Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation

Background: A strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.Objectives: To generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.Design: Cross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).Results: The utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primarymanagement are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.Conclusions: We found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns ofutilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.Funding: The National Institute for Health Research Health Services and Delivery Research programme

Concert recording 2019-03-29

[Track 1]. Ionhontsiá:te (Mother earth). Grandmother moon for soprano and cello / Dawn Ierihò:kwats Avery -- [Track 2]. Lieux ecartez, paisible solitude from Céphale et Procris / Élisabeth Jacquet de La Guerre -- [Track 3]. Four Dickinson songs / Lori Laitman Emily Dickinson -- [Track 4]. Guendae Issume (Because you are here) / Sunae Kim -- [Track 5]. Lee Eung and Arirang (Arirang) / YoungRan Park -- [Track 6]. She tell her love [Track 7]. A boy and a girl / Stephen Caldwell -- [Track 8]. Morgen, op. 27, no. 4 [Track 9]. Heimliche Aufforderung, op. 27, no. 3 / Richard Strauss -- [Track 10]. Suleika, op. 14, no. 1 / Franz Schubert -- [Track 11]. Philine: Singet nicht in Trauertönen, op. 98a, no. 7 / Robert Schumann -- [Track 12]. Mignon: Kennst du das Land / Hugo Wolf -- [Track 13]. From Song of Almah. III. Cedar of Lebanon / Andrew Beall

Modification of Cellular DNA by Synthetic Aziridinomitosenes

Two synthetic aziridinomitosenes (AZMs), Me-AZM and H-AZM, structurally related to mitomycin C (MC) were evaluated for their anticancer activity against six cancer cell lines (HeLa, Jurkat, T47D, HepG2, HL-60, and HuT-78) and tested for their DNA-modifying abilities in Jurkat cells. Cytotoxicity assays showed that Me-AZM is up to 72-fold and 520-fold more potent than MC and H-AZM, respectively. Me-AZM also demonstrated increased DNA modification over MC and H-AZM in alkaline COMET and Hoechst fluorescence assays that measured crosslinks in cellular DNA. Me-AZM and H-AZM treatment of Jurkat cells was found to sponsor significant DNA-protein crosslinks using a K-SDS assay. The results clearly indicate that the AZM C6/C7 substitution pattern plays an important role in drug activity and supports both DNA-DNA and DNA-protein adduct formation as mechanisms for inducing cytotoxic effects

Australia\u27s health 2006 : the tenth biennial report of the Australian Institute of Health and Welfare

The report shows that Australians generally have good health and are privileged to have a range of health care services available to them. There are stark exceptions to this that can be confronting&mdash;even if well-known already&mdash;notably the generally much poorer health status of Indigenous Australians.Health care service provider and funding arrangements are both increasingly complex and increasingly costly to both individuals and taxpayers. A continuing challenge is how to balance both the complementary and competitive perspectives of government and non-government agencies, professional groups, and small businesses. Overall, national expenditure on health was 9.7% of GDP in 2003&ndash;04; and average health expenditure per person has grown by an average 3.8% each year between 1997&ndash;98 to 2002&ndash;03. Expenditure on aids and appliances, health research and pharmaceuticals contributed more to this growth than other areas.While the ageing of the population is having a significant impact on the number and type of health care services delivered, high quality services for children continue to be a priority. Australia&rsquo;s health 2006 has a special chapter focusing on children and their health. The chapter highlights the fact that while our children are generally very healthy, there are concerns that their ongoing health could be affected by more and more of them becoming overweight or obese. Levels of diabetes are now rising among our children and it is a continuing concern that asthma and mental health problems affect so many of them.<br /

Ginseng for Erectile Dysfunction: A Cochrane Systematic Review

The objectives of this study were to assess the effects of ginseng on erectile dysfunction. We searched multiple electronic databases from their inceptions to 30 January 2021 without restrictions by language. We included randomized or quasirandomized controlled trials that evaluated the use of any type of ginseng as a treatment for erectile dysfunction compared to placebo or conventional treatment. The authors independently screened the literature, extracted data, assessed risk of bias, and rated the certainty of evidence (CoE) according to the GRADE approach. We included nine studies, and all compared ginseng to placebo. Ginseng appears to have a trivial effect on erectile dysfunction when compared to placebo based on the Erectile Function Domain of the International Index of Erectile Function (IIEF)-15 instrument (mean difference [MD] 3.52, 95% confidence interval [CI] 1.79 to 5.25; I2=0%; 3 studies; low CoE). Ginseng may have little to no effect on adverse events compared to placebo (risk ratio [RR] 1.45, 95% CI 0.69 to 3.03; I2=0%; 7 studies; low CoE). While ginseng may improve men's self-reported ability to have intercourse (RR 2.55, 95% CI 1.76 to 3.69; I2=23%; 6 studies; low CoE), it may have a trivial effect on men's satisfaction with intercourse based on the Intercourse Satisfaction Domain of the IIEF-15 (MD 1.19, 95% CI 0.41 to 1.97; I2=0%; 3 studies; low CoE). No study reported quality of life as an outcome.publishedVersio

A Large-Scale Study of iPhone App Launch Behaviour

There have been many large-scale investigations of users' mobile app launch behaviour, but all have been conducted on Android, even though recent reports suggest iPhones account for a third of all smartphones in use. We report on the first large-scale analysis of app usage patterns on iPhones. We conduct a reproduction study with a cohort of over 10,000 jailbroken iPhone users, reproducing several studies previously conducted on Android devices. We find some differences, but also significant similarities: e.g. communications apps are the most used on both platforms; similar patterns are apparent of few apps being very popular but there existing a 'long tail' of many apps used by the population; users show similar patterns of 'micro-usage'; almost identical proportions of people use a unique combination of apps. Such similarities add confidence but also specificity about claims of consistency across smartphones. As well as presenting our findings, we discuss issues involved in reproducing studies across platforms

UKIRT Widefield Infrared Survey for Fe+

The United Kingdom Infrared Telescope (UKIRT)Widefield Infrared Survey for Fe+ (UWIFE) is a 180 deg2 imaging survey of the first Galactic quadrant (7° &lt; l &lt; 62° |b| &lt;1°.5) that uses a narrow-band filter centred on the [Fe II] 1.644-μm emission line. The [Fe II] 1.644-μm emission is a good tracer of dense, shock-excited gas, and the survey will probe violent environments around stars: star-forming regions, evolved stars, and supernova remnants, among others. The UWIFE survey is designed to complement the existing UKIRTW idefield Infrared Survey for H2 (UWISH2). The survey will also complement existing broad-band surveys. The observed images have a nominal 5Ï? detection limit of 18.7 mag for point sources, with a median seeing of 0.83 arcsec. For extended sources, we estimate a surface brightness limit of 8.1 Ã? 10-20 W m-2 arcsec-2. In this paper, we present an overview and some preliminary results of this survey. © 2014 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society