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1.
BMC Med ; 21(1): 26, 2023 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-36658550

RESUMO

BACKGROUND: The COVID-19 pandemic caused rapid changes in primary care delivery in the UK, with concerns that certain groups of the population may have faced increased barriers to access. This study assesses the impact of the response to the COVID-19 pandemic on primary care consultations for individuals with multimorbidity and identifies ethnic inequalities. METHODS: A longitudinal study based on monthly data from primary care health records of 460,084 patients aged ≥18 years from 41 GP practices in South London, from February 2018 to March 2021. Descriptive analysis and interrupted time series (ITS) models were used to analyse the effect of the pandemic on primary care consultations for people with multimorbidity and to identify if the effect varied by ethnic groups and consultation type. RESULTS: Individuals with multimorbidity experienced a smaller initial fall in trend at the start of the pandemic. Their primary care consultation rates remained stable (879 (95% CI 869-890) per 1000 patients in February to 882 (870-894) March 2020), compared with a 7% decline among people without multimorbidity (223 consultations (95% CI 221-226) to 208 (205-210)). The gap in consultations between the two groups reduced after July 2020. The effect among individuals with multimorbidity varied by ethnic group. Ethnic minority groups experienced a slightly larger fall at the start of the pandemic. Individuals of Black, Asian, and Other ethnic backgrounds also switched from face-to-face to telephone at a higher rate than other ethnic groups. The largest fall in face-to-face consultations was observed among people from Asian backgrounds (their consultation rates declined from 676 (659-693) in February to 348 (338-359) in April 2020), which may have disproportionately affected their quality of care. CONCLUSIONS: The COVID-19 pandemic significantly affected primary care utilisation in patients with multimorbidity. While there is evidence of a successful needs-based prioritisation of multimorbidity patients within primary care at the start of the pandemic, inequalities among ethnic minority groups were found. Strengthening disease management for these groups may be necessary to control widening inequalities in future health outcomes.


Assuntos
COVID-19 , Humanos , Adolescente , Adulto , COVID-19/epidemiologia , Etnicidade , Londres/epidemiologia , Multimorbidade , Estudos Longitudinais , Fatores de Tempo , Pandemias , Grupos Minoritários , Encaminhamento e Consulta , Atenção Primária à Saúde
3.
Artigo em Inglês | MEDLINE | ID: mdl-36674056

RESUMO

BACKGROUND: Children < 5 years living in temporary accommodation (U5TA) are vulnerable to poor health outcomes. Few qualitative studies have examined service provider perspectives in family homelessness; none have focused on U5TA with a cross-sector approach. This study explored professionals' perspectives of the barriers and facilitators, including pandemic-related challenges, experienced by U5TA in accessing healthcare and optimising health outcomes, and their experiences in delivering services. METHODS: Sixteen semi-structured online interviews were conducted. Professionals working in Newham (London) with U5TA families were recruited from non-profit organisations, the health sector, and Local Authority. A thematic analysis was conducted. FINDINGS: Professionals described barriers including poor parental mental health; unsuitable housing; no social support; mistrust of services; immigration administration; and financial insecurity. Digital poverty, language discordance, and the inability to register and track U5TA made them even less visible to services. Professionals tried to mitigate barriers with improved communication, and through community facilitators. Adverse pandemic effects on U5TA health included delay and regression in developmental milestones and behaviours. In-person services were reduced, exacerbating pre-existing barriers. INTERPRETATION: COVID-19 further reduced the ability of professionals to deliver care to U5TA and significantly impacted the lives of U5TA with potential life-long risks. Innovative and tailored cross-sector strategies are needed, including co-production of public health services and policies focusing on early development, mental health support, employment training, and opportunities for parents/carers.


