scholarly journals Homelessness and health needs in Wales

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Jiao Song ◽  
Charlotte Grey ◽  
Louise Woodfine ◽  
Alisha Davies
Keyword(s):  
Propensity Score ◽  
Substance Misuse ◽  
National Level ◽  
Health Needs ◽  
Mental Wellbeing ◽  
Study Cohort ◽  
Homeless Individual ◽  
Data Set ◽  
Routinely Collected Health Data ◽  
And Control

Background Public Health Wales developed its long-term strategy with the purpose of ‘Working to Achieve a Healthier Future for Wales’. This study is motivated by one of the strategic priorities, ‘Influencing the wider determinants of health’ with an emphasis on homelessness prevention. Main AimTo understand health needs of homeless health service users from routinely collected health data in Wales. To quantify the corresponding differences from general population. MethodsScoping work has completed collaborating with academic researchers, third sectors, clinical professionals, Office for National Statistics, and housing stats of Welsh Government. To construct study cohort, we will perform linkage exercise among Annual District Death Extract, Emergency Department Data Set, Outpatient Dataset for Wales, Patient Episode Database for Wales, Substance Misuse Data Set and Welsh Longitudinal General Practice dataset (from 2007 to 2018) stored in Secure Anonymised Information Linkage (SAIL) Databank. Study cohort includes all patients with an indication (i.e. clinical codes) of homelessness in their registration information and/or health records. We propose to adapt propensity score matching to construct matched case and control groups. This method will assign each homeless individual to individual without homeless flag with same or similar propensity score. We will then proceed to test for the significance of the homelessness and each health and wellbeing indicators (i.e. physical health, mental wellbeing and substance misuse) in the presence of confounders, and estimate the effects of homelessness on these indicators. ResultsThis study will demonstrate how linked data provide a more comprehensive review of the health needs of a vulnerable population, the homeless groups in Wales, and be able to explore changes over time. ConclusionThe relationship between homelessness and health issues is bi-directional. Findings from this study will have implications for health, housing, social, and homelessness policy at both local and national level; as well as contributing to the ability to providing tailored health services to targeted homeless populations groups.

scholarly journals Inter-provincial disparity of COVID-19 transmission and control in Nepal

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Buddhi Pantha ◽  
Subas Acharya ◽  
Hem Raj Joshi ◽  
Naveen K. Vaidya
Keyword(s):  
Growth Rate ◽  
Disease Transmission ◽  
Reproduction Number ◽  
Control Strategies ◽  
National Level ◽  
Effective Control ◽  
Data Set ◽  
Control Policies ◽  
Local Spread ◽  
And Control

AbstractDespite the global efforts to mitigate the ongoing COVID-19 pandemic, the disease transmission and the effective controls still remain uncertain as the outcome of the epidemic varies from place to place. In this regard, the province-wise data from Nepal provides a unique opportunity to study the effective control strategies. This is because (a) some provinces of Nepal share an open-border with India, resulting in a significantly high inflow of COVID-19 cases from India; (b) despite the inflow of a considerable number of cases, the local spread was quite controlled until mid-June of 2020, presumably due to control policies implemented; and (c) the relaxation of policies caused a rapid surge of the COVID-19 cases, providing a multi-phasic trend of disease dynamics. In this study, we used this unique data set to explore the inter-provincial disparities of the important indicators, such as epidemic trend, epidemic growth rate, and reproduction numbers. Furthermore, we extended our analysis to identify prevention and control policies that are effective in altering these indicators. Our analysis identified a noticeable inter-province variation in the epidemic trend (3 per day to 104 per day linear increase during third surge period), the median daily growth rate (1 to 4% per day exponential growth), the basic reproduction number (0.71 to 1.21), and the effective reproduction number (maximum values ranging from 1.20 to 2.86). Importantly, results from our modeling show that the type and number of control strategies that are effective in altering the indicators vary among provinces, underscoring the need for province-focused strategies along with the national-level strategy in order to ensure the control of a local spread.

Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery

2021 ◽  
pp. 1-9
Author(s):  
Hiroki Ushirozako ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Propensity Score ◽  
Spinal Surgery ◽  
Control Group ◽  
Control Groups ◽  
Propensity Score Model ◽  
Significant Difference ◽  
Surgical Data ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

OBJECTIVESurgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score–matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.METHODSThe authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).RESULTSIn a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368–1.111; p = 0.114). Using a one-to-one propensity score–matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243–0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.CONCLUSIONSThe current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

scholarly journals Joint Action on cancer iPAAC - building on experience and streamlining recommendations for the future

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Jelenc ◽  
T Albreht
Keyword(s):  
Cancer Care ◽  
National Level ◽  
Cancer Control ◽  
Professional Community ◽  
The Other ◽  
Consensus Building ◽  
Good Practices ◽  
Policy Initiatives ◽  
European Code ◽  
And Control

Abstract Background Policy initiatives, proposals and projects often end up proposing solutions and/or measures that are eventually either not or only partially implemented or they are lacking a system, which would consistently evaluate their implementation and/or impact. Good solutions are often not visible enough to the broader professional community and it is important to identify certain outstanding challenges in cancer control and policy. Driven by the need to better use the outputs from projects on cancer policy, European Commission was trying to address two challenges - one was in solving the problems with the implementation and use of the solutions that have already been proposed and the other one in identifying the outstanding challenges in cancer policy. Results We have decided to follow the structure to develop a series of recommendations and examples of good practices at the national level by selected areas. These would be streamlined into a roadmap to support policymakers at the national and EU level in formulating their cancer policies. Three pairs of targeted recommendations have been identified: Cancer prevention, including health promotion, implementation of the European Code Against Cancer and the reshaping and extension of cancer registriesGenomics and immunotherapy in cancerChallenges in cancer care and governance of cancer control Conclusions Multinational collaboration can bring about important consensual solutions, which build on the existing good practices in the countries. This can be combined well with the existing work on specific areas, carried out both internationally and nationally. Consensus building on jointly defined challenges represents a task that appears to be resolved rather pragmatically. Key message It is important that advance in cancer care and control are quickly analysed and that policymakers receive up-to-date recommendations to improve their policies on cancer control.

New Evidence on Eastern Europe's Pollution Progress

2003 ◽  
Vol 3 (1) ◽  
Author(s):  
Matthew E Kahn
Keyword(s):  
Sulfur Dioxide ◽  
Carbon Dioxide Emissions ◽  
National Level ◽  
Data Sets ◽  
Local Public Good ◽  
Data Set ◽  
The Czech Republic ◽  
Level Data ◽  
Good Improvement ◽  
New Evidence

Abstract Under communism, Eastern Europe's cities were significantly more polluted than their Western European counterparts. An unintended consequence of communism's decline is to improve urban environmental quality. This paper uses several new data sets to measure these gains. National level data are used to document the extent of convergence across nations in sulfur dioxide and carbon dioxide emissions. Based on a panel data set from the Czech Republic, Hungary and Poland, ambient sulfur dioxide levels have fallen both because of composition and technique effects. The incidence of this local public good improvement is analyzed.

TO EVALUATE THE EFFECT OF PROPHYLACTIC USE OF TRENEXAMIC ACID ON BLEEDING DURING ELECTIVE LSCS. A STUDY CONDUCTED IN TERTIARY CARE HOSPITAL OF CENTRAL INDIA.

2021 ◽  
pp. 223-225
Author(s):  
Dhara Singh ◽  
Sujata bhargava
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Tertiary Care ◽  
Alternative Methods ◽  
World Health ◽  
Study Cohort ◽  
Care Hospital ◽  
Total Blood ◽  
And Control ◽  
The Impact

Background: Recent guidelines of the World Health Organization (WHO) indicated administering tranexamic acid (TXA) in order to treat postpartum bleeding (PPH). Therefore, nding low-cost and lowrisk alternative methods to control obstetric bleeding is of great importance. The present study aimed to evaluate the prophylactic effect of TXA on bleeding during and after the LSCS. In addition, it was attempted to explore the impact of TXA as a safe and inexpensive method for decreasing bleeding during and after CS so that to decrease the hazard of blood transfusion or hysterectomy in these patients. Material and Methods: This prospective study conducted on 100 women in Department of Obstetrics &gynecolgy for one year period. They were divided in two groups: Cases: (n=50; women receiving prophylactic Tranexamic Acid) and Control: (n=50; women receiving saline). Estimated the amount of blood loss during surgery. The amount of blood loss during surgery were calculated Estimation of weight of dry towels and mops before autoclaving is noted. Results: Most common age group among Cases and Control was 26-30 years .%. Mean age among cases group (26.69±7.51 years) was signicantly lesser compared to control study cohort (29.75±7.72). Post operativehemoglobin level was signicantly higher among Case (11.26±12.03) as compared to Control (8.56±1.01). Comparing post operative complications revealedno signicant changes. Use of topical hemostatics was higher among the control (77%) as compared to Cases (57%). Conclusion: Prophylactic treatment with TXA in relation to elective LSCS reduces the overall total blood loss, and the risk of reoperations owing to postoperative hemorrhage as revealed by higher hemoglobin level among cases.

