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1.
J Law Med ; 27(1): 50-54, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682341

RESUMO

In R (on the application of British Homeopathic Association) v National Health Service Commissioning Board [2018] EWHC 1359 (Admin) Supperstone J of the High Court of England and Wales delivered an internationally significant judgment on the processes required to be engaged in when guidance is given to medical practitioners about their involvement in homeopathic prescribing. This column explores the bases upon which the challenge by the British Homeopathic Association was lost and the repercussions of the judgment for the practice of non-evidence-based modalities, such as homeopathy.


Assuntos
Homeopatia , Legislação Médica , Inglaterra , Programas Nacionais de Saúde , País de Gales
2.
J Law Med ; 27(1): 164-177, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682348

RESUMO

A doctor may make a unilateral decision to withdraw or withhold life-sustaining treatment from a patient. Recent cases involving critically ill children in Australia, England and Wales have demonstrated how doctors may determine a child's life is not worth maintaining despite parental demands for treatment. The breadth of a doctor's discretion to not provide treatment is ambiguous though, and the extent to which a doctor may make unilateral quality of life judgments is not clear. The ambiguity arises because of different framing of a doctor's obligations, a lack of clear role delineation between relevant decision-makers and differences in opinion about the appropriate scope of inquiry when applying concepts like "futility" and "best interests". This ambiguity is likely to cause confusion in practice and may be the difference between a child receiving life-sustaining treatment.


Assuntos
Qualidade de Vida , Suspensão de Tratamento , Austrália , Criança , Tomada de Decisões , Inglaterra , Humanos , País de Gales
3.
J Law Med ; 27(1): 192-210, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682350

RESUMO

Courts in England and Wales, Australia, and New Zealand have insisted the question of when it is acceptable to withdraw or withhold life-sustaining medical treatment from a child must be considered on a case-by-case basis. Over the last 40 years a number of cases have considered whether treatment is objectively in the child's best interests. This article seeks to identify whether there are factors identified and weighed in a consistent manner across cases. Thirty cases involving decisions about the provision of life-sustaining medical treatment to children three years old or younger were identified. Judges regularly refer to the need to weigh benefits and burdens and these factors were identified and assigned scores. Eight key factors were identified, and a scoring range was assigned to each. The factors focus on the condition and position of the child and the burdens of invasive medical treatment. The review demonstrates there are factors consistently identified and despite criticisms of the indeterminacy of the best interests test, there may be a broadly consistent approach to decision-making. Cognitive capacity and unavoidably imminent death appear to be the two most influential factors in determining whether life-sustaining treatment should be provided.


Assuntos
Tomada de Decisões , Suspensão de Tratamento , Austrália , Criança , Pré-Escolar , Inglaterra , Humanos , Nova Zelândia , País de Gales
4.
Bone Joint J ; 101-B(10): 1292-1299, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564146

RESUMO

AIMS: This study explores data quality in operation type and fracture classification recorded as part of a large research study and a national audit with an independent review. PATIENTS AND METHODS: At 17 centres, an expert surgeon reviewed a randomly selected subset of cases from their centre with regard to fracture classification using the AO system and type of operation performed. Agreement for these variables was then compared with the data collected during conduct of the World Hip Trauma Evaluation (WHiTE) cohort study. Both types of surgery and fracture classification were collapsed to identify the level of detail of reporting that achieved meaningful agreement. In the National Hip Fracture Database (NHFD), the types of operation and fracture classification were explored to identify the proportion of "highly improbable" combinations. RESULTS: The records were reviewed for 903 cases. Agreement for the subtypes of extracapsular fracture was poor; most centres achieved no better than "fair" agreement. When the classification was collapsed to a single option for "extracapsular" fracture, only four centres failed to have at least "moderate" agreement. There was only "moderate" agreement for the subtypes of intracapsular fracture, which improved to "substantial" when collapsed to "intracapsular". Subtrochanteric fracture types were well reported with "substantial" agreement. There was near "perfect" agreement for internal fixation procedures. "Perfect" or "substantial" agreement was achieved when the type of arthroplasty surgery was reported at the level of "hemiarthroplasty" and "total hip replacement". When reviewing data submitted to the NHFD, a minimum of 5.2% of cases contained "highly improbable" procedures for the stated fracture classification. CONCLUSION: The complexity of collecting fracture classification data at a national scale compromises the accuracy with which detailed classification systems can be reported. Data around type of surgery performed show similar tendencies. Data capture, reporting, and interpretation in future studies must take this into account. Cite this article: Bone Joint J 2019;101-B:1292-1299.


