers
- Health Improvement, Public Health England, Sheffield, UK
| | - S Barnard
- Life Course Centre, Telethon Kids Institute, Perth, Australia
- Health Improvement, Public Health England, Sheffield, UK
| | - PR Burton
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
- Health Improvement, Public Health England, Sheffield, UK
| | - S Fox
- Health Improvement, Public Health England, Sheffield, UK
| | - Z Waller
- Health Improvement, Public Health England, Sheffield, UK
| | - J Fitzpatrick
- Health Improvement, Public Health England, Sheffield, UK
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Newton JN, Griffiths C, Fitzpatrick J, Lamagni T, Campos-Matos I. Sex-disaggregated data is reported by Public Health England. Lancet Glob Health 2021; 9:e1059. [PMID: 34174186 PMCID: PMC8443002 DOI: 10.1016/s2214-109x(21)00249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
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Rizvi I, Abroaf A, Veeratterapillay R, Rogers A, Shaw M, Fitzpatrick J. Management of acute ureteric colic in a large tertiary centre during the initial COVID-19 pandemic - How did our practice change? Eur Urol 2021. [PMCID: PMC8263123 DOI: 10.1016/s0302-2838(21)00636-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Smith M, Orchard JJ, La Gerche A, Gallagher R, Fitzpatrick J. Fit, Female or Fifty - is cardiac rehabilitation fit for purpose? A systematic review and meta-analysis with meta-regression. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention, aimed to address modifiable risk factors for coronary artery disease. It is recommended worldwide for patients following myocardial infarction (MI), Percutaneous Coronary Intervention (PCI) and cardiac surgery. A growing body of evidence points towards a lack of uptake in CR in females and younger people.
Purpose
To examine the effectiveness of contemporary CR programs and assess whether they cater for all patients regardless of age, gender and prior level of fitness, via systematic review, meta-analysis and meta-regression.
Methods
MEDLINE was examined for studies involving exercise prescription or CR following MI, PCI and cardiac surgery from January 2010 to May 2020. RCTs and cohort studies of ≥10 patients were included for programs delivering phase II or III CR. Primary outcome measures were peakVO2max, 6-minute walk test (6MWT) and Metabolic Equivalent of Task (METs). Data were extracted using random effects meta-analysis. Epidemiological data were analysed for age, proportion of males to females and prior level of fitness. Baseline level of fitness was assessed by peakVO2max, 6MWT and METs values on entry into CR programs. Meta-regression was then used to determine change in fitness and the influence of age or gender.
Results
Thirty-three of the 713 studies (13 RCT, 20 cohort) were eligible and included in the review. Participants had a mean age of 60.0 years and 6/49 (12%) of study groups had a mean age <55 years. Male participants comprised 81.9% of those who completed CR and 41/58 (71%) participants were below average for cardiorespiratory fitness (CRF) when compared to normative values for those aged 60-69 years on entering CR.
CRF improved in all study groups by the end of CR programs (mean improvement in peakVO2 3.3mL/kg/min, 6MWT 90.8m and METs 1.7). Meta-regression analysis showed that males were more likely to have an increase in 6MWT distance compared to females (mean difference 3.16m (95% CI 0.44-5.89). However, gender and age did not independently affect peakVO2max or METs.
Conclusion
CR following MI, PCI or cardiac surgery improved mean CRF in all study groups. While males were more likely to show an improvement in 6MWT there was no appreciable difference in effect in other outcomes after controlling for age or gender differences.
Females, younger people and those of average or above CRF appear to be under-represented in data and attendance at cardiac rehabilitation. Given that CR outcomes are equal across gender and age, more effort should be made to encourage female and younger patients to attend. A ‘Precision Medicine’ model of exercise prescription may assist in this aim.
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Affiliation(s)
- M Smith
- Australasian College of Sports and Exercise Physicians, Melbourne, Australia
| | - JJ Orchard
- University of Sydney, Charles Perkins Centre, Sydney, Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - R Gallagher
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - J Fitzpatrick
- University of Melbourne, CHESM, Melbourne, Australia
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Kopecky B, Lin C, Frye C, Dun H, Bayguinov P, Fitzpatrick J, Kreisel D, Lavine K. Modulation of Donor Cardiac Macrophages is Sufficient to Suppress Rejection and Extend Allograft Survival. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Naughton C, Ezhova I, Hayes N, Fitzpatrick J. 77 Developing and Testing An Education-Career Pathway in Healthcare for Older People (ECHO) to Promote Retention in Early-Career Gerontological Nurses. Age Ageing 2020. [DOI: 10.1093/ageing/afz191.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The NHS Long Term Plan (2019) sets specific targets for multidisciplinary services for frail older people over the next ten years. Delivery and sustainability is crucially dependant on the capability and capacity of gerontological nursing. High cost cities such as London experience high staff vacancy rates in acute care older adult services.
Aim
The study took a regional approach, working with NHS Trusts to develop a multicomponent intervention to increase retention and competencies of early career nurses working in gerontological services. The study examined the acceptability and feasibility of the intervention and tested a quasi-experiential evaluation design. Ethical approval was obtained from the University Ethics committee.
Methods
A co-design approach with stakeholders, early career nurses, educationalists and nurse managers, produced a multicomponent intervention: education module (masters level), gerontological competency booklet, external clinical learning opportunities, career coaching and mentorship delivered over a six-month period. The evaluation involved a mix-methods pre-post survey and focus group interviews.
Results
Twenty-nine early career nurses were recruited from five Trusts. The multicomponent intervention was well received, but there were difficulties facilitating external learning opportunities and providing career mentors. The primary outcome was intention to remain in gerontological nursing (measured using a point Likert scale). Pre-post the intervention this remained high (mean score 6 IQR 5-7), p=0.78. There was a significant increase in gerontological knowledge: at baseline the median score was 87 (IQR 81-102) compared to 107 (IQR 98-112) post-intervention, p=0.006. In focus groups participants identified three main mechanism of action for ECHO: building gerontological knowledge and skills; professional identity as older adult nurse; and networking to broaden horizons.
