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Biomedical subjects

D M Fleming

Publications and source records attributed to D M Fleming.

At least 55 records · Page 3Linked to original sources
PubMed2000

Serological evidence of pertussis in patients presenting with cough in general practice in Birmingham.

Three hundred and fifty-six patients in a large suburban practice (registered population 10,400), were diagnosed clinically with acute laryngitis/tracheitis or whooping cough (acute spasmodic cough of three weeks duration) between March 1996 and November 1997. Forty out of 145 who provided specimens for serological testing had evidence of recent infection with Bordetella pertussis. During the study a further 18 patients (mostly younger patients who presented early) had a diagnosis of pertussis confirmed by culture. Fifty-eight cases of pertussis in this population and time period was equivalent to an annual incidence of 330 per 100,000, whereas statutory notifications of pertussis in England and Wales suggested an incidence of less than 4 per 100,000 in the same period. Whooping cough remains an important cause of respiratory illness in all age groups. These results are a reminder for general practitioners to be alert to the diagnosis and a prompt to reconsider national vaccination policy.

Adolescent↗
PubMed2000

Chickenpox increasingly affects preschool children.

Between 1983 and 1998, age specific incidences of chickenpox derived from consultations with general practitioners taking part in the Royal College of General Practitioners Weekly Returns Service doubled in children aged 0 to 4 years, halved in children aged 5 to 14 years, and fell by almost a third in adults aged 15 to 44 years. This downward shift in age of contracting chickenpox may be a result of increased social contact between preschool children.

Adolescent↗
PubMed2000

Presentation with influenza-like illness in general practice: implications for use of neuraminidase inhibitors.

General practitioners in the Midlands Research Practice Consortium (MidReC), combined list size 140,000, completed questionnaires about 918 patients in whom they had made working diagnoses of influenza-like illness during an outbreak of influenza A H3N2 from 1 December 1999 to 4 February 2000. Adults, more females than males consulted most, reflecting the age and sex distribution reported to the Royal College of General Practitioners Weekly Returns Service. Illness at presentation was considered severe in 4%, moderately severe in 49%, mild in 45%, and asymptomatic (for example, attended for certificates) in 1% of patients. In seven tenths of patients, the practitioner estimated that the likelihood of influenza was 70% or more and in just over half, 80% or more. Half of patients aged over 75 years were seen at home, but only 7% of those under 55 years. Less than a quarter of patients consulted within two days of having become ill, with the highest consultation frequency on the third and fourth days. Preschool children presented earliest: 75% were seen within two days, compared with only 17% of adults over 75 years. Four fifths of patients were seen on the same day as they contacted the practice, and 12% on the following day. Given the brief time window for effective antiviral treatment, only a small proportion of patients are likely to be prescribed these drugs unless consulting behaviour, especially in elderly people, changes considerably.

Adolescent↗
PubMed1999

The duration and magnitude of influenza epidemics: a study of surveillance data from sentinel general practices in England, Wales and the Netherlands.

Weekly incidence data for influenza-like illness, routinely collected in sentinel general practices in England and Wales and in the Netherlands over 10 winter periods (week 37 in one year to week 20 in the next, 1987/1988-1996/1997) were examined in conjunction with matching virus isolate data to define epidemic periods of influenza in the two countries. We first defined the background rates of recording influenza-like illness which occurred at times when only sporadic or no isolations of virus were reported. The background rates were similar in the two networks with mean weekly incidence in England and Wales of 28.1 per 100,000 (all ages) and in the Netherlands 29.8. Epidemic periods defined as lying above the upper 95% confidence level of the background rate lasted on an average of about 10 weeks. Once epidemics were recognised, peak incidence was generally achieved within 4 weeks. The excess population (all ages) consulting general practitioners during influenza epidemic periods was calculated from the difference between the observed and background incidence rates, and expressed as a percentage of the total population. In the 10 periods surveyed, the percentage of the population consulting and diagnosed with influenza-like illness in England and Wales ranged from 0.4% in 1991/1992 to 1.7% in 1989/1990 and in the Netherlands from 0.5% in 1990/ 1991 to 2.1% in 1989/1990. The duration and epidemic periods were broadly similar in the two countries though the excess consulting population during the 10 epidemics studied averaged 0.85% in England and Wales compared with 1.39% in the Netherlands. There were substantial differences between the two countries in the impact of influenza in individual years, as measured in the consulting population even though the predominant virus (sub)types were similar.

