RESUMO
OBJECTIVE: This study will analyse respiratory contacts to three healthcare services that capture more of the community disease burden than acute data sources, such as hospitalisations. The objective is to explore associations between contacts to these services and the patient's age, gender and deprivation. Results will be compared between healthcare services, and with non-respiratory contacts to explore how contacts differ by service and illness. It is crucial to investigate the sociodemographic patterns in healthcare-seeking behaviour to enable targeted public health interventions. DESIGN: Ecological study. SETTING: Surveillance of respiratory contacts to three healthcare services in England: telehealth helpline (NHS111); general practitioner in-hours (GPIH); and general practitioner out of hours unscheduled care (GPOOH). PARTICIPANTS: 13 million respiratory contacts to NHS111, GPIH and GPOOH. OUTCOME MEASURES: Respiratory contacts to NHS111, GPIH and GPOOH, and non-respiratory contacts to NHS111 and GPOOH. RESULTS: More respiratory contacts were observed for females, with 1.59, 1.73, and 1.95 times the rate of contacts to NHS111, GPOOH and GPIH, respectively. When compared with 15-44 year olds, there were 37.32, 18.66 and 6.21 times the rate of respiratory contacts to NHS111, GPOOH and GPIH in children <1 year. There were 1.75 and 2.70 times the rate of respiratory contacts in the most deprived areas compared with the least deprived to NHS111 and GPOOH. Elevated respiratory contacts were observed for males <5 years compared with females <5 years. Healthcare-seeking behaviours between respiratory and non-respiratory contacts were similar. CONCLUSION: When contacts to services that capture more of the disease burden are explored, the demographic patterns are similar to those described in the literature for acute systems. Comparable results were observed between respiratory and non-respiratory contacts suggesting that when a wider spectrum of disease is explored, sociodemographic factors may be the strongest influencers of healthcare-seeking behaviour.
Assuntos
Atenção à Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Demografia , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Adulto JovemRESUMO
INTRODUCTION: For the London Olympic and Paralympic Games in 2012, a sentinel ED syndromic surveillance system was established to enhance public health surveillance by obtaining data from a selected network of EDs, focusing on London. In 2017, a new national standard Emergency Care Dataset was introduced, which enabled Public Health England (PHE) to initiate the expansion of their sentinel system to national coverage. Prior to this initiative, we estimated the added value, and potential additional resource use, of an expansion of the sentinel surveillance system. METHODS: The detection capabilities of the sentinel and national systems were compared using the aberration detection methods currently used by PHE. Different scenarios were used to measure the impact on health at a local, subnational and national level, including improvements to sensitivity and timeliness, along with changes in specificity. RESULTS: The biggest added value was found to be for detecting local impacts, with an increase in sensitivity of over 80%. There were also improvements found at a national level with outbreaks being detected earlier and smaller impacts being detectable. However, the increased number of local sites will also increase the number of false alarms likely to be generated. CONCLUSION: We have quantified the added value of national ED syndromic surveillance systems, showing how they will enable detection of more localised events. Furthermore, national systems add value in enabling timelier public health interventions. Finally, we have highlighted areas where extra resource may be required to manage improvements in detection coverage.
Assuntos
Conjuntos de Dados como Assunto/normas , Serviços Médicos de Emergência/normas , Saúde Pública/instrumentação , Conjuntos de Dados como Assunto/tendências , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/tendências , Inglaterra , Humanos , Vigilância da População/métodos , Saúde Pública/métodos , Saúde Pública/normasRESUMO
OBJECTIVES: Gastrointestinal (GI) infections are common and most people do not see a physician. There is conflicting evidence of the impact of socioeconomic status (SES) on risk of GI infections. We assessed the relationship between SES and GI calls to two National Health Service (NHS) telephone advice services in England. METHODS: Over 24 million calls to NHS Direct (2010-13) and NHS 111 (2013-15) were extracted from Public Health England (PHE) syndromic surveillance systems. The relationship between SES and GI calls was assessed using generalised linear models (GLM). RESULTS: Adjusting for rurality and age-sex interactions, in NHS Direct, children in disadvantaged areas were at lower risk of GI calls; in NHS 111 there was a higher risk of GI calls in disadvantaged areas for all ages (0-4 years RR 1.27, 95% CI 1.25-1.29; 5-9 years RR 1.43, 95% CI 1.36-1.51; 10-14 years RR 1.36, 95% CI 1.26-1.41; 15-19 years RR 1.59, 95% CI 1.52-1.67; 20-59 years RR 1.50, 95% CI 1.47-1.53, 60 years and over RR 1.12, 95% CI 1.09-1.14). CONCLUSIONS: Disadvantaged areas had higher risk of GI calls in NHS 111. This may relate to differences in exposure or vulnerability to GI infections, or propensity to call about GI infections.