Assuntos
COVID-19 , Pandemias , Criança , Humanos , COVID-19/epidemiologia , Londres/epidemiologia , Acesso aos Serviços de Saúde , Avaliação de Resultados em Cuidados de Saúde , Pesquisa Qualitativa
4.
PLoS One ; 18(1): e0277913, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36662785

RESUMO

Exploration of dynamic human activity gives significant insights into understanding the urban environment and can help to reinforce scientific urban management strategies. Lots of studies are arising regarding the significant human activity changes in global metropolises and regions affected by COVID-19 containment policies. However, the variations of human activity dynamics amid different phases divided by the non-pharmaceutical intervention policies (e.g., stay-at-home, lockdown) have not been investigated across urban areas in space and time and discussed with the urban characteristic determinants. In this study, we aim to explore the influence of different restriction phases on dynamic human activity through sensing human activity zones (HAZs) and their dominated urban characteristics. Herein, we proposed an explainable analysis framework to explore the HAZ variations consisting of three parts, i.e., footfall detection, HAZs delineation and the identification of relationships between urban characteristics and HAZs. In our study area of Greater London, United Kingdom, we first utilised the footfall detection method to extract human activity metrics (footfalls) counted by visits/stays at space and time from the anonymous mobile phone GPS trajectories. Then, we characterised HAZs based on the homogeneity of daily human footfalls at census output areas (OAs) during the predefined restriction phases in the UK. Lastly, we examined the feature importance of explanatory variables as the metric of the relationship between human activity and urban characteristics using machine learning classifiers. The results show that dynamic human activity exhibits statistically significant differences in terms of the HAZ distributions across restriction phases and is strongly associated with urban characteristics (e.g., specific land use types) during the COVID-19 pandemic. These findings can improve the understanding of the variation of human activity patterns during the pandemic and offer insights into city management resource allocation in urban areas concerning dynamic human activity.


Assuntos
COVID-19 , Pandemias , Humanos , Londres/epidemiologia , Big Data , Controle de Doenças Transmissíveis , COVID-19/epidemiologia , Atividades Humanas
5.
Accid Anal Prev ; 179: 106895, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36399963

RESUMO

Contraflow cycling on one-way streets is a low cost intervention that research shows can improve the cycling experience and increase participation. Evidence from several studies suggest that cyclists on contraflows have a lower crash risk. However, implementing contraflow cycling is often controversial, including in the United Kingdom (UK). In this paper we examine whether contraflow cycling on one-way streets alters crash or casualty rates for pedal cyclists. Focusing on inner London boroughs between 1998 and 2019, we identified 508 road segments where contraflow cycling was introduced on one-way streets. We identified road traffic crashes occurring within 10 m of these segments and labelled them as pre-contraflow, contraflow or contraflow removed crashes. We calculated rates using the number of crashes or casualties divided by the time exposed and generated 95 % confidence intervals using bootstrap resampling. We adjusted the rates for changes in cordon cycling volume and injury severity reporting. There were 1498 crashes involving pedal cyclists: 788 pre-contraflow, 703 contraflow and 7 following contraflow removal. There was no change in adjusted overall pedal cyclist crash or casualty rates when contraflow cycling was introduced. Proximity to a junction doubled the crash rate. The crash rate when pedal cyclists were travelling contraflow was the same as those travelling with flow. We have found no evidence that introducing contraflow cycling increases the crash or casualty rate for pedal cyclists. It is possible that such rates may indeed fall when contraflow cycling is introduced if more accurate spatio-temporal cycling volume data was available. We recommend all one-way streets are evaluated for contraflow cycling but encourage judicious junction design and recommend UK legislative change for mandatory-two-way cycling on one-way streets unless exceptional circumstances exist.


