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Prevalence of pig herds affected by pleuropneumonia associated with Haemophilus pleuropneumoniae in eastern England.

A survey for the macroscopic lesions indicative of pneumonic infection in the pig with Haemophilus pleuropneumoniae was made in an abattoir in eastern England. A total of 78 herds located in 11 counties of eastern or central England were seen between December 1982 and August 1983. Lesions were noted in the batches submitted by 44 (56 per cent) of the 78 herds. A further 16 herds (21 per cent) submitted batches containing pigs affected by pleurisy principally of the caudal lobes but without the pneumonic lesions. Lesions suggestive of enzootic pneumonia were also seen in 61 herds (78 per cent). Circumstances restricted corroborative bacteriological examinations to 53 and serological examinations to 33 herds. Strains of H pleuropneumoniae (predominantly serotype 3 but also serotype 2) were isolated from 26 herds. These comprised 22 out of 42 (51 per cent) of those where typically affected plucks, or plucks with caudal lobe pleurisy, were encountered, and four out of 11 (36 per cent) in which there was either no observable thoracic disease or enzootic pneumonia only. Complement fixing antibodies to serotype 3 or 2 antigens occurred in 26 out of 33 herds (79 per cent). These comprised 25 (83 per cent) of 30 herds with batches exhibiting either typical pulmonary lesions and, or, caudal lobe pleurisy and one of three herds without such lesions. Collectively these data indicate that herds containing pigs with pleuropneumonia are common at least in the more easterly parts of England and that H pleuropneumoniae, usually but not always associated with disease, is also widespread.

Abattoirs↗

Prevalence, regional distribution and control of blowfly strike in England and Wales.

The prevalence and control of blowfly strike in England and Wales was investigated by a postal survey of 2451 sheep farmers, divided into five regions, who were asked about the blowfly seasons of 1988 and 1989. These were important years for the control of blowfly strike because the number of compulsory dips for the control of sheep scab was reduced from two to one in 1989. The response rate was 74.2 per cent. A larger proportion of farmers in the south west and south east reported strike (90 per cent), than in the north of England (60 per cent). The proportion of sheep with strike showed a similar regional variation (0.7 per cent in the north of England to 2.8 per cent in the south west). Dipping was the most common method of blowfly control, followed by tail amputation, dagging, spraying and cyromazine. Twenty per cent of farmers reported reducing the frequency of dipping in 1989, and of those 20 per cent increased the frequency of spraying and 20 per cent used cyromazine.

Administration, Topical↗

Investigation of calf health and welfare on dairy farms in south-west England.

A questionnaire was designed to investigate calf health and welfare on dairy farms in the south west of England with regard to the degree of compliance with the Welfare of Farmed Animals (England) Regulations 2000. The level of veterinary involvement in calf rearing and management on dairy farms in the south west of England was also assessed. The questionnaire was sent to 32 large animal practices in the catchment area of the Veterinary Laboratories Agency--Langford. Compliance with the regulations was found to be variable. The requirements for the isolation of sick calves, provision of bovine colostrum within six hours of birth, the provision of fresh, clean water and restrictions concerning tethering were not well complied with. However, the requirements for twice-daily feeding and inspection, visual and tactile contact between calves, access to forage and the provision of clean, dry bedding were well complied with. The results also suggested that there was some lack of veterinary input into the health and welfare of calves on dairy farms visited by the practices routinely and non-routinely.

Animal Feed↗

Quality of life assessment of growth hormone deficiency in adults (QoL-AGHDA): comparison of normative reference data for the general population of England and Wales with results for adult hypopituitary patients with growth hormone deficiency.

