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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↗
PubMed1994

Using unemployment rates to predict prescribing trends in England.

BACKGROUND: There are many factors underlying trends in prescribing levels in England. AIM: This study set out to examine prescribing trends and their relationship with three measures of morbidity. METHOD: A study was undertaken examining the interrelations between basic prescribing parameters for the 90 family health services authorities in England for the year 1 April 1989 to 31 March 1990. The trends were examined for their associations with three factors which have been linked to morbidity levels: standardized mortality ratios, the Jarman index (through its use as a deprivation index), and unemployment rates. RESULTS: Analysis revealed a strong inverse association between the number of items prescribed per patient and the net ingredient cost per item for the family health services authorities. These two factors together determined the net ingredient cost per patient. Cluster analysis was found to segregate approximately the family health services authorities geographically: the northern, urban areas of England were characterized by a high number of low cost items per patient while the southern semi-rural areas had a low number of high cost items per patient. The trend was such that the former area had a higher overall net ingredient cost per patient. Unemployment rates were the most robust determinant of the inverse trend of number of items and cost of items and were comparable with standardized mortality ratios in their individual correlations with the prescribing net ingredient cost per patient. The Jarman index was the weakest of the predictors. CONCLUSION: The results lend support to the argument that material deprivation, associated with unemployment, is an important determinant of prescribing trends, perhaps acting through its effect on morbidity, and that the Jarman index is a poor indicator of deprivation. The analysis alone cannot, however, determine cause and effect for the apparent relationship between unemployment and prescribing.

Adolescent↗
PubMed1993

Distribution of developmental defects of enamel on ten tooth surfaces in children aged 12 years living in areas receiving different water fluoride levels in Sri Lanka and England.

The prevalence of enamel defects on ten tooth surfaces per subject was recorded in 1990/91 in 12-year-old children living in areas which received drinking water containing either 0.1, 0.5 or 1.0 ppm F, in Sri Lanka and in England. In some communities, children of high and low socioeconomic groups were included. The teeth included were: 46, 14, 13, 12, 11, 21, 22, 23, 24 and 36; buccal surfaces only were examined. One examiner examined all the children under natural light using the modified DDE index (Clarkson and O'Mullane, 1989). Teeth were not especially cleaned or dried. A 10 per cent re-examination of subjects indicated that examiner reproducibility was good. Data were presented for 547 subjects (168 in Sri Lanka and 379 in England). While the maxillary central incisors were affected most often in England and in the 0.1 ppm F area in Sri Lanka, this was not the case in the 0.5 and 1.0 ppm F areas in Sri Lanka where prevalence was highest in premolar and canine teeth. Demarcated and diffuse opacities predominated in the 1.0 ppm F areas in both countries, while hypoplastic lesions were prevalent in Sri Lanka in the 0.1 and 0.5 ppm F areas, especially in maxillary incisor teeth. Nearly half the lesions extended to more than one-third of the tooth surface in the 1.0 ppm F areas. The findings indicate that maxillary canine and premolar teeth are affected much more in high fluoride areas in Sri Lanka and it is suggested that this may be due to their later development relative to incisors and first molars.

Child↗
PubMed1993

The contrast in dental caries experience amongst children in the north west of England.

Professor Philip Holloway has an outstanding reputation in dental science which has led him to be asked to give his advice on dental matters in many different parts of the world. When he came to Manchester in 1964 he came to join the Department of Children's and Preventive Dentistry and the dental welfare of the children in the north west of England has remained one of his abiding central interests. This paper examines the information that has become available on the dental caries experience among children in north west England since the 1960s when Philip Holloway joined the department. The paper collates data on the dramatic reduction in caries prevalence and examines the distribution of dental caries in children today. In the 1990s, typically, only one quarter of children account for three quarters of the dental caries that is present. In the future, efforts should be concentrated on identifying groups of children within the population at risk to dental caries rather than trying to identify individuals. A recent reduction in the provision of restorative treatment amongst 5-year-old children is noted in this region of England and proposals for further research are discussed.