Conclusions
The study has demonstrated the potential of Trusts to work collaboratively with education providers to deliver a model of career-education pathway that may help attract and retain early career nurses to work in gerontology.
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15
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Affiliation(s)
- Allan Baker
- Public Health England, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - Faith Ege
- Public Health England, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - Justine Fitzpatrick
- Public Health England, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - John Newton
- Public Health England, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
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16
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Steel N, Ford JA, Newton JN, Davis ACJ, Vos T, Naghavi M, Glenn S, Hughes A, Dalton AM, Stockton D, Humphreys C, Dallat M, Schmidt J, Flowers J, Fox S, Abubakar I, Aldridge RW, Baker A, Brayne C, Brugha T, Capewell S, Car J, Cooper C, Ezzati M, Fitzpatrick J, Greaves F, Hay R, Hay S, Kee F, Larson HJ, Lyons RA, Majeed A, McKee M, Rawaf S, Rutter H, Saxena S, Sheikh A, Smeeth L, Viner RM, Vollset SE, Williams HC, Wolfe C, Woolf A, Murray CJL. Changes in health in the countries of the UK and 150 English Local Authority areas 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018; 392:1647-1661. [PMID: 30497795 PMCID: PMC6215773 DOI: 10.1016/s0140-6736(18)32207-4] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/17/2018] [Accepted: 08/30/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile. METHODS We extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters. FINDINGS The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791-15 875] in Blackpool to 6888 [6145-7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990-2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer's disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258-2356]) was higher than for ischaemic heart disease (1200 [1155-1246]) or lung cancer (660 [642-679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK, which reflects the relative scarcity of local data on causes of ill health. INTERPRETATION These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression. Improving the quality and completeness of available data on these causes is an essential component of this response. FUNDING Bill & Melinda Gates Foundation and Public Health England.
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Affiliation(s)
| | | | | | - Adrian C J Davis
- AD CAVE Solutions Ltd, London, UK; Imperial College London, London, UK
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Scott Glenn
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Traolach Brugha
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Simon Capewell
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK
| | - Josip Car
- Imperial College London, London, UK; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | | | | | - Felix Greaves
- Public Health England, London, UK; Imperial College London, London, UK
| | | | - Simon Hay
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research (NI), Queens University of Belfast, Belfast, UK
| | - Heidi J Larson
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; London School of Hygiene & Tropical Medicine, London, UK
| | - Ronan A Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | | | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Liam Smeeth
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Hywel C Williams
- Centre of Evidence-Based Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, UK
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17
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Reitzle L, Hansen S, Paprott R, Achtermann W, Baumert J, Bogaert P, Curt L, Diem P, Du Y, Eiser S, Fitzpatrick J, Heidemann C, Jousilahti P, Kulzer B, Lindström J, Neuhauser H, van Oyen H, Pelletier L, Schmidt C, Valabhji J, Weitgasser R, Ziese T, Zahn D, Scheidt-Nave C. National public health system responses to diabetes and other important noncommunicable diseases : Background, goals, and results of an international workshop at the Robert Koch Institute. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1300-1306. [PMID: 30191268 DOI: 10.1007/s00103-018-2806-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Diabetes mellitus and other noncommunicable diseases (NCDs) represent an emerging global public health challenge. In Germany, about 6.7 million adults are affected by diabetes according to national health surveys, including 1.3 million with undiagnosed diabetes. Complications of diabetes result in an increasing burden for individuals and society as well as enormous costs for the health care system. In response, the Federal Ministry of Health commissioned the Robert Koch Institute (RKI) to implement a diabetes surveillance system and the Federal Center for Health Education (BZgA) to develop a diabetes prevention strategy. In a two-day workshop jointly organized by the RKI and the BZgA, representatives from public health institutes in seven countries shared their expertise and knowledge on diabetes prevention and surveillance. Day one focused on NCD surveillance systems and emphasized both the strengthening of sustainable data sources and the timely and targeted dissemination of results using innovative formats. The second day focused on diabetes prevention strategies and highlighted the importance of involving all relevant stakeholders in the development process to facilitate its acceptance and implementation. Furthermore, the effective translation of prevention measures into real-world settings requires data from surveillance systems to identify high-risk groups and evaluate the effect of measures at the population level based on analyses of time trends in risk factors and disease outcomes. Overall, the workshop highlighted the close link between diabetes prevention strategies and surveillance systems. It was generally stated that only robust data enables effective prevention measures to encounter the increasing burden from diabetes and other NCDs.
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Affiliation(s)
- Lukas Reitzle
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), General-Pape-Straße, 12101, Berlin, Germany
| | - Sylvia Hansen
- Federal Center for Health Education (BZgA), Cologne, Germany
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), General-Pape-Straße, 12101, Berlin, Germany
| | | | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), General-Pape-Straße, 12101, Berlin, Germany
| | | | - Laure Curt
- Federal Office of Public Health, Bern, Switzerland
| | - Peter Diem
- Swiss Diabetes Foundation, Baden, Switzerland
| | - Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), General-Pape-Straße, 12101, Berlin, Germany
| | - Stefanie Eiser
- Federal Center for Health Education (BZgA), Cologne, Germany
| | | | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), General-Pape-Straße, 12101, Berlin, Germany
| | | | | | - Jaana Lindström
- National Institute for Health and Welfare, Helsinki, Finland
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), General-Pape-Straße, 12101, Berlin, Germany
| | | | | | - Christian Schmidt
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), General-Pape-Straße, 12101, Berlin, Germany
| | | | | | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), General-Pape-Straße, 12101, Berlin, Germany
| | - Daniela Zahn
- Federal Center for Health Education (BZgA), Cologne, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), General-Pape-Straße, 12101, Berlin, Germany.
