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PubMed1997

Prescription of diamorphine, dipipanone and cocaine in England and Wales.

The vast majority of substitute prescribing to opiate addicts in England and Wales is of oral methadone. The prescription of diamorphine, dipipanone and cocaine to addicts is allowed subject to the 1971 Misuse of Drugs Act. Prescription of these drugs has aroused international interest and controversy in the United Kingdom although research is scanty. This report is a description of the current attitudes about, and practice of, prescribing diamorphine, dipipanone and cocaine by medical practitioners in the addiction field in England and Wales. A questionnaire was devised and sent to drug services in England and Wales which provided a prescribing service. Among respondents who reported that they currently hold a licence for heroin, dipipanone or cocaine, the number of patients treated by each doctor varied widely; from a handful of patients to 100 heroin patients. Dosage currently used ranged from a minimum of 10 mg to a maximum of 1000 mg daily for heroin. Doses of dipipanone were lower. More respondents thought that heroin and dipipanone were clinically justified in some situations than thought that they should never be prescribed, while the opinions were reversed in the case of cocaine.

Journal Article↗
PubMed1982

Trauma to the central and peripheral nervous systems. Part II: A statistical profile of surgical treatment New South Wales 1977.

The epidemiological aspects of the mortality, morbidity and the costs of neurotrauma in New South Wales 1977 were outlined in Part I of this report. Part II outlines the profile of surgical work in this field in New South Wales in 1977. In all, 21,973 patients were admitted to New South Wales Hospitals in 1977 for neurotraumatic conditions (85% with head, 13% with spinal and 2% with peripheral nerve injuries); and 1,513 patients required surgery (49% with head, 22% with spinal and 29% with peripheral nerve injuries). The profile of surgery for disc disease is outlined. The participation of neurosurgeons in the management of neurotrauma is assessed.

Adolescent↗
PubMed1980

Seasonal availability of nematode larvae on pastures grazed by cattle in New South Wales.

Trends in the numbers of infective menatode larvae on pasture plots contaminated by cattle at different seasons of the year were defined in 3 different climatic regions. The main nematodes were Ostertagia ostertagi, Trichostrongylus spp, Haemonchus spp and Cooperia spp. On the North Coast of New South Wales with a sub-tropical climate, the numbers of infective larvae of all 4 nematodes rose rapidly to peak levels soon after each seasonal period of contamination began, then fell quickly within a few months. On the Central Coast of New South Wales, the trends were similar to those on the North Coast, except that the larvae persisted on the pasture for a much longer time. On the Northern Tablelands of New South Wales, where temperatures were much colder than on the coast, larval development was slower and major peaks of larval availability did not occur until early spring. These different seasonal trends in each region were considered to be related to the climatic differences between the regions. On pastures which were contaminated continuously, larval numbers reached maximum levels in mid-winter on the Central Coast and in early spring on the Northern Tablelands. It was concluded that the majority of these larvae were derived from the contamination of pastures in autumn and winter. Subsequently in summer, a rapid dying out of larvae was observed in all the regions, probably due to the effect of hotter weather. The studies suggest that a reduction in the contamination of pasture with nematode eggs in autumn and winter could result in pastures carrying fewer larvae and thus form the basis of effective worm control programs for cattle.

Animals↗
PubMed1980

Seasonal changes in the structure of nematode populations of cattle in New South Wales in relation to inhibited larval development.

Pasture plots in 3 climatic regions were contaminated with worm eggs of Ostertagia ostertagi, Trichostrongylus axei, Haemonchus spp and Cooperia spp in the autumn, winter and spring. Successive pairs of parasite-free calves were grazed on the plots for 7 to 10 days at 4-week intervals and then killed for worm counts 14 days after their removal from pasture. On the Northern Tablelands of New South Wales, irrespective of the season of pasture contamination, the degree of inhibition of O. ostertagi was low in winter and highest in spring. T. axei showed similar trends while Cooperia spp showed negligible inhibition. On the North Coast of New South Wales, inhibited larvae accounted for a very small proportion of the O. ostertagi burdens, while in comparison T. axei showed a much greater degree of inhibition. Larval inhibition of Haemonchus spp occurred in autumn and early winter after which it did not occur. There was negliglible inhibition in Cooperia spp. On the Central Coast of New South Wales, there was little inhibition of O. ostertagi and none in T. axei. For Haemonchus spp, inhibited larvae were found mainly in autumn and winter. The numbers of inhibited Cooperia larvae were also highest in autumn and winter and were associated with large worm burdens. The marked difference between the tablelands and coastal regions in the seasonal trends of inhibition of O. ostertagi was considered to be due to a difference in strains between the geographical regions. The possible effect of climatic factors on the inhibition-proneness of infective larvae on pasture is discussed for Ostertagia and other nematodes. The roles of host resistance and density-dependence are also discussed.