BACKGROUND/AIM: Age- and gender-specific reference values for the quality of life (QoL) measures used in assessing the impact of growth hormone deficiency (GHD) are important. The objective of this study was to develop such data for the QoL-AGHDA instrument for the population of England and Wales and to demonstrate the QoL deficit in patients with GHD. METHODS: For the purpose of this study, a questionnaire was developed that contained the EurQoL EQ-5D, QoL-AGHDA, questions recording an individual's general situation and social functioning, and a self-reported five-point rating scale of general health. The questionnaire was mailed out to a sample of 1,190 individuals drawn from the general population of England and Wales. Corresponding data for 836 patients were retrieved from KIMS (Pfizer International Metabolic Database). The postal survey data were weighted to ensure that they were representative of the general population. RESULTS: The mean weighted QoL-AGHDA scores for the general population were 6.2 and 7.1 for men and women, respectively, compared with 13.6 and 15.7 for patients. For both males and females the differences in mean QoL-AGHDA scores between the general population and patients were statistically significant for all age categories (p < 0.01). In the general population the mean QoL-AGHDA score for each category of self-assessed health status increased progressively, indicating a poorer QoL as health status declined. CONCLUSIONS: This study reports QoL-AGHDA normative values for the population of England and Wales and confirms the extent of QoL impairment in patients with GHD in comparison with the general population.

Adult↗

Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000.

BACKGROUND: Coronary heart disease mortality rates have been decreasing in the United Kingdom since the 1970s. Our study aimed to examine how much of the decrease in England and Wales between 1981 and 2000 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors. METHODS AND RESULTS: The IMPACT mortality model was used to combine and analyze data on uptake and effectiveness of cardiological treatments and risk factor trends in England and Wales. The main data sources were published trials and meta-analyses, official statistics, clinical audits, and national surveys. Between 1981 and 2000, coronary heart disease mortality rates in England and Wales decreased by 62% in men and 45% in women 25 to 84 years old. This resulted in 68 230 fewer deaths in 2000. Some 42% of this decrease was attributed to treatments in individuals (including 11% to secondary prevention, 13% to heart failure treatments, 8% to initial treatments of acute myocardial infarction, and 3% to hypertension treatments) and 58% to population risk factor reductions (principally smoking, 48%; blood pressure, 9.5%; and cholesterol, 9.5%). Adverse trends were seen for physical activity, obesity and diabetes. CONCLUSIONS: More than half the coronary heart disease mortality decrease in Britain between 1981 and 2000 was attributable to reductions in major risk factors, principally smoking. This emphasizes the importance of a comprehensive strategy that promotes primary prevention, particularly for tobacco and diet, and that maximizes population coverage of effective treatments, especially for secondary prevention and heart failure. These findings may be cautiously generalizable to the United States and other developed countries.

Adult↗

Incidence of transient ischemic attacks in Oxfordshire, England.

The Oxfordshire Community Stroke Project is a prospective register of all new cases of stroke and transient ischemic attack (TIA) in a population of 105,000 residents of Oxfordshire, England. Between November 1, 1981, and October 31, 1986, 184 patients presented for the first time to a general practitioner or hospital with a TIA. The crude annual incidence rate was 0.35/1000, 0.42/1000 standardized to the 1981 population of England and Wales. We estimate that each year approximately 21,000 patients in England and Wales (about half of whom are greater than 70 years old) consult a doctor for the first time with a TIA. Approximately 80% of our 184 patients had TIAs in the carotid distribution; the remainder had TIAs in the vertebrobasilar distribution or TIAs of uncertain vascular distribution. The incidence of TIA increased sharply with increasing age, and the overall incidence in men was very similar to that in women (incidence ratio 1.3). However, in middle age, men were much more likely to suffer a TIA than women (odds ratio 2.6), which probably explains the marked male predominance in most hospital-based studies and treatment trials in which the elderly, and thus women, are underrepresented. This has important implications for the design and interpretation of clinical trials of treatment for TIAs.

Adolescent↗

Differences in forensic pathology practice between Scotland and England.

