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McCartney G, Johnstone C, Dover L. The changing shape of general practice in Scotland: the rise of the 'megapractice'. Public Health 2024; 233:185-189. [PMID: 38908308 DOI: 10.1016/j.puhe.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES To describe the trends in the nature of general practices in Scotland between 2014/15 and 2023. STUDY DESIGN Descriptive ecological study. METHODS We obtained data from Public Health Scotland and used general practitioner (GP) practice codes, practice names, and the General Medical Council (GMC) numbers of their listed GPs to describe trends in practice characteristics and to identify individual practices that were likely to be operating as a single entity. RESULTS Defining practice entities is difficult because different GP practice codes are often retained when GPs are performing across multiple practices. If GP practice codes alone are used, the median practice list size increased from 5094 to 5881, and the mean from 5588 to 6289, between 2013/14 and 2020/21. There was one outlier practice that grew to have over 45,000 patients registered by 2020/21. However, this underestimates the extent of this new mega-practice phenomenon. Using the GMC numbers of GPs listed as performers to identify where the same GPs are working across multiple GP practice codes, we identified a series of mega-practices that span across health board areas and which have experienced a dramatic increase in their list size (with the two largest having list sizes of over 101,000 and 77,000 patients, respectively). CONCLUSIONS Further research is needed to better understand: how mega-practices provide services and whether this differs from other practices; where financial rewards accumulate within mega-practices; differences in staffing between mega-practices and other models; and the impacts mega-practices have on the quality and continuity of care and on health and inequality outcomes.
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Affiliation(s)
- Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Adam Smith Building, 28 Bute Gardens, Glasgow G12 8RS, UK.
| | - Chris Johnstone
- Renfrewshire Health and Social Care Partnership, Paisley, UK
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Jansen T, Gouwens S, Meijerink L, Meulman I, Kouwenberg LHJA, de Wit GA, Polder JJ, Kunst AE, Uiters E. Disruption of hospital care during the first year of the COVID-19 pandemic impacted socioeconomic groups differently: population based study using routine registration data. BMC Health Serv Res 2024; 24:294. [PMID: 38448939 PMCID: PMC10918870 DOI: 10.1186/s12913-024-10695-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, provision of non-COVID healthcare was recurrently severely disrupted. The objective was to determine whether disruption of non-COVID hospital use, either due to cancelled, postponed, or forgone care, during the first pandemic year of COVID-19 impacted socioeconomic groups differently compared with pre-pandemic use. METHODS National population registry data, individually linked with data of non-COVID hospital use in the Netherlands (2017-2020). in non-institutionalised population of 25-79 years, in standardised household income deciles (1 = low, 10 = high) as proxy for socioeconomic status. Generic outcome measures included patients who received hospital care (dichotomous): outpatient contact, day treatment, inpatient clinic, and surgery. Specific procedures were included as examples of frequently performed elective and acute procedures, e.g.: elective knee/hip replacement and cataract surgery, and acute percutaneous coronary interventions (PCI). Relative risks (RR) for hospital use were reported as outcomes from generalised linear regression models (binomial) with log-link. An interaction term was included to assess whether income differences in hospital use during the pandemic deviated from pre-pandemic use. RESULTS Hospital use rates declined in 2020 across all income groups. With baseline (2019) higher hospital use rates among lower than higher income groups, relatively stronger declines were found for lower income groups. The lowest income groups experienced a 10% larger decline in surgery received than the highest income group (RR 0.90, 95% CI 0.87 - 0.93). Patterns were similar for inpatient clinic, elective knee/hip replacement and cataract surgery. We found small or no significant income differences for outpatient clinic, day treatment, and acute PCI. CONCLUSIONS Disruption of non-COVID hospital use in 2020 was substantial across all income groups during the acute phases of the pandemic, but relatively stronger for lower income groups than could be expected compared with pre-pandemic hospital use. Although the pandemic's impact on the health system was unprecedented, healthcare service shortages are here to stay. It is therefore pivotal to realise that lower income groups may be at risk for underuse in times of scarcity.
