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Everything posted by benl

  1. I think the press got a bit excited about Sweden and I don't really think it is fair. Doing my public health training there, and having lived there I don't really think it is comparable to other counties. The swedes generally have a lot more trust in their government and their public agencies have a lot more freedom from political intervention. At the start of covid, they issued recommendations that weren't too dissimilar from the UK, self isolate, don't go out other than for essentials, work from home if you can and try to avoid public transport. The difference was they didn't make it law/compulsory, instead leaving it to the judgement of the people. The result seems to be that they ended up with more of a slow burn with the authorities seemingly accepting they aren't going to beat it rather than the peaks and troughs the UK has seen. Society in Sweden is much more socially distant, very few multi-generational households, and a different attitude to working when unwell; you're essentially treated as a danger if you go to work even with a cold and told to go home. Their public health surveillance is incredible, every test, prescription, medical records, school records and essentially any interaction with the state is recorded and linked to your national insurance number. They even use bots to monitor twitter, newspapers and facebook to look for clusters of people who report not feeling well. The result is data you can trust and usually free from political interference. The swedish economy has been hit by exports and other impacts, and they openly accept they failed to protect nursing homes (as happened in the UK). I don't think it's fair to slam them, neither do I think it is fair to hallow their actions. It's just different and proof not one size fits all.
  2. I think the problem with statistics is without knowing the method and the analysis, they are not quite meaningless but very difficult to make sense of. In the defence of epidemiologists, communicating this stuff is an unimaginable task. Case definitions are nothing more than a pre set criteria, i.e postive swab, or clinical symptoms. I think i't just the swabs and antibodies being reported. My slightly educated guess is all cases are under reported. The swab that goes into your mouth is only about 68% sensitive (IIRC) and there have been quite a few people who clinically have it, but there test is negative. Also, many just choose to self-isolate and don't bother with the faff of a test. Death are even harder, I think the UK changed the goal posts to 'within 28 days of positive test'. Death certification has always been a bit crap if you get a blood clot or pneumonia after having had covid, I don't think it counts, so again probably under estimated. I'm sorry to hear about your family and friends, I really don't know what the right answer is. I think a realistic and discussion with family members and whatever means most to them should be respected, but it's harder when other care home residents could be put at risk. I would agree it's not humane, we were informing families their loved one had died via telephone, it's horrific from every angle. I understand the rationale from a population point of view but I can only imagine how it would feel to be that family member. I think hospitals are being more realistic now and rules are being flexed a lot more but still, some people don't want to come to hospital because they wont see their loved ones.
  3. I'd love nothing more than for you to be right. However, in retrospect in A&Es in Liverpool we were seeing cases of covid mainly in young adults from late January/early February, but there was a bit of denial and no real plan on a national level. It was from March it got really messy and the number of cases at that time point was a huge under estimate, doctors were going through notes and binning swabs from people who were being discharged to save testing capacity. The hospitals were somewhat spared because everything else stopped, wards cleared of elective patients, people staying away from hospital and the protective effect of lock-down. The problem with the latest set of events is less likely to be the overall numbers as it was last time, but the insistence that the normal must carry on. The cases of serious COVID were stacking up, not huge but building steadily. I suspect this is going to continue and this time there will be no 'save the NHS' as people fatigue from social restrictions. As the number of asymptomatic cases rise in the community it only takes a few to go to nursing homes to cause absolute carnage. There may well be fewer deaths than last time, as probably some of the more fragile population members have already died, as reflected by the below expected death rates in the last few months. However, I think this resurgence poses a bigger threat to healthcare infrastructure. I think the Island is lucky to have some semblance of normal life, if the borders are closed, it's probably a small price to pay. I'd say the Isle of Man has handled it really well and in the longer term, having kids back at school earlier, people back at work and resumption of the hospitality industry (other than tourism) will be protective.
