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PubMed1997

Age at immigration to England of Asian and Caribbean immigrants and the risk of developing multiple sclerosis.

OBJECTIVES: Previous studies have shown that multiple sclerosis is very uncommon among Indian and Pakistani immigrants to England but that their children born in the United Kingdom, in the age groups available for study, have a similar risk of developing the disease as occurs in the general British population. The present study was to ascertain if these immigrants who enter England as children below the age of 15, have a higher risk of developing multiple sclerosis than those that enter after this age. METHODS: A search was made in Greater London, the West Midlands, Leicester, Bradford, Halifax, and Huddersfield to find ethnic Indian, Pakistani, and Bangladeshi immigrants to England with multiple sclerosis. During the course of the study some immigrants from the Caribbean with multiple sclerosis were also found. The population at risk by ethnic group and age at entry was not available from the 1991 Census but was available in the annual Labour Force Surveys. RESULTS: Indian and Pakistani immigrants who entered England younger than 15 had a higher risk of developing multiple sclerosis than those that entered after this age. Caribbean immigrants, who have a higher multiple sclerosis prevalence than Asian immigrants, did not show this difference. CONCLUSION: This study confirms previous studies which show that the environment during childhood is a major factor in determining the risk of developing multiple sclerosis.

Adolescent↗
PubMed1984

[An approach to the evaluation of medical journals: application to original articles of La Presse Médicale and the New England Journal of Medicine published in 1982].

Medical journals play an important role in the diffusion of scientific medical information. We tried to evaluate the French medical journal, La Presse Médicale, and to compare it with the New England Journal of Medicine. We reviewed all the original articles published in 1982 (207 articles In La Presse Medicale and 152 articles in the New England Journal of Medicine): specialties, methodologies used in the studies, environment (number of authors, geographical origin, institutional origin, number and language of references, number of subjects included in the studies). The articles in both journals concerned virtually the same specialties, more than 50% of the articles dealing with the following: cancerology, cardiology, infectious diseases, endocrinology, gastroenterology. Many specialties including highly prevalent diseases were underrepresented in both journals. When treating the same kind of problems, different methodologies were used: faced with a therapeutical problem, authors in La Presse Medicale used mostly non controlled evaluations (46%, 30 articles), and few randomized controlled trials (12%, 8 articles). On the other hand, authors in the New England Journal of Medicine used mostly randomised controlled trials (56%, 36 articles), and less non controlled evaluations (26%, 16 articles). Most references were in English, even in La Presse Medicale, in which 76% of all references were not in French, and 14% of all articles had no French references. In conclusion, this study shows differences between the two journals: in particular, the methodologies used by the authors in La Presse Medicale were less pertinent than those used by the authors in the New England Journal of Medicine. This finding is important with regard to the formation of and information given to the French speaking physicians, and a strong reaction from the editors and physicians concerned is desirable.

Evaluation Studies as Topic↗
PubMed2000

Surgical resident research in New England.

HYPOTHESIS: This study sought to determine the attitudes of general surgery residents in New England toward research and the factors that affect their research participation and productivity. DESIGN: Survey. SETTING: Eighteen of the 20 general surgery residency programs in New England. PARTICIPANTS: Four hundred fifty-nine surgical residents taking the American Board of Surgery In-Training Examination in 1999. MAIN OUTCOME MEASURES: Rationale for and amount of time spent in research and the number of publications. RESULTS: A majority of residents (61%) participated in research. Rationales for research participation included initiating an academic career (82%) and enhancing fellowship application prospects (83%). Personal debt was substantial, but had little influence on decisions regarding research. Gender was not a factor in the decision to participate in research, although women were more likely to cite a break from residency as a positive influence in their decision for doing research. Residents from larger programs (>25 residents) were more likely to participate in research, spend more time in research, and to publish an article than those from programs with fewer than 25 residents. CONCLUSIONS: Most surgical residents in New England plan to or participate in research and publish their work. Significant differences in the type, duration, and productivity of research exist between larger and smaller programs, and may reflect differing priorities among residents, or differences in the variety of research opportunities available.

Adult↗
PubMed1997

The effect of differences in the distribution of maternal age in England and Wales on the performance of prenatal screening for Down's syndrome.

