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2.
Dis Aquat Organ ; 143: 119-127, 2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-33570045

RESUMEN

Sea lice are amongst the most ecologically and economically damaging parasites of farmed salmonids globally. Spill-over from aquaculture can increase parasite pressure on wild fish populations, but quantifying this effect is challenging due to the relative paucity of data available on 'natural' salmonid louse burdens in the absence of aquaculture, particularly for Atlantic salmon Salmo salar. Here, wild Atlantic salmon and sea trout S. trutta were screened at the tidal limit of the River Tamar (UK) for the presence of sea lice. During 2013 and 2015, the prevalence of sea lice ranged from 41 (n = 361) to 60% (n = 275) and 55 (n = 882) to 58% (n = 800) in Atlantic salmon and sea trout, respectively. All sea lice collected were identified as Lepeophtheirus salmonis. Mean L. salmonis infection intensity across the study period was 5.84 (range: 1-66) in Atlantic salmon and 6.45 (range: 1-37) in sea trout. Infection intensity was positively correlated with the amount of external damage present for both fish species. Given that the fish were examined when returning to freshwater, the lice burdens obtained may represent an underestimate. Nevertheless, these data provide important baseline information on 'natural' sea louse infections in South West England, which has been proposed as a potential region for aquaculture development.


Asunto(s)
Copépodos , Enfermedades de los Peces , Salmo salar , Animales , Inglaterra , Enfermedades de los Peces/epidemiología , Ríos , Trucha , Reino Unido
3.
Nat Commun ; 12(1): 905, 2021 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-33568663

RESUMEN

England has experienced a large outbreak of SARS-CoV-2, disproportionately affecting people from disadvantaged and ethnic minority communities. It is unclear how much of this excess is due to differences in exposure associated with structural inequalities. Here, we report from the REal-time Assessment of Community Transmission-2 (REACT-2) national study of over 100,000 people. After adjusting for test characteristics and re-weighting to the population, overall antibody prevalence is 6.0% (95% CI: 5.8-6.1). An estimated 3.4 million people had developed antibodies to SARS-CoV-2 by mid-July 2020. Prevalence is two- to three-fold higher among health and care workers compared with non-essential workers, and in people of Black or South Asian than white ethnicity, while age- and sex-specific infection fatality ratios are similar across ethnicities. Our results indicate that higher hospitalisation and mortality from COVID-19 in minority ethnic groups may reflect higher rates of infection rather than differential experience of disease or care.


Asunto(s)
Anticuerpos Antivirales/sangre , /inmunología , Adolescente , Adulto , Anciano , Inglaterra/epidemiología , Grupos Étnicos/estadística & datos numéricos , Femenino , Personal de Salud/estadística & datos numéricos , Hospitalización , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Grupos Minoritarios/estadística & datos numéricos , Mortalidad , Prevalencia , Riesgo , Adulto Joven
4.
Environ Pollut ; 274: 116563, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33561599

RESUMEN

Daytime atmospheric oxidation chemistry is conventionally considered to be driven primarily by the OH radical, formed via photolytic sources. In this paper we examine how, during winter when photolytic processes are slow, chlorine chemistry can have a significant impact on oxidative processes in the urban boundary layer. Photolysis of nitryl chloride (ClNO2) provides a significant source of chlorine atoms, which enhances the oxidation of volatile organic compounds (VOCs) and the production of atmospheric pollutants. We present a set of observations of ClNO2 and HONO made at urban locations in central England in December 2014 and February 2016. While direct emissions and in-situ chemical formation of HONO continue throughout the day, ClNO2 is only formed at night and is usually completely photolyzed by midday. Our data show that, during winter, ClNO2 often persists through the daylight hours at mixing ratios above 10-20 ppt (on average). In addition, relatively high mixing ratios of daytime HONO (>65 ppt) provide a strong source of OH radicals throughout the day. The combined effects of ClNO2 and HONO result in sustained sources of Cl and OH radicals from sunrise to sunset, which form additional ozone, PAN, oxygenated VOCs, and secondary organic aerosol. We show that radical sources such as ClNO2 and HONO can lead to a surprisingly photoactive urban atmosphere during winter and should therefore be included in atmospheric chemical models.


