Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENGLAND”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources
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↗
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↗
PubMed2006

Prevalence and mechanisms of cephalosporin resistance in Enterobacteriaceae in London and South-East England.

OBJECTIVES: To investigate the molecular epidemiology of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in London and South-East England. METHODS: A prospective study involving 16 hospital microbiology laboratories in London and South-East England was undertaken over a 12 week period. Each laboratory submitted up to 100 consecutive cephalosporin-resistant Enterobacteriaceae isolates judged clinically significant by microbiology staff. Centralized testing was undertaken to confirm organism identification and cephalosporin resistance and to analyse resistance mechanisms. RESULTS: The predominant mechanism of cephalosporin resistance in isolates from both hospital and community settings was the production of CTX-M-type ESBLs, with CTX-M-producing Escherichia coli as the most numerous resistant organism overall. Other major mechanisms of cephalosporin resistance included production of non-CTX-M ESBLs and AmpC beta-lactamases. Most ESBL (both CTX-M and non-CTX-M) producers were multiply resistant to non-beta-lactam antibiotics, including trimethoprim, ciprofloxacin and gentamicin. CONCLUSIONS: CTX-M enzymes, which were unrecorded in the UK prior to 2000, have become the major mechanism of cephalosporin resistance in Enterobacteriaceae in South-East England. E. coli has overtaken Klebsiella and Enterobacter spp. to become the major host for ESBLs. Due to the multiple antibiotic resistance exhibited by many ESBL-producers, these changes have major implications for antimicrobial therapy.

Adolescent↗
PubMed1999

Prescribing of beta-2 agonists and inhaled steroids in England: trends between 1992 and 1998, and association with material deprivation, chronic illness and asthma mortality rates.

BACKGROUND: British Thoracic Society guidelines published in 1990, revised in 1993 and 1997, recommended that general practitioners should make greater use of inhaled steroids in the management of asthma. British Thoracic Society guidelines have also been published on the management of chronic obstructive pulmonary disease. The objective of this study was to examine trends in the prescribing of beta-2 agonists and inhaled steroids in England between 1992 and 1998, and to investigate the variation at health authority level in the use of these drugs. METHODS: This was an observational study using prescribing analysis and cost (PACT) data, mortality data and data from the 1991 Census for all 100 health authorities in England. RESULTS: The number of defined daily doses of beta-2 agonists prescribed per quarter increased by 20 per cent, from 142 million to 170 million between June 1992 and March 1998. The number of defined daily doses of inhaled steroids prescribed per quarter increased by 78 per cent during the same period, from 69.9 million to 124.7 million. The ratio of inhaled steroids to beta-2 agonists increased from 0.49 to 0.73. The number of items per 1000 specific therapeutic group age-sex related prescribing units (STAR-PUs) in 1997 in health authorities in England varied from 41 to 115 for beta-2 agonists and from 24 to 68 for inhaled steroids. The ratio of the number of items of inhaled steroids to beta-2 agonists varied from 0.50 to 0.70. At health authority level, prescribing rates were most strongly associated with the percentage of patients reporting chronic illness (correlation coefficient 0.82 for beta-2 agonists and 0.72 for inhaled steroids). There were significant negative correlations between the ratio of inhaled steroids to beta-2 agonists and both Jarman deprivation scores (r = -0.51) and chronic illness (r = -0.38). There were no significant associations between health authority prescribing rates and death rates from asthma in people aged 5-44 years. CONCLUSIONS: Prescribing of inhaled steroids has risen more quickly than that of beta-2 agonists between 1992 and 1998, resulting in a marked increase in the ratio of inhaled steroids to beta-2 agonists. At health authority level, there remains a wide variation in the use of beta-2 agonists and inhaled steroids.

Administration, Inhalation↗
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↗
PubMed2002

Availability of primary care doctors and population health in England: is there an association?