Disease Outbreaks↗
PubMed1999

Efficacy and safety of the neuraminidase inhibitor zanamivirin the treatment of influenza A and B virus infections.

The efficacy and safety of zanamivir, administered 2x or 4x daily over 5 days, was evaluated in the treatment of influenza infections. A total of 1256 patients entered the study; 57% of those randomized had laboratory-confirmed influenza infection. The primary end point, "alleviation of major symptoms," was created to evaluate differences in clinical impact. In the overall population with or without influenza infection, zanamivir reduced the median number of days to reach this end point by 1 day (P=.012 2x daily vs. placebo; P=.014 4x daily vs. placebo). The reduction was greater in patients treated within 30 h of symptom onset, febrile at study entry, and in defined high-risk groups. Zanamivir reduced nights of disturbed sleep, time to resumption of normal activities, and use of symptom relief medications. It was well tolerated. These results suggest that zanamivir can significantly reduce the duration and overall symptomatic effect of influenza.

Adult↗
PubMed1999

Weekly Returns Service of the Royal College of General Practitioners.

General practitioners in 69 practices in England and Wales monitor the spread of epidemic diseases in the community through the Weekly Returns Service (WRS) of the Royal College of General Practitioners, which has existed for over 30 years. Participating general practitioners summarise diagnoses and consultation/episode type (new episodes/ongoing consultations) for a defined population (currently about 570,000) and data are extracted to provide the 'weekly return', which includes age specific weekly incidence of new episodes of selected illnesses. The service has been used extensively to measure the burden of influenza and total acute respiratory illness in the community and the impact of enteric infections. It also provides information about illnesses for which there are no other major data sources--for example, chickenpox, scabies, and (historically) mumps. The entire network is electronically linked. Direct links with microbiological laboratories are being forged in order to integrate clinical and microbiological data in defined populations.

Communicable Disease Control↗
PubMed1998

Morbidity and healthcare utilisation of children in households with one adult: comparative observational study.

OBJECTIVE: To identify and consider differences in morbidity in children in households with one adult presenting to general practitioners compared with children in households with more than one adult. DESIGN: Observational study; data analysed with logistic regression controlling for age, sex, and practice. SUBJECTS: 93 356 children aged 0-15 years included in the fourth national study of morbidity in general practice and for whom data about household structure were available. Among them 10 983 (11.8%) were living in households with a sole adult. METHODS: Morbidity data were recorded from each consultation as the assessment diagnosis made by the general practitioner. MAIN OUTCOME MEASURES: Number of consultations and consultations per person for any illness, infections, acute respiratory infections, asthma, and accidents; number presenting and mean consultations per person for immunisation; number receiving home visits and home visits per person visited; average annual frequency of consultation among those consulting. RESULTS: Compared with children in other households, a higher proportion of children in households with one adult consulted for infections and accidents. The proportion consulting for immunisation was lower and the proportion receiving home visits greater. Mean numbers of consultations per person consulting were also generally higher for all conditions. For infections, accidents, and home visits, the differences were evident in all age groups. CONCLUSIONS: The study confirms the importance of single parent families as an indicator of deprivation. Children in such families should be targeted for immunisation and accident prevention.

Adolescent↗
PubMed1998

Patients consulting with Crohn's disease in primary care in England and Wales.

