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Steel N, BauerStaeb C, Ford J, Gillam T, Schmidt J, Hughes AS. Changing life expectancy in Europe 1990-2019: Global Burden of Disease Study 2019. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Improvements in life expectancy have slowed in high income countries, with uncertain causes. We assessed the contribution of different causes of death to changes in life expectancy, and changes in population exposure to major risk factors in 16 European Economic Area countries plus the 4 nations of the United Kingdom from 1990-2013 and 2013-2019, using the Global Burden of Disease Study. After decades of steady improvements in life expectancy, all countries experienced smaller annual improvements after 2013. Norway experienced the smallest mean annual rate of change in improvement from pre 2013 to post 2013 of 0.03 years, and Northern Ireland (followed closely by Scotland and England) experienced the largest annual reduction from pre to post 2013 of 0.25 years. The cause of death responsible for the largest reductions in life expectancy improvements after 2013 was cardiovascular disease, followed by neoplasms. The largest reductions in deaths from cardiovascular disease were attributable to seven major risk factors: high LDL cholesterol, tobacco, dietary risks, high fasting plasma glucose, high systolic blood pressure, high body mass index, and low physical activity. The risk factors for deaths from neoplasm were similar. Exposure to tobacco remains a high risk but exposure declined steadily. Exposure to the other risks generally worsened after 2013, particularly for BMI and high fasting plasma glucose. The European countries that had better maintained reductions in deaths from cardiovascular disease and neoplasms also experienced larger improvements in life expectancy. These changes were underpinned by changing exposure to major risks. Policy responses to the slowdown in life expectancy improvements should include reducing population exposure to major risks, including the broader risks from diet and low physical activity, through prevention and addressing the broad social and commercial determinants of health as well as adequate funding for health services.
Key messages
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Affiliation(s)
- N Steel
- University of East Anglia, Norwich Medical School , Norwich, UK
| | - C BauerStaeb
- Office for Health Improvement and Disparaties, Department of Health and Social Care , London, UK
| | - J Ford
- Primary Care Unit, University of Cambridge , Cambridge, UK
| | - T Gillam
- University of East Anglia, Norwich Medical School , Norwich, UK
| | - J Schmidt
- Office for Health Improvement and Disparaties, Department of Health and Social Care , London, UK
| | - AS Hughes
- Office for Health Improvement and Disparaties, Department of Health and Social Care , London, UK
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2
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Akter N, Kulinskaya E, Steel N, Bakbergenuly I. The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984-2017. BJOG 2021; 129:994-1003. [PMID: 34773357 PMCID: PMC9298998 DOI: 10.1111/1471-0528.17008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the effect of estrogen-only and combined hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in healthy women aged 46-65 at first prescription. DESIGN Matched cohort study. SETTING Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984-2017). POPULATION 105 199 HRT users (cases) and 224 643 non-users (controls) matched on age and general practice. METHODS Weibull-Double-Cox regression models adjusted for age at first treatment, birth cohort, type 2 diabetes, hypertension and hypertension treatment, coronary heart disease, oophorectomy, hysterectomy, body mass index, smoking and deprivation status. MAIN OUTCOME MEASURES All-cause mortality. RESULTS A total of 21 751 women died over an average of 13.5 years follow-up per participant, of whom 6329 were users and 15 422 non-users. The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95% CI 0.88-0.94), and in estrogen-only users was 0.99 (0.93-1.07), compared with non-users. Age-specific adjusted HRs for participants aged 46-50, 51-55, 56-60 and 61-65 years at first treatment were 0.98 (0.92-1.04), 0.87 (0.82-0.92), 0.88 (0.82-0.93) and 0.92 (0.85-0.98) for combined HRT users compared with non-users, and 1.01 (0.84-1.21), 1.03 (0.89-1.18), 0.98 (0.86-1.12) and 0.93 (0.81-1.07) for estrogen-only users, respectively. CONCLUSIONS Combined HRT was associated with a 9% lower risk of all-cause mortality and estrogen-only formulation was not associated with any significant changes. TWEETABLE ABSTRACT Estrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.