Assuntos
Diarreia/epidemiologia , Saúde Pública/estatística & dados numéricos , Fatores Socioeconômicos , Medicina Estatal/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Vômito/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Inglaterra/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
One of the implications of climate change is a predicted increase in frequent and severe heatwaves. The impact of heatwaves on the health of the population is captured through real-time syndromic healthcare surveillance systems monitored daily in England during the summer months. Internet search data could potentially provide improved timeliness and help to assess the wider population health impact of heat by capturing a population sub-group who are symptomatic but do not seek healthcare. A retrospective observational study was carried out from June 2013 to September 2017 in England to compare daily trends in validated syndromic surveillance heat-related morbidity indicators against symptom-based heatwave related Google search terms. The degree of correlation was determined with Spearman correlation coefficients and lag assessment was carried out to determine timeliness. Daily increases in frequency in Google search terms during heatwave events correlated well with validated syndromic indicators. Correlation coefficients between search term frequency and syndromic indicators from 2013 to 2017 were highest with the telehealth service NHS 111 (range of 0.684-0.900 by search term). Lag analysis revealed a similar timeliness between the data sources, suggesting Google data did not provide a delayed or earlier signal in the context of England's syndromic surveillance systems. This work highlights the potential benefits for countries which lack established public health surveillance systems to monitor heat-related morbidity and the use of internet search data to assess the wider population health impact of exposure to heat.
Assuntos
Temperatura Alta , Ferramenta de Busca , Vigilância de Evento Sentinela , Inglaterra , Humanos , Morbidade , Estudos RetrospectivosRESUMO
Background: Syndromic surveillance aims to provide early warning and real time estimates of the extent of incidents; and reassurance about lack of impact of mass gatherings. We describe a novel public health risk assessment process to ensure those leading the response to the 2012 Olympic Games were alerted to unusual activity that was of potential public health importance, and not inundated with multiple statistical 'alarms'. Methods: Statistical alarms were assessed to identify those which needed to result in 'alerts' as reliably as possible. There was no previously developed method for this. We identified factors that increased our concern about an alarm suggesting that an 'alert' should be made. Results: Between 2 July and 12 September 2012, 350 674 signals were analysed resulting in 4118 statistical alarms. Using the risk assessment process, 122 'alerts' were communicated to Olympic incident directors. Conclusions: Use of a novel risk assessment process enabled the interpretation of large number of statistical alarms in a manageable way for the period of a sustained mass gathering. This risk assessment process guided the prioritization and could be readily adapted to other surveillance systems. The process, which is novel to our knowledge, continues as a legacy of the Games.
Assuntos
Vigilância de Evento Sentinela , Esportes , Aglomeração , Humanos , Prática de Saúde Pública , Medição de RiscoRESUMO
BACKGROUND: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) comprises over 100 general practices in England, with a population of around 1 million, providing a public health surveillance system for England and data for research. AIM: To demonstrate the scope of data with the RCGP Annual Report 2014-2015 (May 2014 to April 2015) by describing disparities in the presentation of six common conditions included in the report. DESIGN AND SETTING: This is a report of respiratory and communicable disease incidence from a primary care sentinel network in England. METHOD: Incidence rates and demographic profiles are described for common cold, acute otitis media, pneumonia, influenza-like illness, herpes zoster, and scarlet fever. The impact of age, sex, ethnicity, and deprivation on the diagnosis of each condition is explored using a multivariate logistic regression. RESULTS: With the exception of herpes zoster, all conditions followed a seasonal pattern. Apart from pneumonia and scarlet fever, the odds of presenting with any of the selected conditions were greater for females (P<0.001). Older people had a greater probability of a pneumonia diagnosis (≥75 years, odds ratio [OR] 6.37; P<0.001). Common cold and influenza-like illness were more likely in people from ethnic minorities than white people, while the converse was true for acute otitis media and herpes zoster. There were higher odds of acute otitis media and herpes zoster diagnosis among the less deprived (least deprived quintile, OR 1.32 and 1.48, respectively; P<0.001). CONCLUSION: The RCGP RSC database provides insight into the content and range of GP workload and provides insight into current public health concerns. Further research is needed to explore these disparities in presentation to primary care.
