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1.
BMJ Open ; 12(11): e067233, 2022 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-36332959

RESUMO

INTRODUCTION: In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands. METHODS AND ANALYSIS: This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and will be randomly assigned to intervention and control groups. The intervention group GPs will be exposed to emotive and educational seminars on medical ethics, whereas control group GPs will be given seminars on general medical topics. The primary outcome measure will be GPs' prescribing practices, whereas the secondary outcome measures will be their knowledge and attitudes regarding COI that arises from pharmaceutical incentivisation. In addition to a novel standardised pharmaceutical representatives (SPSR) method, in which field researchers will simulate pharmaceutical marketing with GPs, presurvey and postsurvey, and qualitative interviewing will be performed to collect data on GPs' knowledge, attitudes and practices in relation to COI linked with pharmaceutical incentives. Univariate and multivariate statistical analyses will be performed to measure a change in GPs' knowledge, attitudes and practices, while qualitative analysis will add to our understanding of the quantitative SPSR data. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Pakistan National Bioethics Committee (# 4-87/NBC-582/21/1364), the Aga Khan University (# 2020-4759-1129) and the London School of Hygiene and Tropical Medicine (# 26506). We will release results within 6-9 months of the study's completion. TRIAL REGISTRATION NUMBER: ISRCTN12294839.


Assuntos
Atitude do Pessoal de Saúde , Clínicos Gerais , Humanos , Conhecimentos, Atitudes e Prática em Saúde , Preparações Farmacêuticas , Londres , Padrões de Prática Médica , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
BMJ Open ; 12(11): e067161, 2022 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-36351722

RESUMO

INTRODUCTION: The National Health Service Insight Prioritisation Programme was established to accelerate the implementation and evaluation of innovation that supports post-pandemic working. Supporting this, the Academic Health Science Network and National Institute for Health and Care Research Applied Research Collaboration in South London are testing and evaluating the implementation and scale-up of a type 2 diabetes (T2D) intervention.T2D is estimated to be three times more prevalent in UK African and Caribbean communities than in white Europeans. To tackle ethnic inequities in T2D healthcare access, an evidence-based, culturally tailored self-management and education programme for African and Caribbean adults (Healthy Eating & Active Lifestyles for Diabetes, HEAL-D) has been codeveloped with people with lived experience. Initially a face-to-face programme, HEAL-D pivoted to virtual delivery in response to COVID-19.The purpose of this study is to explore the (1) feasibility and acceptability of a virtual delivery model for HEAL-D in south London and (2) factors affecting its scale-up across other areas in England. METHODS AND ANALYSIS: The study will have two strands: (1) mixed-methods prospective evaluation of HEAL-D virtual delivery in south London using routinely collected service-level data, service delivery staff and service user interviews and observations; and (2) prospective qualitative study of the scale-up of this virtual delivery comprising interviews and focus groups with members of the public, and diabetes services commissioners and providers across England. Qualitative data will be analysed using thematic analysis. Quantitative analysis will use descriptive statistics and reporting summary tables and figures. The study will be grounded in well-established implementation frameworks and service user involvement. ETHICS AND DISSEMINATION: 'Minimal Risk Registration' ethical clearance was granted by King's College London's Research Ethics Office (ref: MRA-21/22-28498). Results will be published in a peer-reviewed journal and summaries provided to the study funders and participants.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Autogestão , Adulto , Humanos , Medicina Estatal , Diabetes Mellitus Tipo 2/terapia , Londres , Inglaterra , Região do Caribe
3.
Technol Cult ; 63(4): 1005-1032, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36341605

RESUMO

This article provides the first critical history of escalators on the London Underground railway and the ways their introduction reconfigured passengers' bodies. As the Underground became a coordinated and unitary technological system, its central Tube stations-particularly their elevators-created friction and exerted systemic drag. The Underground's executives initiated a major modernization program, replacing elevators with automatic escalators. Yet for the new technology to succeed, passengers had to learn certain actions, develop competencies, and acquire new corporeal habits. This article examines the dynamic regimes of instruction and surveillance that the Underground deployed to achieve these aims and assesses the outcome. Despite the assurance that the escalator would mechanize movement and overcome physiological variation, certain users found it discriminatory. While contemporary critics depicted the machine as an agent of dehumanization, beyond rush hour and at less busy stations, "escalator-legged" Londoners found more expressive and autonomous ways of moving.