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Affiliation(s)
- N Akter
- School of Computing Sciences, University of East Anglia, Norwich, UK
| | - E Kulinskaya
- School of Computing Sciences, University of East Anglia, Norwich, UK
| | - N Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - I Bakbergenuly
- School of Computing Sciences, University of East Anglia, Norwich, UK
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Enwo OO, Player E, Steel N, Ford JA. The impact of life events on later life: a latent class analysis of the English Longitudinal Study of Ageing. J Public Health (Oxf) 2021; 43:e180-e187. [PMID: 32157284 DOI: 10.1093/pubmed/fdaa002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Inequalities in life events can lead to inequalities in older age. This research aimed to explore associations between life events reported by older people and quality of life (QoL) and functional ability. METHODS Participants were grouped according to eight life events: parental closeness, educational opportunities in childhood, financial hardship, loss of an unborn child, bereavement due to war, involvement in conflict, violence and experiencing a natural disaster. Linear and logistic regressions were used to explore associations between these groups and the main outcomes of functional ability and QoL. RESULTS 7555 participants were allocated to four LCA groups: 'few life events' (n = 6,250), 'emotionally cold mother' (n = 724), 'violence in combat' (n = 274) and 'many life events' (n = 307). Reduced QoL was reported in the 'many life events' (coefficient - 5.33, 95%CI -6.61 to -4.05), 'emotionally cold mother' (-1.89, -2.62 to 1.15) and 'violence in combat' (-1.95, -3.08 to -0.82) groups, compared to the 'few life events' group. The 'many life events' group also reported more difficulty with activities of daily living. CONCLUSIONS Policies aimed at reducing inequalities in older age should consider events across the life course.
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Affiliation(s)
- O O Enwo
- Norwich Medical School, University of East Anglia
| | - E Player
- Norwich Medical School, University of East Anglia
| | - N Steel
- Norwich Medical School, University of East Anglia
| | - J A Ford
- Norwich Medical School, University of East Anglia.,Institute of Public Health, University of Cambridge
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Gillam TB, Cole J, Gharbi K, Angiolini E, Barker T, Bickerton P, Brabbs T, Chin J, Coen E, Cossey S, Davey R, Davidson R, Durrant A, Edwards D, Hall N, Henderson S, Hitchcock M, Irish N, Lipscombe J, Jones G, Parr G, Rushworth S, Shearer N, Smith R, Steel N. Norwich COVID-19 testing initiative pilot: evaluating the feasibility of asymptomatic testing on a university campus. J Public Health (Oxf) 2021; 43:82-88. [PMID: 33124664 PMCID: PMC7665602 DOI: 10.1093/pubmed/fdaa194] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background There is a high prevalence of COVID-19 in university-age students, who are returning to campuses. There is little evidence regarding the feasibility of universal, asymptomatic testing to help control outbreaks in this population. This study aimed to pilot mass COVID-19 testing on a university research park, to assess the feasibility and acceptability of scaling up testing to all staff and students. Methods This was a cross-sectional feasibility study on a university research park in the East of England. All staff and students (5625) were eligible to participate. All participants were offered four PCR swabs, which they self-administered over two weeks. Outcome measures included uptake, drop-out rate, positivity rates, participant acceptability measures, laboratory processing measures, data collection and management measures. Results 798 (76%) of 1053 who registered provided at least one swab; 687 (86%) provided all four; 792 (99%) of 798 who submitted at least one swab had all negative results and 6 participants had one inconclusive result. There were no positive results. 458 (57%) of 798 participants responded to a post-testing survey, demonstrating a mean acceptability score of 4.51/5, with five being the most positive. Conclusions Repeated self-testing for COVID-19 using PCR is feasible and acceptable to a university population.
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Affiliation(s)
- T Berger Gillam
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - J Cole
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - K Gharbi
- Genomics Pipelines, Earlham Institute, Norwich, NR4 7UZ, UK
| | - E Angiolini
- Scientific Training and Education, Earlham Institute, Norwich NR4 7UZ, UK
| | - T Barker
- Genomics Pipelines, Earlham Institute, Norwich, NR4 7UZ, UK
| | - P Bickerton
- Communications, Earlham Institute, Norwich NR4 7UZ, UK
| | - T Brabbs
- Genomics Pipelines, Earlham Institute, Norwich, NR4 7UZ, UK
| | - J Chin
- School of Computing Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - E Coen
- John Innes Centre, Norwich NR4 7UH, UK
| | - S Cossey
- Earlham Institute, Norwich NR4 7UZ, UK
| | - R Davey
- Earlham Institute, Norwich NR4 7UZ, UK
| | - R Davidson
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - A Durrant