Assuntos
Acidentes de Trânsito , Ciclismo , Humanos , Acidentes de Trânsito/prevenção & controle , Reino Unido , Londres , Viagem
6.
Injury ; 54(1): 232-237, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36503837

RESUMO

OBJECTIVES: The objective of this study is to present a retrospective analysis of patients presenting to a Major Trauma Centre (MTC) following deliberate self-harm (DSH) and identifying the precipitants of DSH and psychiatric morbidity that will serve to inform the provision of care for these patients. PATIENTS AND METHODS: This was a retrospective observational study from a London Major Trauma Centre that identified all injured patients that presented with deliberate self-harm. Data was analysed from our established trauma database. The data was analysed using descriptive statistics. RESULTS: This included 347 patients of whom 253 were male and 94 were female. The median age was 36 (range 14-93) years. Penetrating injuries (shooting and stabbing) occurred in 187 (54%) patients and blunt injuries in 160 (46%) patients. Self-stabbing (52%) was the most common cause for presentation followed by jumping from a height (26%). The median Injury Severity Score (ISS) was 4 (range 1-9). The median LOS was 3 days (range 0-109), with a mean stay of 8 days. Over half of the patients (n = 189) had previous contact with mental health services. Social and mental health were the main triggers for DSH. CONCLUSIONS: Societal and economic factors as well as a mental disorder are associated with trauma related DSH. These complex group of patients presenting to MTCs have not only acute surgical needs but social and psychological as well. Raising awareness of patients' mental health needs across the whole pathway for the major trauma patient is crucial to ensure that appropriate risk assessments are undertaken at every stage. It is also essential to provide psychological support to the multi-disciplinary team for their wellbeing.


Assuntos
Comportamento Autodestrutivo , Ferimentos Penetrantes , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Centros de Traumatologia , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Londres/epidemiologia , Estudos Retrospectivos
7.
Traffic Inj Prev ; 24(1): 98-102, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36480229

RESUMO

OBJECTIVE: Bus travel is relatively safe: however there remains a lack of understanding of passenger injury incidents onboard buses. The objective of this study was to understand more about onboard passenger incidents to help inform injury mitigation. METHODS: The UK national STATS19 data and Transport for London bus incident data (IRIS) were used to determine the size of the problem in Greater London. Other data including onboard incident reports from two bus operators and CCTV footage of 70 incidents were used to understand passenger injury in more depth and identify common themes and challenges. RESULTS: The STATS19 and IRIS analysis showed that there was a difference between nationally reported bus incidents compared to locally reported bus incidents. Non-collision incidents are prevalent in the data suggesting there is a large problem to tackle. The CCTV and bus incident data identified braking to be the single largest problem in onboard bus passenger injury incidents. Inconsistent reporting of passenger incidents and injury descriptions make it difficult to identify injury patterns and trends. Areas on the bus appear to contribute to higher injury incidents namely those seats facing and closest to the wheelchair area. Other challenges relating to expected passenger and driver behaviors were noted where blame for the incident and outcome can be attributed to both parties. CONCLUSIONS: This combined analysis of incident reports and CCTV footage has enabled a better understanding of the events leading to on-board passenger injury incidents. Preventing harsh braking would appear to be the most effective way of reducing passenger injuries. Additionally improved data collection would assist both transport authorities and bus operators to identify and monitor the effect of bus safety improvements.


Assuntos
Acidentes de Trânsito , Cadeiras de Rodas , Humanos , Veículos Automotores , Viagem , Londres/epidemiologia
8.
Epilepsy Behav ; 138: 109019, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36521408

RESUMO

Awareness of the long-term outcomes of status epilepticus is key to understanding the condition overall. Maintaining ties with patients' families is vital to both obtaining better long-term patient outcomes and obtaining that elusive data on long-term conditions. Common language and linked infrastructure support these ties. This position is posed within the context of NORSE (new-onset refractory status epilepticus) and FIRES (febrile infection-related epilepsy syndrome). This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.


