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PubMed1986

The geographical distribution of tuberculosis notifications in a national survey of England and Wales in 1983. Report from the Medical Research Council Tuberculosis and Chest Diseases Unit.

A survey of all tuberculosis notifications in England and Wales for the first 6 months of 1983 has made it possible to estimate the annual notification rates for that year for the White and the Indian subcontinent (Indian, Pakistani and Bangladeshi) ethnic groups for the nine regions of England and Wales and for the 33 boroughs of Greater London. The rates have been compared with those estimated from an earlier 6-month survey in 1978/79. However, for the 53 counties and the 370 local authority areas outside Greater London only the overall rates could be calculated because population data by ethnic group were not available. There was considerable variation between the 9 regions in the notification rates for all ethnic groups combined (range 28.1 per 100,000 in Greater London to 4.5 per 100,000 in Anglia) and for the White ethnic group (range 13.1 per 100,000 in Greater London to 3.1 per 100,000 in Anglia). The rates for the Indian subcontinent (ISC) ethnic group were high in all the regions and were 15-60 times higher than the corresponding rates for the White ethnic group. Between 1978/79 and 1983 there was a decline in all of the regions in the notification rates for all ethnic groups combined and the White group. For the ISC ethnic group there was a decline in all regions apart from Anglia (where the number of cases was small). The difference in rates for the London boroughs, from 92.3 per 100,000 for Brent to 5.7 per 100,000 for Havering, were associated not only with the proportion of the population who were of ISC ethnic origin but also with indices of socio-economic class for the borough. There was, however, no evidence to suggest that high rates in the White population were a consequence of the presence of a large number of infectious patients of ISC ethnic origin. Notification rates for the 53 counties apart from Greater London ranged from 23.7 per 100,000 for the West Midlands to 3.1 per 100,000 for Surrey and with few exceptions there was a decline in rates between the surveys. Considering the 370 local authorities outside Greater London, the number with a notification rate of less than 5 per 100,000 increased from 73 in 1978/79 to 105 in the 1983 survey and the number of local authorities in which no cases were notified in the 6-month survey period increased from 32 to 41.

Bangladesh↗
PubMed1985

Mortality of hepatitis B positive blood donors in England and Wales.

Of 2880 men and 1054 women who were found to be hepatitis B surface antigen positive by the Blood Transfusion Service in England and Wales between 1971 and 1981, more than 92% were traced to the end of 1983. 5 deaths from hepatocellular carcinoma had been reported in men, giving a relative risk compared with the male population of England and Wales as a whole of 42. There had been no deaths from liver cancer in women. In both men and women there was a greater than ten-fold increase in the risk of death from chronic liver disease. Secondary preventive action may be indicated.

Adult↗
PubMed2003

Management and outcome of bloodstream infections due to Candida species in England and Wales.

This two-year prospective hospital population-based study of candidaemia is the first to be conducted in the UK. It was carried out on behalf on the British Society for Medical Mycology (BSMM) as part of the European Confederation of Medical Mycology (ECMM) epidemiological survey of candidaemia. Six hospitals in England and Wales acted as sentinel hospitals. Main outcome measures were hospital population-based incidence and 30-day mortality. There were 18.7 episodes of candidaemia per 100,000 finished consultant episodes or 3.0/100,000 bed days and 45.4% cases occurred in intensive care unit (ICU) patients. Candida albicans was isolated in 64.7% of confirmed cases. The majority of isolates were sensitive to standard antifungal agents, including fluconazole. The overall 30-day mortality was 26.4% and removal of the central venous catheter was associated with a significant reduction in mortality. In conclusion, the incidence of candidaemia in England and Wales is similar to that of the USA, the majority of isolates remain sensitive to commonly used antifungal agents and mortality associated with this infection appears to be falling.

Adolescent↗
PubMedDate not supplied

[Induced abortions among Spanish women in England and Wales (1974-1988)].

