Improving MMR vaccination rates: herd immunity is a realistic goal

Source:Improving MMR vaccination rates: herd immunity is a realistic goal — Cockman et al. 343 — bmj.com.

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Abstract

Problem As measles is a highly infectious disease, the United Kingdom recommendation is for at least 95% of children to receive a first vaccination with the measles, mumps, and rubella (MMR) vaccine before age 2 years and a booster before age 5 years to achieve herd immunity and prevent outbreaks. Reported vaccination rates for England have improved since a low level in 2003-4. Coverage for London is consistently lower than for England, however, and concerns have been expressed that there could be an epidemic of measles in the capital.

Design Observational time series study.

Setting London Borough of Tower Hamlets.

Key measurements for improvement Uptake rates for childhood vaccinations. The key target was to reach 95% coverage for the first MMR vaccine before age 2 years.

Strategies for change Financial support for the development of geographically based networks of general practices. Commissioning of care packages, incentivising delivery of high quality integrated care with network level vaccination targets of 95%. Innovative use of information technology to enable robust call and recall processes, active follow-up of defaulters, and increased knowledge about the demography of the children most difficult to reach.

Effects of change The development of networks of practices facilitated collaborative working among primary care clinicians and other stakeholders; peer review of achievements; and an element of healthy competition. Uptake improved for all childhood vaccinations, and to herd immunity levels for most. Uptake of the first MMR vaccine before age 2 years rose from 80% in September 2009 to 94% in March 2011.

Lessons learnt Achieving herd immunity for childhood vaccinations is an achievable target in an ethnically mixed, socially deprived inner city borough. The ability to identify characteristics of the difficult to reach groups, including significant differences in uptake across different ethnicities, will allow targeted interventions that may further improve overall coverage

East of England Ambulance delay concerns raised

An ambulance service has disclosed a dramatic increase in the numbers of suspected stroke and heart attack patients having to wait more than an hour for a vehicle to take them to hospital.

via BBC News – East of England Ambulance delay concerns raised.

‘Only mugs work in commissioning’: tackling the management brain drain

Source: ‘Only mugs work in commissioning’: tackling the management brain drain | Leader | Health Service Journal.

Of all the postgraduate courses in the country, places on the NHS management training scheme are among the most fiercely contested.

Introduction: Of all the postgraduate courses in the country, places on the NHS management training scheme are among the most fiercely contested…

 

Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis

Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis — Basu et al. 343 — bmj.com.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract

Objectives Almost 20% of people smoke tobacco worldwide—a percentage projected to rise in many poor countries. Smoking has been linked to increased individual risk of tuberculosis infection and mortality, but it remains unclear how these risks affect population-wide tuberculosis rates.

Design We constructed a state transition, compartmental, mathematical model of tuberculosis epidemics to estimate the impact of alternative future smoking trends on tuberculosis control. We projected tuberculosis incidence, prevalence, and mortality in each World Health Organization region from 2010 to 2050, and incorporated changing trends in smoking, case detection, treatment success, and HIV prevalence.

Results The model predicted that smoking would produce an excess of 18 million tuberculosis cases (standard error 16-20) and 40 million deaths from tuberculosis (39-41) between 2010 and 2050, if smoking trends continued along current trajectories. The effect of smoking was anticipated to increase the number of tuberculosis cases by 7% (274 million v 256 million) and deaths by 66% (101 million v 61 million), compared with model predictions that did not account for smoking. Smoking was also expected to delay the millennium development goal target to reduce tuberculosis mortality by half from 1990 to 2015. The model estimated that aggressive tobacco control (achieving a 1% decrease in smoking prevalence per year down to eradication) would avert 27 million smoking attributable deaths from tuberculosis by 2050. However, if the prevalence of smoking increased to 50% of adults (as observed in countries with high tobacco use), the model estimated that 34 million additional deaths from tuberculosis would occur by 2050.

Conclusions Tobacco smoking could substantially increase tuberculosis cases and deaths worldwide in coming years, undermining progress towards tuberculosis mortality targets. Aggressive tobacco control could avert millions of deaths from tuberculosis.

