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PubMed1994

Surveillance of HTLV infection in England and Wales: 1986-1992.

The epidemiology of infection with human T cell leukaemia/lymphoma virus (HTLV) types I and II in England and Wales between 1986 and 1992 has been studied. Two sources of data have been reviewed: reports of cases of infection received by the PHLS Communicable Disease Surveillance Centre, and information about people infected with HTLV-I and II provided on laboratory request forms sent to the Virus Reference Division of the PHLS Central Public Health Laboratory. Most patients were of Caribbean origin. The age and sex distribution of people with disease associated with HTLV-I and II in England and Wales resembles that previously recorded in the Caribbean. The data suggest that the prevalence of disease associated with HTLV infection is low in England and Wales, but case ascertainment may be incomplete.

Adult↗
PubMed1995

How many people in England and Wales risk infection from injecting drug use?

Injecting drug users who share equipment may transmit and acquire bloodborne virus infections, including HIV, hepatitis B virus, and hepatitis C virus. Even without sharing, injection with non-sterile equipment, drugs, or mixing agents may result in infection due to bacteria or fungi. Estimates of the number of people who are currently at risk of infection from injecting drug use are needed in order to plan services and care, and to interpret surveillance data. This paper examines the data from registries of drug use and two recent surveys of the general population from which estimates of the number of current injecting drug users in England and Wales have been derived. Drug registries include only those whose drug use is identified during contact with drug or medical services, so these sources provide minimum estimates but may be used to monitor trends: 25,706 drug users in England and Wales were notified to the Home Office in 1993, 12,253 of whom were current injectors. Estimates derived from surveys of the general population suggest, however, that between 51,900 (95% confidence interval (CI): 33,000-71,600) and 77,700 (95% CI: 4100-151,200) people in England and Wales are at risk of infection from current injecting drug use, of whom between 10,400 (95% CI: 7200-13,800) and 15,500 (95% CI: 800-30,200) are at risk of bloodborne virus infections as a result of sharing injecting equipment. In the 16 to 34 year age group about one in 200 men, and one in 400 to 500 women may be current injectors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Admission rates for hip fracture in Australia in the last decade. The New South Wales scene in a world perspective.

OBJECTIVES: To study the changes in admission rates for hip fracture in New South Wales in the last decade; and to compare the age-adjusted rates with those from Europe, America and Asia. METHODS: Hospital discharge data for the years 1981, 1986 and 1989-1990 for New South Wales were used. The number of patients discharged with hip fracture (International Classification of Diseases code 820) as one of the diagnoses was calculated. Age-specific rates were calculated using the census population for 1981, 1986 and 1991. These rates were then directly standardised to the 1985 United States population and then presented with similarly adjusted rates from countries in Europe, America and Asia. RESULTS: For New South Wales men, the incidence rates of hip fracture (directly standardised to the 1985 United States population) for 1981, 1986 and 1989-1990 were 148 per 100,000, 181 per 100,000 and 182 per 100,000 respectively. In women, the rates for these three years were 437 per 100,000, 537 per 100,000 and 500 per 100,000 respectively. The age-adjusted rates for both men and women were high and were comparable to the rates in the United States and New Zealand. CONCLUSIONS: The incidence of hip fracture in NSW in the last decade was very high by world standards. The prevention of hip fracture is essential as the Australian population ages.

Aged↗
PubMed1995

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

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

England↗
PubMed1996

A survey of the management of breast cancer in England and Wales.