To assess the importance of travelling for abortion in Spanish women from 1974 to 1988, a descriptive epidemiologic study was undertaken, based on information from the United Kingdom Office for Population Censuses and Surveys. Additionally, the effect of the democratic restitution in Spain (1978) and of the passing of the Spanish abortion law in Spain is explored. During the study period, close to 200,000 Spanish women travelled to England and Wales to have an abortion. The annual figures range from 2,978 in 1974 to 22,002 in 1983. In 1988, in spite of the partial decriminalization of abortion in Spain, still 3,188 travelled to the UK for an abortion. In average, 1 out 35 Spanish women in fertile ages travelled to England and Wales for this reason in the study period. The likelihood was higher for the cohort of women born between 1955 and 1959, for which the risk was 4.5%. The proportional distribution by age shows that teenagers increased their relative importance from 9.3% in 1974 to 17% in 1988, suggesting less benefits for this age group than for older women from the democratization of the country and the abortion law.

Abortion, Induced↗
PubMed2001

Clinical, provider and sociodemographic determinants of the number of antenatal visits in England and Wales.

The objective of this study was to measure the independent effects of clinical factors and non-clinical factors, such as provider and sociodemographic characteristics, on the number of antenatal visits made by women in England and Wales. The study was based on a survey of the secondary case records of 20,771 women with singleton pregnancies who were delivered between 1 August 1994 and 31 July 1995. The women in the survey attended one of nine maternity units in Northern England and North Wales selected within those areas to reflect geographical variations, as well as variations in the size and teaching status of the institution. A multivariate Poisson regression model was developed to examine differences in the number of antenatal visits made by women with different clinical and non-clinical characteristics. After controlling for non-clinical factors, primiparous women identified as high risk at booking made 1.0% more visits than primiparous women identified as low risk at booking (p = 0.196). Multiparous women identified as high risk at booking made 3.5% more visits than their low risk counterparts (p<0.001). High risk-defining criteria during antenatal care led to a 0.3% weekly increase in the number of antenatal visits amongst primiparous women (p <0.001) and a 0.4% weekly increase in the number of antenatal visits amongst multiparous women (p < 0.001). Several notable results, not reported elsewhere in the literature, were revealed by the regression analyses. After all independent variables were controlled for, women who were booked into urban teaching hospitals made 10% fewer antenatal visits than the women who were booked into the urban non-teaching hospitals. Women of Pakistani origin made 9.1% fewer antenatal visits than women of white British origin. Similar results were revealed for women of Indian origin and women from other ethnic groups. Non-smokers made 6.0% more antenatal visits than smokers. The planned pattern of antenatal care, number of carers seen, gestation at first presentation and maternal age also had significant independent impacts on the number of antenatal visits. The study highlights the sizeable impact of non-clinical factors on the antenatal care delivery process and indicates ways in which variations in antenatal care might be reduced.

Adult↗
PubMed1998

Mortality variations in England and Wales between types of place: an analysis of the ONS longitudinal study. Office of National Statistics.

This study investigates the extent to which individuals, in England and Wales, in different types of place experience differential mortality once account is taken of personal (individual and household) social circumstances. Data comes from the Longitudinal Study of England and Wales of the Office of National Statistics, the respondents being a one percent national random sample of people aged between 25 and 74 at the 1971 census, followed until the end of 1985. For males and females separately, differences in mortality are found for the 36 types of Craig-Webber classification in models which include, at the individual level, a number of demographic and socio-economic variables (women being classified by their own occupation). In general, for both males and females, the same types of place have elevated or lowered mortality. For males a (cross-level) interaction exists between the proportion in the area in professional social classes and individual social class, the effects of individual social class being larger in areas containing a higher proportion of those in professional occupations. For females mortality is negatively related to the proportion of car-ownership in the area.

Adult↗
PubMed2003

Radiographic equipment and techniques used in general dental practice: a survey of general dental practitioners in England and Wales.

OBJECTIVES: The aims of this study were to determine the self-reported use of panoramic radiography, D- and E-speed film, rectangular collimation, film holders, equipment fitted with a long spacer cone (>200 mm) and the bisecting angle and paralleling techniques by general dental practitioners and to see if use was related to the dentists' age and postgraduate qualifications. METHODS: Three mailings of a self-completion questionnaire were circulated to 800 general dental practitioners working in the National Health General Dental Service in England and Wales. RESULTS: A response rate of 74% was achieved. Sixty-one percent of general dental practitioners reported use of panoramic equipment. Fifty percent of dentists always used E-speed film and 18% always used rectangular collimation. Sixty-eight percent of dentists always used bitewing film holders though fewer (37%) used periapical film holders. Sixty-three percent of dentists always used a long cone. The bisecting angle technique was used by 70% of dentists with 22% always using this technique for periapical radiographs. Thirty-one percent always used the paralleling technique. Use of panoramic equipment, periapical film holders, bisecting angle and paralleling techniques were associated with the dentists' age. Use of periapical film holders, bisecting angle and paralleling techniques and rectangular collimation were associated with dentists' postgraduate qualifications. CONCLUSIONS: There are several features of radiographic equipment and techniques that can aid high quality imaging and reduce patient dose. Although a number of these are being used in general dental practice in England and Wales they have yet to achieve universal adoption.

