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Mortality Attributable to Influenza in England and Wales Prior to, during and after the 2009 Pandemic  [PDF]
Helen K. Green, Nick Andrews, Douglas Fleming, Maria Zambon, Richard Pebody
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079360
Abstract: Very different influenza seasons have been observed from 2008/09–2011/12 in England and Wales, with the reported burden varying overall and by age group. The objective of this study was to estimate the impact of influenza on all-cause and cause-specific mortality during this period. Age-specific generalised linear regression models fitted with an identity link were developed, modelling weekly influenza activity through multiplying clinical influenza-like illness consultation rates with proportion of samples positive for influenza A or B. To adjust for confounding factors, a similar activity indicator was calculated for Respiratory Syncytial Virus. Extreme temperature and seasonal trend were controlled for. Following a severe influenza season in 2008/09 in 65+yr olds (estimated excess of 13,058 influenza A all-cause deaths), attributed all-cause mortality was not significant during the 2009 pandemic in this age group and comparatively low levels of influenza A mortality were seen in post-pandemic seasons. The age shift of the burden of seasonal influenza from the elderly to young adults during the pandemic continued into 2010/11; a comparatively larger impact was seen with the same circulating A(H1N1)pdm09 strain, with the burden of influenza A all-cause excess mortality in 15–64 yr olds the largest reported during 2008/09–2011/12 (436 deaths in 15–44 yr olds and 1,274 in 45–64 yr olds). On average, 76% of seasonal influenza A all-age attributable deaths had a cardiovascular or respiratory cause recorded (average of 5,849 influenza A deaths per season), with nearly a quarter reported for other causes (average of 1,770 influenza A deaths per season), highlighting the importance of all-cause as well as cause-specific estimates. No significant influenza B attributable mortality was detected by season, cause or age group. This analysis forms part of the preparatory work to establish a routine mortality monitoring system ahead of introduction of the UK universal childhood seasonal influenza vaccination programme in 2013/14.
Influenza A (H1N1) 2009 Antibodies in Residents of New South Wales, Australia, after the First Pandemic Wave in the 2009 Southern Hemisphere Winter  [PDF]
Gwendolyn L. Gilbert,Michelle A. Cretikos,Linda Hueston,George Doukas,Brian O'Toole,Dominic E. Dwyer
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0012562
Abstract: The first wave of pandemic influenza A(H1N1)2009 (pH1N1) reached New South Wales (NSW), Australia in May 2009, and led to high rates of influenza-related hospital admission of infants and young to middle-aged adults, but no increase in influenza-related or all-cause mortality.
A new stochastic differential equation modelling incidence and prevalence with an application to systemic lupus erythematosus in England and Wales, 1995  [PDF]
Ralph Brinks
Quantitative Biology , 2012,
Abstract: This article reformulates a common illness-death model in terms of a new system of stochastical differential equations (SDEs). The SDEs are used to estimate epidemiological characteristics and burden of systemic lupus erythematosus in England and Wales in 1995.
The traditional commons of England and Wales in the twenty-first century: meeting new and old challenges  [cached]
Chris Short
International Journal of the Commons , 2008,
Abstract: The commons literature makes much of the changes within the traditional land use sectors of developed countries. This largely focuses on the decline of the economic function of commons that threaten their existence, the emergence of multiple use patterns, and the resilience and policy adaptation needed to continue. The situation in England and Wales is used to illustrate that commons are increasingly important to a number of ‘new’ rural functions and that the associated policy developments may hold an important message for progress towards sustainable multifunctional land management more generally. This article reviews and updates what is meant by the term common land within England and Wales, while outlining its current importance and threats. The commons literature is investigated to see if the approach is useful in revealing the current issues associated with the incorporation of new stakeholders and functions within a traditional structure. Recent changes and developments surrounding the Commons Act 2006 are assessed to see if they are likely to assist in sustaining these commons through the twenty-first century. The article argues that any new approach requires long term planning and a commitment to support local participation among commoners and others who are involved in the governance and management of these areas of land. In order for these challenges to be met there needs to be an understanding of the functions and cultural traditions of common land as well as of the changes in society associated with the decline in traditional agrarian management in developed countries. Such challenges can rarely if ever be achieved through legislation and policy developments, requiring an investment in developing locally based solutions.
