Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Background: Inequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them. Objectives: The objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format. Design: Longitudinal whole-population study at the small-area level. Setting: England from 2001/2 to 2011/12. Participants: A total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people. Main outcome measures: Slope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality. Data sources: Practice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8). Results: Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark. Limitations: General practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible. Conclusions: NHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any administrative geography comprising ≥ 100,000 people

Le symbolisme sacré des couleurs chez deux mystiques médiévales : Hildegarde de Bingen et Julienne de Norwich

Un symbolisme complexe des couleurs s'inscrit dans de nombreuses aires culturelles et traditions sacrées. Certaines signifiances particulières, variant ou s'entremêlant selon l'espace et le temps, se sont peu à peu établies, au cours des âges, entre les différentes couleurs et les univers appréhendés par l'homme : minéral, végétal, animal, nominal, spirituel, divin. Des liens subtils unissent ainsi le microcosme, le macrocosme et le transcosmos qu'est l'Absolu suprême ou le Dieu vivant. Instr..

Roland Maisonneuve. L’univers visionnaire de Julian de Norwich. Thèse de Doctorat d'État soutenue à Paris IV, le 31 mars 1978

Maisonneuve Roland. Roland Maisonneuve. L’univers visionnaire de Julian de Norwich. Thèse de Doctorat d'État soutenue à Paris IV, le 31 mars 1978. In: Bulletin des anglicistes médiévistes, N°15, printemps 1979. pp. 165-167

L'Animation : réflexion dans l'axe d'une activité éducative mouvante et fondamentale

Bibliogr.: p. 45-50Notes (part. bibliogr.) au bas des p

Wood burning: A major source of Volatile Organic Compounds during wintertime in the Paris region

International audienceAuthor contribution BL wrote the original draft, led data collection and processing and led the analysis. VG designed the campaign, gave a deep review on the first draft and participated in analysis. JEP participated in data processing, discussed analysis and reviewed the paper. CH, AB and OP discussed analysis, reviewed the paper and provided data (Airparif measurements and emission inventory). GF and VM discussed analysis, reviewed the paper and provided data (LISA measurements). FT participated in data processing. NB and RSE participated in data collection. MD provided data (CO measurements). AF and FM were involved in the deployment and maintenance of the instruments at LISA. CG was the technical manager for the EPPI project at LISA, she managed the installation and maintenance of the instruments. PF was the scientific manager of the PEGASUS platform where the measurements were conducted at LISA, she was in charge of the coordination of the platform use and instruments setup. SK reviewed the paper, SK and MH provided data (mixed layer height). OF supervised aerosol in situ measurements at SIRTA and reviewed the paper

Association between pancreatic intraductal papillary mucinous neoplasms and extrapancreatic malignancies

Background & Aims: The association between pancreatic intraductal papillary mucinous neoplasms (IPMNs) and extrapancreatic neoplasms (EPNs) is controversial. We performed a multicenter observational study to assess the incidence of EPNs after an IPMN diagnosis. Methods: 1340 patients with IPMNs were evaluated from 2000 through 2013 at 4 academic institutions in Europe for development of EPN. To estimate the actual incidence of EPN, we excluded patients with an EPN previous or synchronous to the IPMN, and patients who had been followed for less than 12 months, resulting in a study population of 816 patients. The incidence of EPN was compared with sex-specific, age-adjusted European cancer statistics; the standardized incidence ratio (SIR), and the 5- and 10-year cumulative incidence rates were calculated. Results: A total of 290/1340 patients had a history of EPN (prevalence of 21.6%). In this subgroup of patients, the IPMN was discovered incidentally in 241. Among the 816 patients included in the incidence analysis, 50 developed an EPN after a median time of 46 months from study enrollment. The incidence of any EPN was not greater in patients with than without IPMN with a SIR of 1.48 (95% confidence interval, 0.94-2.22) in males and of 1.39 (95% CI 0.90-2.05) in females. The 5- and 10-year cumulative incidence rates for development of EPN in patients with IPMN were 7.9% and 16.6% in men, and 3.4% and 23.1% in women. Conclusions: Patients with IPMN do not have a significantly higher incidence of EPNs than the general European population. It might not be necessary to screen patients with IPMN for EPN

COVID-19 mRNA vaccine in pregnancy ::results of the Swiss COVI-PREG registry, an observational prospective cohort study

Background : Pregnant individuals with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease, prematurity, and stillbirth. In March 2021, vaccination for at risk pregnant women was recommended in Switzerland, expanding this to all pregnant women in May 2021. Our aim was to assess the safety of mRNA COVID-19 vaccines in pregnancy. Methods : This multicentre prospective cohort study describes early adverse events and perinatal outcomes in pregnant women who received at least one dose of mRNA vaccine between March 1st and December 27th, 2021 in Switzerland, using the COVI-PREG registry. Early adverse events were collected at least one month following vaccine administration. Pregnancy and neonatal outcomes were extracted from medical records using the maternity discharge letters providing follow-up information up to 5 days after birth. Findings : Of 1012 vaccinated women, 894 (88·3%) received both injections during pregnancy, with BNT162b2 (n = 271) or mRNA-1273 (n = 623) vaccines. Local events (mainly local pain) were reported in 81·3% and 80·5% after the first and second doses. Rates of systemic reactions (mainly fatigue and headache) were similar after the first dose and most frequent after the second dose of mRNA-1273. Of the 1012 women, four (0·4%; 95%CI [0·1-1·0]) severe early adverse events occurred: pulmonary embolism, preterm premature rupture of membranes, isolated fever with hospitalisation, and herpes zoster. Of 107 patients vaccinated before 14 weeks, one (0·9%; 95%CI [0·0-5·1]) early spontaneous abortions was reported (8 weeks). Of 228 vaccinated before 20 weeks one (0·4%; 95%CI [0·0-2·4]) late spontaneous abortion was reported (16 weeks). Of 513 women exposed before 37 weeks, 33 (6·4%; 95%CI [4·5-8·9]) delivered preterm. Among 530 patients exposed in pregnancy, no stillbirth was reported and 25 (4·7%; 95%CI [3·0-6·8]) neonates were admitted to intensive care unit. Interpretation : Frequent local and systemic effects were described after exposure to mRNA COVID-19 vaccines during pregnancy but severe events were rare. Women vaccinated during pregnancy did not experience higher adverse pregnancy or neonatal outcomes when compared to historical data on background risks in the obstetric population. Funding : This research was funded by a grant from the Swiss Federal Office of Public Health and the CHUV Foundation

Les couleurs au Moyen Âge

Ce volume rassemble les communications présentées au douzième Colloque du C.U.E.R. M. A. qui s'est tenu a Aix-en-Provence en Mars 1987 sur le thème: LES COULEURS AU MOYEN AGE Comme les années précédentes, nous avons utilise les dactylogrammes fournis par les confèrenciers (sauf pour ceux d'entre eux qui ont préféré avoir recours aux services d'un secrétariat dont nous avons dû leur demander d'acquitter les frais). Ainsi les communications ont-elles la présentation déterminée par leurs auteurs. Plusieurs textes, qui n'ont pu être presentes au moment du colloque, ont été ajoutés au volume et placés selon l'ordre alphabétique des noms de leurs auteurs. En outre ce volume contient deux des contributions aixoises sous une forme plus développée. Le bureau et le conseil d'administration du C.U.E.R, M. A. remercient l'Université de Provence et l'U.E.R. Arts-lettres Expression qui ont fourni leur aide pour l'organisation du colloque et l'impression de ce volume d'actes