Search PubMed⌕ Search

Biomedical subjects

D M Fleming

Publications and source records attributed to D M Fleming.

At least 91 records · Page 5Linked to original sources
PubMed1994

Incidence of allergic rhinitis in general practice, 1981-92.

OBJECTIVES: To determine the epidemiology of hay fever and to consider the role of pollution. DESIGN: Examination of data on weekly incidence of allergic rhinitis and hay fever by age, sex, region, and location. SETTING: Royal College of General Practitioners Weekly Returns Service. Practice data were based on registered populations of 220,000 in 1981, rising to 700,000 in 1992 from England and Wales. MAIN OUTCOME MEASURES: Numbers of new cases of hay fever and allergic rhinitis. Data on pollen counts for Darlington, Derby, and London. RESULTS: The incidence of allergic rhinitis fluctuated greatly from year to year but showed no trend. Peaks in hay fever coincided with peak pollen counts. No important differences were found between urban and rural locations or different parts of the country with respect to both size and timing of the peaks. Incidence was highest in children (5-14 years). CONCLUSIONS: The similarity of the results throughout England and Wales does not support an important role for local pollutants in hay fever. However, the possibility that levels of pollutants are high enough to act as an adjuvant in hay fever across the whole study area has not been excluded.

Adolescent↗
PubMed1994

The prediction of epidemics of respiratory infection.

Experience from 25 years of clinical monitoring of influenza and related illnesses has been considered in relation to the prediction of epidemics of influenza. The monitoring has taken place in a network of sentinel practices in England and Wales who report new episodes of illness weekly as they occur. The practice data are aggregated at the Birmingham Research Unit of the Royal College of General Practitioners and weekly rates per 100,000 population are published in age-specific groups. Major epidemics of respiratory infection are heralded by an increase in the weekly rates for influenza and influenza-like illness of 30 per 100,000 and by increase in the rate for all acute respiratory illness of 150 per 100,000. Increases of this magnitude have been consistently associated with major epidemics of respiratory illness which in turn cause substantial increases in deaths. When epidemics occur around the turn of the year, respiratory syncytial virus has to be considered as a possible cause but otherwise epidemics of this magnitude are invariably due to infection by Influenza A virus.

Acute Disease↗
PubMed1993

Respiratory illness and mortality in England and Wales. A study of the relationships between weekly data for the incidence of respiratory disease presenting to general practitioners, and registered deaths.

The possible relationship between the incidence of respiratory diseases as reported to general practitioners and numbers of registered deaths in England and Wales has been examined. Morbidity data from sentinel practices for the period 1986-1990 (population covered increased from 220,000 to 470,000) were used to calculate weekly rates of aggregated respiratory disease for persons of all ages and for elderly persons (aged 65 years and over). The elderly respiratory disease rates and numbers of deaths were aggregated into 4-week periods; secular and seasonal trends were removed from each series and the two sets of residuals were examined graphically and cross correlation coefficients calculated. There was a very strong positive association between the respiratory disease rate and number of deaths in the same 4-week period and there was also a significant but less pronounced association between respiratory disease in one 4-week period and deaths in the next. After prior separation of weeks according to temperature into four bands, weekly rates for respiratory disease were also strongly associated with the number of weekly deaths for each temperature band. The synchronisation of peaks and troughs in the two series throughout the year supports the hypothesis that a cause and effect relationship exists between respiratory disease in the elderly and number of deaths. Other climatic and meteorological variables besides temperature may play a part in determining the spread of a respiratory disease. There is a for further research to identify the micro-organisms responsible for acute respiratory infections in the elderly.

Acute Disease↗
PubMed1993

Morbidity registration and the fourth general practice morbidity survey in England and Wales.

The fourth morbidity survey in England and Wales is based on a population of 473,000 persons registered in 60 practices and cared for by 241 general practitioners. This presentation traces the evolution of morbidity surveys in England and Wales. That evolution has taken place against a background of advancing computer technology and the drift towards a paperless record. It is motivated by an increasing recognition of the need for data from primary health care an a realisation that a structured record is capable of servicing information needs without intermediary data sheets and coding procedures. The primary objectives of the study include assessment of disease prevalence by region, age-sex and social group; and to study trends over time. Morbidity and social data are collected in the practices and all relevant information stored on practice computers. At the end of the recording year, the computerised record for each patient is copied on to disks in an anonymized but uniquely identified form and transferred to the national Office of Population Censuses & Surveys for analysis. During the year, weekly extracts are taken of new episodes of illness in age and sex groupings which provide the basis of the Weekly Returns Service of the Royal College of General Practitioners.

