scholarly journals How fast should social restrictions be eased  in England as COVID-19 vaccinations are rolled out?

2021 ◽  
Author(s):  
David Miles ◽  
Adrian Heald ◽  
Mike Stedman
Keyword(s):  
Healthcare Services ◽  
Key Factors ◽  
Healthcare Provision ◽  
Factors Affecting ◽  
Education Outcomes ◽  
Trade Offs ◽  
Standards Of Living ◽  
Life Years ◽  
The Uk ◽  
The Impact

Vaccination against the COVID-19 virus began in December 2020 in the UK and is now running at 5% population/week. High Levels of social restrictions were implemented for the third time in January 2021 to control the second wave and resulting increases in hospitalisations and deaths. Easing those restrictions must balance multiple challenging priorities, weighing the risk of more deaths and hospitalisations against damage done to mental health, incomes and standards of living, education outcomes and provision of non-Covid-19 healthcare. Weekly and monthly officially published values in 2020/21 were used to estimate the impact of seasonality and social restrictions on the spread of COVID-19 by age group, on the economy and healthcare services. These factors were combined with the estimated impact of vaccinations and immunity from past infections into a model that retrospectively reflected the actual numbers of reported deaths closely both in 2020 and early 2021. It was applied prospectively to the next 6 months to evaluate the impact of different speeds of easing social restrictions. The results show vaccinations are significantly reducing the number of hospitalisations and deaths. The central estimate is that relative to a rapid easing, the avoided loss of 57,000 life years from a strategy of relatively slow easing over the next 4 months comes at a cost in terms of GDP reduction of around £0.4 million/life-year loss avoided. This is over 10 times higher than the usual limit the NHS uses for spending against Quality Adjusted Life Years (QALYs) saved. Alternative assumptions for key factors affecting give significantly different trade-offs between costs and benefits of different speeds of easing. Disruption of non-Covid-19 Healthcare provision also increases in times of higher levels of social restrictions. In most cases, the results favour a somewhat faster easing of restrictions in England than current policy implies.

scholarly journals Is the Vaccination program the only factor that should determine how fast the COVID-19 restrictions in England should be eased in 2021?

2021 ◽  
Author(s):  
David Miles ◽  
Adrian Heald ◽  
Mike Stedman
Keyword(s):  
Healthcare Services ◽  
Vaccination Program ◽  
Healthcare Provision ◽  
Future Health ◽  
Factors Affecting ◽  
Trade Offs ◽  
Standards Of Living ◽  
Life Years ◽  
The Uk ◽  
The Impact

Vaccination against the COVID-19 virus began in December 2020 in the UK and is now running at 5% population/week. High Levels of social restrictions were implemented for the third time in January 2021 to control the second wave and resulting increases in hospitalisations and deaths. Easing those restrictions must balance multiple challenging priorities, weighing the risk of more deaths and hospitalisations against damage done to mental health, incomes and standards of living, education outcomes and provision of non-Covid-19 healthcare. Weekly and monthly officially published values in 2020/21 were used to estimate the impact of seasonality and social restrictions on the spread of COVID-19 by age group, on the economy and healthcare services. These plus vaccination program assembled into a model that retrospectively reflected the actual numbers of reported deaths closely both in 2020 and early 2021. It was applied prospectively to the next 6 months to evaluate impact of different speeds of easing social restrictions. The results show vaccinations are significantly reducing the number of hospitalisation and deaths. The central estimate is that relative to a rapid easing the avoided loss of 57,000 life years from a strategy of relatively slow easing over the next 4 months come at a cost in terms of GDP reduction of around £0.4 million/life-year loss avoided. This is over 10 times higher than the usual limit the NHS uses for spending against Quality Adjusted Life Years (QALYs) saved. Alternative assumptions for key factors affecting give significantly different trade-offs between costs and benefits of different speeds of easing. Disruption of non-Covid-19 Healthcare provision also increases in times of higher levels of social restrictions. In most cases, the results favour a somewhat faster easing of restrictions in England than current policy implies. Return of non-Covid-19 healthcare activity to ‘normal’ levels might also improve future health outcomes/mortality.

