Free eye tests introduced for people over 60 in england and wales
Ontology highlight
ABSTRACT:
SUBMITTER: Pownall M
PROVIDER: S-EPMC1115448 | biostudies-literature | 1999 Apr
REPOSITORIES: biostudies-literature
Publications
Free eye tests introduced for people over 60 in england and wales
BMJ (Clinical research ed.) 19990401 7190
Similar Datasets
Project description:BackgroundHip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.Methods and findingsImplants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing); the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs), costs and risk of repeat (revision) surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index) (9159 linked episodes) and competing risks modelling of implant survival (79,775 procedures). Cost of implants and ancillary equipment were obtained from National Health Service procurement data.ResultsEQ5D score improvements (at 6 months) were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001), when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001) for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003) and resurfacing implants, HR = 3.46, p<0.001), with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524) and highest with cementless implants (£1928 to £4285). Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the duration of data collection), the possibility of revision under-reporting, response bias within PROMs data, and issues associated with current outcome scoring systems, which may not accurately reflect level of improvement in some patients.ConclusionsCement fixation, using a polyethylene cup and a standard sized head offers good outcomes, with the lowest risks and at the lowest costs. The most commonly used cementless and resurfacing implants were associated with higher risk of revision and were more costly, while perceptions of improved function and longevity were unsupported.
| S-EPMC4643061 | biostudies-literature
Project description:BackgroundThe recent World Report on Disability highlighted violence as a leading cause of morbidity among disabled people. However, we know little about the extent to which people with disability experience different violence types, and associated health/economic costs. The recent introduction of disability measures into the England&Wales victimization survey provided an opportunity to address this gap.Methods and findingsAnalysis of the 2009/10 British Crime Survey (BCS), a nationally representative cross-sectional survey of 44,398 adults living in residential households in England&Wales. Using multivariate logistic regression, we estimated the relative odds of being a victim of past-year violence (physical/sexual domestic or non-domestic violence) in people with disability compared to those without, after adjusting for socio-demographics, behavioural and area confounders. 1256/44398(2.4%) participants had one or more disabilities including mental illness ('mental illness') and 7781(13.9%) had one or more disabilities excluding mental illness ('non-mental disability'). Compared with the non-disabled, those with mental illness had adjusted relative odds (aOR) of 3.0(95% confidence interval (CI) 2.3-3.8) and those with non-mental disability had aOR of 1.8(95% CI: 1.5-2.2) of being a victim of past-year violence (with similar relative odds for domestic and non-domestic violence). Disabled victims were more likely to suffer mental ill health as a result of violence than non-disabled victims. The proportion of violence that could be attributed to the independent effect of disability in the general population was 7.5%(CI 5.7-9.3%), at an estimated cost of £1.51 billion. The main study limitation is the exclusion of institutionalised people with disability.ConclusionsPeople with disability are at increased risk of being victims of domestic and non-domestic violence, and of suffering mental ill health when victimized. The related public health and economic burden calls for an urgent assessment of the causes of this violence, and national policies on violence prevention in this vulnerable group.
| S-EPMC3577814 | biostudies-literature
Project description:Child maltreatment is a major public health problem, which is plagued with research challenges. Good epidemiological data can help to establish the nature and scope of past and present child maltreatment, and monitor its progress going forward. However, high quality data sources are currently lacking for England and Wales. We employed systematic methodology to harness pre-existing datasets (including non-digitalised datasets) and develop a rich data source on the incidence of Child maltreatment over Time (iCoverT) in England and Wales. The iCoverT consists of six databases and accompanying data documentation: Child Protection Statistics, Children In Care Statistics, Criminal Statistics, Homicide Index, Mortality Statistics and NSPCC Statistics. Each database is a unique indicator of child maltreatment incidence with 272 data variables in total. The databases span from 1858 to 2016 and therefore extends current data sources by over 80 years. We present a proof-of-principle analysis of a subset of the data to show how time series methods may be used to address key research challenges. This example demonstrates the utility of iCoverT and indicates that it will prove to be a valuable data source for researchers, clinicians and policy-makers concerned with child maltreatment. The iCoverT is freely available at the Open Science Framework (osf.io/cf7mv).
