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At least 55 records · Page 3Linked to original sources
PubMed1999

The London Fibromyalgia Epidemiology Study: direct health care costs of fibromyalgia syndrome in London, Canada.

OBJECTIVE: To estimate direct health care costs associated with fibromyalgia (FM) within a representative community sample. METHODS: A random sample of 3395 noninstitutionalized adults was screened for widespread pain. Individuals screening positive were examined for FM. Direct health care costs were compared among those with confirmed FM (FM cases, FC), those with widespread pain not having FM (pain controls, PC), controls without widespread pain (general controls, GC), and a random sample of age, sex and geographically matched controls from the Ontario Health Insurance Plan database (OHIP controls, OC). RESULTS: One hundred FC (86 women) were compared to 76 PC subjects, 135 GC, and 380 OC. FC used more medications and outpatient health services than PC subjects, and about twice the health services at twice the cost compared to GC and OC. The mean difference in direct costs for health services between FC and OC was $493 Cdn annually (p<0.001). CONCLUSION: FM has a major effect on direct health care costs.

Adult↗
PubMed1993

Is London overbedded?

OBJECTIVE: To examine whether there are too many hospital beds in London. DESIGN: Analysis of data from the Hospital In-Patient Enquiry, Mental Health Enquiry, health service indicators, and Emergency Bed Service. SETTING: England, London, and inner London. RESULTS: Hospital admission rates for acute plus geriatric services for London residents were very similar to the national values in all age groups. In the special case considered in the Tomlinson report--acute services in inner London--the admission rate was 22% above the value for England. However, the admission rate of inner deprived Londoners was 9% below that of comparable areas outside London. For psychiatry, admission rates in London roughly equalled those in comparable areas. When special health authorities were excluded, in 1990-1 there were 4% more acute plus geriatric beds available per resident in London than in England. Bed provision has been reduced more rapidly in London than nationally. Extrapolating the trend of bed closures forward indicates that beds (all and acute) per resident in London are now at about the national average. Data from the Emergency Bed Service indicate that the pressure on available hospital beds in London has been increasing since 1985. CONCLUSIONS: Data regarding bed provision and utilisation for all specialties by London residents do not provide a case for reducing the total hospital bed stock in London at a rate faster than elsewhere. Bed closures should take account of London's relatively poorer social and primary health care circumstances, longer hospital waiting lists, poorer provision of residential homes, and evidence from the Emergency Bed Service of increasing pressure on beds. Higher average costs in London, some unavoidable, are forcing hospital beds to be closed at a faster rate in London than nationally.

Acute Disease↗
PubMed1993

Comparison of attendance and emergency admission patterns at accident and emergency departments in and out of London.

OBJECTIVE: To compare the sociodemographic characteristics, diagnoses, and mode of referral of people and emergency admissions between an accident and emergency department in inner London and one in a town outside London. DESIGN: Standardised questionnaire completed prospectively over two weeks by field-workers in each accident and emergency department. SETTING: Accident and emergency departments in an inner London teaching hospital and an associated teaching hospital outside London. SUBJECTS: 3039 adults newly attending the departments, 1476 in inner London and 1563 outside London. MAIN OUTCOME MEASURES: Sociodemographic characteristics, diagnosis, mode of referral, and whether the patient was admitted. RESULTS: General practitioner referrals accounted for similar proportions of the adult attendances (12% in inner London, 15% outside London). People attending at the inner London department were more likely to be tourists or long distance commuters (12% (179/1476) v 6% (95/1563)), single (43% (643) v 32% (505)), to live alone (24% (360) v 14% (225)), to have moved recently (13% (194) v 7% (107)), or to be homeless (3.3% (48) v 0.6% (10)). Broad clinical groupings of patients were similar in both departments. 291 people were admitted in inner London and 284 outside London. The proportions admitted from each sociodemographic group were similar in the two hospitals. CONCLUSION: Differences in sociodemographic characteristics were more important than general practice referral patterns in determining the differences in people attending at accident and emergency departments inside and outside London. Many of these characteristics are likely to be found in other inner city populations. A strategy to improve acute care in inner London should take account of the needs of these sociodemographically different groups.