  4. Depends how old you are, but the schedule of vaccinations is here.
  5. This guy was a total plonker, he upset and undervalued the work of a lot of doctors. Profit seems to be his priority. Can't say he'll be missed. Pulse article on his resignation.
  6. Totally misread it, ignore my blind eyes
  7. As long as the business case wasn't prepared by Ian Longworth, because we all know how those turn out.
  8. Didn't M&S plan to bring food in by plane once using a C-130? I thought they only needed a rough strip. Not quite the Berlin airlift but still possible.
  9. It feels a bit like Shoprite getting upset because it wasn't a commercial success. Whilst only a personal opinion, it has always felt like they have used it as a placeholder. Closing the cafe hasn't helped the alcove area as the thoroughfare has just become a shelter. The countless rebranding exercises and somewhat disorganised interior can't have helped IMO. Lots of low cost supermarkets don't have parking in the UK, perhaps catering to their demographic (Fulton's, Heron, and often Aldi and Lidl).
  10. benl

    Speeding Fine

    The 3FM story seems a little different. I wonder which is correct, attending a stabbing or a meeting following such an event.
  11. I think in many Nordic countries you pay before you see a clinician. It's about £10 for a GP appointment and £30 for an A&E or out of hours service. In Sweden, there is an annual cap on the cost but this depends on the administrative region, so in Stockholm after you've paid £100 in a year all services become free. Personally, I wonder if this is more of a barrier in dissuading those who are reluctant to visit rather than frequent fliers. There seems to be a mantra of saying the service is underfunded but is it really, I think that depends on what our expectations are. I wonder if the Isle of Man should focus more on cost-effective medicine, accepting that some of the novel cancer drugs don't provide a great return for the investment, particularly for quality of life. I think there needs to be an honest discussion about what people want or are willing to pay for. I don't think, in my opinion, that a semi privatisation is equitable and risks driving social inequalities which I suspect are already quite prominent. I don't think the Island will ever win the pay battle for locum doctors, a shortage in the UK, isolated location and no training posts beyond basic training all limit recruitment. That or propose at least secondary care is run by an NHS trust in the UK so staff can rotate through and services can be shared (I suspect this would never be palatable as people hate travelling Douglas-Ramsey as it is). I suspect another review really doesn't seem like the best idea, how many of the west mids suggestions have been acted upon?
  12. Apologies, I cross-read with Humulin R. I think these figures must be per wholesale unit, and the pre-tax price I've seen from this vaccine is around £4.50, so your figure makes more sense. I suspect some of the monoclonal antibodies will be sold in single units because of their price and limited use e.g. Ustekinumab . I'd guess these figures also only cover the hospital rather than primary care where cheap drugs prescribed more frequently probably constitute a large proportion of the expense. Looks like a communication misfire from DHSC.
  13. Surely these figures can't be correct, the BNF lists the prices per individual dosage of Imuvac as £6.59, I wonder if the person preparing this has looked at the wholesale units rather than individual items. I can't see them only ordering 7 flu vaccines and also I'd suspect many of these drugs are used in far greater than single figure quantities. Lookings like a poor response to a badly worded question.
  14. When I listened to his speech I thought the underlying argument was the abuse of science, selecting only papers (namely Freemantle et al.) that supported his viewpoint and negating those that said anything to the contrary. This undermines scientific principles and he attributes it to the 'post-truth' state of the world. I think he is reasonably well qualified to make those points being a world-leading scientist. SH even attacks the NHS saying there is a need for 7-day services, but the changes to be made should be based on a body of evidence, not just single studies. Again, I think these are fair points, it's only more political when he says the extension of services must be resourced. From friends who have worked at Addenbrooke's SH has been a patient advocate to improve services. He's seen his fair share of healthcare and I guess this also makes him more qualified than most to comment. JH position is a poison chalice. The NHS probably is underfunded relative to expectations but no one has the hunger to challenge the latter part. He's unpopular but if he's replaced it will look like a victory to the BMA and look like the Conservative Party are acknowledging they disagree with his decisions. Short of an economic catastrophe, I don't think any party would truly dismantle the NHS, it would be political suicide, though the river does erode the mountain.
