ObjectiveOur aim was to compare the effect of central obesity (measured by waist-to-height ratio, WHtR) and total obesity (measured by body mass index, BMI) on life expectancy expressed as years of life lost (YLL), using data on British adults.MethodsA Cox proportional hazards model was applied to data from the prospective Health and Lifestyle Survey (HALS) and the cross sectional Health Survey for England (HSE). The number of years of life lost (YLL) at three ages (30, 50, 70 years) was found by comparing the life expectancies of obese lives with those of lives at optimum levels of BMI and WHtR.ResultsMortality risk associated with BMI in the British HALS survey was similar to that found in US studies. However, WHtR was a better predictor of mortality risk. For the first time, YLL have been quantified for different values of WHtR. This has been done for both sexes separately and for three representative ages.ConclusionThis study supports the simple message “Keep your waist circumference to less than half your height”. The use of WHtR in public health screening, with appropriate action, could help add years to life.
This paper uses a queuing model to evaluate completion times in Accident and Emergency (A&E) departments in the light of the Government target of completing and discharging 98% of patients inside 4 h. It illustrates how flows though an A&E can be accurately represented as a queuing process, how outputs can be used to visualise and interpret the 4-h Government target in a simple way and how the model can be used to assess the practical achievability of A&E targets in the future. The paper finds that A&E targets have resulted in significant improvements in completion times and thus deal with a major source of complaint by users of the National Health Service in the U.K. It suggests that whilst some of this improvement is attributable to better management, some is also due to the way some patients in A&E are designated and therefore counted through the system. It finds for example that the current target would not have been possible without some form of patient re-designation or re-labelling taking place. Further it finds that the current target is so demanding that the integrity of reported performance is open to question. Related incentives and demand management issues resulting from the target are also briefly discussed.
As a result of population ageing and declining fertility, the UK state pension system is unlikely to continue to be able to deliver the current level of pensions without some combination of a higher state pension age and a steady inflow of young immigrant workers from abroad. However, with prudent economic management and continuing economic growth, the need for additional immigrants can be contained and modest real increases in pensions are also a possibility. Higher economic activity rates among older people, including deferred retirement, will to some extent compensate but not eliminate these pressures. If fertility picks up over the next few years, this will also help, but not until after 2030. Copyright 2006 Royal Economic Society.
Finding alternatives to hospital admissions for older people and helping them to live for as long as possible in their own homes is a key objective of UK health and social policy. However, there is a lack of proof as to whether such alternatives actually work and are costeffective. The research reported in this paper is based on an evaluation of a care co-ordination service with the aim helping people to remain at home and preventing unnecessary hospital admissions and A&E attendances. An initial evaluation found that the effectiveness of the service was at best marginal. The new method of evaluation described in this paper tracks patient attendance at A&E departments and hospital stays 12 months before they are accepted into the care co-ordination service and evaluates the resultant savings in health care activity. It finds that the service results in between 14 and 29 saved hospital bed days per client per year and between three and eight A&E attendances. Whilst the service does not arrest functional decline in individuals, the incidence of falls is significantly reduced, and that the effect on quality of life is neutral to broadly favourable. It finds that mortality levels are higher than in the general population of similar age but this is probably due to selection effects because clients are unhealthier from the outset, and that in the 90+ age group there is no significant difference. Without the benefit of a control group it is not possible to confirm the results with certainty, but corroborating independent evidence is provided that supports the conclusions reached.
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