Adult↗
PubMed1997

Antibiotic resistance in Escherichia coli isolated from blood and cerebrospinal fluid: a 6-year study of isolates from patients in England and Wales.

A study of the incidence of resistance to antimicrobial drugs in Escherichia coli from blood and CSF made in England and Wales in the 6-year period 1991 1996 has demonstrated a significant increase in the incidence of strains resistant to ampicillin and ciprofloxacin, two antibiotics used for first-line therapy of invasive disease. In particular, there has been a dramatic change in the occurrence of isolates with low level or high level resistance to ciprofloxacin; over 90% of isolates in the high level group were also resistant to at least four other antimicrobials. Physicians in England and Wales should be aware that there is now an increasing possibility of treatment failures when ciprofloxacin is used for the treatment of invasive E. coli infections.

Ampicillin Resistance↗
PubMed1995

The increase in tuberculosis notifications in England and Wales since 1987.

SETTING: A retrospective study of tuberculosis notifications in England and Wales published by the Office of Population Censuses and Surveys. OBJECTIVE: To analyse the rise in tuberculosis notifications in England and Wales by different sub groups over the time period 1982-91. DESIGN: The average annual percentage change in tuberculosis notification rates (per 100,000) for the groups were analysed by age, sex, standard region and disease site. RESULTS: The average annual increase in tuberculosis notifications from 1987-91 in females was +2.55 (95% confidence interval [CI] 0.5-4.7); males showed no significant change (-0.6%, 95% CI: -2.9 to +2.7). The increase was greater in younger subjects: 3.2% in females aged 25-44 (95% CI 0.9-5.5) and 4.3% in males aged 15-24 (95% CI 1.7-6.9). Only three standard regions showed an increase: the South East, the West Midlands, Yorkshire and Humberside. This increase was significant only in females from the South East, and was predominantly in non-respiratory tuberculosis. CONCLUSION: The rise in tuberculosis notification rates from 1987-91 has been predominantly in females, in those under 65, has occurred in 3 regions, and predominantly in non-respiratory tuberculosis. The analysis highlights some of the inadequacies of the present notification system for tuberculosis.

AIDS-Related Opportunistic Infections↗
PubMed1999

Mortality, long-term illness and deprivation in rural and metropolitan wards of England and Wales.

The relationships between mortality, limiting long-term illness and indicators of social deprivation were investigated using regression analysis on data for rural wards, metropolitan wards and the remaining wards in England and Wales. Regional differences were controlled. In rural wards, people had better health than average and slightly better health than would be expected from their deprivation scores. Average levels of health in rural areas were only weakly related to deprivation, which was partly but not fully due to the restricted range of average deprivation values in rural wards. In metropolitan areas, relatively poor levels of health were largely explained by social deprivation, but people in Inner London were healthier than might be expected from measures of deprivation. The relationship between health and social deprivation is therefore not uniform over England and Wales, but varies between geographical types of area. One consequence is that resource allocation on the basis of social deprivation would put the populations of rural areas and Inner London at an advantage.

Adolescent↗
PubMed1987

Onchocerciasis in British cattle: a study of Onchocerca gutturosa and O. lienalis in North Wales.

