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1.
BMJ Open ; 8(2): e020771, 2018 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-29490969

RESUMO

OBJECTIVES: To assess the number of parents who visited community pharmacies in London seeking pain medications for their children's pain and specifically for oral pain, to identify which health services parents contacted before their pharmacy visit and to estimate the cost to the National Health Service (NHS) when children with oral pain who visit pharmacies also see health professionals outside dentistry. DESIGN: A cross-sectional study. SETTING: 1862 pharmacies in London in November 2016-January 2017. PARTICIPANTS: Parents, carers and adolescents purchasing over-the-counter pain medications or collecting pain prescriptions for children (0-19 years). BRIEF INTERVENTION: A survey administered by pharmacy staff to participants and a guidance pack. MAIN OUTCOME MEASURES: The number of parents who visited pharmacies seeking pain medications for their children's pain and oral pain and the number of parents who contacted health professionals outside dentistry before their pharmacy visit. Estimated costs of visits by children with oral pain to health professionals outside dentistry. RESULTS: One in two (951) pharmacies participated collecting information from 6915 parents seeking pain medications for their children. The majority (65%) of parents sought pain medications to relieve their children's oral pain. Only 30% of children with oral pain had seen a dentist before the pharmacy visit, while 28% of children had seen between one and four different health professionals. The cost to the NHS of children contacting health professionals outside dentistry was £36 573, extrapolated to an annual cost of £373 288. Replicating these findings across all pharmacies in England could mean that the NHS spends an estimated £2.3 million annually when children with oral pain inappropriately use multiple health services. CONCLUSION: Most parents who visited pharmacies for children's pain medications in London sought pain medications for children's oral pain. Children's inappropriate contact with multiple health services when they have oral pain adds significant costs to the NHS.


Assuntos
Serviços Comunitários de Farmácia/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Comportamento de Busca de Ajuda , Pais , Odontalgia/epidemiologia , Adolescente , Criança , Pré-Escolar , Serviços Comunitários de Farmácia/economia , Estudos Transversais , Feminino , Pessoal de Saúde/economia , Humanos , Lactente , Recém-Nascido , Londres/epidemiologia , Masculino , Medicamentos sem Prescrição/uso terapêutico , Inquéritos e Questionários , Odontalgia/tratamento farmacológico , Adulto Jovem
2.
Glob Chang Biol ; 6(S1): 59-68, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35026935

RESUMO

This paper examines, with examples, controls on the energy and water balance of northern wetlands. Most wetlands have organic soils and are thus peatlands. High-latitude wetlands are underlain by ice-rich permafrost, which helps maintain wetland systems and also imparts special characteristics to their energy and water balances. In North America, components of the radiation balance decrease linearly poleward, whereas the poleward rate of decrease of temperature and precipitation lessens. During the four-month summer of a high subarctic wetland, net radiation is large and the latent heat flux dominates the energy cycle. The ground heat flux is substantial, especially in early summer, when the ice-rich ground is rapidly thawing. Winter begins in October and heat loss from the ground approximately balances negative net radiation. The summer energy and water balance differs among terrain units. Large shallow lakes exhibit larger net radiation and potential evaporation rates than surrounding wetland surfaces which, in turn, exhibit substantially larger magnitudes than dryland terrain. There is a variable withdrawal rate of soil moisture depending on soil types and plant rooting characteristics, which influences the actual evaporation from the surface. Synoptic weather systems play a major role in day-to-day energy and water responses to climate forcing. Long-term modelling of the water balance of a wetland shows year-to-year persistence in climatic patterns. Although net radiation, temperature and precipitation all influence the magnitudes of water deficit, the precipitation inputs are of paramount importance. Our ability to fully understand, model and extrapolate, in space and time, the major controls on the surface climate of wetlands, is evaluated. Spatial extrapolation is seen to be more readily achieved than temporal extrapolation.

3.
Glob Chang Biol ; 6(S1): 84-115, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35026939

RESUMO

This paper summarizes and analyses available data on the surface energy balance of Arctic tundra and boreal forest. The complex interactions between ecosystems and their surface energy balance are also examined, including climatically induced shifts in ecosystem type that might amplify or reduce the effects of potential climatic change. High latitudes are characterized by large annual changes in solar input. Albedo decreases strongly from winter, when the surface is snow-covered, to summer, especially in nonforested regions such as Arctic tundra and boreal wetlands. Evapotranspiration (QE ) of high-latitude ecosystems is less than from a freely evaporating surface and decreases late in the season, when soil moisture declines, indicating stomatal control over QE , particularly in evergreen forests. Evergreen conifer forests have a canopy conductance half that of deciduous forests and consequently lower QE and higher sensible heat flux (QH ). There is a broad overlap in energy partitioning between Arctic and boreal ecosystems, although Arctic ecosystems and light taiga generally have higher ground heat flux because there is less leaf and stem area to shade the ground surface, and the thermal gradient from the surface to permafrost is steeper. Permafrost creates a strong heat sink in summer that reduces surface temperature and therefore heat flux to the atmosphere. Loss of permafrost would therefore amplify climatic warming. If warming caused an increase in productivity and leaf area, or fire caused a shift from evergreen to deciduous forest, this would increase QE and reduce QH . Potential future shifts in vegetation would have varying climate feedbacks, with largest effects caused by shifts from boreal conifer to shrubland or deciduous forest (or vice versa) and from Arctic coastal to wet tundra. An increase of logging activity in the boreal forests appears to reduce QE by roughly 50% with little change in QH , while the ground heat flux is strongly enhanced.

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