Journal of public health medicine最新文献

{"title":"Arts and health.","authors":"Michael Eakin","doi":"10.1093/pubmed/fdg018","DOIUrl":"https://doi.org/10.1093/pubmed/fdg018","url":null,"abstract":"","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22318524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of community pharmacists on prevention of HIV and hepatitis B and C: current practice and attitudes in Grampian.","authors":"Lorna Watson,&nbsp;Christine Bond,&nbsp;Caroline Gault","doi":"10.1093/pubmed/fdg004","DOIUrl":"https://doi.org/10.1093/pubmed/fdg004","url":null,"abstract":"<p><strong>Background: </strong>Prevention of infection with the blood-borne pathogens (BBPs) HIV and hepatitis B and C remains a major public health challenge. The aim of this study was to assess the activity, knowledge and attitudes of community pharmacists in Grampian in prevention of HIV and hepatitis B and C.</p><p><strong>Method: </strong>A questionnaire survey of community pharmacies was carried out in Grampian, a mixed urban-rural Health Board area in NE Scotland with a population of 532,432.</p><p><strong>Results: </strong>Ninety-nine out of 128 (77 per cent) community pharmacies responded. Many pharmacies were providing services for drug misusers. Nearly all pharmacies stocked condoms, 57 pharmacists stated that they stocked extra-strong condoms, and two stocked dental dams. Two-thirds had leaflets relating to safer sex, HIV or hepatitis. Less than half stated that they had lists of local agencies dealing with drug-related or sexual health problems. Knowledge of the BBPs, and confidence in giving advice, were greater for HIV than for hepatitis B and C. Few were aware of recommendatons for hepatitis B vaccination. The majority felt that in the future pharmacists could have a greater role in prevention of these infections. Principal barriers to preventive activity were described as time pressure, lack of a private area and lack of training.</p><p><strong>Conclusions: </strong>There is untapped potential for community pharmacists to be a focus for advice and information relating to prevention of HIV and hepatitis B and C; however, resources are needed to address the current barriers identified field.</p>","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22317492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Place of death: analysis of cancer deaths in part of North West England.","authors":"Anthony C Gatrell,&nbsp;Juliet C Harman,&nbsp;Brian J Francis,&nbsp;Carol Thomas,&nbsp;Sara M Morris,&nbsp;Malcolm McIllmurray","doi":"10.1093/pubmed/fdg011","DOIUrl":"https://doi.org/10.1093/pubmed/fdg011","url":null,"abstract":"<p><strong>Background: </strong>Relatively little work of a detailed geographical nature has been undertaken on the distribution of place of death. In particular, given evidence that most cancer patients would prefer to die at home there is a need to examine the extent to which this preference is met differentially from place to place.</p><p><strong>Methods: </strong>Using data on cancer deaths for a single Health Authority in North West England we conducted both small area and individual analyses of place of death, using binomial and binary logistic regression models, respectively.</p><p><strong>Results: </strong>Results from the small area analysis show that in more deprived areas cancer patients are more likely to die in hospital or hospice, and less likely to die at home, but that the effect disappears for home and hospice deaths once other factors are controlled for. At the individual level, the probability of death at home decreases among those living in deprived areas, whereas the probability of death in hospital increases as area deprivation increases. Age, gender, type of cancer, and proximity to hospital or hospice all have some effect on the probability of dying in a particular setting.</p><p><strong>Conclusion: </strong>There is significant place-to-place variation in place of death among cancer patients in part of North West England. However, studies of place of death among cancer patients need to consider the full range of settings and, if examining the impact of deprivation or social class, need to adjust for other factors, including proximity to different settings.</p>","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22318518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Very high cost treatment for a single individual--a case report.","authors":"Jeremy Wight,&nbsp;Mike Richards","doi":"10.1093/pubmed/fdg002","DOIUrl":"https://doi.org/10.1093/pubmed/fdg002","url":null,"abstract":"<p><p>A Health Authority was requested to fund immune tolerance induction for a young haemophiliac at a potential cost of up to 2 million pounds sterling over a year. The decision-making process adopted included an external review of the case, literature review to establish the evidence base for treatment, and extensive discussions with the clinicians involved. The Health Authority agreed to fund treatment, but with continuous review of the case and explicit criteria for abandoning treatment if it was not working. After 11 months these criteria were met, and the treatment was abandoned. The decision-making process and ethical issues involved in deciding whether or not to fund extremely high cost treatment for an individual patient are discussed. Cases such as this present a stark contrast between rights-based and utilitarian ethical approaches. Primary Care Trusts (PCTs) are more vulnerable (because of their smaller populations and budgets) than Health Authorities were to the financial destabilization that high-cost cases can cause. PCTs are advised to make arrangements to enter risk-sharing arrangements to spread the cost of such high-cost treatments.