Assuntos
Elevadores e Escadas Rolantes , Movimento , Londres , Hábitos
4.
J Am Chem Soc ; 144(43): 19861-19871, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36260790

RESUMO

London dispersion (LD) is attracting more and more attention in catalysis since LD is ubiquitously present and cumulative. Since dispersion is hard to grasp, recent research has concentrated mainly on the effect of LD in individual catalytic complexes or on the impact of dispersion energy donors (DEDs) on balance systems. The systematic transfer of LD effects onto confined and more complex systems in catalysis is still in its infancy, and no general approach for using DED residues in catalysis has emerged so far. Thus, on the example of asymmetric Brønsted acid catalyzed transfer hydrogenation of imines, we translated the findings of previously isolated balance systems onto confined catalytic intermediates, resulting in a systematic enhancement of stereoselectivity when employing DED-substituted substrates. As the imine substrate is present as Z- and E-isomers, which can, respectively, be converted to R- and S-product enantiomers, implementing tert-butyl groups as DED residues led to an additional stabilization of the Z-imine by up to 4.5 kJ/mol. NMR studies revealed that this effect is transferred onto catalyst/imine and catalyst/imine/nucleophile intermediates and that the underlying reaction mechanism is not affected. A clear correlation between ee and LD stabilization was demonstrated for 3 substrates and 10 catalysts, allowing to convert moderate-good to good-excellent enantioselectivities. Our findings conceptualize a general approach on how to beneficially employ DED residues in catalysis: they clearly showcase that bulky alkyl residues such as tert-butyl groups must be considered regarding not only their repulsive steric bulk but also their attractive properties even in catalytic complexes.


Assuntos
Iminas , Hidrogenação , Londres , Catálise , Estereoisomerismo
5.
PLoS Negl Trop Dis ; 16(10): e0010799, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36264976

RESUMO

BACKGROUND: Leprosy is rare in the United Kingdom (UK), but migration from endemic countries results in new cases being diagnosed each year. We documented the clinical presentation of leprosy in a non-endemic setting. METHODS: Demographic and clinical data on all new cases of leprosy managed in the Leprosy Clinic at the Hospital for Tropical Diseases, London between 1995 and 2018 were analysed. RESULTS: 157 individuals with a median age of 34 (range 13-85) years were included. 67.5% were male. Patients came from 34 different countries and most contracted leprosy before migrating to the UK. Eighty-two (51.6%) acquired the infection in India, Sri Lanka, Bangladesh, Nepal and Pakistan. 30 patients (19.1%) acquired leprosy in Africa, including 11 from Nigeria. Seven patients were born in Europe; three acquired their leprosy infection in Africa, three in South East Asia, and one in Europe. The mean interval between arrival in the UK and symptom onset was 5.87 years (SD 10.33), the longest time to diagnosis was 20 years. Borderline tuberculoid leprosy (n = 71, 42.0%), and lepromatous leprosy (n =, 53 33.1%) were the commonest Ridley Jopling types. Dermatologists were the specialists diagnosing leprosy most often. Individuals were treated with World Health Organization recommended drug regimens (rifampicin, dapsone and clofazimine). CONCLUSION: Leprosy is not a disease of travellers but develops after residence in an leprosy endemic area. The number of individuals from a leprosy endemic country reflect both the leprosy prevalence and the migration rates to the United Kingdom. There are challenges in diagnosing leprosy in non-endemic areas and clinicians need to recognise the symptoms and signs of leprosy.