- Genomics Pipelines, Earlham Institute, Norwich, NR4 7UZ, UK
| | - D Edwards
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - N Hall
- Earlham Institute, Norwich NR4 7UZ, UK.,UEA Biosciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - S Henderson
- Genomics Pipelines, Earlham Institute, Norwich, NR4 7UZ, UK
| | - M Hitchcock
- UEA Health and Social Care Partners, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - N Irish
- Genomics Pipelines, Earlham Institute, Norwich, NR4 7UZ, UK
| | - J Lipscombe
- Genomics Pipelines, Earlham Institute, Norwich, NR4 7UZ, UK
| | - G Jones
- Communications, Earlham Institute, Norwich NR4 7UZ, UK
| | - G Parr
- School of Computing Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - S Rushworth
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - N Shearer
- Genomics Pipelines, Earlham Institute, Norwich, NR4 7UZ, UK
| | - R Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - N Steel
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
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Berger Gillam T, Chin J, Cossey S, Culley K, Davidson RK, Edwards DR, Gharbi K, Goodwin N, Hall N, Hitchcock M, Jupp OJ, Lipscombe J, Parr G, Shearer N, Smith R, Steel N. Phase 2 of the Norwich COVID-19 testing initiative: an evaluation. J Public Health (Oxf) 2021; 43:e749-e750. [PMID: 33839796 PMCID: PMC8083310 DOI: 10.1093/pubmed/fdab124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Berger Gillam
- Health Services and Primary Care Research Group, University of East Anglia, Norwich NR4 7TJ, UK
| | - J Chin
- School of Computing Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - S Cossey
- Earlham Institute, Norwich NR4 7UZ, UK
| | - K Culley
- Anglia Innovation Partnership LLP, Centrum, Norwich Research Park, Norwich NR4 7UG, UK
| | - R K Davidson
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7UQ, UK
| | - D R Edwards
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7UQ, UK
| | - K Gharbi
- Earlham Institute, Norwich NR4 7UZ, UK
| | - N Goodwin
- Anglia Innovation Partnership LLP, Centrum, Norwich Research Park, Norwich NR4 7UG, UK
| | - N Hall
- Earlham Institute, Norwich NR4 7UZ, UK.,UEA Biosciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - M Hitchcock
- UEA Health and Social Care Partners, University of East Anglia, Norwich NR4 7TJ, UK
| | - O J Jupp
- BCRE CTC, Norfolk and Norwich University Foundation Hospital Microbiology Department, Norwich NR4 7GJ, UK
| | | | - G Parr
- School of Computing Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - N Shearer
- Earlham Institute, Norwich NR4 7UZ, UK
| | - R Smith
- School of Computing Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - N Steel
- Health Services and Primary Care Research Group, University of East Anglia, Norwich NR4 7TJ, UK
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Ford J, Steel N, Aasheim E, Devleesschauwer B, Gallay A, Morgan D, Schmidt J, Ziese T, Newton J. Slowing improvements in life expectancy across European Economic Area countries. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Life expectancy improvements have slowed down in several European countries since around 2011. The relative contributions from changes in specific conditions (e.g. cancers) and broader risk factors (e.g. smoking or austerity) remain unclear. We aimed to explore the different potential causes in 17 European Economic Area (EEA) countries.
Methods
We compared Global Burden of Disease (GBD) study estimates for life expectancy, years of life lost (YLLs) and population attributable fractions (PAFs) for risk factors, for 2005-2011 and 2011-2017 for 17 EEA countries. Three countries with the largest absolute improvements and three with the smallest were selected for analysis by gender, age, condition and risk factors.
Results
Norway, France and Belgium had the largest improvement in life expectancy (+1.5, +1.2 and +1.2 years respectively) from 2011 to 2017, and Germany, Iceland and the UK the smallest (+0.1, +0.2 and +0.2 years). Life expectancy reduced slightly for women aged over 80 in Germany and UK, men aged over 50 in Germany, and for men in all age groups up to 90 years in Iceland. Norway, France and Belgium saw faster improvements in YLLs from lung cancer and Norway and France for COPD in both men and women, and from self-harm in men, after 2011 than before. PAF for tobacco declined faster after 2011. Germany, Iceland and the UK saw slower improvements in cardiovascular disease and in Germany and the UK lung cancer. In Iceland, YLLs for cancers, self harm, respiratory disease, cirrhosis and dementia all worsened after 2011. PAF for tobacco remained high or declined less after 2011 in all 3 countries. PAFs for alcohol and drug use remained high in Iceland and UK.
Conclusions
Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies, but national differences in data availability may affect results. Further research is needed into the ‘causes of the causes’, such as the 2008 economic crash in Iceland.
Key messages
Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies. Norway, France and Belgium had the largest improvement in life expectancy from 2011 to 2017, and Germany, Iceland and the UK the smallest.