Onchocerca gutturosa and O. lienalis infections in British cattle were studied by examination of cattle post-mortem originating from North Wales and Cheshire (north west England). In 463 adult animals, the microfilarial (mf) prevalence was 28.5%. In 95.3% of the mf infected animals, gravid worms could not be found at either the ligamentum nuchae or the gastro-splenic omentum. Dermal mf at the head were identified as O. gutturosa on the basis of their highly significant association with the presence of gravid O. gutturosa at the ligamentum nuchae, which were found in only 3.2% of cattle. Mfs were isolated from different skin sites and from adult worms and a minimum of 10 mfs from each isolate were examined for width and acid phosphatase (AP) staining pattern. The width of O. gutturosa dermal mf was less than 4 micron (4 isolations), narrower than that of putative O. lienalis mf isolated from umbilical skin of cattle without evidence of O. gutturosa, which were in 20/22 isolations greater than 4 micron wide. The dermal mf were also distinguished on the basis of different AP staining patterns which, for each species, correlated closely with that of hatched intrauterine mf from their respective adult female worms. Based on the criteria of morphology and AP staining patterns the mf species prevalences in the survey population were estimated as O. lienalis 24.1% and O. gutturosa 2.2%, with a further 2.2% of cattle infected with both species. The results indicate that the predilection site of adult O. lienalis is not the gastro-splenic omentum. In North Wales, the distribution of the two species was different; O. lienalis was widely distributed in all cattle rearing areas both lowland and upland, whereas O. gutturosa was largely restricted to valleys close to major rivers.

Acid Phosphatase↗
PubMed1984

Distribution of immunity to pertussis in the population of England and Wales.

This paper presents three different methods of estimating the number and age distribution of individuals susceptible to pertussis in England and Wales. The first approach is an extrapolation from data in the prevaccine era, the second is based upon theoretical consideration of the transmission dynamics of pertussis, and the third is a detailed cohort analysis of available notification and vaccination data. Each of these analyses suggests that the total number of people susceptible to pertussis infection in England and Wales has remained at 3-4 million for the past 40 years, despite the increase and changes in numbers vaccinated. The effect of vaccination has been to reduce the incidence of infection and disease, but not to reduce the number of susceptibles. These findings, which are consistent with 'mass action theory', could be tested by an appropriately designed seroepidemiological survey.

Adolescent↗
PubMed2001

Changes in rates of suicide by car exhaust asphyxiation in England and Wales.

BACKGROUND: Self-asphyxiation using car exhaust gas is a common method of suicide in England and Wales, particularly in young males. The introduction of catalytic converters has reduced the toxicity of car exhausts. The main aims of the study were: to seek evidence of a fall in car exhaust suicides in the general population and in age and gender groups; to relate any fall to changes in car exhaust systems, particularly since legislation on car exhaust emissions in 1993; and to examine rates of suicide by other methods for evidence of method substitution. METHODS: Population study in England and Wales using national suicide statistics for 1987 to 1998. RESULTS: There was a fall in suicide by car exhaust asphyxiation in all age and gender groups. This change was most marked after 1993. The overall population suicide rate (all methods) also fell but there was no overall change in suicides by young males or females. In these groups suicide by hanging increased. CONCLUSIONS: Legislation on catalytic converters appears to have contributed to a fall in car exhaust suicides. However, the effect on overall suicide rates in young people has been reduced by method substitution.

Adolescent↗
PubMed1998

Cognitive function and dementia in six areas of England and Wales: the distribution of MMSE and prevalence of GMS organicity level in the MRC CFA Study. The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).

BACKGROUND: This two-stage prevalence survey involved geographically delimited areas, four urban (Liverpool, Newcastle, Nottingham and Oxford) and two rural (Cambridgeshire and Gwynedd), including institutions. METHODS: Stratified random population samples of people in their 65th year and above, from Family Health Service Authorities were studied. The sample was stratified (65-74 years and > or = 75) to provide equal numbers. In Liverpool equal numbers in 5 year age groups were taken. After an initial screening interview, approximately 20% were selected on the basis of age, AGECAT organicity confidence level and MMSE score to proceed to a detailed assessment interview from which the full AGECAT organicity confidence level could be derived. RESULTS: Major influences on MMSE were confirmed as age, sex, social class and educational level. Estimates of prevalence of AGECAT O3 and above for each centre and the entire sample according to age are given, based on 1991 Census population structure, and suggest that around half a million (543,400) people in England and Wales would be defined as case level by this method. The five centres employing the same methodology showed no heterogeneity in prevalence. CONCLUSIONS: Prevalence of cognitive impairment and dementia appear not to vary widely across the centres examined in this study, which provides stable estimates by age and sex for AGECAT O3 and above, and norms for MMSE. Using these estimates as an indication of the size of the population affected, around 550,000 individuals in England and Wales would be expected to be suffering from dementia of mild or greater severity.