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Affiliation(s)
- Tessa Jansen
- Centre for Public Health, Healthcare, and Society, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - Sigur Gouwens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000, LE, Tilburg, The Netherlands
| | - Lotta Meijerink
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000, LE, Tilburg, The Netherlands
| | - Iris Meulman
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000, LE, Tilburg, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105, BK, Amsterdam, the Netherlands
| | - Lisanne H J A Kouwenberg
- Centre for Public Health, Healthcare, and Society, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
- Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1007, MB, Amsterdam, The Netherlands
| | - G Ardine de Wit
- Centre for Public Health, Healthcare, and Society, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
- Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), 3720, BA, Bilthoven, The Netherlands
| | - Johan J Polder
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000, LE, Tilburg, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105, BK, Amsterdam, the Netherlands
| | - Anton E Kunst
- Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1007, MB, Amsterdam, The Netherlands
| | - Ellen Uiters
- Centre for Public Health, Healthcare, and Society, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
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Thomson RM, Kopasker D, Bronka P, Richiardi M, Khodygo V, Baxter AJ, Igelström E, Pearce A, Leyland AH, Katikireddi SV. Short-term impacts of Universal Basic Income on population mental health inequalities in the UK: A microsimulation modelling study. PLoS Med 2024; 21:e1004358. [PMID: 38437214 PMCID: PMC10947674 DOI: 10.1371/journal.pmed.1004358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/18/2024] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Population mental health in the United Kingdom (UK) has deteriorated, alongside worsening socioeconomic conditions, over the last decade. Policies such as Universal Basic Income (UBI) have been suggested as an alternative economic approach to improve population mental health and reduce health inequalities. UBI may improve mental health (MH), but to our knowledge, no studies have trialled or modelled UBI in whole populations. We aimed to estimate the short-term effects of introducing UBI on mental health in the UK working-age population. METHODS AND FINDINGS Adults aged 25 to 64 years were simulated across a 4-year period from 2022 to 2026 with the SimPaths microsimulation model, which models the effects of UK tax/benefit policies on mental health via income, poverty, and employment transitions. Data from the nationally representative UK Household Longitudinal Study were used to generate the simulated population (n = 25,000) and causal effect estimates. Three counterfactual UBI scenarios were modelled from 2023: "Partial" (value equivalent to existing benefits), "Full" (equivalent to the UK Minimum Income Standard), and "Full+" (retaining means-tested benefits for disability, housing, and childcare). Likely common mental disorder (CMD) was measured using the General Health Questionnaire (GHQ-12, score ≥4). Relative and slope indices of inequality were calculated, and outcomes stratified by gender, age, education, and household structure. Simulations were run 1,000 times to generate 95% uncertainty intervals (UIs). Sensitivity analyses relaxed SimPaths assumptions about reduced employment resulting from Full/Full+ UBI. Partial UBI had little impact on poverty, employment, or mental health. Full UBI scenarios practically eradicated poverty but decreased employment (for Full+ from 78.9% [95% UI 77.9, 79.9] to 74.1% [95% UI 72.6, 75.4]). Full+ UBI increased absolute CMD prevalence by 0.38% (percentage points; 95% UI 0.13, 0.69) in 2023, equivalent to 157,951 additional CMD cases (95% UI 54,036, 286,805); effects were largest for men (0.63% [95% UI 0.31, 1.01]) and those with children (0.64% [95% UI 0.18, 1.14]). In our sensitivity analysis assuming minimal UBI-related employment impacts, CMD prevalence instead fell by 0.27% (95% UI -0.49, -0.05), a reduction of 112,228 cases (95% UI 20,783, 203,673); effects were largest for women (-0.32% [95% UI -0.65, 0.00]), those without children (-0.40% [95% UI -0.68, -0.15]), and those with least education (-0.42% [95% UI -0.97, 0.15]). There was no effect on educational mental health inequalities in any scenario, and effects waned by 2026. The main limitations of our methods are the model's short time horizon and focus on pathways from UBI to mental health solely via income, poverty, and employment, as well as the inability to integrate macroeconomic consequences of UBI; future iterations of the model will address these limitations. CONCLUSIONS UBI has potential to improve short-term population mental health by reducing poverty, particularly for women, but impacts are highly dependent on whether individuals choose to remain in employment following its introduction. Future research modelling additional causal pathways between UBI and mental health would be beneficial.