Asunto(s)
Contaminantes Atmosféricos , Ozono , Compuestos Orgánicos Volátiles , Contaminantes Atmosféricos/análisis , Atmósfera , Inglaterra
5.
Artículo en Inglés | MEDLINE | ID: mdl-33578949

RESUMEN

Introduction: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is delivering an exercise programme for people with dementia. The Lincolnshire partnership National Health Service (NHS) foundation Trust successfully delivered PrAISED through a video-calling platform during the Coronavirus Disease 2019 (COVID-19) pandemic. METHODS: This qualitative case-study aimed to identify participants that video delivery worked for, to highlight its benefits and its challenges. Interviews were conducted between May and August 2020 with five participants with dementia and their caregivers (n = 10), as well as five therapists from the Lincolnshire partnership NHS foundation Trust. The interviews were analysed through thematic analysis. RESULTS: Video delivery worked best when participants had a supporting caregiver and when therapists showed enthusiasm and had an established rapport with the client. Benefits included time efficiency of sessions, enhancing participants' motivation, caregivers' dementia awareness, and therapists' creativity. Limitations included users' poor IT skills and resources. DISCUSSION: The COVID-19 pandemic required innovative ways of delivering rehabilitation. This study supports that people with dementia can use tele-rehabilitation, but success is reliant on having a caregiver and an enthusiastic and known therapist.


Asunto(s)
Demencia/rehabilitación , Telerrehabilitación , Cuidadores , Inglaterra/epidemiología , Humanos , Pandemias , Medicina Estatal
6.
Rev Infirm ; 70(268): 49-50, 2021 Feb.
Artículo en Francés | MEDLINE | ID: mdl-33608100

RESUMEN

Catherine is an advanced nurse practitioner working in a large general practice in the north of England. She works alongside her medical colleagues and receives and treats patients with undifferentiated complaints. Marcelina is bringing 6-year-old Nathaniel to see her.


Asunto(s)
Maltrato a los Niños , Enfermeras Practicantes , Niño , Inglaterra , Femenino , Medicina General , Humanos , Masculino , Enfermeras Practicantes/psicología , Atención Primaria de Salud
7.
BMC Med ; 19(1): 52, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33602244

RESUMEN

BACKGROUND: England's COVID-19 response transitioned from a national lockdown to localised interventions. In response to rising cases, these were supplemented by national restrictions on contacts (the Rule of Six), then 10 pm closing for bars and restaurants, and encouragement to work from home. These were quickly followed by a 3-tier system applying different restrictions in different localities. As cases continued to rise, a second national lockdown was declared. We used a national survey to quantify the impact of these restrictions on epidemiologically relevant contacts. METHODS: We compared paired measures on setting-specific contacts before and after each restriction started and tested for differences using paired permutation tests on the mean change in contacts and the proportion of individuals decreasing their contacts. RESULTS: Following the imposition of each measure, individuals tended to report fewer contacts than they had before. However, the magnitude of the changes was relatively small and variable. For instance, although early closure of bars and restaurants appeared to have no measurable effect on contacts, the work from home directive reduced mean daily work contacts by 0.99 (95% confidence interval CI] 0.03-1.94), and the Rule of Six reduced non-work and school contacts by a mean of 0.25 (0.01-0.5) per day. Whilst Tier 3 appeared to also reduce non-work and school contacts, the evidence for an effect of the lesser restrictions (Tiers 1 and 2) was much weaker. There may also have been some evidence of saturation of effects, with those who were in Tier 1 (least restrictive) reducing their contacts markedly when they entered lockdown, which was not reflected in similar changes in those who were already under tighter restrictions (Tiers 2 and 3). CONCLUSIONS: The imposition of various local and national measures in England during the summer and autumn of 2020 has gradually reduced contacts. However, these changes are smaller than the initial lockdown in March. This may partly be because many individuals were already starting from a lower number of contacts.


Asunto(s)
/epidemiología , Cuarentena/tendencias , Adolescente , Adulto , Anciano , Niño , Preescolar , Inglaterra/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Instituciones Académicas/tendencias , Lugar de Trabajo , Adulto Joven
8.
Br J Nurs ; 30(2): 133, 2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33529112

RESUMEN

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the stressful situation of the frontline response to COVID-19, and reflects on a gap between ideal ratios and reality.