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18
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Saxena S, George J, Barber J, Fitzpatrick J, Majeed A. Association of Population and Practice Factors with pOtentially Avoidable Admission Rates for Chronic Diseases in London: Cross Sectional Analysis. J R Soc Med 2017; 99:81-9. [PMID: 16449782 PMCID: PMC1360495 DOI: 10.1177/014107680609900221] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine the association between underlying ill health, material deprivation and primary care supply factors and hospital admission rates for potentially avoidable admissions in primary care trusts in London. DESIGN Cross sectional analysis at primary care trusts level using routine data from multiple sources. SETTING All 31 primary care trusts in London with a total resident population of 7 million patients. MAIN OUTCOME MEASURES Age-standardized hospital admission rates for asthma, diabetes, heart failure, hypertension and chronic obstructive pulmonary disease. RESULTS Admission rates varied widely for the conditions examined across the 31 primary care trusts. In 2001, age adjusted admission rates for asthma varied from 76 to 189 per 100,000 and for diabetes from 38 to 183 per 100,000. There was a significant association between higher admission rates and measures of underlying ill health and material deprivation but not quantitative measures of primary care service provision. Provision of specialist chronic disease services in primary care for diabetes but not for asthma were significantly associated with reduced admission rates. There was no association of prescribing levels in primary care trusts with admission rates for any of the conditions examined. CONCLUSIONS Although hospital admission for some chronic diseases is potentially avoidable and rates of hospital admission for these conditions are possible indicators of the quality of care, they should be interpreted in conjunction with measures of population composition and deprivation. Failure to do this may result in primary care trusts and general practitioners being criticized for aspects of health care utilization that are not under their direct control.
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Affiliation(s)
- Sonia Saxena
- Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, London W6 8RP.
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19
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Fitzpatrick J, Fox E, Hoffman A, Dehlendorf C. Differences in social communication about contraception by age and race/ethnicity: baseline results from a randomized controlled trial. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Abstract
A kit for serum calcium determination (Calcium Rapid Stat Kit), based on a methyl thymol blue method, has been investigated and the results compared with those obtained from an AutoAnalyzer cresolphthalein complexone method. The kit technique is simple, requires a small amount of serum and has a better precision than the AutoAnalyzer method, with which it correlates well. The standards supplied should be checked before use.
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Affiliation(s)
- J. M. Cossar
- Area Laboratory, Ballochymyle Hospital, Mauchline, Ayrshire
| | - J. Fitzpatrick
- Area Laboratory, Ballochymyle Hospital, Mauchline, Ayrshire
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21
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Affiliation(s)
- John N Newton
- Public Health England, Wellington House, London SE1 8UG, UK
| | - Richard Pebody
- Public Health England, Wellington House, London SE1 8UG, UK
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Morris M, O'Neill A, Gillis A, Charania S, Fitzpatrick J, Redmond A, Rosli S, Ridgway P. Prepared for Practice? Interns' Experiences of Undergraduate Clinical Skills Training in Ireland. J Med Educ Curric Dev 2016; 3:10.4137_JMECD.S39381. [PMID: 29349313 PMCID: PMC5736273 DOI: 10.4137/jmecd.s39381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND Many previous studies on internship have reported a lack of preparedness for the role. More recently in Ireland, medical schools have introduced formal clinical skills training programmes. This study sought to evaluate the impact, if any, of formal skills training in the medical training on intern's preparedness for practice. METHODS The study utilized a survey approach followed by focus group discussions. The aim was to identify the skills that were taught and assessed in medical training and the skills that were actually required in their intern year. RESULTS Most interns had received skills training in designated skills laboratories. No intern had received training in all skills advised in the European guidelines. Skills taught to all interns were intravenous cannulation, basic life support, and basic suture. Skills required from all interns were intravenous cannulation, phlebotomy, and arterial blood sampling. Removal of peripherally inserted central line (PICC) lines, central lines, and chest drains were commonly requested but not taught. Senior staff underestimated skill abilities and expected failure. CONCLUSION These findings identify discordance between the skills taught and the skills required in the job. There is a need for standardization in the clinical skills training to ensure that all interns enter practice with equal competencies. Consideration should be given to experiential learning opportunities such as subintern programmes to consolidate learning and improve preparedness. Improvement in communications with senior clinicians is indicated to ensure that expectations are realistic and reflective of actual training.