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Affiliation(s)
- Rachel M. Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Patryk Bronka
- Institute for Social and Economic Research, University of Essex, Essex, England, United Kingdom
| | - Matteo Richiardi
- Institute for Social and Economic Research, University of Essex, Essex, England, United Kingdom
| | - Vladimir Khodygo
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Andrew J. Baxter
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Erik Igelström
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - S. Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom
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Macintyre AK, Shipton D, Sarica S, Scobie G, Craig N, McCartney G. Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews. Syst Rev 2024; 13:58. [PMID: 38331910 PMCID: PMC10851517 DOI: 10.1186/s13643-023-02429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND A fairer economy is increasingly recognised as crucial for tackling widening social, economic and health inequalities within society. However, which actions have been evaluated for their impact on inclusive economy outcomes is yet unknown. OBJECTIVE Identify the effects of political, economic and social exposures, interventions and policies on inclusive economy (IE) outcomes in high-income countries, by systematically reviewing the review-level evidence. METHODS We conducted a review of reviews; searching databases (May 2020) EconLit, Web of Science, Sociological Abstracts, ASSIA, International Bibliography of the Social Sciences, Public Health Database, Embase and MEDLINE; and registries PROSPERO, Campbell Collaboration and EPPI Centre (February 2021) and grey literature (August/September 2020). We aimed to identify reviews which examined social, political and/or economic exposures, interventions and policies in relation to two IE outcome domains: (i) equitable distribution of the benefits of the economy and (ii) equitable access to the resources needed to participate in the economy. Reviews had to include primary studies which compared IE outcomes within or between groups. Quality was assessed using a modified version of AMSTAR-2 and data synthesised informed by SWiM principles. RESULTS We identified 19 reviews for inclusion, most of which were low quality, as was the underlying primary evidence. Most reviews (n = 14) had outcomes relating to the benefits of the economy (rather than access to resources) and examined a limited set of interventions, primarily active labour market programmes and social security. There was limited high-quality review evidence to draw upon to identify effects on IE outcomes. Most reviews focused on disadvantaged groups and did not consider equity impacts. CONCLUSIONS Review-level evidence is sparse and focuses on 'corrective' approaches. Future reviews should examine a diverse set of 'upstream' actions intended to be inclusive 'by design' and consider a wider range of outcomes, with particular attention to socioeconomic inequalities.
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Affiliation(s)
- Anna K Macintyre
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK.
| | - Deborah Shipton
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Shifa Sarica
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Graeme Scobie
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Neil Craig
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Gerry McCartney
- School of Social & Political Sciences, University of Glasgow, Glasgow, UK
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Zhang A, Gagné T, Walsh D, Ciancio A, Proto E, McCartney G. Trends in psychological distress in Great Britain, 1991-2019: evidence from three representative surveys. J Epidemiol Community Health 2023; 77:468-473. [PMID: 37188500 PMCID: PMC10313989 DOI: 10.1136/jech-2022-219660] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Previously improving UK mortality trends stalled around 2012, with evidence implicating economic policy as the cause. This paper examines whether trends in psychological distress across three population surveys show similar trends. METHODS We report the percentages reporting psychological distress (4+ in the 12-item General Health Questionnaire) from Understanding Society (Great Britain, 1991-2019), Scottish Health Survey (SHeS, 1995-2019) and Health Survey for England (HSE, 2003-2018) for the population overall, and stratified by sex, age and area deprivation. Summary inequality indices were calculated and segmented regressions fitted to identify breakpoints after 2010. RESULTS Psychological distress was higher in Understanding Society than in SHeS or HSE. There was slight improvement between 1992 and 2015 in Understanding Society (with prevalence declining from 20.6% to 18.6%) with some fluctuations. After 2015 there is some evidence of a worsening in psychological distress across surveys. Prevalence worsened notably among those aged 16-34 years after 2010 (all three surveys), and aged 35-64 years in Understanding Society and SHeS after 2015. In contrast, the prevalence declined in those aged 65+ years in Understanding Society after around 2008, with less clear trends in the other surveys. The prevalence was around twice as high in the most deprived compared with the least deprived areas, and higher in women, with trends by deprivation and sex similar to the populations overall. CONCLUSION Psychological distress worsened among working-age adults after around 2015 across British population surveys, mirroring the mortality trends. This indicates a widespread mental health crisis that predates the COVID-19 pandemic.
