ABSTRACT
Objectives: This pragmatic review provides a summary of the recently published economic cost of four preventable diseases in the UK (type 2 diabetes, obesity, myocardial infarction, and stroke). Method(s): A MEDLINE (OvidSP) search strategy was designed to identify UK studies reporting economic costs. The search was restricted to UK papers from 2016 onwards. 1,590 records were screened based on title/. 86 were reviewed for eligibility and 20 included. Result(s): 17 studies were extracted, including retrospective studies preceding 2016 with some overlap between diseases. Comparability was difficult due to the variety of methods and models being used, for example: One diabetes study estimated costs of >3Bn associated with poor glycaemic control, and another estimated costs of 5.6Bn/year for hospital care. Obesity studies estimated incremental per obese person costs compared with the general population and by magnitude of obesity but did not estimate an overall direct and societal cost. Myocardial infarction studies also estimated incremental per patient costs. One study estimated a potential saving of 68Bn to the health and social care system over 25 years if people at high risk of cardiovascular disease were detected and managed. Atrial fibrillation is estimated to cost the UK health system between 8 and 16Bn. A stroke study estimated the annual UK health and social care cost will be 17Bn in 2025, while a 2017 European study estimated the annual direct and societal cost to the UK at 7.5Bn. Conclusion(s): These representative preventable diseases impose strong collective pressure on the healthcare system and are costly. These examples also show that delayed action increases the economic burden. Longer-term care represents a significant burden on a constrained health and social care system which the Covid-19 pandemic has further highlighted as fragile. Action should be taken now against preventable disease to help protect the NHS from future shocks. Copyright © 2022
ABSTRACT
Objective: Social determinants of health (SDOH) contribute to health inequities in pregnancy. The availability, convenience, and timeliness of access to care affects healthcare utilization. The COVID-19 pandemic exposed the need for efficient and widespread implementation of telehealth services. However, expanding telehealth services has changed adherence to maternal fetal medicine (MFM) at a large, urban, Federally Qualified Health Center (FQHC). We describe the utilization of these services and its effect on adherence to MFM visits. Study Design: This is a retrospective, quality improvement project comparing non-adherence to scheduled visits looking at two time frames: 1) Pre-COVID (8/1/2018-2/29/2020) in-person only 2) Post-COVID 1/1/2021-7/31/2022 in-person or virtual. All encounters in MFM at FQHC were included during these periods. In the Post-COVID period, patients had the option for either in-person or virtual visit at the time of scheduling, while in pre-COVID period, in-person visit was the only option. Chi-square was used to compare differences between groups, with p< 0.05 defined as significant. Result(s): A total of 1,607 encounters were included, n=609 in the pre-COVID and n=998 in the post-COVID group. Encounter completion rates differed between the pre-COVID and post-COVID groups (80% vs. 86%, p= 0.001), Table. In the post-COVID group, when telehealth was an alternative option, non-adherence rates were significantly lower in comparison to when telehealth was not an option in the pre-COVID group. However, in the post-COVID group, the non-adherence rate between virtual only or in-person only visits were not significantly different (p=0.178). Conclusion(s): The availability of either in-person or virtual visits improved compliance and access to MFM care in a FQHC. While the option of telehealth services can improve patient compliance with visits, this may exacerbate other disparities due to limited internet services, access to remote devices, or language barriers. Further research is needed to understand how telehealth can be an ongoing solution to overcome the SDOH that create inequity. [Formula presented] [Formula presented] Copyright © 2022
ABSTRACT
The increasing significance of managing or changing habits is evident across a range of pressing contemporary issues: climate change, waste management, travel practices, and crowd control. Assembling and Governing Habits engages with the diverse ways in which habits are governed through the knowledge practices and technologies that have been brought to bear on them. The volume addresses three main concerns. The first focuses on how the habit discourses proposed by a range of disciplines have informed the ways in which different forms of expertise have shaped the ways in which habits have been managed or changed to bring about specific social objectives. The second concerns the ways in which habits are acted on as aspects of infrastructures which constitute the interfaces through which technical systems, human conducts and environments are acted on simultaneously. The third concerns the specific ways in which habit discourses and habit infrastructures are brought together in the regulation of 'city habits': that is, habits which have specific qualities arising out of the specific conditions - the rhythms and densities - of urban life and ones which, in the wake of the COVID-19 pandemic, have been profoundly disrupted. Written in a clear and direct style, the book will appeal to students and scholars with an interest in cultural studies, sociology, cultural geography, history of the sciences, and posthuman studies. © 2021 selection and editorial matter, Tony Bennett, Ben Dibley, Gay Hawkins, Greg Noble;individual chapters, the contributors.
ABSTRACT
Introduction: The re-deployment of anaesthetic trainees to support COVID-19 patients in intensive care, reduced elective surgery and pauses to trainee rotations1 have affected access to training. The 2020 PATRN swift survey examined the impact on UK paediatric anaesthetic training following the first wave of the pandemic. Method: Sixteen questions, designed by the PATRN committee, focussed on trainee experience of paediatric anaesthesia from March-August 2020. Paediatric anaesthesia experience in the UK occurs at all stages with the option for an 'advanced' module. The survey was reviewed by members of the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) Scientific Committee before distribution. Distribution was via email to UK traineesy College Tutors through The Royal College of Anaesthetists (RCOA) and APAGBI trainee members from December 2020March 2021. Results: 90/170 (53%) of respondents were due to complete a paediatric training module, representing all stages of training. Only 23% (n=21) remained working in paediatric anaesthesia, mainly trainees completing higher or advanced modules (n=19). The majority of trainees who experienced disruption with re-deployment was to support adult intensive care (33/69;48%). Most trainees felt they had insufficient paediatric experience for progression of training (37/69;54%) and did not have enough cases to achieve module completion (32/66;48%). This was due to re-deployment or a lack of elective training lists. Conclusion: Paediatric anaesthesia is a 'hands-on' specialty and requires experience for confidence. New annual competency progression outcomes2 have been created to identify missed training due to COVID-19. There will be an impact in the short-term for covering on-call cases and longer term on workforce if training extensions result in delays to completion. Access to training needs to be prioritised, especially for junior trainees most affected by re-deployment. There should be ongoing discussions nationally on how to address these issues.