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Affiliation(s)
- M. Morris
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
| | - A. O'Neill
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - A. Gillis
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - S. Charania
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - J. Fitzpatrick
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - A. Redmond
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - S. Rosli
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - P.F. Ridgway
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
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Kramar A, Negrier S, Sylvester R, Joniau S, Mulders P, Powles T, Bex A, Bonnetain F, Bossi A, Bracarda S, Bukowski R, Catto J, Choueiri T, Crabb S, Eisen T, El Demery M, Fitzpatrick J, Flamand V, Goebell P, Gravis G, Houédé N, Jacqmin D, Kaplan R, Malavaud B, Massard C, Melichar B, Mourey L, Nathan P, Pasquier D, Porta C, Pouessel D, Quinn D, Ravaud A, Rolland F, Schmidinger M, Tombal B, Tosi D, Vauleon E, Volpe A, Wolter P, Escudier B, Filleron T, Kramar A, Sylvester R, Filleron T, Negrier S, Joniau S, Mulders P, Powles T, Escudier B, Bex A, Bonnetain F, Bossi A, Braccarda S, Bukowski R, Catto J, Choueiri T, Crabb S, Eisen T, El Demery M, Fitzpatrick J, Flamand V, Goebell PJ, Gravis G, Houédé N, Jacqmin D, Kaplan R, Malavaud B, Massard C, Melichar B, Mourey L, Nathan P, Pasquier D, Porta C, Pouessel D, Quinn D, Ravaud A, Rolland F, Schmidinger M, Tombal B, Tosi D, Vauleon E, Volpe A, Wolter P. Guidelines for the definition of time-to-event end points in renal cell cancer clinical trials: results of the DATECAN project. Ann Oncol 2015; 26:2392-8. [DOI: 10.1093/annonc/mdv380] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/24/2015] [Indexed: 12/19/2022] Open
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Fitzpatrick J, Biju D, Amer T, Hutton R, Nair B. Timing of second resection in high-grade non-muscle-invasive bladder cancer: Does delay adversely affect outcome? Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Fitzpatrick J, Nolke L, Redmond M, McGuinness J. Oxygen requirements on admission predict longer length of stay in paediatric empyema: Findings from a nine-year national referral centre retrospective study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Fitzpatrick J, Anderson N, Kuppermann M, Steinauer J, Wittman A, Dehlendorf C. Pilot study of “My Birth Control,” a contraceptive counseling decision support tool. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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El-Mokadem I, Fitzpatrick J, Bondad J, Rauchhaus P, Cunningham J, Pratt N, Fleming S, Nabi G. Chromosome 9p deletion in clear cell renal cell carcinoma predicts recurrence and survival following surgery. Br J Cancer 2014; 111:1381-90. [PMID: 25137021 PMCID: PMC4183850 DOI: 10.1038/bjc.2014.420] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/25/2014] [Accepted: 07/01/2014] [Indexed: 11/23/2022] Open
Abstract
Background: Wider clinical applications of 9p status in clear cell renal cell carcinoma (ccRCC) are limited owing to the lack of validation and consensus for interphase fluorescent in situ hybridisation (I-FISH) scoring technique. The aim of this study was to analytically validate the applicability of I-FISH in assessing 9p deletion in ccRCC and to clinically assess its long-term prognostic impact following surgical excision of ccRCC. Methods: Tissue microarrays were constructed from 108 renal cell carcinoma (RCC) tumour paraffin blocks. Interphase fluorescent in situ hybridisation analysis was undertaken based on preset criteria by two independent observers to assess interobserver variability. 9p status in ccRCC tumours was determined and correlated to clinicopathological variables, recurrence-free survival and disease-specific survival. Results: There were 80 ccRCCs with valid 9p scoring and a median follow-up of 95 months. Kappa statistic for interobserver variability was 0.71 (good agreement). 9p deletion was detected in 44% of ccRCCs. 9p loss was associated with higher stage, larger tumours, necrosis, microvascular and renal vein invasion, and higher SSIGN (stage, size, grade and necrosis) score. Patients with 9p-deleted ccRCC were at a higher risk of recurrence (P=0.008) and RCC-specific mortality (P=0.001). On multivariate analysis, 9p deletion was an independent predictor of recurrence (hazard ratio 4.323; P=0.021) and RCC-specific mortality (hazard ratio 4.603; P=0.007). The predictive accuracy of SSIGN score improved from 87.7% to 93.1% by integrating 9p status to the model (P=0.001). Conclusions: Loss of 9p is associated with aggressive ccRCC and worse prognosis in patients following surgery. Our findings independently confirm the findings of previous reports relying on I-FISH to detect 9p (CDKN2A) deletion.
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Affiliation(s)
- I El-Mokadem
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - J Fitzpatrick
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - J Bondad
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - P Rauchhaus
- Division of Population Sciences, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - J Cunningham
- Department of Clinical Genetics, NHS Tayside Health Board, Dundee DD1 9SY, UK
| | - N Pratt
- Department of Clinical Genetics, NHS Tayside Health Board, Dundee DD1 9SY, UK
| | - S Fleming
- Department of Pathology, Medical Research Institute, School of Medicine, Dundee DD1 9SY, UK
| | - G Nabi
- Academic section of Urology, Medical Research Institute, School of Medicine, University of Dundee, Dundee DD1 9SY, UK
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Fitzpatrick J, Kricka W, James TC, Bond U. Expression of three Trichoderma reesei cellulase genes in Saccharomyces pastorianus for the development of a two-step process of hydrolysis and fermentation of cellulose. J Appl Microbiol 2014; 117:96-108. [PMID: 24666670 DOI: 10.1111/jam.12494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/26/2014] [Accepted: 03/04/2014] [Indexed: 11/26/2022]
Abstract
AIMS To compare the production of recombinant cellulase enzymes in two Saccharomyces species so as to ascertain the most suitable heterologous host for the degradation of cellulose-based biomass and its conversion into bioethanol. METHOD AND RESULTS cDNA copies of genes representing the three major classes of cellulases (Endoglucanases, Cellobiohydrolases and β-glucosidases) from Trichoderma reesei were expressed in Saccharomyces pastorianus and Saccharomyces cerevisiae. The recombinant enzymes were secreted by the yeast hosts into the medium and were shown to act in synergy to hydrolyse cellulose. The conditions required to achieve maximum release of glucose from cellulose by the recombinant enzymes were defined and the activity of the recombinant enzymes was compared to a commercial cocktail of T. reesei cellulases. CONCLUSIONS We demonstrate that significantly higher levels of cellulase activity were achieved by expression of the genes in S. pastorianus compared to S. cerevisiae. Hydrolysis of cellulose by the combined activity of the recombinant enzymes was significantly better at 50°C than at 30°C, the temperature used for mesophilic yeast fermentations, reflecting the known temperature profiles of the native enzymes. SIGNIFICANCE AND IMPACT OF THE STUDY The results demonstrate that host choice is important for the heterologous production of cellulases. On the basis of the low activity of the T. reesei recombinant enzymes at fermentation temperatures, we propose a two-step process for the hydrolysis of cellulose and its fermentation into alcohol using cellulases produced in situ.