| S-EPMC6110478 | biostudies-literature
Project description:While old age is a known risk factor for developing active tuberculosis (TB), studies on TB in the population aged 60 years and older (considered elderly in this study) are few, especially in the developing world. Results of the TB prevalence survey in Uganda found high TB prevalence (570/100,000) in people over 65. We focused on treatment outcomes in the elderly to understand this epidemic better. We conducted a retrospective analysis of data from TB facility registers in Kampala City for the period 2014-2015. We analyzed the 2014-15 cohort with respect to age, sex, disease class, patients' human immunodeficiency virus (HIV) and directly observed therapy (DOT) status, type of facility, and treatment outcomes and compared findings in the elderly (≥60) and younger (<60) age groups. Of 15,429 records, 3.3% (514/15,429) were for elderly patients. The treatment success rate (TSR) among elderly TB patients (68.3%) was lower than that of the non-elderly (80.9%) and the overall TSR 80.5%, (12,417/15,429) in Kampala. Although the elderly were less likely to test positive for HIV than the young (AOR 0.39; 95% CI 0.33-0.48, p<0.001), they had a two-fold higher risk of unfavorable treatment outcomes (AOR 2.14; CI 1.84-2.72, p<0.001) and were more likely to die while on treatment (AOR 1.86; CI 1.27-2.73; p = 0.001). However, there was no statistically significantly difference between treatment outcomes among HIV-positive and HIV-negative elderly TB patients. Compared to the younger TB patients, elderly TB patients have markedly poorer treatment outcomes, although TB/HIV co-infection rates in this age group are lower.
| S-EPMC6300205 | biostudies-literature
Project description:ObjectivesThe number of deaths occurring in private homes in England and Wales had been rising for years, increasingly rapidly from 2020. Media stories and research linked decomposing bodies found in private homes with pandemic-related social isolation. We aim to explore whether these incidents are one-offs or part of a wider trend.DesignDescriptive analysis of publicly available Office for National Statistics (ONS) data.SettingEngland and Wales.ParticipantsAll residents of England and Wales, 1979 to 2020.Main outcome measuresUsing data from the Office for National Statistics, we calculate European Age Standardised Rates for deaths coded as R98 ('unattended death') and R99 ('other ill-defined and unknown causes of mortality') in the 10th version of the International Classification of Diseases (ICD-10), and the corresponding codes in ICD-9, by sex and age group from 1979 (when ICD-9 began) to 2020. These are proxy markers for deaths where decomposition precludes attribution of a specific cause at postmortem.ResultsWhile mortality from all other causes decreased from 1979 to 2020, the opposite was seen for deaths from R98 and R99 (or 'undefined deaths'), with men more affected than women. There was a sharp rise in these deaths in both sexes but in men particularly in the 1990s and 2000s, coinciding with a time when overall mortality was rapidly improving.ConclusionsThe increase in people found dead from unknown causes suggests wider societal breakdowns of both formal and informal social support networks. They are concerning and warrant urgent further investigation. We call on national and international authorities to consider measures that would make it possible to identify these deaths more easily in routine data.
| S-EPMC11284264 | biostudies-literature
Project description:The purpose of the study was to determine what proportion of new certifications between 1 April 2007 and 31 March 2008 could be attributed to age-related macular degeneration (AMD) and to describe the AMD-certified population in England and Wales.An electronic version of the Certificate of Vision Impairment form (CVI), the ECVI, was used at the certifications office to transfer information from the paper-based certificates into a database. The electronic certifications data set was queried for all certificates completed between 1 April 2007 and 31 March 2008 with the main cause of certifiable visual loss being AMD or with the main cause of certifiable visual loss being multiple pathology but a contributory cause being AMD. The electronic data set was adapted so that a distinction could be made between geographic atrophy (GA) and neovascular AMD (nAMD).The Certifications Office received 23 185 CVIs between April 2007 and March 2008, of whom 9823 (42%) were people registered severely sight impaired (SSI) and 12 607 (52%) were certified as sight impaired (SI). AMD contributed to 13 000 causes of registration on the CVI forms during this period and was the main cause in 11 015 people. In these 11 015 people, GA accounted for 49.3%, nAMD 35.1%, and AMD not specified 15.7%.The data in this report provide detailed information on CVI registration due to AMD before the widespread adoption of ranibizumab therapy in NHS practice and provide an insight into the burden of vision loss due to AMD at a time of great change in the management of nAMD.
| S-EPMC4094800 | biostudies-other
Project description:BackgroundAlthough falls in older adults are related to multiple risk factors, these factors have commonly been studied individually. We aimed to identify risk profiles for injurious falls in older adults by detecting clusters of established risk factors and quantifying their impact on fall risk.MethodsParticipants were 2,566 people, aged 60 years and older, from the population-based Swedish National Study on Aging and Care in Kungsholmen. Injurious falls was defined as hospitalization for or receipt of outpatient care because a fall. Cluster analysis was used to identify aggregation of possible risk factors including chronic diseases, fall-risk increasing drugs (FRIDs), physical and cognitive impairments, and lifestyle-related factors. Associations between the clusters and injurious falls over 3, 5, and 10 years were estimated using flexible parametric survival models.ResultsFive clusters were identified including: a "healthy", a "well-functioning with multimorbidity", a "well-functioning, with multimorbidity and high FRID consumption", a "physically and cognitively impaired", and a "disabled" cluster. The risk of injurious falls for all groups was significantly higher than for the first cluster of healthy individuals in the reference category. Hazard ratios (95% confidence intervals) ranged from 1.71 (1.02-2.66) for the second cluster to 12.67 (7.38-21.75) for the last cluster over 3 years of follow-up. The highest risk was observed in the last two clusters with high burden of physical and cognitive impairments.ConclusionRisk factors for injurious fall tend to aggregate, representing different levels of risk for falls. Our findings can be useful to tailor and prioritize clinical and public health interventions.
