Impact of the NHS Stop Smoking Services on smoking prevalence in England:A simulation modelling evaluation

Background The English National Health Service NHS Stop Smoking Services (SSS), established in 2001, were the first such services in the world. An appropriate evaluation of the SSS has national and international significance. This modelling study sought to evaluate the impact of the SSS on changes in smoking prevalence in England. Methods A discrete time state-transition model was developed to simulate changes in smoking status among the adult population in England during 2001-2016. Input parameters were based on data from national statistics, population representative surveys and published literature. The main outcome was the percentage point reduction in smoking prevalence attributable to the SSS. Results Smoking prevalence was reduced by 10.8 % in absolute terms during 2001-2016 in England, and 15.3 % of the reduction could be attributable to the SSS. The percentage point reduction in smoking prevalence each year was on average 0.72%, and 0.11 % could be attributable to the SSS. The proportion of SSS supported quit attempts increased from 5.5 % in 2001, to as high as 18.9 % in 2011, and then reduced to 8.2 % in 2016. Quit attempts with SSS support had a higher success rate than those without SSS support (15.1% vs 11.3%). Smoking prevalence in England continued to decline after the SSS was much reduced from 2013 onwards. Conclusions Approximately 15% of the percentage point reduction in smoking prevalence during 2001-2016 in England may be attributable to the NHS SSS, although uncertainty remains regarding the actual impact of the formal smoking cessation services

A comparison between omeprazole and a dietary supplement for the management of squamous gastric ulceration in horses

Although several studies have assessed the short-term effect of dietary supplements on the treatment and prevention of gastric ulceration in horses, few have assessed the response over a duration of more than 30 days. A blinded randomized noninferiority clinical trial was conducted using 42 Thoroughbred horses in race training with squamous ulceration of ≥ grade 2/4, randomly assigned to one of two treatment groups for a period of 90 days: omeprazole at the full label dose of 4 mg/kg or the Succeed digestive conditioning supplement. Noninferiority analyses and Wilcoxon sign rank tests were used to analyze the data. At day 90, Succeed was noninferior to 4 mg/kg omeprazole administered daily in terms of the proportion of horses with complete resolution of squamous ulceration. At day 30, Succeed was found to be inferior to omeprazole in terms of the proportion of horses with grade ≤1/4 squamous ulceration. The proportion of horses with reducing squamous ulcer score (compared with day 0) was statistically significant for both treatments at days 30 and 60. At day 90 of the 17 horses on Succeed, nine had a reducing squamous ulcer score (P value = .049), and of the 19 horses on omeprazole, 10 had a reducing squamous ulcer score at day 90 (P value = .091). The noninferiority of Succeed compared to omeprazole at 90 days for the complete resolution of squamous ulceration and the reduced efficacy of omeprazole following 90 days of treatment are likely to be of interest to practitioners managing gastric ulceration in performance horses

Episode 22 : The Pandemic Pivot—Corporate Social Responsibility During a Pandemic

In this episode, we chat with leaders at L.L. Bean about how they successfully pivoted manufacturing and operations capabilities to protect and support employees, healthcare workers, and Maine residents at the start of the COVID-19 pandemic. Our guests share their experiences making face coverings, procuring PPE by leveraging their supply chain, and boxing food for Good Shepherd Food Bank. Discussion topics include the decision-making process, the manufacturing transition, corporate social responsibility, and the impacts to employee morale

Corporate financial accounting and reporting

2nd edition, ©200

Un enfoque de terapia ocupacional adaptada a la rehabilitación cognitiva de los efectos cognitivos colaterales asociados a la quimioterapia en pacientes supervivientes de cáncer de mama: dos estudios de mujeres postmenopáusicas afectadas

This article describes a tailored occupational therapy program to rehabilitate chemotherapy-related cognitive side effects. A literature review of cognitive rehabilitation as well as pharmacological trials used to improve cognition in breast cancer patients is included. Two outpatient case studies of young women premenopausally affected with breast cancer (both BRCA-1 gene mutation carriers) are used to discuss the role of tailored occupational therapy techniques for developing compensatory strategies and for delivering cognitive remediation. Neuropsychological evaluation pre and post occupational therapy is used to document the result of tailored occupational therapy on cognitive performance. The case studies illustrate the neuropsychological profile of chemotherapy-related cognitive changes and the course of deficits over 7-9 months. For younger, educated patients who must return to competitive, fast-paced jobs, cognitive side-effects post-treatment are especially noxious as young adult patients are building their professional lives and are not necessarily provided time to wait for the usual trajectory of recovery to take its course.En este artículo se describe un programa de terapia ocupacional adaptado para rehabilitar los efectos cognitivos secundarios asociados a la quimioterapia. Se incluye una revisión de la literatura de la rehabilitación cognitiva, así como de los ensayos farmacológicos utilizados para mejorar la cognición en pacientes de cáncer de mama. Se exponen dos estudios de caso ambulatorios de mujeres jóvenes premenopáusicas afectadas de cáncer de mama (ambas portadoras de mutaciones del gen BRCA-1) para examinar la función de técnicas de terapia ocupacional adaptadas para el desarrollo de estrategias compensatorias y para administrar rehabilitación cognitiva. La evaluación neuropsicológica antes y después de la terapia ocupacional se utiliza para documentar el resultado de la terapia ocupacional adaptada para el rendimiento cognitivo. Los estudios de casos ilustran el perfil neuropsicológico de los cambios asociados a la quimioterapia y el curso de los déficits durante 7-9 meses. En los pacientes jóvenes, con estudios que deben retornar a puestos de trabajo de ritmo rápido y competitivos, los efectos cognitivos secundarios postratamiento son especialmente nocivos, ya que los pacientes jóvenes adultos están construyendo sus vidas profesionales y no disponen del tiempo necesario de espera para que la trayectoria habitual de recuperación siga su curso

