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PubMed2001

Developing a cancer genetics service in Wales: opinions of gynaecologists on the management of women at risk of familial ovarian cancer.

In Wales, a cancer genetics service has been developing since 1998. Gynaecologists play an integral role in the management of women with a family history of ovarian cancer and we were interested in investigating referral practice and management for relatives of patients with ovarian cancer among gynaecologists in Wales. In 1999, a postal questionnaire was sent to all gynaecologists. The response rate was 51%. The questionnaire contained structured questions about current provision and a number of hypothetical scenarios to explore referral patterns to the cancer genetics service. The results of this study showed that referrals varied widely among specialists, as did the numbers who required onward referral to cancer genetics. The offer of screening to women at high risk of ovarian cancer was consistent, although there were variations in how often it was offered and the age at which it was offered. Most gynaecologists were easily able to establish when it was appropriate to refer onwards to cancer genetics, differentiating between women at high or low risk. There was some confusion about women at moderate risk of ovarian cancer. This study demonstrated the need for clear referral guidelines in Wales. Guidelines have since been distributed to all general practitioners and specialists; however, continued monitoring and further evaluation of referral practices will be necessary.

Family↗
PubMed2000

Self-esteem in community mental health nurses: findings from the all-Wales stress study.

The authors conducted an all-Wales survey of community mental health nurses (CMHNs) to determine their levels of stress, coping and burnout. A total of 301 CMHNs were surveyed in 10 NHS Trusts in Wales. A range of measures were used. These included the General Health Questionnaire (GHQ-12), Maslach Burnout Inventory (MBI), Rosenberg Self-Esteem Scale (SES), Community Psychiatric Nursing (CPN) Stress Questionnaire, and PsychNurse Methods of Coping Questionnaire. The findings from the Rosenberg SES are reported here. Community mental health nurses in Wales scored as having average self-esteem. When the data were divided into high and low self-esteem, a large group of CMHNs (40%) were found to have low self-esteem. Factors that are associated with low and high self-esteem were identified. Alcohol consumption and being on lower nursing grades (D, E, F) were associated with low self-esteem, whilst amount of experience working as a CMHN was associated with high self-esteem.

Adaptation, Psychological↗
PubMed1999

Hospital admission and mortality differentials of asthma between urban and rural populations in New South Wales.

It remains unclear whether there are any differentials in hospital admission and mortality rates of asthma between urban and rural populations. An observational study was conducted, based on patient hospital records, to examine the distribution of asthma admissions and mortality in New South Wales. Data on all reported cases of asthma were obtained from New South Wales hospitals between 1989 and 1994. Information on deaths of asthma was collected between 1983 and 1992. The hospital admission rates of asthma varied from 4.8 per 1000 in 1990 to 5.4 per 1000 in 1992 for rural population, and from 3.0 per 1000 in 1991 to 3.4 per 1000 in 1992 for urban population. The hospital admission rates were 51.2-69.1% higher for rural residents than urban dwellers. The mortality rates of asthma ranged from 4.8 per 100,000 in 1983 to 8.0 per 100,000 in 1985 for rural population, and from 3.8 per 100,000 in 1983 to 6.0 per 100,000 in 1989 for urban population. The mortality rates of asthma were 3.62-42.85% higher for rural residents than urban dwellers. These results indicate that the non-age-adjusted hospital admission and mortality rates of asthma were considerably higher in rural populations than in urban populations in New South Wales.

Age Distribution↗
PubMed2001

Service to the poor: the foundations of community nursing in England, Ireland and New South Wales.

This paper describes the foundations of community nursing in England, Ireland and New South Wales. It is guided by Foucault's work on power, discourse and knowledge, and argues that the common discourse of poverty coupled with the influence of socially advantaged women in the nineteenth century was the impetus for the development of community nursing in England, Ireland and New South Wales. Throughout the nineteenth century in Great Britain, economic and industrial development, coupled with an unprecedented growth in the population (particularly among the poor) inspired socially advantaged women to extend traditional gender-specific roles to address the needs of the poor. Protestant women in England advanced professional nursing as a career for women and in Ireland and New South Wales; Catholic women pioneered professional nursing, targeting the poor as the focus of their practice. These women used prevailing social conditions to enhance their life options within the limits prescribed by social norms.

Catholicism↗
PubMed2002

The prevalence of hepatitis C in England and Wales.

