• 【在英格兰农村地区实施当地空气质量管理方面取得的进展。】 复制标题 收藏 收藏
    DOI:10.1006/jema.2000.0391 复制DOI
    作者列表:Ing C,Beattie C,Longhurst J
    BACKGROUND & AIMS: :Air quality in the UK, although vastly improved from the smogs of the 1950s, now faces a new set of challenges from a variety of sources and pollutants. Poor air quality has long been associated with urban areas, but it is becoming clear that many rural locations also have locations likely to exceed the UK Air Quality Strategy-objectives: This paper will examine the extent to which rural authorities have been engaged in the local air-quality management (LAQM) process, a new regime by which air quality control is being accomplished in the UK. Results are presented from a questionnaire survey of environmental health officers of 100 rural authorities undertaken in January 1999. The paper investigates both the technical aspects of the LAQM process as well as the management approaches. The current progress of rural authorities, and some of the problems they face, are discussed particularly in comparison with urban areas. It is concluded that some rural authorities with air pollution problems stemming either from within or outwith their borough, may face significant challenges from the LAQM review and assessment process, particularly where air pollution responsibilities have only relatively recently been addressed. Rural authorities seem to be embracing these new responsibilities enthusiastically, but it is almost inevitable that they will be trailing behind urban authorities who have several decades of experience and joint working to draw upon.
    背景与目标: :尽管1950年代的烟雾大大改善了英国的空气质量,但如今它面临着来自各种来源和污染物的一系列新挑战。长期以来,空气质量差一直与城市地区有关,但是越来越明显的是,许多农村地区的位置也可能超过英国《空气质量战略》的目标:本文将研究农村当局在当地开展活动的程度。空气质量管理(LAQM)流程,这是英国正在实施的一种新的空气质量控制制度。结果来自于1999年1月对100个农村当局的环境卫生官员进行的问卷调查。该文件同时调查了LAQM流程的技术方面和管理方法。特别是与城市地区相比,讨论了农村当局的当前进展以及他们面临的一些问题。结论是,一些农村当局因其行政区内部或外部产生的空气污染问题可能会面临来自LAQM审查和评估过程的重大挑战,特别是在空气污染责任只是在最近才得到解决的地方。农村当局似乎热情地承担着这些新的责任,但是,它们将不可避免地落后于拥有数十年经验和共同工作经验的城市当局。
  • 【英格兰初级保健质量与冠心病住院治疗之间的关联:国家横断面研究。】 复制标题 收藏 收藏
    DOI:10.1007/s11606-007-0390-2 复制DOI
    作者列表:Bottle A,Gnani S,Saxena S,Aylin P,Mainous AG 3rd,Majeed A
    BACKGROUND & AIMS: BACKGROUND:A new pay-for-performance scheme for primary care physicians was introduced in England in 2004 as part of an initiative to link the quality of primary care with physician pay. OBJECTIVE:To investigate the association between the quality of primary care and rates of hospital admissions for coronary heart disease. DESIGN:Ecological cross-sectional study using data from the Quality and Outcomes Framework for family practice, hospital admissions, and census data. PARTICIPANTS:All 303 primary care trusts in England, covering approximately 50 million people. MEASUREMENTS:Rates of elective and unplanned hospital admissions for coronary heart disease and rates of coronary angioplasty and coronary artery bypass grafting were regressed against quality-of-care measures from the Quality and Outcomes Framework, area socioeconomic scores, and disease prevalence. RESULTS:Correlations between prevalence, area socioeconomic scores, and admission rates were generally weak. The strongest relations were seen between area socioeconomic scores and elective and unplanned hospital admissions and revascularization procedures among the age group 45-74 years. Among those aged 75 years and over, the only positive association observed was between area socioeconomic scores and unplanned hospital admissions. CONCLUSIONS:The lack of an association between quality scores and admission rates suggests that improving the quality of primary care may not reduce demands on the hospital sector and that other factors are much better predictors of hospitalization for coronary heart disease.
    背景与目标: 摘要背景:2004年在英格兰引入了一种新的针对基层医疗医生的绩效工资计划,该计划是将基层医疗质量与医生薪酬联系起来的一项举措。
    目的:探讨基层医疗质量与冠心病住院率之间的关系。
    设计:采用横断面质量和结果框架中的数据进行生态横断面研究,以获取家庭执业,住院人数和人口普查数据。
    参与者:英格兰所有303个初级保健信托基金,覆盖约5000万人。
    测量:根据“质量和结果框架”,区域社会经济得分和疾病患病率,对护理质量指标进行回归分析,得出针对冠心病的选择性和计划外入院率,冠状动脉成形术和冠状动脉搭桥术的发生率。
    结果:患病率,地区社会经济得分和入学率之间的相关性通常较弱。在45-74岁年龄段中,地区社会经济得分与选择性和计划外的入院和血运重建程序之间的关系最密切。在75岁及以上的人群中,观察到的唯一正相关是地区社会经济得分与计划外的住院人数之间的关系。
    结论:质量得分与入院率之间缺乏关联,表明改善初级保健质量可能不会减少对医院部门的需求,而其他因素则更能预测冠心病住院率。
  • 【疼痛和功能在全膝关节置换术后确定患者满意度中的作用。英格兰和威尔士国家联合登记处的数据。】 复制标题 收藏 收藏
    DOI:10.1302/0301-620X.89B7.19091 复制DOI
    作者列表:Baker PN,van der Meulen JH,Lewsey J,Gregg PJ,National Joint Registry for England and Wales.
