Journal of public health medicine最新文献

{"title":"Communicable disease and health protection quarterly review: July-September 2002. From the PHLS Communicable Disease Surveillance Centre.","authors":"","doi":"10.1093/pubmed/fdg016","DOIUrl":"https://doi.org/10.1093/pubmed/fdg016","url":null,"abstract":"The Department of Health (DoH) issued new guidance on the management of hepatitis C infected health care workers (HCWs). Previous guidance from the Advisory Group on Hepatitis (AGH) recommended that HCWs infected with hepatitis C should be restricted from undertaking exposure-prone procedures (EPPs) only if they had been associated with transmission of infection to a patient. There have, however, now been five documented incidents in England and Wales in which infected health care workers have transmitted hepatitis C infection to a total of 15 patients during EPPs. As a consequence, it is now recommended that all HCWs who know they carry the hepatitis C virus (i.e. are hepatitis C virus RNA positive) should not perform EPPs. HCWs who are known to have antibodies to hepatitis C virus and who carry out EPPs should be tested for hepatitis C virus RNA. Hepatitis C infected HCWs who have received antiviral treatment and remain hepatitis C virus RNA negative 6 months after cessation of treatment may return to performing EPPs but will require a further check 6 months later to show they remain hepatitis C virus RNA negative. It is also recommended that all HCWs intending to start professional training in a career that relies upon the performance of EPPs should be tested for antibodies for hepatitis C virus before commencing training. Routine testing for hepatitis C of all HCWs who currently perform EPPs is not recommended, but HCWs who perform EPPs and who believe they may have been exposed to hepatitis C are advised to seek professional advice on whether they should be tested. Patient notification exercises are recommended whenever transmission of hepatitis C from an infected HCW to a patient has been identified. Guidance to assist in the implementation of the new arrangements is available online at http://www.doh.gov.uk/hepatitisc/healthcareworkers.htm. The DoH also released the Hepatitis C strategy for England for consultation. This strategy will form the basis of a hepatitis C action plan to be drawn up by the end of the year. The main aims of the strategy are to prevent new cases of hepatitis C infection occurring, to increase testing so as to identify those individuals with chronic infection, to ensure that those who are infected can receive specialist advice and to deliver the appropriate treatment through co-ordinated pathways of patient care. The strategy encourages the offering of hepatitis C testing in a range of clinical settings, including to those attending drug treatment centres. The importance of raising awareness of hepatitis C infection in the general population and increasing the awareness and knowledge amongst primary care health professionals is also stressed. The strategy encourages and promotes the use of Communicable Disease and Health Protection Quarterly Review: July–September 2002","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/fdg016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22318523","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":"Putting the quality into quality-adjusted life years.","authors":"Adam Oliver","doi":"10.1093/pubmed/fdg003","DOIUrl":"https://doi.org/10.1093/pubmed/fdg003","url":null,"abstract":"<p><p>Over recent decades, a great deal of effort has been devoted towards developing instruments that can be used to elicit health state values. All of these instruments are conceptually very different from one another and all suffer from serious inherent biases. In this paper I outline the conceptual foundations and empirical limitations of the three principal health state value elicitation instruments. Given that the conceptual parameters internalized within an instrument influence the elicited health state values, I argue that it is necessary to attain a broad agreement on what the appropriate parameters ought to be. When the appropriate conceptual parameters have been identified we will be in a position to develop the methodology of a single standardized instrument.</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/fdg003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22317491","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":"Is the National Service Framework standard for thrombolytic therapy achievable in a rural area?","authors":"Anne-Marie Harney,&nbsp;Rosaleen McClean,&nbsp;John Rawles,&nbsp;David Stewart","doi":"10.1093/pubmed/fdg005","DOIUrl":"https://doi.org/10.1093/pubmed/fdg005","url":null,"abstract":"The National Service Framework (NSF) for coronary heart disease requires that patients with acute myocardial infarction should start thrombolytic therapy within 60 min of the patient making contact with the National Health Service. In an audit of 700 patients with suspected acute myocardial infarction, patients' first contact was