Assuntos
Hanseníase Dimorfa , Hanseníase Virchowiana , Hanseníase , Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Londres , Hanseníase/epidemiologia , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Dimorfa/tratamento farmacológico , Nigéria
6.
Ambix ; 69(4): 374-398, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36278316

RESUMO

This paper discusses fourteen letters that Heinrich Will (1812-1890), Justus Liebig's (1803-1873) successor at the University of Giessen, sent to Robert Warington (1807-1867), the chemical operator at Apothecaries' Hall in London, between 1842 and 1854. The correspondence illuminates a range of topics related to the development of the British chemical community in mid-Victorian Britain - its organisations, networks, and commercial opportunities, as well as offering insights into the importance of family, friendship, and collegiality in sustaining scientific careers. Studying such an exchange of material and textual knowledge helps to further understand how science was organised and ideas disseminated in a key period for institutional development in chemistry.


Assuntos
Amigos , Humanos , História do Século XIX , Reino Unido , Alemanha , Relação Estrutura-Atividade , Londres
7.
PLoS Med ; 19(10): e1004109, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36256607

RESUMO

BACKGROUND: Sleep duration has been shown to be associated with individual chronic diseases but its association with multimorbidity, common in older adults, remains poorly understood. We examined whether sleep duration is associated with incidence of a first chronic disease, subsequent multimorbidity and mortality using data spanning 25 years. METHODS AND FINDINGS: Data were drawn from the prospective Whitehall II cohort study, established in 1985 on 10,308 persons employed in the London offices of the British civil service. Self-reported sleep duration was measured 6 times between 1985 and 2016, and data on sleep duration was extracted at age 50 (mean age (standard deviation) = 50.6 (2.6)), 60 (60.3 (2.2)), and 70 (69.2 (1.9)). Incidence of multimorbidity was defined as having 2 or more of 13 chronic diseases, follow-up up to March 2019. Cox regression, separate analyses at each age, was used to examine associations of sleep duration at age 50, 60, and 70 with incident multimorbidity. Multistate models were used to examine the association of sleep duration at age 50 with onset of a first chronic disease, progression to incident multimorbidity, and death. Analyses were adjusted for sociodemographic, behavioral, and health-related factors. A total of 7,864 (32.5% women) participants free of multimorbidity had data on sleep duration at age 50; 544 (6.9%) reported sleeping ≤5 hours, 2,562 (32.6%) 6 hours, 3,589 (45.6%) 7 hours, 1,092 (13.9%) 8 hours, and 77 (1.0%) ≥9 hours. Compared to 7-hour sleep, sleep duration ≤5 hours was associated with higher multimorbidity risk (hazard ratio: 1.30, 95% confidence interval = 1.12 to 1.50; p < 0.001). This was also the case for short sleep duration at age 60 (1.32, 1.13 to 1.55; p < 0.001) and 70 (1.40, 1.16 to 1.68; p < 0.001). Sleep duration ≥9 hours at age 60 (1.54, 1.15 to 2.06; p = 0.003) and 70 (1.51, 1.10 to 2.08; p = 0.01) but not 50 (1.39, 0.98 to 1.96; p = 0.07) was associated with incident multimorbidity. Among 7,217 participants free of chronic disease at age 50 (mean follow-up = 25.2 years), 4,446 developed a first chronic disease, 2,297 progressed to multimorbidity, and 787 subsequently died. Compared to 7-hour sleep, sleeping ≤5 hours at age 50 was associated with an increased risk of a first chronic disease (1.20, 1.06 to 1.35; p = 0.003) and, among those who developed a first disease, with subsequent multimorbidity (1.21, 1.03 to 1.42; p = 0.02). Sleep duration ≥9 hours was not associated with these transitions. No association was found between sleep duration and mortality among those with existing chronic diseases. The study limitations include the small number of cases in the long sleep category, not allowing conclusions to be drawn for this category, the self-reported nature of sleep data, the potential for reverse causality that could arise from undiagnosed conditions at sleep measures, and the small proportion of non-white participants, limiting generalization of findings. CONCLUSIONS: In this study, we observed short sleep duration to be associated with risk of chronic disease and subsequent multimorbidity but not with progression to death. There was no robust evidence of an increased risk of chronic disease among those with long sleep duration at age 50. Our findings suggest an association between short sleep duration and multimorbidity.