Assuntos
Artroplastia de Quadril/métodos , Fixação Interna de Fraturas/métodos , Hemiartroplastia/métodos , Fraturas do Quadril/classificação , Fraturas do Quadril/cirurgia , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Estudos de Coortes , Confiabilidade dos Dados , Inglaterra , Feminino , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura/fisiologia , Hemiartroplastia/efeitos adversos , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Amplitude de Movimento Articular/fisiologia , Reoperação/métodos , Resultado do Tratamento , País de Gales
5.
Bone Joint J ; 101-B(10): 1199-1208, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564148

RESUMO

AIMS: We compared implant and patient survival following intraoperative periprosthetic femoral fractures (IOPFFs) during primary total hip arthroplasty (THA) with matched controls. PATIENTS AND METHODS: This retrospective cohort study compared 4831 hips with IOPFF and 48 154 propensity score matched primary THAs without IOPFF implanted between 2004 and 2016, which had been recorded on a national joint registry. Implant and patient survival rates were compared between groups using Cox regression. RESULTS: Ten-year stem survival was worse in the IOPFF group (p < 0.001). Risk of revision for aseptic loosening increased 7.2-fold following shaft fracture and almost 2.8-fold after trochanteric fracture (p < 0.001). Risk of periprosthetic fracture of the femur revision increased 4.3-fold following calcar-crack and 3.6-fold after trochanteric fracture (p < 0.01). Risk of instability revision was 3.6-fold after trochanteric fracture and 2.4-fold after calcar crack (p < 0.001). Risk of 90-day mortality following IOPFF without revision was 1.7-fold and 4.0-fold after IOPFF with early revision surgery versus uncomplicated THA (p < 0.001). CONCLUSION: IOPFF increases risk of stem revision and mortality up to ten years following surgery. The risk of revision depends on IOPFF subtype and mortality risk increases with subsequent revision surgery. Surgeons should carefully diagnose and treat IOPFF to minimize fracture progression and implant failure. Cite this article: Bone Joint J 2019;101-B:1199-1208.


Assuntos
Artroplastia de Quadril/efeitos adversos , Osteoartrite do Quadril/cirurgia , Fraturas Periprotéticas/cirurgia , Sistema de Registros , Reoperação/métodos , Fatores Etários , Idoso , Artroplastia de Quadril/métodos , Estudos de Casos e Controles , Inglaterra , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Irlanda do Norte , Osteoartrite do Quadril/diagnóstico por imagem , Fraturas Periprotéticas/diagnóstico por imagem , Fraturas Periprotéticas/epidemiologia , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Reino Unido , País de Gales
7.
Lancet ; 394(10204): 1181-1190, 2019 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-31472930

RESUMO

BACKGROUND: In women with late preterm pre-eclampsia, the optimal time to initiate delivery is unclear because limitation of maternal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether planned earlier initiation of delivery reduces maternal adverse outcomes without substantial worsening of neonatal or infant outcomes, compared with expectant management (usual care) in women with late preterm pre-eclampsia. METHODS: In this parallel-group, non-masked, multicentre, randomised controlled trial done in 46 maternity units across England and Wales, we compared planned delivery versus expectant management (usual care) with individual randomisation in women with late preterm pre-eclampsia from 34 to less than 37 weeks' gestation and a singleton or dichorionic diamniotic twin pregnancy. The co-primary maternal outcome was a composite of maternal morbidity or recorded systolic blood pressure of at least 160 mm Hg with a superiority hypothesis. The co-primary perinatal outcome was a composite of perinatal deaths or neonatal unit admission up to infant hospital discharge with a non-inferiority hypothesis (non-inferiority margin of 10% difference in incidence). Analyses were by intention to treat, together with a per-protocol analysis for the perinatal outcome. The trial was prospectively registered with the ISRCTN registry, ISRCTN01879376. The trial is closed to recruitment but follow-up is ongoing. FINDINGS: Between Sept 29, 2014, and Dec 10, 2018, 901 women were recruited. 450 women (448 women and 471 infants analysed) were allocated to planned delivery and 451 women (451 women and 475 infants analysed) to expectant management. The incidence of the co-primary maternal outcome was significantly lower in the planned delivery group (289 [65%] women) compared with the expectant management group (338 [75%] women; adjusted relative risk 0·86, 95% CI 0·79-0·94; p=0·0005). The incidence of the co-primary perinatal outcome by intention to treat was significantly higher in the planned delivery group (196 [42%] infants) compared with the expectant management group (159 [34%] infants; 1·26, 1·08-1·47; p=0·0034). The results from the per-protocol analysis were similar. There were nine serious adverse events in the planned delivery group and 12 in the expectant management group. INTERPRETATION: There is strong evidence to suggest that planned delivery reduces maternal morbidity and severe hypertension compared with expectant management, with more neonatal unit admissions related to prematurity but no indicators of greater neonatal morbidity. This trade-off should be discussed with women with late preterm pre-eclampsia to allow shared decision making on timing of delivery. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Cesárea , Trabalho de Parto Induzido , Pré-Eclâmpsia/terapia , Nascimento Prematuro , Adulto , Pressão Sanguínea , Parto Obstétrico/métodos , Gerenciamento Clínico , Inglaterra , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação , Morte Materna , Morbidade , Morte Perinatal , Gravidez , País de Gales , Adulto Jovem
8.
Crim Behav Ment Health ; 29(4): 247-255, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31478306