Assuntos
Epilepsia Resistente a Medicamentos , Encefalite , Estado Epiléptico , Humanos , Estado Epiléptico/complicações , Estado Epiléptico/terapia , Convulsões , Londres
9.
Epilepsy Behav ; 138: 109034, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36525922

RESUMO

Status epilepticus is a frequent neurological emergency associated with a case fatality of about 10-15% depending on age, cause, and other factors, and a high burden for patients, caregivers, and society. In pregnancy, it can occur in two different clinical constellations: (1) In women with a history of epilepsy and (2) as new onset status epilepticus in pregnancy (NOSEP). Both entities are relatively rare but differ in terms of etiology. Here we describe the epidemiology, etiologies, diagnosis, clinical course with the maternal and fetal outcome, and the suggested management strategies for either manifestation. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.


Assuntos
Estado Epiléptico , Gravidez , Humanos , Feminino , Estado Epiléptico/diagnóstico , Estado Epiléptico/epidemiologia , Estado Epiléptico/terapia , Convulsões/diagnóstico , Família , Cuidado Pré-Natal , Londres
10.
Epilepsy Behav ; 138: 109050, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36549100

RESUMO

Earlier and more aggressive treatment of status epilepticus has long been established orthodoxy. In addition to increasing therapeutic options, it is of critical importance to understand whether or not this has translated into improved prognosis. In this review, we examine the evidence as to whether the mortality of convulsive status epilepticus changed over the past few decades. In particular, we discuss a recent systematic review and meta-analysis examining this question and its implications. We discuss potential reasons why there is no evidence of improved prognosis in terms of mortality and ways in which this may be addressed. Finally, we advocate the urgent need for accurate data on functional outcomes in non-fatal cases of status epilepticus. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.


Assuntos
Estado Epiléptico , Humanos , Estado Epiléptico/tratamento farmacológico , Convulsões/terapia , Prognóstico , Londres
11.
Environ Sci Technol ; 57(1): 96-108, 2023 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-36548159

RESUMO

We performed more than a year of mobile, 1 Hz measurements of lung-deposited surface area (LDSA, the surface area of 20-400 nm diameter particles, deposited in alveolar regions of lungs) and optically assessed fine particulate matter (PM2.5), black carbon (BC), and nitrogen dioxide (NO2) in central London. We spatially correlated these pollutants to two urban emission sources: major roadways and restaurants. We show that optical PM2.5 is an ineffective indicator of tailpipe emissions on major roadways, where we do observe statistically higher LDSA, BC, and NO2. Additionally, we find pollutant hot spots in commercial neighborhoods with more restaurants. A low LDSA (15 µm2 cm-3) occurs in areas with fewer major roadways and restaurants, while the highest LDSA (25 µm2 cm-3) occurs in areas with more of both sources. By isolating areas that are higher in one source than the other, we demonstrate the comparable impacts of traffic and restaurants on LDSA. Ratios of hyperlocal enhancements (ΔLDSA:ΔBC and ΔLDSA:ΔNO2) are higher in commercial neighborhoods than on major roadways, further demonstrating the influence of restaurant emissions on LDSA. We demonstrate the added value of using particle surface in identifying hyperlocal patterns of health-relevant PM components, especially in areas with strong vehicular emissions where the high LDSA does not translate to high PM2.5.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Ambientais , Material Particulado/análise , Poluentes Atmosféricos/análise , Dióxido de Nitrogênio/análise , Londres , Emissões de Veículos/análise , Pulmão , Monitoramento Ambiental , Poluição do Ar/análise
13.
BMJ Open ; 12(12): e066288, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36456017