BACKGROUND: In the United States, an association has been proposed between better access to primary care and lower mortality. This paper reports an ecological analysis that evaluated whether population health was associated with general practitioner (GP) supply in England. METHODS: Data were analysed for 99 health authorities in England in 1999. Health outcomes included standardized mortality ratios, infant mortality rate (per 1,000), hospital admissions with acute and chronic conditions (per 100,000), and teenage conception rates (per 1,000). The number of GPs per 10,000 population was included as explanatory variable. Confounders included the Townsend deprivation score, proportion of ethnic minorities, proportion in social classes IV and V, and proportion with limiting long-term illness. Analyses were by linear regression weighted for population size. RESULTS: Higher GP supply was associated with lower mortality in univariate analyses. After adjusting for deprivation score, ethnic group and social class, the standardized mortality ratio for all-cause mortality at 15-64 years decreased by -5.2 (95 per cent confidence interval -8.3 to -2.0, p = 0.002) per unit increase in GP supply. After additional adjustment for limiting long-term illness, the decrease was -3.3 (-6.7 to 0.1, p = 0.060). In the fully adjusted model, each unit increase in GP supply was associated with a decrease in hospital admission rates for acute conditions (-14.4, -21.4 to -7.4 per 100,000, p < 0.001) and chronic conditions (-10.6, -17.2 to -4.0, p = 0.002). CONCLUSIONS: In England, lower supply of GPs was associated with increased hospital utilization, but a strong univariate association with mortality might be explained by confounding.

Adolescent↗
PubMed2006

Prevalence of problematic and injecting drug use for Drug Action Team areas in England.

BACKGROUND: National and local monitoring of policies on illicit drug use requires information on the number of problematic drug users in a country. This article reports the findings from a study that estimated the number of problematic and injecting drug users for all Drug Action Teams (DATs) in England for 2001. METHODS: The Multiple Indicator Method (MIM) is a statistical technique for using aggregated data to estimate numbers of drug users across a large number of areas. The MIM was used to combine eight indicators available for all DATs, with prevalence estimates available from a small number of DATs. The indicators were drug possession and supply offences, arrest referrals, people recorded in drug treatment databases, methadone prescriptions, drug-related hospital episodes, drug-related deaths and DATs' Townsend score. The latter is a measure of material deprivation. A three-stage process involved, (i) factor analysis of the drug indicators, (ii) regression linking factor scores to known prevalence estimates and (iii) imputation of estimates to all other DATs. RESULTS: Factor analysis yielded two statistically significant factors underlying the drug indicators in 150 DATs in England. The estimated prevalence rate of problematic drug use in the DATs varied from 0.2 to 1.5 per cent of the population. The estimated average number of problematic drug users per DAT was 1943 (standard deviation = 1300). The estimated average number of injecting drug users per DAT was 627 (standard deviation = 572). The estimates for England in 2001 were 287,670 (population rate = 0.64 per cent) problem drug users, and 93,185 (population rate = 0.23 per cent) injecting drug users. CONCLUSIONS: Although the model cannot take account of specific local factors, the results are likely to be accurate in areas that do not have these idiosyncrasies. The estimated prevalence figures provide a basis for all DATs to assess their contact rates with problematic and injecting drug users.

Adolescent↗
PubMed2006

Pneumococcal polysaccharide vaccine uptake in England, 1989-2003, prior to the introduction of a vaccination programme for older adults.