    BACKGROUND & AIMS: :A postal questionnaire was sent to 10,000 patients more than one year after their total knee replacement (TKR). They were assessed using the Oxford knee score and were asked whether they were satisfied, unsure or unsatisfied with their TKR. The response rate was 87.4% (8231 of 9417 eligible questionnaires) and a total of 81.8% (6625 of 8095) of patients were satisfied. Multivariable regression modelling showed that patients with higher scores relating to the pain and function elements of the Oxford knee score had a lower level of satisfaction (p < 0.001), and that ongoing pain was a stronger predictor of this. Female gender and a primary diagnosis of osteoarthritis were found to be predictors of lower levels of patient satisfaction. Differences in the rate of satisfaction were also observed in relation to age, the American Society of Anesthesiologists grade and the type of prosthesis. This study has provided data on the Oxford knee score and the expected levels of satisfaction at one year after TKR. The results should act as a benchmark of practice in the United Kingdom and provide a baseline for peer comparison between institutions.
    背景与目标: :在他们的全膝关节置换术(TKR)一年多后,向10,000名患者发送了邮政问卷。使用牛津膝关节评分对他们进行评估,并询问他们是否对TKR感到满意,不确定或不满意。回应率为87.4%(9417份合格问卷中的8231份),总计81.8%(8095的6625份)患者满意。多变量回归模型显示,与牛津膝盖评分的疼痛和功能要素相关的评分较高的患者满意度较低(p <0.001),而持续疼痛是对此的更强预测指标。发现女性和骨关节炎的初步诊断是患者满意度降低的预测因素。满意度的差异还与年龄,美国麻醉医师学会等级和假体类型有关。这项研究提供了有关牛津膝关节评分和TKR一年后预期满意度的数据。结果应作为英国实践的基准,并为机构之间的同行比较提供基准。
  • 【在英格兰早期盎格鲁撒克逊时代是否有必要采取种族隔离般的社会结构?】 复制标题 收藏 收藏
    DOI:10.1098/rspb.2008.0352 复制DOI
    作者列表:Pattison JE
    BACKGROUND & AIMS: :It has recently been argued that there was an apartheid-like social structure operating in Early Anglo-Saxon England. This was proposed in order to explain the relatively high degree of similarity between Germanic-speaking areas of northwest Europe and England. Opinions vary as to whether there was a substantial Germanic invasion or only a relatively small number arrived in Britain during this period. Contrary to the assumption of limited intermarriage made in the apartheid simulation, there is evidence that significant mixing of the British and Germanic peoples occurred, and that the early law codes, such as that of King Ine of Wessex, could have deliberately encouraged such mixing. More importantly, the simulation did not take into account any northwest European immigration that arrived both before and after the Early Anglo-Saxon period. In view of the uncertainty of the places of origin of the various Germanic peoples, and their numbers and dates of arrival, the present study adopts an alternative approach to estimate the percentage of indigenous Britons in the current British population. It was found unnecessary to introduce any special social structure among the diverse Anglo-Saxon people in order to account for the estimates of northwest European intrusion into the British population.
    背景与目标: :最近有人争辩说,英格兰早期盎格鲁-撒克逊人有一个类似种族隔离的社会结构。提出这一点是为了解释西北欧洲日耳曼语地区与英格兰之间相对较高的相似度。关于在此期间是否发生了大规模的日耳曼式入侵或仅少量入侵英国的观点不一。与种族隔离模拟中对通婚的限制相反,有证据表明英国人和日耳曼人发生了重大的混合,而且早期的法律法规,例如韦塞克斯国王伊内国王的法规,可能会故意鼓励这种混合。更重要的是,模拟没有考虑到盎格鲁-撒克逊早期之前和之后到达的任何西北欧洲移民。鉴于各种日耳曼人民的原籍地及其数量和到达日期尚不确定,因此本研究采用另一种方法来估计当前英国人口中土著英国人的比例。人们发现没有必要在盎格鲁-撒克逊人中引入任何特殊的社会结构,以解释西北欧洲入侵英国人口的估计。
  • 【使用多层层次回归模型,研究组织结构对英格兰所有急诊医院急诊就诊单元中患者体验得分的影响程度。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2016-012133 复制DOI
    作者列表:Sullivan P,Bell D
    BACKGROUND & AIMS: OBJECTIVES:Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital. SETTING:Acute medical admission units in all NHS Acute Trusts in England. PARTICIPANTS:We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1-2 nights, so as to isolate the experience delivered during the acute admission process. PRIMARY AND SECONDARY OUTCOME MEASURES:We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected 'being treated with respect and dignity' and 'pain control' as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters. RESULTS:The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors. CONCLUSIONS:When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between Trusts and should prompt further research to explore if more discriminant surveys can be developed.