RESUMO

OBJECTIVES: To quantify the effect of the COVID-19 pandemic on the timeliness of, and geographical and sociodemographic inequalities in, receipt of first measles, mumps and rubella (MMR) vaccination. DESIGN: Longitudinal study using primary care electronic health records. SETTING: 285 general practices in North East London. PARTICIPANTS: Children born between 23 August 2017 and 22 September 2018 (pre-pandemic cohort) or between 23 March 2019 and 1 May 2020 (pandemic cohort). MAIN OUTCOME MEASURE: Receipt of timely MMR vaccination between 12 and 18 months of age. METHODS: We used logistic regression to estimate the ORs (95% CIs) of receipt of a timely vaccination adjusting for sex, deprivation, ethnic background and Clinical Commissioning Group. We plotted choropleth maps of the proportion receiving timely vaccinations. RESULTS: Timely MMR receipt fell by 4.0% (95% CI: 3.4% to 4.6%) from 79.2% (78.8% to 79.6%) to 75.2% (74.7% to 75.7%) in the pre-pandemic (n=33 226; 51.3% boys) and pandemic (n=32 446; 51.4%) cohorts, respectively. After adjustment, timely vaccination was less likely in the pandemic cohort (0.79; 0.76 to 0.82), children from black (0.70; 0.65 to 0.76), mixed/other (0.77; 0.72 to 0.82) or with missing (0.77; 0.74 to 0.81) ethnic background, and more likely in girls (1.07; 1.03 to 1.11) and those from South Asian backgrounds (1.39; 1.30 to 1.48). Children living in the least deprived areas were more likely to receive a timely MMR (2.09; 1.78 to 2.46) but there was no interaction between cohorts and deprivation (Wald statistic: 3.44; p=0.49). The proportion of neighbourhoods where less than 60% of children received timely vaccination increased from 7.5% to 12.7% during the pandemic. CONCLUSIONS: The COVID-19 pandemic was associated with a significant fall in timely MMR receipt and increased geographical clustering of measles susceptibility in an area of historically low and inequitable MMR coverage. Immediate action is needed to avert measles outbreaks and support primary care to deliver timely and equitable vaccinations.


Assuntos
COVID-19 , Sarampo , Caxumba , Rubéola (Sarampo Alemão) , Masculino , Criança , Feminino , Humanos , Caxumba/epidemiologia , Caxumba/prevenção & controle , Pandemias , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Longitudinais , Registros Eletrônicos de Saúde , Londres/epidemiologia , Rubéola (Sarampo Alemão)/epidemiologia , Rubéola (Sarampo Alemão)/prevenção & controle , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacinação
14.
BMC Oral Health ; 22(1): 624, 2022 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-36544118

RESUMO

BACKGROUND: Numerous dental age estimation methods have been devised and practised for decades. Among these, the London Atlas and Willems methods were two of the most frequently adopted, however dependent on atlantes or tables. A new estimation method less reliant on external measurement could be efficient and economical. AIM: This study aimed to evaluate the utility and applicability of the dental age estimation methods of London Atlas, Willems, and a new quick method that subtracts the number of developing teeth from the universal root mature age of 16 years in one of the lower quadrants reported in this work among Chinese Uyghur children. METHODS: A comparative cross-sectional study was conducted. Subjects enrolled in the study were screened according to preset inclusion and exclusion criteria. The observer then obtained the dental age from the subjects' panoramic radiographs based on the estimated rules of the London Atlas, Willems, and a new quick method. Paired t-test was used to compare the accuracy and precision of the above three estimation methods. Independent-sample t-test was used to find the difference between gender. RESULTS: Totally, 831 radiographs entered the analyses of this study. Among the three methods evaluated, the Willems method, in particular, showed a distinct underestimated tendency. The mean error of the dental age predicted by the London Atlas, the Willems method, and the quick method was 0.06 ± 1.13 years, 0.44 ± 1.14 years, and 0.30 ± 0.63 years, respectively. The mean absolute error was 0.86 ± 0.75 years according to the London Atlas, 1.17 ± 0.89 years under the Willems method, and 0.70 ± 0.54 years under our quick method. No significant difference was found between the chronological age and dental age using the London Atlas, generally for the 10 to 15 years group (p > 0.05), but our quick method for the 15-16 years children (p < 0.05) and Willems method (p < 0.001). CONCLUSION: The London Atlas outperformed the Willems method with better accuracy and precision among 10-15 years Chinese Uyghur children. Our new quick method may be comparable to the London Atlas for children aged 10-14 and potentially become a more straightforward dental age prediction instrument.