Scotland and England are part of the United Kingdom but have separate legal systems. These legal differences have a substantial effect on forensic pathology practice, and are probably best appreciated by those pathologists who have worked on both sides of the border. This paper seeks to highlight the differences in forensic pathology practice between Scotland and England, discussing the investigation of death in both countries. It concludes that a knowledge of the Scottish procurator fiscal system of death investigation may be beneficial to those contemplating changes to the coroner system. All three authors have practised forensic pathology in Scotland and England or Wales.

Autopsy↗

Public health powers in relation to infectious tuberculosis in England and France: a comparison of approaches.

This article examines the legal responses to infectious tuberculosis in England and France. Given that tuberculosis has re-emerged as a public health threat in both countries, the differing jurisprudence and legal frameworks of disease control in the two jurisdictions warrant examination. Two questions arise in that respect: firstly, what is the role of the State in the protection of public health in the context of tuberculosis, and secondly, to what extent can the law intervene to coerce individuals to undertake health measures for the protection of society at large. These issues reveal the tensions that exist between the individual and public interest. France and England differ greatly in their responses to such tensions. Paradoxically, France, that has traditionally embraced strong State intervention, has been reluctant to curtail individual freedoms for the benefit of public health. Conversely, England, that has tended to be more closely associated with liberalism, has been ready to accept and even promote restrictions to individual freedoms in the collective interest.

Communicable Disease Control↗

Clinical pharmacy education in new England: a report of the Whispering Pines Conference.

Clinical pharmacy practice as it relates to the future of the pharmacy profession has been examined at Hilton Head in 1985 and at regional conferences throughout the U.S. between 1986 and 1988. However, clinical pharmacy education and its role in the future of the profession had not been the focus of this type of "futuristic" conference. In 1988, the clinical pharmacy faculties from the four colleges of pharmacy in New England met to discuss the "Directions for Clinical Pharmacy Education in New England." Through a series of workshops, and stimulated by challenges from keynote speakers, the participants focused on the current status of clinical pharmacy education in New England, the barriers to change, and the strategies required to accomplish these changes. Consensus on prioritization of changes and their strategies was reached, and those that could be implemented in the near future were identified. Since the conference, changes have occurred and the professional networking that began at the conference has continued. This paper is a summary of the proceedings of this conference.

Curriculum↗

What determines geographical variation in rates of acceptance onto renal replacement therapy in England?

OBJECTIVE: To determine the independent effects of need and supply factors on the known geographical variation in acceptance rates onto renal replacement therapy (RRT) in England. METHODS: Data were obtained from all renal units in England on the characteristics of all cases aged 16 years and over, resident in England, who were accepted onto RRT in 1991 and 1992. Of these, 5715 (94.5%) had a valid postcode that could be matched to a census ward. Multilevel modelling using Poisson regression was used. The number of acceptances in each census ward within age bands 16-34, 35-64 and 65+ was the dependent variable. Independent effects modelled were: (1) individual factors (age, sex); (2) census ward need factors--ethnicity (expressed as the percentage of the ward population that was Asian or African-Caribbean), socio-economic deprivation--and supply factors--'access' to the nearest renal unit using crowfly and road travel time and distance, and services available to each ward expressed as number of haemodialysis stations per 100,000 catchment population of the nearest renal unit; (3) district health authority level effects. RESULTS: Age was a major determinant of acceptance, with a 7-fold higher rate in males aged over 64 years compared with younger men. Acceptance rates were lower in females, with a negative age-sex interaction in females aged over 64 years. The percentage of both Asian and African-Caribbean populations per ward was a highly significant positive determinant. Deprivation was also a significant determinant, best represented by a customised index. There was an inverse relation of acceptance with distance, especially road travel time. Other supply side variables had a significant effect though there was no independent district effect. There was some variation in the strength of these relationships by type of area (Greater London, urban and non-urban). CONCLUSIONS: Need and supply factors influence service use as expressed as acceptance onto RRT. Pressure to expand RRT services needs to be aimed at areas with large minority ethnic populations and those living far from existing units.

Adolescent↗

Partnership working between university researchers and self-advocacy organizations: 'A way forward for inclusion?'in England and 'Fine feathers make a fine bird'in Flanders.