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Yorkshire PCT has ‘significant concerns’ about GP minor surgery letter

Yorkshire PCT has ‘significant concerns’ about GP minor surgery letter | HSJ Local | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

NHS North Yorkshire and York has said it has “significant concerns” about a letter sent by a GP practice to patients it believed wanted minor surgery, in which the practice offered to carry out procedures it said were no longer funded by the primary care trust for a fee

York GPs tell patients they can pay for NHS-limited procedures

Source: York GPs tell patients they can pay for NHS-limited procedures | HSJ Local | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

A GP surgery has written to patients who it believed wanted minor surgery which is no longer funded by its primary care trust, offering to carry out the procedures for a fee, it has emerged

 

Fair skinned people and vitamin D

Fair skinned people and vitamin D – Health News – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Links to the headlines

Fair-skinned people may need extra vitamin D. BBC News October 4 2011

Why freckles mean you need vitamin D pills. The Daily Telegraph, October 4 2011

Links to the science

Davies JR, Chang Y-M, Snowden H, et al. The determinants of serum vitamin D levels in participants in a melanoma case–control study living in a temperate climate. Cancer Causes and Control 2011; 10: 1471-1482

 

Further reading

Vitamin D consensus statement. Cancer Research UK

Unison ‘will not campaign’ against all reconfigurations

A senior Unison figure has revealed to HSJ that the union is prepared to accept some hospital reconfigurations.

via Unison ‘will not campaign’ against all reconfigurations | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Rich countries can learn from poor ones about delivering good care at low cost, conference hears

Source: Rich countries can learn from poor ones about delivering good care at low cost, conference hears — Richards 343 — bmj.com.

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Rich countries that provide wasteful, inefficient, and inequitable health services should be more accountable for the money they spend and should adapt cost effective models of care pioneered in poor countries, delegates agreed at a meeting last week on global health.

 

Thousands of records accidentally destroyed by Dartford and Gravesham

Source: Thousands of records accidentally destroyed by Dartford and Gravesham | HSJ Local | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

 

Dartford and Gravesham NHS Trust breached the Data Protection Act by accidentally destroying 10,000 archived records, the Information Commissioner’s Office has said

NHS managers to be balloted for industrial action

Source: NHS managers to be balloted for industrial action, HSJ learns | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Members of Managers in Partnership will be asked whether they want to join action being planned by unions including Unison, to which MiP is aligned, against changes to public sector pensions.

 

Government to oppose Lords move for extra Health Bill scrutiny

Source: Government to oppose Lords move for extra Health Bill scrutiny | News | Health Service Journal.

The government will strongly resist calls for large parts of its Health Bill to be referred to a select committee in the Lords – a move which would further frustrate its progress through Parliament

The government will strongly resist calls for large parts of its Health Bill to be referred to a select committee in the Lords – a move which would further frustrate its progress through Parliament

 

Pull bill now, public health doctors urge Lords

Source: Pull bill now, public health doctors urge Lords | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

The government’s health reforms will do “irreparable harm” to the NHS, a group of public health doctors and specialists, including Sir Michael Marmot, have warned

 

Farrar clashes with Lansley over ‘over-managed’ claim

Source: Farrar clashes with Lansley over ‘over-managed’ claim | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Health secretary Andrew Lansley has been forced to defend himself against charges that patients will suffer due as a result of management cuts.

 

Foreign GPs will face English language test – Lansley

Doctors with a poor grasp of English will be prevented from working for the NHS in the future, Health Secretary Andrew Lansley has said

via BBC News – Foreign GPs will face English language test – Lansley.

‘Flexible’ work call for women doctors

The NHS should make flexible working more available in order to respond to the increasing number of female doctors, a medical group has said.

via BBC News – ‘Flexible’ work call for women doctors.

Factor analysis of self-treatment in diabetes mellitus: a cross sectional study

Abstract | Factor analysis of self-treatment in diabetes mellitus: a cross sectional study.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract (provisional)

 

Background

Self-treatment is a treatment of oneself without professional help, which may cause health-related consequences. This investigation examined the self-treatment behaviors in patients with diabetes mellitus in Iran/kashan.

Methods

The patients who referred to the clinic of diabetes and those who were admitted to the General hospital in the city of Kashan due to diabetes mellitus were asked to participate in this cross-sectional study. For data collection, The 25 item questionnaire of Likert scale type with four scales was used. Factor analysis was performed to define the patterns of self-treatment.

Results

398 patients participated in the study. The mean age of the study population was 54.9 +/- 12.9 years. The majority (97%) had type 2 diabetes. 50% of patients reported self- treatment. The self-treatment score was 45.8 +/- 8.8 (25-100). Female gender, lower education and co-morbid illnesses of hypertension, hyperlipidemia and cardiac disease had significant relationship with self-treatment. The factor analysis procedure revealed seven factors that explained the 43% of variation in the self-treatment. These seven factors were categorized as knowledge, deficiencies of formal treatments, available self-treatment methods, physician related factors, the tendency to use herbal remedies, underlying factors such as gender and factors related to diabetes.

