6,713 research outputs found
The unavoidable costs of ethnicity : a review of evidence on health costs
This report was commissioned by the Advisory Committee on Resource Allocation (ACRA), and prepared
by the Centre for Health Services Studies (CHESS) and the Centre for Research in Ethnic Relations
(CRER) at the University of Warwick. The NHS Executive does not necessarily assent to the factual
accuracy of the report, nor necessarily share the opinions and recommendations of the authors.
The study reviews the evidence concerning the degree to which the presence of populations of minority
ethnic origin was associated with ‘unavoidable additional costs’ in health service delivery. While local
health authorities retail full autonomy in their use of funds allocated to them under the Hospital and
Community Health Services formula, the size of that budget is governed by a set of weightings applied to
their population, to allow for factors known to influence levels of need, and the costs of providing services.
The study began by considering the definitions used in describing ‘ethnicity’ and ethnic groups in relevant
medical and social policy literature. It is clear that no fixed set of terms can be adopted, and that flexibility
is required to respond to social changes. The terms used in the 1991 Census, with additions to allow for
local and contemporary developments, provide a suitable baseline but require additional information on
religion language and migration history for clinical and health service delivery planning.
There have been notable developments in health service strategy to meet the needs of black and minority
ethnic groups which have been encouraged by good practice guidelines and local initiatives. Together with
research into epidemiology and ethnic monitoring of services, these have enlarged understanding of the
impact of diversity. A conceptual model is developed which explores the potential for such diversity to lead
to variations in the cost of providing health services to a multi-ethnic population.
The research team reviewed the existing published evidence relating to ethnic health and disease treatment
in medical, social science, academic and practitioner literature, using conventional techniques. Additional
evidence was located through trawls of ‘grey’ literature in specialist collections, and through contacting all
English health districts with a request for information. A number of authorities and trusts provided written
and oral evidence, and a bibliography of key materials is provided.
Key issues considered include the need for and use of, interpreter and translation services, the incidence of
‘ethnically-specific’ disease, and variations in the prevalence and cost of treating ‘common’ conditions in
minority ethnic populations. Sources of variation are discussed, and a ‘scoping’ approach adopted to
explore the extent to which these variations could be adequately modelled. It is clear that while some
additional costs can be identified, and seen to be unavoidable, there are other areas where the presence of
minority populations may lead to lessened pressures on budgets, or where provision of ‘ethnic-specific’
facilities may be alternative to existing needs.
The literature provides a range of estimates which can be used in a modelling exercise, but is deficient in
many respects, particularly in terms of precise costs associated with procedure and conditions, or in
associating precise and consistent categories of ethnic group with epidemiological and operational service
provision data. Certain other activities require funding to set them up, and may not be directly related to
population size. There is considerable variation in the approaches adopted by different health authorities,
and many services are provided by agencies not funded by NHS budgets. The study was completed before
the announcement of proposed changes in health service commissioning which may have other implications
for ethnic diversity.
The presence of minorities is associated with the need to provide additional services in respect of
interpreting and translation, and the media of communication.
In order to achieve clinical effectiveness, a range of advocacy support facilities or alternative models of
provision seem to be desirable.
Ethnic diversity requires adaptation and additional evidence in order to inform processes of consultation
and commissioning.
Minority populations do create demands for certain additional specific clinical services not required by the
bulk of the majority population: it is not yet clear to what extent the reverse can be stated since research on
‘under-use’ is less well developed.
Some variations in levels of need, particularly those relating to established clinical difference in
susceptibility or deprivation, are already incorporated in funding formulae although it is not clear how far
the indicators adequately reflect these factors.
Costs are not necessarily simply related to the size of minority populations.
The provision of services to meet minority needs is not always a reflection of their presence, but has
frequently depended upon the provision of additional specific funds.
There is a consensus that the NHS research and development strategy should accept the need for more work
to establish the actual levels of need and usage of service by ethnic minority groups, and that effort should
be made to use and improve the growing collection of relevant information through ethnic monitoring
activities.
A variety of modelling techniques are suggested, and can be shown to have the potential to provide
practical guidance to future policy in the field.
Current data availability at a national or regional scale is inadequate to provide estimates of the ‘additional
costs of ethnicity’ but locally collected data and the existence of relevant policy initiatives suggest that a
focused study in selected districts would provide sufficiently robust information to provide reliable
estimates.
The review has demonstrated that there are costs associated with the presence of minority ethnic groups in
the population which can be shown to be unavoidable and additional, but that others are either ‘desirable’ or
‘alternative’. It would be wrong to assume that all cost pressures of this nature are in the same direction.
Our study has drawn attention to deficiencies in data collection and budgeting which may hinder
investigation of the effectiveness of the service in general. The process of drawing attention to ethnic
minority needs itself leads to developments in services which are functional and desirable for the majority
population
An overview of the research evidence on ethnicity and communication in healthcare
• The aim of the present study was to identify and review the available
research evidence on 'ethnicity and communication' in areas relevant to
ensuring effective provision of mainstream services (e.g. via interpreter,
advocacy and translation services); provision of services targeted on
communication (e.g. speech and language therapy, counselling,
psychotherapy); consensual/ participatory activities (e.g. consent to
interventions), and; procedures for managing and planning for linguistic
diversity
Review of the occupational health and safety of Britain’s ethnic minorities
This report sets out an evidence-based review on work-related health and safety issues relating to black and
minority ethnic groups. Data included available statistical materials and a systematic review of published research
and practice-based reports.