RESUMO

BACKGROUND: Mentally disordered offenders may suffer discrimination on the basis of mental disorder, or on the basis of being offenders, or both. AIMS: The aim of this paper is to outline a framework for examining discrimination affecting mentally disordered offenders. It is argued that there should be systematic comparisons between offenders with mental disorder and nonoffenders with mental disorder in order to identify and characterise specific failures to ensure equivalence of mental health care; and systematic comparisons between offenders with mental disorder and offenders without mental disorder in order to identify how mental disorder may constitute a barrier to forms of support and constructive intervention available to other offenders. METHODS: A critical review was conducted of official documents presenting criminal justice and mental health policy for England and Wales, principally since 2012, together with reports of inspectorate and oversight bodies and relevant research studies. FINDINGS: There is evidence that offenders with mental disorder may not be able to access mental health care equivalent to that for nonoffenders with mental disorder. There is also evidence that they may not be able to access interventions available to other offenders. Further disadvantage may arise in the criminal courts since, in England and Wales, if inpatient care is required, the powers of criminal courts to effect hospital admission under Part III of mental health legislation are weakened by the statutory requirement of information that places are available. This is discriminatory against offenders with mental disorder insofar as forms of court disposal for other offenders are not prevented by the capacity of criminal justice agencies. CONCLUSIONS AND IMPLICATIONS: The review supports the need for systematic comparisons to identify forms of disadvantage and discrimination experienced by mentally disordered offenders in relation to both mental health and criminal justice policies services.


Assuntos
Direito Penal , Criminosos/psicologia , Discriminação (Psicologia) , Transtornos Mentais/psicologia , Serviços de Saúde Mental/legislação & jurisprudência , Saúde Mental/legislação & jurisprudência , Direito Penal/legislação & jurisprudência , Inglaterra , Hospitalização , Humanos , Transtornos Psicóticos , País de Gales
9.
Community Dent Health ; 36(3): 177-180, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31433137

RESUMO

This article describes a project that assessed whether routinely collected antibiotic prescribing and NHS dental treatment data could be linked to produce personalised prescribing profiles for general dental practitioners working in Wales, UK. Dental public health competencies required for this work included: Multi-agency working to develop a sustainable system of monitoring antibiotic prescribing in primary dental care in Wales, Dental public health intelligence, Development of dental service quality indicators.


Assuntos
Antibacterianos , Assistência Odontológica , Padrões de Prática Odontológica , Antibacterianos/uso terapêutico , Coleta de Dados , Estudos de Viabilidade , Humanos , País de Gales
10.
Community Dent Health ; 36(3): 203-206, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31436921