Adolescent↗
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

Data initiatives: HEDIS and the New England Business Coalition.

The New England Business Coalition is a group of 15 health maintenance organizations, large employers, and health care purchasers operating in the New England area. Formally launched in 1994, the coalition's mission is to standardize health care reporting, improve quality, and allow for comparison of managed health care plans for the participating organizations. The National Committee for Quality Assurance (NCQA) and its measurement instrument, the Health Plan Employer Data Information Set (HEDIS) became involved in the coalition's reporting project in 1992 to help the participating plans fulfill their mission of standardization, quality improvement, and comparative evaluation. In the past 5 years, HEDIS has undergone change and development to meet the needs of both health care plans and purchasers who use the HEDIS information to make decisions about health care for employers. Changes enacted within HEDIS have been brought about with the input of HEDIS users such as the New England Business Coalition, a pilot report card project, and a nationally based HEDIS users group. Future enhancements to HEDIS will result in added value for HEDIS users as development and change continue to meet the evolving needs of plans and purchasers.

Databases, Factual↗
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

Influenza surveillance in England and Wales: October 1995 to June 1996.

This report summarises information collected for the surveillance of influenza virus infection in England and Wales from October 1995 to June 1996 (weeks 40/95 to 25/96). Total respiratory disease' activity, as reported by the Birmingham Research Unit of the Royal College of General Practitioners, rose to peaks in weeks 48/95, 51/95, and 01/96. The first peak coincided with a peak in "influenza and flu-like illness'. The subsequent peaks were accounted for by an increase in reports of acute bronchitis, including bronchiolitis, and may have been associated with the annual rise in infections with respiratory syncytial virus. Influenza A virus was responsible for most infections, with moderate activity occurring in the early part of the winter, peaking in December (week 48/95). Influenza A subtype H3N2 predominated until week 07/96, after which subtype H1N1 accounted for most infections. Influenza activity was first seen in central and northern England, followed by the south of England, Wales, and Scotland. Circulating influenza viruses were antigenically similar to the components of the 1995/96 vaccine. International surveillance during 1995/96 has led to a different H3N2 component being included in the influenza vaccine recommended for 1996/97.

Adolescent↗
PubMed1997

Progress with cholecystectomy: improving results in England and Wales.

BACKGROUND: The Comparative Audit Service of the Royal College of Surgeons of England studied laparoscopic cholecystectomy in England and Wales during 1990-1991. The follow-on study undertaken during 1994 provides data to assess progress. METHODS: Pro formas were sent to consultant surgeons, requesting data on open and laparoscopic cholecystectomies performed in their units during 1994 with data on mean stay, mortality, complications, and the use of peroperative cholangiography and bile duct exploration. The identity of the consultants was treated confidentially. RESULTS: Data were provided by 110 surgeons on 4823 cholecystectomies (1019 open and 3804 laparoscopic) and outcome was compared with that of 3319 attempted laparoscopic and 8035 open cholecystectomies carried out during 1990-1991. The proportion of cases attempted laparoscopically rose from 27.2 per cent in 1990-1991 to 78.9 per cent in 1994, and conversion to open cholecystectomy rose from 5.3 to 6.7 per cent respectively. During 1994 peroperative cholangiography was undertaken in 22.9 per cent of laparoscopic and 44.6 per cent of open cases. Complication rates were similar in the two study periods, except the number of reported haemorrhagic complications was reduced by 40 per cent and bile duct injuries by fivefold (from 0.33 to 0.07 per cent). CONCLUSION: During 1994 the audit sampled approximately 10 per cent of all cholecystectomies performed in England and Wales. The results suggest progress in surgical techniques compared with findings in 1990-1991.

Cholangiography↗
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↗
PubMed1998

[Genetic carrier screening for hemoglobinopathies: the situation in the Netherlands compared with England].