Adult↗
PubMed1994

Deaths of cyclists in London 1985-92: the hazards of road traffic.

OBJECTIVE: To determine the characteristics of cyclists and vehicles involved in fatal cycling accidents. DESIGN: Analysis of data routinely collected by police for each accident from January 1985 to December 1992 and held in a national master file (Stats 19) by the Department of Transport. SETTING: Greater London, which comprises inner London (12 boroughs and the City of London) and outer London (20 boroughs). SUBJECTS: 178 cyclists who died (78 in inner London and 100 in outer London; age range 3-88). MAIN OUTCOME MEASURES: Associations between characteristics of cyclists, type of vehicle involved, and place of accident. RESULTS: Motor vehicles were involved in 173 deaths. Heavy goods vehicles were involved in 75 deaths (30/100 (30%) in outer London and 45/78 (58%) in inner London); cars in 74 (54/100) (54%) in outer London and 20/78 (26%) in inner London); light goods vehicles in 12/178 (7%); and buses in 6/178 (3%). Thirty five of the people who died were children aged < or = 16. Female cyclists were especially at risk from heavy goods vehicles in inner London (22 deaths), while male cyclists were especially at risk from cars in outer London (50 deaths). DISCUSSION: Cyclists who died in urban areas are more likely to be adults than children. In inner London, in relation to their traffic volume, heavy goods vehicles are estimated to cause 30 times as many cyclists' deaths as cars and five times as many as buses. Until the factors leading to this excess risk are understood, a ban on heavy goods vehicles in urban areas should be considered.

Accidents, Traffic↗
PubMed2004

The management for tuberculosis control in Greater London in comparison with that in Osaka City: lessons for improvement of TB control management in Osaka City urban setting.

The tuberculosis (TB) notification in Osaka City has been persistently high compared with other urban areas in Japan. Although the TB notification in Greater London has kept much lower level compared with that in Osaka City, it has been also persistently high compared with other urban areas in the UK. Nonetheless, the contexts of the two cities relating TB control programme as well as the epidemiological situation greatly vary; there must be some lessons to be learnt from each other to improve each TB control programme to tackle against TB more effectively. Comparing the epidemiological situation of TB in both cities, it is obvious that Osaka City suffers TB more than Greater London in terms of the TB notification rate. Concerning the context of the TB control programme, Osaka City has centralised approach with strong local government commitment; Greater London, on the other hand, has an approach that is greatly fragmented but coordinated through voluntary TB Networks. This paper aims to draw some constructive and practical lessons from Greater London TB control management for further improvement of Osaka City TB control management through literature review and interview to health professionals. TB epidemiology in Greater London shows distinct features in the extent of TB in new entrants and TB co-infected with HIV in comparison with those in Osaka City. TB epidemiology in Osaka City is to a great extent specifically related to homeless people whereas in Greater London, this relationship occurs to a lesser extent. Both areas have relatively high TB-notification rates compared with national figures, and they have "TB hot spots" where remarkably high TB-notification rates exist. TB control in Greater London is characterised with decentralised and devolved services to local government health authorities supplemented with co-ordinating bodies across sectors as well as across Greater London. Sector-wide TB Network as well as London TB Group (LTBG) and London TB Nurses Network are major key functioning bodies to involve relevant professionals as wide as possible. The specialist TB nurses play key roles for TB case management across Greater London, while in Osaka City, TB control is characterised with strong leadership and commitment of Osaka City Government for the TB control programme. The Osaka City Public Health Centre (PHC) takes initiatives to expand "Cohort Analysis and Case Management Conferences" at each of the 24 Ward Health and Welfare Centres as well as "DOTS Conferences" at hospitals for improvement of case management by physicians and nurses at hospitals as well as by the health centre staff. Public health nurses (PHNs) play very important roles for TB case management as frontline in Osaka City. Comparing the TB control in both cities, the following suggested recommendations are made to both cities for further improvement. Four suggested recommendations to Osaka City are: more resource re-allocation to community-based TB care than to hospital-based TB care should be done; Cohort Analysis and Case Management Conferences should be strengthened through involving more multi-disciplinary sectors; specialist TB PHN at each of the 24 Ward Health and Welfare Centres should be assigned in order to concentrate more on TB control activities; and accessibility to laboratory data such as drug susceptibility test for health centre staff should be improved. Two suggested recommendations to Greater London are: screening for TB high-risk group like homeless people should be strengthened, and regular sector-wide multi-disciplinary case conferences for proper case management should be strengthened.