RESUMO

OBJECTIVE: A review of the distribution of d3mft scores for Wales was undertaken to inform decisions on future reporting of decay experience. Visual examination of data from one survey suggested that caries in Wales is distributed along an exponential decay curve. BASIC RESEARCH DESIGN: Weighted d3mft data from 2007/8, 2011/12 and 2014/15 was utilised. The data was compared with a pragmatically chosen exponential decay model. Distribution curves for d3mft were plotted for each data set, correlation coefficients calculated and residuals plotted. RESULTS: The three surveys demonstrate similar exponential decay distributions across the range of d3mft scores. Plots of each curve against the exponential decay model demonstrated close correlation (0.9826 - 0.9871). The progressive shift of these similarly shaped curves suggest similar levels of caries reduction across the spectrum of caries experience and thus improved oral health without widening of health inequality. The close fit with this simple mathematical model suggests that caries prevalence could be used to generate a theoretical distribution and thereby and estimate of mean d3mft score. Such an approach could facilitate simplified oral health surveillance in areas where caries distributions are known from previous surveys. CONCLUSIONS: Within Wales caries does seem to be distributed in line with an exponential decay curve. As a result decay prevalence and mean d3mft are mathematically related. This finding may have potential to support simplified local oral health surveillance. The data provides evidence suggesting improvements in caries experience in Wales are not at the expense of increased inequality.


Assuntos
Cárie Dentária , Disparidades nos Níveis de Saúde , Índice CPO , Cárie Dentária/epidemiologia , Humanos , Saúde Bucal , Prevalência , País de Gales/epidemiologia
11.
Ecotoxicol Environ Saf ; 182: 109458, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31398784

RESUMO

Acid mine drainage (AMD) is a significant contributor of metal pollution leading to ecosystem damage. Bioindicator organisms such as intertidal brown macroalgae have an important role in quantifying the risks of metal bioaccumulation in coastal locations exposed to AMD contamination. Measurement of As, Cd, Cu, Fe, Pb, and Zn accumulation was performed in Fucus serratus, Fucus vesiculosus and Ascophyllum nodosum sampled from two marine locations near to an abandoned Cu mine in Anglesey, Wales, UK. Transect samples were taken from a coastal location (Amlwch) that has seen a substantial increase in AMD contamination over 15 years, in comparison to a nearby estuarine location (Dulas Estuary leading to Dulas Bay) with a historic legacy of pollution. These were compared with samples from the same sites taken 30 years earlier. Some of the Dulas macroalgae samples had Cd, Cu and Zn concentrations that were above background but in general indicated a non-polluted estuary in comparison to substantial pollution over previous decades. In contrast, Fucus samples collected from directly below an AMD outflow at Amlwch showed extremely elevated metal bioaccumulation (>250 mg Fe g-1, >6 mg Cu g-1, >2 mg Zn g-1, >190 µg As g-1) and evidence of macroalgae toxicity, indicating severe pollution at this site. However, the pollution dispersed within 200 m of the outflow source. This study has demonstrated the efficiency of three brown macroalgae species as indicators for metal bioavailability at high spatial resolution and over time.


Assuntos
Monitoramento Ambiental/métodos , Recuperação e Remediação Ambiental , Metais/análise , Mineração , Poluentes Químicos da Água/análise , Biomarcadores Ambientais , Poluição Ambiental , Metais Pesados/análise , Alga Marinha , País de Gales
12.
BMC Public Health ; 19(1): 931, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31412819

RESUMO

BACKGROUND: Lyme disease is a tick-borne disease of increasing global importance. There is scant information on Lyme disease patient demographics in England and Wales, and how they interact with the National Health Service (NHS). Our aims were to explore the demographic characteristics of Lyme disease patients within the Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW), and to describe patient pathways. METHODS: Data from 1st January 1998 to 31st December 2015 was retrieved from the two administrative hospital datasets (HES and PEDW), based on patients coded with Lyme disease. Information was collected on demographic characteristics, home address and case management. Incidence rates were calculated, and demographics compared to the national population. RESULTS: Within HES and PEDW, 2361 patients were coded with Lyme disease. There was a significant increase (p < 0.01) in incidence from 0.08 cases/100,000 in 1998, to 0.53 cases/100,000 in 2015. There was a bimodal age distribution, patients were predominantly female, white and from areas of low deprivation. New cases peaked annually in August, with higher incidence rates in southern central and western England. Within hospital admission data (n = 2066), most cases were either referred from primary care (28.8%, n = 596) or admitted via accident and emergency (A&E) (29.5%, n = 610). This population entering secondary care through A&E suggest a poor understanding of the recommended care pathways for symptoms related to Lyme disease by the general population. CONCLUSIONS: These data can be used to inform future investigations into Lyme disease burden, and patient management within the NHS. They provide demographic information for clinicians to target public health messaging or interventions.