OBJECTIVE: To determine annual incidence and prevalence for patients consulting their GP because of Crohn's disease in England and Wales and compare demographic details with matched controls. DESIGN: We used the fourth Morbidity Statistics in General Practice study (MSGP-4) which covered 468 042 person-years during a 12-month period in 1991-92. METHODS: All GPs reporting a patient with Crohn's disease in MSGP-4 were sent a questionnaire to confirm the diagnosis and obtain supportive details (surgical, pathological, radiological and/or endoscopic). Data concerning ethnicity, social class, smoking status, living in an urban or rural environment and employment had been collected previously. Conditional logistic regression models were used to analyse the data for cases and matched controls. RESULTS: Three hundred and fifteen patients were reported to have Crohn's disease. Replies were obtained to 251 (80%) questionnaires. The diagnosis of Crohn's disease was confirmed in 184 cases (89%) and refuted in 23 cases (11%) -- details were unavailable for 44 patients. The mean age of patients was 44 years, the female:male ratio was 1.46:1, and 108 (59%) patients had required surgery. Thirty-three of 178 (18.5%) patients were diagnosed within the study period. Hence, this study detected a prevalence for consulting Crohn's disease of 54.6-59.8/100,000 and an annual incidence of 10.1-11.1/100,000 in 1991-92. No significant differences were found between cases (n = 291) and controls (n = 1682) with regard to ethnicity, social class, smoking or living in an urban/rural environment. Patients with Crohn's disease had similar employment levels as controls, but were significantly more likely to be registered as permanently sick, odds ratio 4.01 (CI 2.21-7.29). CONCLUSIONS: This national survey, including 1% of the population, suggests there are approximately 30,600 patients consulting their GP because of Crohn's disease in England and Wales, with 5700 new cases diagnosed per year.

Adolescent↗
PubMed1998

Influenza surveillance in England and Wales: October 1997 to June 1998.

Influenza caused low levels of mortality and morbidity in England and Wales in the 1997/98 season. Influenza viruses of the H3N2 and H1N1 subtypes were isolated in small numbers from community and hospital patients in November and December. Their numbers subsequently increased to peak in February, H1N1 a week or two before H3N2. Most of the H1N1 isolates were similar to the A/Bayern/7/95-like virus, included in the vaccine recommended for 1997-98, whereas most H3N2 isolates were A/Sydney/5/97-like, a virus not covered by the season's vaccine but recommended for 1998/99. Consultation rates in general practice for influenza-like illnesses remained low until early February, when a small increase coincided with the increase in laboratory confirmed influenza. Fewer deaths directly attributed to influenza were registered during the surveillance period than in recent years. Localised outbreaks occurred in schools and nursing homes towards the end of the winter.

Disease Outbreaks↗
PubMed1997

Influenza surveillance in England and Wales: October 1996 to June 1997.

This report summarises information collected for the surveillance of influenza in England and Wales during the winter of 1996/97. Consultations for 'influenza and influenza-like illness' with sentinel general practitioners in England and Wales began to increase towards the end of November and peaked at the start of January. In England, consultations for 'aggregated respiratory disease' (ARD) began to increase a little earlier, perhaps as a result of increased respiratory syncytial virus activity, but also peaked in early January. Influenza A (H3N2) viruses were first detected in early October, but rarely until November, and activity peaked in early January, coinciding with the peak in consultations for flu-like illness. A few influenza B viruses were detected in late November and early December, and substantial activity was recorded in mid-January. Approximately equal numbers of influenza A(H3N2) and B viruses were identified over the winter as a whole, and circulating strains were antigenically similar to those included in the vaccine for 1996/97. Although influenza activity was 'moderate' in terms of consultations and laboratory confirmed infections, a large peak in death registrations occurred at the same time as influenza A(H3N2) virus activity peaked. The number of deaths during the winter was similar to that seen in 1989/90, when the last severe influenza epidemic occurred in England and Wales.

Disease Outbreaks↗
PubMed1997

Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenzavirus infections. GG167 Influenza Study Group.