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Affiliation(s)
- Anwen Zhang
- Adam Smith Business School, University of Glasgow, Glasgow, UK
| | - Thierry Gagné
- International Centre for Lifecourse Studies in Society and Health, London, UK
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
| | - Alberto Ciancio
- Adam Smith Business School, University of Glasgow, Glasgow, UK
| | - Eugenio Proto
- Adam Smith Business School, University of Glasgow, Glasgow, UK
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
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Džakula A, Vočanec D, Lončarek K. Fragmentation, dehumanization, commodification: crisis of medicine. Croat Med J 2023; 64:208-210. [PMID: 37391920 PMCID: PMC10332291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023] Open
Affiliation(s)
| | - Dorja Vočanec
- Dorja Vočanec, Department of Social Medicine and Organization of Health Care, Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia,
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Meier P, Katikireddi SV, Smith K. Bold action is needed to strengthen primary prevention. BMJ 2023; 380:595. [PMID: 36921929 DOI: 10.1136/bmj.p595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Katherine Smith
- School of Social Work and Social Policy, University of Strathclyde, Strathclyde, UK
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Shah SA, Brophy S, Kennedy J, Fisher L, Walker A, Mackenna B, Curtis H, Inglesby P, Davy S, Bacon S, Goldacre B, Agrawal U, Moore E, Simpson CR, Macleod J, Cooksey R, Sheikh A, Katikireddi SV. Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people. EClinicalMedicine 2022; 49:101462. [PMID: 35611160 PMCID: PMC9121886 DOI: 10.1016/j.eclinm.2022.101462] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/14/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Uncontrolled infection and lockdown measures introduced in response have resulted in an unprecedented challenge for health systems internationally. Whether such unprecedented impact was due to lockdown itself and recedes when such measures are lifted is unclear. We assessed the short- and medium-term impacts of the first lockdown measures on hospital care for tracer non-COVID-19 conditions in England, Scotland and Wales across diseases, sexes, and socioeconomic and ethnic groups. Methods We used OpenSAFELY (for England), EAVEII (Scotland), and SAIL Databank (Wales) to extract weekly hospital admission rates for cancer, cardiovascular and respiratory conditions (excluding COVID-19) from the pre-pandemic period until 25/10/2020 and conducted a controlled interrupted time series analysis. We undertook stratified analyses and assessed admission rates over seven months during which lockdown restrictions were gradually lifted. Findings Our combined dataset included 32 million people who contributed over 74 million person-years. Admission rates for all three conditions fell by 34.2% (Confidence Interval (CI): -43.0, -25.3) in England, 20.9% (CI: -27.8, -14.1) in Scotland, and 24.7% (CI: -36.7, -12.7) in Wales, with falls across every stratum considered. In all three nations, cancer-related admissions fell the most while respiratory-related admissions fell the least (e.g., rates fell by 40.5% (CI: -47.4, -33.6), 21.9% (CI: -35.4, -8.4), and 19.0% (CI: -30.6, -7.4) in England for cancer, cardiovascular-related, and respiratory-related admissions respectively). Unscheduled admissions rates fell more in the most than the least deprived quintile across all three nations. Some ethnic minority groups experienced greater falls in admissions (e.g., in England, unscheduled admissions fell by 9.5% (CI: -20.2, 1.2) for Whites, but 44.3% (CI: -71.0, -17.6), 34.6% (CI: -63.8, -5.3), and 25.6% (CI: -45.0, -6.3) for Mixed, Other and Black ethnic groups respectively). Despite easing of restrictions, the overall admission rates remained lower in England, Scotland, and Wales by 20.8%, 21.6%, and 22.0%, respectively when compared to the same period (August-September) during the pre-pandemic years. This corresponds to a reduction of 26.2, 23.8 and 30.2 admissions per 100,000 people in England, Scotland, and Wales respectively. Interpretation Hospital care for non-COVID diseases fell substantially across England, Scotland, and Wales during the first lockdown, with reductions persisting for at least six months. The most deprived and minority ethnic groups were impacted more severely. Funding This work was funded by the Medical Research Council as part of the Lifelong Health and Wellbeing study as part of National Core Studies (MC_PC_20030). SVK acknowledges funding from the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE - The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. BG has received research funding from the NHS National Institute for Health Research (NIHR), the Wellcome Trust, Health Data Research UK, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme.