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Affiliation(s)
- J Ford
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - N Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - E Aasheim
- Norwegian Directorate of Health, Ministry of Health and Care Services, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - B Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - A Gallay
- Santé Publique France, Saint-Maurice, Paris, France
| | - D Morgan
- Health Statistics, OECD, Paris, France
| | - J Schmidt
- Public Health Data Science, Public Health England, London, UK
| | - T Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - J Newton
- Chief Knowledge Officer, Public Health England, London, UK
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Steel N, Ford J, Lenaghan L, Salter C, Shiner A, Murdoch J, Clark A, Turner D. 104GOAL SETTING FOR PATIENTS WITH MULTIMORBIDITY IN PRIMARY CARE: A CLUSTER RANDOMISED FEASIBILITY TRIAL. Age Ageing 2019. [DOI: 10.1093/ageing/afy202.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Steel
- Norwich Medical School, University of East Anglia
| | - J Ford
- Norwich Medical School, University of East Anglia
| | - L Lenaghan
- Norwich Medical School, University of East Anglia
| | - C Salter
- Norwich Medical School, University of East Anglia
| | - A Shiner
- Norwich Medical School, University of East Anglia
| | - J Murdoch
- Norwich Medical School, University of East Anglia
| | - A Clark
- Norwich Medical School, University of East Anglia
| | - D Turner
- Norwich Medical School, University of East Anglia
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Steel N, Ford J, Newton J, Davis A, Vos T, Naghavi M, Hughes A, Dalton A, Schmidt J, Murray C. Global burden of disease (GBD) 2016 subnational estimates for 150 English local authorities. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Steel
- University of East Anglia, Norwich, UK
| | - J Ford
- University of East Anglia, Norwich, UK
| | - J Newton
- Public Health England, London, UK
| | - A Davis
- Public Health England, London, UK
| | - T Vos
- Institute for Health Metrics and Evaluation, Seattle, USA
| | - M Naghavi
- Institute for Health Metrics and Evaluation, Seattle, USA
| | - A Hughes
- Public Health England, London, UK
| | - A Dalton
- University of East Anglia, Norwich, UK
| | | | - C Murray
- Institute for Health Metrics and Evaluation, Seattle, USA
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Codde E, Munro A, Stewart C, Spilsbury K, Bowen S, Codde J, Steel N, Leung Y, Tan J, Salfinger SG, Mohan GR, Cohen PA. Risk of persistent or recurrent cervical neoplasia in patients with 'pure' adenocarcinoma-in-situ (AIS) or mixed AIS and high-grade cervical squamous neoplasia (cervical intra-epithelial neoplasia grades 2 and 3 (CIN 2/3)): a population-based study. BJOG 2017; 125:74-79. [PMID: 28678394 DOI: 10.1111/1471-0528.14808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare outcomes of patients with pure adenocarcinoma-in-situ (AIS) and mixed AIS/CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma. DESIGN Retrospective cohort study. SETTING Statewide population in Western Australia. POPULATION Women diagnosed with AIS between 2001 and 2012. METHODS We conducted a retrospective, population-based cohort study. MAIN OUTCOME MEASURES De-identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post-treatment), and adenocarcinoma. RESULTS 636 patients were eligible for analysis. The mean age was 32.3 years and median follow-up interval was 2.5 years. Within the study cohort, 266 patients (41.8%) had pure AIS and 370 (58.2%) had mixed AIS/CIN 2/3. Overall, 47 patients (7.4%) had AIS persistence/recurrence and 12 (1.9%) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio (HR) 2.3; 95%CI 1.28-3.94; P = 0.005), age >30 years (HR 2.1; 95%CI 1.16-3.81; P = 0.015), positive endocervical margins (HR 5.8; 95%CI 3.05-10.92; P = <0.001) and AIS lesions >8 mm (HR 2.5; 95%CI 1.00-6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence. CONCLUSION In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS/CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease. TWEETABLE ABSTRACT Pure cervical adenocarcinoma-in-situ (AIS) may have greater risk of recurrence than AIS co-existing with CIN 2/3.
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Affiliation(s)
- E Codde
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - A Munro
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia
| | - Cjr Stewart
- Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - K Spilsbury
- Centre for Population Health Research, Curtin University, Bentley, WA, Australia
| | - S Bowen
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia
| | - J Codde
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - N Steel
- WA Cervical Cancer Prevention Program, WA Health, Perth, WA, Australia
| | - Y Leung
- Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - J Tan
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia.,WOMEN Centre, West Leederville, WA, Australia
| | - S G Salfinger
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - G R Mohan
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - P A Cohen
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.,St. John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, WA, Australia.,WOMEN Centre, West Leederville, WA, Australia
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Munro A, Leung Y, Spilsbury K, Stewart C, Semmens J, Codde J, Williams V, O'Leary P, Steel N, Cohen P. Comparison of cold knife cone biopsy and loop electrosurgical excision procedure in the management of cervical adenocarcinoma in situ: What is the gold standard? Gynecol Oncol 2015; 137:258-63. [DOI: 10.1016/j.ygyno.2015.02.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
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Hughes C, Steel N. A service evaluation of a primary care Tier 3 weight management service using the National Obesity Observatory Standard Evaluation Framework. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Mounce LTA, Steel N, Hardcastle AC, Henley WE, Bachmann MO, Campbell JL, Clark A, Melzer D, Richards SH. Patient characteristics predicting failure to receive indicated care for type 2 diabetes. Diabetes Res Clin Pract 2015; 107:247-58. [PMID: 25533855 DOI: 10.1016/j.diabres.2014.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/01/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
AIMS To determine which patient characteristics were associated with failure to receive indicated care for diabetes over time. METHODS English Longitudinal Study of Ageing participants aged 50 or older with diabetes reported receipt of care described by four diabetes quality indicators (QIs) in 2008-9 and 2010-11. Annual checks for glycated haemoglobin (HbA1c), proteinuria and foot examination were assessed as a care bundle (n=907). A further QI (n=759) assessed whether participants with cardiac risk factors were offered ACE inhibitors or angiotensin II receptor blockers (ARBs). Logistic regression modelled associations between failure to receive indicated care in 2010-11 and participants' socio-demographic, lifestyle and health characteristics, diabetes self-management knowledge, health literacy, and previous QI achievement in 2008-9. RESULTS A third of participants (2008-9=32.8%; 2010-11=32.2%) did not receive all annual checks in the care bundle. Nearly half of those eligible were not offered ACE inhibitors/ARBs (2008-9=44.6%; 2010-11=44.5%). Failure to receive a complete care bundle was associated with lower diabetes self-management knowledge (odds ratio (OR) 2.05), poorer cognitive performance (1.78), or having previously received incomplete care (3.32). Participants who were single (OR=2.16), had low health literacy (1.50) or had received incomplete care previously (6.94) were more likely to not be offered ACE inhibitors/ARBs. Increasing age (OR=0.76) or body mass index (OR=0.70) was associated with lower odds of failing to receive this aspect of care. CONCLUSIONS Quality improvement initiatives for diabetes might usefully target patients with previous receipt of incomplete care, poor knowledge of annual diabetes care processes, and poorer cognition and health literacy.