The management of breast cancer is controversial. In order to obtain an overview of the way that surgeons manage breast cancer in England and Wales and to assess trends in management by comparisons with the results of previous surveys a postal questionnaire was sent to all consultant general surgeons in England and Wales (n = 985). The response rate was 61%. Fine-needle aspiration is now the preferred technique to obtain a tissue diagnosis by 85% of surgeons. The majority of surgeons now treat early breast cancer either by breast-conserving surgery or offer the patient the choice of conservation or mastectomy. Comparisons with previous surveys carried out in the last 10 years suggest that fewer surgeons now recommend mastectomy. In all, 83% of surgeons indicated that they would biopsy the ipsilateral axilla routinely. Opinion is divided with regard to treatment of breast cancer in the elderly and treatment of an incompletely excised tumour, although the majority perform a mastectomy for a local recurrence after conservative surgery. Follow-up was regarded as worthwhile by 90%, but the majority do not routinely do follow-up investigations on asymptomatic patients apart from mammography. This study has shown very little consensus regarding the management of breast cancer in England and Wales. We suggest that the management of breast cancer should be in the hands of those with a special interest in the subject, as these surgeons will be more aware of ongoing clinical trials and current literature, more patients will then be entered into clinical trials and further trials instigated.

Age Factors↗
PubMed1996

The senior SHO rotation in Wales--a basis for BST training.

Between 1969-1992 there was a successful surgical registrar rotation in South Wales (1). This was a three-year rotation comprising two years general surgery, six months trauma and orthopaedics and six months surgical specialty. The rotation was aimed at those doctors who had completed senior house officer (SHO) posts in accident and emergency, 6-12 months general surgery and had already obtained the primary FRCS. However, with the recent recommendations of the Calman Report concerning general surgical training (2) changes to this rotation have become necessary, namely to reduce the number of surgical registrars in order to achieve a balance in numbers entering higher surgical training and to shorten the period of training to seven years with two years Basic Surgical Training (BST) and five years Higher Surgical Training (HST). A modified rotation was therefore designed and implemented in South Wales since July 1992. The previous registrar rotation was shortened to two years instead of three ensuring the pre-requirements for entry into HST and eligibility to sit the second part FRCS. The aim of this study was to assess whether the new senior SHO/BST rotation in South Wales is providing adequate training for our surgical trainees to enter into HST. We present our data as a potential basis for setting up a formal BST rotation.

Attitude of Health Personnel↗
PubMed1997

Sexually transmitted diseases among teenagers in England and Wales.

A profile of sexually transmitted diseases (STDs) and HIV infections among teenagers in England and Wales was obtained from reports of newly diagnosed STDs among teenagers attending genitourinary medicine (GUM) clinics in 1995, laboratory reports of newly diagnosed HIV infections between 1985 when reporting began and the end of 1995, and the prevalence of HIV (unlinked anonymous programme) among teenagers attending genitourinary medicine clinics and antenatal clinics in 1994 and 1995. STD reports were analysed by sex, age group, and place of residence of patients--whether in the NHS Thames regions or elsewhere in England and Wales. High rates of STDs were reported in teenagers, particularly in girls. The incidences of gonorrhoea, chlamydia infection, and first attack genital wart infections were higher in teenage girls than in any other age group. Boys under 16 years of age had substantially higher rates of infection with all STDs in the Thames regions than elsewhere. Rates of gonorrhoea in teenagers of both sexes in the Thames regions were more than twice those in the rest of the country. Infection rates for genital herpes, and chlamydia in girls, were also higher in the Thames regions, although the geographical differences were less marked. The seroprevalence of HIV among heterosexual teenagers was very low. In contrast, 226 HIV infections among teenage boys had probably been acquired through sexual intercourse with other males. Unlinked anonymous testing revealed HIV antibody in 7.5% of routinely collected serology specimens taken from teenage homosexual or bisexual males attending GUM clinics in London. The high rates of STDs among teenage girls and all teenagers in the Thames regions make these groups a high priority for sexual health promotion, with special consideration given to homo/bisexual male teenagers. Detailed surveillance of risk factors for STDs, and further studies of teenage sexual behaviour will help to effectively target resources to improve the sexual health of teenagers in England and Wales.

Adolescent↗
PubMed1997

The annual risk of infection with Mycobacterium tuberculosis in England and Wales since 1901.