    背景与目标: 目的:先前的研究发现,医院和专科医院对患者经验得分的影响有限,患者水平因素更为重要。这可能是由于组织内各个子部门之间经验交付的异质性。我们旨在确定,如果在每家医院中分析相同的亚专业微系统的分数,组织水平因素是否会产生更大的影响。
    地点:英格兰所有NHS急性信托基金中的急性医疗收治单位。
    参与者:我们分析了来自英国成人住院调查的患者经验数据,该数据每年在英格兰的每个急性NHS信托基金中对850名患者进行管理。我们选择了所有返回调查的8753名患者,这些患者均为急诊入院,并在其入院病房中停留了1-2个晚上,以隔离急性入院过程中提供的经验。
    主要和次要指标:我们使用多级逻辑回归分析确定宿主组织和组织水平因素(规模和教学状况)以及患者水平因素(人口统计学,长期病情和残疾)的分配影响。我们选择“受到尊重和尊严对待”和“疼痛控制”作为主要结局指标。将其他Picker Domain问题分数作为次要参数进行分析。
    结果:在组织层面,总体差异的比例很小;尊重和尊严为0.5%(NS),控制疼痛为0.4%(NS)。长期的状况和随之而来的残疾与低分相关。其他项目得分也表明,影响最大的是患者水平因素。
    结论:当一个单独的系统(即急性医疗入院流程)被隔离时,经验得分的差异主要可以由受组织水平影响有限的患者水平因素来解释。这对于使用通用的患者经验调查来在Trust之间进行比较具有影响,并且应该促使进行进一步的研究以探索是否可以开发出更多的有区别的调查。
  • 【新英格兰稀有植物的生物地理学和衰落:历史证据和当代监测。】 复制标题 收藏 收藏
    DOI:10.1890/1051-0761(2006)016[1327:badorp]2.0.co;2 复制DOI
    作者列表:Farnsworth EJ,Ogurcak DE
    BACKGROUND & AIMS: :Detecting range shifts and contractions is critical for determining the conservation priority of rare and declining taxa. However, data on rare species occurrences frequently lack precise information on locations and habitats and may present a biased picture of biogeographic distributions and presumed habitat preferences. Herbarium or museum specimen data, which otherwise could be useful proxies for detecting temporal trends and spatial patterns in species distributions, pose particular challenges. Using data from herbaria and Natural Heritage Programs on numbers of occurrences within individual municipalities (towns, cities, or townships), we quantified temporal changes in the estimated distributions of 110 rare plant species in the six New England (USA) states. We used the partial Solow equation and a nonparametric test to estimate the probability of observing multiple absences (gaps in the collection record) if a given population was actually still extant. Bayes' Theorem was used to estimate the probability that occurrences were misclassified as extinct. Using the probabilities obtained from these three methods, we eliminated taxa with high probabilities of pseudo-absence (that would yield an inaccurate profile of species distributions), narrowing the set for final analysis to 71 taxa. We then expressed occurrences as centroids of town polygons and estimated current and historical range areas (extents of occurrence as defined by alpha-hulls inscribing occurrences), mean distances between occurrences, and latitudinal and longitudinal range boundaries. Using a geographic information system, we modeled first, second, and third circular standard deviational polygons around the mean center of the historical range. Examining the distribution of current occurrences within each standard deviational polygon, we asked whether ranges were collapsing to a center, expanding, fragmenting, or contracting to a margin of the former range. Extant ranges of the species were, on average, almost 67% smaller than their historical ranges, and distances among occurrences decreased. Five New England hotspots were observed to contain >35% of rare plant populations. Extant occurrences were more frequently marginalized at the periphery of the historical range than would be expected by chance. Coarse-grained data on current and historical occurrences can be used to examine large suites of species to prioritize taxa and sites for conservation.