Animals↗
PubMedDate not supplied

Culture care of Iranian immigrants in New South Wales, Australia: sharing transcultural nursing knowledge.

Discovery and analysis of care meanings, expressions, and practices of Iranian Immigrants in New South Wales, Australia was the focus of this ethnonursing qualitative research. The purpose of the study was to systematically discover, describe and analyse the values, beliefs, and practices of Iranian immigrants in New South Wales, Australia. The aim of the investigation was to discover transcultural nursing knowledge to guide nurses and health professionals to provide culturally congruent nursing and health care to Iranians. Leininger's theory of Culture Care Diversity and Universality (Leininger, 1991) was used as the conceptual framework for the study. It was predicted that care meanings and expressions of Iranian immigrants would be influenced by their worldview, social structure features, language, and cultural values rooted in their long ethnohistorical past and reflected in their lifeways in Australia. Using the ethnonursing qualitative research method, key and general informants were purposefully selected among Iranian immigrants residing in New South Wales. Three care themes supported by a number of universal and some diverse patterns were identified for Iranian immigrants. The three themes were: (1) Care meant family and kinship ties (hambastegie) as expressed in daily lifeways and interactions with family, friends, and community; (2) Care as expressed in carrying out traditional urban gender roles (role-zan-o-mard) (Azadie zan) as well as in fulfilling emerging new role responsibilities related to equality for female Iranian immigrants; and (3) Care as preservation of Iranian identity (inhamoni, hamonandi) as expressed in traditional cultural events and health care practices. Leininger's (1991) three modes of actions and decisions were used to develop appropriate and culturally meaningful nursing care actions and decisions which were in harmony with the cultural beliefs of Iranian immigrants.

Adult↗
PubMedDate not supplied

Child, adolescent and youth suicide and undetermined deaths in England and Wales compared with Australia, Canada, France, Germany, Italy, Japan and the USA for the 1974-1999 period.

Successive British Governments have aimed to reduce suicide, especially amongst younger people. Using WHO standardised data for the age bands "child" (5-14 years) and "adolescent and youth" (15-24 years) suicide rates for England and Wales were compared with the other major Western countries with end-points being average of 1974-1976 and average 1997-1999, by gender. "Undetermined deaths" were also analysed to consider any "hidden suicides". Over the period there was little change in child suicide for both genders in any country. Female "adolescent and youth" suicide rates fell in most countries, in contrast to male "adolescent and youth" rates, which rose substantially in six countries, including England & Wales. With the exception of Spain, there was little statistical significant difference between female Anglo-Welsh rates and the other countries. Apart from Spain and Australia, Anglo-Welsh youth rates were significantly worse than Canada, France, Germany and Japan. "Undetermined" deaths showed marked variation across many countries, but Anglo-Welsh rates were up substantially for both males and females [116% and 83%, respectively], whilst falling substantially in six countries. Child suicide continues to be a statistical rarity with little change in either suicide or "undetermined" deaths over the period. The dichotomy between male and female young people's suicide is a matter of concern, as the improvements in female rates are not matched in the male rates--the majority of which rose substantially. The "undetermined deaths" results continue to be problematic, especially regarding the substantial rises in England and Wales. Country-specific research is required to determine, why Anglo-Welsh adolescent and youth rates have deteriorated relative to other countries.

Adolescent↗
PubMed1982

Incidence of homozygous beta-thalassaemia in New South Wales, 1961-1976.

A case-finding survey yielded 58 persons with transfusion-dependent homozygous beta-thalassaemia who lived either in New South Wales or in the Australian Capital Territory. Of those born between 1961 and 1976 in New South Wales, nearly 70% were of Greek or Greek-Cypriot origin and 18% of Italian origin. The New South Wales incidence rates for homozygous beta-thalassaemia were estimated as follows: one in 934 births, Greek origin; one in 264 births, Cypriot origin and one in 3441 births, Italian origin.

Adolescent↗
PubMed2005

New diagnoses of HTLV infection in England and Wales: 2002-2004.