OBJECTIVES: To estimate the background population prevalence of hepatitis C in England and Wales, observe the prevalence over time and assess the extent of infection outside of known risk groups. METHODS: Sera from residual specimens from adult patients submitted to laboratories in England and Wales were tested for anti-HCV. Testing was carried out using a cost-effective pooling strategy. RESULTS: Although the prevalence of anti-HCV was highest in 1986 (1.07%), in the multivariable analysis, prevalence did not vary significantly between the 3 periods 1986, 1991 and 1996 (P=0.14). The prevalence of infection was higher in males than in females (P=0.0013). An age-period-cohort analysis revealed a cohort effect due to a lower HCV prevalence in the most recent birth cohorts, that is, those born between the calendar years 1971-1975 and 1976-1980. CONCLUSIONS: The majority of HCV infections in England and Wales were probably acquired before 1986. Infections in younger males identified in 1996 may signify more recent acquisition by injecting drug use.

Adult↗
PubMed1997

Classifying sub-acute and non-acute patients: results of the New South Wales Casemix Area Network study.

In 1994 the New South Wales Casemix Area Network initiated a study to develop a classification and funding model for sub-acute and non-acute care. Thirty-five rehabilitation, geriatric, psychogeriatric and palliative care services were recruited into the study throughout eight area health services. The aim of the first phase, summarised here, was to capture and analyse a sufficiently large quantity of data to select those variables most likely to predict resource utilisation, for subsequent use in a detailed costing study. It is known that acute care diagnosis related groups are not predictive of costs in sub-acute care. This phase of the project confirmed that, in New South Wales, the most predictive variables were case type, functional status measures, impairment type for rehabilitation, phase for palliative care and severity of symptoms for palliative care. The resultant Phase 1 casemix classification, which has built on recent United States experience and studies in other Australian States, has been termed the New South Wales Sub-Acute and Non-Acute Patient (SNAP) Version 1 classification.

Activities of Daily Living↗
PubMed2005

Changes in testing methods for genital Chlamydia trachomatis in New South Wales, Australia, 1999 to 2002.

BACKGROUND: Over the last decade, significant advances have occurred in the area of chlamydia diagnostics. The relative frequency of different testing methods employed in the diagnosis of Chlamydia trachomatis infection in New South Wales has not been previously reported. METHODS: Testing methods--both laboratory method and specimen type--employed in the diagnosis of chlamydia cases notified in New South Wales between 1999 and 2002 were collated from Health Department records. RESULTS: During a period of increasing notifications, the proportion of men diagnosed with C. trachomatis using nucleic acid tests (NATs) increased from 36% in 1999 to 90% in 2002. Among women, the proportion diagnosed using NATs increased from 42% in 1999 to 92% in 2002. Urine samples were consistently used in the diagnosis of two-thirds of the men, and one-third of the women. CONCLUSION: Between 1999 and 2002, a rapid shift towards NATs for genital C. trachomatis took place in New South Wales.

Chlamydia Infections↗
PubMed1996

Suicide patterns and trends in people of Indian subcontinent and Caribbean origin in England and Wales.

OBJECTIVES: To examine suicide rates and trends in people of Indian subcontinent, east African and Caribbean origin using the latest mortality data available for England and Wales. To compare suicide rates in these groups with the baseline and target rates for suicide in the Health of the Nation strategy. METHODS: Suicide data for England and Wales for 1988-1992, classified by the country of birth of the deceased, and population denominators from the 1991 Census were used for the analysis. Standardised mortality ratios (SMRs) for ages 15-64 and age-specific ratios were computed, using the age-sex specific rates for England and Wales as the standard. Trends over the preceding decade and suicide by burning were also analysed. Directly age-standardised suicide rates were derived to facilitate comparison with Health of the Nation baseline and target rates. RESULTS: Suicide ratios were significantly low (SMRs 32, 52 and 55 respectively) in Bangladeshi, Sri Lankan and Pakistani born men at all ages, but raised in young Indian and east African men. Ratios were significantly high in Indian and east African women (143 and 154), with a 2-3 fold excess at ages 15-34 years. Ratios were low in Pakistani and Bangladeshi women overall, but elevated at 15-24 years. For the Caribbean-born, ratios were low overall but raised at ages 25-34. 20% of Asian female suicides were by burning. Indians are a high risk group in terms of the Health of the Nation suicide targets. Suicide trends in the minority ethnic groups reflect national trends. CONCLUSIONS: This study confirms previous findings of high suicide rates in young Asian women. A new finding is the raised suicide rate in young Caribbeans. High suicide risks among young people from some ethnic minority communities are significant in the context of both the Health of the Nation strategy and recent governmental concern about the need to tackle health variations in the UK. Such deaths are indicative of larger numbers of young ethnic minority adults at risk of mental distress and self harm.