Transformation from “Carbon Valley” to a “Post-Carbon Society” in a Climate Change Hot Spot: the Coalfields of the Hunter Valley, New South Wales, Australia
Geoffrey R. Evans
Ecology and Society , 2008,
Abstract: This paper examines the possibilities for transformation of a climate-change hot spot—the coal-producing Hunter Region of New South Wales, Australia—using complex adaptive systems (CAS) theory. It uses CAS theory to understand the role of coal in the region’s history and efforts to strengthen the ecological, economic, and social resilience of the region’s coal industry in the face of demands for a shift from fossil fuel dependency to clean, renewable energy and genuine resilience and sustainability. It uses CAS theory to understand ways in which the resilience of two alternative futures, labeled “Carbon Valley” and “Post-Carbon Society” (Heinberg 2004), might evolve. The paper discusses ways in which changes implemented through the efforts of local communities at local, smaller scales of the nested systems seek to influence the evolution of adaptive cycles of the system at the local, national, and global scales. It identifies the influences of “attractors,” defined as factors driving the evolution of the system, that are influential across the panarchy. These include climate change threats, markets, regulatory regimes, political alliances, and local concerns about the environmental and social impacts of the Hunter’s coal dependency. These factors are weakening the apparent resilience of the coal industry, which is being propped up by the coal industry corporations, labor unions, and governments to maintain coal dependency in the Carbon Valley. Moreover, they are creating an alternative basin of attraction in which a Post-Carbon Society might emerge from the system’s evolutionary processes.
England's new Mental Health Act represents law catching up with science: a commentary on Peter Lepping's ethical analysis of the new mental health legislation in England and Wales
Anthony Maden
Philosophy, Ethics, and Humanities in Medicine , 2007, DOI: 10.1186/1747-5341-2-16
Abstract: This approach is essentially nostalgic and fails to do justice to progress in mental health care. Lepping attributes his premises, including "the failure of community care, the need for new legislation and new community treatment realities", to the Department of Health in 1998 [1] But it is only possible to understand these concerns if one looks a little further back at their context, and 1983 is the logical place to start because that was when our present Mental Health Act came into force.A few years later, psychiatry discovered violence. Doctors in 1983 believed there was no link between mental illness and violence [2] but they were proven wrong. A significant positive association between schizophrenia and violence is now well established [3-5] and services have had to adapt to a risk that was unknown 25 years ago.As ethical concerns go, the association of violence with mental illness – and, in some cases, with inadequate medical treatment – is a Big One. It is extremely rare for medical treatment ever to present a risk to a third party so, when it does present such a risk, we should not be surprised that the public finds it unacceptable. The general principle is that individuals readily tolerate risks for which they volunteer, and when they are counterbalanced by pleasure or other benefit; they do not tolerate risks imposed upon them without their consent, particularly when there is no counterbalancing benefit.Homicides by the mentally ill account for 5–10% of all killings in England and Wales. Whilst they are not increasing [6] neither are they falling, and recent research shows that non-compliance with treatment in the community is an important cause of such tragedies [7]. About half of all patients with schizophrenia discontinue medication within twelve months, and discontinuance is more likely in patients with other risk factors for violence, including personality disorder and substance misuse. The best that professionals can do under the 1983 law is sometime
A new fetal RHD genotyping test: Costs and benefits of mass testing to target antenatal anti-D prophylaxis in England and Wales
Ala Szczepura, Leeza Osipenko, Karoline Freeman
BMC Pregnancy and Childbirth , 2011, DOI: 10.1186/1471-2393-11-5