Assuntos
Multimorbidade , Transtornos do Sono-Vigília , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Masculino , Estudos de Coortes , Estudos Prospectivos , Seguimentos , Sono , Transtornos do Sono-Vigília/epidemiologia , Londres/epidemiologia , Fatores de Risco
8.
Environ Pollut ; 315: 120398, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36228845

RESUMO

The Arctic is a sink for major pollutants in the Northern Hemisphere, and is an ideal place to investigate the migration of concerned metals on the local environment. In this study, 13 elements including Li, Ti, V, Cr, Mn, Fe, Co, Cu, Zn, As, Cd, Hg, and Pb were determined in mosses (Dicranum angustum) from London Island in Ny-Ålesund. The results showed that the concentrations of different elements varied greatly at different altitudes, while their distributions in low (0-200 m) and high (200-300 m) altitudes based on cluster analysis were significantly different. Among them, Li, Ti, V, Cr, Mn, Fe, Co, Cu, and As showed significant positive correlations with elevation. This result may be due to the influence of key environmental factors such as elements transported by the airborne dust carried by winds, and surface runoff from snow meltwater. Multiple receptor models (PCA, PMF, and UNMIX) were employed to discuss the sources of metals in mosses from London Island. Elements that showed positive correlation with altitude were attributed to natural sources, and Zn, Cd, Hg, and Pb, which lacked apparent correlation with elevation, were interpreted as from anthropogenic sources by the models. Among them, Zn, Cd, and Hg were from long-range deposition, while Pb was from mixed industrial sources.


Assuntos
Briófitas , Mercúrio , Metais Pesados , Monitoramento Ambiental/métodos , Londres , Svalbard , Cádmio/análise , Chumbo/análise , Metais Pesados/análise , Mercúrio/análise , China
9.
Eur Psychiatry ; 65(1): e67, 2022 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-36193673

RESUMO

BACKGROUND: Patients diagnosed with mental health problems are more predisposed to cardiovascular disease, including cardiac surgery. Nevertheless, health outcomes after cardiac surgery for patients with mental health problems as a discrete group are unknown. This study examined the association between secondary care mental health service use and postoperative health outcomes following cardiac surgery. METHODS: We conducted a retrospective observational research, utilizing data from a large South London mental healthcare supplier linked to national hospitalization data. OPCS-4 codes were applied to classify cardiac surgery. Health results were compared between those individuals with a mental health disorder diagnosis from secondary care and other local residents, including the length of hospital stay (LOS), inpatient mortality, and 30-day emergency hospital readmission. RESULTS: Twelve thousand three hundred and eighty-four patients received cardiac surgery, including 1,481 with a mental disorder diagnosis. Patients with mental health diagnosis were at greater risk of emergency admissions for cardiac surgery (odds ratio [OR] 1.60; 1.43, 1.79), longer index LOS (incidence rate ratio 1.28; 1.26, 1.30), and at higher risk of 30-day emergency readmission (OR 1.53; 1.31, 1.78). Those who underwent pacemaker insertion and major open surgery had worse postoperative outcomes during index surgery hospital admission while those who had major endovascular surgery had worse health outcomes subsequent 30-day emergency hospital readmission. CONCLUSION: People with a mental health disorder diagnosis undertaking cardiac surgery have significantly worse health outcomes. Personalized guidelines and policies to manage preoperative risk factors require consideration and evaluation.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Serviços de Saúde Mental , Humanos , Estudos Retrospectivos , Londres/epidemiologia , Tempo de Internação , Readmissão do Paciente
10.
Nature ; 611(7935): 312-319, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36261521

RESUMO

Infectious diseases are among the strongest selective pressures driving human evolution1,2. This includes the single greatest mortality event in recorded history, the first outbreak of the second pandemic of plague, commonly called the Black Death, which was caused by the bacterium Yersinia pestis3. This pandemic devastated Afro-Eurasia, killing up to 30-50% of the population4. To identify loci that may have been under selection during the Black Death, we characterized genetic variation around immune-related genes from 206 ancient DNA extracts, stemming from two different European populations before, during and after the Black Death. Immune loci are strongly enriched for highly differentiated sites relative to a set of non-immune loci, suggesting positive selection. We identify 245 variants that are highly differentiated within the London dataset, four of which were replicated in an independent cohort from Denmark, and represent the strongest candidates for positive selection. The selected allele for one of these variants, rs2549794, is associated with the production of a full-length (versus truncated) ERAP2 transcript, variation in cytokine response to Y. pestis and increased ability to control intracellular Y. pestis in macrophages. Finally, we show that protective variants overlap with alleles that are today associated with increased susceptibility to autoimmune diseases, providing empirical evidence for the role played by past pandemics in shaping present-day susceptibility to disease.


