A “citizens’ jury” of 25 women, assembled this week to provide advice for the drafting of a new leaflet on breast cancer screening, has reached consensus on some of the tricky issues.
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Background and aims: Socioeconomic differences in smoking have been well established. While previous studies have mostly relied on one socioeconomic indicator at a time, this study examined socioeconomic differences in smoking by using several indicators that reflect different dimensions of socioeconomic position. Data and methods: Data derive from Helsinki Health Study baseline surveys conducted among the employees of the City of Helsinki in 2000 and 2001. The data include 6243 respondents aged 40–60 years (response rate 68%). Six socioeconomic indicators were used: education, occupational status, household income per consumption unit, housing tenure, economic difficulties and economic satisfaction. Their associations with current smoking were examined by fitting sequential logistic regression models. Results: All socioeconomic indicators were strongly associated with smoking among both men and women. When the indicators were examined simultaneously their associations with smoking attenuated, especially when education and occupational status were considered together, and when income and housing tenure were introduced into the models already containing education and occupational status. After mutual adjustment for all socioeconomic indicators, housing tenure and economic satisfaction remained associated with smoking in men. In women, all indicators except income and economic difficulties were inversely associated with smoking after adjustments. Conclusions:Smoking was associated with structural, material as well as perceived dimensions of socioeconomic disadvantage. Attempts to reduce smoking among the socioeconomically disadvantaged need to target several dimensions of socioeconomic position.
Despite a growing awareness of patients’ crucial part in contributing to healthcare, the ways by which this can be achieved are still limited. For patients’ innovative power to be efficiently utilised, we strongly believe that patients need to be given a more equal and profitable role in the hea...
Background Despite a wealth of research and policy initiatives, progress in tackling the UK's health inequalities has been limited. This article explores whether there appears to be consensus among researchers about the kinds of policies likely to reduce health inequalities.
Methods Ninety-nine proposals for addressing health inequalities were identified from multiple sources. Forty-one researchers participated in a survey assessing the extent to which they believed each proposal would reduce health inequalities, based on three criteria. The 20 proposals generating most support were employed in a second stage, in which 92 researchers indicated which proposals they felt would have the greatestimpact on reducing health inequalities.
Results Some consensus exists among researchers about the policy approaches likely to reduce UK health inequalities: a more progressive distribution of income/wealth, greater investment in services for deprived communities, plus regulatory policies to limit the impact of lifestyle-behavioural risks. However, researchers' support for proposals varies depending whether they are asked to express their expert opinion or to comment on the strength of the available evidence.
Conclusions When consulting researchers about health inequalities, policymakers need to consider whether they are seeking research-informed expertise or assessments of the available evidence; these questions are likely to yield different responses.
Objective To assess the waste of research related to inadequate methods in trials included in Cochrane reviews and to examine to what extent this waste could be avoided. A secondary objective was to perform a simulation study to re-estimate this avoidable waste if all trials were adequately reported.
Design Methodological review and simulation study.
Data sources Trials included in the meta-analysis of the primary outcome of Cochrane reviews published between April 2012 and March 2013.
Data extraction and synthesis We collected the risk of bias assessment made by the review authors for each trial. For a random sample of 200 trials with at least one domain at high risk of bias, we re-assessed risk of bias and identified all related methodological problems. For each problem, possible adjustments were proposed that were then validated by an expert panel also evaluating their feasibility (easy or not) and cost. Avoidable waste was defined as trials with at least one domain at high risk of bias for which easy adjustments with no or minor cost could change all domains to low risk. In the simulation study, after extrapolating our re-assessment of risk of bias to all trials, we considered each domain rated as unclear risk of bias as missing data and used multiple imputations to determine whether they were at high or low risk.
Results Of 1286 trials from 205 meta-analyses, 556 (43%) had at least one domain at high risk of bias. Among the sample of 200 of these trials, 142 were confirmed as high risk; in these, we identified 25 types of methodological problem. Adjustments were possible in 136 trials (96%). Easy adjustments with no or minor cost could be applied in 71 trials (50%), resulting in 17 trials (12%) changing to low risk for all domains. So the avoidable waste represented 12% (95% CI 7% to 18%) of trials with at least one domain at high risk. After correcting for incomplete reporting, avoidable waste due to inadequate methods was estimated at 42% (95% CI 36% to 49%).
Conclusions An important burden of wasted research is related to inadequate methods. This waste could be partly avoided by simple and inexpensive adjustments.
