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91.
Nicola Barghout BDS MS Yousef Khader BDS MSc MSPH MHPE FFPH ScD Hayder Alwaeli BDS MS 《Journal of evaluation in clinical practice》2010,16(5):976-980
Objectives To assess Jordanian doctors' knowledge of the connection between diabetes and oral health and assess their willingness to advise their diabetic patients to seek dental treatment and determine the associated factors. Methods Data were collected from 164 doctors practising in Jordan using a structured questionnaire. Chi‐squared test and regression analyses were conducted to reveal factors influencing the awareness, perception and knowledge of health care professionals regarding diabetes and oral health. Results Of the respondents, 70% had heard of the link between diabetes and oral health. The majority agreed that diabetes increased the tendency to have periodontitis but only half advised their diabetic patients to consult a dentist concerning their oral health. Only a third of doctors agreed that oral health was an issue in controlling diabetes. Books, magazines and pamphlets were the main source of information with the rate of 58%, medical journals and medical curriculum were the second and third sources, respectively. General medical practitioners were less informed than specialized doctors about the relationship between oral health and diabetes. Factors that significantly predicted doctors would advise dental visits were: (1) being a specialist (P = 0.037); (2) having positive knowledge about the association between diabetes and oral health (P = 0.02, P = 0.007 and P = 0.004, respectively). Conclusion There is limited knowledge of the relationships between oral health and diabetes. The more knowledgeable doctors are, the more likely they are to make dental referrals. Screening and referral by health professionals may benefit diabetic patients by improving access to dental care. Therefore, there is a need to educate doctors about oral health and diabetes. 相似文献
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David Evans BA MA DPhil FFPH RGN Jane Powell BSc MSc PhD PG Cert ILTM † Tanya Cross MSc MBChB MFPH MRCPCH ‡ 《Health expectations》2008,11(3):304-316
Objective To assess the extent national standards for Patient Advice and Liaison Services (PALS) were achieved across England.
Context PALS are an important element of patient and public involvement strategy in England. Seven national standards for PALS were identified. Previous research has not assessed PALS across all trust types in England.
Design Audit survey as part of a mixed method 'realistic evaluation' in which regularities of context, mechanism and outcome are hypothesized and tested.
Setting and participants PALS based in 570 NHS trusts in England between October and December 2005.
Main outcome measures Self reported achievement against PALS national standards.
Results Three hundred and thirty-six valid responses were received, a response rate of 65%. However because some PALS serve more than one trust, this represents an estimated 76% of trusts. Overall, PALS rated themselves highly against all the standards, though somewhat less highly against standard 2 (seamlessness across health and social care) and standard 6 (acting as a catalyst for culture change). There was a wide range of responses with regard to PALS budget, staffing and activity levels, and statistically significant associations between levels of funding and staffing and higher levels of performance.
Conclusions The overall response rate was good so there can be a high degree of confidence in the reliability of the results. The results indicate the challenging context in which PALS are operating. Although the majority of PALS are single trust PALS, there is a high degree of variation in key mechanism factors such as budget and staffing. 相似文献
Context PALS are an important element of patient and public involvement strategy in England. Seven national standards for PALS were identified. Previous research has not assessed PALS across all trust types in England.
Design Audit survey as part of a mixed method 'realistic evaluation' in which regularities of context, mechanism and outcome are hypothesized and tested.
Setting and participants PALS based in 570 NHS trusts in England between October and December 2005.
Main outcome measures Self reported achievement against PALS national standards.
Results Three hundred and thirty-six valid responses were received, a response rate of 65%. However because some PALS serve more than one trust, this represents an estimated 76% of trusts. Overall, PALS rated themselves highly against all the standards, though somewhat less highly against standard 2 (seamlessness across health and social care) and standard 6 (acting as a catalyst for culture change). There was a wide range of responses with regard to PALS budget, staffing and activity levels, and statistically significant associations between levels of funding and staffing and higher levels of performance.
Conclusions The overall response rate was good so there can be a high degree of confidence in the reliability of the results. The results indicate the challenging context in which PALS are operating. Although the majority of PALS are single trust PALS, there is a high degree of variation in key mechanism factors such as budget and staffing. 相似文献
94.