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Affiliation(s)
- J Fitzpatrick
- School of Genetics and Microbiology, Moyne Institute, Trinity College Dublin, College Green, Dublin 2, Ireland
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Canning C, Martin Z, Colgan MP, Abdulrahim O, McCafferty M, Fitzpatrick J, Haider SN, Madhavan P, O'Neill S. Fenestrated endovascular repair of complex aortic aneurysms. Ir J Med Sci 2014; 184:249-55. [PMID: 24599499 DOI: 10.1007/s11845-014-1095-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 02/18/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fenestrated endovascular aneurysm repair (FEVAR) provides an endovascular solution for patients with large abdominal aortic aneurysms and challenging neck anatomy in addition to repair of endoleaks and pseudoaneurysms. This article reports the midterm outcomes of FEVAR from a single-tertiary referral centre in Ireland. METHODS From 2006 to 2012, nine consecutive asymptomatic patients with neck anatomy unfavourable for standard EVAR underwent endovascular repair with a customised fenestrated Zenith stent graft. An additional three patients had fenestrated grafts for repair of pseudoaneurysms (n = 2) following open AAA repair and a type I endoleak (n = 1). All patients were prospectively enrolled in a computerised database. Outcomes including mortality, morbidity, renal function, target vessel patency, endoleak and reintervention were analysed. FINDINGS The mean age and aneurysm size in the primary repair group were 74 years (65-84 years) and 6 cm (5-8.3 cm), respectively, and in the secondary repair group, the mean age was 66 years (61-75 years). No procedures required open conversion, and no visceral arteries were lost. On completion angiography, two patients in group 1 had a type I endoleak and one had a type III endoleak. There were no endoleaks in the secondary repair group. Follow-up ranged from 30 days to 6 years. There was one death within 30 days (8 %) and two deaths at 3 years from non-aneurysm-related causes. Six patients required secondary interventions. Three patients had a transient post-operative creatinine rise of >30 %. CONCLUSION Our study supports FEVAR as a feasible and effective therapy in the management of patients with complex aortic aneurysms.
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Affiliation(s)
- C Canning
- St James's Hospital, Dublin, Ireland,
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Yu NYC, Gdalevitch M, Murphy CM, Mikulec K, Peacock L, Fitzpatrick J, Cantrill LC, Ruys AJ, Cooper-White JJ, Little DG, Schindeler A, Schindeler A. Spatial control of bone formation using a porous polymer scaffold co-delivering anabolic rhBMP-2 and anti-resorptive agents. Eur Cell Mater 2014; 27:98-109; discussion 109-111. [PMID: 24488823 DOI: 10.22203/ecm.v027a08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Current clinical delivery of recombinant human bone morphogenetic proteins (rhBMPs) utilises freeze-dried collagen. Despite effective new bone generation, rhBMP via collagen can be limited by significant complications due to inflammation and uncontrolled bone formation. This study aimed to produce an alternative rhBMP local delivery system to permit more controllable and superior rhBMP-induced bone formation. Cylindrical porous poly(lactic-co-glycolic acid) (PLGA) scaffolds were manufactured by thermally-induced phase separation. Scaffolds were encapsulated with anabolic rhBMP-2 (20 µg) ± anti-resorptive agents: zoledronic acid (5 µg ZA), ZA pre-adsorbed onto hydroxyapatite microparticles, (5 µg ZA/2% HA) or IkappaB kinase (IKK) inhibitor (10 µg PS-1145). Scaffolds were inserted in a 6-mm critical-sized femoral defect in Wistar rats, and compared against rhBMP-2 via collagen. The regenerate region was examined at 6 weeks by 3D microCT and descriptive histology. MicroCT and histology revealed rhBMP-induced bone was more restricted in the PLGA scaffolds than collagen scaffolds (-92.3% TV, p < 0.01). The regenerate formed by PLGA + rhBMP-2/ZA/HA showed comparable bone volume to rhBMP-2 via collagen, and bone mineral density was +9.1% higher (p < 0.01). Local adjunct ZA/HA or PS-1145 significantly enhanced PLGA + rhBMP-induced bone formation by +78.2% and +52.0%, respectively (p ≤ 0.01). Mechanistically, MG-63 human osteoblast-like cells showed cellular invasion and proliferation within PLGA scaffolds. In conclusion, PLGA scaffolds enabled superior spatial control of rhBMP-induced bone formation over clinically-used collagen. The PLGA scaffold has the potential to avoid uncontrollable bone formation-related safety issues and to customise bone shape by scaffold design. Moreover, local treatment with anti-resorptive agents incorporated within the scaffold further augmented rhBMP-induced bone formation.
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Affiliation(s)
- N Y C Yu
- Orthopaedic Research & Biotechnology, Research Building, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145,
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Lim AKP, Patel N, Eckersley RJ, Fitzpatrick J, Crossey MME, Hamilton G, Goldin RD, Thomas HC, Vennart W, Cosgrove DO, Taylor-Robinson SD. A comparison of 31P magnetic resonance spectroscopy and microbubble-enhanced ultrasound for characterizing hepatitis c-related liver disease. J Viral Hepat 2011; 18:e530-4. [PMID: 21914073 DOI: 10.1111/j.1365-2893.2011.01455.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We compared in vivo hepatic (31) P magnetic resonance spectroscopy ((31) P MRS) and hepatic vein transit times (HVTT) using contrast-enhanced ultrasound with a microbubble agent to assess the severity of hepatitis C virus (HCV)-related liver disease. Forty-six patients with biopsy-proven HCV-related liver disease and nine healthy volunteers had (31) P MRS and HVTT performed on the same day. (31) P MR spectra were obtained at 1.5 T. Peak areas were calculated for metabolites, including phosphomonoesters (PME) and phosphodiesters (PDE). Patients also had the microbubble ultrasound contrast agent, Levovist (2 g), injected into an antecubital vein, and time-intensity Doppler ultrasound signals of the right and middle hepatic veins were measured. The HVTT was calculated as the time from injection to a sustained rise in Doppler signal 10% greater than baseline. The shortest times were used for analysis. Based on Ishak histological scoring, there were 15 patients with mild hepatitis, 20 with moderate/severe hepatitis and 11 with cirrhosis. With increasing severity of disease, the PME/PDE ratio was steadily elevated, while the HVTT showed a monotonic decrease. Both imaging modalities could separate patients with cirrhosis from the mild and moderate/severe hepatitis groups. No statistical difference was observed in the accuracy of each test to denote mild, moderate/severe hepatitis and cirrhosis (Fisher's exact test P =1.00). (31) P MRS and HVTT show much promise as noninvasive imaging tests for assessing the severity of chronic liver disease. Both are equally effective and highly sensitive in detecting cirrhosis.