In the Netherlands, in contrast to England, no screening for carriership of haemoglobinopathy (sickle-cell anaemia and thalassaemia) is being carried out. The absolute prevalence is low, but the prevalence in proportion to birth figures is approximately the same in the two countries. The lack of knowledge of the professional groups involved can be rectified by adequate instruction. The question whether screening should be carried out before pregnancy or early prenatally proved not difficult to solve in England. Screening for carriership is technically possible and in England it is also cost-effective. This screening should be performed in the Netherlands, as well.

Adult↗
PubMed2006

Disease and disadvantage in the United States and in England.

CONTEXT: The United States spends considerably more money on health care than the United Kingdom, but whether that translates to better health outcomes is unknown. OBJECTIVE: To assess the relative heath status of older individuals in England and the United States, especially how their health status varies by important indicators of socioeconomic position. DESIGN, SETTING, AND PARTICIPANTS: We analyzed representative samples of residents aged 55 to 64 years from both countries using 2002 data from the US Health and Retirement Survey (n = 4386) and the English Longitudinal Study of Aging (n = 3681), which were designed to have directly comparable measures of health, income, and education. This analysis is supplemented by samples of those aged 40 to 70 years from the 1999-2002 waves of National Health and Nutrition Examination Survey (n = 2097) and the 2003 wave of the Health Survey for England (n = 5526). These surveys contain extensive and comparable biological disease markers on respondents, which are used to determine whether differential propensities to report illness can explain these health differences. To ensure that health differences are not solely due to health issues in the black or Latino populations in the United States, the analysis is limited to non-Hispanic whites in both countries. MAIN OUTCOME MEASURE: Self-reported prevalence rates of several chronic diseases related to diabetes and heart disease, adjusted for age and health behavior risk factors, were compared between the 2 countries and across education and income classes within each country. RESULTS: The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. These differences between countries or across SES groups within each country are not due to biases in self-reported disease because biological markers of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence is twice as high in the United States and only one fifth of this difference can be explained by a common set of risk factors. Similarly, among middle-aged adults, mean levels of C-reactive protein are 20% higher in the United States compared with England and mean high-density lipoprotein cholesterol levels are 14% lower. These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well. CONCLUSION: Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution.

Aged↗
PubMed2001

Journal provision and the prevalence of journal clubs: a survey of physiotherapy departments in England and Australia.

BACKGROUND AND PURPOSE: Evidence-based journal clubs can promote evidence-based practice and continuing professional development (CPD). Although studies have evaluated the impact of journal clubs in medical and nursing departments, there is little information concerning journal clubs or journal provision in physiotherapy departments. The present survey was conducted to address this deficit. METHOD: A postal questionnaire, designed to ascertain the type and extent of journal provision, and prevalence and attributes of journal clubs in physiotherapy departments, was distributed to physiotherapy managers in 150 facilities in England and in south-east Australia. Sixty-two per cent of facilities approached in England and 55% of those approached in Australia responded to the survey. RESULTS: The provision of journals in physiotherapy departments was limited, and alternative access to physiotherapy journals was generally poor. Certain facilities were innovative in providing additional journal literature for physiotherapy staff. Physiotherapy journal clubs existed in 42% of responding facilities in England and 18% of those surveyed in Australia. Several facilities provided alternative forms of journal review as part of in-service training. Relatively few journal clubs utilized a 'problem-based' format, which fosters the teaching of critical appraisal skills. Evidence of enthusiasm emerged in some facilities, but in contrast, barriers and a degree of apathy were also revealed in others. CONCLUSIONS: Physiotherapy managers, hospital administrators and academic institutions should jointly agree a strategy to both promote evidence-based journal clubs and to facilitate journal provision within physiotherapy departments.

Australia↗
PubMed1992

A survey of pediatric management of dyslipidemias in New England.