Colostomy irrigation (part 1): impact on quality of life

2021 ◽  
Vol 19 (3) ◽  
pp. 24-29
Author(s):  
Hayley Jones
Keyword(s):  
Quality Of Life ◽  
Positive Impact ◽  
Key Factors ◽  
Factors Affecting ◽  
Colostomy Irrigation ◽  
Faecal Continence ◽  
Peristomal Skin ◽  
The Uk ◽  
The Impact

Colostomy irrigation (CI) involves instillation of water via the stoma into the colon, where it stimulates peristalsis, causing expulsion of stool and water from the stoma. CI allows colostomates to regain controlled evacuation and faecal continence. A review of the literature suggests that CI is safe and can have a positive impact on key factors affecting quality of life, including flatus, odour and peristomal skin health. CI is also convenient in avoiding the need for frequent disposal of used appliances. All of this has also been shown to improve psychological wellbeing. However, use of CI in the UK remains relatively low. This first article considers the impact of CI on colostomates' quality of life, and the second will explore the barriers to uptake.

scholarly journals Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048772
Author(s):  
Toby O Smith ◽  
Pippa Belderson ◽  
Jack R Dainty ◽  
Linda Birt ◽  
Karen Durrant ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Study ◽  
Online Survey ◽  
Musculoskeletal Diseases ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Healthcare Provision ◽  
Social Restriction ◽  
The Uk ◽  
The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

scholarly journals Informal Caregiving and Disaster Risk Reduction: A Scoping Review

2021 ◽  
Vol 12 (2) ◽  
pp. 169-187
Author(s):  
Christina J. Pickering ◽  
Maya Dancey ◽  
Karen Paik ◽  
Tracey O’Sullivan
Keyword(s):  
Risk Reduction ◽  
Scoping Review ◽  
Disaster Risk Reduction ◽  
Informal Caregivers ◽  
Healthcare Services ◽  
Informal Caregiving ◽  
Disaster Risk ◽  
Healthcare Provision ◽  
Strategic Action ◽  
Factors Affecting

AbstractInformal caregivers are a population currently in the shadows of disaster risk reduction (DRR), and yet essential to the provision of healthcare services. This scoping review explored the literature to understand issues related to informal caregiving and promising practices to support resilience for disasters. Following guidelines for scoping review as outlined by Tricco et al. (2016), relevant publications were identified from five major databases—Medline, Embase, PubMed, Web of Science, and Scopus. Relevant studies referenced informal caregiving and disasters for a variety of population groups including children, people with disabilities or chronic illnesses, and older adults. Studies were excluded if they discussed formal caregiving services (for example, nursing), lacked relevance to disasters, or had insufficient discussion of informal caregiving. Overall, 21 articles met the inclusion criteria and were fully analyzed. Five themes were identified: (1) the need for education and training in DRR; (2) stressors around medication and supply issues; (3) factors affecting the decision-making process in a disaster; (4) barriers leading to disaster-related problems; and (5) factors promoting resilience. Recommended areas of strategic action and knowledge gaps are discussed. Many informal caregivers do not feel adequately prepared for disasters. Given the important role of informal caregivers in healthcare provision, preparedness strategies are essential to support community resilience for those requiring personal care support. By understanding and mobilizing assets to support the resilience of informal caregivers, we also support the resilience of the greater healthcare system and the community, in disaster contexts.

scholarly journals A Cost-Effectiveness Analysis of Newborn Screening for Severe Combined Immunodeficiency in the UK

2019 ◽  
Vol 5 (3) ◽  
pp. 28 ◽  
Author(s):  
Alice Bessey ◽  
James Chilcott ◽  
Joanna Leaviss ◽  
Carmen de la Cruz ◽  
Ruth Wong
Keyword(s):  
Cost Effectiveness ◽  
Severe Combined Immunodeficiency ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Combined Immunodeficiency ◽  
Tree Model ◽  
Life Years ◽  
The Uk ◽  
The Cost ◽  
The Impact