Assuntos
DNA Antigo , Predisposição Genética para Doença , Imunidade , Peste , Seleção Genética , Yersinia pestis , Humanos , Aminopeptidases/genética , Aminopeptidases/imunologia , Peste/genética , Peste/imunologia , Peste/microbiologia , Peste/mortalidade , Yersinia pestis/imunologia , Yersinia pestis/patogenicidade , Seleção Genética/imunologia , Europa (Continente)/epidemiologia , Europa (Continente)/etnologia , Imunidade/genética , Conjuntos de Dados como Assunto , Londres/epidemiologia , Dinamarca/epidemiologia
11.
Br J Anaesth ; 129(6): 889-897, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36192218

RESUMO

BACKGROUND: Most patients fully recover after surgery. However, high-risk patients may experience an increased burden of medical disease. METHODS: We performed a prospectively planned analysis of linked routine primary and secondary care data describing adult patients undergoing non-obstetric surgery at four hospitals in East London between January 2012 and January 2017. We categorised patients by 90-day mortality risk using logistic regression modelling. We calculated healthcare contact days per patient year during the 2 yr before and after surgery, and express change using rate ratios (RaR) with 95% confidence intervals. RESULTS: We included 70 021 patients, aged (mean [standard deviation, sd]) 49.8 (19) yr, with 1238 deaths within 2 yr after surgery (1.8%). Most procedures were elective (51 693, 74.0%), and 20 441 patients (29.1%) were in the most deprived national quintile for social deprivation. Elective patients had 12.7 healthcare contact days per patient year before surgery, increasing to 15.5 days in the 2 yr after surgery (RaR, 1.22 [1.21-1.22]), and those at high-risk of 90-day mortality (11% of population accounting for 80% of all deaths) had the largest increase (37.0 days per patient year before vs 60.8 days after surgery; RaR, 1.64 [1.63-1.65]). Emergency patients had greater increases in healthcare burden (13.8 days per patient year before vs 24.8 days after surgery; RaR, 1.8 [1.8-1.8]), particularly in high-risk patients (28% of patients accounting for 80% of all deaths by day 90), with 21.6 days per patient year before vs 49.2 days after surgery; RaR, 2.28 [2.26-2.29]. DISCUSSION: High-risk patients who survive the immediate perioperative period experience large and persistent increases in healthcare utilisation in the years after surgery. The full implications of this require further study.


Assuntos
Procedimentos Cirúrgicos Eletivos , Atenção Secundária à Saúde , Humanos , Adulto , Aceitação pelo Paciente de Cuidados de Saúde , Hospitais , Londres/epidemiologia
12.
BMJ Open ; 12(10): e062356, 2022 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-36229152

RESUMO

INTRODUCTION: An impoverished medical workforce is a global phenomenon, which can impact patient care significantly. Greater flexibility in working patterns is one approach policy-makers adopt to address this issue, and the expansion of less than full-time (LTFT) working forms part of this. Studies suggest that LTFT working has the potential to improve recruitment and retention by aligning with how doctors increasingly want to balance their careers with other commitments and interests. What is less well understood are the influencing factors and outcomes related to LTFT working among doctors. This protocol outlines the methodology for a systematic review that will evaluate existing knowledge on LTFT working in the medical profession. METHODS AND ANALYSIS: The Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines will be followed. Embase, MEDLINE, PsycINFO, Health Management Information Consortium, Web of Science, Cochrane Library, Healthcare Administration, and Applied Social Sciences Index and Abstracts will be searched for studies published up to March 2022. Unpublished literature from EThos and ProQuest Dissertations & Theses Global will also be searched. Bibliographic searching, citation searching and handsearching will be used to retrieve additional papers. Authors will be contacted for data or publications if necessary. Two independent reviewers will undertake study screening, data extraction and quality assessment, with disagreements resolved by consensus or by a third reviewer if necessary. Data synthesis will be by narrative synthesis and meta-analysis if possible. ETHICS AND DISSEMINATION: The proposed study does not require ethical approval; however, it forms part of a larger body of research on the impact of LTFT working on the medical workforce for which ethics approval has been granted by the Research Ethics Committee at University College London. Findings will be published in a peer-reviewed journal and will be presented at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42022307174.