| S-EPMC5861922 | biostudies-literature
Project description:English national guidelines regarding dementia assessment and management recommend consideration of cultural and linguistic diversity when assessing people with cognitive complaints. To date there has been no assessment of adherence to these guidelines. We aimed to assess whether current services provided in memory assessment services (MAS) adhere to national policy, in their approach to the assessment and management of individuals with memory problems from minority ethnic backgrounds. We sent a survey to 213 memory services in England and Wales. Twenty MAS from seven regions responded to the survey. We found that 80% (16) provided translated resources, 70% (14) used cognitive assessment tools that are culturally sensitive and appropriate, and 65% (13) showed good use of sufficiently skilled and knowledgeable interpreters. Communication barriers, particularly language, were raised as a potential obstacle to diagnosing minority ethnic patients. Memory clinics appear to reflect national policy for the assessment and management of memory problems in minority ethnic patients. However, only a minority of services responded and they may be more engaged in considering these populations. We need wider knowledge of practice to explore how guidelines support healthcare professional's assessment of patients from minority ethnic groups in memory service diagnostic procedures.
| S-EPMC7913949 | biostudies-literature
Project description:ObjectivesTo identify aspects of the organisation and delivery of acute inpatient services for people with dementia that are associated with shorter length of hospital stay.Design and settingRetrospective cohort study of patients admitted to 200 general hospitals in England and Wales.Participants10 106 people with dementia who took part in the third round of National Audit of Dementia.Main outcome measureLength of admission to hospital.ResultsThe median length of stay was 12 days (IQR=6-23 days). People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission (estimated effect -0.24, 95% CI: -0.29 to -0.18, p<0.001). People from ethnic minorities had shorter length of stay (difference -0.066, 95% CI: -0.13 to -0.002, p=0.043). Patients with documented evidence of discussions having taken place between their carers and medical staff spent longer in hospital (difference 0.26, 95% CI: 0.21 to 0.32, p<0.001). These associations held true in a subsample of 669 patients admitted with hip fracture and data from 74 hospitals with above average carer-rated quality of care.ConclusionsThe way that services for inpatients with dementia are delivered can influence how long they spend in hospital. Initiating discharge planning within the first 24 hours of admission may help reduce the amount of time that people with dementia spend in hospital.
| S-EPMC8527135 | biostudies-literature
Project description:BackgroundLittle is known about people who are admitted to medium secure services (MSSs) from prison, including characteristics and factors that influence clinical pathways and subsequent discharge. We recently published the first study to establish the circumstances by which MSS "prison-transfer" patients are returned to prison. Of particular concern was the finding that a quarter of prison-transfer patients were returned to prison by Responsible Medical Officers (RMOs) because they were not engaging with treatment or were deemed too "high risk" to remain detained within the services, circumstances that would be unacceptable when considering discharge via a community care pathway. It is important to further explore the characteristics of people admitted to MSSs from prison, and to investigate how these may differ for individuals who are returned to prison, as compared to those discharged into the community.Aim(a) To describe the characteristics of prison-transfers who receive an RMO directed discharge from MSSs; and (b) to compare these characteristics by discharge destination; prison return and community discharge.MethodsProspective cohort comparative study: all prison-transfer patients discharged under the instruction of their RMO over a 6-month period, from 33 NHS medium secure units across England and Wales. Data on patient demographic, clinical and legal characteristics were extracted via full patient health record review and collateral information from clinicians was also obtained. This information was used to complete The Historical, Clinical and Risk--20 items (HCR-20v3) and The Structured Assessment of Protective Factors (SAPROF). Individuals who were returned to prison were compared with those who were discharged to the community.ResultsPersons returned to prison represented a vulnerable group at time of discharge as compared to those discharged into the community and had a significantly shorter length of stay in MSSs. Over half of those returned to prison had a length of stay of <6 months. Individuals returned to prison displayed significantly more issues with psychological adjustment at time of discharge, and had a higher risk of future violence and a lower prevalence of protective factors that mitigate subsequent risks of relapse and reoffending.DiscussionMSs in England and Wales are returning vulnerable individuals to prison in lieu of adequate aftercare services. The role of and responsibilities of MSSs as regards admissions from prison needs to be reconsidered.
| S-EPMC9277066 | biostudies-literature