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1.
Environ Pollut ; : 123871, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38729507

RESUMO

Poor air quality is the largest environmental health risk in England. In the West Midlands, UK, ∼2.9 million people are affected by air pollution with an average loss in life expectancy of up to 6 months. The 2021 Environment Act established a legal framework for local authorities in England to develop regional air quality plans, generating a policy need for predictive environmental impact assessment tools. In this context, we developed a novel Air Quality Lifecourse Assessment Tool (AQ-LAT) to estimate electoral ward-level impacts of PM2.5 and NO2 exposure on outcomes of interest to local authorities, namely morbidity (asthma, coronary heart disease (CHD), stroke, lung cancer), mortality, and associated healthcare costs. We apply the Tool to assess the health economic burden of air pollutant exposure and estimate benefits that would be generated by meeting WHO 2021 Global Air Quality Guidelines (AQGs) (annual average concentrations) for NO2 (10 µg/m3) and PM2.5 (5 µg/m3) in the West Midlands Combined Authority Area. All West Midlands residents live in areas which exceed WHO AQGs, with 2070 deaths, 2070 asthma diagnoses, 770 CHD diagnoses, 170 lung cancers and 650 strokes attributable to air pollution exposure annually. Reducing PM2.5 and NO2 concentrations to WHO AQGs would save 10,700 lives reducing regional mortality by 1.8%, gaining 92,000 quality-adjusted life years (QALYs), and preventing 20,500 asthma, 7400 CHD, 1400 lung cancer, and 5700 stroke diagnoses, with economic benefits of £3.2 billion over 20 years. Significantly, we estimate 30% of QALY gains relate to reduced disease burden. The AQ-LAT has major potential to be replicated across local authorities in England and applied to inform regional investment decisions.

3.
BMJ ; 337: a1720, 2008 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-18829640

RESUMO

OBJECTIVE: To identify major concerns of national and local importance in the provision, commissioning, research, and use of generalist end of life care. DESIGN: A national consultation and prioritising exercise using a modified form of the nominal group technique. PARTICIPANTS: Healthcare practitioners, commissioners, academics, and representatives of user and voluntary groups. SETTING: Primary and secondary care, specialist palliative care, and academic and voluntary sectors in England and Scotland. RESULTS: 74% of those invited (210/285) participated. The stage of life to which "end of life care" referred was not understood in a uniform way. Perceptions ranged from a period of more than a year to the last few days of life. Prominent concerns included difficulties in prognosis and the availability of adequate support for patients with advanced non-malignant disease. Generalists in both primary and secondary care were usually caring for only a few patients approaching the end of life at any one time at a point in time. It was therefore challenging to maintain skills and expertise particularly as educational opportunities were often limited. End of life care took place among many other competing and incentivised activities for general practitioners in the community. More needs to be known about models of end of life care and how these can be integrated in a generalist's workload. A greater evidence base is needed about the effectiveness and application of current tools such as the gold standards framework and Liverpool care pathway and about models of palliation in patients with diseases other than cancer. CONCLUSIONS: Definitions of end of life care need clarification and standardisation. A greater evidence base is needed to define models of good practice together with a commitment to provide education and training and adequate resources for service provision. More needs to be known about the context of provision and the influence of competing priorities and incentives.


Assuntos
Medicina de Família e Comunidade/normas , Cuidados Paliativos/normas , Assistência Terminal/normas , Atitude do Pessoal de Saúde , Competência Clínica/normas , Consenso , Inglaterra , Processos Grupais , Acessibilidade aos Serviços de Saúde , Humanos , Relações Interprofissionais , Avaliação de Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente , Lealdade ao Trabalho , Escócia
8.
Health Serv J ; 112(5796): 24-7, 2002 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-11915404

RESUMO

At present, NHS managers are highly constrained, suffering excessive regulation and central control. More autonomy for trusts would mean fewer directives and less performance management. Giving trusts a new organisational form, such as a public interest company or foundation hospital, might be reinvigorating and would not involve further reorganisation. These new freedoms should be accompanied by new accountabilities, not solely to politicians but to independent NHS regulators, local communities and patients. Devolved power and greater patient choice could produce a more responsive NHS. Its potential needs to be explored through experimentation and evaluation.


Assuntos
Planejamento em Saúde Comunitária/organização & administração , Tomada de Decisões Gerenciais , Liderança , Política , Medicina Estatal/organização & administração , Empreendedorismo , Hospitais Públicos/organização & administração , Humanos , Inovação Organizacional , Responsabilidade Social , Reino Unido
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