Assuntos
Determinação da Idade pelos Dentes , Dente , Humanos , Criança , Londres , Estudos Transversais , Determinação da Idade pelos Dentes/métodos , Radiografia Panorâmica
16.
Br Dent J ; 233(12): 998-1002, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36526763

RESUMO

This is the second part of the thalassaemia update series which focuses on the dental journey of thalassaemia patients and the challenges encountered. This paper is a guide for recently qualified dentists who may not be experienced in the clinical implications of thalassaemia. A patient focus group was carried out with the UK Thalassaemia Society (UKTS) using a semi-structured interview format. All participants suffered from beta-major thalassaemia. The interview was conducted at the UKTS head office in London, UK. Participants consented for this interview and written consent forms were reviewed and completed by the author. The objectives were to: 1) review feedback from thalassaemia patients on the quality of dental care they receive in primary dental services; 2) evaluate the influence of social media in the thalassaemia community and how this has affected the self-confidence of thalassaemia patients; and 3) identify protocols that can be implemented for the primary care management and criteria for secondary care referral of thalassaemia patients.


Assuntos
Talassemia , Talassemia beta , Humanos , Talassemia/terapia , Talassemia/complicações , Talassemia beta/complicações , Encaminhamento e Consulta , Londres
17.
Br Dent J ; 233(12): 1022-1028, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36526775

RESUMO

Introduction This survey reports the incidence of traumatic dental injuries in an adult population attending an adult dental trauma clinic in a London teaching hospital.Materials and methods Retrospective data were collected from patients attending an adult dental trauma clinic between 2012 and 2018.Results In total, 1,769 patients attended, with more men seen (1,030; 58.2%) compared to women (739; 41.8%) and this was statistically significant (p <0.05). The most common aetiological factor was an accidental fall (728; 41.15%), followed by assaults (413; 23.35%), bicycle accidents (253; 14.3%), sports injuries (132; 7.46%) and road traffic accidents (84; 4.75%). Lateral luxation (833) was the most common traumatic injury and this was followed by avulsions (362; 17%). Enamel-dentine fractures were the most common type of fracture injury (1,273; 64%).Discussion This retrospective survey attempts to report on the incidence of traumatic dental injuries in a London-based cohort of patients attending a specialised dental trauma clinic. In line with other reports, there were more men than women affected, which is probably attributed to behavioural activities.Conclusion(s) Accidental falls are the most common cause of a traumatic dental injury, lateral luxation was the most common type of displacement injury and enamel-dentine fractures were the most common type of fracture injury.


Assuntos
Avulsão Dentária , Fraturas dos Dentes , Traumatismos Dentários , Masculino , Humanos , Adulto , Feminino , Traumatismos Dentários/epidemiologia , Traumatismos Dentários/etiologia , Estudos Retrospectivos , Londres/epidemiologia , Fraturas dos Dentes/epidemiologia , Fraturas dos Dentes/etiologia
18.
Prim Dent J ; 11(4): 30-37, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36533375

RESUMO

This article is based upon a webinar presented by the author in July 2022 as part of the ongoing collaboration between CGDent and ProDental CPD, and the handouts provided for those webinar participants. It also reflects the author's seminar given at the Dentistry Show in London in October 2022. Some of the background information also appeared in lectures on this topic given by the author to the UK Committee of Postgraduate Dental Deans and Directors (COPDEND) and East Midlands Dental School in 2015-2017. It aims to bust some myths about the duty of candour as it applies to dentistry and explains its implications for practice owners, dentists and other team members, the conversations we need to be having and the records we need to keep in order to satisfy the legal, ethical and perhaps contractual aspects of this duty, as well as the human aspects. It should be noted that the situation regarding the legal duty of candour differs across the four nations of the UK; this article explains the dynamic nature of those differences, but in terms of detail it focuses upon the situation as it exists in England where the duty has existed for much longer and affecting more members of the dental profession.