We aimed to determine how differences in the age at which women had their pregnancies influenced the expected detection and false-positive rates of serum screening for Down's syndrome (i) between 1970 and 1993 in England and Wales, and (ii) between regions and districts of England and Wales in 1991. We applied published estimates of Down's syndrome screening to regional and district data on the age distribution of maternities and changes in the age distribution over time in England and Wales obtained from the Office of Population Censuses and Surveys. From 1970 to 1993 women, on average, became pregnant at an older age; the percentage of maternities among women aged 35 or more increased from 7 to 9.2 per cent. This was not a great enough change to have had a material effect on the performance of Down's syndrome screening. In 1991, the percentage of maternities among women aged 35 or more varied from 5 to 20 per cent among Health Districts, a difference that would influence the performance of screening; for example, using the triple test and a risk cut-off of 1 in 250, the detection rates would have varied from about 55 to 70 per cent and the false-positive rates from 4.4 to 8.8 per cent across different districts. The tendency for women to have their pregnancies at an older age would have had a negligible impact on the performance of serum screening for Down's syndrome, but differences in the age when women had their pregnancies in different parts of the country would lead to twice as many women being referred for amniocentesis in some districts than in others when offered the same method of serum screening and at the same risk cut-off level. The results will have important implications for the local purchasers of Down's syndrome screening services.

Adult↗
PubMed1983

Possible introduction of Huntington's chorea into Pacific Islands by New England whalemen.

Huntington's disease (HD) has been reported in two isolated South Pacific islands, New Britain in Papua New Guinea, and Malaita in the Solomon Islands. The earliest presumptive choreics in these foci were born in the latter part of the 19th century, prior to the colonial period. It is known that these islands were visited by certain New England whalers in the precolonial era, and inspection of the crew lists of these whalers shows many men with surnames common to families in New England known to have produced HD individuals. In some instances, the name, age, and origin of whalemen correspond with those of known choreic individuals. It is suggested that New England whalemen carrying the trait for HD introduced the disease to these islands.

Female↗
PubMed1994

Brief communication: bioarcheological and biocultural evidence for the New England vampire folk belief.

Folk beliefs associated with death and disease can impact on the bioarcheological record. Unusual postmortem actions by humans and distinctive paleopathological evidence may be clues to these beliefs. This report presents bioarcheological and paleopathological evidence in support of a 19th century New England folk belief in vampires with a particular reference to a colonial period burial. The New England folk belief in vampires revolves around the ability of a deceased tuberculosis victim to return from the dead as a vampire and cause the "wasting away" of the surviving relatives. To stop the actions of the vampire, the body of the consumptive was exhumed and disrupted in various ways. Twelve historic accounts of this activity indicate that the belief was not uncommon in 19th century New England. This creative interpretation of contagion is consistent with the etiology of tuberculosis. Three pieces of evidence are important in this case. The skeletal of a 50- to 55-year-old male from a mid-19th century Connecticut cemetery exhibiting pulmonary tuberculosis rib lesions are discussed. In addition, certain bones in the skeleton were rearranged after decomposition was complete. A historic vampire account from the same time period and geographical location place the belief within the parameters of the cemetery.

Burial↗
PubMed2006

Trends in paediatric circumcision and its complications in England between 1997 and 2003.

BACKGROUND: It has been suggested that too many English boys undergo circumcision. This report describes how circumcision rates have changed in England between 1997 and 2003, including data on complication rates and on how age, medical indication and surgical specialty affect postoperative haemorrhage rates. METHODS: Data were extracted from the Hospital Episode Statistics database of admissions to National Health Service hospitals in England. Patients were included in the study if an Office of Population Censuses and Surveys version 4 code for circumcision was present in any of the operative procedure fields of the database; 75 868 boys below 15 years of age were included in the study. RESULTS: Circumcision rates declined by about 20 per cent, from 2.6 per 1000 boys per year in 1997 to 2.1 in 2003. Between 2000 and 2003, circumcision rates remained static at 2.1 per 1000 boys per year. Circumcision rates fell by 31.2 per cent for boys aged 0-4 years, 9.3 per cent for boys aged 5-9 years and increased by 7.7 per cent in boys aged 10-14 years; 90.2 per cent of circumcisions were done for phimosis and 1.2 per cent of boys experienced a complication. CONCLUSION: Circumcision rates in England continued to fall up until 2000, particularly in those aged under 5 years, in whom pathological phimosis is rare. The circumcision rate remains five times higher than the reported incidence of Phimosis.