This article gives accounts of differing experiences of self-advocate partnerships in research with universities in England and Flanders. In England the partnership grew up within a local People First group built upon a personal working relationship with one support person. It is focused almost exclusively on empirical research and, because it is aimed at influencing policy and practice, questions of funding and control are to the fore. In Flanders the partnership is closely linked with the development of a national movement of self-advocates in which the university was a close ally. Research is important in both contexts but in Flanders the university is more clearly identified with the wider movement. Partnerships have their ups and downs but in both countries researchers with the label 'learning difficulties' wish to set their own agendas and place great importance on trust in their work with their support worker (England) or ally (Flanders).

Belgium↗

Comparative genomics of Helicobacter pylori isolates recovered from ulcer disease patients in England.

BACKGROUND: Genomic diversity of H. pylori from many different human populations is largely unknown. We compared genomes of 65 H. pylori strains from Nottingham, England. Molecular analysis was carried out to identify rearrangements within and outside the cag-pathogenicity-island (cag PAI) and DNA sequence divergence in candidate genes. Phylogenetic analysis was carried out based on various high-resolution genotyping techniques. RESULTS: Analyses of virulence genes (cagT, cagE, cagA, vacA, iceA, oipA and babB) revealed that H. pylori strains from England are genetically distinct from strains obtained from other countries. The toxigenic vacA s1m1 genotype was found to be less common and the plasticity region cluster was found to be disrupted in all the isolates. English isolates showed a predominance of iceA1 alleles and a functional proinflammatory oipA gene. The English H. pylori gene pool revealed several Asian/oriental features. This included the predominance of cagA - glr (cagA right junction) motif types III and II (up to 42%), presence of vacA m1c alleles and phylogenetic affinity towards East Asian / Amerindian gene pools based on fluorescent amplified fragment length polymorphism (FAFLP) analysis and glmM sequence analysis. CONCLUSION: Overall, our results demonstrated genetic affinities of H. pylori in England with both European and the Asian gene pools and some distinctive genetic features of virulence genes that may have evolved in this important European population.

Bacterial Proteins↗

Admission to hospital following head injury in England: incidence and socio-economic associations.

BACKGROUND: Head injury in England is common. Evidence suggests that socio-economic factors may cause variation in incidence, and this variation may affect planning for services to meet the needs of those who have sustained a head injury. METHODS: Socio-economic data were obtained from the UK Office for National Statistics and merged with Hospital Episodes Statistics obtained from the Department of Health. All patients admitted for head injury with ICD-10 codes S00.0-S09.9 during 2001-2 and 2002-3 were included and collated at the level of the extant Health Authorities (HA) for 2002, and Primary Care Trust (PCT) for 2003. Incidence was determined, and cluster analysis and multiple regression analysis were used to look at patterns and associations. RESULTS: 112,718 patients were admitted during 2001-2 giving a hospitalised incidence rate for England of 229 per 100,000. This rate varied across the English HA's ranging from 91-419 per 100,000. The rate remained unchanged for 2002-3 with a similar magnitude of variation across PCT's. Three clusters of HA's were identified from the 2001-2 data; those typical of London, those of the Shire counties, and those of Other Urban authorities. Socio-economic factors were found to account for a high proportion of the variance in incidence for 2001-2. The same pattern emerged for 2002-3 at the PCT level. The use of public transport for travel to work is associated with a decreased incidence and lifestyle indicators, such as the numbers of young unemployed, increase the incidence. CONCLUSION: Head injury incidence in England varies by a factor of 4.6 across HA's and PCT's. Planning head injury related services at the local level thus needs to be based on local incidence figures rather than regional or national estimates. Socio-economic factors are shown to be associated with admission, including travel to work patterns and lifestyle indicators, which suggests that incidence is amenable to policy initiatives at the macro level as well as preventive programmes targeted at key groups.

Adolescent↗

Fatal injuries while under the influence of psychoactive drugs: a cross-sectional exploratory study in England.

