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PubMed1999

Sociodemographic distribution of measures of body fatness among children and adolescents in New South Wales, Australia.

BACKGROUND: Obesity in childhood and adolescence is associated with health problems, increases in cardiovascular disease (CVD) risk factors and a greater likelihood of becoming overweight as an adult. A description of the sociodemographic distribution of overweight and obesity among children and adolescents in the population may allow us to determine if health promotion resources should be differentially allocated to particular groups. METHODS: The New South Wales Schools Fitness and Physical Activity Survey, 1997 (n = 5518) was a cross-sectional survey which measured height, weight, waist and hip girths and skinfold thicknesses of randomly selected New South Wales students in school years 4, 6, 8 and 10. Height and weight only were measured among Year 2 students. The mean ages of students in school years 2, 4, 6, 8 and 10 were 7.3y, 9.3y, 11.3y, 13.3y and 15.3y, respectively. The values of body mass index (BMI), waist girth, waist-to-hip ratio (WHR) and sum of three skinfolds for students resident in urban and rural areas and in tertiles of socioeconomic status (SES) were compared. RESULTS: There were no differences on any of the anthropometric measures between urban and rural boys and girls, with the exception that WHR was higher among urban girls. Among boys, there were no differences between the SES tertiles on any of the measures. Among girls, each of the anthropometric measures (except sum of skinfolds) was inversely associated with SES, with body fatness tending to be lower in the high SES tertile, compared with the low and middle SES tertiles. None of the statistical interactions between school year and body fatness was significant, suggesting that the relationship is consistent from childhood to adolescence. CONCLUSION: On the basis of these results, we suggest that health promotion programs aimed at weight management among Australian girls of lower SES are not warranted. We recommend that health promotion programs emphasize regular physical activity, a healthy diet and acceptance of the normal range of body shapes.

Adolescent↗
PubMed2006

Social deprivation and survival on renal replacement therapy in England and Wales.

This study examines the association between social deprivation and patient characteristics and outcomes in a nationally representative cohort of incident renal replacement therapy (RRT) patients. All Caucasian patients reported to the UK Renal Registry between 1997 and 2004 by centers in England and Wales with high data completeness were included. Social deprivation was assessed using the Townsend index. Socially deprived patients were more likely to be referred late. They were less likely to receive peritoneal dialysis (25.1 vs 34.8% on day 1, P trend <0.0001) or a renal transplant (5.3 vs 12.4% at 1 year, P trend <0.0001), and were less likely to attain UK Renal Association standards for hemoglobin and phosphate at 1 year. Crude survival decreased significantly with increasing deprivation for patients under the age of 65 years, but not for those aged 65 years and above (likelihood ratio for age-social deprivation interaction P<0.0001). Social deprivation was significantly associated with poorer survival after adjustment for age, gender, and cause of renal failure. After adjusting for baseline co-morbidity, social deprivation was no longer associated with poorer survival. Baseline differences in co-morbidity seem to explain poorer crude survival in incident Caucasian RRT patients from socially deprived areas in England and Wales. Differences also exist in some processes of care and intermediate outcomes, which may be amenable to intervention.

Aged↗
PubMed2002

Heroin use in New South Wales, Australia, 1996-2000: 5 year monitoring of trends in price, purity, availability and use from the Illicit Drug Reporting System (IDRS).

AIMS: To document trends in the price, purity, availability and use of heroin in New South Wales detected by the Illicit Drug Reporting System (IDRS) between 1996 and 2000, and to demonstrate the utility of the IDRS in identifying such trends. DESIGN: The IDRS compares information derived from interviews with injecting drug users, key informants who work in the illicit drugs field, and key indicator data on illicit drug trends. SETTING: New South Wales, Australia. FINDINGS: The price of heroin approximately halved over this period, from a median of A$400 per gram in 1996 to A$220 per gram in 2000. While the price of heroin fell dramatically over the study period, the purity of police seizures of the drug was high across all years, ranging between 62% and 71%. In all years heroin was considered easy to obtain by both heroin users who purchased the drug, and by key informants from the law enforcement and health fields. Concurrent with the large fall in heroin prices, there appeared to have been an increase in the number of heroin users. Between 1997 and 1998 there was a sharp increase in the injecting use of cocaine by heroin users in NSW, a pattern that has persisted. CONCLUSIONS: Regular and formal monitoring of illicit drug trends provides timely data in a systematic way to inform health and law enforcement policies towards current and emerging illicit drug problems.