Assuntos
Resfriado Comum/epidemiologia , Herpes Zoster/epidemiologia , Influenza Humana/epidemiologia , Otite Média/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia/epidemiologia , Atenção Primária à Saúde , Escarlatina/epidemiologia , Adolescente , Adulto , Idoso , Povo Asiático/estatística & dados numéricos , População Negra/estatística & dados numéricos , Criança , Pré-Escolar , Inglaterra/epidemiologia , Monitoramento Epidemiológico , Etnicidade/estatística & dados numéricos , Feminino , Medicina Geral , Disparidades em Assistência à Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estações do Ano , Fatores Sexuais , Sociedades Médicas , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Introduction of infant oral rotavirus vaccination in the UK in July 2013 has resulted in decreased hospitalisations and Emergency Department (ED) visits for acute gastroenteritis (AGE), for both adults and children. We investigated reductions in AGE incidence seen in primary care in the two years after vaccine introduction, and estimated the healthcare costs averted across healthcare settings in the first year of the vaccination programme. METHODS: We used primary care data from the Clinical Practice Research Datalink and age-stratified time-series analyses to derive adjusted incidence rate ratios (IRRa) for AGE in the first two years of the post-vaccination era (July 2013-April 2015) compared to the pre-vaccination era (July 2008-June 2013). We estimated cases averted among children aged <5years in the first year of the vaccination programme by comparing observed numbers of AGE cases in 2013-2014 to numbers predicted from the time-series models. We then estimated the healthcare costs averted for general practice consultations, ED visits and hospitalisations. RESULTS: In general practice, AGE rates in infants (the target group for vaccination) decreased by 15% overall after vaccine introduction (IRRa=0.85; 95%CI=0.76-0.95), and by 41% in the months of historically high rotavirus circulation (IRRa=0.59; 95%CI=0.53-0.66). Rates also decreased in other young children and to a lesser degree in older individuals, indicating herd immunity. Across all three settings (general practice, EDs, and hospitalisations) an estimated 87,376 (95% prediction interval: 62,588-113,561) AGE visits by children aged <5years were averted in 2013-14, associated with an estimated £12.5million (9,209-16,198) reduction in healthcare costs. CONCLUSIONS: The marked decreases in the general practice AGE burden after rotavirus vaccine introduction mirror decreases seen in other UK healthcare settings. Overall, these decreases are associated with substantial averted healthcare costs.
Assuntos
Gastroenterite/economia , Gastroenterite/prevenção & controle , Infecções por Rotavirus/economia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Vacinas contra Rotavirus/economia , Vacinação/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviços Médicos de Emergência/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Gastroenterite/epidemiologia , Custos de Cuidados de Saúde , Hospitalização , Humanos , Programas de Imunização , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Infecções por Rotavirus/epidemiologia , Adulto JovemRESUMO
There is an increasing body of evidence illustrating the negative health effects of air pollution including increased risk of respiratory, cardiac and other morbid conditions. During March and April 2014 there were two air pollution episodes in England that occurred in close succession. We used national real-time syndromic surveillance systems, including general practitioner (GP) consultations, emergency department attendances, telehealth calls and ambulance dispatch calls to further understand the impact of these short term acute air pollution periods on the health seeking behaviour of the general public. Each air pollution period was comparable with respect to particulate matter concentrations (PM10 and PM2.5), however, the second period was longer in duration (6 days vs 3 days) and meteorologically driven 'Sahara dust' contributed to the pollution. Health surveillance data revealed a greater impact during the second period, with GP consultations, emergency department attendances and telehealth (NHS 111) calls increasing for asthma, wheeze and difficulty breathing indicators, particularly in patients aged 15-64 years. Across regions of England there was good agreement between air quality levels and health care seeking behaviour. The results further demonstrate the acute impact of short term air pollution episodes on public health and also illustrate the potential role of mass media reporting in escalating health care seeking behaviour.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Respiratórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/induzido quimicamente , Criança , Pré-Escolar , Inglaterra/epidemiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Vigilância da População , Saúde Pública , Doenças Respiratórias/induzido quimicamente , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: The burden of heat illness on health systems is not well described in the UK. Although the UK generally experiences mild summers, the frequency and intensity of hot weather is likely to increase due to climate change, particularly in Southern England. We investigated the impact of the moderate heatwave in 2013 on primary care and emergency department (ED) visits using syndromic surveillance data in England. METHODS: General practitioner in hours (GPIH), GP out of hours (GPOOH) and ED syndromic surveillance systems were used to monitor the health impact of heat/sun stroke symptoms (heat illness). Data were stratified by age group and compared between heatwave and non-heatwave years. Incidence rate ratios were calculated for GPIH heat illness consultations. RESULTS: GP consultations and ED attendances for heat illness increased during the heatwave period; GPIH consultations increased across all age groups, but the highest rates were in school children and those aged ≥75â years, with the latter persisting beyond the end of the heatwave. Extrapolating to the English population, we estimated that the number of GPIH consultations for heat illness during the whole summer (May to September) 2013 was 1166 (95% CI 1064 to 1268). This was double the rate observed during non-heatwave years. CONCLUSIONS: These findings support the monitoring of heat illness (symptoms of heat/sun stroke) as part of the Heatwave Plan for England, but also suggest that specifically monitoring heat illness in children, especially those of school age, would provide additional early warning of, and situation awareness during heatwaves.
