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Biomedical subjects

D M Fleming

Publications and source records attributed to D M Fleming.

At least 73 records · Page 4Linked to original sources
PubMed1996

Epidemiological, virological, and clinical features of an epidemic of hand, foot, and mouth disease in England and Wales.

We describe the epidemiological, virological, and clinical features of an epidemic of hand, foot, and mouth disease, attributed to coxsackie A virus serotype 16, that occurred throughout England and Wales in the last quarter of 1994. Nine hundred and fifty-two cases were reported by spotter practices that make weekly returns to the Royal College of General Practitioners, which made this the largest epidemic of hand, foot, and mouth disease in England and Wales reported to date. Most patients were aged 1 to 4 years and lived in central or southern regions. Clinical features were unavailable from the weekly returns but were described in detail for 39 patients, mostly by means of a questionnaire to general practitioners near the PHLS Coxsackie Reference Laboratory. All cases had a rash on their hands and 23 also had rashes on their feet and in their mouths. Most cases were mild. Severity was associated with the degree of mouth involvement. Secondary cases in family members were rare. Data from the Royal College of General Practitioners since 1963 reveal a period between epidemics of two to three years. The epidemics in 1988 and 1990 also occurred in the last quarters of these years and cases were concentrated in the central and southern regions.

Adolescent↗
PubMed1996

Experience of European collaboration in influenza surveillance in the winter of 1993-1994.

BACKGROUND: The spread of influenza is of major public health concern. Surveillance programmes exist in many countries. We here describe an international collaboration sharing information from Belgium, France, The Netherlands, Portugal and the United Kingdom during the influenza A(H3N2) epidemic occurring in Europe at the end of 1993. METHODS: Procedures for clinical and virological surveillance in each country are described. National data were assembled at one point in each country and entered on a computerized data base in Paris for integration. A background rate of influenza was identified from the two previous winters (1991-1992 and 1992-1993) using the measurement of incidence routinely used in each country. The epidemic in late 1993 was described in relation to the background rate. The proportion of cases in each of three age groups (0-14, 15-44 and 65 years and over) was compared in different stages of the epidemic. RESULTS: All national systems effectively identified the onset and monitored the course of the epidemic. Standardization of incidence data gave only limited assistance to the interpretation of the data. The distribution of cases by age group was similar in the early and late periods of the epidemic in all countries. Increased clinical incidence was matched by a simultaneous increase in positive virus identifications in all countries except England and Wales, where the interval between the week of peak clinical incidence and of peak virus reports is mainly due to a reporting procedure based on date of report received at the Central Public Health Laboratory rather than date of specimen capture. CONCLUSION: An international early warning system for monitoring influenza has been established.

Adolescent↗
PubMed1996

Training physicians and health care providers to accurately read coronary arteriograms. A training program.

UNLABELLED: Patterns in visual interpretation of coronary arteriograms (CAs) frequently cause incorrect assessment of percent diameter stenosis (%DS). These errors result in overestimating the results of angioplasty as well as of the number of arteries significantly affected by coronary artery (CAD) disease. METHODS: Forty-one physicians, nurses, and students participated in the standardization of 45 Kodachromes (39 arteries, 6 phantoms) and 5 photographic reproductions. Eleven of the 41 participated in a three-part training program designed to eliminate errors and improve accuracy of interpreting %DS from CAs. RESULTS: Improvement in reading %DS was seen in 69% of CAs with statistical (P < or = 0.05) improvement in one third of these cases, whose narrowings ranged from 4% to 84%DS. Variability of reporting was reduced in 26% of the cases. Skewing, representing an overestimation of "severe" disease and underestimation of "less severe" disease, was reduced with statistical improvement (P < or = 0.05) in reported %DS noted after training. Similar improvement was seen with phantoms but not in photographic images where the arterial edges were outlined. CONCLUSION: The outcomes of clinical management, invasive and interventional (mechanical, thrombolytic) procedures, as well as research studies depend in part upon the accuracy of reading %DS from CAs. Most studies to date have completed using extremely unreliable estimates of %DS with resultant problems in data interpretation. The use of this standardized training program has led to significant improvement in accurately assessing CAD.