Adolescent↗
PubMedDate not supplied

Cirrhosis and primary liver cancer amongst first generation migrants in England and Wales.

OBJECTIVE: To examine mortality from cirrhosis of the liver and primary liver cancer among first generation migrants to England and Wales. DESIGN: Comparison of standardised mortality ratios (SMRs) for cirrhosis of the liver and primary liver cancer in men and women aged 20-69, by country of birth for the five year period 1988-1992. SETTING: England and Wales. RESULTS: There was a statistically significant two-fold excess of mortality from cirrhosis of the liver among male migrants from East Africa (SMR 286), India (SMR 261) and Bangladesh (SMR 254) as well as men born in Scotland (SMR 253) and Ireland (SMR252). Among women, only those born in Scotland (SMR 254) and Ireland (SMR 237) showed significant excess mortality. For liver cancer, significant excess mortality occurred among men born in the Caribbean (SMR 312), Bangladesh (910) and the African Commonwealth other than East Africa (1014), with Scottish and Irish born men showing more moderate excesses (136 and 170, respectively). SMRs were elevated also in all groups of foreign-born women but, probably owing to the small numbers of deaths, none of the findings reached statistical significance. CONCLUSIONS: Of public health concern is the excess mortality from cirrhosis in first generation immigrants to England and Wales from Scotland and Ireland (men and women) and in male migrants from India, Bangladesh and East Africa. Of equal concern is increased mortality from liver cancer in all foreign-born groups of both sexes, particularly among Bangladeshis, and African-Caribbeans. As well as promoting sensible drinking among immigrant men, specific preventive measures for those of Bangladeshi, African-Caribbean origin may include selective screening for hepatitis B and C and other tumour markers. Screening for liver cancer using imaging techniques needs further investigation. The benefit/cost ratio should be assessed by the Screening Committees of the UK Departments of Health. At local level, variation in incidence and prevalence of hepatic disease and feasible prevention programmes should be assessed within developing health improvement programmes.

Adult↗
PubMed2005

Prevalence of psychoses on reception to male prisons in New South Wales.

OBJECTIVE: To estimate the prevalence of psychotic illnesses among men received to prisons in New South Wales. The study also sought to estimate the sensitivity and specificity of the psychosis screener in the Composite International Diagnostic Interview (CIDI-Auto). METHOD: The study was part of a larger study on psychiatric disorder in men received to New South Wales prisons. Using a structured questionnaire, the CIDI-Auto (modified), which included screening questions for psychotic illness, the prisoners who gave positive responses to the screening questions for psychosis as well as any subjects considered by the experienced clinicians performing the CIDI-Auto interviews to show features of a psychotic illness, were referred to the researchers for a clinical assessment. The clinical assessment included a review of all available information. RESULTS: Of the prisoners, 5.1% were thought to have definite psychotic illness and 1.9% to have possible psychotic illness. The psychosis screener was found to be neither sensitive nor specific. CONCLUSIONS: The rate of psychotic illness among people remanded to New South Wales prisons is between 10 and 14 times the rate found in a similar study in the wider community. The poor performance of the psychosis screener suggests that screening for psychotic illness on reception to prisons should be performed by clinically trained staff.

Adult↗
PubMed1996

Winter excess mortality: a comparison between Norway and England plus Wales.

Seasonal fluctuations in mortality are associated with age, outdoor temperature, and influenza. The relative excess winter mortality is approximately twice as high in the UK compared with the Scandinavian countries. Using data from Norway and England plus Wales, this study compares the effect of age, temperature and influenza on winter excess mortality in the two countries. Bivariate analyses showed that the excess winter mortality (December-March) in England and Wales was nearly twice as high in old as in middle-aged people, and also markedly higher than in Norway, while the association between excess winter deaths and influenza was of a similar magnitude. In the British data only, a marked and statistically significant negative relationship existed between outdoor temperature and excess winter mortality, corresponding to an increase of approximately 3,500 deaths in England and Wales (approximately 2/10,000 in the population aged 45 years and over) per 1 degree C reduction in winter temperature, after adjustment for age and influenza. Using data from 20 Western European countries, a highly significant positive correlation (R = 0.71, p < 0.001) was found between total mortality rates for the elderly (65 years and over) and relative excess winter mortality.

Age Factors↗
PubMed1997

Continuing medical education in Wales: a survey of geriatricians.

