The UK's response to the pandemicThe UK has recorded one of the highest death rates associated with COVID-19 globally, whether measured as deaths that are directly attributable to COVID-19 or by excess mortality. The reasons for this high rate are complex and not yet fully understood, but elements of the UK Government response have been criticised, including delayed implementation of physical distancing measures, poor coordination with local authorities and public health teams, a dysfunctional track and trace system, and an absence of consultation with devolved nations. The role of the National Health Service (NHS) and relevant national executive agencies in relation to testing capacity, availability of personal protective equipment (PPE), the cancellation and postponement of many aspects of routine care, and decisions around discharge from hospital to care homes should also be critically examined. Conversely, aspects of the response by the NHS and relevant national executive agencies deserve recognition. In only a few weeks, capacity for critical care was mas sively expanded, many thousands of staff were reallocated, and services were reorganised to reduce transmission of SARS-CoV-2. The NHS also collaborated with academic institutions to share knowledge about clinical characteristics of the disease and to establish world-leading clinical trials on vaccines and treatments.The response to COVID-19 brings to attention some of the chronic weaknesses and strengths of the UK's health and care systems and real challenges in society to health. Failures in leadership, an absence of trans parency, poor integration between the NHS and social care, chronic underfunding of social care, a fragmented and disempowered public health service, ongoing staffing shortfalls, and challenges in getting data to flow in real time were all important barriers to coordinating a comprehensive and effective response to the pan demic. More positively, the high amount of financial protection that was provided by the NHS and an allocation of resources that explicitly accounted for differing geographical needs have, to some extent, mitigated the already substantial effect of the pandemic on health inequalities. The London School of Economics and Political Science-Lancet Commission on the future of the NHSThis UK-wide London School of Economics and Political Science (LSE)-Lancet Commission on the future of the NHS provides the first analysis of the initial phases of the COVID-19 response as part of a uniquely comprehensive assessment of the fundamental strengths of and chal lenges that are faced by the NHS. The NHS has long been regarded as one of the UK's greatest achievements, providing free care at the point of delivery for over 66 million people from birth to death.Against this backdrop, and considering international evidence, this Commission sets out a long-term vision for the NHS: working together for a publicly funded, integrated, and innovative service that improves health and reduces inequalities for all. This Commission makes seven reco...

The aim of this investigation was to compare the dental health behaviour of toddlers in low caries (A) and high caries (B) communities in St Helens. Parents of 60 children aged between 17 and 20 months in community A, and 68 in community B were interviewed at home. Using 24-hour dietary recall, sugar intake was recorded as sugar episodes-a sugar episode being a half-hour period during which any amount of non-milk extrinsic sugars (NMES) was consumed. Exposure to fluoride was recorded according to the number of times fluoride toothpaste was used and whether a fluoride supplement was given in the 24-hour period. The median sugar episode score for community A was 6 per 24-hour period (interquartile range 5 to 8), compared with 10.5 (7 to 13) for community B. Sixty per cent of parents in community A compared with 37% in community B reported brushing their child's teeth twice daily with fluoride toothpaste. The respective figures for use of fluoride supplements were 12% and 6%. It is concluded that patterns of dental health behaviour are established early in children's lives, and that marked differences exist between communities within the same district. Recommendations are made for oral health promotion policy.

No abstract

A greater proportion of industrial land in a ward is associated with a higher mortality of the ward residents, even after controlling for the level of socio-economic deprivation of the residents. The association between deprivation and mortality is stronger than the association between atmospheric pollution and mortality. There is an urgent need for better measures of atmospheric pollution which are usable in epidemiological studies.

23 Takala AK, Eskola J, Nissinen A, Leinonen AM, Pekkanen E, Miakela PH.Effect of vaccination with Haemophilus influenzac type b (Hib) conjugate vaccine ott the oropharyngeal carriage of Hib. In: Programs and abstracts of the -30th inieyscience conference on antimicrobial agents and chemotherapy. Atlanta, Georgia: American Society for Microbiology, 1990: 187. (Abstract 605.) 24 Ward JI, Fraser DlW, Baraft' LJ, Plikaytis Bi). Haemophilus influenzae meningitis. A national study of secondary spread in household contacts.