Abstract: We conducted an economic analysis of NIPD implementation in England and Wales. Two scenarios were considered. Scenario 1 assumed that NIPD will be only used to target antenatal prophylaxis with serology tests continuing to direct post-delivery prophylaxis. In Scenario 2, NIPD would also displace postnatal serology testing if an RhD negative fetus was identified. Costs were estimated from the provider's perspective for both scenarios together with a threshold royalty fee per test. Incremental costs were compared with clinical implications.The basic cost of an NIPD in-house test is £16.25 per sample (excluding royalty fee). The two-dose antenatal prophylaxis policy recommended by NICE is estimated to cost the NHS £3.37 million each year. The estimated threshold royalty fee is £2.18 and £8.83 for Scenarios 1 and 2 respectively. At a £2.00 royalty fee, mass NIPD testing would produce no saving for Scenario 1 and £507,154 per annum for Scenario 2. Incremental cost-effectiveness analysis indicates that, at a test sensitivity of 99.7% and this royalty fee, NIPD testing in Scenario 2 will generate one additional sensitisation for every £9,190 saved. If a single-dose prophylaxis policy were implemented nationally, as recently recommended by NICE, Scenario 2 savings would fall.Currently, NIPD testing to target anti-D prophylaxis is unlikely to be sufficiently cost-effective to warrant its large scale introduction in England and Wales. Only minor savings are calculated and, balanced against this, the predicted increase in maternal sensitisations may be unacceptably high. Reliability of NIPD assays still needs to be demonstrated rigorously in different ethnic minority populations. First trimester testing is unlikely to alter this picture significantly although other emerging technologies may.In white Caucasian populations about 10% of all pregnancies involve a mother with rhesus (Rh) D negative blood group and an RhD positive fetus, potentially placing the mother at risk of sen
Primary scene responses by Helicopter Emergency Medical Services in New South Wales Australia 2008–2009
Taylor Colman B,Liu Bette,Bruce Eleanor,Burns Brian
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-402
Abstract: Background Despite numerous studies evaluating the benefits of Helicopter Emergency Medical Services (HEMS) in primary scene responses, little information exists on the scope of HEMS activities in Australia. We describe HEMS primary scene responses with respect to the time taken, the distances travelled relative to the closest designated trauma hospital and the receiving hospital; as well as the clinical characteristics of patients attended. Methods Clinical service data were retrospectively obtained from three HEMS in New South Wales between July 2008 and June 2009. All available primary scene response data were extracted and examined. Geographic Information System (GIS) based network analysis was used to estimate hypothetical ground transport distances from the locality of each primary scene response to firstly the closest designated trauma hospital and secondly the receiving hospital. Predictors of bypassing the closest designated trauma hospital were analysed using logistic regression. Results Analyses included 596 primary missions. Overall the HEMS had a median return trip time of 94min including a median of 9min for activation, 34min travelling to the scene, 30min on-scene and 25min transporting patients to the receiving hospital. 72% of missions were within 100km of the receiving hospital and 87% of missions were in areas classified as ‘major cities’ or ‘inner regional’. The majority of incidents attended by HEMS were trauma-related, with road trauma the predominant cause (44%). The majority of trauma patients (81%) had normal physiology at HEMS arrival (RTS = 7.84). We found 62% of missions bypassed the closest designated trauma hospital. Multivariate predictors of bypass included: age; presence of spinal or burns trauma; the level of the closest designated trauma hospital; the transporting HEMS. Conclusion Our results document the large distances travelled by HEMS in NSW, especially in rural areas. The high proportion of HEMS missions that bypass the closest designated trauma hospital is a seldom mentioned benefit of HEMS transport. These results along with the characteristics of patients attended and the time HEMS take to complete primary scene responses are useful in understanding the benefit HEMS provides and the services it replaces.
Estimating the Disease Burden of 2009 Pandemic Influenza A(H1N1) from Surveillance and Household Surveys in Greece  [PDF]
Vana Sypsa,Stefanos Bonovas,Sotirios Tsiodras,Agoritsa Baka,Panos Efstathiou,Meni Malliori,Takis Panagiotopoulos,Ilias Nikolakopoulos,Angelos Hatzakis
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0020593
Abstract: The aim of this study was to assess the disease burden of the 2009 pandemic influenza A(H1N1) in Greece.
Adverse Events Following Pandemic A (H1N1) 2009 Monovalent Vaccines in Pregnant Women — Taiwan, November 2009–August 2010  [PDF]
Wan-Ting Huang,Wan-Chin Chen,Hwa-Jen Teng,Wei-I Huang,Yu-Wen Huang,Chien-Wen Hsu,Jen-Hsiang Chuang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0023049
Abstract: During the 2009 H1N1 pandemic, pregnant women were prioritized to receive the unadjuvanted or MF59?-adjuvanted pandemic A (H1N1) 2009 monovalent vaccines (“2009 H1N1 vaccines”) in Taiwan regardless of stage of pregnancy. Monitoring adverse events following 2009 H1N1 vaccination in pregnant women was a priority for the mass immunization campaign beginning November 2009.
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