SETTING: England and Wales. OBJECTIVE: To estimate the magnitude and trend in the annual risk of infection with Mycobacterium tuberculosis in England and Wales since 1901. DESIGN: Estimates for the prechemotherapy era are derived assuming that 1% of new infections among 0-4 year olds led to fatal tuberculosis meningitis, as found in the Netherlands. The estimates are validated against data from the 1949-1950 national tuberculin survey. We explore the trend thereafter using tuberculous meningitis notifications and data from the 1971-1973 national tuberculin survey, and discuss the utility of data collected under the national bacille Calmette-Guérin (BCG) vaccination scheme for estimating the annual risk of infection. RESULTS: Tuberculosis meningitis mortality rates among 0-4 year olds declined at 4% per annum until 1950, and suggest that the annual risk of infection declined from 12% in 1901 to 1.9% in 1949. The decline in the annual risk of infection probably accelerated in 1950, although its magnitude cannot be determined accurately. CONCLUSION: An accelerated decline in the annual risk of infection in England and Wales from 1950 probably resulted from the introduction of chemotherapy, which dramatically reduced the prevalence of sources of infection in the population. Data collected during the national BCG vaccination scheme were found to be unsuitable for estimating infection risks.

Adolescent↗
PubMed1997

Influenza surveillance in England and Wales: October 1996 to June 1997.

This report summarises information collected for the surveillance of influenza in England and Wales during the winter of 1996/97. Consultations for 'influenza and influenza-like illness' with sentinel general practitioners in England and Wales began to increase towards the end of November and peaked at the start of January. In England, consultations for 'aggregated respiratory disease' (ARD) began to increase a little earlier, perhaps as a result of increased respiratory syncytial virus activity, but also peaked in early January. Influenza A (H3N2) viruses were first detected in early October, but rarely until November, and activity peaked in early January, coinciding with the peak in consultations for flu-like illness. A few influenza B viruses were detected in late November and early December, and substantial activity was recorded in mid-January. Approximately equal numbers of influenza A(H3N2) and B viruses were identified over the winter as a whole, and circulating strains were antigenically similar to those included in the vaccine for 1996/97. Although influenza activity was 'moderate' in terms of consultations and laboratory confirmed infections, a large peak in death registrations occurred at the same time as influenza A(H3N2) virus activity peaked. The number of deaths during the winter was similar to that seen in 1989/90, when the last severe influenza epidemic occurred in England and Wales.

Disease Outbreaks↗
PubMed1998

Uptake of measles containing vaccines in the measles, mumps, and rubella second dose catch-up programme in Wales.

A two dose schedule for measles, mumps, and rubella (MMR) vaccination was introduced in England and Wales on 1 October 1996 in order to prevent the accumulation of susceptible individuals and thus prevent future epidemics. A routine second dose of MMR vaccine is now offered with the diphtheria, tetanus and polio (DTPol) preschool booster. In addition a second dose of MMR is being offered to all children born since 1 January 1990 without documented histories of two doses of measles containing vaccine in a catch up programme due to end in March 1998. Progress in the catch up programme in Wales was assessed by examining uptake of all possible combinations of measles containing vaccines in four birth cohorts by 1 May 1997. Of 126,550 children born between January 1990 and March 1993 (aged 4 years, 1 month to 7 years, 3 months) and living in Wales on 1 May 1997, 63,855 (50.5%) had received two doses of measles containing vaccine and 120,668 (95.4%) had received at least one dose, but 5882 children (4.6%) had no record of having received any measles containing vaccine. Uptake of the preschool DTPol booster in the same cohort was 87.2%. Uptake of two measles containing vaccines varied between health authority (range: 35.4-58.3%) and between birth cohorts (range: 40.0-81.8%). Few (18.4%) previously unimmunised children had attended for the MMR catch-up dose. Successful elimination of measles may depend on targeting this group in order to improve coverage. Although this analysis was carried out during the catch-up programme, these data suggest that the programme may not reach the children who most need to be immunised.