most commonly with a general practitioner (GP) (505/700; 72 per cent), who attended on 88 per cent (446/505) of occasions when they were called. In 93 per cent (255/284) of cases where both GP and an ambulance attended, the GP arrived first, by 25 min (median). In the final audit period, median call-to-thrombolysis time was 90 min (26 per cent < or = 60). We conclude that with existing physical and personnel resources in this semi-rural area of Northern Ireland, the NSF standard for thrombolytic treatment is unlikely to be met in a majority of cases unless GPs adopt prehospital thrombolysis.","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/fdg005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22317493","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":"Active life expectancy in people with and without diabetes.","authors":"Carol Jagger,&nbsp;Elizabeth Goyder,&nbsp;Michael Clarke,&nbsp;Nicolas Brouard,&nbsp;Antony Arthur","doi":"10.1093/pubmed/fdg009","DOIUrl":"https://doi.org/10.1093/pubmed/fdg009","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to investigate the feasibility of monitoring older people's health by measuring active life expectancy among older people with and without diabetes using routinely collected primary care data.</p><p><strong>Methods: </strong>The study comprised the first five rounds of a routine health assessment of those aged 75 years and over belonging to a large Midlands general practice (list size 32,500). A nurse carried out the health assessments in the participant's home. Being active was defined as the ability to perform (without difficulty, help or use of aids) at least six of seven activities of daily living (ADLs). Mortality data were collected through the practice register together with regular linkage to information from the Office for National Statistics. Period health expectancies were calculated for those known or found to be diabetic through the health assessments and for non-diabetic individuals.</p><p><strong>Results: </strong>Calculation of active life expectancies (ALE) was based on 2,474 persons (212 with and 2,262 without diabetes). At all ages, people with diabetes had lower life expectancy and spent fewer years active. The proportion of remaining life spent active was, however, similar for both groups at younger ages, but by age 85 years people with diabetes spent only 32 per cent of remaining life active compared with 42 per cent for those without diabetes.</p><p><strong>Conclusion: </strong>Annual health assessments of the over-75s in primary care together with linkage to mortality data provide a feasible method of monitoring older people's health, particularly for subgroups at greater risk of disability. At Strategic Health Authority or Primary Care Trust level these methods can monitor health needs, highlight health inequalities and evaluate intervention strategies.</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/fdg009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22318516","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":"Prevalence and management of coronary heart disease in primary care: population-based cross-sectional study using a disease register.","authors":"Kevin Carroll,&nbsp;Azeem Majeed,&nbsp;Caroline Firth,&nbsp;Jeremy Gray","doi":"10.1093/pubmed/fdg007","DOIUrl":"https://doi.org/10.1093/pubmed/fdg007","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronary heart disease are at high risk of further coronary events. Hence, one of the main priorities in the National Service Framework for Coronary Heart Disease strategy is the identification and treatment of patients with pre-existing coronary heart disease. We aimed to determine the prevalence of established coronary heart disease in a large primary care population and to compare the management of risk factors in these patients with the standards given in the National Service Framework.</p><p><strong>Methods: </strong>A population-based cross-sectional study was carried out using data collected from primary care. Sixty-three general practices (total list size 378,021) in four primary care groups in SW London took part. Data collection was confined to 103,613 patients over 44 years of age. We calculated age- and sex-specific and age-standardized prevalence rates, and age-adjusted relative risks for men and women.</p><p><strong>Results: </strong>A total of 6,778 patients with coronary heart disease were identified (8 per cent of men and 5 per cent of women over 44 years of age). There was a history of myocardial infarction in 30 per cent (1204/3991) of men and 22 per cent (613/2787) of women (relative risk 1.57; 1.37-1.81). Coronary revascularization procedures had been performed in 27 per cent (1068/3991) of men and 11 per cent (312/2787) of women (2.02; 1.73-2.35). Most patients had been assessed for hypertension (89 per cent (3538/3991) of men; 90 per cent (2500/ 2787) of women), but in many patients blood pressure was poorly controlled (26 per cent (902/3538) of men; 27 per cent (678/2500) of women). Total cholesterol had been recently measured in 51 per cent (2018/3991) of men and 44 per cent (1218/2787) of women and was elevated in 44 per cent (881/ 2018) of men and 59 per cent (716/1218) of women (0.74; 0.69-0.79). Statins were prescribed to 49 per cent (1967/3991) of men and 38 per cent (1064/2787) of women (1.06; 1.00-1.12). Aspirin was prescribed to 65 per cent (2586/3991) of men and 59 per cent (1631/2787) of women (1.08; 1.03-1.14). Beta-blockers were prescribed to 20 per cent (181/913) of men and 15 per cent (72/499) of women with a history of myocardial infarction (1.11; 0.85-1.44).