Adolescent↗
PubMed2003

Trends in drug overdose deaths in England and Wales 1993-98: methadone does not kill more people than heroin.

AIMS: To test the hypothesis that methadone is responsible for a greater increase in overdose deaths than heroin, and causes proportionally more overdose deaths than heroin at weekends. DESIGN AND SETTING: Multivariate analysis of 3961 death certificates mentioning heroin, morphine and/or methadone held on the Office for National Statistics drug-related poisoning mortality database from 1993 to 1998 in England and Wales. MEASUREMENTS: Percentage increase in deaths by year by drug, odds ratio (OR) of dying at the weekend from methadone-related overdose compared to dying from heroin/morphine overdose. FINDINGS: From 1993 to 1998, annual opiate overdose deaths increased from 378 to 909. There was a 24.7% (95% confidence interval (CI) 22-28%) yearly increase in heroin deaths compared to 9.4% (95% CI 6-13%) for methadone only. This difference was significant (P < 0.001 by test of interaction) after adjustment for sex, age group, polydrug use, area of residence and underlying cause of death. The largest number of deaths occurred on Saturday (673). The OR of death from methadone overdose on Saturday and Sunday was 1.48 (95% CI 1.29-1.71) for methadone-only deaths compared to dying from heroin/morphine at the weekend after adjustment for other covariates, but the OR was not significant (1.09, 95% CI 0.95-1.25) if the weekend was defined as Friday and Saturday. CONCLUSIONS: There was no evidence that the threefold increase in deaths over time was due to methadone. There was equivocal support only for the hypothesis that there was an excess of deaths from methadone at weekends. Increased interventions to prevent overdose among injectors in England and Wales are long overdue.

Adolescent↗
PubMed2003

Signs of intoxication and server intervention among 18-39-year-olds drinking at licensed premises in New South Wales, Australia.

AIMS: To estimate the extent of responsible service of alcohol (RSA) practice to young adults showing signs of alcohol intoxication on licensed premises in New South Wales. DESIGN: Telephone-based cross-sectional survey. SETTING: New South Wales, Australia. PARTICIPANTS: A total of 1090 people aged 18-39 years old. FINDINGS: Seventy-five per cent of males and 64% of females reported that they had consumed at levels for acute alcohol-related harm during the previous 12 months, with 34% of males and 24% of females reporting doing so weekly; 54% (95% CI: 51-58%) of both males and females who had consumed at acute-risk levels, reported that this last drinking occasion occurred at a licensed premises. Of these, 56% (95% CI: 51-61%) reported that they had exhibited at least one sign of overt alcohol intoxication, while 19% (95% CI: 15-23%) reported showing three or more signs of intoxication. Among those reporting at least one sign of intoxication, only 10% (95% CI: 7-15%) reported that the licensed premises staff had provided at least one of seven different responsible service initiatives, while 55% (95% CI: 48-61%) reported that they were continued to be served alcohol. While these results suggest that intoxicated patrons are not being refused service as often as they should, there was evidence for some degree of responsible service provision with around half of the 'non-intoxicated' patrons reporting that they had seen licensed premises staff intervene in some way with other 'intoxicated' patrons. CONCLUSIONS: While the majority of 18-39-year-olds report showing signs of intoxication while drinking at licensed premises in NSW, only a small minority report experiencing RSA initiatives from bar staff in response to these signs.