Via Heather Swift
A 69-year-old woman was diagnosed as having metastatic pancreatic cancer. She had a history of type 2 diabetes mellitus, which was diagnosed 7 years earlier. Initially, her diabetes was controlled by strict adherence to a healthy lifestyle. For example, she had stopped eating ice cream, which...
BOB WACHTER: As the health-care world finally shifts from analog to digital, increasing numbers of patients have access to a patient portal–a site that allows them to schedule appointments, email their physicians, refill medications, and check the results of laboratory studies.
Via Philippe Marchal/Pharma Hub
Background: For the second time a plan to monitor public health and health inequalities in the Netherlands through general practice was put into action: the Second National Survey of General Practice (DNSGP-2, 2001). The first aim of this paper is to describe the general design of DNSGP-2. Secondly, to describe self assessed health inequalities in the Netherlands. Thirdly, to present differences in prevalence of chronic conditions by educational attainment using both self-assessed health and medical records of GPs. Finally, inequalities in 1987 (DNSGP-1) and 2001 will be compared. Methods: Data were collected from 96 (1987) and 104 (2001) general practices. The data include background information on patients collected via a census, approximately 12 000 health interview surveys per time point and more than one million recorded contacts of patients with their GPs in both years. The method of statistical analysis is logistic regression. Results: The analyses shows that the lower educated have significantly higher odds of feeling unhealthy and having chronic conditions in 2001. Diabetes and myocardial infarction (GP data) showed the largest difference in prevalence between educational groups (OR 2.5 and 2.4, self-reported data). The way the data is collected (self-assessment versus GP registration) hardly affects the magnitude of the educational differences in the prevalence of chronic conditions. The pattern of health inequalities across chronic conditions in 1987 and 2001 hardly differs. Diabetes doubled in prevalence and health inequalities were not significant in 1987, but compared to the other conditions were largest in 2001 (OR 1.1 versus 2.5). Conclusion: Health inequalities were shown to be substantial in 2001 and persistent over time. Socio-economic differences were shown to be similar using self-assessed health data and GP data. Hence, a person's educational attainment did not appear to play a part in presenting health problems to the GP.
Your several articles on the theme of 'too much medicine' highlights what I feel to be the cause of many of the crises within the NHS.
Your question is truly fundamental. Who should have the responsibility for directing medical care for the individual patient? Medical triage!
From the foundation of the NHS it was the role of the doctor to detect the presence of illness, its severity, its treatability and prognosis in the context in which the individual presented. A doctor was considered to be the most trained and, more importantly, the most experienced in such diagnosis and gate-keeping. In the great majority of cases this would be a GP. The triage of the health of the society was the role of Medical Officers of Health.
Since the 1970s the numerous NHS reforms ostensibly promoted to better the care of patients have been driven by the mission to better management - - more political and executive power for a wider range of stakeholders. It was much influenced by US business consultants.
Despite protestations at all stages very little evidence of better clinical outcomes for individuals or even cohorts have been proffered to vindicate the reforms.
Instead triage has been diluted and the pathways to care obfuscated by the introduction of other potential sources of advice for concerned patients, relatives and doctors.
Sadly doctors have colluded. Appointments have precluded immediacy of contact for patients; contracts, targets, the restraints on personal judgement and the increasing availability of guidelines, drugs and technology have detracted from value and rewards of bringing clinical experience to bear on individual patients. This and the burden of bureaucracy has brought a demoralised attitude which encourages an acceptance of other incentives.
Society and the new Act seems to imply that medical and social diagnosis can merge. This cannot surely be so. It can only be as doctors define the values of treatments to individuals and populations that they can advise managers as to the best pathway to use the resources the Government supply. This will also hopefully define the very important role of public health physicians.
The articles you have published in conjunction with your editorial appear to show ways forward in line with this view. Such continuing education on definitions --diagnoses-- is the bread and butter of medicine!
Background: E-therapies for depression and anxiety rarely account for lesbian and gay users. This is despite lesbians and gay men being at heightened risk of mood disorders and likely to benefit from having access to tailored self-help resources.
Objective: We sought to determine how e-therapies for depression and anxiety could be improved to address the therapeutic needs of lesbians and gay men.
Methods: We conducted eight focus groups with lesbians and gay men aged 18 years and older. Focus groups were presented with key modules from the popular e-therapy “MoodGYM”. They were asked to evaluate the inclusiveness and relevance of these modules for lesbians and gay men and to think about ways that e-therapies in general could be modified. The focus groups were analyzed qualitatively using a thematic analysis approach to identify major themes.