Human T cell lymphotropic viruses (HTLV) are retroviruses transmitted through breastfeeding, sexual contact, blood transfusion and injecting drug use. HTLV is endemic in the Caribbean, and parts of Africa, Japan and South America, with isolated foci in other areas. Infection is life long. Fewer than 5% of those infected progress to one of the HTLV-related diseases, but these are debilitating and often fatal. In England and Wales, laboratory and clinical reports of new HTLV diagnoses are routinely collected, including infections identified by the blood service since the introduction of anti-HTLV testing in August 2002. Between 2002 and 2004, 273 individuals were diagnosed with HTLV: 102 (37%) were male and 169 female (sex was not reported for two). Median ages at diagnosis were 54 and 50 years respectively. Clinical reports were received for 78% (212/273) individuals. Where reported, 58% (116/199) of individuals were of black Caribbean ethnicity and 29% (57/199) white; 87% (128/147) were probably infected heterosexually or through mother-to-child transmission; 45% (66/146) were probably infected in the Caribbean and 40% (59/146) in the United Kingdom. An appreciable number of HTLV infections continue to be diagnosed within England and Wales, with increases in 2002-2003 because of anti-HTLV testing of blood donations. While most infections diagnosed are directly associated with the Caribbean, transmission of HTLV infection is occurring within England and Wales. Specialist care services for HTLV-infected individuals and their families have improved in recent years, but prevention remains limited.

Comparative Study↗
PubMed1980

Melanoma in new South Wales 1970-1976. Confirmation of increased incidence.

A random sample of 500 cases from a total 5611 cases collected from a survey of melanoma in New South Wales, Australia, has confirmed an incidence rise which is apparent across all degrees of severity and all histogenetic classes. It therefore can be stated that the apparent increasing incidence of melanoma in New South Wales is not due to diagnostic errors. Nor is it due to inadequate registration of early melanomas in the initial years of study. The present study concludes that the increased rate of reporting of melanoma by New South Wales pathology services represents a true rise in the incidence of melanoma in the State.

Adult↗
PubMed2001

Thalidomide usage in Wales: the need to follow guidelines.

BACKGROUND: Thalidomide is a potentially useful drug for several dermatological disorders. OBJECTIVES: To assess prescribing and monitoring practices for this drug in Wales. METHODS: A questionnaire was completed by 17 of 19 consultant dermatologists concerning thalidomide usage in Wales (population 2.93 million). RESULTS: Eleven of the 17 respondents had used thalidomide in 40 patients. Only two consultants gave information leaflets and only five obtained written consent. Four obtained baseline nerve conduction studies and nine obtained these during therapy. Of seven women of child-bearing age currently taking thalidomide, none had had baseline pregnancy tests. CONCLUSIONS: We describe variability in prescribing practices for thalidomide. Published guidelines are reviewed and suggestions made concerning consent forms, pregnancy testing, nerve conduction studies and patient information.

Dermatologic Agents↗
PubMed2001

One-year survey of carcinoma of the oesophagus and stomach in Wales.

BACKGROUND: The aim of the study was to identify all patients who presented with oesophagogastric malignancy within a single National Health Service region (Wales) over 1 year, and to follow the cohort for 5 years. Management and outcome were analysed to identify current practice and draft guidelines for Wales. METHODS: Patients were identified from hospital records. Details were recorded in structured format for analysis. RESULTS: Analysable data were obtained for 910 of 916 patients. The overall incidence was 31.4 per 100 000 population. Treatment was by resection 298 (33 per cent), palliation 397 (44 per cent) or no treatment 215 (24 per cent). The 30-day mortality rate was 12 per cent and the in-hospital mortality rate was 13 per cent. Some 226 patients (25 per cent) were alive at 2 years. Resection conferred a significant survival advantage over palliation (P < 0.001) and no treatment. Anastomotic leakage occurred in 16 patients (5 per cent), of whom eight died in hospital. 'Open and close' operations were common (23 per cent), laparoscopy was infrequent (16 per cent), and many surgeons undertook small caseloads. Operating on fewer than six patients per year increased the mortality rate after partial gastrectomy (P < 0.05) and was associated with a trend to a higher mortality rate after mediastinal and cardia surgery. Operating on more than 70 per cent of patients seen resulted in a significantly higher mortality rate (P < 0.01) irrespective of case volume. CONCLUSION: Tumour resection conferred a survival advantage. Wider use of laparoscopy is advocated. Improved selection for surgery should result in a lower mortality rate.

Adult↗
PubMed2000

Bacteraemia and antibiotic resistance of its pathogens reported in England and Wales between 1990 and 1998: trend analysis.