OBJECTIVE: Following the licensure of 23-valent pneumococcal polysaccharide vaccine (23vPPV) in 1989, a risk-group-only immunization policy was implemented in 1992 in England. The PPV programme was extended in 2003 to include all individuals 65 years and over. In England, this was phased in over 3 years. To ascertain the performance of the risk group policy in those 65 years of age and over and provide a baseline to estimate the impact of the universal elderly programme. METHODS: Information was gathered on vaccine uptake for the period 1989-2003 in England from a national survey of general practitioners (GPs) through NHS primary care trusts (PCTs), the prescription cost analysis (PCA) system and the General Practice Research Database (GPRD). RESULTS: Between 1991 and 2003, 4.5 million doses of PPV were prescribed. The GP survey found that by 2003, 29% of those 65 years and over of age and 36% of those 80 years of age over had received PPV. Sixty-two per cent of general practices had implemented a risk-group-only policy, 14.4% had targeted all those 65 years of age over and 14.2% had targeted all those 75 years of age over. The GPRD study found that 38% of those 65 years over and 41% of those 80 years over fell into one or more high-risk groups. By 2003, 36.6% of the high-risk group and 30.2% of all those 65 years over had ever been vaccinated. Vaccine uptake increased with age, with 52.3% of the high-risk group and 37% of all those 80 years over having ever been vaccinated. CONCLUSIONS: A large proportion of those in risk groups remained unvaccinated with PPV in 2003. Formal evaluation of the impact and effectiveness of the universal elderly immunization programme will be required.

Aged↗
PubMed2000

Rheumatology telephone helplines: an activity analysis. South and West of England Rheumatology Consortium.

BACKGROUND: Anecdotal evidence suggests that the services offered by rheumatology telephone helplines in the UK vary widely between NHS Trusts because of the lack of national or European guidelines. OBJECTIVE: To conduct an activity analysis of six NHS Trust rheumatology telephone helplines in the south and west of England. METHODS: Serial data were collected on the first 100 calls received on or after 1 January 1999 by six rheumatology helplines in the south and west of England. Background information was gathered on the management, availability, setting and purpose of each helpline. Data on the time taken to manage these calls and patient satisfaction were not collected. RESULTS: Patients with rheumatoid arthritis were the major users and no significant differences were found in the outcome of their calls between centres, but wide variations were revealed in the management of the helplines, the populations they serve and the services they offer. CONCLUSION: The rheumatology helpline services in six NHS Trusts in the south and west of England were shown to be the same in name only. They lacked uniformity in the delivery of care and accessibility to relevant patient groups. The geographical variation in service delivery may result in patient dissatisfaction and confusion if a number of hospitals are attended over the course of a patient's chronic disease. Further research is required to identify the helpline needs of the broader rheumatology population, patient satisfaction, outcomes and system costs, and to progress towards the development of national and European guidelines.

Aged↗
PubMed2004

Prevalent diagnosed HIV in England, Wales and Northern Ireland: adjusted totals 1996 to 2001 and extrapolations to 2004.

OBJECTIVE: To predict trends in diagnosed HIV prevalence by extrapolation to 2004 using data from the annual surveys of individuals receiving HIV-related care in England, Wales and Northern Ireland from 1996 to 2001. METHODS: Data from the annual surveys of prevalent HIV infections diagnosed (SOPHID) were adjusted for under-reporting and non-attendance and separately extrapolated for infections acquired homosexually, heterosexually and by other routes. The data were extrapolated using negative binomial and linear regression models based on the 1996 to 2001 annual surveys. RESULTS: The negative binomial model predicted an increase of 56% in diagnosed HIV prevalence in England, Wales and Northern Ireland between 2001 and 2004. The linear model predicted an increase of 25% for the same time period. The predicted increases are mostly driven by the large rise in the number of new diagnoses, in particular in individuals infected heterosexually. CONCLUSION: Increases in HIV prevalence in England, Wales and Northern Ireland have diverged from a linear trend. Negative binomial modelling of the data predicts that large rises in prevalence will continue during the early 2000s.

Binomial Distribution↗
PubMed1999

Different prevalences of reflux oesophagitis and hiatus hernia among dyspeptic patients in England and Singapore.