</p>","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22317490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple-cause coding of death from myocardial infarction: population-based study of trends in death certificate data.","authors":"Michael J Goldacre,&nbsp;Stephen E Roberts,&nbsp;Myfanwy Griffith","doi":"10.1093/pubmed/fdg014","DOIUrl":"https://doi.org/10.1093/pubmed/fdg014","url":null,"abstract":"<p><strong>Background: </strong>Data on long-term trends in mortality are generally unavailable for multiple-cause coding of deaths. We wanted to know whether multiple-cause coding of deaths for myocardial infarction contributes much to the interpretation of death certificate data on mortality rates for this condition.</p><p><strong>Methods: </strong>We analysed all causes of death on death certificates in the former Oxford health service region from 1979 to 1998.</p><p><strong>Results: </strong>Of 69,333 death certificates that included myocardial infarction as a cause of death, it was the underlying cause of death in 93.6 per cent. The ratio of 'mentions' to 'underlying cause' was broadly similar over the study period, during which time there were substantial falls in mortality rates. There were significant changes to the ratios, associated with timing of changes to coding rules; but their effects were small. The ratio of mentions to underlying cause was similar in men and women and in different age groups.</p><p><strong>Conclusion: </strong>The underlying cause of death was a robust and almost complete measure of certified deaths for myocardial infarction.</p>","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22318521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based public health: Cochrane update.","authors":"E Waters,&nbsp;J Doyle","doi":"10.1093/pubmed/fdg015","DOIUrl":"https://doi.org/10.1093/pubmed/fdg015","url":null,"abstract":"","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22318522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in adult health following medical priority rehousing: a longitudinal study.","authors":"Tim Blackman,&nbsp;Jan Anderson,&nbsp;Paul Pye","doi":"10.1093/pubmed/fdg006","DOIUrl":"https://doi.org/10.1093/pubmed/fdg006","url":null,"abstract":"<p><strong>Background: </strong>Over 90 per cent of local housing authorities in England allocate medical priority for rehousing (MPR) to applicants with medical or care needs but very few studies have been undertaken to investigate the health effects of this practice. This longitudinal study compares the change in health status of adult applicants for MPR who were rehoused with applicants who were not rehoused.</p><p><strong>Methods: </strong>A total of 566 households applying for MPR were interviewed before any rehousing, and of these 253 households were re-interviewed between 9 and 12 months later. Data from initial and follow-up interviews were analysed for 227 adults, of whom 104 were rehoused. The rehoused and not rehoused groups were not significantly different in terms of health status, gender, education, income or housing conditions, but participants who were not rehoused were more likely to report mobility problems and to be aged over 50. Health data were collected by interview using the Short Form 36 (SF-36) questionnaire. Questions were also asked about housing conditions and the local neighbourhood, instrumental activities of daily living (IADL) and health-related behaviour.</p><p><strong>Results: </strong>The health status of adult applicants for MPR was very poor. Those who were not rehoused experienced a slight improvement in five dimensions of the SF-36 whereas those who were rehoused experienced much larger improvements in six dimensions. For those who were rehoused, significant net improvements occurred in reports of tiredness, feeling depressed, sleeplessness, use of prescribed medication, use of medical services and problems with IADL. No changes occurred in reports of respiratory problems, longstanding illness or disability, use of antidepressants, sleeping pills or tranquillizers, smoking or social support.</p><p><strong>Conclusions: </strong>MPR was associated with improvements in mental health status and mobility, and among respondents aged 50 years or under with a reduced use of prescribed medication and medical services. Whereas most applicants applied for MPR because of mobility problems, they were less likely than other applicants to be rehoused. The health improvements that appeared to occur should be qualified by the extent of unmet need for appropriately adapted housing and the high level of ill-health that persisted even among adults who were rehoused.</p>","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22317494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Values in the NHS.","authors":"N Vetter","doi":"10.1093/pubmed/fdg001","DOIUrl":"https://doi.org/10.1093/pubmed/fdg001","url":null,"abstract":"The NHS is going through one of its splitting phases, with an increasingly large number of small organizations containing many people new to the health service, or indeed health services, in charge. In addition, the prospect of local authority Overview and Scrutiny Committees auditing the work of the health groups and the combining of health and social work services under the umbrellas of children’s and elderly people’s trusts will make it increasingly difficult to know where the NHS begins and local authorities end. This is therefore an important time to check on what are the agreed core values of our services. The government obviously believes that an increased input from local authorities to the NHS is likely to make the NHS more responsive to the local population. Curiously, Nye Bevan resisted giving the NHS reins to local authorities on the grounds of reducing inequalities between different areas. First we have to decide whose values should shape these services. It depends on who has the main role in the NHS – the government, the physicians, nurses, other professionals, the managers who direct it or the people who use the system and pay for it through taxes or their elected representatives. All of these players have ownership of a sort of the NHS. The government and boards have financial responsibilities, the service providers and managers have clinical governance responsibilities and they earn their living from the work they do. Each of these has some expertise about how