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Affiliation(s)
- L T A Mounce
- Primary Care Research Group and School of Public Health and Epidemiology, University of Exeter Medical School, United Kingdom
| | - N Steel
- Norwich Medical School, University of East Anglia, United Kingdom
| | - A C Hardcastle
- Norwich Medical School, University of East Anglia, United Kingdom
| | - W E Henley
- Health Statistics Research Group, University of Exeter Medical School, United Kingdom
| | - M O Bachmann
- Norwich Medical School, University of East Anglia, United Kingdom
| | - J L Campbell
- Primary Care Research Group, University of Exeter Medical School, United Kingdom
| | - A Clark
- Norwich Medical School, University of East Anglia, United Kingdom
| | - D Melzer
- School of Public Health and Epidemiology, University of Exeter Medical School, United Kingdom
| | - S H Richards
- Primary Care Research Group, University of Exeter Medical School, United Kingdom.
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Steel N, Hardcastle AC, Bachmann MO, Richards SH, Mounce LTA, Clark A, Lang I, Melzer D, Campbell J. Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study. BMJ Open 2014; 4:e005530. [PMID: 25344482 PMCID: PMC4212182 DOI: 10.1136/bmjopen-2014-005530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment. DESIGN The English Longitudinal Study of Ageing, a panel study of 12,765 participants aged 50 years and older in four waves from 2004 to 2011, selected using a stratified random sample of households in England. Distribution of illness burden, diagnosis and treatment by wealth was estimated using regression analysis. OUTCOME MEASURES The main outcome measures were ORs for the illness burden, diagnosis and treatment, respectively, adjusted for age, sex and wealth. We estimated the illness burden for angina with the Rose Angina scale, diabetes with fasting glycosylated haemoglobin, depression with the Centre for Epidemiologic Studies Depression Scale, osteoarthritis with self-reported pain and disability and cataract with self-reported poor vision. Medical diagnoses were self-reported for all conditions. Treatment was defined as β-blocker prescription for angina, surgery for osteoarthritis and cataract, and receipt of predefined effective interventions for diabetes and depression. RESULTS Compared with the wealthiest, the least wealthy participant had substantially higher odds for illness burden from any of the five conditions at all four time points, with ORs ranging from 4.2 (95% CI 2.6 to 6.8) for diabetes to 15.1 (11.4 to 20.0) for osteoarthritis. The ORs for diagnosis and treatment were smaller in all five conditions, and ranged from 0.9 (0.5 to 1.4) for diabetes treatment to 4.5 (3.3 to 6.0) for angina diagnosis. CONCLUSIONS The substantially higher illness burden in less wealthy participants was not matched by appropriately higher levels of diagnosis and treatment.
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Affiliation(s)
- N Steel
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - A C Hardcastle
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - M O Bachmann
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - A Clark
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - I Lang
- NIHR CLAHRC South West Peninsula, Exeter, UK
| | - D Melzer
- University of Exeter Medical School, Exeter, UK
| | - J Campbell
- University of Exeter Medical School, Exeter, UK
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Jennings A, Hughes CA, Kumaravel B, Bachmann MO, Steel N, Capehorn M, Cheema K. Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care. Clin Obes 2014; 4:254-66. [PMID: 25825858 PMCID: PMC4253319 DOI: 10.1111/cob.12066] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 05/05/2014] [Accepted: 05/26/2014] [Indexed: 12/01/2022]
Abstract
A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m(-2) , or 30 kg·m(-2) with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m(-2) . A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services.