Assuntos
Pessoal de Saúde , Projetos de Pesquisa , Humanos , Londres , Metanálise como Assunto , Revisões Sistemáticas como Assunto
15.
Braz J Cardiovasc Surg ; 37(Spec 1): 1-6, 2022 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-36053997

RESUMO

In this review, I summarise the circumstances leading to the collaboration between London and Örebro on the basic research performed to study potential mechanisms underlying the improved patency of saphenous veins harvested by the no-touch technique. Histological studies reveal various forms of vascular damage to saphenous vein grafts harvested in conventional coronary artery bypass grafting (CABG) whereas no-touch grafts retain a normal architecture. The perivascular fat that remains intact on no-touch saphenous vein grafts seems to play a particularly important role as the "protector" of all layers of the graft. In addition, the perivascular fat is a source of adipose cell-derived factors that may contribute to the success of the no-touch technique. While a number of trials have compared no-touch with conventional grafts following CABG, these have generally been limited to short follow-up periods, low patient numbers, and inadequate histological data. When handling no-touch saphenous vein at harvesting, there is no direct contact of the vein by surgical instruments, spasm does not occur, and high-pressure intraluminal distension is not required. While damage to both endothelial and vascular smooth muscle cells are evident at the microscopic and ultrastructural level in conventional saphenous vein grafts, their structure in no-touch grafts is preserved. Also, in no-touch veins, the vasa vasorum remains intact and transmural blood supply is maintained. This microvascular network is disrupted during conventional harvesting, a situation likely to stimulate processes involved in graft occlusion. The use of excess graft material for histology is to be encouraged for the assessment of vascular damage and even surgeon competence. If you don't look, you don't find.


Assuntos
Ponte de Artéria Coronária , Veia Safena , Ponte de Artéria Coronária/métodos , Humanos , Londres , Veia Safena/transplante , Vasa Vasorum , Grau de Desobstrução Vascular/fisiologia
17.
BMJ Open ; 12(9): e061875, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109027

RESUMO

OBJECTIVE: Older people and people with complex needs often require both health and social care services, but there is limited insight into individual journeys across these services. To help inform joint health and social care planning, we aimed to assess the relationship between hospital admissions and domiciliary care receipt. DESIGN: Retrospective cohort study, using linked data on primary care activity, hospital admissions and social care records. SETTING: London Borough of Barking and Dagenham, England. PARTICIPANTS: Adults aged 19 and over who lived in the area on 1 April 2018 and who were registered at a general practice in East London between 1 April 2018 and 31 March 2020 (n=140 987). OUTCOME MEASURES: The outcome was initiation of domiciliary care. We estimated the rate of hospital-associated care package initiation, and of care packages unrelated to hospital admission. We also described the characteristics of hospital admissions that preceded domiciliary care, including primary diagnosis codes. RESULTS: 2041/140 987 (1.4%) participants had a domiciliary care package during a median follow-up of 1.87 years. 32.6% of packages were initiated during a hospital stay or within 7 days of discharge. The rate of new domiciliary care packages was 120 times greater (95% CI 110 to 130) during or after a hospital stay than at other times, and this association was present for all age groups. Primary admission reasons accounting for the largest number of domiciliary care packages were hip fracture, pneumonia, stroke, urinary tract infection, septicaemia and exacerbations of long-term conditions (chronic obstructive pulmonary disease and heart failure). Admission reasons with the greatest likelihood of a subsequent domiciliary care package were fractures and strokes. CONCLUSION: Hospitals are a major referral route into domiciliary care. While patients admitted due to new and acute illnesses account for many domiciliary care packages, exacerbations of long-term conditions and age-related and frailty-related conditions are also important drivers.