BACKGROUND: Studies of drug-related mortality rarely describe fatal injuries due to psychoactive drug intoxication (FIUI). The main aim of this study was to determine the nature, extent and pattern of FIUI. METHODS: This observational study covered the period January 1999 to December 2001. Data were provided by members of a study panel of coroners in England using a standard protocol. Sources of data for this study included autopsy protocols, death certificates, hospital records, police reports, toxicology reports and inquest transcripts. Inclusion criteria for this were (i) the mention of one or more psychoactive substances as contributing to fatality; and (ii) the presence of a Controlled Drug at post mortem. RESULTS: A total of 3,803 drug-related deaths of persons aged 16-64 years were reported by the study panel during the three-year period. The study panel accounted for 86% of drug-related deaths in England in this period. There were 147 FIUI cases (119 males, 28 females), giving a proportionate mortality ratio of approximately 4%. The majority of FIUI cases (84%) were aged 16-44 years, with a median age at death of 33 years (Quartile deviation = 7). Fifty-six percent of FIUI occurred in urban areas of England. The population of the study jurisdictions aged 16-64 years contributed 49,545,766 person-years (py) to the study, giving an annual crude rate of 3/1,000,000 person-years (py). Rates for male and females were 4.9 and 1.1/1,000,000 py respectively, giving a male/female rate ratio of 4.5 (95%CI = 2.9-6.8). The rates of intentional and unintentional FIUI were 2 and 1/1,000,000 py respectively. The leading mechanism for intentional FIUI was suffocation while the predominant mechanisms in unintentional FIUI were road traffic accidents and falls. There is a significant difference in the pattern of drug-specific risk between FIUI and fatal poisoning. Risks of intentional FIUI are elevated among Black and Minority Ethnic groups. CONCLUSION: There are differences in the nature, extent and pattern of intentional and unintentional FIUI that should necessitate targeted prevention strategies. Also, there is an opportunity for cross-discipline collaboration between injury prevention specialists and substance abuse/mental health specialists.

Accidents↗

Levels of second hand smoke in pubs and bars by deprivation and food-serving status: a cross-sectional study from North West England.

BACKGROUND: The UK government proposed introducing partial smokefree legislation for England with exemptions for pubs and bars that do not prepare and serve food. We set out to test the hypothesis that pubs from more deprived areas and non food-serving pubs have higher levels of particulate air pollution. METHODS: We conducted a cross sectional study in four mainly urban areas of the North West of England. We recruited a stratified random sample of 64 pubs divided into four groups based on whether their local population was affluent or deprived (using a UK area based deprivation measure), and whether or not they served food. The timing of air quality monitoring stratified to ensure similar distribution of monitoring by day of the week and time of evening between groups. We used a portable air quality monitor to collect fine particle (PM2.5) levels over a minimum of 30 minutes in areas where smoking was allowed,, and calculated mean time-time weighted average PM2.5 levels. RESULTS: Mean PM2.5 was 285.5 microg/m3 (95% CI 212.7 to 358.3). Mean levels in the four groups were: affluent food-serving pubs (n = 16) 188.1 microg/m3 (95%CI 128.1 to 248.1); affluent non food-serving (n = 16) 186.8 microg/m3 (95%CI 118.9 to 254.3); deprived food-serving (n = 17) 399.4 microg/m3 (95%CI 177.7 to 621.2); and deprived non food-serving (n = 15) 365.7 microg/m3 (195.6 to 535.7). Levels were higher in pubs in deprived communities: mean 383.6 microg/m3 (95% CI 249.2 to 518.0) vs 187.4 microg/m3 (144.8 to 229.9); geometric mean 245.2 microg/m3 vs 151.2 microg/m3 (p = 0.03). There was little difference in particulate levels between food and non food-serving pubs. CONCLUSION: This study adds to the evidence that the UK government's proposals for partial smokefree legislation in England would offer the least protection to the most heavily exposed group--bar workers and customers in non food-serving pubs in deprived areas. The results suggest these proposals would work against the UK government's stated aim to reduce health inequalities.