UK South Asians are generally under-represented within the most hazardous occupational groups. They have
lower accident rates overall, while Black Caribbean workers rates are similar to the general population;
Bangladeshi and Chinese workers report lowest workplace injury rates
UK South Asian people exhibit higher levels of limiting long-term illness (LLI) and self reported poor health than the
general population while Black Africans and Chinese report lower levels. Ethnic minority workers with LLI are more
likely than whites to withdraw from the workforce, or to experience lower wage rates.
Some of these findings conflict with evidence of differentials from USA, Europe and Australasia, but there is a
dearth of effective primary research or reliable monitoring data from UK sources.
There remains a need to improve monitoring and data collection relating to black and ethnic minority populations
and migrant workers. Suggestions are made relating to workshops on occupational health promotion programmes
for ethnic minorities, and ethnic minority health and safety 'Beacon' sites
Why does a good thing become too much? Interactions between foliar nutrients and toxins determine performance of an insect herbivore
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102682/1/fec12163.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/102682/2/fec12163-sup-0001-LaySummary.pd
Ethnicity : UK colorectal cancer screening pilot : final report
27. In summary, the overall evaluation of the UK Pilot has demonstrated that key parameters of test and programme performance observed in randomised studies of FOBt screening can be repeated in population-based pilot programmes. However, our study provides strong evidence of very low CRC screening uptake for ethnic groups in the Pilot area. This is coupled with a very low uptake of colonoscopy for individuals from ethnic groups with a positive FOBt result.
28. It has long been acknowledged that a diverse population may require diverse responses. Following the implementation of the Race Relations Amendment Act 2000, there has been a statutory duty laid upon all NHS agencies to ‘have due regard to the need to eliminate unlawful discrimination’, and to make explicit consideration of the implications for racial equality of every action or policy.
29. Because the observed overall outcomes in the UK Pilot generally compare favourably with the results of previous randomised trials of FOBt screening, the main Evaluation Group has concluded that benefits observed in the trials should be repeatable in a national roll-out.
30. However, our study indicates that any national colorectal cancer screening programme would need to very carefully consider the implications of ethnicity for roll-out, and develop a strategic plan on how best to accommodate this at both a national and local level. Based on our findings, consideration will clearly need to be given to improved access and screening service provision for ethnic minorities.
31. In order to ensure adequate CRC screening provision for a diverse UK population, and to address the explicit implications for racial equality highlighted by our findings, interventions now urgently need to be evaluated to improve access for ethnic minorities. This work should be undertaken as part of the second round of CRC screening currently underway in the English Pilot
Assessment of the costs to the NHS arising from the need for interpreter, advocacy and translation services
Dynamic communities in multichannel data: An application to the foreign exchange market during the 2007--2008 credit crisis
We study the cluster dynamics of multichannel (multivariate) time series by
representing their correlations as time-dependent networks and investigating
the evolution of network communities. We employ a node-centric approach that
allows us to track the effects of the community evolution on the functional
roles of individual nodes without having to track entire communities. As an
example, we consider a foreign exchange market network in which each node
represents an exchange rate and each edge represents a time-dependent
correlation between the rates. We study the period 2005-2008, which includes
the recent credit and liquidity crisis. Using dynamical community detection, we
find that exchange rates that are strongly attached to their community are
persistently grouped with the same set of rates, whereas exchange rates that
are important for the transfer of information tend to be positioned on the
edges of communities. Our analysis successfully uncovers major trading changes
that occurred in the market during the credit crisis.Comment: 8 pages, 6 figures, accepted for publication in Chao
Experimental evidence of non-Amontons behaviour at a multicontact interface
We report on normal stress field measurements at the multicontact interface
between a rough elastomeric film and a smooth glass sphere under normal load,
using an original MEMS-based stress sensing device. These measurements are
compared to Finite Elements Method calculations with boundary conditions
obeying locally Amontons' rigid-plastic-like friction law with a uniform
friction coefficient. In dry contact conditions, significant deviations are
observed which decrease with increasing load. In lubricated conditions, the
measured profile recovers almost perfectly the predicted profile. These results
are interpreted as a consequence of the finite compliance of the multicontact
interface, a mechanism which is not taken into account in Amontons' law
A simple all-microwave entangling gate for fixed-frequency superconducting qubits
We demonstrate an all-microwave two-qubit gate on superconducting qubits
which are fixed in frequency at optimal bias points. The gate requires no
additional subcircuitry and is tunable via the amplitude of microwave
irradiation on one qubit at the transition frequency of the other. We use the
gate to generate entangled states with a maximal extracted concurrence of 0.88
and quantum process tomography reveals a gate fidelity of 81%
Myometrial transcriptional signatures of human parturition
The process of parturition involves the transformation of the quiescent myometrium (uterine smooth muscle) to the highly contractile laboring state. This is thought to be driven by changes in gene expression in myometrial cells. Despite the existence of multiple myometrial gene expression studies, the transcriptional programs that initiate labor are not known. Here, we integrated three transcriptome datasets, one novel (NCBI Gene Expression Ominibus: GSE80172) and two existing, to characterize the gene expression changes in myometrium associated with the onset of labor at term. Computational analyses including classification, singular value decomposition, pathway enrichment, and network inference were applied to individual and combined datasets. Outcomes across studies were integrated with multiple protein and pathway databases to build a myometrial parturition signaling network. A high-confidence (significant across all studies) set of 126 labor genes were identified and machine learning models exhibited high reproducibility between studies. Labor signatures included both known (interleukins, cytokines) and unknown (apoptosis, , cell proliferation/differentiation) pathways while cyclic AMP signaling and muscle relaxation were associated with non-labor. These signatures accurately classified and characterized the stages of labor. The data-derived parturition signaling networks provide new genes/signaling interactions to understand phenotype-specific processes and aid in future studies of parturition
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