The Control of Methicillin-Resistant Staphylococcus aureus Blood Stream infections in England

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI) is a major healthcare burden in some but not all healthcare settings, and it is associated with 10%–20% mortality. The introduction of mandatory reporting in England of MRSA BSI in 2001 was followed in 2004 by the setting of target reductions for all National Health Service hospitals. The original national target of a 50% reduction in MRSA BSI was considered by many experts to be unattainable, and yet this goal has been far exceeded (∼80% reduction with rates still declining). The transformation from endemic to sporadic MRSA BSI involved the implementation of serial national infection prevention directives, and the deployment of expert improvement teams in organizations failed to meet their improvement trajectory targets. We describe and appraise the components of the major public health infection prevention campaign that yielded major reductions in MRSA infection. There are important lessons and opportunities for other healthcare systems where MRSA infection remains endemic

Aging in the United Kingdom and Europe - A snapshot of the future?

The implications for society of increasing life span to 120 years can only be guessed, but comparing the diversity of responses to aging in different countries may give insights into the possible effect. A European Union–funded study of the recipients of community care services in 11 European countries illustrates how such studies can help identify some of the issues. The study, made possible by the availability of a multidimensional standardized assessment for community care, illustrates how diversity of social and political history and culture results in widely different patterns of dependency in those cared for at home, different levels of formal care, and informal caregiver burden. There is wide variation in living arrangements, marital status, and dependency between countries. The average age of recipients of community care is approximately 82, regardless of the average age of the national population. In Italy, which has the oldest population in Europe, dependency in people supported at home in extended families is high, with little formal care and significant levels of informal caregiver burden. In contrast the Nordic countries have lower levels of dependency and greater proportions of people with no informal caregiver. In Germany, informal caregiver burden may be related to the regulatory mechanisms rather than dependency and levels of formal care. With a life expectancy of 120, it will be these 80-year-olds who will be caring for their parents. Although humankind is resourceful, it will require a unified approach to aging to overcome the challenging diversity in our societies

The efficiency of health production: re-estimating the WHO panel data using parametric and non-parametric approaches to provide additional information

The World Health Report 2000 focuses on the performance of health-care systems around the globe. The report uses efficiency measurement techniques to create a league table of health-care systems, highlighting good and bad performers. Efficiency is measured using panel data methods. This paper suggests that the WHO's estimation procedure is too narrow and that contextual information is hidden by the use of one method. This paper uses and validates a range of parametric and non-parametric empirical methods to measure efficiency using the WHO data. The rankings obtained are compared to the WHO league table and we demonstrate that there are trends and movements of interest within the league tables. We recommend that the WHO broaden its range of techniques in order to reveal this hidden information. Copyright © 2002 John Wiley & Sons, Ltd.