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Affiliation(s)
- A Jennings
- Norwich Medical School, University of East Anglia, Norwich, UK
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Ford A, Johnston M, Shiner A, Howe A, Steel N. O3.04: Does resilience prevent functional decline in older adults? A cohort study. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70132-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hardcastle AC, Steel N, Bachmann MO, Melzer D. OP32 Symptoms, Diagnosis and Treatment in Socio-Economic Inequalities of Health. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Steel N, Abdelhamid A, Stokes T, Fleetcroft R, Qureshi N, Howe A. 030 Primary Care Physicians’ Views On Relevance Of Clinical Guideline Recommendations: Delphi Panel. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ighomereho A, Steel N, Bachmann M. P68 The prevalence of eye disease in Norfolk and Waveney. Br J Soc Med 2010. [DOI: 10.1136/jech.2010.120477.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
AIMS Diabetes UK estimates a quarter of UK cases of diabetes are undiagnosed; 750,000 people have undiagnosed diabetes in addition to 2.25 million with known diabetes, but research studies examining this are contradictory. The aim was to determine the prevalence of, and risk factors for, undiagnosed diabetes in the population of England aged > 50 years and to calculate the percentage of cases of undiagnosed diabetes. METHODS This was a cross-sectional study in a nationally representative sample of 6739 people aged 52-79 years from the English Longitudinal Study of Ageing (ELSA) 2004/2005. Diabetes cases were ascertained by self-reported doctor diagnosis of diabetes. A fasting plasma glucose measurement after a minimum of 8-h fast was available for 2387 (38% of the participants without diabetes). Undiagnosed diabetes cases were based on a fasting plasma glucose >or= 7.0 mmol/l. RESULTS The overall weighted prevalence of diabetes was 9.1%; 502 people (7.5%) had self-reported diabetes (9.0% of men and 6.0% of women); 36 (1.7%) had undiagnosed diabetes (2.6% of men and 0.8% of women). Of cases of diabetes, 18.5% were undiagnosed (22% in men, 12% in women). Significant risk factors for undiagnosed diabetes were male sex, higher body mass index, waist circumference, systolic blood pressure and triglycerides. CONCLUSIONS In 2004 the prevalence of undiagnosed diabetes, and the proportion of cases of diabetes that were undiagnosed, appear smaller than in previous studies. This is likely to be due to increased awareness of diabetes and improved clinical care resulting in many of those with previously undetected disease having been diagnosed.
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Affiliation(s)
- M B Pierce
- Department of Epidemiology and Public Health, University College London, London, UK.
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Lang IA, Gibbs SJ, Steel N, Melzer D. Neighbourhood deprivation and dental service use: a cross-sectional analysis of older people in England. J Public Health (Oxf) 2008; 30:472-8. [PMID: 18587145 DOI: 10.1093/pubmed/fdn047] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Appropriate dental care is an important part of maintaining good oral health. We examined the relationship between socioeconomic status, neighbourhood deprivation levels and older people's dental service use. METHODS We used logistic regression analysis to assess the relationship between self-reported dental service use and neighbourhood deprivation, adjusting for individual socioeconomic and health factors, in individuals aged 65+ in the 2005 Health Survey for England (n = 4240). RESULTS Among dentulous respondents, 69.9% reported attending for regular check-ups, 6.2% occasional check-ups, 18.4% only saw a dentist when in trouble and 5.6% never went to a dentist. In our adjusted model age, sex, region, education level, occupational social class, self-reported health and smoking status, but not degree of urbanization, were associated with use of dental services. Following adjustment for these other factors those living in the most deprived 20% of neighbourhoods, compared with those in the least deprived, had a relative risk ratio of 2.25 (95% confidence interval 1.59-3.17) of using dental services only when symptomatic, rather than going for regular or occasional check-ups. When alternative outcomes of reporting having recently seen a doctor or been a hospital inpatient were assessed these deprivation-related patterns in service use were not evident. CONCLUSION Levels of neighbourhood deprivation are associated with the use of dental services by older people. Action is needed to ensure older people in deprived communities access appropriate and comprehensive dental services.
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Affiliation(s)
- I A Lang
- Epidemiology and Public Health Group, Peninsula Medical School, Exeter, UK.