Assuntos
Hospitalização/estatística & dados numéricos , Doença de Lyme/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Doença de Lyme/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , País de Gales/epidemiologia , Adulto Jovem
13.
BMC Infect Dis ; 19(1): 699, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31391003

RESUMO

BACKGROUND: The SELPHI study (An HIV Self-Testing Public Health Intervention) is an online randomised controlled trial (RCT) of HIV self-testing (HIVST). The aim of this study was to assess the feasibility of recruiting UK men who have sex with men (cis and trans) and trans women who have sex with men to the SELPHI pilot, and the acceptability of the HIVST intervention used among those randomised to receive a kit. METHODS: A mixed-methods approach to assessing trial feasibility and intervention acceptability was taken, using quantitative data from advertising sources and RCT surveys alongside qualitative data from a nested sub-study. RESULTS: Online recruitment and intervention delivery was feasible. The recruitment strategy led to the registration of 1370 participants of whom 76% (1035) successfully enrolled and were randomised 60/40 to baseline testing vs no baseline testing. Advertising platforms performed variably. Reported HIVST kit use increased from 83% at two weeks to 96% at three months. Acceptability was very high across all quantitative measures. Participants described the instructions as easy to use, and the testing process as simple. The support structures in SELPHI were felt to be adequate. Described emotional responses to HIVST varied. CONCLUSIONS: Recruiting to a modest sized HIVST pilot RCT is feasible, and the recruitment, intervention and HIVST kit were acceptable. Research on support needs of individuals with reactive results is warranted.


Assuntos
Infecções por HIV/diagnóstico , Homossexualidade Masculina , Marketing de Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Pessoas Transgênero , Adolescente , Adulto , Inglaterra , Estudos de Viabilidade , Infecções por HIV/psicologia , Inquéritos Epidemiológicos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Autocuidado , Minorias Sexuais e de Gênero , Pessoas Transgênero/psicologia , País de Gales
14.
Oral Health Prev Dent ; 17(4): 303-308, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31423495

RESUMO

PURPOSE: Historically, the healthcare needs of 'Looked After Children' (LAC) within the UK have been relatively neglected and there is no universally adopted designated dental care pathway (DDCP) in place to ensure their care. This paper aims to discover the contribution of the community dental service (CDS) to the dental health of LAC throughout England and Wales. MATERIALS AND METHODS: An electronic questionnaire was sent to CDS Clinical Directors in England and local health boards in Wales between November 2011 and January 2012. Ten questions were included with 5-point Likert scale responses and the option for free text comments. RESULTS: In Wales, 41 questionnaires were returned (35% response rate) of which 37 services provided care for LAC. In England, 67 questionnaires were returned (44% response rate), of which 59 services provided care for LAC. CONCLUSION: The study found that the majority of CDSs in the UK provide care for LAC, However, we cannot ascertain if the CDS is the most appropriate service to provide dental care for this group of patients. The use of DDCPs, non-attendance and other care policies varied markedly amongst respondents, which may suggest that provision of dental care for LAC within the CDS in England and Wales is inconsistent. The authors believe that the utilisation of an LAC-specific and universally accepted DDCP that has been developed could help to reduce these inconsistencies. Further surveys are planned in order to monitor the care of this vulnerable group of patients and assess the impact of these recommendations.


Assuntos
Odontologia Comunitária , Saúde Bucal , Criança , Inglaterra , Humanos , Inquéritos e Questionários , País de Gales
15.
BMJ ; 366: l4912, 2019 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-31444168

RESUMO

The studyFeatherstone K, Northcott A, Harden J, et al. Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. Health Serv Deliv Res 2019;7.This study was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 13/10/80).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000779/understanding-dementia-care-in-hospitals.


Assuntos
Demência/enfermagem , Demência/psicologia , Hospitalização , Cooperação do Paciente , Inglaterra , Humanos , Relações Profissional-Paciente , Medicina Estatal/normas , País de Gales
16.
Health Qual Life Outcomes ; 17(1): 139, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412878