Asunto(s)
/enfermería , Personal de Enfermería en Hospital/psicología , Estrés Laboral/epidemiología , /epidemiología , Inglaterra/epidemiología , Hospitales Universitarios , Humanos
9.
BMC Geriatr ; 21(1): 102, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33546612

RESUMEN

BACKGROUND: From late February 2020, English care homes rapidly adapted their practices in response to the COVID-19 pandemic. In addition to accommodating new guidelines and policies, staff had to adjust to rapid reconfiguration of services external to the home that they would normally depend upon for support. This study examined the complex interdependencies of support as staff responded to COVID-19. The aim was to inform more effective responses to the ongoing pandemic, and to improve understanding of how to work with care home staff and organisations after the pandemic has passed. METHODS: Ten managers of registered care homes in the East Midlands of England were interviewed by videoconference or phone about their experiences of the crisis from a structured organisational perspective. Analysis used an adapted organisational framework analysis approach with a focus on social ties and interdependencies between organisations and individuals. RESULTS: Three key groups of interdependencies were identified: care processes and practice; resources; and governance. Care home staff had to deliver care in innovative ways, making high stakes decisions in circumstances defined by: fluid ties to organisations outside the care home; multiple, sometimes conflicting, sources of expertise and information; and a sense of deprioritisation by authorities. Organisational responses to the pandemic by central government resulted in resource constraints and additional work, and sometimes impaired the ability of staff and managers to make decisions. Local communities, including businesses, third-sector organisations and individuals, were key in helping care homes overcome challenges. Care homes, rather than competing, were found to work together to provide mutual support. Resilience in the system was a consequence of dedicated and resourceful staff using existing local networks, or forging new ones, to overcome barriers to care. CONCLUSIONS: This study identified how interdependency between care home organisations, the surrounding community, and key statutory and non-statutory organisations beyond their locality, shaped decision making and care delivery during the pandemic. Recognising these interdependencies, and the expertise shown by care home managers and staff as they navigate them, is key to providing effective healthcare in care homes as the pandemic progresses, and as the sector recovers afterwards.


Asunto(s)
Pandemias , Inglaterra/epidemiología , Humanos , Investigación Cualitativa
11.
J Affect Disord ; 282: 991-995, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33601744

RESUMEN

BACKGROUND: The COVID-19 pandemic and public health measures necessary to address it may have major effects on mental health, including on self-harm. We have used well-established monitoring systems in two hospitals in England to investigate trends in self-harm presentations to hospitals during the early period of the pandemic. METHOD: Data collected in Oxford and Derby on patients aged 18 years and over who received a psychosocial assessment after presenting to the emergency departments following self-harm were used to compare trends during the three-month period following lockdown in the UK (23rd March 2020) to the period preceding lockdown and the equivalent period in 2019. RESULTS: During the 12 weeks following introduction of lockdown restrictions there was a large reduction in the number of self-harm presentations to hospitals by individuals aged 18 years and over compared to the pre-lockdown weeks in 2020 (mean weekly reduction of 13.5 (95% CI 5.6 - 21.4) and the equivalent period in 2019 (mean weekly reduction of 18.0 (95% CI 13.9 - 22.1). The reduction was greater in females than males, occurred in all age groups, with a larger reduction in presentations following self-poisoning than self-injury. CONCLUSIONS: A substantial decline in hospital presentations for self-harm occurred during the three months following the introduction of lockdown restrictions. Reasons could include a reduction in self-harm at the community level and individuals avoiding presenting to hospital following self-harm. Longer-term monitoring of self-harm behaviour during the pandemic is essential, together with efforts to encourage help-seeking and the modification of care provision.


Asunto(s)
Conducta Autodestructiva , Adolescente , Adulto , Control de Enfermedades Transmisibles , Servicio de Urgencia en Hospital , Inglaterra/epidemiología , Femenino , Hospitales , Humanos , Masculino , Pandemias , Conducta Autodestructiva/epidemiología
15.
Int J Law Psychiatry ; 74: 101649, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33418151