Cardiology↗
PubMed1996

Assessing the independent effect of dietary counseling and hypolipidemic medications on serum lipids.

Determination of changes in total cholesterol (TC) and triglyceride (TG) levels has focused primarily on hypolipidemic drug effects. Changes resulting from dietary effect alone versus diet and drug effect have not yet been fully established. Seventy subjects were enrolled into four treatment groups to determine the impact of diet and drug effect upon TC and TG. Group 1 (n = 28) served as the control group and received no dietary counseling or drug therapy. Group 2 (n = 22) received dietary counseling. Group 3 (n = 7) underwent dietary counseling for six months and drug therapy for eighteen months. Subjects in groups 1-3 were monitored for eighteen months. Patients in group 4 (n = 13) were followed up for thirty-six months. No intervention occurred during the first eighteen months, and hypolipidemic medications were used during the second eighteen-month period. Subjects in groups 1 and 4 received no specific dietary counseling and demonstrated no significant improvement over the course of the study. Patients in groups 2 and 3 showed significant reductions in both TC and TG. The improvement in TC seen for patients in group 3 was reduced after dietary counseling ceased. Dietary intervention is necessary if patients are to statistically significantly reduce TC and TG levels. Drug therapy demonstrated the expected reductions in both TC and TG but did not statistically significantly lower lipid levels without concomitant dietary counseling. When dietary counseling and hypolipidemic medications are used together, reductions in TC and TG values are even greater than those seen with dietary effect alone. Diet control alone appears to significantly reduce TC and TG levels, resulting in reduced need for antianginal medications.

Cardiology↗
PubMed1996

The impact of three influenza epidemics on primary care in England and Wales.

The numbers of persons with influenza presenting to general practitioners in England and Wales during the epidemics of late 1989, late 1993, and early 1995 are estimated to be approximately 760,00, 480,000 and 192,000, respectively. The expected numbers used to derive these estimates were obtained by averaging incidence by week over the 9 winters of 1986/87 to 1994/95, excluding those weeks in which influenza was prevalent. These 3 epidemics varied in magnitude and in the relative impact on persons in different age groups. The influenza B epidemic in 1995 scarcely affected elderly people. During the 3 epidemic periods, increased numbers of persons consulted their general practitioners with other respiratory diseases, including pneumonia, acute bronchitis and otitis media. The patterns of increase were not consistent between the epidemics, partly because of the differing impact on the various age groups and partly because of the effect of other respiratory viral illnesses prevalent at the same time. No increase occurred in the numbers of persons reported with new episodes of cerebrovascular accident or of acute myocardial infarction. A similar method was used to estimate excess deaths, which amounted to 25,000 in 1989, 13,000 in 1993, and 500 in 1995. In the periods immediately following the influenza epidemics, the observed pattern of deaths conformed to the expected, demonstrating that persons dying during the epidemics were not just dying a few weeks prematurely.

Aging↗
PubMed1996

The capture of socioeconomic data in general practice.

BACKGROUND: It is common practice to record the reasons why patients have an encounter with the practice, but the collection of socioeconomic data with which to link this morbidity data is less easy to achieve. AIM: To describe the social enquiry used in the Fourth National General Practice-based morbidity study (1991-1992) and to consider its effectiveness for use in practice. METHOD: Socioeconomic data were collected suing a structured questionnaire administered by a trained interviewer. Data were provided by both consulting and non-consulting registered patients. RESULTS: The interview technique proved to be acceptable to patients, interviewers and general practitioners, simple to administer, and inexpensive to collect. Eighty-three per cent of the 502,000 people included in the study provided social and occupational data. Less than 1.5% of patients refused to be interviewed. Fifty-four of the 60 practices achieved the target level of 90% of registered patients being successfully interviewed. CONCLUSION: A method of socioeconomic data collection based on that used in the 1991-1992 study would be of benefit for health care planning, allocation of resources, design of performance indicators and epidemiological research.

England↗
PubMed1996

The role of oak pollen in hay fever consultations in general practice and the factors influencing patients' decisions to consult.