OBJECTIVE: to determine what practising geriatricians in Wales do to continue their education; what they would prefer to do; and what their views are on study leave, resources and funding. DESIGN: questionnaire survey. SETTING: the principality of Wales. PARTICIPANTS: hospital-based, career-grade geriatricians. RESULTS: the overall response rate from a total of 56 questionnaires was 87%. More than half [26 (53%)] of the respondents stated they were able to take only half of their study leave entitlement of 10 days a year. Twenty-five (51%) considered this to be due to service commitment. Geriatricians regarded attendance at routine hospital meetings [47 (96%)] and specialist society meetings [45 (92%)], reading books and journals [49 (100%)] and discussion with colleagues [44 (90%)] as their preferred methods of keeping up to date. Most respondents [44 (90%)] said that the resources and funding required to underpin the system of continuing medical education (CME) should be provided by the employing authority. CONCLUSIONS: the many barriers to the continuing education of geriatricians in Wales include service commitments and funding constraints. Geriatricians placed great emphasis on the traditional CME methods such as reading books and journals, attending meetings and conferences and discussion with colleagues and were reluctant to use technology-based educational methods. The results of this study have implications for the way in which geriatricians fulfil CME obligations in the future and provide directions for the planners of CME.

Adult↗
PubMed2002

Information from primary care: its importance and value. A comparison of information from Slovenia and England and Wales, viewed from the 'Health 21' perspective.

BACKGROUND: The WHO have set health standards in the form of 21 targets--Health 21--and the EU are developing a set of health indicators whereby national health status can be measured. Data from Slovenia and from England and Wales assessing information systems in primary care and their capacity to deliver the requirements of these initiatives have been examined. In both countries, primary care is provided through a state-led service. METHODS: Consultation data from the annual report of the Department of Health Slovenia (1999) are compared in respect of relevant targets with data from the Fourth National Morbidity Survey (1992) in England and Wales. Consultation rates were standardized to the European Union 15 country population (1998). RESULTS: Consultation rates in females were similar in the two countries whereas in males rates were higher in Slovenia. The proportionate distributions of consultations by chapter of the International Classification of Diseases (ICD) were similar in both countries, respiratory (17%) and musculoskeletal (9%) disorders ranked first and second. For eye diseases, injury and poisoning, factors influencing health status (e.g. medical examination). proportions were higher in Slovenia: for mental disorders higher in England and Wales. The relativity of male to female consultation rates was broadly similar with higher rates in females in most ICD chapters. These differences are considered in detail against the background of WHO targets. CONCLUSIONS: Data gathered systematically from the surveillance of consultations in primary care are important to the measurement of WHO 'Health 21' targets.

Adolescent↗
PubMed1984

Suicide and self-poisoning in three countries--a study from Ireland, England and Wales, and Denmark.

Because it has been suggested that both the frequency of deliberate self-poisoning and the characteristics of those who self-poison differ between Ireland, and England and Wales on the one hand and Denmark on the other we have examined self-poisoning rates and suicide rates in these three countries. Higher self-poisoning rates were found for England and Wales than for the other two countries below age 35. After this age self-poisoning rates decline in both England and Ireland but female rates continue to rise in Denmark up to age 45. Danish suicide rates are conspicuously higher than those of both England and Wales, and Ireland. Because combined death rates for suicide, undetermined and accidental deaths diminish but do not remove the differences between countries it is suggested that the Danish suicide death rate reflects a genuinely higher rate of suicide in that country.

Adolescent↗
PubMed1996

Hospital admissions attributable to rotavirus infection in England and Wales.

Laboratory reports and data on hospital admissions were used to estimate the number of hospitalizations due to group A rotavirus infection in England and Wales. Between January 1990 and December 1994, there were 75,059 laboratory reports of rotavirus infection, and 66,062 of these were in children <5 years old; rotavirus represented 39% of all pathogens identified in fecal specimens from this age group. Between April 1993 and March 1994, 1904 hospital admissions coded as "infectious intestinal disease" and 2354 coded as "noninfective gastroenteritis" occurred in children <5 in the North Thames region (a health authority representing 13% of the population in England and Wales). By modeling admission and laboratory reporting data, it was estimated that 54% of hospitalizations for intestinal infectious disease and 34% for noninfective gastroenteritis were attributable to rotavirus. By extrapolation of the North Thames data, it was estimated that 17,810 rotavirus-related hospitalizations (5/1000 children <5 years old) occurred in England and Wales during the same period. Effective vaccines have the potential to substantially reduce the number of hospital admissions due to group A rotavirus infection.