RESUMEN

This article investigates the lawfulness of isolating residents of care and group homes during the COVID-19 pandemic. Many residents are mobile, and their freedom to move is a central ethical tenet and human right. It is not however an absolute right and trade-offs between autonomy, liberty and health need to be made since COVID-19 is highly infectious and poses serious risks of critical illness and death. People living in care and group homes may be particularly vulnerable because recommended hygiene practices are difficult for them and many residents are elderly, and/or have co-morbidities. In some circumstances, the trade-offs can be made easily with the agreement of the resident and for short periods of time. However challenging cases arise, in particular for residents and occupants with dementia who 'wander', meaning they have a strong need to walk, sometimes due to agitation, as may also be the case for some people with developmental disability (e.g. autism), or as a consequence of mental illness. This article addresses three central questions: (1) in what circumstances is it lawful to isolate residents of social care homes to prevent transmission of COVID-19, in particular where the resident has a strong compulsion to walk and will not, or cannot, remain still and isolated? (2) what types of strategies are lawful to curtail walking and achieve isolation and social distancing? (3) is law reform required to ensure any action to restrict freedoms is lawful and not excessive? These questions emerged during the first wave of the COVID-19 pandemic and are still relevant. Although focussed on COVID-19, the results are also relevant to other future outbreaks of infectious diseases in care and group homes. Likewise, while we concentrate on the law in England and Wales, the analysis and implications have international significance.


Asunto(s)
/epidemiología , Hogares para Grupos/ética , Hogares para Grupos/legislación & jurisprudencia , Casas de Salud/ética , Casas de Salud/legislación & jurisprudencia , Aislamiento de Pacientes/ética , Aislamiento de Pacientes/legislación & jurisprudencia , Inglaterra/epidemiología , Ética Médica , Humanos , Pandemias , Gales/epidemiología
16.
Environ Int ; 146: 106316, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33395952

RESUMEN

Recent studies suggested a link between long-term exposure to air-pollution and COVID-19 mortality. However, due to their ecological design based on large spatial units, they neglect the strong localised air-pollution patterns, and potentially lead to inadequate confounding adjustment. We investigated the effect of long-term exposure to NO2 and PM2.5 on COVID-19 mortality in England using high geographical resolution. In this nationwide cross-sectional study in England, we included 38,573 COVID-19 deaths up to June 30, 2020 at the Lower Layer Super Output Area level (n = 32,844 small areas). We retrieved averaged NO2 and PM2.5 concentration during 2014-2018 from the Pollution Climate Mapping. We used Bayesian hierarchical models to quantify the effect of air-pollution while adjusting for a series of confounding and spatial autocorrelation. We find a 0.5% (95% credible interval: -0.2%, 1.2%) and 1.4% (95% CrI: -2.1%, 5.1%) increase in COVID-19 mortality risk for every 1 µg/m3 increase in NO2 and PM2.5 respectively, after adjusting for confounding and spatial autocorrelation. This corresponds to a posterior probability of a positive effect equal to 0.93 and 0.78 respectively. The spatial relative risk at LSOA level revealed strong patterns, similar for the different pollutants. This potentially captures the spread of the disease during the first wave of the epidemic. Our study provides some evidence of an effect of long-term NO2 exposure on COVID-19 mortality, while the effect of PM2.5 remains more uncertain.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Contaminantes Atmosféricos/análisis , Contaminantes Atmosféricos/toxicidad , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Teorema de Bayes , Estudios Transversales , Inglaterra/epidemiología , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/análisis , Humanos , Dióxido de Nitrógeno/análisis , Dióxido de Nitrógeno/toxicidad , Material Particulado/análisis , Material Particulado/toxicidad , Análisis Espacial
18.
Community Dent Health ; 38(1): 5-9, 2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33507652

RESUMEN

Dental public health in action: foundation dentists' delivery of an oral health promotion outreach project for people experiencing homelessness in London.Within a decade, the UK has seen a dramatic increase in homelessness. This is defined as being without an available home that could reasonably be occupied. The increase has been driven by increasing poverty, welfare reform, cuts to public services and lack of affordable housing (Bramley et al., 2015; Fitzpatrick et al., 2013; Fitzpatrick et al., 2018). Rough sleeping in England alone has increased by 2,909 people or 165% since 2010 (Ministry of Housing, Communities and Local Government, 2018). This increase has been particularly visible in London (National Audit Office, 2018), where approximately a quarter of the country's rough sleepers reside (Ministry of Housing, Communities and Local Government, 2018).


Asunto(s)
Promoción de la Salud , Personas sin Hogar , Odontólogos , Inglaterra , Humanos , Londres , Salud Bucal , Salud Pública
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