Screening af S‐togsbetjening til Roskilde og Helsingør

Trafikstyrelsen har gennemført en screening af mulighederne for at udvide S‐togsbetjeningen til Helsingør og Roskilde. Her er forskellige løsningsmuligheder undersøgt og evalueret i en samfundsøkonomisk analyse. Resultaterne viser, at man kan sigte efter ibrugtagning i 2020, hvor man bør satse på en fuld ombygning til S‐baneteknologi. Derved undgås en fremrykket udskiftning og overflødiggørelse af nuværende S‐tog. Desuden kan ombygningen billiggøres ved at udnytte en option i Signalprogrammet om udførelse af S‐ banesignaler i stedet for fjernbanesignaler på de pågældende strækninger. Dette vil kræve endelig beslutning senest i 2014 og dermed snarlig igangsætning af et målrettet videre undersøgelsesforløb. Hvis man ikke ønsker dette, kan man i stedet sigte efter ibrugtagning omkring 2030, hvor man snarere bør satse på en 2‐systemløsning med indsættelse af en ny type S‐tog, der kan håndtere begge tekniske systemer. Derved undgås en kostbar ombygning af baneanlæg. Anskaffelse af 2‐systemmateriel skal da ske i sammenhæng med en udskiftning af nuværende S‐tog i perioden 2026‐2036, hvilket formentlig kræver endelig beslutning omkring 2020. Begge muligheder har god samfundsøkonomi

Ethnic disparities in preventable hospitalisation in England: an analysis of 916 375 emergency admissions.

OBJECTIVES: To study ethnic inequalities in ambulatory care sensitive conditions (ACSC) in England. DESIGN: Observational study of inpatient hospital admission database enhanced with ethnicity coding of patient surnames. The primary diagnosis of the first episode in spells with emergency admission were coded with definitions for acute ACSC, chronic ACSC and vaccine-preventable diseases. SETTING: National Health Service England. PARTICIPANTS: 916 375 ACSC emergency admissions in 7 39 618 patients were identified between April 2011 and March 2012. MAIN OUTCOME MEASURES: ORs of ACSC for each ethnic group relative to the White British majority group adjusted for age, sex and area deprivation. RESULTS: Acute ACSC admission risk adjusted for age and sex was particularly high among Other (OR 1.73; 95% CI 1.69 to 1.77) and Pakistani (1.51; 95% CI 1.48 to 1.54) compared with White British patients. For chronic ACSC, high risk was found among Other (2.02; 95% CI 1.97 to 2.08), Pakistani (2.07; 95% CI 2.02 to 2.12) and Bangladeshi (1.36; 95% CI 1.30 to 1.42). For vaccine-preventable diseases, other (2.42; 95% CI 2.31 to 2.54), Pakistani (1.94; 95% CI 1.85 to 2.04), Bangladeshi (1.48; 95% CI 1.36 to 1.62), Black African (1.45; 95% CI 1.36 to 1.54) and white other (1.38; 95% CI 1.33 to 1.43) groups. Elevated risk was only partly explained in analyses also adjusting for area deprivation. CONCLUSIONS: ACSC admission was especially high among individuals of Bangladeshi, Pakistani, Black African, white other or other background with up to twofold differences compared with the white British group. This suggests that these ethnic groups are not receiving optimal primary care

Ethnic inequalities in hospital admissions in England: an observational study.

BACKGROUND: Ethnic inequalities in health are well-known and partly explained by social determinants such as poorer living and working conditions, health behaviours, discrimination, social exclusion, and healthcare accessibility factors. Inequalities are known both for self-reported health and for diseases such as diabetes, cardiovascular diseases, respiratory diseases, and non-specific chest pains. Most studies however concern individual diseases or self-reported health and do not provide an overview that can detect gaps in existing knowledge. The aim of this study is thus to identify ethnic inequalities in inpatient hospital admission for all major disease categories in England. METHODS: Observational study of the inpatient hospital admission database in England enhanced with ethnicity coding of participants' surnames. The primary diagnosis was coded to Level 1 of the Global Burden of Disease groups. For each year, only the first admission for each condition for each participant was included. If a participant was readmitted within two days only the first admission was counted. Admission risk for all major disease groups for each ethnic group relative to the White British group were calculated using logistic regression adjusting for age and area deprivation. RESULTS: 40,928,105 admissions were identified between April 2009 and March 2014. Ethnic inequalities were found in cardiovascular diseases, respiratory diseases, chest pain, and diabetes in line with previous studies. Additional inequalities were found in nutritional deficiencies, endocrine disorders, and sense organ diseases. CONCLUSIONS: The results of this study were consistent with known inequalities, but also found previously unreported disparities in nutritional deficiencies, endocrine disorders, and sense organ diseases. Further studies would be required to map out the relevant care pathways for ethnic minorities and establish whether preventive measures can be strengthened

Names-based ethnicity enhancement of hospital admissions in England, 1999-2013.