Adolescent↗
PubMed2004

Helicobacter pylori antibiotic resistance patterns and genotypes in adult dyspeptic patients from a regional population in North Wales.

OBJECTIVE: Surveillance data on Helicobacter pylori antibiotic susceptibilities in Wales are limited, despite resistance being a key factor in treatment failure. A single-centre survey was undertaken over 3 years to determine local antibiotic resistance rates on isolates from dyspeptic patients in Bangor, Gwynedd (North Wales). METHODS: Susceptibilities were determined for 363 isolates by disc diffusion and the Etest. Isolates were also genotyped (cagA presence and vacA allelic types). RESULTS: Overall in vitro resistance rates were 24% for metronidazole and 7% for clarithromycin, with 4% resistant to both antibiotics. Resistant strains typically had high MICs of >256 mg/L. Tetracycline resistance was identified in only one isolate whereas no isolates showed resistance to amoxicillin. There was a two-fold increase in resistance over the study period. No gender and age associations with resistance were detected. Resistant and susceptible isolates were genotypically diverse with respect to cagA/vacA type but the vacA s1m2 form was a feature of all clarithromycin-resistant isolates compared with 56% of the susceptible isolates. CONCLUSION: Although the overall antibiotic resistance rates of H. pylori from North Wales were low compared with many other regions in Europe, continued surveillance, particularly of high-level resistance (MIC >256 mg/L), is recommended to monitor the effects of the 'test and treat' strategy for H. pylori eradication.

Adult↗
PubMed2004

Silicosis and lung cancer: a mortality study of compensated men with silicosis in New South Wales, Australia.

BACKGROUND: Lung cancer mortality has been found to be in excess in several groups with silicosis, but allowance for smoking was not always possible. We investigated the lung cancer mortality in men with silicosis in New South Wales, Australia, who were compensated, making allowance for smoking habits. METHODS: A mortality study of 1467 men with silicosis in New South Wales who were compensated was carried out comparing observed mortality with that expected from the New South Wales death rates adjusting for age and period. Their smoking habits were compared with national survey smoking rates and the expected number of lung cancer deaths adjusted for smoking. Cases were coded for occupation and industry. RESULTS: The observed mortality was higher than expected, but the only site of cancer showing a significant excess was the lung. The group with silicosis had smoked more than the national rates. After adjusting for smoking the standardized mortality ratio for lung cancer was 1.9 (95% confidence interval 1.5-2.3). Although there were differences in lung cancer mortality between industries and occupations, these differences were not statistically significant. CONCLUSIONS: The excess lung cancer death rate may not be entirely due to silica exposure because compensation may have been influenced by the presence of chronic obstructive respiratory disease and there is some evidence that the presence of this disease increases lung cancer risk independently of smoking.

Aged↗
PubMed2002

Trends in violence in England and Wales 1995-2000: an accident and emergency perspective.

BACKGROUND: Prevention of violence-related injury has become an important public health issue but national, regional and local data are lacking. The aims of this study were to determine trends, seasonality and rates of violence-related injury according to Accident and Emergency (A&E) recorded data in England and Wales over a 5 year period, 1995-2000. METHODS: A stratified sample of 58 major A&E departments in England and Wales were recruited for the study. Electronic data on age, gender and date of attendance of all those reporting violence-related injury over a 5 year period, May 1995 to April 2000, were retrieved. Injury rates (number of injured per 100 resident population) were computed and ordinary least-squares regression analysis was used to evaluate linear and non-linear trends in these time series data. RESULTS: A total of 353442 (258719 males: 73 per cent) violence-related attendances were identified. Overall annual violence-related attendance did not change significantly (p > 0.05) but attendance of females aged 11-17 years increased steadily and significantly (p < 0.05) over the 5 year period. Health-region, gender- and age-specific increases in violence-related attendance slowed (p < 0.05). Compared with spring there were significantly lower levels of violence in autumn and winter for both males and females (p < 0.05). Violence affecting males aged 18-30 years was not subject to seasonality. Males, those aged 18-30 years and those living in the northern and western regions in England and Wales were at highest risk of violence-related injury. CONCLUSIONS: This national study from the perspective of health services suggests that violence did not increase over the period 1995-2000. Slowing of age-, gender- and health-region-specific increases in violence-related injury suggests that violence is coming under control. The reasons for significant trends in individual urban centres deserve further study, and could provide important new directions for violence prevention.

Adolescent↗