OBJECTIVE: To compare the frequency of reflux oesophagitis and hiatus hernia in dyspeptic patients in England with that in Singapore. DESIGN: Demographic, clinical and endoscopic findings in consecutive dyspeptic patients seen in England and Singapore by the same clinician were compared. The association of various factors with the occurrence of hiatus hernia and oesophagitis was analysed by logistic regression. SETTING: District general hospital in England and university hospital in Singapore. PARTICIPANTS: The English series comprised 212 consecutive patients, and 173 patients were seen in Singapore. RESULTS: Reflux oesophagitis and hiatus hernia were found in 52 (25%) and 50 (49%) of the English patients, and 12 (6%) and 7 (4%) of the Singapore patients, respectively (P<0.005 in each case). Race, body mass index and age were independently associated with hiatus hernia (odds ratios 3.07, 1.08 and 1.04, respectively). The risk factors for oesophagitis were race, sex, body mass index and age (odds ratios 4.04, 2.37, 1.11 and 1.02, respectively). If hiatus hernia was included in the analysis, the risk factors were hiatus hernia, sex, race and body mass index (odds ratios 20.10, 3.07, 2.81 and 1.09, respectively). CONCLUSIONS: Reflux oesophagitis and hiatus hernia are more common in English dyspeptic patients compared to those in Singapore. The most important risk factor for both oesophagitis and hiatus hernia is race.

Adult↗
PubMed1989

Employment status and the frequency and causes of burn injuries in New England.

We analyzed a subset of data from the New England Regional Burn Program (NERBP) to assess the effects of employment status on the rates and causes of burn injuries in New England. The subset of the NERBP data analyzed pertained to residents of the six New England states who were hospitalized for the treatment of a burn injury sustained between July 1, 1978 and June 30, 1979 and who were aged 20 years or older at the time of the injury. Analysis of the data identified that men, particularly black men and young men, experienced higher burn rates than did their female, white, and older counterparts among both employed and unemployed persons. High burn rates were observed in Maine; low rates were observed in Rhode Island. Scalds were the most common type of burn among work-related burns to women and to men aged 20 to 54 years, and flame or flash burns were the most common otherwise. The majority of work-related burn injuries were caused by activities related to food preparation or consumption, motor vehicle repair and maintenance, and use of flammable liquids. Persons employed as operatives and laborers, or persons employed in the service occupations, appeared to have the highest risk of sustaining a burn injury while at work.

Accidents, Occupational↗
PubMed2004

Surveillance of HIV-1 subtypes among heterosexuals in England and Wales, 1997-2000.

The molecular diversity and demographic characteristics among 976 anti-HIV-1-positive heterosexuals attending 15 sexually transmitted infection (STI) clinics participating in an unlinked anonymous HIV prevalence serosurvey in England and Wales during 1997-2000 were investigated. Subtypes were assigned by heteroduplex mobility assay or sequencing of the p17/p24 region of gag and the V3/V4 region of env and by sequencing of the protease gene. Overall, there was no significant change in the subtype distribution, with subtype C accounting for the majority (32%) of subtyped infections. Subtypes B (29%), A (12%), circulating recombinant forms (CRFs, 9%), unique recombinant forms (URFs, 8%), and subtypes D-H (8%) were also detected. Thirty-nine percent of infections in men were with subtype B, whereas subtype C was most common (38%) in women. Logistic regression analyses showed the relative risk (RR) of infection with a non-B subtype, compared with subtype B, to be greater in African-born individuals (RR = 28.9, P < 0.01), among newly diagnosed infections (RR = 3.4, P < 0.01), and in women (RR = 2.4, P < 0.01). These findings indicate a high level of genetic diversity among HIV-infected heterosexual STI clinic attendees in England and Wales. Recently, subtype C has become most prevalent, particularly in younger age groups, suggesting recent acquisition of this viral strain. The high proportion of non-B, CRF, and URF infections among UK-born individuals is consistent with mixing between migrants and UK-born individuals in England and Wales. As migration patterns change, continued monitoring of HIV genetic diversity will aid understanding of transmission patterns.

Africa↗
PubMed2006

Cardiac rehabilitation in England: a detailed national survey.