Adolescent↗
PubMed2005

Trends in suicide by drowning in the elderly in England and Wales 1979-2001.

BACKGROUND: Suicide by drowning increases with age but its rates vary between countries and among communities. Drowning suicide rates in some of the available studies may have been over reported or under reported because of misclassification. OBJECTIVE: This study presents data on the time trends, age/sex mortality rates from death by drowning in the elderly in England and Wales between 1979 and 2001. All coroners' verdicts in death by drowning; suicide, deaths undetermined whether accidentally or purposely inflicted were examined. METHODS: Counts of suicide due to drowning and submersion [ICD 9 codes; E954] and undetermined injury deaths [E984] (WHO, 1977), reported in England and Wales between 1979 and 2001 were obtained from National Statistics (ONS). RESULTS: There has been a gradual reduction in suicide by drowning in men and women by more than a third the observed count in 1979 (p < 0.01). However, this decline was less evident in the elderly particularly those over the age of 75. Elderly drownings appear to attract more verdicts of suicide compared to younger age groups (Odds Ratio 4.3 95% CI 2.3-8.3). Women, particularly elderly, are more likely to have a suicide verdict returned in drowning compared to men (Odds Ratio 1.5 95% CI 1.1-1.6). CONCLUSIONS: The high rate of open verdicts in elderly drowning over the study period and compared to any other method of fatal self harm in England and Wales confirms the difficulties in reaching a firm conclusion in drowning death. Therefore combining suicide and all undetermined deaths in drowning as a matter of course, in nationally collected statistics, may result in grossly exaggerated rates and misleading trends in suicidal drowning. Suicide by drowning is probably not amenable to prevention and although the elderly are often thought to benefit more from suicide prevention than younger adults, the study findings seem to suggest that this is not likely to be the case in drowning.

Aged↗
PubMed2003

Epidemiology of Varicella-Zoster Virus in England and Wales.

Many countries are studying currently the possibility of mass vaccination against varicella. The objective of this study was to provide a complete picture of the pre-vaccine epidemiology of the Varicella-Zoster Virus in England and Wales to aid in the design of immunisation programs. Population-based data including general practitioner sentinel surveillance, hospitalisation data, and death certificates from England and Wales were analysed. The average incidence rates for varicella and zoster between 1991 and 2000 were 1,291 and 373 per 100,000 years, respectively. Overall hospitalisation rates were equal for varicella and zoster (4.5 vs. 4.4 hospitalisation per 100,000 population) with 5 and 8%, respectively, having underlying immunosuppressive conditions. The age-specific proportion of cases hospitalised and length of stay were similar between the two diseases. However, the overall burden of disease is considerably higher for zoster. The number of inpatient days and case-fatality due to zoster are roughly 4 to 6 times greater than for varicella (11 vs. 3 days and 25 vs. 4 deaths per 100,000 case). These results provide base-line estimates should mass varicella vaccination be introduced in England and Wales.

Adolescent↗
PubMed2002

Remediation of contaminated land and groundwater: experience in England and Wales.

Remediation of contaminated land and groundwater is of common international concern. The context and approach taken to the problem are, however, country-specific. A survey of remedial activity occurring within England and Wales over the period 1996-1999 was commissioned by the Environment Agency (for England and Wales) to establish a baseline against which future trends in remedial activity could be judged. This paper: explains the context of contaminated land and groundwater remediation in England and Wales (Britain); provides an overview of the 1996-1999 survey of remedial activity, discussing its findings within its legislative and institutional context; and, discusses the survey results of significance to the management of contaminated land and groundwater internationally. The survey obtained specific data from 367 remediated sites supplemented by general data from a further 1189 contaminated (not necessarily remediated) sites. The survey aimed to be, and was indicative of remediation practice, and did not seek to identify every remediation scheme operating. Previous anecdotal evidences were generally confirmed. Civil engineering-based techniques dominated and were used at 94% of sites with in situ techniques (predominantly vapour extraction-based) on 16% and ex situ on just 5%. Although disposal to landfill was dominant and occurred at over 80% of sites, integrated use of multiple techniques was common. Remediation was predominantly of soil (rather than water), development-based, designed to protect human health and reflected national development-led and 'suitable for use' policies. Lessons of international relevance from the survey and general British experience are drawn concerning remediation technique selection, regulatory and financial support of innovative remediation techniques and demonstration sites, competent use of risk-based approaches to allow pragmatic remediation and effective use of quality guidelines, need for effective guidance to highlight water quality issues, the necessity of post remediation monitoring to prove remediation effectiveness and the keeping of remediation databases.