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Affiliation(s)
- A K P Lim
- Imaging Sciences Department, Institute of Clinical Sciences Centre, Faculty of Medicine, London, UK.
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Schukken YH, Günther J, Fitzpatrick J, Fontaine MC, Goetze L, Holst O, Leigh J, Petzl W, Schuberth HJ, Sipka A, Smith DGE, Quesnell R, Watts J, Yancey R, Zerbe H, Gurjar A, Zadoks RN, Seyfert HM. Host-response patterns of intramammary infections in dairy cows. Vet Immunol Immunopathol 2011; 144:270-89. [PMID: 21955443 DOI: 10.1016/j.vetimm.2011.08.022] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 07/28/2011] [Accepted: 08/26/2011] [Indexed: 01/12/2023]
Abstract
Many different bacterial species have the ability to cause an infection of the bovine mammary gland and the host response to these infections is what we recognize as mastitis. In this review we evaluate the pathogen specific response to the three main bacterial species causing bovine mastitis: Escherichia coli, Streptococcus uberis and Staphylococcus aureus. In this paper we will review the bacterial growth patterns, host immune response and clinical response that results from the intramammary infections. Clear differences in bacterial growth pattern are shown between bacterial species. The dominant pattern in E. coli infections is a short duration high bacteria count infection, in S. aureus this is more commonly a persistent infection with relative low bacteria counts and in S. uberis a long duration high bacteria count infection is often observed. The host immune response differs significantly depending on the invading bacterial species. The underlying reasons for the differences and the resulting host response are described. Finally we discuss the clinical response pattern for each of the three bacterial species. The largest contrast is between E. coli and S. aureus where a larger proportion of E. coli infections cause potentially severe clinical symptoms, whereas the majority of S. aureus infections go clinically unnoticed. The relevance of fully understanding the bovine host response to intramammary infection is discussed, some major gaps in our knowledge are highlighted and directions for future research are indicated.
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Affiliation(s)
- Ynte H Schukken
- Quality Milk Production Services, Cornell University, 240 Farrier Road, Ithaca, NY 14853, USA.
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Pyörälä S, Hovinen M, Simojoki H, Fitzpatrick J, Eckersall PD, Orro T. Acute phase proteins in milk in naturally acquired bovine mastitis caused by different pathogens. Vet Rec 2011; 168:535. [DOI: 10.1136/vr.d1120] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S. Pyörälä
- Department of Production Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Paroninkuja 20 04920 Saarentaus Finland
| | - M. Hovinen
- Department of Production Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Paroninkuja 20 04920 Saarentaus Finland
| | - H. Simojoki
- Department of Production Animal Medicine; Faculty of Veterinary Medicine; University of Helsinki; Paroninkuja 20 04920 Saarentaus Finland
| | - J. Fitzpatrick
- Moredun Research Institute; Pentlands Science Park, Bush Loan Penicuik Midlothian EH2 0PZ
| | - P. D. Eckersall
- Division of Animal Production and Public Health; Faculty of Veterinary Medicine; University of Glasgow; Bearsden Road Glasgow G61 1QH
| | - T. Orro
- Department of Animal Health and Environment; Institute of Veterinary Medicine and Animal Sciences; Estonian University of Life Sciences; Kreutzwaldi 62 51014 Tartu Estonia
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Fitzpatrick J, Aoki H, Koh S, deBarbadillo C, Midorikawa I, Miyazaki M, Omori A, Shimizu T. Phosphorus Recovery with New Ultra-Low Adsorption Process. ACTA ACUST UNITED AC 2011. [DOI: 10.2175/193864711802867270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fitzpatrick J, Weaver T, Boner M, Anderson M, O'Bryan C, Tarallo S. Wet-Weather Piloting Toward the Largest Compressible Media Filter on the Planet. ACTA ACUST UNITED AC 2011. [DOI: 10.2175/193864711802766218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mercer D, Morrell NT, Fitzpatrick J, Silva S, Child Z, Miller R, DeCoster TA. The course of the distal saphenous nerve: a cadaveric investigation and clinical implications. Iowa Orthop J 2011; 31:231-235. [PMID: 22096447 PMCID: PMC3215141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Injury to the saphenous nerve at the ankle has been described as a complication resulting from incision and dissection over the distal tibia and medial malleolus. However, the exact course and location of the distal saphenous nerve is not well described in the literature. The purpose of this study was to determine the distal limit of the saphenous nerve and its anatomic relationship to commonly identified orthopaedic landmarks and surgical incisions. METHODS Sixteen cadaveric ankles were examined at the level of the distal tibia medial malleolus. An incision was made along the medial aspect of the lower extremity from the knee to the hallux to follow the course and branches of the saphenous nerve under direct visualization. We recorded the shortest distance from the most distal visualized portion of the saphenous nerve to the tip of the medial malleolus, to the antero-medial arthroscopic portal site, and to the tibialis anterior tendon. RESULTS The saphenous nerve runs posterior to the greater saphenous vein in the leg and divides into an anterior and posterior branch approximately 3 cm proximal to the tip of the medial malleolus. These branches terminate in the integument proximal to the tip of the medial malleolus, while the vein continues into the foot. The anterior branch ends at the anterior aspect of the medial malleolus near the posterior edge of the greater saphenous vein. The posterior branch ends near the posterior aspect of the medial malleolus. The average distance from the distal-most visualized aspect of the saphenous nerve to the tip of the medial malleolus measured 8mm +/-; 5mm; from the nerve to the medial arthroscopic portal measured 14mm +/-2mm; and from the nerve to the tibialis anterior measured 16mm +/-3mm. In only one case (of 16) was there an identifiable branch of the saphenous nerve extending to the foot and in this specimen it extended to the first metatarsophalangeal joint. The first metatarsophalangeal joint was innervated by the superficial peroneal nerve in all cases. Small variations were also noted. DISCUSSION AND CONCLUSIONS This study highlights the proximity of the distal saphenous nerve to common landmarks in orthopaedic surgery. This has important clinical implications in ankle arthroscopy, tarsal tunnel syndrome, fixation of distal tibia medial malleolar fractures, and other procedures centered about the medial malleolus. While the distal course of the saphenous nerve is generally predictable, variations exist and thus the orthopaedic surgeon must operate cautiously to prevent iatrogenic injury. To avoid saphenous nerve injury, incisions should stay distal to the tip of the medial malleolus. The medial arthroscopic portal should be more than one centimeter from the anterior aspect of the medial malleolus which will also avoid the greater saphenous vein. Incision over the anterior tibialis tendon should stay within one centimeter of the medial edge of the tendon.