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Affiliation(s)
- Syed Ahmar Shah
- Usher Institute, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Sinead Brophy
- Data Science Building, Medical School, Swansea University, UK
| | - John Kennedy
- Data Science Building, Medical School, Swansea University, UK
| | - Louis Fisher
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alex Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian Mackenna
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Helen Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Inglesby
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Davy
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St. Andrews, St Andrews, UK
| | | | - Colin R Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - John Macleod
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Roxane Cooksey
- Data Science Building, Medical School, Swansea University, UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
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Wyper GMA, Fletcher E, Grant I, Harding O, de Haro Moro MT, McCartney G, Stockton DL. Widening of inequalities in COVID-19 years of life lost from 2020 to 2021: a Scottish Burden of Disease Study. J Epidemiol Community Health 2022; 76:jech-2022-219090. [PMID: 35613856 DOI: 10.1136/jech-2022-219090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous studies have highlighted the large extent of inequality in adverse COVID-19 health outcomes. Our aim was to monitor changes in overall, and inequalities in, COVID-19 years of life lost to premature mortality (YLL) in Scotland from 2020 and 2021. METHODS Cause-specific COVID-19 mortality counts were derived at age group and area deprivation level using Scottish death registrations for 2020 and 2021. YLL was estimated by multiplying mortality counts by age-conditional life expectancy from the Global Burden of Disease 2019 reference life table. Various measures of absolute and relative inequality were estimated for triangulation purposes. RESULTS There were marked inequalities in COVID-19 YLL by area deprivation in 2020, which were further exacerbated in 2021; confirmed across all measures of absolute and relative inequality. Half (51%) of COVID-19 YLL was attributable to inequalities in area deprivation in 2021, an increase from 41% in 2020. CONCLUSION Despite a highly impactful vaccination programme in preventing mortality, COVID-19 continues to represent a substantial area of fatal population health loss for which inequalities have widened. Tackling systemic inequalities with effective interventions is required to mitigate further unjust health loss in the Scottish population from COVID-19 and other causes of ill-health and mortality.
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Affiliation(s)
- Grant M A Wyper
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
| | - Eilidh Fletcher
- Data Driven Innovation Directorate, Public Health Scotland, Edinburgh, UK
| | - Ian Grant
- Data Driven Innovation Directorate, Public Health Scotland, Edinburgh, UK
| | - Oliver Harding
- Directorate of Public Health, NHS Forth Valley, Stirling, UK
| | | | - Gerry McCartney
- College of Social Sciences, University of Glasgow, Glasgow, UK
- Clinical and Protecting Health Directorate, Public Health Scotland, Edinburgh, UK
| | - Diane L Stockton
- Clinical and Protecting Health Directorate, Public Health Scotland, Edinburgh, UK
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Adaptive Reuse of Social and Healthcare Structures: The Case Study as a Research Strategy. SUSTAINABILITY 2022. [DOI: 10.3390/su14084712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The regeneration and reuse of abandoned healthcare facilities represent one of the most complex issues in the broader field of disused public architectural heritage and its valorization. The leading causes of an elevated quantity of abandoned hospitals are the lack of resilience of these structures, as well as the evolution of the regulatory framework used to increase the quality standards of the National Health System and the constant changes caused by medical discoveries. In addition, the transfer to a new building typically does not involve consideration of the future of the dismissed facility with a lack of a strategic view for its regeneration, thus causing its progressive degradation. Although their large dimensions and unbuilt areas make recovery plans complex, the re-functionalization of these facilities represents an excellent opportunity for social and economic development, as several case studies demonstrate. This paper selects some useful examples of the reconversion and reuse of disused social and healthcare buildings through an accurate comparison that highlights the importance of the topic and the possible actions to be taken into consideration. Although this research focuses on a limited number of case studies, the paper gives rise to some strategies that can be applied to several current cases of disused buildings that could be used to support Decision Makers (DMs) from different countries.
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