Klim McPherson PhD FFPH FMedSci Aleks Herbert MSc † rew Judge BSc MSc † Aileen Clarke MD MRCGP FFPH ‡ Stephen Bridgman MBChB MD FRCS MPH MFPHM § Michael Maresh BSc MD FRCOG ¶ Chris Overton MB ChB Liverpool MRCOG 《Health expectations》2005,8(3):234-243
BACKGROUND: We report a population-based comparison of psychosexual health 5 years after contrasting amounts of surgical treatments for heavy periods [dysfunctional uterine bleeding (DUB)]. Women's fears about sexual function after hysterectomy might not be unfounded. The psychosexual problems may return and/or develop with time. The removal of ovaries at the time of hysterectomy is associated with greater deterioration of self-reported sexual function. Surgical menopause significantly impairs sexual wellbeing. We failed to observe uniform beneficial effects of hormone replacement therapy (HRT) on reported psychosexual health. OBJECTIVE: To compare self-reported bothersome sexual function; loss of interest in sex, difficulty in becoming sexually excited and vaginal dryness 5 years after surgical management of DUB [transcervical endometrial resection/ablation (TCRE) or subtotal and total hysterectomy, with and without prophylactic bilateral oophorectomy (BO)]. DESIGN: Prospective cohort study up to 5 years post-surgery for DUB, TCRE or hysterectomy, with or without BO. SETTING: Over 400 NHS and private hospitals in England, Northern Ireland and Wales. COHORT: Of 11,325 women who responded to the 5-year questionnaire, over 9500 (84%) were valid cases, and over 8900 (94%) did complete the questions relating to psychosexual function. Most were between the ages of 39 and 45 years, married or cohabiting. MAIN OUTCOMES: Self-reported experience of bother, recorded as 'some', 'severe' and 'extreme', to questions on (1) libido loss, (2) difficulty with sexual arousal, and (3) vaginal dryness during the past 4 weeks, 5 years after surgery. RESULTS: Five years after surgery for DUB, the crude and adjusted prevalence of psychosexual problems was higher after hysterectomy than after TCRE. Amongst the women with concurrent BO, the age- and HRT-adjusted odds ratios for extreme psychosexual problems were increased by 80% (libido loss), 82% (difficult sex arousal) and 69% (vaginal dryness) compared with TCRE. CONCLUSIONS: Five years after hysterectomy more women reported having bothersome psychosexual function than did the women who had a less invasive operation. Hormone therapy, although related to surgical method, did not reduce this long-term detrimental effect. The odds were particularly high amongst women with concurrent BO. Women should be advised that they might be at higher risk of psychosexual problems following hysterectomy, compared with a less invasive procedure. 相似文献
95.
Martin Hoyle PhD Colin Green PhD Jo Thompson-Coon PhD Zulian Liu BA Karen Welch BA Tiffany Moxham MSc Ken Stein MRCGP FFPH PhD 《Value in health》2010,13(1):55-60
Objectives: To estimate the cost-effectiveness of sorafenib (Nexavar, Bayer, Leverkusen, Germany) versus best supportive care (BSC) for second-line treatment of advanced renal cell carcinoma from the perspective of the UK National Health Service.
Methods: A decision analytic model was developed to estimate the cost-effectiveness of sorafenib. The clinical effectiveness of sorafenib versus BSC was taken from a recent randomized phase III trial. Utility values were taken from a phase II trial of sunitinib, using EQ-5D tariffs. Cost data were obtained from published literature and were based on current UK practice. The effect of parameter uncertainty on cost-effectiveness was explored through extensive one-way and probabilistic sensitivity analyses.
Results: Compared to BSC, sorafenib treatment resulted in an incremental cost per quality-adjusted life year (QALY) gained of £75,398, based on an estimated mean gain of 0.27 QALYs per patient, at a mean additional cost of £20,063 (inflated to 2007/2008). The probability that sorafenib is cost-effective compared to BSC at a willingness to pay threshold of £30,000 per QALY is 0.0%. In sensitivity analysis, estimates of cost per QALY were sensitive to changes in the clinical effectiveness parameters, and to health state utilities and drug costs.
Conclusions: Sorafenib has been shown to be clinically effective compared to BSC, offering additional health benefits; however, with a cost per QALY in excess of £70,000, it may not be regarded as a cost-effective use of resources in some health-care settings. 相似文献
Methods: A decision analytic model was developed to estimate the cost-effectiveness of sorafenib. The clinical effectiveness of sorafenib versus BSC was taken from a recent randomized phase III trial. Utility values were taken from a phase II trial of sunitinib, using EQ-5D tariffs. Cost data were obtained from published literature and were based on current UK practice. The effect of parameter uncertainty on cost-effectiveness was explored through extensive one-way and probabilistic sensitivity analyses.
Results: Compared to BSC, sorafenib treatment resulted in an incremental cost per quality-adjusted life year (QALY) gained of £75,398, based on an estimated mean gain of 0.27 QALYs per patient, at a mean additional cost of £20,063 (inflated to 2007/2008). The probability that sorafenib is cost-effective compared to BSC at a willingness to pay threshold of £30,000 per QALY is 0.0%. In sensitivity analysis, estimates of cost per QALY were sensitive to changes in the clinical effectiveness parameters, and to health state utilities and drug costs.