    背景与目标: :检测范围的变化和收缩对于确定稀有和下降的类群的保护优先级至关重要。但是,关于稀有物种发生的数据通常缺乏有关位置和栖息地的精确信息,并且可能会呈现出生物地理分布和假定的栖息地偏好的偏见。植物标本室或博物馆的标本数据,否则可能是检测物种分布的时间趋势和空间格局的有用代理,这带来了特殊的挑战。使用来自草本植物和自然遗产计划的数据,了解各个城市(城镇,城市或乡镇)内的发生次数,我们量化了六个新英格兰(美国)州110种稀有植物物种的估计分布的时间变化。如果给定人口实际上仍然存在,我们使用偏Solow方程和非参数检验来估计观察到多个缺勤(收集记录中存在缺口)的可能性。贝叶斯定理用于估计发生错误归类为灭绝的可能性。使用从这三种方法获得的概率,我们消除了伪伪概率很高的分类单元(这将导致物种分布的轮廓不准确),从而将最终分析的范围缩小到71个分类单元。然后,我们将事件表示为城镇多边形的质心,并估计当前和历史范围区域(事件发生的程度,由包含事件的alpha壳定义),事件之间的平均距离以及纬度和纵向范围边界。使用地理信息系统,我们围绕历史范围的平均中心对第一,第二和第三圆形标准偏差多边形进行了建模。检查每个标准偏差多边形中当前事件的分布,我们询问范围是否塌陷到中心,正在扩展,碎片化或收缩到前一个范围的边缘。该物种的现存范围平均比其历史范围小了近67%,并且出现次数之间的距离减小了。观察到五个新英格兰热点的稀有植物种群超过35%。在历史范围的外围,现存的事件比被偶然预期的更经常地被边缘化。可以使用有关当前和历史事件的粗粒度数据来检查大型物种,从而优先考虑分类单元和保护地点。
  • 【应对污名和歧视:来自英国精神卫生服务使用者的证据。】 复制标题 收藏 收藏
    DOI:10.1017/S204579601700021X 复制DOI
    作者列表:Isaksson A,Corker E,Cotney J,Hamilton S,Pinfold V,Rose D,Rüsch N,Henderson C,Thornicroft G,Evans-Lacko S
    BACKGROUND & AIMS: AIMS:Mental health stigma and discrimination are significant problems. Common coping orientations include: concealing mental health problems, challenging others and educating others. We describe the use of common stigma coping orientations and explain variations within a sample of English mental health service users. METHODS:Cross-sectional survey data were collected as part of the Viewpoint survey of mental health service users' experiences of discrimination (n = 3005). Linear regression analyses were carried out to identify factors associated with the three stigma coping orientations. RESULTS:The most common coping orientation was to conceal mental health problems (73%), which was strongly associated with anticipated discrimination. Only 51% ever challenged others because of discriminating behaviour, this being related to experienced discrimination, but also to higher confidence to tackle stigma. CONCLUSIONS:Although stigma coping orientations vary by context, individuals often choose to conceal problems, which is associated with greater anticipated and experienced discrimination and less confidence to challenge stigma. The direction of this association requires further investigation.
    背景与目标: 目的:心理健康的污名和歧视是重大问题。常见的应对方向包括:隐藏心理健康问题,挑战他人并教育他人。我们描述了常见的耻辱应对方式的使用,并解释了英国精神卫生服务用户样本中的变化。
    方法:收集横断面调查数据作为对精神卫生服务使用者歧视经历的观点调查的一部分(n = 3005)。进行了线性回归分析,以确定与三个柱头应对方向相关的因素。
    结果:最常见的应对方法是隐瞒心理健康问题(73%),这与预期的歧视密切相关。只有51%的人曾因为歧视行为而挑战过其他人,这既与经历的歧视有关,也与解决污名的更高信心有关。
    结论:尽管耻辱应对的方向因环境而异,但个人经常选择隐瞒问题,这与更大的预期和经历的歧视以及挑战耻辱的信心不足有关。该协会的方向需要进一步调查。
  • 【一项对英格兰和威尔士囚犯自杀危险因素的国家病例对照研究[已更正]。】 复制标题 收藏 收藏
    DOI:10.1007/s00127-012-0632-4 复制DOI
    作者列表:Humber N,Webb R,Piper M,Appleby L,Shaw J
    BACKGROUND & AIMS: PURPOSE:To examine risk factors for suicide among prisoners in a national population. METHODS:The Ministry of Justice identified all suicides occurring in prisons in England and Wales between 2005 and 2008. Two hundred and twenty suicides were matched to 220 living controls on age, gender, date of reception into prison and establishment type. Relative risks for clinical, custodial, service-response and socio-demographic characteristics were estimated using conditional logistic regression models. RESULTS:Having a history of violence and several indicators of past or current psychiatric illness were strong predictors at univariate level. Prisoners who died by suicide were over nine times more likely than controls to have been identified and managed as being at-risk of self-harm/suicide during the prison term. Multivariate analysis identified five mutually independent predictors: previous psychiatric service contact, history of self-harm, single cell occupation, remand status, and non-white ethnicity. CONCLUSIONS:Suicide risk is elevated among certain types of prisoners, and targeted suicide prevention strategies should be developed for the monitoring, care and support of the high-risk groups that we identified. Further research is needed to determine the causal mechanisms that explain why some prisoners have a higher suicide risk than their peers.