BACKGROUND: Patients often consult for hay fever before significant counts of grass pollen are recorded, and this has prompted the question, 'Are symptoms already present or are patients consulting to obtain medication in anticipation?' AIM: The study is concerned with the relationship between hay fever symptoms and pollens, and also with the impact of the media on patient consulting behaviour. METHOD: Symptom questionnaires were presented to patients consulting with hay fever for the first time that year in 1994 in four Birmingham practices. The questionnaire concerned the nature and duration of symptoms and the influence of the media on their decision to consult. Incidence data collected over the spring and summer periods (1989-1995) in the Weekly Returns Service (WRS) were examined in relation to pollen counts reported by the Midlands Asthma and Allergy Research Association at Derby. Data are presented for oak, birch and grass pollen, but other pollen data including rape, nettle and other trees were also examined. RESULTS: Questionnaire data from 1994 were analysed in two periods starting from 4 April: early (day 1-60) and late (day 61-124). Out of the 364 subjects, 38% consulted in the early period and 62% in the late period. Altogether, 41% developed symptoms before the start of the grass pollen season. Overall, 91% of patients first consulting in the early period had already experienced symptoms compared with 99% late period and were not simply collecting prescriptions in anticipation. The influence of the media on consultation behaviour was very small, except in children, 23% of whom (or their parents) were reported to be influenced. The new episode data from the WRS examined over 7 years showed an early peak that was coterminous with oak pollen, and a later and higher peak with grass pollen. CONCLUSION: The consistency of the relationship between oak pollen and the early peak of hay fever over the years examined suggests that oak pollen is a major cause of hay fever symptoms.

Adolescent↗
PubMed1995

Influenza surveillance in England and Wales: October 1994 to June 1995.

This report summarises the information obtained by surveillance of influenza in England and Wales from October 1994 to June 1995 (weeks 40/94 to 25/95). Influenza B viruses were responsible for most infections, with moderate activity occurring throughout the winter, peaking in February. Influenza A became more active towards the end of the winter, and laboratory reports reached a peak in May (week 21/95). Influenza activity was seen first in Wales, then England, followed by Scotland. An increase in 'total respiratory disease' was reported in December 1994 by the Birmingham Research Unit of the Royal College of General Practitioners (RCGP) in England and Wales. This was probably due largely to an increase in reports of acute bronchitis, and was concurrent with the annual increase in respiratory syncytial virus infection which is often associated with bronchiolitis. Circulating influenza viruses were antigenically similar to components of the vaccine chosen for 1994/95. This report summarises the recommendations for the 1995/96 influenza vaccine.

England↗
PubMed1995

Study of the effectiveness of influenza vaccination in the elderly in the epidemic of 1989-90 using a general practice database.

The effectiveness of influenza vaccination in preventing serious illness and death was determined in an elderly population during the influenza epidemic of was determined in an elderly population during the influenza epidemic of was determined in an elderly population during the influenza epidemic of 1989-90. A retrospective cohort study was carried out using computerized general practitioner records on nearly 10,000 patients aged 55 years and over. After adjustment for potential confounding factors, recent immunization was found to have a protective effect of 75% (95% confidence intervals: 21-92%) against death. Protection did not appear to vary with either age or the presence of underlying chronic disease. As the complications of influenza are most common in those with underlying chronic disease, the study findings are consistent with the recommended policy for the use of influenza vaccine in the UK. Further work is necessary to determine the cost-effectiveness of extending immunization to other groups.

Aged↗
PubMed1995

Concurrence of monthly variations of mortality related to underlying cause in Europe.