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Steel N, Clark A, Lang IA, Wallace RB, Melzer D. Racial Disparities in Receipt of Hip and Knee Joint Replacements Are Not Explained by Need: The Health and Retirement Study 1998-2004. J Gerontol A Biol Sci Med Sci 2008; 63:629-34. [DOI: 10.1093/gerona/63.6.629] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVES Hip and knee joint replacements are effective, and yet little is known about how closely the need for joint replacement matches supply in different population groups. Our objective was to compare the prevalence of existing joint replacements with that of need in population groups in England. METHODS A total of 7101 people aged 60 yrs or older, representative of the population of England, were interviewed. Participants were asked about both receipt and need for joint replacement, socio-economic status and co-morbidity. 'Need' classification was based on hip or knee pain and difficulty walking, with adjustment for potential surgical contraindications. Associations between participants' characteristics and both need and receipt were estimated. RESULTS The prevalence of existing joint replacement (receipt) was 6% [95% confidence intervals (CI) 5, 6], and this was lower in the North than the South [adjusted odds ratio (OR) 0.72, CI 0.53, 0.96]. In contrast, the prevalence of estimated need was higher in the North (OR 1.27, CI 1.03, 1.58). Need was greater in women than men (OR 1.30, CI 1.09, 1.53), and showed an increasing gradient from the wealthiest to poorest quintile (ORs 1.00, 1.52, 2.18, 2.49, 3.23). In contrast, receipt did not differ significantly by sex or socio-economic group. CONCLUSIONS People living in the North of England, women and the less wealthy experience relatively high levels of need, yet do not receive relatively more hip and knee joint replacements.
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Affiliation(s)
- N Steel
- Primary Care Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK.
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Abstract
BACKGROUND It is currently believed that most fungal exposure occurs external to the home. AIMS To enumerate the fungal flora of used synthetic and feather pillows and the dust vacuumed from them, in the UK. METHODS 10 pillows aged between 1.5 and >20 years in regular use were collected and quantitatively cultured for fungi. Swatches were taken from nine sections of the pillow and dust was also collected by vacuum from five pillows. Pillow vacuuming was carried out prior to pillow culture. All were cultured at room temperature, 30 and 37 degrees C for 7 days in broth before plating, and a subset were also cultured for 24 h in broth and then plated. Fungi were identified by standard morphological methods. RESULTS The commonest three species isolated were Aspergillus fumigatus (n = 10), Aureobasidium pullulans (n = 6) and Rhodotorula mucilaginosa (n = 6). Another 47 species were isolated from pillows and vacuum dust. The number of species isolated per pillow varied from 4 to 16, with a higher number from synthetic pillows. Compared with the nonallergenic A. pullulans, more A. fumigatus was found in synthetic than feather pillows. CONCLUSIONS We have examined pillows for fungal contamination, and show that the typical used pillow contains a substantial load of many species of fungi, particularly A. fumigatus. Given the time spent sleeping, and the proximity of the pillow to the airway, synthetic and feather pillows could be the primary source of fungi and fungal products. This has important implications for patients with respiratory disease, and especially asthma and sinusitis.
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Affiliation(s)
- A A Woodcock
- North West Lung Centre, Wythenshawe Hospital and University of Manchester, Manchester, UK
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Steel N, Melzer D, Shekelle PG, Wenger NS, Forsyth D, McWilliams BC. Developing quality indicators for older adults: transfer from the USA to the UK is feasible. Qual Saf Health Care 2004. [PMID: 15289628 DOI: 10.1136/qshc.2004.010280] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Measurement of the quality of health care is essential for quality improvement, and patients are an underused source of data about quality of care. We describe the adaptation of a set of USA quality indicators for use in patient interview surveys in England, to measure the extent to which older patients receive a broad range of effective health care interventions in both primary and secondary care. METHOD One hundred and nineteen quality indicators covering 16 clinical areas, based on a set of indicators for the care of vulnerable elderly patients in the USA, were reviewed by a panel of 10 clinical experts in England. A modified version of the RAND/UCLA appropriateness method was used and panel members were supplied with literature reviews summarising the evidence base for each quality indicator. The indicators were sent for comment before the panel meeting to UK charitable organisations for older people. RESULTS The panel rated 102 of the 119 indicators (86%) as valid for use in England; 17 (14%) were rejected as invalid. All 58 indicators about treatment or continuity and follow up were rated as valid compared with just over half (13 of 24) of the indicators about screening. CONCLUSIONS These 102 indicators are suitable for use in patient interview surveys, including the English Longitudinal Study of Ageing (ELSA). The systematic measurement of quality of care at the population level and identification of gaps in quality is essential for quality improvement. There is potential for transfer of quality indicators between countries, at least for the health care of older people.
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Affiliation(s)
- N Steel
- Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK.