    背景与目标: 目的:研究全国人口中囚犯自杀的危险因素。
    方法:司法部确定了2005年至2008年在英格兰和威尔士监狱中发生的所有自杀事件。将220例自杀与220名生活控制相匹配,包括年龄,性别,入狱日期和机构类型。使用条件逻辑回归模型估算了临床,保管,服务响应和社会人口统计学特征的相对风险。
    结果:具有暴力病史和过去或现在的精神疾病的几个指标是单因素水平的有力预测指标。在监狱任期内,被自杀死亡的囚犯被识别和管理为有自残/自杀风险的可能性是对照组的九倍以上。多变量分析确定了五个相互独立的预测因素:以前的精神病服务联系,自我伤害史,单细胞职业,还押状况和非白人种族。
    结论:在某些类型的囚犯中自杀风险较高,因此应制定有针对性的自杀预防策略,以监测,护理和支持我们确定的高危人群。需要做进一步的研究以确定导致某些囚犯自杀风险高于同龄人的原因的成因机制。
  • 【[在英格兰对全国性自体血清滴眼液进行集中服务的经验]。】 复制标题 收藏 收藏
    DOI:10.1007/s00347-008-1753-8 复制DOI
    作者列表:Maclennan S,Hartwig D,Geerling G
    BACKGROUND & AIMS: :The majority of patients with dry eye syndromes respond to conventional treatment aimed at optimising the ocular surface environment. There are some, however, who do not respond adequately to conventional lubricants. The first description of the use of autologous serum as a nutrient tears substitute was published more than 20 years ago. In 1997, NHS Blood and Transplant (NHSBT) developed a reliable and reproducible method for the production of eyedrops derived from autologous serum according to GMP Guidelines. The current cost of a batch of eyedrops (i. e. the product from one donation episode) is approximately 1300 GBP - this covers costs of collection, processing, testing and distribution. One "batch" of eyedrops will last for approximately 5 months if a bottle a day is used. A 6 month shelf life is put on the product and patients keep them in their domestic freezer.
    背景与目标: :大多数患有干眼症的患者对旨在优化眼表环境的常规治疗有反应。但是,有些人对常规润滑剂的反应不充分。使用自体血清作为营养眼泪替代品的第一个描述已发表于20多年前。 1997年,NHS血液与移植(NHSBT)根据GMP指南开发了一种可靠且可重现的方法,用于生产自体血清衍生的滴眼剂。一批眼药水(即一次捐赠的产品)的当前成本约为1300英镑-这包括了收集,加工,测试和分发的成本。如果每天使用一瓶,一滴眼药水将持续约5个月。该产品的保质期为6个月,患者将其保存在家用冰箱中。
  • 【在英格兰,十分之九的日光浴浴床发出的紫外线辐射水平超过了当前的安全限制。】 复制标题 收藏 收藏
    DOI:10.1111/bjd.12181 复制DOI
    作者列表:Tierney P,Ferguson J,Ibbotson S,Dawe R,Eadie E,Moseley H
    BACKGROUND & AIMS: BACKGROUND:Exposure to ultraviolet (UV) radiation from sunlight is recognized as the principal cause of skin cancer. Moreover, sunbeds have been classified as carcinogenic by the International Agency for Research on Cancer. Despite this, there is a shortage of objective data on UV exposure levels in sunbeds in England. OBJECTIVES:We set out to measure UV emission levels in sunbeds at sites around England, and to compare these levels with both current standards and natural sunlight. METHODS:Between October 2010 and February 2011, UV spectra were measured on site from a total of 402 artificial tanning units in England. Measurement instrumentation was calibrated, traceable to the National Physical Laboratory. Compliance with the relevant British and European standard was determined, and a skin-cancer weighting factor was used to compare the carcinogenic potential of sunbeds with that of sunlight. RESULTS:For compliance with the European standard, erythemal-effective irradiance should not exceed 0·3 W m(-2). The values that we measured ranged between 0·10 and 1·32 W m(-2) with a mean of 0·56 ± 0·21 W m(-2) . Only 10% of sunbeds surveyed were within the recommended limit. Application of the skin-cancer weighting factor produced values that varied from 0·17 to 2·52 W m(-2) with a mean of 0·99 ± 0·41 W m(-2). The comparable value for Mediterranean noon day sun was 0·43 W m . CONCLUSIONS:Nine out of 10 sunbeds surveyed throughout England emitted levels of UV radiation that exceed the maximum levels contained within the European standard. Moreover, the skin cancer risk for comparable times of exposure was up to six times higher than that for Mediterranean sunlight. This situation is unacceptable and stricter control measures must be put in place.