Assuntos
Odontologia , Humanos , Inglaterra , Londres
19.
BMJ Open ; 12(12): e061842, 2022 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-36549736

RESUMO

OBJECTIVES: Student assistantships are recommended to prepare medical graduates for clinical practice. Traditionally, assistantships have consisted of longer placements, often up to 15 weeks. However, within the constraints of the final year, medical schools need to carefully balance the time required for specialty placements, assessments and the risk of student burnout. We set out to evaluate the effectiveness of shorter, personalised student assistantships. DESIGN: An evaluative study on the changes in final year student confidence in preparedness for practice after a 3-week assistantship with defined learning objectives and learning needs assessment. SETTING: Eight hospitals affiliated with Imperial College School of Medicine. OUTCOMES: Student confidence in 10 learning outcomes including organising ward rounds, documentation, communication with colleagues, communication with patients and relatives, patient handover, practical procedures, patient management, acute care, prioritisation and out-of-hours clinical work. RESULTS: Two hundred and twenty final year medical students took part in the student assistantship, of whom 208 completed both the pre-assistantship and post-assistantship confidence rating questionnaires (95% completion rate). After the assistantship, 169 (81%) students expressed increased confidence levels in one or more learning objectives. For each individual learning objective, there was a significant change in the proportion of students who agreed or strongly agreed after the assistantship (p<0.0001). CONCLUSION: Overall, the focused 3-week, personalised student assistantships led to significant improvement across all learning objectives related to preparedness for practice. The use of the pre-assistantship confidence rating questionnaire allowed students to identify and target areas of learning needs during their assistantship.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Humanos , Londres , Competência Clínica , Aprendizagem , Hospitais
20.
BMJ Open ; 12(12): e065747, 2022 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-36564110

RESUMO

OBJECTIVES: To assess primary impact of selective Licensing (SL), an area-based intervention in the private rented housing market, on individual self-reported anxiety and neighbourhood mental health (MHI-Mental Healthcare Index) and secondary impacts on antisocial behaviour (ASB), population turnover and self-reported well-being. DESIGN: Difference-in-difference (DiD) was used to evaluate effects of SL schemes initiated 2012-2018. 921 intervention areas (lower super output areas) were matched 3:1 using propensity scores derived from sociodemographic and housing variables (N=3.684 including controls). Average treatment effect on treated (ATT) was calculated for multiple time period DiD in area-level analyses. Canonical DiD was used for individual-level analysis by year of treatment initiation while adjusting for age, sex, native birth and occupational class. SETTING: Intervention neighbourhoods and control areas in Greater London, UK, 2011-2019. PARTICIPANTS: We sampled 4474 respondents renting privately in intervention areas (N=17 347 including controls) in Annual Population Survey and obtained area-level MHI population data. INTERVENTIONS: Private landlords in SL areas must obtain a licence from the local authority, allow inspection and maintain minimum housing standards. RESULTS: ATT after 5 years was significantly lower for MHI (-7.5%, 95% CI -5.6% to -8.8%) than controls. Antidepressant treatment days per population reduced by -5.4% (95% CI -3.7% to -7.3), mental health benefit receipt by -9.6% (95% CI -14% to -5.5%) and proportion with depression by -12% (95% CI -7.7% to -16.3%). ASB reduced by -15% (95% CI -21% to -8.2%). Population turnover increased by 26.5% (95% CI 22.1% to 30.8%). Sensitivity analysis suggests overlap with effects of London 2012 Olympic regeneration. No clear patterns were observed for self-reported anxiety. CONCLUSIONS: We found associations between SL and reductions in area-based mental healthcare outcomes and ASB, while population turnover increased. A national evaluation of SL is feasible and necessary.


Assuntos
Habitação , Saúde Mental , Humanos , Londres/epidemiologia , Inglaterra , Características de Residência
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