AIMS: The purpose of this study is to conduct a detailed analysis of cardiac rehabilitation programmes in England to compare actual provision with the recommendations of the National Service Framework and Scottish Intercollegiate Guideline Network guidelines. METHODS: Questionnaires and interviews were conducted with key staff from one centre in each Strategic Health Authority in England to establish staffing levels, patient throughput, programme details, data collection and funding. RESULTS: There were major discrepancies between programmes and the national recommendations. Perceptions of the service were often at variance within key staff in the trust. Staffing levels, lack of facilities and space were identified as a weakness in many of the programmes. Inadequate exercise sessions, poor record keeping and a failure to tailor the sessions to the patients needs were common. Mean funding was pound288 per patient rehabilitated. CONCLUSIONS: For those 30% of eligible patients who enter cardiac rehabilitation in England, the service suffers from inadequate staffing, facilities and space, associated with gross underfunding. If the recommended 85% of eligible patients were included the situation would be much worse. The Department of Health recommendations for cardiac rehabilitation have not been translated into action, with most hospitals giving it low priority compared with other cardiology services. A treatment with demonstrable benefits should at least meet the standards recommended by national guidelines.

Delivery of Health Care↗
PubMed2003

Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland.

OBJECTIVE: To investigate the numbers, clinical characteristics, resource use, and outcomes of admissions who met precise clinical and physiologic criteria for severe sepsis (as defined in the PROWESS trial) in the first 24 hrs in the intensive care unit. DESIGN: Observational cohort study, with retrospective analysis of prospectively collected data. SETTING: Ninety-one adult general intensive care units in England, Wales, and Northern Ireland between 1995 and 2000. PATIENTS: Patients were 56,673 adult admissions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We found that 27.1% of adult intensive care unit admissions met severe sepsis criteria in the first 24 hrs in the intensive care unit. Most were nonsurgical (67%), and the most common organ system dysfunctions were seen in the cardiovascular (88%) and respiratory (81%) systems. Modeling the data for England and Wales for 1997 suggested that 51 (95% confidence interval, 46-58) per 100,000 population per year were admitted to intensive care units and met severe sepsis criteria in the first 24 hrs.Of the intensive care unit admissions who met severe sepsis criteria in the first 24 hrs, 35% died before intensive care unit discharge and 47% died during their hospital stay. Hospital mortality rate ranged from 17% in the 16-19 age group to 64% in those >85 yrs. In England and Wales in 1997, an estimated 24 (95% confidence interval, 21-28) per 100,000 population per year died after intensive care unit admissions with severe sepsis in the first 24 hrs. For intensive care unit admissions who met severe sepsis criteria in the first 24 hrs, median intensive care unit length of stay was 3.56 days (interquartile range, 1.50-9.32) and median hospital length of stay was 18 days (interquartile range, 8-36 days). These admissions used 45% of the intensive care unit and 33% of the hospital bed days used by all intensive care unit admissions. CONCLUSIONS: Severe sepsis is common and presents a major challenge for clinicians, managers, and healthcare policymakers. Intensive care unit admissions meeting severe sepsis criteria have a high mortality rate and high resource use.

Adolescent↗
PubMed2004

Lipid levels and the use of lipid-lowering agents in England and Scotland.

OBJECTIVE: Preventing cardiovascular events with lipid-lowering drugs has been established in several trials reported since 1994. Consequently national guidelines recommend statins for those with established cardiovascular disease (CVD) and those at high risk of developing CVD. We evaluated blood lipid levels, and compare treatment and control of dyslipidaemia in English and Scottish adults with national recommendations for lipid lowering. DESIGN AND METHODS: In 1998 the nationally-representative Health Survey for England and the Scottish Health Survey included valid cholesterol results for 9631 (England) and 6065 (Scotland) adults aged 16-74. Mean blood levels of total, high-density lipoproteins (HDL-), and total:HDL-cholesterol ratio; prevalence of elevated total cholesterol levels, and total:HDL-cholesterol ratios; prevalence of use of lipid-lowering agents in high risk subgroups; and lipid levels of those on treatment were calculated. RESULTS: Levels of dyslipidaemia, treatment and control were not significantly different between Scotland and England. Combining these data, mean total cholesterol levels were 5.43 and 5.48 mmol/l in men and women respectively; and mean HDL-cholesterol levels were 1.29 and 1.56 mmol/l. Overall 64.6% of adults had a total cholesterol > or =5 mmol/l, 24.6% had a total:HDL ratio > or =5 and 2.3% reported taking lipid-lowering drugs. Treatment rates among those with a total cholesterol >5 mmol/l and a history of coronary heart disease or stroke, hypertension, or diabetes, were 27.3%, 15.4% and 17.8% respectively, and control rates (total cholesterol <5 mmol/l) among those treated were 45.3%, 38.5% and 32.7%. CONCLUSIONS: Low treatment rates with lipid-lowering drugs existed overall, among high-risk patients suitable for primary prevention, and among those with established cardiovascular disease.