Severe combined immunodeficiency (SCID) can be detected through newborn bloodspot screening. In the UK, the National Screening Committee (NSC) requires screening programmes to be cost-effective at standard UK thresholds. To assess the cost-effectiveness of SCID screening for the NSC, a decision-tree model with lifetable estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality-adjusted life years (QALYs) were discounted at 3.5%. Probabilistic, one-way sensitivity analyses and an exploratory disbenefit analysis for the identification of non-SCID patients were conducted. Screening for SCID was estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,222 with a reduction in SCID mortality from 8.1 (5–12) to 1.7 (0.6–4.0) cases per year of screening. Results were sensitive to a number of parameters, including the cost of the screening test, the incidence of SCID and the disbenefit to the healthy at birth and false-positive cases. Screening for SCID is likely to be cost-effective at £20,000 per QALY, key uncertainties relate to the impact on false positives and the impact on the identification of children with non-SCID T Cell lymphopenia.

scholarly journals The impact of the COVID-19 lockdown on orthopaedic emergency presentations in a remote and rural population

2020 ◽  
Vol 1 (10) ◽  
pp. 621-627
Author(s):  
Ahmed S. Elhalawany ◽  
James Beastall ◽  
Gerard Cousins
Keyword(s):  
Healthcare Providers ◽  
Local Area ◽  
Time Frame ◽  
Healthcare Provision ◽  
Proportional Increase ◽  
Minor Injuries ◽  
The Uk ◽  
A Minor ◽  
The Impact ◽  
Second Wave

Aims COVID-19 remains the major focus of healthcare provision. Managing orthopaedic emergencies effectively, while at the same time protecting patients and staff, remains a challenge. We explore how the UK lockdown affected the rate, distribution, and type of orthopaedic emergency department (ED) presentations, using the same period in 2019 as reference. This article discusses considerations for the ED and trauma wards to help to maintain the safety of patients and healthcare providers with an emphasis on more remote geography. Methods The study was conducted from 23 March 2020 to 5 May 2020 during the full lockdown period (2020 group) and compared to the same time frame in 2019 (2019 group). Included are all patients who attended the ED at Raigmore Hospital during this period from both the local area and tertiary referral from throughout the UK Highlands. Data was collected and analyzed through the ED Information System (EDIS) as well as ward and theatre records. Results A total of 1,978 patients presented to the ED during the lockdown period, compared to 4,777 patients in the same timeframe in 2019; a reduction of 58.6%. Orthopaedic presentations in 2020 and 2019 were 736 (37.2%) and 1,729 (36.2%) respectively, representing a 57.4% reduction. During the lockdown, 43.6% of operations were major procedures (n = 48) and 56.4% were minor procedures (n = 62), representing a significant proportional shift. Conclusion During the COVID- 19 lockdown period there was a significant reduction in ED attendances and orthopaedic presentations compared to 2019. We also observed that there was a proportional increase in fractures in elderly patients and in minor injuries requiring surgery. These represented the majority of the orthopaedic workload during the lockdown period of 2020. Given this shift towards smaller surgical procedures, we suggest that access to a minor operating theatre in or close to ED would be desirable in the event of a second wave or future crisis.

Factors Affecting Design Decisions for Customer Relationship Management Data Warehouses

2011 ◽  
pp. 159-191
Author(s):  
Colleen Cunningham ◽  
Il-Yeol Song
Keyword(s):  
Customer Relationship Management ◽  
Data Warehousing ◽  
Relationship Management ◽  
Customer Relationship ◽  
Data Warehouses ◽  
Key Factors ◽  
Design Decisions ◽  
Factors Affecting ◽  
Percent Success ◽  
The Impact

Customer relationship management (CRM) is a strategy that integrates concepts of knowledge management, data mining, and data warehousing in order to support an organization’s decision-making process to retain long-term and profitable relationships with its customers. Key factors for successfully implementing CRM (e.g., data quality issues, organizational readiness, customer strategies, selection of appropriate KPIs, and the design of the data warehouse model) are discussed with the main thrust of the chapter focusing on CRM analyses and the impact of those analyses on CRM data warehousing design decisions. This chapter then presents a robust multidimensional starter model that supports CRM analyses. Additional research contributions include the introduction of two new measures, percent success ratio and CRM suitability ratio by which CRM models can be evaluated, the identification/ classification of CRM queries, and a preliminary heuristic for designing data warehouses to support CRM analyses.