Conservation of Natural Resources↗
PubMedDate not supplied

Comparative histologic study of adenomas of the large intestine in Japan and England, with special reference to malignant potential.

The malignant potential of large-intestinal adenomas varies with size, histologic type, and grade of epithelial atypia in the same way in England and in Japan. Adenomas in England have greater malignant potential than those in Japan because they grow larger and more often show a villous growth pattern. Although the adenoma--carcinoma sequence operates in the same way in the two countries it is suggested that the higher incidence of colorectal cancer in England is due to the greater prevalence as well as the greater size of English adenomas. More studies of the epidemiology and geographic pathology of large-intestinal adenomas are needed to clarify their importance as a predisposing cause of colorectal cancer in low-risk as well as high-risk areas.

Adenoma↗
PubMed2001

Persuading the persuadable: evaluating compulsory treatment in England using Supervised Discharge Orders.

BACKGROUND: Supervised Discharge Orders (SDOs) were introduced in 1995, as an amendment to the Mental Health Act in England and Wales. They require patients to abide by specific conditions on discharge from hospital, but can not enforce medication compliance. On introduction, SDOs were received with scepticism by the psychiatric profession. The purpose of this study was to describe the use of SDOs in England and the characteristics of patients made subject to these orders, and to evaluate the effectiveness of the order in securing treatment compliance on discharge from hospital. METHOD: A survey was conducted of 170 mental health provider Trusts in England. Interviews with senior managers in 12 Trusts and associated Local Authorities were subjected to qualitative analysis, and a cohort of patients subject to SDOs in 56 randomly sampled Trusts was described. RESULTS: SDOs were being used for 596 patients (1.2 per 100,000 total population) at the survey date in 1999, and use had been increasing steadily since its introduction. The order is not systematically considered for all potential cases. The majority of the 182 patients in the cohort had complied, if sometimes intermittently, with conditions of the order. CONCLUSIONS: For patients compliant with SDOs, the pressures necessary to treat effectively need not involve powers to enforce medication compliance.

Adult↗
PubMed2003

An evaluation of vernal pool creation projects in New England: project documentation from 1991-2000.

Vernal pools are vulnerable to loss through development and agricultural and forestry practices owing to their isolation from open water bodies and their small size. Some vernal pool-dependent species are already listed in New England as Endangered, Threatened, or Species of Special Concern. Vernal pool creation is becoming more common in compensatory mitigation as open water ponds, in general, may be easier to create than wooded wetlands. However, research on vernal pool creation is limited. A recent National Research Council study (2001) cites vernal pools as "challenging to recreate." We reviewed documentation on 15 vernal pool creation projects in New England that were required by federal regulatory action. Our purpose was to determine whether vernal pool creation for compensatory mitigation in New England replaced key vernal pool functions by assessing project goals and documentation (including mitigation plans, pool design criteria, monitoring protocols, and performance standards). Our results indicate that creation attempts often fail to replicate lost pool functions. Pool design specifications are often based on conjecture rather than on reference wetlands or created pools that function successfully. Project monitoring lacks consistency and reliability, and record keeping by regulatory agencies is inadequate. Strengthening of protection of isolated wetlands in general, and standardization across all aspects of vernal pool creation, is needed to ensure success and to promote conservation of the long-term landscape functions of vernal pools.

Agriculture↗
PubMed1983

Beyond decentralization: the evolution of population distribution in England and Wales, 1961-1981.