Adolescent↗
PubMed2004

Trends in inpatient pediatric trauma care in new England.

BACKGROUND: The annual number of childhood injury admissions to New England hospitals decreased by more than half from 1991 through 2000. This study was undertaken to determine whether this decrease was caused by decreased injury incidence or changes in the diagnosis and/or management of childhood injury. METHODS: Patients younger than 16 years of age with an injury diagnosis code were extracted from the New England Pediatric Trauma Database and an Injury Severity Score and hospital-specific variables were assigned. U.S. Census Bureau age-specific population estimates were used to generate population-based data. Admission rates were analyzed by organ system injured and injury severity category. Acute care length of stay and hospital charges were analyzed. Femur fracture admission rate was used to determine the baseline rate of childhood injury admission, and rates of admission for other injuries were divided by the rate of femur fracture admissions to produce a femur-standardized rate. Variation in this standardized rate was felt to be secondary to changes in the diagnosis and/or management of the injury. RESULTS: The population-based pediatric trauma hospital admission rates decreased 56% during the 10-year study period, from 464 to 208 per 100,000 children per year. Femur fracture admission rates decreased 26% over the same time period. Admission rates for minor injuries decreased by 61% and, when standardized by the rate of injury incidence, as determined by the femur fracture rate, still decreased by 47%. Standardized admission rates for moderate and severe injuries were unchanged. Injury admission rates decreased for most organ systems, except for thoracic and abdominal injuries, which increased 20%. Admission rates for unspecified intracranial, skull, and spine injuries decreased 60%, whereas the admission rate for specified brain injuries was unchanged. The mean, median, and 75th percentile length of stay decreased significantly for moderate and severe injuries. Despite this, median per-patient hospital charges increased each year. CONCLUSION: Fewer New England children were hospitalized for injury each year during the past decade. Although the overall rate of childhood injury hospitalization declined by half, the majority of the decrease was secondary to changes in the diagnosis and/or management of pediatric injury. Evaluation of the true effectiveness of injury prevention efforts should take this changing diagnosis and management pattern into account.

Adolescent↗
PubMed2007

The criminalization of HIV transmission in England and Wales: a brief review of the issues arising.

PURPOSE OF REVIEW: The HIV virus has been present in our society for more than two decades. Although there was originally much academic interest in the possibility of prosecuting for the reckless transmission of HIV in England and Wales, it was thought impossible by many (including the government) under existing legislation. The first prosecution in England in 2003 (following the first UK prosecution in 2001, in Scotland) provoked a great deal of surprise not least in the HIV voluntary sector, which has since been campaigning for the cessation of such prosecutions. This review examines the law in this area and provides an understanding of the development of the ethical and other issues involved. RECENT FINDINGS: Since 2003 there have been seven further convictions for the reckless transmission of HIV in England and Wales. These prosecutions have led to several responses that are discussed here and the current developments in this area outlined. SUMMARY: Whether it is right to prosecute the reckless transmission of HIV remains a controversial, pressing question. This brief article aims to dissect and question the relevant issues and help inform this debate.

Criminal Law↗