Geographical inequalities in uptake of NHS funded eye examinations: Poisson modelling of small-area data for Essex, UK.

Background: Small-area analysis of National Health Service (NHS)-funded sight test uptake in Leeds showed significant inequalities in access among people aged <16 or ≥60. Methods: Data were extracted from 604 126 valid General Ophthalmic Services (GOS)1 claim forms for eye examinations for Essex residents between October 2013 and July 2015. Expected GOS1 uptake for each lower super output area was based on England annual uptake. Poisson regression modelling explored associations in GOS1 uptake ratio with deprivation. Results: People aged ≥60 or <16 living in the least deprived quintile were 15% and 26%, respectively, more likely to have an NHS funded eye examination than the most deprived quintile, although all are equally entitled. GOS1 uptake is higher in the more deprived quintiles among 16-59-year old, as means tested social benefits are the main eligibility criteria in this age-group. Inequalities were also observed at local authority level. Conclusions: Inequalities in access among people ≥60 years were not as large as those reported in Leeds, although inequalities in <16-year old were similar. However, demonstrable inequalities in this data set over a longer time period and a larger and more diverse area than Leeds, reinforce the argument that interventions are needed to address eye examination uptake inequalities.

Cobalt-induced genotoxicity in male zebrafish (Danio rerio), with implications for reproduction and expression of DNA repair genes.

Although cobalt (Co) is an environmental contaminant of surface waters in both radioactive (e.g. (60)Co) and non-radioactive forms, there is relatively little information about Co toxicity in fishes. The objective of this study was to investigate acute and chronic toxicity of Co in zebrafish, with emphasis on male genotoxicity and implications for reproductive success. The lethal concentration for 50% mortality (LC(50)) in larval zebrafish exposed (96 h) to 0-50 mg l(-1) Co was 35.3 ± 1.1 (95%C.I.) mg l(-1) Co. Adult zebrafish were exposed (13 d) to sub-lethal (0-25 mg l(-1)) Co and allowed to spawn every 4 d and embryos were collected. After 12-d exposure, fertilisation rate was reduced (6% total eggs fertilised, 25 mg l(-1)) and embryo survival to hatching decreased (60% fertilised eggs survived, 25 mg l(-1)). A concentration-dependent increase in DNA strand breaks was detected in sperm from males exposed (13 d) to Co, and DNA damage in sperm returned to control levels after males recovered for 6 d in clean water. Induction of DNA repair genes (rad51, xrcc5, and xrcc6) in testes was complex and not directly related to Co concentration, although there was significant induction in fish exposed to 15 and 25 mg l(-1) Co relative to controls. Induction of 4.0 ± 0.9, 2.5 ± 0.7, and 3.1 ± 0.7-fold change (mean ± S.E.M. for rad51, xrcc5, and xrcc6, respectively) was observed in testes at the highest Co concentration (25 mg l(-1)). Expression of these genes was not altered in offspring (larvae) spawned after 12-d exposure. Chronic exposure to Co resulted in DNA damage in sperm, induction of DNA repair genes in testes, and indications of reduced reproductive success.

Will emergency health care providers respond to mass casualty incidents?

UNLABELLED: Emergency response plans often call on health care providers to respond to the workplace outside of their normal working pattern. HYPOTHESIS: Providers will report to work during a mass casualty emergency regardless of family duties, type of incident, or availability of treatment. METHODS: Survey of emergency personnel needed to respond to a mass casualty incident. Two scenarios were presented: one involving the release of a non-transmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. At critical time points, participants were asked whether they would report to work. Additional questions considered the effect of commonly used treatment dissemination methods. RESULTS: A total of 186 surveys were issued and returned. (45 physicians, 29 nurses, 86 EMS personnel, and 20 support staff); 6 were incomplete and excluded. Initial commitment rates were 78%. The highest commitment rate identified was 84% and the lowest was 18%. Any treatment dissemination method excluding providers' family members led to decreases in commitment rate, as did agents identified to be transmissible. CONCLUSIONS: As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers' family increases commitment to work. These factors should be considered in emergency planning.

Will emergency health care providers respond to mass casualty incidents?

INTRODUCTION: Emergency response plans often call on health care providers to respond to the workplace outside of their normal working pattern. HYPOTHESIS: Providers will report to work during a mass casualty emergency regardless of family duties, type of incident, or availability of treatment. METHODS: Survey of emergency personnel needed to respond to a mass casualty incident. Two scenarios were presented: one involving the release of a nontransmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. At critical time points, participants were asked whether they would report to work. Additional questions considered the effect of commonly used treatment dissemination methods. RESULTS: A total of 186 surveys were issued and returned. (45 physicians, 29 nurses, 86 EMS personnel, and 20 support staff); 6 were incomplete and excluded. Initial commitment rates were 78%. The highest commitment rate identified was 84% and the lowest was 18%. Any treatment dissemination method excluding providers' family members led to decreases in commitment rate, as did agents identified to be transmissible. CONCLUSIONS: As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers' family increases commitment to work. These factors should be considered in emergency planning.

Description and evaluation of a pilot physician-directed emergency medical services diversion control program.

OBJECTIVES: To describe the characteristics and feasibility of a physician-directed ambulance destination-control program to reduce emergency department (ED) overcrowding, as measured by hospital ambulance diversion hours. METHODS: This controlled trial took place in Rochester, New York and included a university hospital and a university-affiliated community hospital. During July 2003, emergency medical services (EMS) providers were asked to call an EMS destination-control physician for patients requesting transport to either hospital. The destination-control physician determined the optimal patient destination by using patient and system variables as well as EMS providers' and patients' input. Program process measures were evaluated to characterize the program. Administrative data were reviewed to compare system characteristics between the intervention program month and a control month. RESULTS: During the intervention month, 2,708 patients were transported to the participating hospitals. EMS providers contacted the destination-control physician for 1,866 (69%) patients. The original destination was changed for 253 (14%) patients. Reasons for redirecting patients included system needs, patient needs, physician affiliation, recent ED or hospital care, patient wishes, and primary care physician wishes. During the intervention month, EMS diversion decreased 190 (41%) hours at the university hospital and 62 (61%) hours at the community hospital, as compared with the control month. CONCLUSIONS: A voluntary, physician-directed destination-control program that directs EMS units to the ED most able to provide appropriate and timely care is feasible. Patients were redirected to maximize continuity of care and optimally use available emergency health care resources. This type of program may be effective in reducing overcrowding.