BACKGROUND: The sialic acid analogue zanamivir (GG167) is a selective inhibitor of influenza A and B virus neuraminidases. These viral enzymes are essential for the release of virus from infected cells, and they may also reduce the inactivation of virus by respiratory secretions. When administered experimentally directly to the respiratory tract, zanamivir has potent antiviral effects. We assessed the therapeutic activity of zanamivir in adults with acute influenza. METHODS: We conducted separate randomized, double-blind studies in 38 centers in North America and 32 centers in Europe during the influenza season of 1994-1995. A total of 417 adults with influenza-like illness of < or =48 hours' duration were randomly assigned to one of three treatments: 6.4 mg of zanamivir by intranasal spray plus 10 mg by inhalation, 10 mg of zanamivir by inhalation plus placebo spray, or placebo by both routes. Treatments were self-administered twice daily for five days. RESULTS: Of 262 patients with confirmed influenza-virus infection (63 percent of all patients), the median length of time to the alleviation of all major symptoms was one day shorter (four days vs. five days) in the 88 patients given inhaled and intranasal zanamivir (P=0.02) and the 85 patients given inhaled zanamivir alone (P=0.05) than in the 89 patients given placebo. Among the infected patients who were febrile at enrollment and among those who began treatment within 30 hours after the onset of symptoms, the median time to the alleviation of major symptoms was four days in both zanamivir groups and seven days in the placebo group (P< or =0.01). Viral titers of nasal washings in the group given inhaled and intranasal zanamivir were significantly lower than those in the placebo group. The topically administered zanamivir was well tolerated. CONCLUSIONS: In adults with influenza A or B virus infections, direct administration of a selective neuraminidase inhibitor, zanamivir, to the respiratory tract is safe and reduces symptoms if begun early.

Administration, Inhalation↗
PubMed1997

Multiplex reverse transcription-PCR for surveillance of influenza A and B viruses in England and Wales in 1995 and 1996.

Multiple-target (multiplex) reverse transcription-PCR (RT-PCR) for detection, typing, and subtyping of the hemagglutinin gene of influenza type A (H3N2 and H1N1) and type B viruses was developed and applied prospectively to virological surveillance of influenza in England in the 1995-1996 winter season. During this season both influenza A H3N2 and H1N1 viruses were circulating, although at different times. Six hundred nineteen combined nose and throat swabs taken by general practitioners in sentinel practices from individuals presenting with "influenzalike illness" were analyzed by culture, multiplex RT-PCR, and immunofluorescence. Of the 619 samples, 246 (39.7%) were positive by multiplex RT-PCR compared with 200 (32.3%) which yielded influenza viruses on culture. There was 100% correlation between multiplex RT-PCR typing and subtyping and the influenza types and subtypes obtained from culture. There was also excellent correlation between the temporal detection of influenza A H3N2 and H1N1 viruses by multiplex RT-PCR and by culture. During the peak weeks of influenza virus activity, a total of 259 specimens were received, of which 101 (38.9%) yielded influenza viruses on culture while 149 (57.5%) were positive in multiplex RT-PCR, providing an increase in detection of influenza viruses of approximately 20%. The increased detection of influenza virus occurred in all the age groups sampled. Samples which were positive by multiplex RT-PCR but negative by culture were not detected significantly earlier or later in the winter of 1995-1996 but were detected during the peak weeks of clinical influenza virus activity. Multiplex RT-PCR was successfully used in surveillance of influenza to provide accurate, sensitive diagnosis directly on clinical specimens sent through the post.

Adolescent↗
PubMed1997

Service profiles of general practitioners in Europe. European GP Task Profile Study.

