Spatial Risk Factors for Pillar 1 COVID-19 Excess Cases and Mortality in Rural Eastern England, UK.

Understanding is still developing about spatial risk factors for COVID-19 infection or mortality. This is a secondary analysis of patient records in a confined area of eastern England, covering persons who tested positive for SARS-CoV-2 through end May 2020, including dates of death and residence area. We obtained residence area data on air quality, deprivation levels, care home bed capacity, age distribution, rurality, access to employment centers, and population density. We considered these covariates as risk factors for excess cases and excess deaths in the 28 days after confirmation of positive Covid status relative to the overall case load and death recorded for the study area as a whole. We used the conditional autoregressive Besag-York-Mollie model to investigate the spatial dependency of cases and deaths allowing for a Poisson error structure. Structural equation models were applied to clarify relationships between predictors and outcomes. Excess case counts or excess deaths were both predicted by the percentage of population age 65 years, care home bed capacity and less rurality: older population and more urban areas saw excess cases. Greater deprivation did not correlate with excess case counts but was significantly linked to higher mortality rates after infection. Neither excess cases nor excess deaths were predicted by population density, travel time to local employment centers, or air quality indicators. Only 66% of mortality was explained by locally high case counts. Higher deprivation clearly linked to higher COVID-19 mortality separate from wider community prevalence and other spatial risk factors.

Introduction to and spread of COVID-19-like illness in care homes in Norfolk, UK.

BACKGROUND: Residential care homes for the elderly are important settings for transmission of the SARS-CoV-2 virus that causes COVID-19 disease. METHODS: We undertook secondary analysis of 248 care homes in Norfolk, UK. The dataset counted nurses, care workers and non-care workers, their status (available, absent due to leave or sickness and extra staff needed to address the coronavirus pandemic) and residents (if any) with suspected COVID-19 in the period 6 April to 6 May 2020. Concurrent descriptions of access by the home to personal protection equipment (PPE: gloves, masks, eye protection, aprons and sanitizer) were in the data. PPE access was categorized as (most to least) green, amber or red. We undertook two-stage modelling, first for suspected COVID-19 cases amongst residents and second relating any increases in case counts after introduction to staffing or PPE levels. RESULTS: Counts of non-care workers had strongest relationships (P < 0.05) to introduction of suspected SARS-CoV-2 to the homes. Higher staff levels and more severe PPE shortages were linked to higher case counts (P < 0.05) during the monitoring period. CONCLUSION: Managing aspects of staff interaction with residents and some working practices might reduce ingression to and spread of COVID-19-like illness within care homes.

Glioblastoma in England: 2007-2011.

AIMS: Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumour in adults, with a poor prognosis. Changing treatment paradigms suggest improved outcome, but whole nation data for England is scarce. The aim of this report is to examine the incidence of patients with glioblastoma in England, and to assess the influence of gender, age, geographical region and treatment on outcome. METHODS: A search strategy encompassing all patients coded with GBM and treated from January 2007 to December 2011 was obtained from data linkage between the National Cancer Registration Service and Hospital Episode Statistics for England. RESULTS: There were 10,743 patients coded with GBM in this 5-year period (6451 male, 4292 female), giving an overall national age standardised incidence of 4.64/100,000/year. Incidence increases with age. Median survival overall was 6.1 months. One, 2 and 5-year survivals, were 28.4%, 11.5% and 3.4% respectively. Age stratified median survivals decreased significantly (p<0.0001) with increasing age from 16.2 months for the 20-44 year age group, to 7.9 months for the 45-69 years, and 3.2 months for 70+years. In the maximal treatment subgroup, patients aged up to 69 years had a median survival of 14.9 months. Patients over 60 years were less likely to receive maximal combination treatment but median survival was better with maximal treatment at all ages. CONCLUSIONS: The overall outcome for patients with GBM remains poor. However, aggressive treatment at every age group is associated with extended survival similar to that described in clinical trials.

Evaluation of partnership working in cities in phase IV of the WHO Healthy Cities Network.

An intersectoral partnership for health improvement is a requirement of the WHO European Healthy Cities Network of municipalities. A review was undertaken in 59 cities based on responses to a structured questionnaire covering phase IV of the network (2003-2008). Cities usually combined formal and informal working partnerships in a pattern seen in previous phases. However, these encompassed more sectors than previously and achieved greater degrees of collaborative planning and implementation. Additional WHO technical support and networking in phase IV significantly enhanced collaboration with the urban planning sector. Critical success factors were high-level political commitment and a well-organized Healthy City office. Partnerships remain a successful component of Healthy City working. The core principles, purpose and intellectual rationale for intersectoral partnerships remain valid and fit for purpose. This applied to long-established phase III cities as well as newcomers to phase IV. The network, and in particular the WHO brand, is well regarded and encourages political and organizational engagement and is a source of support and technical expertise. A key challenge is to apply a more rigorous analytical framework and theory-informed approach to reviewing partnership and collaboration parameters.

Positive effect of a targeted intervention to improve access and availability of fruit and vegetables in an area of deprivation.

Increasing fruit and vegetable intake has the potential to prevent chronic disease risk but substantial inequalities in intake exist between advantaged and disadvantaged communities. Access and availability of fruit and vegetables have been shown to be important determinants of intake. The current study aimed to evaluate the effectiveness of a Mobile Food Store intervention to improve access to fruit and vegetables by making cost-price produce available to targeted communities. Postcode mapping identified communities with low fruit and vegetable intake and high chronic disease risk. The Mobile Food Store travelled to these communities each week. Evaluation of self-reported fruit and vegetable intake was collected by validated questionnaire for 255 users (62% response rate). Store use resulted in a significant increase in intake (1.2 portions per day, 95%CI 0.83-1.48; p<0.001) which was greater than all but one previous intervention in the UK. The targeted model of improving access to fruit and vegetables was effective in increasing intake; however future controlled trials are required to objectively examine potential effects on fruit and vegetable intake and health outcomes.

Reliability of using 238U/235U and 234U/238U ratios from alpha spectrometry as qualitative indicators of enriched uranium contamination.

Alpha spectrometry is a commonly used technique for the measurement of uranium isotopes in environmental samples because it is widely available at a relatively low cost. For natural uranium the (234)U to (238)U activity ratio should be 1 and the (238)U to (235)U activity ratio should be 21.7. However, a lower (238)U to (235)U ratio is usually observed in alpha spectrometric analysis of environmental soil samples. This observation has led to the conclusion that soils from nuclear weapons facilities were contaminated with highly enriched uranium. This study was undertaken to test the reliability of using activity ratios from alpha spectrometry to infer the presence of highly enriched uranium in soil samples. The results of these experiments indicate that the (238)U to (235)U activity ratio is not a reliable indicator, but that the (234)U to (238)U activity ratio can be used to qualitatively indicate the presence of highly enriched uranium at concentrations near 10 ng g(-1) and above.