We recently surveyed physicians attending the New England Pediatric Preventive Cardiology Society. Sixteen physicians who actively evaluated children with dyslipidemia completed questionnaires; at least one representative from six of the seven medical schools in New England was included. The survey elicited responses to five hypothetical cases of childhood dyslipidemia which were representative of the types of lipid problems commonly referred to pediatric lipid specialists. Diet modification was the initial treatment of choice of all participants. For any set of lipid values, postpubertal age increased the proportion of respondents who would have prescribed medication. When pharmacologic intervention was elected, resin binders (cholestyramine or cholestipol) and niacin were most commonly prescribed. The responses of the physicians showed considerable variation in the threshold for beginning medications. In summary, this survey suggests substantial variation in the approach to pharmacologic management of pediatric dyslipidemias in the New England region.

Adolescent↗
PubMed1977

Pathologic analysis of mink mortality in New England mink.

The underlying cause of death of a group of New England mink, which died in 1969 to 1970 was explored. PCB and chlorinated hydrocarbon pesticide levels were measured. Aroclor 1254 levels in these mink were elevated 73 fold over levels in healthy mink in 1974. DDT levels were elevated 5 times and DDE 3 times over those control animals. Gross pathology revealed desions of the lungs, liver and kidneys. There lesions were confirmed microscopically. The lungs of the New England mink showed inflammation and congestion. Areas of inflammation were also present in the liver. Massive areas of necrosis were seen in the kidneys, both in the medullary and cortical areas. Kidney involvement was greater than any other organ. P.A.S. positive material was seen in each of these organs with the kidneys showing largest amounts of this material. Since the New England mink did not show lesions of the G.I. tract, did not exhibit fatty degeneration of the liver, which PCB toxicity is known to induce in mink and because they showed areas of congestion, inflammation and positive P.A.S. material, PCB's were not considered the toxic agent. However, fungus or bacterial infection might be the causative agent.

Adipose Tissue↗
PubMed1984

Temporal trends of cancer mortality in eastern New England compared to the nation, 1950-1975.

Cancer mortality trends among the white population in eastern New England are compared to National trends for the years 1950-1975 for 62 age and sex-standardized sites. The 26 years considered in the study are divided into five time periods (1950-1954, 1955-1959, 1960-1964, 1965-1969, 1970-1975) representing rates age-adjusted to the 1960 white population. The findings show that male cancer mortality in eastern New England is increasing at a rate consistently higher than and almost parallel to National male cancer mortality. Female cancer rates in eastern New England are declining, but less rapidly than National female cancer mortality. Female lung cancer in the study region has experienced a dramatic increase from 1950 to 1975; and the greatest increases occurred in areas of the lowest relative urbanization.

Connecticut↗
PubMed2005

A review of hand surgery provision in England.

This study reviews hand surgical activity and the resources available for provision of hand surgery in England in 2001. Operation rates for three common procedures, viz. carpal tunnel release, Dupuytren's surgery and ganglion surgery, were considered. The local population and the number of hand surgeons in each NHS Hospital Trust were compared. We identified 275 consultant surgeons with an interest in hand surgery working in the NHS in England. Approximately two-thirds were orthopaedic surgeons, almost one-third were plastic surgeons and a small number were accident and emergency surgeons. Half of all hand surgeons worked in large units, with three or more hand surgeons, but almost 20% of hand surgery was delivered in hospitals in which there was no surgeon with a declared interest in hand surgery. Surgery rates for Dupuytren's contracture varied from 0.04 to 0.36 cases per 1,000 population per annum and for carpal tunnel syndrome varied from 0.25 to 1.31 cases per 1,000 per annum. We found a correlation between rates of surgery and the number of hand surgeons, locally. A recent audit (Burke, Dias, Heras-Pelou, Bradley, & Wildin, 2004. Providing care for hand disorders, a reappraisal of need. Journal of Hand Surgery, 29B: 575-579.) has suggested that one hand surgeon is required to meet the needs of a population of 125,000, with a national requirement for 393 hand surgeons. We conclude that there are insufficient hand surgeons in England and believe that the wide local variations in hand surgery rates are indicative of a significant unmet demand for hand surgery in the English population.

Carpal Tunnel Syndrome↗