Investigating the distribution of primary and secondary care referrals for public-funded bariatric surgery at Counties Manukau Health (CMH)

AIMS

This study investigated variations in referral rates for bariatric surgery from primary and secondary care providers across the Counties Manukau district health board (CMDHB), with the aim of identifying "hot spots" for referrals so that intervention to help achieve equitable access to bariatric surgery can be implemented.

METHODS

Referral data was gathered from hospital referral records from January 2017 to January 2019 (n=1,440). Referral rate per geographical location within the CMDHB catchment was calculated using 2018 census figures.

RESULTS

Of the 1,195 referrals included, 1040 (87%) referrals were from primary care. The referrals came from 328 general practitioners (GPs) across 158 practices. There was considerable regional variation in referral rates per 1000 people, from a peak of 71.5/1000 to a low of 0.2/1000. Eighty-six percent of secondary care referrals were received from the public system and the remainder from private practice. The most common referral specialty was diabetes, followed by general surgery and orthopaedics. Out of these referrals, 434 (36%) proceeded to bariatric surgery. Pākehā (50%) were more likely to proceed to surgery than Māori (31%) and Pasifika (22%), despite similar referral numbers.

CONCLUSION

There is significant variation in referrals for bariatric surgery across CMDHB. Systematic discussion of bariatric surgery with every patient who is likely to benefit is not occurring, given relatively low referral volumes.

Disclosure among Youth Stopped by the Police: Repercussions for Mental Health

Police contact is a common and consequential experience disproportionately endured by youth of color living in heavily surveilled neighborhoods. Disclosing police contact to others (including parents, siblings, or friends) may buffer against the harmful mental health repercussions of police contact, but little is known about the relationship between disclosure of police contact and mental health. We use data from the Fragile Families and Child Wellbeing Study, a cohort of urban children born around the turn of the 21st century and followed through age 15, to examine the relationship between disclosure of police contact and mental health among youth. Results suggest three conclusions. First, youth who experience police contact (regardless of whether they disclose this contact) report more depressive symptoms and anxiety than youth who do not experience police contact. Second, among youth who experience police contact, disclosure is associated with significantly less anxiety (but is not significantly associated with depressive symptoms). Third, this protective nature of disclosure is concentrated among Black youth and boys. Taken together, these findings suggest that disclosing police contact, particularly for groups most likely to experience it, may ameliorate some of the harmful mental health repercussions of this contact for youth.

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

BACKGROUND

80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality.

METHODS

This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494.

FINDINGS

Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications.

INTERPRETATION

Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications.

FUNDING

National Institute for Health Research Global Health Research Unit.

Vitamin D and UV exposure in construction workers-a randomized control trial using text messaging to promote positive behaviours

BACKGROUND

The aim of this study was to determine whether a text messaging intervention (supported by a smartphone application) would be effective in the promotion of sun-safe behaviours. Both excessive and insufficient exposure to ultra-violet (UV) radiation were considered.

METHODS

A randomized control crossover trial was conducted. 112 participants from nine sites in the United Kingdom contributed to the study. There were three intervention waves, two in winter (Vitamin D-focussed) and one in summer (UV exposure-focussed). Stages of Change, Standard Erythemal (UV) Dose and assayed blood samples (Vitamin D) were employed to evaluate the effectiveness throughout the 21-day data collection periods.

RESULTS

The intervention was effective in promoting positive progression in Stages of Change for Vitamin D; and this in turn was predictive of increased Vitamin D levels in participants. More limited positive findings were found with respect to UV exposure. Overall, for those in the Intervention, Vitamin D levels were significantly predicted to increase during both of the winter data collection waves.

CONCLUSIONS

Interventions of this type are recommended to promote healthy Vitamin-D levels in construction workers.

Bystander Interventions on Behalf of Sexual Assault and Intimate Partner Violence Victims

Using newly available U.S. nationally representative data from the No More study (N = 1,307), this article investigates (a) knowledge of sexual assault and intimate partner violence (IPV) victims within one's social network; (b) who intervenes, whom they intervene on behalf of, and how they intervene; and (c) the perceived barriers to intervening in IPV specifically. The findings reveal that knowledge of violence, the likelihood of intervening, and the intervention approaches taken all vary demographically and by violence type. Among respondents who have known a victim, one- third report having intervened for sexual assault, while one-half report having intervened for IPV. For both types of violence, respondents are more likely to have intervened on behalf of family or friends than on behalf of more distant network members. However, respondents are more likely to have solicited the help of authorities and less likely to have offered safe haven in instances of sexual assault than in instances of IPV. The most commonly cited barriers to IPV intervention include fear of injury, fear of misinterpretation, and belief that IPV is a private matter, though these vary across demographic groups. These findings indicate that the decision to intervene is highly contextual-contingent on the individual characteristics of the intervener, situational characteristics of the violence, and the relationship between the intervener and the victim.