  15. There is actually evidence that we're living longer, but more recently the rate has slowed (http://www.instituteofhealthequity.org/about-our-work/marmot-indicators-release-2017). The increase in life expectancy has been attributed to declines in smoking and cardiovascular disease. I think there is a risk of those in manual occupations being unfairly punished with rising life expectancies as social inequalities grow. My other concern would be if retirement ages increase, does it not make it harder for the younger generations to find work? Just because people retire later doesn't mean there are more jobs, just that people stay in their jobs for longer.
  16. You really would hope that someone in seemingly knowledgeable position wouldn't be stupid enough to use his/her own name and address when posting a class B drug.
  17. I'm not quite sure I understand your first argument. I accept that we're talking about the simplified version of prevention and causation etc rather than the hyper correct epidemiological terminology. That said, I think you could argue that physical activity prevents such illnesses by reducing the overall risk/odds ratio of developing the conditions listed. The subsequent consequence of lower odds is that fewer would develop the disease of interest calculable by the population attributable fraction. I'm sure the number needed to treat at a certain threshold is high but on a population level this will still result in large benefits. I completely agree that you can't do double blind trials in public health, but you can perform randomised control trials which equally distributes confounding factors. Many of the papers listed in the Canadian review were randomised. I'd say you can never really prove a concept like this but I'd say it meets many of the Bradford Hill criteria. I think what they are addressing here is physical activity, not exercise (which has to be planned and structured). Overall, I think behaviour change is poorly understood and is typically expensive (also not my area of expertise so willing to be corrected). Nudges do work and several people may well have changed their actions after simply reading this thread, though they were likely quite motivated prior. Public health always feels a bit patronising, like your mum telling you to take your coat, because it addresses a problem before it happens or impacts on liberties. That said, nobody likes being told that their ill health is their fault, we'd all happily adopt the sick role and then complain about waiting times and costs. I agree on the assertion of health inequalities. Maybe the DOI would be better using their resources to actually assess the health impact of their major projects. This really didn't seem to be considered with the prom, perhaps the island's largest recreational facility (my objections still aren't as strong as some of my family members, we all know who I mean). Removing parking spaces definitely helps, but I can already imagine the threads on here. PS sorry to all of you who bothered to read this and don't really care.
  18. I agree, yes. I know it's frustrating but isn't this the type of thing that's worth submitting to the consultation? I mean for safety, maybe someone has a suggestion for improving legislation that encourages cycling safety (I await the response, make cyclists pay insurance). As with the others, yes the weather is fecking horrible and cycling/walking is never going to be favourable. Lack of routing can surely be addressed in the consultation, surely if enough people favour certain routes etc it would show where to focus resources. It might even identify the need for a new crossing or something relatively cheap (though I'm sure the DOI will find a way to make this cost £1million and take 6,852 weeks). Isn't there a tax rebate scheme now with cycling? So it does look like there doing something, even if it's just making people angry enough to think about it.
  19. OK, before I start, I'll put my cards on the table, I work for a university research group and most of our work is on the consequences of physical exercise on health and well-being. That doesn't mean I'm an advocate of everything, but I see and even produce some research on this topic. I don't really know if I can counter your point on the narrative, but this consultation, if done properly, should elicit the barriers people have to exercise to see what the government can do to reduce them. I'd guess it's more about small substitutions, you know, walking into the town centre if you live a couple of miles away etc. Public health is always a battle as the benefits are always seen as intangible. Remeber the uproar about seatbelts. Emerging evidence is showing that providing information isn't enough to encourage healthy behaviours. Perhaps the best summary of the benefits of physical exercise is in "A systematic review of the evidence for Canada’s Physical Activity Guidelines for Adults". The review shows a cumulative benefit in exercise and activity with an optimum of about 30 minutes per day. There are reductions in seven major illnesses including type 2 diabetes and cancer. Most health outcomes are down to diet and physical activity - really basic things. Genetic elements only account for about 30% (yes there is always going to be a debate about attributable fractions). Preventing these things takes more strain off the health service and increases the quality of your years of life far greater than quantity. Also, fewer cars means less wear on the roads and the tax implications. I also read a post saying we're not living longer... we are. The rate has slowed, likely due to social pressures and recession but, we are still gaining a good couple of minutes for every hour of life. We see more reporting of younger people dying due to reporting bias. Death is a little bit of Poisson regression, random events occurring at a fixed rate. Summary: exercise does work, it's cheaper to prevent than treat, everyone hates public health and probably me.