OBJECTIVES: Determination of causes, trends, and antibiotic resistance in reports of bacterial pathogens isolated from blood in England and Wales from 1990 to 1998. DESIGN: Description of bacterial isolates from blood, judged to be clinically significant by microbiology staff, reported to the Communicable Disease Surveillance Centre. SETTING: Microbiology laboratories in England and Wales. SUBJECTS: Patients yielding clinically significant isolates from blood. MAIN OUTCOME MEASURES: Frequency and Poisson regression analyses for trend of reported causes of bacteraemia and proportions of antibiotic resistant isolates. RESULTS: There was an upward trend in total numbers of reports of bacteraemia. The five most cited organisms accounted for over 60% of reports each year. There was a substantial increase in the proportion of reports of Staphylococcus aureus resistant to methicillin, Streptococcus pneumoniae resistance to penicillin and erythromycin, and Enterococcus faecalis and Enterococcus faecium resistance to vancomycin. No increase was seen in resistance of Escherichia coli to gentamicin. CONCLUSIONS: Reports from laboratories provide valuable information on trends and antibiotic resistance in bacteraemia and show a worrying increase in resistance to important antibiotics.

Bacteremia↗
PubMed2005

A review of troponin assay performance in Wales: can the same (method-dependent) decision limits be used in different sites?

An audit of troponin measurement protocols in use in Wales showed significant variations in practice with no consensus on analytical methods, or in the selection of a decision limit for the diagnosis of myocardial damage. Peer review data on assay imprecision at concentrations approaching the analytical limit of detection are lacking. The objective of the study was to establish clinically relevant precision profiles for the troponin methods used throughout Wales, which could be used to develop a standardized approach to the selection of a decision limit. A series of five pools of human serum spiked with troponin I-T complex were prepared and stored at -70 degrees C until dispatch. Five sets of each pool were dispatched to all Welsh laboratories and stored at -20 degrees C until analysis. The analysis protocol consisted of two replicates of each pool per batch, and two batches per day for five days (n=20). All the laboratories performed all the measurements in the same week. The lowest concentration providing a 10% coefficient of variation (CV) was 0.02 microg/L for the Roche method and 0.11 microg/L for the Beckman AccuTnI. The lowest concentrations that could be distinguishable from the 99th percentile reference limit were 0.02 microg/L for the Roche method and 0.07 microg/L for the Beckman AccuTnI. Current methods do not achieve the 10% CV at the 99th percentile reference limit proposed by the European Society of Cardiology. Use of the lowest concentration that can be reliably distinguished from the 99th percentile reference limit offers a novel alternative decision limit, which provides a slightly lower concentration than at the 10% CV but maintaining confidence in the assay that false-positive rates will be minimized.

Chemistry, Clinical↗
PubMed1999

The most prevalent hepatitis C virus genotypes in England and Wales are 3a and 1a.

Hepatitis C virus (HCV) genotypes were assigned to 567 individuals by restriction fragment length polymorphism analysis of the 5' noncoding region of the HCV genome following reverse transcription-polymerase chain reaction. The groups of individuals in this study included hemophilia patients, injecting drug users (IDUs), blood donors, antenatal patients, those attending genitourinary medicine (GUM) clinics, and patients with chronic liver disease, all from England and Wales. The majority of HCV infections were types 1a (32%), 1b (15%), or 3a (37%). The genotype distribution in individual groups was similar to the overall genotype distribution except for hemophilia patients, in whom the frequencies were 1a (39%), 1b (23%), and 3a (21%). With the exception of hemophilia patients, subpopulations in England and Wales appear to share common modes of HCV transmission. There is a need for continued surveillance to monitor the spread of possibly more virulent or drug-resistant HCV genotypes.

5' Untranslated Regions↗
PubMed1996

Modelling lymphocytic leukaemia incidence in England and Wales using generalizations of the two-mutation model of carcinogenesis of Moolgavkar, Venzon and Knudson.

Generalizations of the two-mutation carcinogenesis model of Moolgavkar, Venzon and Knudson (MVK) are fitted to England and Wales lymphocytic leukaemia incidence data covering the period 1971-1988. Both acute lymphocytic leukaemia (ALL) and chronic lymphocytic leukaemia (CLL) can be fitted by a model with two mutations. These two-mutation models are such that the first (but not the second) mutation rate and the susceptible stem cell population vary rapidly with age. CLL is also adequately fitted by a model with three mutations, and the mutation rates and the variation in the stem cell population numbers implied by the three-mutation model are more plausible than those of the two-mutation model. For CLL there are no significant differences between the sexes in either of the optimal models fitted, but this is not the case for ALL. Thus the original MVK model adequately describes population rates of lymphocytic leukaemia in England and Wales.

Adolescent↗
PubMed2001

Socioeconomic inequalities in cancer survival in England and Wales.