Data Collection↗
PubMed1993

Incidence of episodes of acute asthma and acute bronchitis in general practice 1976-87.

The incidence of episodes of acute asthma and acute bronchitis was analysed for an 11-year period and studied in relation to epidemiological data on viral illness and virus isolation data. Between 1976 and 1987, the weekly returns service estimates of the incidence of acute asthmatic episodes in England and Wales increased from 10.2 to 27.1 per 100,000 patients per week (all ages). The increase was most marked in children up to the age of 14 years. Acute bronchitis attack rates (all ages) increased from 78.7 to 111.9 per 100,000 patients over the same period. Because of this rise in rates of acute bronchitis, it is unlikely that labelling shifts contributed to the increase in reported episodes of asthma. These data support the belief that the rise in the prevalence of asthma is real, and also that in the United Kingdom this rise may even be underestimated by partial concealment in the rates of acute bronchitis. In 1987, if 10% of attacks of acute bronchitis were attacks of asthma, this would represent a 41% underestimation of asthma attack rates. Rates for other respiratory illnesses showed a fall over the same period, apart from the common cold which showed an increase. The winter increase in acute bronchitis coincided with viruses with strong seasonal patterns (respiratory syncytial virus, parainfluenza viruses 1 and 2 and influenza A and B), but there was no evidence that these viruses were related to the overall increase in acute asthma attacks over this 11 year period.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1993

Prevalence of hearing loss among people aged 65 years and over: screening and hearing aid provision.

The aim of this study was to assess the prevalence of hearing loss among people aged 65 years and over and to offer hearing aids where necessary. The study was carried out in a large health centre practice in Birmingham with a computerized record system. All patients aged 65 years, and a 20% random sample of patients aged 66 years and over were invited for interview. They were questioned about hearing loss and examined audiometrically. All patients with a hearing loss in the better ear of 35 decibels or more over the speech frequencies (0.5-4 kHz) were offered a hearing aid. A total of 322 patients attended (72% of those invited) and of these 34 patients already had a hearing aid. A further 142 patients were identified for whom an aid was recommended and 69 of these accepted. The acceptance rate was higher among men than women (57% compared with 43%). Sixty one patients (19% of those screened) had an asymmetrical hearing loss and of these 24 required consultant assessment; none had serious underlying pathology. There is a large unmet need for hearing aid provision. Simple audiometric assessment in health centres provides an opportunity to meet this need.

Aged↗
PubMed1992

The problem of diagnostic variability in general practice.

STUDY OBJECTIVE: The aim was to examine the scale, source, and relevance of variation between general practices in respect of the rates with which patients consulted with illnesses falling in each of several diagnostic groups. DESIGN: This study involved a general practice morbidity survey conducted over two years, 1970-72. All patients who consulted their general practitioners were identified and the number of these who consulted with diagnoses attributable to each of the 18 main chapters of the International classification of diseases were counted. Patients who consulted for more than one diagnosis within a chapter were counted once only; those who consulted for one or more diagnoses in each of several chapters were counted once for each chapter. SETTING: This was a national survey involving general practitioners in England and Wales. SUBJECTS: The study involved 214,524 patients from 53 selected general practices (115 doctors) who were registered with their general practitioners for the whole of the year 1970-71 and for whom their morbidity data had been linked with their social data from the 1971 census. MEASUREMENTS AND MAIN RESULTS: Using the numbers of patients on the practice lists as denominators, practice patient consulting rates (PPCR) were calculated for each practice and for each ICD chapter. Variability in chapter PPCR was examined by calculating coefficients of variation and, after allowance for random variation, coefficients of residual variation. There were large interpractice (doctor) variations in all chapter rates. These variations were only marginally attributable to: chance; different age, sex and social class mixes of practice populations; geographical locations; and practice organisation. The rates were, however, consistent from one year to the next for any one practice. Approximately half of the interpractice (doctor) diagnostic variability was associated with overall patient consulting behaviour. When the effects of this behaviour were discounted, any major residual diagnostic variability was confined largely to ICD chapters I-V, XVI, and XVII, ie, those chapters where aetiology forms the basis of classification. CONCLUSION: Variations in recorded diagnostic rates are mainly due to the consistent but idiosyncratic and selective exclusion by practitioners of some components from the total set which often coexist in a new diagnosis. Because of the scale of interpractice diagnostic variability, the use of algorithms and information technology is largely precluded from outcome studies, auditing procedures, and studies of practice work loads in general. However, (1) the consistency of any individual doctor's pattern of diagnostic recording from one year to another permits studies of trends; and (2) given a reasonable number of recording practices, the population mean practice consulting rates can be estimated with sufficient accuracy for many epidemiological research and administrative uses.