Heterogeneity of reasons for attendance in frequent attenders of emergency departments and its relationship to future attendance

2021 ◽  
pp. emermed-2020-210412
Author(s):  
Richard Hotham ◽  
Colin O'Keeffe ◽  
Tony Stone ◽  
Suzanne M Mason ◽  
Christopher Burton
Keyword(s):  
Mental Health ◽  
Mental Disorder ◽  
Emergency Care ◽  
Health Problem ◽  
Patient Characteristics ◽  
Health Needs ◽  
Data Set ◽  
Frequent Attenders ◽  
History Of ◽  
Ed Visits

BackgroundEDs globally are under increasing pressure through rising demand. Frequent attenders are known to have complex health needs and use a disproportionate amount of resources. We hypothesised that heterogeneity of patients’ reason for attendance would be associated with multimorbidity and increasing age, and predict future attendance.MethodWe analysed an anonymised dataset of all ED visits over the course of 2014 in Yorkshire, UK. We identified 15 986 patients who had five or more ED encounters at any ED in the calendar year. Presenting complaint was categorised into one of 14 categories based on the Emergency Care Data Set (ECDS). We calculated measures of heterogeneity (count of ECDs categories and entropy of categories) and examined their relationship to total number of ED visits and to patient characteristics. We examined the predictive value of these and other features on future attendance.ResultsMost frequent attenders had more than one presenting complaint type. Heterogeneity increased with number of attendances, but heterogeneity adjusted for number of attendances did not vary substantially with age or sex. Heterogeneity was associated with the presence of one or more contacts for a mental health problem. For a given number of attendances, prior mental health contact but not heterogeneity was associated with further attendance.ConclusionsHeterogeneity of presenting complaint can be quantified and analysed for ED use: it is increased where there is a history of mental disorder but not with age. This suggests it reflects more than the number of medical conditions.

Monitoring, Diagnostics, and Prognostics for Robot Tool Center Accuracy Degradation

2018 ◽  
Author(s):  
Guixiu Qiao ◽  
Brian A. Weiss
Keyword(s):  
Health Management ◽  
Control Strategies ◽  
Test Methods ◽  
Component Level ◽  
Data Set ◽  
Root Cause ◽  
Robot Systems ◽  
Robot Performance ◽  
And Control ◽  
Constituent Elements

Over time, robots degrade because of age and wear, leading to decreased reliability and increasing potential for faults and failures; this negatively impacts robot availability. Economic factors motivate facilities and factories to improve maintenance operations to monitor robot degradation and detect faults and failures, especially to eliminate unexpected shutdowns. Since robot systems are complex, with sub-systems and components, it is challenging to determine these constituent elements’ specific influence on the overall system performance. The development of monitoring, diagnostic, and prognostic technologies (collectively known as Prognostics and Health Management (PHM)), can aid manufacturers in maintaining the performance of robot systems by providing intelligence to enhance maintenance and control strategies. This paper presents the strategy of integrating top level and component level PHM to detect robot performance degradation (including robot tool center accuracy degradation), supported by the development of a four-layer sensing and analysis structure. The top level PHM can quickly detect robot tool center accuracy degradation through advanced sensing and test methods developed at the National Institute of Standards and Technology (NIST). The component level PHM supports deep data analysis for root cause diagnostics and prognostics. A reference data set is collected and analyzed using the integration of top level PHM and component level PHM to understand the influence of temperature, speed, and payload on robot’s accuracy degradation.

scholarly journals Automatic Promotion and Student Dropout: Evidence from Uganda, Using Propensity Score in Difference in Differences Model

2018 ◽  
Vol 7 (2) ◽  
pp. 191 ◽  
Author(s):  
Jeje Moses Okurut
Keyword(s):  
Propensity Score ◽  
Dropping Out ◽  
Probit Regression ◽  
Difference In Differences ◽  
Student Dropout ◽  
Analysis Technique ◽  
Analysis Strategy ◽  
Negative Effect ◽  
And Control ◽  
The Impact

The impact of automatic promotion practice on students dropping out of Uganda’s primary education was assessed using propensity score in difference in differences analysis technique. The analysis strategy was instrumental in addressing the selection bias problem, as well as biases arising from common trends over time, and permanent latent differences between the treated and control groups. Probit regression results indicate a negative effect on the probability of students dropping out, but only at P3. There seems to be no policy effect at P6. Decomposing the effect incidence along school location shows the policy as having had an effect only on P3 students studying in urban schools; otherwise, there is no effect among students at P3 rural, P6 rural or P6 Urban. In terms of the gender component, automatic promotion appears to have had an effect on P3 male and female students and no effect on either sex at P6.