BACKGROUND: Cancer survival often has been reported as lower for the poor than the rich, but, to the authors' knowledge, systematic national estimates of deprivation gradients in survival over long periods of time have not been available. METHODS: The authors estimated national population-based survival rates for almost 3 million people who were diagnosed with 1 of 58 types of cancers (47 in adults, 11 in children) in England and Wales during the 20-year period 1971-1990 and followed through December 31, 1995. Cancer patients were assigned by their address at diagnosis to 1 of 5 categories (quintiles of the national distribution) of material deprivation by using a standard index derived from census data on unemployment, car ownership, household overcrowding, and social class that was available for all 109,000 census tracts in Great Britain. The authors used relative survival rates: the ratio of observed survival among the cancer patients to the survival that would have been expected if they had had the same background mortality as the general population. Background mortality differed widely among socioeconomic categories, and the authors constructed life tables from raw national mortality data by gender, single year of age, calendar period of death, and socioeconomic category to adjust for it. The authors used variance-weighted least squares regression to estimate both time trends in age standardized survival and socioeconomic gradients in survival. The number of avoidable deaths was estimated from the observed mortality excess compared with the expected mortality in each group of patients. RESULTS: Survival rose steadily for most cancers over 25 years to 1995 in England and Wales, but inequalities in survival between patients living in rich and poor areas were geographically widespread and persistent over this period of time. These patterns existed for 44 of 47 adult cancers examined but not for 11 childhood cancers. These inequalities in survival represented more than 2500 deaths that would have been avoided each year if all cancer patients had had the same chance of surviving up to 5 years after diagnosis as patients in the most affluent group. CONCLUSIONS: The largest national cancer survival study has provided strong evidence of systematic disadvantage in outcome among patients who lived in poorer districts compared with those who lived in wealthier districts.

Adolescent↗
PubMed2001

Trends in the incidence of cutaneous malignant melanoma in New South Wales, 1983-1996.

The incidence of cutaneous malignant melanoma (CMM) has been rising in fair-skinned populations throughout the world for decades. The upward trend may, however, finally be slowing in some of these populations. Recent (1983-1996) CMM incidence trends for a high incidence area (New South Wales, Australia) have been examined according to gender, age group, body site and tumour thickness. Despite continuing upward trends in older age groups, particularly among men (e.g., 7.20% increase per year in men aged 75+), incidence for younger ages is stabilizing (in men) or declining (in women): average annual percentage changes of -3.03 and -0.88 were observed for women aged 15-34 and 35-54, respectively. Patterns suggest a birth-cohort effect, with those born since 1945 or 1950 having lower (females) or similar (males) rates to those born earlier. For each gender, all-ages incidence rose by a similar amount for each of the main body sites except the leg in women, where incidence fell by 0.49% per year. In men, the incidence of both thin (</=75 mm) and thick (>75 mm) melanomas increased (significantly, by 2.63% per year and non-significantly, by 0.93% per year, respectively) between 1989 and 1996. In women, incidence remained stable for both thickness subgroups. These data are consistent with a stabilization or reduction in either total sun exposure or intermittency of exposure among New South Wales cohorts born since about 1950. Because incidence rates are still much higher than they were a few decades ago, however, efforts to reduce sun exposure, particularly in children and youth, must continue.

Adolescent↗
PubMed2002

Sero-epidemiological patterns of Epstein-Barr and herpes simplex (HSV-1 and HSV-2) viruses in England and Wales.

The aim was to carry out a population-based sero-prevalence survey of Epstein-Barr virus (EBV) across a wide age range in England and Wales and to identify any associations between EBV and herpes simplex virus types one and two (HSV-1 and 2). Sera from an age-stratified sample of 2,893 individuals, submitted for diagnostic purposes to 15 public health laboratories in England and Wales in 1994, were tested for immunoglobulin G (IgG) antibody to EBV. The samples had been tested previously for IgG antibody to HSV-1 and HSV-2. The serological profile of EBV was consistent with an endemic infection with peaks in transmission in those less than 5 years old and in young adults. An age adjusted analysis found a significant association between EBV and HSV-1 seropositivity that is most likely explained by similarities in their mode of transmission. The very low seroprevalence of HSV-2 in this sample complicated the comparisons of EBV and HSV-1 with HSV-2. Any associations were most likely explained by chance. Given the association between EBV and HSV-1, it is likely that recently documented epidemiological changes in HSV-1 also apply to EBV. Continuing surveillance of these herpes viruses is necessary as the predicted changes could have a significant public health impact, especially in the young adult population.

Adolescent↗