    背景与目标: 背景:暴露于阳光下的紫外线(UV)被认为是皮肤癌的主要原因。此外,日光浴床被国际癌症研究机构归类为致癌物质。尽管如此,英格兰缺乏关于日光浴床紫外线暴露水平的客观数据。
    目的:我们着手测量英格兰周围地区日光浴床的紫外线辐射水平,并将这些水平与当前标准和自然阳光进行比较。
    方法:2010年10月至2011年2月,在英格兰现场测量了总共402个人工晒黑装置的紫外线光谱。测量仪器经过校准,可追溯到国家物理实验室。确定是否符合相关的英国和欧洲标准,并使用皮肤癌加权因子比较日光浴床和日光浴的致癌潜力。
    结果:为了符合欧洲标准,红斑有效辐照度不应超过0·3 W m(-2)。我们测量的值在0·10和1·32 W m(-2)之间,平均值为0·56±0·21 W m(-2)。被调查的日光浴浴床中只有10%在建议的限制范围内。皮肤癌加权因子的应用产生的值从0·17到2·52 W m(-2)不等,平均值为0·99±0·41 W m(-2)。地中海正午太阳的可比值是0·43 W m。
    结论:在整个英格兰进行调查的10个日光浴床中,有9个日光浴床的紫外线辐射水平超过了欧洲标准所规定的最大水平。此外,可比暴露时间的皮肤癌风险比地中海阳光高六倍。这种情况是不可接受的,必须采取更严格的控制措施。
  • 【加拿大,美国和英国为改善健康信息系统安全所做的国家努力。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijmedinf.2012.12.006 复制DOI
    作者列表:Kushniruk AW,Bates DW,Bainbridge M,Househ MS,Borycki EM
    BACKGROUND & AIMS: OBJECTIVE:In this paper we review progress as well as challenges encountered in Canada, the United States and England with regard to ensuring safety of health information technology. METHOD:A review of major programs and initiatives for ensuring safety of health information technology in the three countries was conducted. Published literature and Web resources from national programs were reviewed for relevant information. RESULTS:It was found that in all three countries the issue of technology-induced error has been recognized as being of critical importance. The three countries have developed approaches for dealing with the issue that have some commonalities; however, they are at varying different stages of maturity, with England having the longest standing and most well developed safety programs, while Canada and the United States are at earlier stages. The types of approaches employed have included work on developing standards related to usability and interface design, certifications, directives from regulatory bodies, educational initiatives in health information technology (HIT) safety as well as research into safer HIT design and implementation methods. CONCLUSIONS:HIT promises to lead to improved patient safety. However, it has become recognized that if not designed and deployed appropriately, such systems can lead to new types of errors. Based on this recognition, a variety of initiatives are being undertaken in Canada, the United States and England to promote the safe design, procurement and deployment of HIT. It is concluded that improved approaches to system design, testing, regulation, error reporting, safety education and cross-country collaboration will be needed to further promote safer HIT.
    背景与目标: 目的:在本文中,我们回顾了在确保健康信息技术安全方面在加拿大,美国和英国所取得的进步以及所面临的挑战。
    方法:对确保这三个国家卫生信息技术安全的主要计划和举措进行了审查。审查了来自国家计划的已出版文献和网络资源,以获取相关信息。
    结果:发现在所有三个国家中,技术引起的错误问题已被认为是至关重要的。这三个国家已经制定了处理这一问题的方法,这些方法具有一些共同点。但是,它们处于不同的成熟阶段,英格兰的历史最悠久,安全计划也最完善,而加拿大和美国则处于较早的阶段。所采用的方法类型包括:开发与可用性和界面设计有关的标准,认证,监管机构的指令,健康信息技术(HIT)安全方面的教育计划以及对更安全的HIT设计和实施方法的研究。
    结论:HIT有望改善患者的安全性。但是,人们已经认识到,如果设计和部署不当,此类系统可能会导致新型错误。基于这种认识,加拿大,美国和英国正在采取各种举措来促进HIT的安全设计,采购和部署。结论是,将需要改进的系统设计,测试,法规,错误报告,安全教育和跨国合作的方法,以进一步促进更安全的HIT。
  • 【英格兰过敏性鼻炎全科医生会诊中的社会经济和地理差异,2003-2014年:一项观察性研究。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2017-017038 复制DOI
    作者列表:Todkill D,Loveridge P,Elliot AJ,Morbey R,Lusignan S,Edeghere O,Smith G
    BACKGROUND & AIMS: OBJECTIVE:Allergic rhinitis (AR) is a global health problem, potentially impacting individuals' sleep, work and social life. We aimed to use a surveillance network of general practitioners (GPs) to describe the epidemiology of AR consultations in England. SETTING:A large GP surveillance network covering approximately 53% of the English population. METHODS:GP consultations for AR across England between 30 December 2002 and 31 December 2014 were analysed. Using more granular data available between 2 April 2012 and 31 December 2014 rates and rate ratios (RR) of AR were further analysed in different age groups, gender, rural-urban classification and index of multiple deprivation score quintile of location of GP. RESULTS:The mean weekly rate for AR consultations was 19.8 consultations per 100 000 GP registered patients (range 1.13-207), with a regular peak occurring during June (weeks 24-26), and a smaller peak during April. Between 1 April 2012 and 31 December 2014, the highest mean daily rates of consultations per 1 00 000 were: in age group 5-14 years (rate=8.02, RR 6.65, 95% CI 6.38 to 6.93); females (rate=4.57, RR 1.12 95% CI 1.12 to 1.13); persons registered at a GP in the most socioeconomically deprived quintile local authority (rate=5.69, RR 1.48, 95% CI 1.47 to 1.49) or in an urban area with major conurbation (rate=5.91, RR 1.78, 95% CI 1.69 to 1.87). CONCLUSIONS:AR rates were higher in those aged 5-14 years, females and in urban and socioeconomically deprived areas. This needs to be viewed in the context of this study's limitations but should be considered in health promotion and service planning.