Hepatitis B prevalence in Denmark - an estimate based on nationwide registers and a national screening programme, as on 31 December 2007

The prevalence of chronic hepatitis B virus (HBV) infection in Denmark is not clear. The primary aim of this study was to estimate the prevalence of chronic HBV infection in Denmark. The capture–recapture method was used to estimate the total population diagnosed with chronic HBV infection in Denmark using four nationwide registers. The population with undiagnosed chronic HBV infection was estimated by incorporating data from a two-year nationwide HBsAg screening programme in pregnant women. We identified 4,466 individuals with chronic HBV infection in the four registers until the end of 2007, and the capture–recapture estimate of the total population diagnosed with chronic hepatitis B was 7,112 (95% confidence interval (CI): 6,953–10,747). Only 17% of the identified patients attended recommended clinical care according to national guidelines. Including undiagnosed patients, the current population alive with HBV infection was 10,668 (95% CI: 10,224–16,164), corresponding to a prevalence of 0.24% (95% CI: 0.23–0.37%) in the Danish population older than 15 years. The estimated prevalence of chronic HBV infection among adults in Denmark was lower than reported from other northern European countries. Only half of the infected population had been diagnosed, and a minority attended specialised clinical care.

Description and analysis of 12 years of surveillance for Creutzfeldt–Jakob disease in Denmark, 1997 to 2008

Binary file ES_Abstracts_Final_ECDC.txt matches

Description and analysis of 12 years of surveillance for Creutzfeldt-Jakob disease in Denmark, 1997 to 2008

Prospective surveillance of Creutzfeldt–Jakob disease (CJD) was initiated in Denmark in 1997, following the observation of variant CJD in the United Kingdom. Demographic, clinical and diagnostic information was collected for each patient with clinical suspicion of CJD. Here we describe the methods for surveillance and the observed outcomes between 1 January 1997 and 31 December 2008. A total of 83 patients were classified as sporadic CJD, 47 were definite diagnoses, 34 probable and two possible. This resulted in a mean incidence of 1.26 patients with probable and definite sporadic CJD per million inhabitants. Two sporadic CJD patients were found to have a genetic variant of unknown significance: Thr201Ser and Glu200Asp. One patient was diagnosed with Gerstmann-Sträussler-Scheinker syndrome. No patients were classified as having variant, iatrogenic or familial CJD. The Danish surveillance system, like those in other countries, has a multidisciplinary approach, which is labour-intensive and time-consuming but ensures the most complete set of information possible. With this approach we think that patients with variant CJD would have been detected had they occurred in Denmark. Certain aspects of CJD surveillance need further discussion at European level and beyond, in order to find a balance between efficiency of the systems and accuracy of surveillance data.

Exciton formation, relaxation, and decay in PCDTBT

The nature and time evolution of the primary excitations in the pristine conjugated polymer, PCDTBT, are investigated by femtosecond-resolved fluorescence up-conversion spectroscopy. The extensive study includes data from PCDTBT thin film and from PCDTBT in chlorobenzene solution, compares the fluorescence dynamics for several excitation and emission wavelengths, and is complemented by polarization-sensitive measurements. The results are consistent with the photogeneration of mobile electrons and holes by interband π-π* transitions, which then self-localize within about 100 fs and evolve to a bound singlet exciton state in less than 1 ps. The excitons subsequently undergo successive migrations to lower energy localized states, which exist as a result of disorder. In parallel, there is also slow conformational relaxation of the polymer backbone. While the initial self-localization occurs faster than the time resolution of our experiment, the exciton formation, exciton migration, and conformational changes lead to a progressive relaxation of the inhomogeneously broadened emission spectrum with time constants ranging from about 500 fs to tens of picoseconds. The time scales found here for the relaxation processes in pristine PCDTBT are compared to the time scale (<0.2 ps) previously reported for photoinduced charge transfer in phase-separated PCDTBT:fullerene blends (Phys. Rev. B 2010, 81, 125210). We point out that exciton formation and migration in PCDTBT occur at times much longer than the ultrafast photoinduced electron transfer time in PCDTBT:fullerene blends. This disparity in time scales is not consistent with the commonly proposed idea that photoinduced charge separation occurs after diffusion of the polymer exciton to a fullerene interface. We therefore discuss alternative mechanisms that are consistent with ultrafast charge separation before localization of the primary excitation to form a bound exciton.