BACKGROUND: Accurate recording of ethnicity in electronic healthcare records is important for the monitoring of health inequalities. Yet until the late 1990s, ethnicity information was absent from more than half of records of patients who received inpatient care in England. In this study, we report on the usefulness of a names-based ethnicity classification, Ethnicity Estimator (EE), for addressing this gap in the hospital records. MATERIALS AND METHODS: Data on inpatient hospital admissions were obtained from Hospital Episode Statistics (HES) between April 1999 and March 2014. The data were enhanced with ethnicity coding of participants' surnames using the EE software. Only data on the first episode for each patient each year were included. RESULTS: A total of 111,231,653 patient-years were recorded between April 1999 and March 2014. The completeness of ethnicity records improved from 59.5 % in 1999 to 90.5 % in 2013 (financial year). Biggest improvement was seen in the White British group, which increased from 55.4 % in 1999 to 73.9 % in 2013. The correct prediction of NHS-reported ethnicity varied by ethnic group (2013 figures): White British (89.8 %), Pakistani (81.7 %), Indian (74.6 %), Chinese (72.9 %), Bangladeshi (63.4 %), Black African (57.3 %), White Other (50.5 %), White Irish (45.0 %). For other ethnic groups the prediction success was low to none. Prediction success was above 70 % in most areas outside London but fell below 40 % in parts of London. CONCLUSION: Studies of ethnic inequalities in hospital inpatient care in England are limited by incomplete data on patient ethnicity collected in the 1990s and 2000s. The prediction success of a names-based ethnicity classification tool has been quantified in HES for the first time and the results can be used to inform decisions around the optimal analysis of ethnic groups using this data source

British surname origins, population structure and health outcomes-an observational study of hospital admissions.

Population structure is a confounder on pathways linking genotypes to health outcomes. This study examines whether the historical, geographical origins of British surnames are associated with health outcomes today. We coded hospital admissions of over 30 million patients in England between 1999 and 2013 to their British surname origin and divided their diagnoses into 125 major disease categories (of which 94 were complete-case). A base population was constructed with patients' first admission of any kind. Age- and sex-standardised odds ratios were calculated with logistic regression using patients with ubiquitous English surnames such as "Smith" as reference (alpha = .05; Benjamini-Hochberg false discovery rate (FDR) = .05). The results were scanned for "signals", where a branch of related surname origins all had significantly higher or lower risk. Age- and sex-standardised admission (alpha = .05) was calculated for each signal across area deprivation and surname origin density quintiles. Signals included three branches of English surnames (disorders of teeth and jaw, fractures, upper gastrointestinal disorders). Although the signal with fractures was considered unusual overall, 2 out of the 9 origins in the branch would only be significant at a FDR > .05: OR 0.92 (95% confidence interval 0.86-0.98) and 0.70 (0.55-0.90). The risk was only different in the quintile with the highest density of that group. Differential risk remained when studied across quintiles of area deprivation. The study shows that surname origins are associated with diverse health outcomes and thus act as markers of population structure over and above area deprivation

A modeling study of functional magnetic resonance imaging to individualize target definition of seminal vesicles for external beam radiotherapy

Background Pre-treatment magnetic resonance imaging (MRI) can give patient-specific evaluation of 25 suspected pathologically-involved volumes in the seminal vesicles (SV) in prostate cancer patients. By 26 targeting this suspicious volume we hypothesize that radiotherapy is more efficient without introducing more 27 toxicity. In this study we evaluate the concept of using MRI-defined target volumes in terms of tumor 28 control probability (TCP) and rectal normal tissue complication probability (NTCP). Materials and methods Twenty-one high-risk prostate cancer patients were included. Pre-treatment CT 30 images, T2 weighted (T2w) MRI and two multi-parametric MRI were acquired. Overlap between a 31 suspicious volume in the SV observed on T2w images and a suspicious volume observed on either multi-32 parametric MRI was assumed to reflect a true malignant region (named “MRI positive”). In addition the 33 entire SV on the CT-scan was delineated. Three treatment plans of 2Gyx39 fractions were generated per 34 patient: one covering the MRI positive volume in SV and prostate with margin of 11 mm to the MRI positive 35 in the SV and two plans covering prostate and SV using 11mm and 7mm SV margin, respectively. All plans 36 prescribed the same PTV mean dose. Rectal NTCP grade≥2 was evaluated with the Lyman-Kutcher-Burman 37 model and TCP was estimated by a logistic model using the combined MRI positive volume in SV and 38 prostate as region-of-interest. Results 14/21 patients were classified as MRI positive, 6 of which had suspicious volumes in all three MRI 40 modalities. On average TCP for the plan covering prostate and the MRI positive volume was 3% higher (up 41 to 11%) than the two other plans which was statistically significant. The increased TCP was obtained without 42 increasing rectal NTCP grade≥2. Conclusion Using functional MRI for individualized target delineation in the seminal vesicles may improve 44 the treatment outcome in radiotherapy of prostate cancer without increasing the rectal toxicity.</p

Nye regionale banekoncepter

Stikordsreferat fra Trafikdage i Aalborg, 28. august 201