Conclusions: Sorafenib has been shown to be clinically effective compared to BSC, offering additional health benefits; however, with a cost per QALY in excess of £70,000, it may not be regarded as a cost-effective use of resources in some health-care settings. 相似文献
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Jennifer Hollowell PhD Mike P. W. Grocott MRCP FRCA Rebecca Hardy PhD Fares S. Haddad MCh FRCS Monty G. Mythen MD FRCA Rosalind Raine MBBS PhD FFPH 《Journal of evaluation in clinical practice》2010,16(3):529-538
Background Patient deprivation is associated with greater need for total hip and knee replacement surgery (THR/TKR) and a higher prevalence of risk factors for surgical complications. Our aim was to examine associations between deprivation and aspects of the inpatient episode for patients undergoing these procedures. Methods We analysed socioeconomic variations in preoperative surgical risk, postoperative morbidity and length of stay for 655 patients undergoing elective THR/TKR at a large metropolitan hospital. Surgical risk was assessed using the orthopaedic version of the POSSUM scoring system, postoperative morbidity was assessed using the postoperative morbidity survey, and socioeconomic status was measured using the Index of Multiple Deprivation. We adjusted for age, sex, surgical site and primary vs. revision surgery. Results We found only a modest, clinically insignificant socioeconomic gradient in preoperative surgical risk and no socioeconomic gradient in postoperative morbidity. There was a strong socioeconomic gradient in length of stay, but only for patients undergoing TKR. This was due to deprived patients being more likely to remain in hospital without morbidity following TKR. Conclusions Our findings suggest differential selection of healthier patients for surgery. Hospitals serving deprived communities may have excess, unfunded costs because of the increased length of stay of socioeconomically disadvantaged patients. 相似文献
98.
Abstract
Background
There is intense political interest in retaining older workers in the workforce, to fund lengthening retirements. While health is important in early exit from work, the health of early retirees has been little studied.
Objective
The aim of this study was to compare the health status of economically active 50- to 64-year-olds with economically inactive former workers (termed early retirees).
Methods
A total of 1,875 respondents to the 2000 Psychiatric Morbidity Survey of Great Britain were included in the analysis. Current common mental (neurotic) disorder presence was based on the revised Clinical Interview Schedule (CIS-R).
Results
Results In all, 71.2% of men and 66.4% of women early retirees reported having a long-standing illness. Of early retired men, 22.2% have a common mental disorder compared to 8.2% of those still in work (p value of difference <0.001). In contrast, the respective figures for women were 18.2% and 16.9%. In fully adjusted regression models for men, early retirees were more likely to have generalised anxiety disorders (OR 3.1: 95% CI: 1.2–7.8) and depressive disorders (OR 4.3: 95% CI: 1.7–11.0).
Conclusion
There is a substantial burden of specific mental health disorders in early retiree men. Understanding the mechanisms of this excess of mental disorders in early retiree men may be a prerequisite to increasing the numbers seeking or staying in work up to age 65. 相似文献
99.
The contribution of a negative colorectal screening test result to symptom appraisal and help‐seeking behaviour among patients subsequently diagnosed with an interval colorectal cancer 下载免费PDF全文
Karen N Barnett PhD Project Researcher David Weller PhD Co‐Investigator Steve Smith PhD Robert JC Steele PhD Peter Vedsted PhD Sheina Orbell PhD Sue M Moss PhD Jane W Melia PhD Julietta Patnick FFPH Christine Campbell PhD Corresponding author 《Health expectations》2018,21(4):764-773
Background
Colorectal cancer (CRC) screening programmes using a guaiac faecal occult blood test (gFOBt) reduce CRC mortality. Interval cancers are diagnosed between screening rounds: reassurance from a negative gFOBt has the potential to influence the pathway to diagnosis of an interval colorectal cancer.Methods
Twenty‐six semi‐structured face‐to‐face interviews were carried out in Scotland and England, with individuals diagnosed with an interval colorectal cancer following a negative gFOBt result.Results
Participants reported they were reassured by a negative gFOBt, interpreting their result as an “all clear”. Therefore, most did not suspect cancer as a possible cause of symptoms and many did not recall their screening result during symptom appraisal. Among those who did consider cancer, and did think about their screening test result, reassurance from a negative gFOBt led some to “downplay” the seriousness of their symptoms with some interviewees explicitly stating that their negative test result contributed to a delayed decision to seek help.Conclusion
Screening participants need to be informed of the limitations of screening and the ongoing risk of developing colorectal cancer even when in receipt of a negative result: the importance of minimizing delay in seeking medical advice for colorectal symptoms should be emphasized. 相似文献100.
Vincent C. H. Chung BCM PhD Polly H. X. Ma MPH Chun Hong Lau MSSc PhD Samuel Y. S. Wong MPH MD Eng Kiong Yeoh MBBS FHKAM Sian M. Griffiths MB BChir FFPH 《Health expectations》2014,17(5):622-636