Syphilis in Denmark-Outbreak among MSM in Copenhagen, 2003-2004

Denmark is currently experiencing an outbreak of syphilis that began in 2003 and has continued in 2004. Data from the national surveillance system show that most cases are in men who have sex with men (MSM), and that a large proportion of these patients are also HIV positive. The proportion of known HIV positive cases in MSM notified with syphilis during the outbreak has, however, not been significantly different from previous years. The majority of cases were reported from Copenhagen municipality, and 70% of the cases were acquired domestically. The outbreak does not seem to be affecting the age group under 20 years. We speculate that most of the MSM found with both syphilis and HIV were already HIV positive when they acquired syphilis infection.

[Sleeping position to prevent sudden infant death syndrome in Latin-american and Caribbean hospitals]

Background The prone sleeping position for sleeping has been identified as the principal risk factor for sudden infant death syndrome (SIDS).ObjectiveThe aim of this study was to determine the prevalence of different sleeping positions and other risk factors for SIDS and to identify the advice given to parents in several maternity units in Latin America and the Caribbean through a specially-designed questionnaire.MethodsDescriptive cross-sectional study based in hospitals. All the countries in Latin America and the Caribbean were contacted through the Pan American Health Organization and responses were obtained from 16 countries.ResultsTwo hundred thirteen hospitals answered the survey. The preferred sleeping position for healthy infants was prone in 8.5 % of the hospitals, side in 48.8 %, and supine in 25.2 %. In 17.5 % of the hospitals no position was preferred or the answers were inconsistent.Concerning the recommendations given to parents on the best position for their infants at home, 25.7 % recommended the supine position, 7.6 % the prone position, 59.0 % the side position while 7.6 % made no recommendations.ConclusionsThe results of this study show that in the hospitals surveyed there is a policy of not placing healthy neonates in the prone position. However, the most frequent position was the side, which is not advisable as it increases the risk of SIDS. To reduce in the incidence of SIDS, campaigns to increase the use of the supine position should be carried out in hospitals and among the general public.

Nurses' behavioural intentions towards self-poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables

BACKGROUND

The incidence of self-poisoning is on the increase. Most patients who self-poison are dealt with initially in the general hospital. Therefore, the type and quality of care self-poisoning patients receive will depend, in part, on how they are viewed by nursing staff within the general hospital setting. A knowledge and understanding of the attitudes held by nurses towards self-poisoning patients is therefore important to those involved in the planning and delivery of care towards this client group. Previous studies have examined health care professionals' attitudes towards people who self-poison. Usually, however, these have not focused specifically on nurses' attitudes, and they have ignored the relationship between the attitudes expressed by staff and their intentions to engage in subsequent caring behaviour of one sort or another. It is hence unclear how the findings of such studies are relevant or applicable to nursing policy and practice.

AIMS

The present study aims to address these limitations using a methodology informed by the theory of reasoned action. The study aims to separate out the distinctive roles played by nurses' own attitudes, and the social pressures represented by other people's attitudes, in determining the types of caring behaviour in which nurses intend to engage when dealing with self-poisoning patients.

DESIGN/METHODS

The study adopts a questionnaire-based approach incorporating two specially designed vignettes.

RESULTS

The results show that nurses' own attitudes, and what they believe about the attitudes of others, predict their behavioural intentions towards self-poisoning patients. The study also shows that nurses with a more positive orientation towards self-poisoning patients differ in behavioural and normative beliefs from nurses who have a less positive orientation.

CONCLUSIONS

The implications for future attempts to explore the relationship between nurses' attitudes and subsequent caring behaviour are considered, along with implications for nursing policy and practice.

Lignans from Strophanthus gratus

Three lignans, pinoresinol (1), 8-hydroxypinoresinol (2) and olivil (3) have been isolated from the leaves of Strophanthus gratus by reversed-phase HPLC.