Air Pollution, Indoor↗

Palliative care and policy in England: a review of health improvement plans for 1999-2003.

Since 1987 health authorities in England have been required to make plans for palliative care provision, but their record in doing so has been patchy. The production of health improvement plans (HlmPs), in which each health authority must set out its priorities and actions designed to improve the health and well-being of its local population, provides an opportunity to examine the extent to which palliative care provision in the NHS is regarded as a priority by policy makers in England. This paper reports on a structured documentary review of the HlmPs published by the 99 health authorities in England. The review indicates that at the moment, in spite of the longstanding duty placed on health authorities to develop strategic plans for palliative care and to assess the level of local palliative care needs, not all have made significant progress in this direction. Among those that do have plans for palliative care, the vast majority of these plans are for people with cancer. What emerges most clearly is a sense in which specialist palliative care, especially for non-cancer patients, is perceived as an 'optional extra' by many health authorities rather than an integral and essential part of the overall supportive care strategy which they clearly are at pains to develop.

Community Health Planning↗

Where do cancer patients die? Ten-year trends in the place of death of cancer patients in England.

Although studies have found that 50-70% of cancer patients would prefer to die at home, there has been a trend towards the hospitalization of the dying in many countries. No study has attempted to analyse the changes in place of death in detail. The aim was to analyse the 10-year trends in place of death of cancer patients, by region and by diagnosis, within England. To do this, data on the place of death and patients' characteristics were derived from death registrations for all cancer deaths between the years 1985-94. We examined trends in the place of death for the whole of England, for each region separately and for the main cancer diagnoses. The results show that there were over 1.3 million death registrations from cancer during the 10 years. The mean age increased over the period from 69.9 years in 1985, to 71.3 years in 1994. The percentage who died in a UK National Health Service (NHS) hospital or nursing home fell gradually from 58% (1985) to 47.3% (1994), while the percentage who died in non-NHS hospitals, nursing homes, hospices and communal establishments increased. The percentage who died at home fell slightly but steadily between 1985 and 1992 from 27% to 25.5% and since then increased slightly to 26.5% in 1994. The percentage of home deaths was lowest in the two Thames regions (less than 25%) and highest in the West Midlands, Anglia and Oxford (over 29%). These differentials were maintained across age groups and diagnoses. Older people and women were less likely to die at home than younger people and men. Significant trends showing an increase in home deaths were found in two regions: North Thames and South Thames. Patients with cancers of the lung, colorectum, respiratory organs, bone or connective tissue and lip, oral cavity and pharynx were more likely to die at home (over 29% in 1994) than patients with cancers of the (breast (women, 25% in 1994) or the lymphatic or haematological system 16% in 1994). It can be concluded that the trend towards a reducing home death rate from cancer in England appears to have halted, although this varies between regions. This has implications for primary care services. Although hospital is still the most common place of death from cancer, the percentage of cancer patients who die in hospital is reducing. The largest rise is in the increasing use of hospices and communal establishments, including residential and nursing homes. Given the ageing population, this trend is likely to continue.

Adult↗

Seasonal variation in suicides: diminished or vanished. Experience from England and Wales, 1982-1996.

BACKGROUND: Seasonal variation in suicidal death has been observed in many countries. In particular, a cyclic variation was found for both men and women in England and Wales in the 1960s and 1970s. Men showed a single 12-month cycle whereas women showed two cycles. AIMS: To re-examine the seasonal variation in suicides in England and Wales for the period 1982-1996. METHOD: A harmonic analysis was used to detect the seasonality of the suicide data. RESULTS: The seasonal effect on suicide is greatly diminished in England and Wales. This is shown by the reduced amplitude and smaller proportion of variance accounted for by the season. CONCLUSIONS: The seasonal effect on suicide has either diminished or vanished.

Adolescent↗