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Affiliation(s)
- D Mercer
- The University of New Mexico Albuquerque, NM 87131-0001, USA
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Alba R, Phillips A, Mackie S, Gillikin N, Maxwell C, Brune P, Ridley W, Fitzpatrick J, Levine M, Harris S. Improvements to the International Life Sciences Institute Crop Composition Database. J Food Compost Anal 2010. [DOI: 10.1016/j.jfca.2010.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cobbold JFL, Crossey MME, Colman P, Goldin RD, Murphy PS, Patel N, Fitzpatrick J, Vennart W, Thomas HC, Cox IJ, Taylor-Robinson SD. Optimal combinations of ultrasound-based and serum markers of disease severity in patients with chronic hepatitis C. J Viral Hepat 2010; 17:537-45. [PMID: 19804501 DOI: 10.1111/j.1365-2893.2009.01209.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Combinations of noninvasive markers may improve discrimination of chronic liver disease severity. The aims of this study were to compare four validated serum and ultrasound-based markers of hepatic disease severity head-to-head with liver biopsy and to assess optimal combinations with consideration of cost. A total of 67 patients with biopsy-proven chronic hepatitis C underwent all four techniques on the same visit [aspartate aminotransferase (AST) to platelet ratio index (APRI); Enhanced Liver Fibrosis (ELF) panel; transient elastography (TE) and ultrasound microbubble hepatic transit times (HTT)]. Markers were combined according to increasing financial cost and ordinal regression used to determine contributions. APRI, ELF, TE and HTT predicted cirrhosis with diagnostic accuracy of 86%, 91%, 90% and 83% respectively. ELF and TE were the most reliable tests with an intra-class correlation of 0.94 each. Either ELF or TE significantly enhanced the prediction of fibrosis stage when combined with APRI, but when combined together, did not improve the model further. Addition of third or fourth markers did not significantly improve prediction of fibrosis. Combination of APRI with either ELF or TE effectively predicts fibrosis stage, but combinations of three or more tests lead to redundancy of information and increased cost.
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Affiliation(s)
- J F L Cobbold
- Department of Hepatology and Gastroenterology, Division of Medicine, Imperial College London, London, UK
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Watson RA, Pride NB, Thomas EL, Fitzpatrick J, Durighel G, McCarthy J, Morin SX, Ind PW, Bell JD. Reduction of total lung capacity in obese men: comparison of total intrathoracic and gas volumes. J Appl Physiol (1985) 2010; 108:1605-12. [PMID: 20299612 PMCID: PMC2886677 DOI: 10.1152/japplphysiol.01267.2009] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/16/2010] [Indexed: 11/22/2022] Open
Abstract
Restriction of total lung capacity (TLC) is found in some obese subjects, but the mechanism is unclear. Two hypotheses are as follows: 1) increased abdominal volume prevents full descent of the diaphragm; and 2) increased intrathoracic fat reduces space for full lung expansion. We have measured total intrathoracic volume at full inflation using magnetic resonance imaging (MRI) in 14 asymptomatic obese men [mean age 52 yr, body mass index (BMI) 35-45 kg/m2] and 7 control men (mean age 50 yr, BMI 22-27 kg/m2). MRI volumes were compared with gas volumes at TLC. All measurements were made with subjects supine. Obese men had smaller functional residual capacity (FRC) and FRC-to-TLC ratio than control men. There was a 12% predicted difference in mean TLC between obese (84% predicted) and control men (96% predicted). In contrast, differences in total intrathoracic volume (MRI) at full inflation were only 4% predicted TLC (obese 116% predicted TLC, control 120% predicted TLC), because mediastinal volume was larger in obese than in control [heart and major vessels (obese 1.10 liter, control 0.87 liter, P=0.016) and intrathoracic fat (obese 0.68 liter, control 0.23 liter, P<0.0001)]. As a consequence of increased mediastinal volume, intrathoracic volume at FRC in obese men was considerably larger than indicated by the gas volume at FRC. The difference in gas volume at TLC between the six obese men with restriction, TLC<80% predicted (OR), and the eight obese men with TLC>80% predicted (ON) was 26% predicted TLC. Mediastinal volume was similar in OR (1.84 liter) and ON (1.73 liter), but total intrathoracic volume was 19% predicted TLC smaller in OR than in ON. We conclude that the major factor restricting TLC in some obese men was reduced thoracic expansion at full inflation.