Age Distribution↗
PubMed1999

Partners in life and in death: the suicide pact in England and Wales 1988-1992.

BACKGROUND: We describe the epidemiology of suicide pacts in England and Wales and assess the health, circumstances and motivation of those who died in pacts; the first such account for 35 years. METHODS: We have analysed the death certificates, coroners' records and medical notes of all people who died in suicide pacts in England and Wales between 1 January 1988 and 31 December 1992. RESULTS: The 124 suicides in 62 pacts accounted for 0.6% of all suicides giving a rate of 0.6 per million. The average age was 56 years. Poisoning by car exhaust or medicines caused 95% of deaths, both members of each pair using the same method. Forty-eight pacts were between married couples, five between blood relatives. Mental disorder was present in half and medical illness in one-third. Motives were avoiding loss of a partner from ill-health in 26 pacts, euthanasia in nine, thwarted love in four. CONCLUSIONS: The findings are similar to those of 35 years ago except the incidence of pacts is less. Improved management of illness might avoid some pacts especially when partners in an enduring, affectionate relationship, with few social ties, are both ill.

Adolescent↗
PubMed2003

Comparison of apparent efficiency of haemodialysis satellite units in England and Wales using data envelopment analysis.

OBJECTIVES: To expand care for chronic haemodialysis (HD) patients throughout England and Wales by studying two aspects of service delivery that are important: to identify relative performance of haemodialysis satellite units (HDSUs), and understand the factors that influence the performance. As a first step toward these aspects, this work reports a study of apparent comparative efficiency in the delivery of HDSUs and demonstrates the potential of data envelopment analysis (DEA). METHODS: DEA was applied to data obtained from a national survey of the organizational structures and processes of delivering care at HDSUs in England and Wales. RESULTS: DEA was found to be a judicious approach for performance assessment of HDSUs, although valid results depend on appropriate model specification and quality of data available. The available data were not of sufficient comprehensiveness or quality to produce definitive results but suggested that overall efficiency could improve; these data suggested by as much as 10% overall (mean efficiency score 90%) and variably within the sample (46 [65%] that HDSUs were potentially inefficient, the lowest unit scoring 38%). CONCLUSIONS: Addressing questions raised by comparative inefficiency could help plans to improve capacity to deal with the growing demand for HD delivered in HDSUs. The application was an important start and needs to be followed by further research to establish model validity and obtain authoritative results.

Ambulatory Care Facilities↗
PubMed2004

Health technology assessment in England and Wales.

In this study, we describe the current state of the Health Technology Assessment (HTA) system in England and Wales. This system rests on a distinction between assessment and appraisal and has three main strands: researcher-led HTA, the research and development program, and the HTA-NICE (National Institute for Clinical Excellence) process. We outline the pressures for HTA and how it has evolved in the British National Health Service. We discuss how HTA priorities are chosen, how HTA information is collected and assessed, how HTA evidence is used, and we make some observations about its impact. In our discussion, we consider some limitations of the HTA system, its possible divergence from evidence-based health care, its centralization, and some of the key challenges for managing HTA-driven policy. But we remain hopeful that HTA can contribute to better and more explicit decision-making within England and Wales.

England↗
PubMed1995

Predicting the impact of measles vaccination in England and Wales: model validation and analysis of policy options.

Measles incidence in England and Wales has fallen to an all-time low. Attention is now focused on preventing local outbreaks, and, in the long run, on the elimination of indigenous measles. A realistic age-structured (RAS) mathematical model of measles transmission is used to reconstruct the impact of measles vaccination in England and Wales from 1968 to the present and to evaluate the merits of future policy options. In general, the predictions of the model show good agreement with long-term age stratified case reports and seroprevalence surveys. The model underestimates the proportion of cases that are notified in 0-2-year-old children. However, recent work suggests a high degree of misdiagnosis in this age group. Projections on the basis of the existing vaccination strategy in the UK suggest that the present level of measles vaccine coverage will be insufficient to eliminate small seasonal outbreaks of measles. This result is, however, sensitive to the assumed level of vaccine efficacy. Explorations of a variety of changes to current vaccination strategy favour a 2-dose schedule with the second dose administered at age 4 years irrespective of vaccination history. A vaccination campaign in school-age children, to reduce deficits in herd immunity, would accelerate progress towards measles elimination.

Adolescent↗