Results: The focus groups indicated that some but not all aspects of MoodGYM were suitable, and suggested ways of improving e-therapies for lesbian and gay users. Suggestions included avoiding language or examples that assumed or implied users were heterosexual, improving inclusiveness by representing non-heterosexual relationships, providing referrals to specialized support services and addressing stigma-related stress, such as “coming out” and experiences of discrimination and harassment. Focus group participants suggested that dedicated e-therapies for lesbians and gay men should be developed or general e-therapies be made more inclusive by using adaptive logic to deliver content appropriate for a user’s sexual identity.
Conclusions: Findings from this study offer in-depth guidance for developing e-therapies that more effectively address mental health problems among lesbians and gay men.
Socio-economic differentials in mortality are examined using the explanatory framework advanced by the Black Report. The evidence reviewed largely relates to studies carried out in Britain, although data from other European countries and the United States have also been considered. The many possible forms of artefactual distortion of associations between socio-economic status and mortality risk are examined and judged to have little effect; if anything, artefactual factors mean that conventional ideas about the magnitude of socio-economic differentials in mortality are an underestimate. Social selection is also considered to have little effect. Neither intragenerational downward drift nor direct intergenerational selection contribute significantly to the size of the differentials. Indirect selection has yet to be evaluated, although whether ft should be considered as a form of health selection rather than one form of accumulated disadvantage is unclear. Behavioural factors, while making important contributions to mortality risk, do not adequately account for the differences between social groups. Materialist factors, that is differential exposure to physical hazards determined by the distribution of income and opportunity, are an attractive explanatory category, since the persisting (or growing) socio-economic and geographical mortality differentials, seen during a period of broad secular declines in mortality rates, would be the anticipated outcome of their action. However, neither the social processes determining risk exposure nor the mechanisms by which exposures produce disease are well understood. Progress jn this area will depend upon studies which can examine how exposures interact and accumulate over the course of life to produce the observed pattern of mortality risk.
A Canadian paper that weighs the cost of using pre-exposure prophylaxis (PrEP) to prevent HIV infections against the lifetime total cost of one HIV infection finds that, using figures available for Quebec and Ontario provinces, PrEP would be cost-saving under most scenarios, even if the overall lifetime cost of HIV care falls in the future.
Les impacts de la transformation numérique sur les laboratoires pharmaceutiques ont été discutés lors des sixièmes Assises des technologies numériques de santé, organisées le 10 mars à Neuilly-sur-Seine (Hauts-de-Seine) par l'agence Aromates.
Via Philippe Marchal/Pharma Hub, Marie Françoise de Roulhac, Lionel Reichardt / le Pharmageek
How Your Patients Use Social Media
It seems as if healthcare providers have only recently considered using social media to connect with their patients. This might be due to many considerations, not the least of which is protecting patient confidentiality. Social media is a great marketing tool that will help build your practice and help your clients. Learn how your patients are using different social platforms and understand how your practice can reach out.
Growth of Social Media
According to the Pew Research Center, Facebook is the most popular site, (as of September 2014). Facebook is no longer experiencing the growth surge that it did just a few years ago, but the user is engaging with it more than they used to. LinkedIn, Instagram, and Pinterest are seeing significant growth and gaining more popularity among adults who use social media.
Who Is Using Which Platform?
Over 52 percent of adults who go online use two or more social media sites. Around 56 percent of adults 65 and older who are online use Facebook. In the younger crowd, ages 18-29, 53 percent of the ones who go online are on Instagram. When it comes to Pinterest, you will reach more women than men. LinkedIn is growing among the college-educated. Around 50% of the internet users who have higher education backgrounds use it.
Facebook is by far the most popular platform, and it seems to be home base for many people. Around 70 percent of individuals who use check in daily at least once. Just a year ago, that figure was only 63 percent. The number of people who use Facebook hasn’t changed, but how much they use it has. About 36 percent of Twitter users check in daily, but this is a 10 percent drop from last year. LinkedIn has more users, but they are not logging on with more frequency.
Using Social Media as a Tool
As a healthcare provider, you do need to be cautious about how you use social media in your practice. However, when used appropriately and with forethought, it is a good marketing tool. You can also increase your patient’s awareness of health issues that they may forget. A quick reminder to come in a get a flu shot during the season benefits the community and keeps your patients healthy.
Develop a social media strategy and risk management plan now to fully utilize the capability of it, while maintaining the legal requirements for your business. This technology has a place in your marketing plan, but you do need to proceed wisely to get the full benefits. Reach out to your patients and build your practice wisely.
Via Plus91, Andrea Robotti