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Steel N, Melzer D, Shekelle PG, Wenger NS, Forsyth D, McWilliams BC. Developing quality indicators for older adults: transfer from the USA to the UK is feasible. Qual Saf Health Care 2004; 13:260-4. [PMID: 15289628 PMCID: PMC1743867 DOI: 10.1136/qhc.13.4.260] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022]
Abstract
BACKGROUND Measurement of the quality of health care is essential for quality improvement, and patients are an underused source of data about quality of care. We describe the adaptation of a set of USA quality indicators for use in patient interview surveys in England, to measure the extent to which older patients receive a broad range of effective health care interventions in both primary and secondary care. METHOD One hundred and nineteen quality indicators covering 16 clinical areas, based on a set of indicators for the care of vulnerable elderly patients in the USA, were reviewed by a panel of 10 clinical experts in England. A modified version of the RAND/UCLA appropriateness method was used and panel members were supplied with literature reviews summarising the evidence base for each quality indicator. The indicators were sent for comment before the panel meeting to UK charitable organisations for older people. RESULTS The panel rated 102 of the 119 indicators (86%) as valid for use in England; 17 (14%) were rejected as invalid. All 58 indicators about treatment or continuity and follow up were rated as valid compared with just over half (13 of 24) of the indicators about screening. CONCLUSIONS These 102 indicators are suitable for use in patient interview surveys, including the English Longitudinal Study of Ageing (ELSA). The systematic measurement of quality of care at the population level and identification of gaps in quality is essential for quality improvement. There is potential for transfer of quality indicators between countries, at least for the health care of older people.
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Affiliation(s)
- N Steel
- Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK.
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Warn PA, Brampton MW, Sharp A, Morrissey G, Steel N, Denning DW, Priest T. Infrared body temperature measurement of mice as an early predictor of death in experimental fungal infections. Lab Anim 2003; 37:126-31. [PMID: 12689423 DOI: 10.1258/00236770360563769] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Temperatures of mice were measured using an infrared high performance non-contact thermometer, after the device had been calibrated using implantable microchips containing temperature transponders. Mice were infected with three species of Candida (isolates) and the resultant disseminated infections monitored. Mouse temperatures could be reliably measured using the infrared device and this measurement caused little distress to the mice. We were further able to demonstrate that mice rarely recovered if their body temperature dropped below 33.3 degrees C (sensitivity 68%, specificity 97%). Adoption of a 33.3 degrees C endpoint in fungal sepsis experiments measured by infrared non-contact thermometer would significantly reduce the suffering in the terminal stages of this type of infection model.
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Affiliation(s)
- P A Warn
- School of Medicine, University of Manchester, Hope Hospital, Salford, UK.
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Steel N. Radio: 28 Minutes to Save the NHS. West J Med 2002. [DOI: 10.1136/bmj.324.7335.491/a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND An index of the need for health visiting in general practice populations in the United Kingdom was developed, using routinely held data, to inform decisions about the deployment of health visitors. METHODS The following indicators of need for health visiting were developed by consensus among health visitors and others: the population aged under 5 years; elective admissions under 5 years; births under 2,500 g; deaths under 65 years; all expressed as rates per 10,000 people registered with general practices in Norfolk. All indicators were compared with the number of health visitors per 10,000 people, obtained by a postal survey of health visitors. The indicators were converted to Z-scores and summed to produce a composite score of need for each general practice. The results were compared with the results of a workload profile using data compiled by health visitors within one Primary Care Group. RESULTS Health visitors are not allocated according to need at either the practice or Primary Care Group level. The Pearson's correlation coefficient between the allocation suggested by this method and current allocation is 0.37 (p < 0.01). The correlation between this method and the allocation suggested by health visitors' workload profiling in one Primary Care Group was 0.76 (p < 0.01). CONCLUSIONS Health visitors are currently distributed according to historic patterns rather than need. This paper describes a simple method of determining need at general practice level, which can be used to allocate health visitors equitably.
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Affiliation(s)
- N Steel
- Public Health Department, Norfolk Health Authority, Thorpe St Andrew, Norwich.
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Steel N, Myers L, Bailey J. An outbreak of viral gastro-enteritis at a charity function. Commun Dis Public Health 2001; 4:68-70. [PMID: 11467025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
One hundred and thirty-eight people of 431 who attended a charity function fell ill with gastro-enteritis mainly between 12 and 72 hours later. Three people were ill at the event, and a further three became ill within two hours of the event. A cohort study undertaken using a postal questionnaire showed that illness was statistically associated with having eaten cream, mints, or profiteroles. The duration of illness ranged from two to 120 hours, with a median of 48 hours. Twenty-three of the cases sent a stool sample to the laboratory. Six of these were taken to the laboratory within three days of the onset of illness and examined for bacteria before being sent for virological examination by electron microscopy (EM) and polymerase chain reaction (PCR). All six were positive for small round structured virus (SRSV) on PCR, and negative on EM. The illness was likely to have been transmitted both by foodborne transmission and person to person spread at the event.
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Affiliation(s)
- N Steel
- Norfolk Health Authority, Cambridge CB2 2SR.
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Affiliation(s)
- N Steel
- School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ.
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Steel N. Planning your life and career. West J Med 1999. [DOI: 10.1136/bmj.319.7202.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McMurray J, Galton DJ, Seed M, Edwards A, Elwyn G, Stott N, Steel N, Skolbekken JA. Communicating risk reductions. West J Med 1999. [DOI: 10.1136/bmj.318.7183.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Steel N. Communicating risk reductions. Modifying risk is different to treating illness. BMJ 1999; 318:603-4. [PMID: 10189217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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