Child↗
PubMed1998

Surveillance of influenza in Wales: interpreting sentinel general practice rates using contemporaneous laboratory data. Opportunities and limitations.

OBJECTIVES: To evaluate the opportunities and limitations of using laboratory data to enhance sentinel general practice surveillance of influenza. DESIGN: Descriptive study of active sentinel surveillance of clinically diagnosed influenza in general practice and passive total population surveillance of laboratory reports of influenza A, influenza B, Mycoplasma pneumoniae, and respiratory syncitial virus infections. SETTING: Wales. SUBJECTS: Total sentinel practices population (currently 228,130); population of Wales (2,913,000, 1994 mid-year estimate). MAIN OUTCOME MEASURES: Simplicity, flexibility, acceptability, sensitivity, predictive value positive, representativeness, and timeliness of a surveillance system. Rate of influenza and other respiratory infections. RESULTS: Sentinel general practice surveillance of influenza in Wales is simple, flexible, acceptable, timely, representative, and relatively sensitive. Current laboratory surveillance is complex and less timely than sentinel practice surveillance but is complete and has a relatively high positive predictive value. For the period January 1993 to September 1996, peaks in rates of influenza reported by sentinel practices during winters 1993/94 and 1995/96 were temporally associated with increased rates of laboratory confirmed influenza A and respiratory syncitial virus, whereas the peak in 1994/95 was associated with increased rates of laboratory confirmed influenza B, M pneumoniae, and respiratory syncitial virus. CONCLUSIONS: Timely laboratory data can add value to influenza data already obtained from sentinel general practice surveillance. However continuous audit is essential to resolve the possible limitations of either surveillance system.

Evaluation Studies as Topic↗
PubMed1998

Adult hernia surgery in Wales revisited: impact of the guidelines of The Royal College of Surgeons of England.

This study investigated the impact of the guidelines of The Royal College of Surgeons of England on the practice of hernia surgery in Wales. This was assessed by means of a postal survey to all consultant general surgeons in Wales in 1996-1997. The areas covered were: awareness of the guidelines of The Royal College of Surgeons of England and the impact of such guidelines on their practice, attendance at hernia courses, operative technique, materials used for repair and skin suture, proportion of day case hernias, length of inpatient stay, thromboembolic (TE) prophylaxis and postoperative advice to patients with regard to light work, heavy work and sport. In all, 79 replies were received (85%). Almost all the surgeons had read the guidelines; this changed the practice of 20% of respondents but did not in 32%. A further 48% did not answer the question. In contrast with our 1993 survey results, in Wales there is now a uniform surgical management of adult inguinal hernias: the most common operation is the Liechtenstein, with monofilament non-absorbable suture to secure the mesh, followed by the Shouldice repair. The Bassini and inguinal darn operations are becoming much less common and none now uses braided or absorbable sutures for the repair. Skin closure is still rather variable, with only 58% of respondents adhering to the recommended absorbable subcuticular suture. Postoperative advice is now uniform and in accordance with the guidelines. A trend towards more TE prophylaxis and more day case hernia surgery is also seen.

England↗
PubMed1988

The morphometrics of Babesia motasi (Wales) and its transmission by Haemaphysalis punctata (Canestrini and Fanzago 1877) to sheep.

Babesia motasi (Wales) was transmitted to sheep by larvae, nymphs and adult female Haemaphysalis punctata ticks which were either collected from rough grazing pasture, at Mynydd Mawr, Aberdaron, North Wales, or from laboratory cultures derived from ticks collected at the above site. Both transovarial and transstadial transmission of infection were demonstrated. Only larvae were shown to pick up infection. The parasite could not be demonstrated in intact sheep, either in blood films or following passage of whole blood from intact into splenectomised sheep. Organisms were detectable only in peripheral blood following blood transmission between splenectomised animals or in splenectomised sheep which were tick-infested. In such sheep a parasitaemia occurred 8-9 days after infected ticks started to feed and was accompanied by a mild fever. Splenectomised animals which recovered from acute infection remained as subclinical carriers but infection was eliminated with Ludobal, rendering animals resusceptible to infection. Morphological studies indicated that B. motasi (Wales) is similar to descriptions of isolates in Sweden, Holland and W. Germany but unlike an isolate from Turkey. The most common form is is a double pyriform with a mean length of 2.234 micron.

