Elective Open Suprarenal Aneurysm Repair in England from 2000 to 2010 an Observational Study of Hospital Episode Statistics

Background: Open surgery is widely used as a benchmark for the results of fenestrated endovascular repair of complex abdominal aortic aneurysms (AAA). However, the existing evidence stems from single-centre experiences, and may not be reproducible in wider practice. National outcomes provide valuable information regarding the safety of suprarenal aneurysm repair. Methods: Demographic and clinical data were extracted from English Hospital Episodes Statistics for patients undergoing elective suprarenal aneurysm repair from 1 April 2000 to 31 March 2010. Thirty-day mortality and five-year survival were analysed by logistic regression and Cox proportional hazards modeling. Results: 793 patients underwent surgery with 14% overall 30-day mortality, which did not improve over the study period. Independent predictors of 30-day mortality included age, renal disease and previous myocardial infarction. 5-year survival was independently reduced by age, renal disease, liver disease, chronic pulmonary disease, and known metastatic solid tumour. There was significant regional variation in both 30-day mortality and 5-year survival after risk-adjustment. Regional differences in outcome were eliminated in a sensitivity analysis for perioperative outcome, conducted by restricting analysis to survivors of the first 30 days after surgery. Conclusions: Elective suprarenal aneurysm repair was associated with considerable mortality and significant regional variation across England. These data provide a benchmark to assess the efficacy of complex endovascular repair of supra-renal aneurysms, though cautious interpretation is required due to the lack of information regarding aneurysm morphology. More detailed study is required, ideally through the mandatory submission of data to a national registry of suprarenal aneurysm repair

Internal Migration of Ethnic Groups in England and Wales by Age and District Type

This paper examines how internal migration propensities vary by age and ethnic group using data from level 1 (district) scale in England and Wales extracted from the 2001 Census Special Migration Statistics and from tables specially commissioned from the Office of National Statistics. The paper identifies age-specific variation in migration propensities by ethnic group at national level before examining the spatial patterns of age-specific inter-district migration using the family and class groupings defined in a recent area classification, demonstrating how minority ethnic group propensities and patterns compare with those of white migrants

Ethnic enclaves and employment in England and Wales

This paper examines the effects of ethnic enclaves on the employment probability of ethnic minorities living in England and Wales. Controlling for the endogeneity of residential location we find that living in a high own ethnic concentration area has no systematic effect across all ethnic groups. However, once we disaggregate we find that for some ethnic groups (Indians) enclaves seem to have a positive and significant impact on their employment probability while for other groups (Caribbeans and African-Asians), enclaves have a negative and significant impact. These results are non-trivial and are in accordance with a set of theoretical views in this literature that argue that ethnic spatial concentration can have positive as well as negative effects. The perceived disadvantages of ethnic enclaves are not omnipresent. What seem to be driving this are the differences in the quality of ethnic enclaves where Indian enclaves by being more dynamic in terms of self-employment create more jobs for others within the enclave

Professional self-regulation in a changing architecture of governance: comparing health policy in the UK and Germany

This chapter compares transformations in professional self-regulation in the UK and Germany through the lens of governance. We introduce an expanded concept of governance that includes national configurations of state–profession relationships and places selfregulation in the context of other forms of governance. The analysis shows that a general trend towards network governance plays out differently. In the UK, a plural structure of network governance and stakeholder arrangements is emerging in the context of stateled change. In Germany, partnership governance between sickness funds and medical associations shape the transformations and act as a barrier towards the entry of new players

Evaluating the effects of planning policies on the retail sector: or do town centre first policies deliver the goods?

Few studies conceive of land as a productive factor but British land use policies may lower total factor productivity (TFP) in the retailing industry by (i) restricting the total availability of land for retail, thereby increasing space costs (ii) directly limiting store size and (iii) concentrating retail development on specific central locations. We use unique store-specific data to estimate the impact of space on retail productivity and the specific effects of planning restrictiveness and micromanagement of store locations. We use the quasi natural experiment generated by the variation in planning policies between England, Wales, Scotland and Northern Ireland to isolate the impact of town centre first policies. We find that TFP rises with store size and that planning policy directly reduces productivity both by reducing store sizes and forcing retail onto less productive sites. Our results, while they strictly only apply to the supermarket group whose data we analyse, are likely to be representative of supermarkets in general and suggest that since the late 1980s planning policies have imposed a loss of TFP of at least 20%

Trends in long-term prescribing of dependence forming medicines

Using patient-level primary care data to estimate the extent to which antidepressant medicines are prescribed to people continuously for long periods of time. Aim This descriptive research used patient-level primary care data to estimate the extent to which antidepressant medicines are prescribed to people continuously for long periods of time. The study also drew on survey data and data on the number of prescriptions dispensed. Findings - The number of antidepressant prescriptions dispensed each year in England doubled between 2008 and 2018 - Survey data show that the proportion of adults reporting use of antidepressants in the past year increased in the 1990s, and again between 2007 and 2014 - The average length of time that antidepressants are continuously prescribed to people for has increased over time. - Some types of antidepressants (for example, tricyclics and other antidepressants) tend to be prescribed for longer periods than other types (such as SSRIs). - In 2014, one in twelve prescribing periods for tricyclics and other antidepressants lasted for three years or more Methods The analyses in this report are descriptive and show the overall prevalence of long-term prescribing in each year. We used a sample of around 50,000 patients prescribed at least one antidepressant medicine between 2000 and 2017. This was drawn from the Clinical Practice Research Datalink (CPRD). The CPRD contains data about prescriptions issued by GPs (including the length and size of prescription) and characteristics of the patients prescribed to (such as their age, sex, and area where they live). Medicines were grouped for analysis into: tricyclics, selective serotonin reuptake inhibitors (SSRIs), and other ADMs. The length of individual prescriptions and continuous prescribing periods were derived using information on consultation dates, the quantity of tablets prescribed, and the numeric daily dose