Age Factors↗
PubMed1991

Disease concurrence in diabetes mellitus: a study of concurrent morbidity over 12 months using diabetes mellitus as an example.

STUDY OBJECTIVE: The aim was to examine disease concurrence, using diabetes mellitus as an ullustrative example. DESIGN: The study involved a general practice morbidity survey, conducted over 12 months in 1981-82. All patients who consulted their general practitioners with a diagnosis of diabetes mellitus (type 1 or type 2) were identified and the number of these who consulted with additional morbidities were counted for each rubric of the Royal College of General Practitioners' modification of the International Classification of Disease. These observed numbers were then compared with expected numbers calculated from the total non-diabetic population after standardisation by age. Standardised person consulting ratios (SPCR) were derived and the 99% confidence intervals (CI) surrounding these values calculated. SETTING: This was a national survey involving the whole of England and Wales. PATIENTS: The study involved 280,000 patients from selected general practices, of whom 953 males and 1035 females consulted their general practitioners with diabetes. MEASUREMENTS AND MAIN RESULTS: In an examination of 80 disease rubrics in the diabetic population in which there were at least 20 observed or expected cases, there were 34 among males and 28 among females in which there were increased values of the SPCR, and none in which the SPCR was decreased. SPCRs were high for infections generally (bacterial, fungal, and viral) and particularly so for cardiovascular disorders and for hypothyroidism in males. Though SPCRs for upper respiratory infections were increased, those for asthma and hay fever were not. SPCRs for neoplasms as a group were not raised. CONCLUSION: By confirming other work and widely held clinical opinion, this study has shown the potential of this data base for the examination of disease concurrence.

Cohort Studies↗
PubMed1991

The measurement of morbidity in general practice.

(1) The need for morbidity data based on general practice arises because: (a) the consultation in general practice is the entry point into the health care system; (b) among the health problems brought to the attention of doctors, most are dealt with completely in general practice; (c) general practice records can provide a comprehensive database for health care. (2) The routine measurement of morbidity has to be based on "working diagnostic terms" derived by consensus amongst recorders because: (a) many episodes of illness involve only one consultation and the doctor is required to make the most of the information available to him at the time; (b) the specification of criteria would require validating evidence of conformity and this is not a realistic option on a wide scale; (c) health care data which include the opinion of the general practitioner are more valuable than data based on patient perceptions of illness. (3) The analysis and interpretation of data from general practice: (a) should preferably be based on persons as the unit of analysis; (b) when based on consultations, may be useful for examining workload, but has limited epidemiological value; (c) can, by person linkage, facilitate the study of disease concurrence; and (d) is essential for managing the health care system and monitoring the public health.

Data Collection↗
PubMed1991

The design and management of national morbidity surveys.

This paper describes the three major morbidity surveys in general practice which have been conducted in England and Wales. In it, the evolution of the recording method is traced from the patient summary card of the first survey to the diagnostic index of the second and third surveys and finally, to the fully computerised recording programme to be used in the fourth survey due to start in September, 1991. Issues relating to the capture of social data, the use of diagnostic terms and the value of obtaining data over a 12 month period are discussed.

Data Collection↗
PubMed1991

Changes in practice morbidity between the 1970 and 1981 national morbidity surveys.