Animals↗
PubMed2005

Use of complementary medicine among outpatients with dermatologic conditions within Yorkshire and South Wales, United Kingdom.

BACKGROUND: The use of complementary and alternative medicine (CAM) is increasing throughout the Western world, particularly by patients with chronic disease. In 1999, 20% of the United Kingdom population reported that they had used CAM in the preceding 12 months. OBJECTIVES: We sought to investigate the use of CAM by outpatients with general dermatologic conditions in 3 United Kingdom cities: Leeds (North England), and Cardiff and Swansea (South Wales). METHODS: Independently constructed, anonymous, self-directed questionnaires were designed and distributed to 400 consecutive outpatients with dermatologic conditions in Leeds and 637 consecutive outpatients with dermatologic conditions in Cardiff and Swansea. RESULTS: In Leeds 302/400 questionnaires were fully completed with 39% patients having used CAM. In South Wales 415/637 questionnaires were fully completed with 34% having used CAM. Of these, 45% of patients in Leeds and 50% of patients in South Wales were using CAM to treat their dermatologic condition. The most popular treatments in Leeds, Cardiff, and Swansea were herbal medicine and homeopathy. LIMITATIONS: These results were obtained from outpatients with dermatologic conditions in the United Kingdom and may not be applicable to other populations. CONCLUSIONS: More than one third of outpatients with general dermatologic conditions in two geographically distant regions are using CAM. More than 45% of these patients used CAM to treat their dermatologic condition.

Adolescent↗
PubMed2006

Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America.

BACKGROUND: There are substantial social inequalities in adult male mortality in many countries. Smoking is often more prevalent among men of lower social class, education, or income. The contribution of smoking to these social inequalities in mortality remains uncertain. METHODS: The contribution of smoking to adult mortality in a population can be estimated indirectly from disease-specific death rates in that population (using absolute lung cancer rates to indicate proportions due to smoking of mortality from certain other diseases). We applied these methods to 1996 death rates at ages 35-69 years in men in three different social strata in four countries, based on a total of 0.6 million deaths. The highest and lowest social strata were based on social class (professional vs unskilled manual) in England and Wales, neighbourhood income (top vs bottom quintile) in urban Canada, and completed years of education (more than vs less than 12 years) in the USA and Poland. RESULTS: In each country, there was about a two-fold difference between the highest and the lowest social strata in overall risks of dying among men aged 35-69 years (England and Wales 21%vs 43%, USA 20%vs 37%, Canada 21%vs 34%, Poland 26%vs 50%: four-country mean 22%vs 41%, four-country mean absolute difference 19%). More than half of this difference in mortality between the top and bottom social strata involved differences in risks of being killed at age 35-69 years by smoking (England and Wales 4%vs 19%, USA 4%vs 15%, Canada 6%vs 13%, Poland 5%vs 22%: four-country mean 5%vs 17%, four-country mean absolute difference 12%). Smoking-attributed mortality accounted for nearly half of total male mortality in the lowest social stratum of each country. CONCLUSION: In these populations, most, but not all, of the substantial social inequalities in adult male mortality during the 1990s were due to the effects of smoking. Widespread cessation of smoking could eventually halve the absolute differences between these social strata in the risk of premature death.

Adult↗
PubMed2000

Stressors, moderators and stress outcomes: findings from the All-Wales Community Mental Health Nurse Study.