"Using preliminary figures from the 1981 Census, this paper details recent population shifts at a variety of areal scales in England and Wales. It compares trends in the 1971-1981 period with those in the previous decade and assesses the relative contributions of net migration and natural change. Within its broad descriptive objectives, the paper considers whether England and Wales has kept abreast of patterns of counter-urbanization that have been claimed for other industrialized nations." The authors propose some definitions for various terms, including decentralization, deconcentration, and counter-urbanization. "The conclusion is drawn that even if the postulated international continuum of changes ranging from urbanization through to counter-urbanization is valid, the limited geographical size of England and Wales will preclude this country from reaching the final stages of such a model. Finally, some policy implications which stem from the recent population redistributions are introduced and some themes for future research are considered."

Demography↗
PubMed1991

Chernobyl fallout and perinatal mortality in England and Wales.

Previous studies have concluded that radioactive fallout from Chernobyl may have caused an increase in perinatal mortality in West Germany and the U.S.A. The existence of marked geographical variations in contamination from Chernobyl in England and Wales provides an opportunity to investigate this question further by means of a geographical study. The highest doses from Chernobyl in England and Wales were in the counties of Cumbria, Clwyd and Gwynedd where there was heavy rainfall during the passage of the radioactive cloud. However, perinatal mortality in these areas did not rise relative to the national average in the year following Chernobyl. This negative finding was confirmed by a wider study of 14 counties grouped in accordance with levels of radioactive contamination of local milk. It is concluded that this study provides no evidence that radiation from Chernobyl caused a rise in perinatal mortality in England and Wales.

Accidents↗
PubMed1994

Coronary heart disease: trends in spatial inequalities and implications for health care planning in England.

The idea of health gain has recently received particular emphasis in health policy in England. One of the areas where there is considerable scope for health gain is in the reduction of mortality due to Coronary Heart Disease. Some reduction in mortality rates due to this cause have already been achieved in England in the 1980s. However, the change in standardised mortality rates varies around the country. A review of studies of geographies of declining CHD mortality shows that such geographical variation is typical of other countries which have recently experienced a reduction in the CHD epidemic. The paper presents the results of an analysis of change in spatial inequality in coronary heart disease mortality among the population aged 35-74 for the 190 District Health Authorities in England over the period 1982-1989. Data were derived from counts of cause-specific deaths and population estimates published by the Office of Population Censuses and Surveys. Various approaches were used to assess the change in spatial disparity which has accompanied the average overall reduction in mortality rates over the study period. The results show that the trends vary between age and sex groups in the population and that, particularly for older people, overall health gain across the country is being achieved at the cost of greater inequality in health between areas. The implications for local health strategies with respect to coronary heart disease reduction are discussed.

Adult↗
PubMed1982

The prevalence of Gasterophilus intestinalis in horses in northern England and Wales.

The stomachs of 448 horses from northern England and Wales were examined for Gasterophilus larvae, and 237 (52.7%) were found to be infected with G. intestinalis. Larvae were present in stomachs examined during each month of the year except August. Second instar larvae occurred from September through February and third instars were present from November through July. Adult fly activity began in August as indicated by the presence of eggs on horses. The life-cycle of G. intestinalis in northern England and Wales is outlined from the data presented. The mean instar burdens were 15.7 second and 38.0 third instars, and more than 75% of the infections consisted of up to 50 larvae. Prevalence of infection and mean larval burdens declined with increasing age of host. Only one of 258 duodena examined was infected with G. nasalis and this horse originated from the south coast of England, outside of the catchment area of the other horses examined.

Animals↗
PubMed2004

Psycho-social influences on food choice in Southern France and Central England.

This study used attitudinal scales to investigate the nature of attitudes to diet and health in a northern European country (Central England) and a southern European country (Mediterranean France). Cross-sectional studies were conducted using self-administered postal questionnaires that were distributed simultaneously in April 2001 in Montpellier, France and Nottingham, England. A stratified random sample of 1000 males and 1000 females aged 18-65 years was generated from the electoral roll in each country. The final sample comprised England: n = 826 (58% male and 42% female; mean age=44 years) and France: n = 766 (42% male and 58% female; mean age=42 years). This study has demonstrated that the pleasurable and social aspects of eating, certain food quality issues, as well as health as a value were regarded as priorities by French respondents. On the other hand, English respondents reported that organic and ethical issues and convenience were important factors influencing their food choices. In conclusion, the two populations can be differentiated overall in their attitudes and beliefs to food choice.

Adolescent↗