Assuntos
Efeitos Psicossociais da Doença , Exaustão por Calor , Temperatura Alta/efeitos adversos , Vigilância da População/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Inglaterra/epidemiologia , Feminino , Hospitalização , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Annual vaccination of all children 6-59 months of age is recommended in the United States but not in most of Europe. This paper reviews issues surrounding the epidemiology of influenza and vaccine effectiveness relevant to the determination of vaccination policy. Most clinical trials of vaccines (and treatments) that provide the evidence for current policy took place in the 1990s when rates of influenza-like illness (ILI) were twice those reported in recent years. The impact of influenza in the community is concealed by the variety of diagnoses appropriate to describing acute respiratory infections. Even in influenza virus active periods diagnoses of coryza, acute bronchitis, and otitis media made by general practitioners greatly exceed those of ILI. Respiratory syncytial virus presents particular problems because it often circulates at the same time as influenza. Thus, the diagnostic uncertainty and variety of respiratory pathogens causing similar illnesses are major confounders when estimating influenza vaccine effectiveness. Although meta-analyses have cast doubt on the wisdom of the universal vaccination of children, high-quality clinical trials have demonstrated efficacy against laboratory-confirmed infection. The distinction between this positive benefit and the wider issue of effectiveness against ILI in the community poses difficulties for determining policy. Mathematical models examining this issue are populated with data that are mostly estimated: therefore, the sensitivity analysis is critical and the conclusions are invariably accompanied by reservations. National policies based on demonstrated cost effectiveness are desirable, but these should not become a barrier to parents wishing to secure a benefit for their child or family, provided there is clear evidence of clinical efficacy.
Assuntos
Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Vacinação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-IdadeRESUMO
There are many small differences in national influenza vaccination polices, some are age related and others morbidity related. This study examines a large English general practice database for 2003 to estimate the size of the England and Wales population at risk because of co-morbidity and to make recommendations on the choice of morbidity codes for use when estimating demand for vaccine and in auditing medical records to assess vaccination uptake. Morbidity codes relevant to the assessment of risk were defined and the database was analysed to estimate the annual period prevalence of the various diseases and groups of diseases. A set of morbidity codes is recommended which taken together include 3.2% of age group 0-14 years, 7.5% of 15-44 years and 16.6% of 45-64 years.
Assuntos
Política de Saúde , Vacinas contra Influenza/administração & dosagem , Adolescente , Adulto , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Despite intensive research, influenza viruses still present one of the major causes of respiratory disease throughout the world. The elderly population and those individuals considered "at risk" due to presenting co-morbidity are especially vulnerable to influenza infection; this is evident from increased rates of morbidity and mortality in these populations during winter epidemic periods. Successful vaccination campaigns have targeted these groups over the last few years, providing protection to an increasing number of susceptible individuals. However, during periods of influenza virus activity there are still seasonal pressures put on both primary and secondary health care services. In the event of a serious influenza epidemic or pandemic, these burdens could jeopardise health care provision to at risk populations. In this report we discuss current issues surrounding the impact of influenza on the health care utilisation of elderly people.