</p><p><strong>Conclusions: </strong>Most patients with coronary heart disease in primary care were being treated with aspirin but less than half with statins or beta-blockers. More men than women were treated with aspirin and statins, even though women had higher cholesterol levels than men. Men were also more likely to have a confirmed diagnosis and to have undergone a coronary revascularization procedure. There is considerable scope for improving the secondary prevention of coronary heart disease and addressing gender inequalities in primary care.</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/fdg007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22317495","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":"Contact tracing and population screening for tuberculosis - who should be assessed?","authors":"R. Whitfield, R. Khan, Anne Smith, C. Rayner","doi":"10.1093/pubmed/fdg098","DOIUrl":"https://doi.org/10.1093/pubmed/fdg098","url":null,"abstract":"","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/fdg098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61195179","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":"Patterns of physical activity - Reply","authors":"L. Hayes, M. White, N. Unwin, R. Bhopal, C. Fischbacher","doi":"10.1093/PUBMED/FDG074","DOIUrl":"https://doi.org/10.1093/PUBMED/FDG074","url":null,"abstract":"","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/PUBMED/FDG074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61195068","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":"Putting public health practice into primary care practice: practical implications of implementing the changes in shifting the balance of power in England.","authors":"Sian Griffiths,&nbsp;David Haslam","doi":"10.1093/pubmed/24.4.243","DOIUrl":"https://doi.org/10.1093/pubmed/24.4.243","url":null,"abstract":"","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/24.4.243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22210748","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":"The ability of general practitioners to detect mental disorders among primary care patients in a stressful environment: Gaza Strip.","authors":"Abdel-hamid Afana,&nbsp;Odd Steffen Dalgard,&nbsp;Espen Bjertness,&nbsp;Berthold Grunfeld","doi":"10.1093/pubmed/24.4.326","DOIUrl":"https://doi.org/10.1093/pubmed/24.4.326","url":null,"abstract":"<p><strong>Background: </strong>The aim of the present study was to investigate the detection rate by general practitioners (GPs) of mental disorders in a primary health care setting and relating the findings to selected GP characteristics and the patient sociodemographic characteristics.</p><p><strong>Methods: </strong>The patients were assessed with respect to mental disorders by Hopkins Symptom Checklist 25 (HSCL-25), and the GPs were independently asked to fill in the Goldberg checklist II to assess the patient after consultation. The sample consisted of 10 primary health care clinics in the Gaza Strip, which were randomly selected from the five regions that form the Gaza Strip (Northern, Southern region, Gaza City, Middle region, Khan-Younis and Rafah). Thirty-two GPs and 661 patients participated in the study.</p><p><strong>Results: </strong>The study showed that the GPs detected only 11.6 per cent of patients with mental disorders at HSCL-25 score >1.75, and that the GP's assessment was not significantly associated with the HSCL-25 scores. GPs with postgraduate psychiatric training performed better in detecting mental disorders, likewise female GPs and those who were more than 40 years old. The results also revealed that the GPs were more able to detect mental disorders among patients older than 25 years, and in female patients.</p><p><strong>Conclusions: </strong>The GPs' poor detection rate of mental disorders indicates the importance of mental health training for GPs working in primary health care clinics.</p>","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/24.4.326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211912","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":"Childhood cancer in Seascale.","authors":"Richard Wakeford","doi":"10.1093/pubmed/24.4.343","DOIUrl":"https://doi.org/10.1093/pubmed/24.4.343","url":null,"abstract":"","PeriodicalId":77224,"journal":{"name":"Journal of public health medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/pubmed/24.4.343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211918","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}