scholarly journals PERIOPERATIVE OPIOID EXPOSURE PATTERNS IN PEDIATRIC ACL PATIENTS: A TEN YEAR ADMINISTRATIVE DATABASE STUDY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0027
Author(s):  
Dharman Anandarajan ◽  
Brendan A. Williams ◽  
Nathan Markiewitz ◽  
Divya Talwar ◽  
Lawrence Wells
Keyword(s):  
Pediatric Patients ◽  
Cruciate Ligament ◽  
National Level ◽  
Bayesian Regression ◽  
Pediatric Care ◽  
Administrative Database ◽  
Study Cohort ◽  
Prescribing Practices ◽  
Database Study ◽  
Commercial Insurance

Background: Pediatric patients sustaining anterior cruciate ligament (ACL) or related injuries are at high risk for opioid exposure in the acute, perioperative and postoperative phases of injury. Early and repeated exposure to these medications may increase the risk of future misuse. While variation in opioid prescribing practices has been documented in the outpatient setting and other realms of pediatric care, perioperative opioid exposure in this procedural cohort has not been previously examined on a national level. Purpose: To assess for demographic, temporal, regional, and hospital-level variability in perioperative opioid exposure in pediatric ACL patients. Methods: The Pediatric Health Information Systems Database (PHIS) was used to identify pediatric patients (≤18 years old) undergoing surgical treatment for ACL injury between January 2008 and December 2017. Perioperative opioids were converted to a morphine equivalent dose (MED) and summed for each patient. A hierarchical bayesian regression was performed to identify demographic factors that predicted opioid exposure while adjusting for the effect of hospital. Results: The study cohort included 23,071 patients across 52 hospitals. We report model estimates in Table 1 and mean MME by hospital in Figure 1. Compared to older adolescents (15-18yo), younger adolescents (11-14yo; b=-0.13 95% Credible Interval[-0.19, -0.07]) and children <10yo (b=-1.62 [-1.72, -1.52]) received less MED. Patients located in an observation unit (b=-1.15 [-1.25, -1.06]) or an inpatient unit (b=-1.31;[-1.42, -1.20]) received less MED than patients in an ambulatory surgical setting. Patients with commercial insurance also were dispensed more MED compared to those with other payers (b=0.10 [0.04, 0.16]). Female patients received less opioids than male patients (b=-0.08 [-0.13, -0.02]). Of the hospital random effects, the 95% credible intervals of 24 (46%) intercepts and 21 (40%) slopes did not include zero. Conclusions: This administrative database study identified hospital and patient-level characteristics predictive of perioperative narcotic exposure among pediatric ACL patients. Those who were older, in an ambulatory surgery setting, or had commercial insurance received more opioids. Cumulative perioperative opioid exposure has not declined on a national level in recent years and significant variability in opioid exposure exists between hospitals. Future work should seek to identify and utilize opioid-minimizing practices that appear present in some clinical settings. [Table: see text][Figure: see text]

Regulatory Administration: An Evolving and Neglected Area of Public Administration in India

2018 ◽  
Vol 64 (4) ◽  
pp. 686-702
Author(s):  
Yudhishthira Sapru ◽  
R.K. Sapru
Keyword(s):  
National Level ◽  
Current Phase ◽  
The Public ◽  
The People ◽  
Policies And Procedures ◽  
Governance Process ◽  
Regulatory Bodies ◽  
The Government ◽  
Political Economic ◽  
And Control

In the current phase of liberalisation, privatisation and globalisation, and now broadly governance, regulatory administration has acquired growing importance as an instrument of achieving socio-economic objectives. It is through instrumentality of regulatory administration that the government is able to exercise effective political and economic sovereignty and control over the country’s governance process and resources. Governments of nearly all developing countries have initiated policies and procedures to promote and strengthen regulatory bodies and agencies. However, the results of these promotional and regular activities have varied considerably, often reflecting large inadequacies in policies, organisational structures and procedures. Increasing emphasis is now being placed at the national level on a more flexible regulatory administration to enforce compliance with nationally established policies and requirements in various political, economic and social spheres. As a watchdog for the public interest, governments both at central and state levels should engage in activities for the promotion of social and economic justice, so as to ensure the happiness and prosperity of the people.

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