    背景与目标: 目的:过敏性鼻炎(AR)是一个全球性的健康问题,可能会影响个人的睡眠,工作和社交生活。我们旨在使用全科医生(GPs)的监视网络来描述英格兰AR咨询的流行病学。
    地点:大型GP监控网络覆盖了大约53%的英国人口。
    方法:分析了2002年12月30日至2014年12月31日在英格兰进行的AR的GP咨询。使用2012年4月2日至2014年12月31日期间可用的更详细的数据,进一步分析了不同年龄组,性别,城乡分类以及GP的多个剥夺得分五分之一指数的AR发生率和比率(RR)。
    结果:AR咨询的平均每周比率为每10万名GP注册患者(范围为1.13-207)有19.8宗咨询,在6月(第24-26周)有一个定期的高峰,而在4月有一个较小的高峰。在2012年4月1日至2014年12月31日期间,每1万000的最高每日平均诊症率是:5-14岁年龄组(比率= 8.02,RR 6.65,95%CI CI 6.38至6.93);女性(比率= 4.57,RR 1.12 95%CI 1.12至1.13);在社会经济地位最差的五分之一地方当局(GP = 5.69,RR 1.48,95%CI 1.47至1.49)或大城市地区(GP = 5.91,RR 1.78,95%CI 1.69至1.87)注册的人)。
    结论:5-14岁的女性,城市和社会经济贫困地区的AR发病率较高。需要根据本研究的局限性来考虑这一点,但应在健康促进和服务计划中予以考虑。
  • 【英国治疗阴道和外阴癌的费用(2009-2015年)。】 复制标题 收藏 收藏
    DOI:10.1186/s12889-020-08545-4 复制DOI
    作者列表:Stephens S,Chatterjee A,Coles V,Crawford R
    BACKGROUND & AIMS: BACKGROUND:Human papillomavirus (HPV) infection is a pre-requisite for cervical cancer, which represents the third most common cancer among women worldwide. A causal relationship also exists between HPV and cancer in other areas of the female reproductive system including the vagina and vulva. Whilst the incidence of vaginal cancer in the UK has remained relatively stable over the past 25 years, vulval cancer rates are increasing. A body of literature exists on the epidemiology and aetiology of vaginal and vulval cancer, but little is known about the economic burden. The objective of this study was to quantify the costs of treating these cancers on the National Health Service (NHS) in England. METHODS:Inpatient and outpatient episodes were derived from Hospital Episode Statistics (HES). Health Resource Group (HRG) tariffs and National Reference Costs were used to estimate the cost of treating pre-cancerous and invasive vaginal and vulval lesions in England. RESULTS:The study showed that for the 5 years from 2009/2010 to 2014/2015 the total cost associated with pre-cancerous and invasive vaginal and vulval lesions was over £14 million per year on average (95% of which was attributed to inpatient costs). Vulval cancer accounted for the largest proportion; an estimated 60% of the total cost (£8.82 million). On average 4316 patients per year in England were admitted to hospital and 912 patients attended outpatient settings for pre-cancerous and invasive disease of the vagina and vulva. CONCLUSION:The results indicate that vaginal and vulval cancer cost the English health care system over £14 million per year. Given the causal role of HPV in a proportion of these cancers, preventative measures such as the national HPV immunisation programme have the potential to reduce the economic burden. To ensure optimal use of NHS resources, it is important that future economic evaluations of such preventative measures consider the full burden of HPV related disease.