Factors associated with access to care and healthcare utilisation in the homeless population of England

Introduction: People experiencing homelessness are known to have complex health needs which are often compounded by poor access to healthcare. This study investigates the individual-level factors associated with access to care and healthcare utilisation among homeless people in England. Methods: A cross-sectional sample of 2,505 homeless people from 19 areas of England was used to investigate associations with access to care and healthcare utilisation. Results: Rough sleepers were much less likely to be registered with a GP (OR 0.45, CI 0.30-0.66) than single homeless in accommodation (reference group) or the hidden homeless (OR 1.48 CI 0.88-2.50). Those who had recently been refused registration by a GP or dentist also had lower odds of being admitted to hospital (OR 0.67, CI 0.49-0.91) or using an ambulance (OR 0.73, CI 0.54-0.99). Conclusions: The most vulnerable homeless people appear to face the greatest barriers to utilising healthcare. Rough sleepers have particularly low rates of GP registration and this appears to have a knock-on effect on admission to hospital. Improving primary care access for the homeless population could ensure that some of the most vulnerable people in society are able to access vital services which they are currently missing out on

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study.

OBJECTIVE: To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs). DESIGN: Controlled longitudinal study. SETTING: English National Health Service between 1998/99 and 2010/11. PARTICIPANTS: Populations registered with each of 6975 family practices in England. MAIN OUTCOME MEASURES: Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs. RESULTS: Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11. CONCLUSIONS: The introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities

Variability of the North Atlantic summer storm track: mechanisms and impacts on European climate

The summertime variability of the extratropical storm track over the Atlantic sector and its links to European climate have been analysed for the period 1948–2011 using observations and reanalyses. The main results are as follows. (1) The dominant mode of the summer storm track density variability is characterized by a meridional shift of the storm track between two distinct paths and is related to a bimodal distribution in the climatology for this region. It is also closely related to the Summer North Atlantic Oscillation (SNAO). (2) A southward shift is associated with a downstream extension of the storm track and a decrease in blocking frequency over the UK and northwestern Europe. (3) The southward shift is associated with enhanced precipitation over the UK and northwestern Europe and decreased precipitation over southern Europe (contrary to the behaviour in winter). (4) There are strong ocean–atmosphere interactions related to the dominant mode of storm track variability. The atmosphere forces the ocean through anomalous surface fluxes and Ekman currents, but there is also some evidence consistent with an ocean influence on the atmosphere, and that coupled ocean–atmosphere feedbacks might play a role. The ocean influence on the atmosphere may be particularly important on decadal timescales, related to the Atlantic Multidecadal Oscillation (AMO)

Socioeconomic position and depression in South African adults with long term health conditions: a longitudinal study of causal pathways

Aims. There is convincing evidence that lower socioeconomic position is associated with increased risk of mental disorders. However, the mechanisms involved are not well understood. This study aims to elucidate the causal pathways between socioeconomic position and depression symptoms in South African adults. Two possible causal theories are examined: social causation, which suggests that poor socioeconomic conditions cause mental ill health; and social drift, which suggests that those with poor mental health are more likely to drift into poor socioeconomic circumstances.Methods. The study used longitudinal and cross-sectional observational data on 3904 adults, from a randomised trial carried out in 38 primary health care clinics between 2011 and 2012. Structural equation models and counterfactual mediation analyses were used to examine causal pathways in two directions. First, we examined social causation pathways, with language (a proxy for racial or ethnic category) being treated as an exposure, while education, unemployment, income and depression were treated as sequential mediators and outcomes. Second, social drift was explored with depression treated as a potential influence on health-related quality of life, job loss and, finally, income.Results. The results suggest that the effects of language on depression at baseline, and on changes in depression during follow-up, were mediated through education and income but not through unemployment. Adverse effects of unemployment and job loss on depression appeared to be mostly mediated through income. The effect of depression on decreasing income appeared to be mediated by job loss.Conclusions. These results suggest that both social causation and social selection processes operate concurrently. This raises the possibility that people could get trapped in a vicious cycle in which poor socioeconomic conditions lead to depression, which, in turn, can cause further damage to their economic prospects. This study also suggests that modifiable factors such as income, employment and treatable depression are suitable targets for intervention in the short to medium term, while in the longer term reducing inequalities in education will be necessary to address the deeply entrenched inequalities in South Africa