BACKGROUND: General practice is the focal point of primary care. There are national differences in the structure and organization of practice, the relationship with secondary care is being redefined, and in some countries major changes are taking place. AIM: To describe and examine differences in the service profiles of general practitioners (GPs) in European countries. METHOD: Standardized questionnaires in the national languages were sent to samples of GPs in 1993. Four areas of service provision were measured: the GP's position in the first contact with selected health problems, the involvement in minor surgery and the application of medical procedures, disease management and preventive care. The importance of the gatekeeping role, remuneration system, and geographical region in Europe was examined by comparing scores in appropriate national groupings. RESULTS: Data were received from 7233 GPs in 30 countries. Most national samples were random and the average response rate was 47%. In countries where GPs have a gatekeeping role, they had a relatively stronger position as doctors of first contact. In those countries where GPs were usually self-employed, they had a stronger role in disease management and screening for blood cholesterol. In the examination of the three structural elements of health care, the most striking differences were evident in the comparison between eastern and western Europe. GPs throughout Europe had a comparatively small role in organized health education. CONCLUSION: The position of GPs is weak in eastern Europe and some Mediterranean countries, where service profiles have a limited range. General practice was more comprehensive where the doctors had a gatekeeping role.

Employment↗
PubMed1996

Influenza surveillance in England and Wales: October 1995 to June 1996.

This report summarises information collected for the surveillance of influenza virus infection in England and Wales from October 1995 to June 1996 (weeks 40/95 to 25/96). Total respiratory disease' activity, as reported by the Birmingham Research Unit of the Royal College of General Practitioners, rose to peaks in weeks 48/95, 51/95, and 01/96. The first peak coincided with a peak in "influenza and flu-like illness'. The subsequent peaks were accounted for by an increase in reports of acute bronchitis, including bronchiolitis, and may have been associated with the annual rise in infections with respiratory syncytial virus. Influenza A virus was responsible for most infections, with moderate activity occurring in the early part of the winter, peaking in December (week 48/95). Influenza A subtype H3N2 predominated until week 07/96, after which subtype H1N1 accounted for most infections. Influenza activity was first seen in central and northern England, followed by the south of England, Wales, and Scotland. Circulating influenza viruses were antigenically similar to the components of the 1995/96 vaccine. International surveillance during 1995/96 has led to a different H3N2 component being included in the influenza vaccine recommended for 1996/97.

Adolescent↗
PubMed1996

Infectious intestinal disease in elderly people.

This paper analyses routinely available data on infectious intestinal diseases occurring in people aged 65 years and over in England and Wales from 1990 to 1994. These data include annual reports of consultations with general practitioners in spotter practices collated by the Royal College of General Practitioners, notifications of food poisoning collated by the Office of Population Censuses and Surveys, hospital admissions extracted from Hospital Episode Statistics data, reports of general outbreaks and laboratory reports of faecal isolates both collated by the PHLS Communicable Disease Surveillance Centre, and death registrations held at the Office of Population Censuses and Surveys. From 1 January 1990 to 31 December 1994 a total of 8,910 episodes of infectious intestinal disease in people aged 65 years and over were seen in the 93 spotter practices that care for a population of all ages of about 700,000. This extrapolates to about 925,000 cases in elderly people in England and Wales, if consultation rates in spotter practices are representative. Twenty-seven thousand two hundred and thirty-three cases of food poisoning were notified and 46,216 faecal isolates were reported in people of the same age group. The commonest pathogens detected were campylobacter, Clostridium difficile and salmonellas. Thirteen thousand five hundred and eighty-five people aged 65 years and over were admitted to hospital with infectious intestinal disease between 1 April 1991 and 31 March 1994. The PHLS Communicable Disease Surveillance Centre learnt of 360 outbreaks in residential institutions and hospital wards for elderly people between 1 January 1992 and 31 December 1994, 52% of which were caused by small round structured viruses. Seven hundred and seventy-seven deaths attributable to infectious intestinal disease in elderly people were registered from 1990 to 1994. Infectious intestinal disease is a largely preventable group of conditions that cause substantial morbidity and mortality in elderly people. Appropriate food hygiene and infection control measures, particularly in institutions, will help to reduce the incidence of infectious intestinal disease in elderly people.

Aged↗