Sustainable Communities: Affordable Housing and Socio-economic Relations

2008 ◽  
Vol 23 (4) ◽  
pp. 267-276 ◽  
Author(s):  
Vida Maliene ◽  
Joseph Howe ◽  
Naglis Malys
Keyword(s):  
Affordable Housing ◽  
Sustainable Communities ◽  
Key Factors ◽  
Economic Relations ◽  
Sustainable Housing ◽  
The Social ◽  
The Uk ◽  
The Impact ◽  
Existing Housing

Recent UK government objectives are focused on creating sustainable communities to improve quality of life. Housing is a key issue to consider in delivering healthy and attractive communities. In certain areas of housing, lack of supply and consequent problems of affordability have created persistent social and economic pressure. For sustainable communities, housing should be easily available, high-quality, economic, ecological, aesthetically designed and comfortable, thus better suiting the needs of a person. Moreover, the housing must be affordable according to the local and national situation. This article addresses the issue of sustainable communities from the perspectives of housing markets and socio-economics. The study focuses on key factors that are believed to contribute to the currently existing housing situation, assessing the impact of regulated socio-economics upon the sustainable housing and communities. The study also reviews past and current government initiatives and policies relevant to housing and regeneration in the UK. The article finishes with the interview-based study carried out in the Northwest with a reflection on the notion of the sustainable communities plan and its eight key components, the housing market and its dependence on the economic, the social and political environment and it offers recommendations for the further sustainable communities' development within the UK.

scholarly journals Effective diabetes complication management is a step toward a carbon-efficient planet: an economic modeling study

2020 ◽  
Vol 8 (1) ◽  
pp. e001017
Author(s):  
Ric Fordham ◽  
Ketan Dhatariya ◽  
Rachel Stancliffe ◽  
Adam Lloyd ◽  
Mou Chatterjee ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Single Agent ◽  
Economic Modeling ◽  
Total Carbon ◽  
Carbon Intensity ◽  
Diabetes Model ◽  
Life Years ◽  
Third Line ◽  
The Uk ◽  
The Impact

BackgroundThe management of diabetes-related complications accounts for a large share of total carbon dioxide equivalent (CO2e) emissions. We assessed whether improving diabetes control in people with type 2 diabetes reduces CO2e emissions, compared with those with unchanging glycemic control.MethodsUsing the IQVIA Core Diabetes Model, we estimated the impact of maintaining glycated hemoglobin (HbA1c) at 7% (53 mmol/mol) or reducing it by 1% (11 mmol/mol) on total CO2e/patient and CO2e/life-year (LY). Two different cohorts were investigated: those on first-line medical therapy (cohort 1) and those on third-line therapy (cohort 2). CO2e was estimated using cost inputs converted to carbon inputs using the UK National Health Service’s carbon intensity factor. The model was run over a 50-year time horizon, discounting total costs and quality adjusted life years (QALYs) up to 5% and CO2e at 0%.ResultsMaintaining HbA1c at 7% (53 mmol/mol) reduced total CO2e/patient by 18% (1546 kgCO2e/patient) vs 13% (937 kgCO2e/patient) in cohorts 1 and 2, respectively, and led to a reduction in CO2e/LY gain of 15%–20%. Reducing HbA1c by 1% (11 mmol/mol) caused a 12% (cohort 1) and 9% (cohort 2) reduction in CO2e/patient with a CO2e/LY gain reduction of 11%–14%.ConclusionsWhen comparing people with untreated diabetes, maintaining glycemic control at 7% (53 mmol/mol) on a single agent or improving HbA1c by 1% (11 mmol/mol) by the addition of more glucose-lowering treatment was associated with a reduction in carbon emissions.