    背景与目标: 背景:人类乳头瘤病毒(HPV)感染是宫颈癌的先决条件,它是全球女性中第三大最常见的癌症。在女性生殖系统的其他区域(包括阴道和外阴)中,HPV与癌症之间也存在因果关系。在过去的25年中,英国阴道癌的发病率一直保持相对稳定,但外阴癌的发病率却在上升。关于阴道和外阴癌的流行病学和病因学,已有大量文献报道,但对其经济负担知之甚少。这项研究的目的是量化英格兰国家卫生局(NHS)治疗这些癌症的费用。
    方法:住院和门诊发作均来自《医院发作统计》(HES)。使用卫生资源集团(HRG)的关税和国家参考成本来估算英格兰治疗癌前病变和侵入性阴道及外阴病变的成本。
    结果:研究表明,从2009/2010年到2014/2015年的5年中,与癌前和浸润性阴道和外阴病变相关的总费用平均每年超过1400万英镑(其中95%归因于住院费用)。外阴癌所占比例最大。估计占总成本的60%(882万英镑)。在英格兰,平均每年有4316名患者入院,有912名患者因阴道和外阴癌前性和浸润性疾病就诊。
    结论:结果表明,阴道和外阴癌每年使英国卫生保健系统损失超过1400万英镑。鉴于HPV在这些癌症中的一部分具有因果作用,因此预防措施(如国家HPV免疫计划)有可能减轻经济负担。为了确保最佳利用NHS资源,对此类预防措施的未来经济评估必须考虑与HPV相关疾病的全部负担,这一点很重要。
  • 【影响英格兰小学和中学儿童免费学校用餐的因素。】 复制标题 收藏 收藏
    DOI:10.1017/S136898001300092X 复制DOI
    作者列表:Sahota P,Woodward J,Molinari R,Pike J
    BACKGROUND & AIMS: OBJECTIVE:The present study sought to explore the factors that influence registration for free school meals and the subsequent take-up following registration in England. DESIGN:The research design consisted of two phases, a qualitative research phase followed by an intervention phase. Findings are presented from the qualitative research phase, which comprised interviews with head teachers, school administrators, parents and focus groups with pupils. SETTING:The study took place in four primary schools and four secondary schools in Leeds, UK. SUBJECTS:Participants included head teachers, school administrators, parents and pupils. RESULTS:Findings suggested that parents felt the registration process to be relatively straightforward although many secondary schools were not proactive in promoting free school meals. Quality and choice of food were regarded by both pupils and parents as significant in determining school meal choices, with stigma being less of an issue than originally anticipated. CONCLUSIONS:Schools should develop proactive approaches to promoting free school meals and attention should be given not only to the quality and availability of food, but also to the social, cultural and environmental aspects of dining. Processes to maintain pupils' anonymity should be considered to allay parents' fear of stigma.
    背景与目标: 目的:本研究旨在探讨影响免费学校餐注册以及在英格兰注册后的后续学习的影响因素。
    设计:研究设计包括两个阶段,定性研究阶段和干预阶段。在定性研究阶段提出了发现,其中包括对班主任,学校管理者,父母和学生焦点小组的访谈。
    地点:该研究在英国利兹的四所小学和四所中学进行。
    主题:参与者包括班主任,学校管理员,父母和学生。
    结果:研究结果表明,尽管许多中学并不主动提倡免费提供校餐,但父母认为注册过程相对简单。学生和父母都认为食物质量和食物选择对决定学校用餐选择很重要,污名的问题比最初预期的要少。
    结论:学校应制定积极的方法来促进免费学校用餐,不仅应注意食物的质量和供应量,还应注意就餐的社会,文化和环境方面。应考虑维持学生匿名的过程,以减轻父母对污名的恐惧。
  • 【牛奶和奶制品中李斯特菌物种的发生:英格兰和威尔士的一项全国调查。】 复制标题 收藏 收藏
    DOI:10.1016/0168-1605(91)90070-6 复制DOI
    作者列表:Greenwood MH,Roberts D,Burden P
    BACKGROUND & AIMS: :A total of 4172 samples of milk, cheese and other dairy products were examined over a 1-year period for the presence of Listeria species. Strains of Listeria were found most frequently in soft, ripened cows milk cheese; 63 out of 769 (8.2%) samples contained Listeria monocytogenes, 25 samples contained species other than L. monocytogenes, and 18 samples contained both L. monocytogenes and other Listeria spp. Eleven samples of pasteurized cows milk (1.1%) from four dairies contained L. monocytogenes, and other Listeria spp. were isolated from a further five samples. Goats and ewes milk and their products, yogurt, cream and ice cream also occasionally contained Listeria spp. Levels of Listeria were usually low, but 20 samples of cheese contained more than 1000 cfu/g. Most strains of L. monocytogenes belonged to serotype 1/2 (58%) or serotype 4b (33%).
    背景与目标: :在1年期间内,共检查了4172份牛奶,奶酪和其他乳制品的样品中是否存在李斯特菌。李斯特菌菌株最常见于成熟的软牛奶奶酪中。在769个样本中,有63个(8.2%)包含单核细胞增生李斯特菌,25个样本包含单核细胞增生李斯特氏菌以外的物种,18个样本同时包含单核细胞增生李斯特氏菌和其他李斯特菌。来自四个奶牛场的11个巴氏杀菌牛奶样品(1.1%)包含单核细胞增生李斯特菌和其他李斯特菌属。从另外五个样品中分离出来。山羊和母羊牛奶及其制品,酸奶,奶油和冰淇淋中也偶尔含有李斯特菌属。李斯特菌水平通常很低,但是20个奶酪样品中的1000 cfu / g以上。单核细胞增生李斯特氏菌的大多数菌株属于血清型1/2(58%)或血清型4b(33%)。

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