  20. Don't you think it would be interesting to get a copy of the correspondence where they determine a request vexatious? I think that might cause a few red faces.
  21. benl

    Mr Shimmins

    Should companies such as Manx Gas be expected to contribute to these schemes to reduce the cost? If they can't reliably know where their pipes/infrastructure is and this adds to the overall time and cost of the project should they not be culpable? Perhaps I'm unrealistic and uninformed. Surely they also benefit as they can do work whilst the scheme is ongoing to update their own infrastructure at a lower cost too (granted it prevents the digging up and destruction of a freshly resurfaced road too)?
  22. I'm not sure what state it is they are kept in? I think it's sad you've never seen the benefits programmes such as they can offer, perhaps volunteer and open your mind? Everyone can make a valuable contribution to society, and people with mental ill-health are included in that. There is evidence to suggest the less people with serious mental health conditions are excluded from society, the lower their care needs are. Shunning people doesn't work, giving them purpose through schemes such as this can improve lives. On a side note, have a look at the Global Burden of Disease report, it shows that nearly half is attributable to mental ill-health with only a fraction of the money spent on physical health (even though separating the two is often artificial). My only fear with these project is capital expenditure doesn't always equate to care, yes they have a new building but are they proposing better or new services with it?
  23. As a genuine question, how much damage was done by closing Glenside and how much pressure has this placed on the rest of the system? Whilst I suspect it wasn't up to modern standards it seemed to be closed without any sort of strategic plan and in the years since there has been a lot of talk about the lack of social care/residential facilities. If it was a cock-up how has the minister who recommended its closure escaped repercussions? I'm pretty naive when it comes to what is expected in terms of legal requirements, but surely something OK is better than an abject shortage?
  24. Does anyone know if this figure includes the 'Meals-on-Wheels' service, as I think they are made in the hospital kitchens? If so, perhaps the loss is partly cost of the service? That said they could even up the prices of the vending machines in the hospital, it's pretty cheap for the NHS.
  25. Admin is a bit of a nightmare in every hospital, but Noble's does need to modernise. Discharge summaries are really in need of change to free up admin time but I think they are sorting these. The whole modernisation of IT systems that Quayle has overseen is pretty commendable IMHO. The IOM Govt has a pretty hard job with health and controlling spending. I think less is spent less per head on the IOM than in the UK but it's hard to separate the figures and with overspends etc. The other challenge on the Island is the demographic, it's 90,000 and very top heavy and so the spend will be disproportionate to the UK. Then there is the isolation, lack of on-site specialists (no friends to ask when the proverbial hits the fan) and covering 24 hour rotas. Change in the NHS is hard and changing a process takes on average 3 years. The Isle of Man has the potential to be nimble in this. I think online service could improve a lot and publishing transparent data re waiting times, incidents and infection rates would be a cheap and reasonable push for change. I wonder what other people think, crowd sourcing positive solutions might be a way forward as would frank discussions about what the island can afford. In positive news, locate.im is pushing some figures, as part of nursing recruitment which would suggest life expectancy is one of the best in the world. Whilst this could be trickery with stats, it could equally prove that current achievements with the health service are spot on?
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