The primary aim of the study was to evaluate practice differences in reported morbidity in the second and third national morbidity surveys (1970/71, 1981/82) and to discuss their cause. A secondary aim concerned the validation of trends identified from analysis of the data from the total populations in the practices. Altogether 19 practices participated in both surveys. Annual prevalences (that is, the number of patients attending the general practitioner with a condition per 1000 persons at risk) were examined for: all conditions; each of three categories of seriousness of disease; diseases aggregated by chapter of the International classification of diseases; and each of 130 rubrics of the disease classification. Annual prevalence for 'all conditions' was approximately the same for males in both surveys, whereas for females there was an increase. In both sexes, annual prevalence for 'serious conditions' increased slightly and for 'trivial conditions' increased substantially. For 'intermediate conditions', there was a modest decrease in males. In the analysis at ICD chapter level, substantial increases in prevalence occurred in infectious diseases, nervous system diseases, circulatory diseases, genitourinary diseases, musculoskeletal diseases, symptoms, signs and ill-defined conditions, injuries and poisonings. Decreases were found in blood diseases, mental disorders and digestive diseases. Among 130 individual conditions examined, increased annual prevalence was found for mumps, fungal infections, hypothyroidism, diabetes, gout, senile dementia, angina, left heart failure, catarrh, hay fever and asthma, orchitis, acne, osteoarthritis and for some symptoms. Decreases were found for iron deficiency anaemia, anxiety state, refractive errors, haemorrhoids, chronic bronchitis, functional disorders of the stomach, carbuncle and skin infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Observations on the influenza epidemic of November/December 1989.

This paper reports on the surveillance of influenza by the weekly returns service of the Royal College of General Practitioners during the epidemic of November/December 1989. An epidemic of influenza became evident in mid-November and incidence peaked in the week beginning 6 December. The increase in incidence of influenza-like illness and of aggregated data for all respiratory disease to above the levels for non-epidemic years occurred one week before that attributed to influenza. The pattern of incidence was similar in the three geographic regions of England and Wales. The peak was first achieved in the age group 5-14 years and last in age 65+ years. The pattern of deaths from all causes closely followed the pattern of respiratory disease with an interval of between one and two weeks. During the period 15 November to the end of the year there were approximately twice as many people reporting respiratory disease than was usual for this time of year. The peak weekly incidence was the highest recorded for 12 years but it was substantially less than the peaks for the winters of 1969/70, 1972/73 and 1975/76. Further research is in progress to establish the most effective means of monitoring influenza epidemics.

Adolescent↗
PubMed1989

Geographical variations in persons consulting rates in general practice in England and Wales.

Using data from the Third National Morbidity Study, we have examined annual period prevalence in three large geographical areas of England and Wales--North, Midlands and Wales & South. Standardised persons' consulting ratios (SPCRs) have been obtained by the indirect method using five-year age bands as the basis for standardisation. There were several comparatively small differences between area SPCRs. There was reduced prevalence of diabetes in both sexes in the North; increased prevalence of respiratory disease in the North with the notable exception of asthma: increased prevalence of cardiovascular and cerebrovascular disease in the North which constrasted with increased recognition of hypertension in the South and the Midlands and Wales. There were no area differences in the prevalence of mental disorder; SPCRs for preventive care were relatively high in the North; the SPCR for cervical cytology was low in the Midlands and Wales. Although these differences are statistically significant, they were, in general, of small magnitude and do not suggest any major difference in morbidity between the areas.

Adult↗
PubMed1989

Consultation rates in English general practice.

Methods of estimating the annual consulting rate per patient are reviewed. Methodological problems include the definition of consultations as opposed to problems encountered, the definition of population at risk, the reliability of data about home visits and the limitations of extrapolating data collected over a short period. Estimates of consultation rate are usually obtained from surveys which have other primary objectives. The annual consultation rate in 1981, excluding telephone contacts, was estimated at 3.5 consultations per patient. In spite of its limited sample size, the general household survey provides a reliable estimate of the national consulting rate. There is, however, a need to validate it against a survey covering a longer period in which consultation rates are measured and not just estimated from memory. The total workload of the 'average' doctor changed little between 1970 and 1981 in spite of reducing list size. Home visits accounted for approximately 15% of all consultations in 1981 and this value has been consistent over the period 1980-83.

Adolescent↗