RESUMO

PURPOSE: The study of mental wellbeing requires reliable, valid, and practical measurement tools. One of the most widely used measures of mental wellbeing is the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Our aim was to examine the psychometric properties of SWEMWBS (a brief seven-item version) in a 'real-world' population sample of young people. METHODS: We used data from the 2017 School Health Research Network Student Health and Wellbeing Survey, completed by 103,971 students in years 7 to 11 from 193 secondary schools in Wales. We first estimated polychoric correlation matrices for the whole sample and by school year, and undertook a principal components analysis to check for configural invariance. Subsequently, we used a multiple-groups structural equation model with successively greater constraints to test measurement invariance. To examine external construct validity, we calculated correlations between the SWEMWBS score and four covariates: life satisfaction, somatisation, school pressure and bullying victimisation. RESULTS: Parallel analysis suggested that extraction of one factor was appropriate both overall and in each year group. Inspection of standardised loadings suggested that four items had progressively stronger correlations with the factor as students are older, but change in fit indices between models suggested that loadings and thresholds, but not residual variances, were invariant by age group. SWEMWBS scores were moderately correlated with measures of life satisfaction and somatisation, and weakly to moderately correlated with school pressure and bullying victimisation. CONCLUSIONS: This study adds to the growing evidence that SWEMWBS is appropriate for measuring mental wellbeing in young people and suggests that SWEMWBS is appropriate for tracking the development of wellbeing across adolescence.


Assuntos
Escalas de Graduação Psiquiátrica/normas , Qualidade de Vida/psicologia , Estudantes/psicologia , Adolescente , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Satisfação Pessoal , Análise de Componente Principal , Psicometria , Reprodutibilidade dos Testes , País de Gales , Adulto Jovem
17.
Vet Parasitol ; 272: 79-82, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31395209

RESUMO

The astigmatid mite Psoroptes ovis (Acari: Proroptidae) causes the highly contagious and debilitating ovine disease, sheep scab. This ectoparasitic infection has a high economic and animal welfare impact on British sheep farming. Following recent work demonstrating resistance of Psoroptes mites to moxidectin, a widely used macrocyclic lactone (ML) treatment for scab, the current study compared the toxicity of three of the commonly administered macrocylic lactone therapeutic treatments (moxidectin, ivermectin and doramectin) to P. ovis from outbreak populations that had appeared unresponsive to treatment. These outbreak populations were from Wales and south west England. The data presented demonstrate that there is resistance to all three available ML compounds in populations of Psoroptes mites. However, considerable variation in response suggested that resistance alone was not responsible for the reported lack of efficacy in all of the submitted cases; lack of response in others may be associated with inappropriate treatment application or management. These data highlight the importance of the appropriate use of these compounds to manage national scab incidence at levels that are consistent with acceptable animal welfare standards, while attempting to reduce the development and spread of resistance.


Assuntos
Resistência a Múltiplos Medicamentos , Lactonas/administração & dosagem , Lactonas/farmacologia , Infestações por Ácaros/veterinária , Psoroptidae/efeitos dos fármacos , Criação de Animais Domésticos/normas , Animais , Antiparasitários/administração & dosagem , Antiparasitários/farmacologia , Inglaterra , Infestações por Ácaros/tratamento farmacológico , Infestações por Ácaros/epidemiologia , Infestações por Ácaros/prevenção & controle , Ovinos , Doenças dos Ovinos/tratamento farmacológico , Doenças dos Ovinos/epidemiologia , Doenças dos Ovinos/prevenção & controle , País de Gales
19.
J Forensic Leg Med ; 66: 147-154, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31306914

RESUMO

Spit guards, also known as spit hoods or spit masks (and occasionally bite guards) are devices intended to cover the mouth, face and sometimes the head of a restrained person in order to prevent them spitting at, or biting others. There is substantial controversy about their use with views often polarised between civil and human rights campaigners who express concerns about their utility, their safety, and their possible encroachment on human rights, and in contrast by (predominantly) law enforcement campaigners highlighting concerns about the possible risks of transmission of infection and subsequent need for prophylaxis by law enforcement professionals exposed to biological fluids. This study explored the extent to which police services deploy spit guards and the rationale underpinning their use. A mixed qualitative and quantitative approach was used to analyse data obtained from police services under the Freedom of Information Act. This study shows there is paucity of information readily available from police services in respect of quantifying the numbers of police officers who have contracted infectious disease as a result of spitting and/or bites, despite the fact that risk of infection and the need for subsequent prophylaxis is a driver of police services adopting the use of spit guard devices. Consideration must be afforded to the possibility that the use of spit guards represents a form of mechanical restraint rather than a means to prevent transmission of infection, especially given the paucity of information available from police services in respect of officers who have contracted infectious disease as a result of spiting and/or bites.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Doenças Profissionais/prevenção & controle , Equipamento de Proteção Individual , Polícia , Mordeduras Humanas/prevenção & controle , Inglaterra , Humanos , Irlanda do Norte , Saliva , País de Gales
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