STUDY OBJECTIVE: The study aimed to examine the concurrence in the variation of monthly numbers of deaths in summer and winter from the four main underlying causes - respiratory, circulatory, neoplastic, and all others - in four countries. In particular, the hypothesis that most non-respiratory concurrent deaths are miscoded respiratory deaths and that a large proportion of the winter mortality currently attributed to circulatory disorders should be attributed to respiratory causes was considered. DESIGN: Mortality data were analysed graphically in relation to cause. Each of the four series of monthly data underwent time series analysis to remove auto-correlation, seasonality, and secular trends. Associations between paired causes of death and between multiple series (using Kendall's coefficient of concordance) were then examined after modelling. SETTING: Monthly deaths (65 years and over) related to underlying cause were examined for England and Wales (nine years), The Netherlands (nine years), Denmark (10 years), and Portugal (10 years - all ages). Weekly data for England and Wales (51 weeks) were also analysed. MAIN RESULTS: All combinations of monthly deaths related to underlying cause were strongly associated in all four countries. This concurrence was evident down to the lowest monthly values so that all seasonally related deaths above the minimum monthly value can be used as an estimate of the "concurrent" proportion. Associations involving deaths from neoplasm were weakest. Concurrence was evident even on a weekly analysis (England and Wales). Concurrent deaths in England and Wales accounted for 31.1% of respiratory, 16.0% of circulatory, 3.5% of neoplastic, 14.1% of deaths from other causes and 14.2% for all deaths combined. The equivalent percentages for concurrent deaths from all causes were 8.4% in the Netherlands, 9.3% in Denmark, and 16.8% in Portugal. CONCLUSIONS: Concurrence, which was present in each of the underlying causal groups in each of the four national data sets examined, suggests a common cause separate from the underlying cause that has been used in the presentation of mortality statistics. If the person concerned had not died at that time, as a result of this cause, he would not have died from the recorded underlying cause. Most of these non-respiratory concurrent deaths are miscoded. As a consequence, a large proportion of winter mortality currently attributed to circulatory disorders should be attributed to other causes, probably respiratory. More intensive research into the contribution made by acute respiratory diseases is proposed. The proportion of concurrent deaths varied in the four countries thereby limiting the validity of simple comparisons of national mortality statistics.

Adolescent↗
PubMed1995

Treating hyperlipidemia in the elderly.

BACKGROUND: Determination of the effects of dietary modification and hyperlipidemic medications in the elderly (> sixty-five years of age) patient has not been significantly investigated to date despite knowledge that elevated cholesterol (TC) and triglyceride (TG) levels increase the risk of coronary artery disease (CAD). METHODS: Twenty-seven individuals were placed into one of three treatment groups and longitudinally followed up to examine the effects of diet and hyperlipidemic medications on TC and TG levels. Group 1 (n = 14) received neither dietary nor drug therapy. Group 2 (n = 9) received dietary counseling without concomitant hyperlipidemic medications. Subjects in group 3 (n = 4) underwent dietary instruction for six months and hyperlipidemic medication(s) for eighteen months. RESULTS: Subjects in group 1 demonstrated a statistical increase in TC (P < or = 0.001) during the study. Patients in groups 2 (P < or = 0.001) and 3 (P < or = 0.05) demonstrated statistical improvement in TC reduction during dietary counseling. The effect on TC was blunted in group 3 after dietary counseling was discontinued. Reductions in TG levels were significant (P < or = 0.001) only for patients in group 2. CONCLUSION: Elderly individuals were able to significantly reduce both TC and TG levels by dietary modification alone. Minimal improvement was seen with the addition of hyperlipidemic medications.

Aged↗
PubMed1995

Health care utilization in the British National Health Service.

Four national surveys of primary care services in England and Wales demonstrate that utilization rates have not continued to increase significantly since the initiation of the National Health Service in 1948, despite an initial surge in demands for medical services. The author examines morbidity surveys, consultation patterns, and referrals to secondary care and examines the ethical dilemma of basing services on costs.

Dental Staff, Hospital↗
PubMed1994

Influenza surveillance, England and Wales: October 1993 to June 1994.

This report summarises the information obtained by surveillance of influenza activity in England and Wales from 30 October 1993 to 24 June 1994 (weeks 93/44 to 94/25). A moderate epidemic of influenza occurred, which was earlier than in recent years. It followed an increase in influenza activity reported in Scotland in early October. Activity spread from north to south. Influenza A(H3N2) viruses accounted for over 98% of isolates typed, but a few strains of influenza B were identified.

Adolescent↗