the system works and could work. One may feel that trying to reach a consensus on the core values between all of these groups would be an impossible task. It is, however, important to try. The Oxford Shorter English Dictionary defines a value as ‘worthy of esteem for its own sake; that which has intrinsic worth’. A Canadian task-force, looking at the reorganization of their health service (it is a very popular game world-wide) have defined values in relation to health services as ‘relatively stable cultural propositions about what is deemed to be good or bad by a society’. They make the point that they are derived from human experience, and therefore they do change over time. In the NHS we are constantly dealing with issues that are value-laden. Programmes relating to effectiveness of treatment, quality improvement, equal opportunities, patient’s rights and rationing health care rely on sets of values. Despite Mr Milburn’s comments there is no real statement of the primary values underlying the structure, policy and work for the NHS or, for that matter, for parts of it and no feeling of a need to update our agreed values on a regular basis if we are agreed that they change over time. Most of Mr Millburn’s statements are not really things that have ‘intrinsic worth’; indeed, although most of them are aspirational many of them raise questions about what is meant exactly. Then again, are there ‘evidence-based values’ or are values set at a level above the need for evidence, as","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22317489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid endarterectomy in Scotland: 1981-1996.","authors":"Marikie M Benade,&nbsp;Alan Finlayson,&nbsp;Charles P Warlow","doi":"10.1093/pubmed/fdg008","DOIUrl":"https://doi.org/10.1093/pubmed/fdg008","url":null,"abstract":"<p><strong>Background: </strong>Our aim was to assess the geographical, social and hospital variation in carotid endarterectomy (CEA) over time in Scotland using routinely generated data, and to assess the outcome of CEA in terms of the 7 day case-fatality.</p><p><strong>Methods: </strong>A descriptive, retrospective study was carried out using computerized medical records at national level of all patients in Scotland who had a CEA during 1981-1996. Medical record linkage was used to identify the study population with the index event specified as CEA. The annual rate of CEA in Scotland and length of hospital stay for the procedure were determined. The geographical distribution of CEA, and the social circumstances of these CEA patients were described. Hospitals where CEAs were performed were evaluated in terms of high-, medium- and low-volume hospitals.</p><p><strong>Results: </strong>A total of 2,892 CEA patients were identified for the period 1981-1996. The CEA rate increased from 1.2/100,000 (1989) to 8.6/100,000 (1996) with a maximum of 19/100,000 in Tayside Health Board (1994). Most of the CEAs in Scotland after the publication of the trials were in a small number of 'high'-volume hospitals (> 50 operations/year). There was no gender inequality in the provision of CEA in Scotland but substantial social and regional variation was observed. The 7 day operative mortality of 1.5 per cent was higher than that observed in the randomized trials.</p><p><strong>Conclusions: </strong>CEA in Scotland is performed now at about the expected rate, but there are still probably too many operations being carried out in low-volume hospitals. Length of stay has decreased over time. The operative mortality, however, was higher than in the randomized trials.</p>","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22318515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-reported stress and subsequent hospital admissions as a result of hypertension, varicose veins and haemorrhoids.","authors":"Chris Metcalfe,&nbsp;George Davey Smith,&nbsp;John Macleod,&nbsp;Pauline Heslop,&nbsp;Carole Hart","doi":"10.1093/pubmed/fdg013","DOIUrl":"https://doi.org/10.1093/pubmed/fdg013","url":null,"abstract":"<p><strong>Background: </strong>This study examines a cohort in which individuals of privileged socio-economic position report greater psychological stress. We have previously shown in this cohort that stress is unrelated to coronary heart disease as measured by hospital discharge diagnosis and cause-specific death. In contrast, stress and hospitalization for cardiovascular conditions not requiring mandatory admission were associated. We hypothesized that psychosocial factors, in particular reporting tendency, are the likely mediator of this association, and the present study considers this further.</p><p><strong>Methods: </strong>A total of 5,596 men underwent a health screening during which they completed the Reeder Stress Inventory. Details of hospital admissions were retrieved from the Scottish Morbidity Records over a 21 year follow-up. Relationships between stress and admission were evaluated using proportional hazards regression.</p><p><strong>Results: </strong>Compared with low stress, reported high stress was found to be associated with increased numbers of admissions for each of three most common cardiovascular causes of non-mandatory admission: adjusted hazard ratios were 3.43 for essential hypertension (95 per cent confidence interval (CI) 1.36-8.65), 1.91 for lower limb varicose veins (95 per cent CI 1.12-3.24), and 2.01 for haemorrhoids (95 per cent CI 1.16-3.51). Stress and blood pressure at baseline were not associated.</p><p><strong>Conclusion: </strong>The association between stress and admissions as a result of hypertension appears unlikely to be mediated by blood pressure. More likely is a mechanism based upon the reporting of symptoms, or the recording of discharge diagnoses. There is no obvious medical explanation for associations between stress and hospitalization as a result of varicose veins or haemorrhoids, and again it is likely that psychosocial factors provide the mechanism.</p>","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22318520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}