Assuntos
Serviços de Assistência Domiciliar , Adulto , Idoso , Estudos de Coortes , Inglaterra , Hospitais , Humanos , Londres/epidemiologia , Estudos Retrospectivos
18.
BMJ Open ; 12(9): e066880, 2022 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-36175094

RESUMO

INTRODUCTION: Exposure to adverse childhood experiences (ACEs) is associated with poorer health outcomes throughout life. In England, health visiting is a long-standing, nationally implemented service that aims to prevent and mitigate the impact of adversity in early childhood, including for children exposed to ACEs. A range of health visiting service delivery practices exist across England (from the minimum five recommended contacts to tailored intensive interventions), but there is a lack of evidence on who receives what services, how this varies across local authorities (LAs) and the associated outcomes. METHODS AND ANALYSIS: This study will integrate findings from analysis of individual-level, deidentified administrative data related to hospital admissions (Hospital Episode Statistics (HES)) and health visiting contacts (Community Services Data Set (CSDS)), aggregate LA-level data, in-depth case studies in up to six LAs (including interviews with mothers), a national survey of health visiting services, and workshops with stakeholders and experts by experience. We will use an empirical-to-conceptual approach to develop a typology of health visiting service delivery in England, starting with a data-driven classification generated from latent class analysis of CSDS-HES data, which will be refined based on all other available qualitative and quantitative data. We will then evaluate which models of health visiting are most promising for mitigating the impact of ACEs on child and maternal outcomes using CSDS-HES data for a cohort of children born on 1 April 2015 to 31 March 2019. ETHICS AND DISSEMINATION: The University College London Institute of Education Research Ethics Committee approved this study. Results will be submitted for publication in a peer-reviewed journal and summaries will be provided to key stakeholders including the funders, policy-makers, local commissioners and families.


Assuntos
Experiências Adversas da Infância , Criança , Pré-Escolar , Inglaterra , Feminino , Humanos , Londres , Mães
19.
BMJ Lead ; 6(2): 81-83, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-36170525

RESUMO

BACKGROUND: The NHS is a fascinating health care system and is enjoying a lot of support from all layers of British society. However, it is clear that the system has excellent features but also areas that can be improved. STORY OF SELF: A number of years as a chief executive in one of London's largest hospital has brought me a wealth of impressions, experiences, and understanding about working in the NHS. Contrasting those to my previous experience as chief executive in Amsterdam (The Netherlands) provides an interesting insight. OBSERVATIONS: Very strong features of the NHS are the high level of health care professionals, the focus on quality and safety, and involvement of patients and the public. However, the NHS can significantly improve by addressing the lack of clinical professionals in the lead, curtailing ever increasing bureaucracy, and reducing its peculiar preference for outsourcing even the most crucial activities to private parties. The frequent inability to swiftly and successfully complete goal-directed negotiations as well as the large but from a clinical point of view irrelevant private sector are areas of sustained bewilderment. Lastly, the drive for innovation and transformation as well as the level of biomedical research in the NHS and supported by the British universities is fascinating and outstanding.


Assuntos
Hospitais , Medicina Estatal , Humanos , Londres , Países Baixos , Setor Privado
20.
Angew Chem Int Ed Engl ; 61(45): e202212546, 2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36102180

RESUMO

Heterobimetallic [BiRh] tetracarboxylate catalysts endowed with 1,3-disilylated phenylglycine paddlewheels benefit from interligand London dispersion. They were originally designed for asymmetric cyclopropanation but are now shown to perform very well in asymmetric C-H functionalization reactions too. Because of the confined ligand sphere about the derived donor/acceptor carbenes, insertions into unhindered methyl groups are kinetically favored, although methylene units also react with excellent levels of asymmetric induction; even gaseous ethane is a suitable substrate. Moreover, many functional groups in both partners are tolerated. The resulting products are synthetically equivalent to the outcome of traditional asymmetric ester alkylation, allylation, benzylation, propargylation and aldol reactions and therefore constitute a valuable nexus to more conventional chemical logic.


Assuntos
Ródio , Ródio/química , Bismuto , Londres , Estereoisomerismo , Catálise
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