Conclusions

There is a medium tendency for self-treatment in diabetic patients. The assessment of self-treatment practices must be an essential part of patients’ management in diabetes care.

Presumed consent plan: Wales supplies more organ donors

A call has been made for more research into presumed consent for organ donation as Wales is poised to become the first part of the UK to adopt it.

via BBC News – Presumed consent plan: Wales supplies more organ donors.

Case-based reported mortality associated with laboratory-confirmed influenza A(H1N1) 2009 virus infection in the Netherlands: the 2009-2010 pandemic season versus the 2010-2011 influenza season.

Source: Abstract | Case-based reported mortality associated with laboratory-confirmed influenza A(H1N1) 2009 virus infection in the Netherlands: the 2009-2010 pandemic season versus the 2010-2011 influenza season..

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract (provisional)

 

Background

In contrast to seasonal influenza epidemics, where the majority of deaths occur amongst elderly, a considerable part of the 2009 pandemic influenza related deaths concerned relatively young people. In the Netherlands, all deaths associated with laboratory-confirmed influenza A(H1N1) 2009 virus infection had to be notified, both during the 2009-2010 pandemic season and the 2010-2011 influenza season. To assess whether and to what extent pandemic mortality patterns were reverting back to seasonal patterns, a retrospective analyses of all notified fatal cases associated with laboratory-confirmed influenza A(H1N1) 2009 virus infection was performed.

Methods

The notification database, including detailed information about the clinical characteristics of all notified deaths, was used to perform a comprehensive analysis of all deceased patients with a laboratory-confirmed influenza A(H1N1) 2009 virus infection. Characteristics of the fatalities with respect to age and underlying medical conditions were analysed, comparing the 2009-2010 pandemic and the 2010-2011 influenza season.

Results

A total of 65 fatalities with a laboratory-confirmed influenza A(H1N1) 2009 virus infection were notified in 2009-2010 and 38 in 2010-2011. During the pandemic season, the population mortality rates peaked in persons aged 0-15 and 55-64 years. In the 2010-2011 influenza season, peaks in mortality were seen in persons aged 0-15 and 75-84 years. During the 2010-2011 influenza season, the height of first peak was lower compared to that during the pandemic season. Underlying immunological disorders were more common in the pandemic season compared to the 2010-2011 season (p=0.02), and cardiovascular disorders were more common in the 2010-2011 season (p=0.005).

Conclusions

The mortality pattern in the 2010-2011 influenza season still resembled the 2009-2010 pandemic season with a peak in relatively young age groups, but concurrently a clear shift toward seasonal patterns was seen, with a peak in mortality in the elderly, i.e. >75 years of age.

A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study

Source: Abstract | A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract (provisional)

 

Background

Physical activity (PA) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior (SB) may be detrimental to children’s health independent of PA. The primary aim of the Transform-Us! study is to determine whether an 18-month, behavioral and environmental intervention in the school and family settings results in higher levels of PA and lower rates of SB among 8-9 year old children compared with usual practice (post-intervention and 12-months follow-up). The secondary aims are to determine the independent and combined effects of PA and SB on children’s cardio-metabolic health risk factors; identify the factors that mediate the success of the intervention; and determine whether the intervention is cost-effective.

Methods

A four-arm cluster-randomized controlled trial (RCT) with a 2×2 factorial design, with schools as the unit of randomization. Twenty schools will be allocated to one of four intervention groups, sedentary behavior (SB-I), physical activity (PA-I), combined SB and PA (SB+PA-I) or current practice control (C), which will be evaluated among approximately 600 children aged 8-9 years in school year 3 living in Melbourne, Australia. All children in year 3 at intervention schools in 2010 (8-9 years) will receive the intervention over an 18-month period with a maintenance ‘booster’ delivered in 2012 and children at all schools will be invited to participate in the evaluation assessments. To maximize the sample and to capture new students arriving at intervention and control schools, recruitment will be on-going up to the post-intervention time point. Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey.

Discussion

To our knowledge, Transform-Us! is the first group RCT to examine the effectiveness of intervention strategies for reducing children’s overall sedentary time, promoting PA and optimizing health outcomes. The integration of consistent strategies and messages to children from teachers and parents in both school and family settings is a critical component of this study, and if shown to be effective, may have a significant impact on educational policies as well as on pedagogical and parenting practices.