AIDS-Related Opportunistic Infections↗
PubMed1993

HIV prevalence and HIV risk behaviour among injecting drug users in London and Glasgow.

This paper reports on the British findings from a cross-national study of HIV prevalence and HIV risk behaviour among 1,037 injecting drug users (IDUs) recruited from a variety of treatment- and community-based settings during 1990. Confirmed HIV saliva test results show 12.8% (63) of London respondents and 1.8% (8) of Glasgow respondents to be HIV antibody positive. Among London respondents, a higher rate of prevalence was found in those with no experience of drug treatment. A greater proportion of Glasgow respondents (68%) than London respondents (47%) reported sharing used injecting equipment in the 6 months prior to interview. The majority (88% in both cities) attempted cleaning borrowed equipment, although less than a third (31% in London and 30% in Glasgow) usually used bleach. The majority of respondents (71% in London and 82% in Glasgow) were sexually active with partners of the opposite sex in the last 6 months, and respondents had a mean number of 2.4 non-commercial sexual partners in London and 2.1 in Glasgow. Levels of reported condom use were comparable with reports in the heterosexual population as a whole, with 70% of London respondents and 75% of Glasgow respondents never using condoms with primary partners, and 34% of London and 52% of Glasgow respondents never using condoms with casual partners. Half (48%) of London respondents and 42% of Glasgow respondents reported sexual intercourse with non-injecting private sexual partners, while 14% of female respondents in London and 22% in Glasgow had engaged in prostitution. Levels of risk-taking in each of the two cities indicate the potential for further transmission of HIV among drug injectors, and their sexual and sharing partners.

Adult↗
PubMed2006

Police deaths in New York and London during the twentieth century.

OBJECTIVES: To describe the incidences and causes of occupational police deaths in New York City in the United States and Greater London in the United Kingdom during the twentieth century. To assess the relation between overall societal violence and violence directed toward police officers in these metropolitan areas. DESIGN AND SETTING: Ecological study of New York and London from 1900 through 1999. MAIN OUTCOME MEASURES: Intentional and unintentional occupational police mortality rates for New York and London were estimated for each decade. The general population homicide rates of both New York and London were assessed for their correlation with their respective intentional occupational police mortality rates. RESULTS: During the 20th century, 585 police officers in New York and 160 police officers in London died while participating in law enforcement activities. New York had markedly greater intentional police mortality rates compared to London throughout most of the 20th century, but these differences decreased significantly by the end of the century. Intentional gunshot wounds comprised 290 police deaths in New York, but only 14 police deaths in London. In New York, gun shot wounds (both intentional and unintentional) accounted for more occupational police deaths (51.6%) than did all other injury mechanisms combined. In London, motor vehicle collision was the most common cause (47.5%) of occupational police death. There were no apparent correlations between the general population homicide rates and intentional police mortality rates in either New York (r(2) = 0.05, 95% CI -0.77 to 0.81) or London (r(2) = 0.34, 95% CI -0.61 to 0.89). CONCLUSIONS: During the 20th century, both intentional and unintentional occupational police mortality rates were significantly greater in New York compared to London. These differences are likely from several socioeconomic, cultural, and occupational factors. The declines in police deaths in New York during the latter part of the 20th century indicate that at least some measures taken by the New York Police Department have been successful at significantly reducing the incidence of both intentional and unintentional police deaths.

Accidents, Occupational↗