The All-Wales Community Mental Health Nurse Stress Study was the largest study undertaken in the UK to date to investigate stress, burnout and coping amongst the CMHN workforce. The aim of the study was to examine the variety, frequency and severity of stressors, to describe coping strategies used to reduce work-based stress, and to determine stress outcomes. Questionnaires were sent out to 614 CMHNs from ten NHS Trusts throughout Wales. The response rate was 49% (n = 301). The measures used included the Maslach Human Services Survey, the CPN Stress Questionnaire, the Psychnurse Methods of Coping Questionnaire, the Rosenberg Self-Esteem Scale and the General Health Questionnaire GHQ-12. Community mental health nurses indicated that trying to maintain a good quality service in the midst of long waiting lists, poor resources, and having too many interruptions while trying to work in the office were particularly stressful items. The coping strategies that CMHNs utilized the most were having a stable home life and looking forward to going home at the end of the day, having outside interests and hobbies and talking to people that they got on well with. Forty per cent of CMHNs tended to view themselves negatively, feeling that others did not hold much respect for them. The GHQ-12 measure indicated that 35% of CMHNs had crossed a threshold of psychiatric caseness. Measured against a normative sample of mental health workers, 51% of CMHNs were experiencing high levels of long-term emotional exhaustion. Twenty-four per cent were suffering from high levels of depersonalization burnout and were not relating well to clients, whilst 14% were experiencing severe long-term feelings of lack of personal accomplishment. The results from the study provided us with a picture of stress and coping in CMHNs in Wales. Addressing these factors may help to reduce levels of experienced stress and burnout.

Adult↗
PubMed2003

Inpatient mortality as related to triage category in three New South Wales regional base hospitals.

OBJECTIVE: To establish the incidence of death after admission via the ED for each of the five categories of the Australasian Triage Scale in three New South Wales base hospitals, and to compare this with published data from an adult tertiary referral hospital in Victoria. To examine the causes of death in each category. METHODS: Information was collected from databases established as part of quality assurance projects at three New South Wales rural base hospitals from 1 January 2000 to 31 December 2000. RESULTS: Overall mortality rates per ED presentation and per ED admission were significantly lower than for similar data from an adult tertiary referral hospital. There were significant differences in mortality per ED presentation for categories 2, 3 and 4 and significant differences in mortality per admission for Australasian Triage Scale categories 2 and 3. The commonest causes of death were acute cardiac/respiratory and malignancy related conditions. Triage category 3 had both the highest number of total admissions and the highest number of deaths post admission. This finding differs from published data from an adult tertiary referral hospital where category 4 represented the largest number of admissions and of in-hospital deaths following admission. CONCLUSION: This study has established the mortality rates per ED presentation and admission for each of the five categories of the Australasian Triage Scale in three New South Wales rural base hospitals. Significant differences were found between these rates and the published rates for an adult tertiary referral hospital.

Australia↗
PubMed2004

Ozone adsorption on carbon nanotubes: the role of Stone-Wales defects.

First-principles calculations within the density functional theory have been performed in order to investigate ozone adsorption on carbon nanotubes. Particular emphasis is placed on the effects of Stone-Wales-like defects on the structural and electronic properties of (i) ideal tubes and (ii) tubes in the presence of ozone. Our results show that structural deformations induced on the pure carbon nanotubes by Stone-Wales defects are similar, as expected, to those induced on graphite; for the (10,0) tube, the semiconducting character is kept, though with a small reduction of the band gap. As for the ozone adsorption, the process on ideal nanotubes is most likely physisorption, though slightly stronger if compared to other previously studied molecules and consistent with the strong oxydizing nature of O(3). However, when ozone adsorbs on Stone-Wales defects, a strong chemisorption occurs, leading to relevant structural relaxations and to the formation of a CO covalent bond; this is consistent with experimental observations of CO functional groups, as well as of the liberation of CO gas phase and of the formation of C vacancies, thus explaining the consumption of the nanotube film upon ozone exposure.

Journal Article↗