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Affiliation(s)
- R. A. Watson
- Faculty of Medicine, National Heart and Lung Institute, and
| | - N. B. Pride
- Faculty of Medicine, National Heart and Lung Institute, and
| | - E. Louise Thomas
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - J. Fitzpatrick
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - G. Durighel
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - J. McCarthy
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - S. X. Morin
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
| | - P. W. Ind
- Faculty of Medicine, National Heart and Lung Institute, and
| | - J. D. Bell
- Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, London, United Kingdom
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Wilkinson JR, Lam M, Fitzpatrick J. Public health observatories on the international stage. Public Health 2010; 124:269-73. [PMID: 20417533 DOI: 10.1016/j.puhe.2010.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 03/08/2010] [Indexed: 12/01/2022]
Abstract
This article reviews the involvement of public health observatories in the UK in international public health. It does not aim to be a comprehensive review, but to offer some examples of work in an international context.
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Affiliation(s)
- J R Wilkinson
- Wolfson Research Institute, Durham University, Stockton on Tees TS17 6BH, UK.
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Morin S, Cobbold J, Lim A, Eliahoo J, Thomas E, Mehta S, Durighel G, Fitzpatrick J, Bell J, Taylor-Robinson S. Incidental findings in healthy control research subjects using whole-body MRI. Eur J Radiol 2009; 72:529-33. [DOI: 10.1016/j.ejrad.2008.08.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 07/14/2008] [Accepted: 08/12/2008] [Indexed: 12/21/2022]
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Cooke R, Fitzpatrick J. Haemorrhage from femoral vein cannula: an additional potential source of haemorrhage among intravenous drug users. Emerg Med J 2009; 26:675. [PMID: 19700592 DOI: 10.1136/emj.2008.071175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R Cooke
- West Midlands Ambulance Service NHS Trust, Millenium Point, Waterfront Business Park, Waterfront Way, Brierley Hill, West Midlands DY5 1LX, UK.
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Fitzpatrick J, Aoki H, deBarbadillo C, Kubota A, Omori A, Midorikawa I, Shimizu T. Pilot Testing of a High Efficiency Adsorbent System for Phosphorus Removal and Recovery to Meet Ultra-Low Phosphorus Limits. ACTA ACUST UNITED AC 2009. [DOI: 10.2175/193864709793901149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
The production of viable sperm is essential for male reproductive success. However, because females in many species mate with several males during a single reproductive episode, leading to sperm competition, a male's reproductive success also depends critically on the ability of his sperm to compete efficiently with those from rival males for fertilizations. Therefore, males who regularly encounter sperm competition are expected to produce high quality ejaculates. Here, I will provide an overview of how sperm morphology and performance are influenced by sperm competition, both within and between species, using recent empirical examples. Having established the importance of producing high quality ejaculates in males experiencing sperm competition, I will then examine the reproductive consequences of producing sub-optimal sperm. Given the well known role that inbreeding plays in reducing genetic quality and reproductive success, I will focus in particular on how inbreeding acts to reduce sperm quality. Finally, I will examine the consequences of inbreeding for male reproductive success in species where sperm competition is rampant. Together, these results highlight the evolutionary importance of sperm competition and inbreeding in shaping ejaculate traits.
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Watson W, Gill C, O'Neill A, Dowling C, Fitzpatrick J. 307 POSTER Effects of triple knockdown of cIAP-1, c-IAP-2 and XIAP on prostate cancer cell susceptibility to apoptosis. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Dowling C, Cuffe S, Tacke M, Fitzpatrick J, Watson W. 493 POSTER Manipulating prostate cancer cell susceptibility to docetaxel and novel titanocene analogues induced apoptosis. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Boyle P, Anderson B, Andersson L, Ariyaratne Y, Auleley GR, Barbacid M, Bartelink H, Baselga J, Behbehani K, Belardelli F, Berns A, Bishop J, Brawley O, Burns H, Clanton M, Cox B, Currow D, Dangou JM, de Valeriola D, Dinshaw K, Eggermont A, Fitzpatrick J, Forstmane M, Garaci E, Gavin A, Kakizoe T, Kasler M, Keita N, Kerr D, Khayat D, Khleif S, Khuhaprema T, Knezevic T, Kubinova R, Mallath M, Martin-Moreno J, McCance D, McVie J, Merriman A, Ngoma T, Nowacki M, Orgelbrand J, Park JG, Pierotti M, Ashton L, Puska P, Escobar C, Rajan B, Rajkumar T, Ringborg U, Robertson C, Rodger A, Roovali L, Santini L, Sarhan M, Seffrin J, Semiglazov V, Shrestha B, Soo K, Stamenic V, Tamblyn C, Thomas R, Tuncer M, Tursz T, Vaitkiene R, Vallejos C, Veronesi U, Wojtyla A, Yach D, Yoo KY, Zatonski W, Zaridze D, Zeng YX, Zhao P, Zheng T. Need for global action for cancer control. Ann Oncol 2008; 19:1519-21. [DOI: 10.1093/annonc/mdn426] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Domino M, Maxwell J, Cody M, Cheal K, Busch A, Stone WV, Cooley S, Zubtritsky C, Estes C, Shen Y, Lynch M, Grantham S, Wohlford P, Aoyama M, Fitzpatrick J, Zaman S, Dodson J, Levkoff S. The Influence of Integration on the Expenditures and Costs of Mental Health and Substance Use Care: Results from the randomized PRISM-E Study. Ageing Int 2008; 32:108-127. [PMID: 19777089 PMCID: PMC2748957 DOI: 10.1007/s12126-008-9010-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We compared the healthcare costs associated with an integrated care model to an enhanced referral model for the treatment of depression, anxiety, and at-risk drinking from the randomized Primary Care Research in Substance Abuse and Mental Health for the Elderly study. We examined total healthcare costs and cost components, separately for Veteran's Affairs and non-VA participants. No differences in total health expenditures were detected between study arms. No differences in behavioral health expenditures were detected for non-VA sites, but the VA integrated arm had slightly higher ($38; p<0.05) behavioral health costs. Differences in other types of services use were detected.
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Affiliation(s)
- Me Domino
- The University of North Carolina School of Public Health
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