scholarly journals Public health air pollution impacts of pathway options to meet the 2050 UK Climate Change Act target: a modelling study

2018 ◽  
Vol 6 (7) ◽  
pp. 1-124
Author(s):  
Martin L Williams ◽  
Sean Beevers ◽  
Nutthida Kitwiroon ◽  
David Dajnak ◽  
Heather Walton ◽  
...  
Keyword(s):  
Public Health ◽  
Climate Change ◽  
Air Pollution ◽  
Great Britain ◽  
Road Transport ◽  
Air Pollutant ◽  
Life Years ◽  
The Uk ◽  
The Impact

BackgroundThe UK’sClimate Change Act 2008(CCA; Great Britain.Climate Change Act 2008. Chapter 27. London: The Stationery Office; 2008) requires a reduction of 80% in carbon dioxide-equivalent emissions by 2050 on a 1990 base. This project quantified the impact of air pollution on health from four scenarios involving particulate matter of ≤ 2.5 µm (PM2.5), nitrogen dioxide (NO2) and ozone (O3). Two scenarios met the CCA target: one with limited nuclear power build (nuclear replacement option; NRPO) and one with no policy constraint on nuclear (low greenhouse gas). Another scenario envisaged no further climate actions beyond those already agreed (‘baseline’) and the fourth kept 2011 concentrations constant to 2050 (‘2011’).MethodsThe UK Integrated MARKAL–EFOM System (UKTM) energy system model was used to develop the scenarios and produce projections of fuel use; these were used to produce air pollutant emission inventories for Great Britain (GB) for each scenario. The inventories were then used to run the Community Multiscale Air Quality model ‘air pollution model’ to generate air pollutant concentration maps across GB, which then, combined with relationships between concentrations and health outcomes, were used to calculate the impact on health from the air pollution emitted in each scenario. This is a significant improvement on previous health impact studies of climate policies, which have relied on emissions changes. Inequalities in exposure in different socioeconomic groups were also calculated, as was the economic impact of the pollution emissions.ResultsConcentrations of NO2declined significantly because of a high degree of electrification of the GB road transport fleet, although the NRPO scenario shows large increases in oxides of nitrogen emissions from combined heat and power (CHP) sources. Concentrations of PM2.5show a modest decrease by 2050, which would have been larger if it had not been for a significant increase in biomass (wood burning) use in the two CCA scenarios peaking in 2035. The metric quantifying long-term exposure to O3is projected to decrease, while the important short-term O3exposure metric increases. Large projected increases in future GB vehicle kilometres lead to increased non-exhaust PM2.5and particulate matter of ≤ 10 µm emissions. The two scenarios which achieve the CCA target resulted in more life-years lost from long-term exposures to PM2.5than in the baseline scenario. This is an opportunity lost and arises largely from the increase in biomass use, which is projected to peak in 2035. Reduced long-term exposures to NO2lead to many more life-years saved in the ‘CCA-compliant’ scenarios, but the association used may overestimate the effects of NO2itself. The more deprived populations are estimated currently to be exposed to higher concentrations than those less deprived, the contrast being largest for NO2. Despite reductions in concentrations in 2050, the most socioeconomically deprived are still exposed to higher concentrations than the less deprived.LimitationsModelling of the atmosphere is always uncertain; we have shown the model to be acceptable through comparison with observations. The necessary complexity of the modelling system has meant that only a small number of scenarios were run.ConclusionsWe have established a system which can be used to explore a wider range of climate policy scenarios, including more European and global scenarios as well as local measures. Future work could explore wood burning in more detail, in terms of the sectors in which it might be burned and the spatial distribution of this across the UK. Further analyses of options for CHP could also be explored. Non-exhaust emissions from road transport are an important source of particles and emission factors are uncertain. Further research on this area coupled with our modelling would be a valuable area of research.FundingThe National Institute for Health Research Public Health Research programme.

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