Adolescent↗
PubMed2003

Trends in oesophageal and gastric cancer incidence, mortality and survival in England and Wales 1971-1998/1999.

BACKGROUND: In England and Wales, 7% of cancers diagnosed in 1997 were oesophageal or gastric cancer. AIM: To review the epidemiology of these cancers in England and Wales using cancer registration data from 1971 to 1998 and mortality data from 1971 to 1999. METHODS: We calculated age-specific and age-standardised incidence and mortality rates; crude and relative survival by age group; age-standardised relative survival; and relative survival by socio-economic status. RESULTS: The age-standardised incidence of oesophageal cancer increased from 7.6 to 12.8 per 100,000 men and from 4.2 to 5.7 per 100,000 women. The incidence of gastric cancer decreased from 31.8 to 18.9 per 100,000 men and from 15.1 to 7.3 per 100,000 women. For both cancers, the 1- and 5-year age-standardised relative survival improved for men and women from 1971-1975 to 1992-1994; the 5-year age-standardised relative survival was significantly higher in women than in men diagnosed in 1992-1994; for some periods from 1971-1975 to 1986-1990, the 1-year relative survival was significantly higher in the least deprived men than in the most deprived men. CONCLUSIONS: Survival improved for both cancers over the study period, but there were unexplained differences related to sex and deprivation.

Adolescent↗
PubMed1997

Child Health Surveillance in England and Wales: the bad news.

Postal surveys were conducted in 1993 among all, or samples of, six groups of providers and managers of pre-school child health surveillance (CHS) in England and Wales. Content analyses were also carried out of strategic policy statements for CHS produced by 54 district health authorities in England and Wales. The surveys aimed to document the views and experiences of CHS providers and managers about the impact of recent changes affecting the structure and operation of CHS, including the publication of Health for All Children, the 1990 Contract for General Practitioners (GPs), the implementation of the National Health Service and Community Care Act 1990, and the changing roles of community doctors and health visitors. Four adverse findings from the surveys are discussed: fragmentation in the child health service; the unwanted effects of the NHS internal market; the adverse consequences of the changing role of health visitors; and the concerns voiced by the community doctors about the quality of CHS in general practice.

Child↗
PubMed1997

Child Health Surveillance in England and Wales: the good news.

Postal surveys were conducted in 1993 among all, or samples of, six groups of providers and managers of pre-school child health surveillance (CHS) in England and Wales. Content analyses were also carried out of strategic policy statements for CHS produced by 54 district health authorities in England and Wales. The surveys aimed to document the views and experiences of CHS providers and managers about the impact of recent changes affecting the structure and operation of CHS, including the publication of Health for All Children, the 1990 Contract for General Practitioners (GPs), the implementation of the National Health Service and Community Care Act 1990, and the changing roles of community doctors and health visitors. Five positive findings from the surveys are discussed: the impact of the first edition of Health for All Children; improvements in the development and use of child health information systems; the beneficial effects of the growing Involvement of GPs in CHS; the developing understanding of, and commitment to, the principle of clinical audit in CHS; and the growing collaboration between providers in the NHS internal market. A separate paper reports the negative findings from the study.

Child↗
PubMed1999

The contribution of 'holiday deaths' to seasonal variations in asthma mortality in England and Wales.

BACKGROUND: In younger age groups there is a summer peak in asthma deaths, but whether this is due to social or environmental factors is not known. One suggested social factor is a summer holiday away from home during which there may be a lack of compliance with medication or greater difficulty in getting medical help. In older age groups there is a winter peak in asthma deaths. OBJECTIVE: To study the contribution of 'holiday deaths' to seasonal variations in asthma mortality in England and Wales. METHODS: Routinely collected mortality statistics were used (all asthma deaths of persons dying in England and Wales, 1991-93 and 1995). Deaths occurring 40 miles or more from home were estimated using the District Health Authority in which the person was usually resident; the registration district of death; and the 'transferability code' (derived by the Office for National Statistics). RESULTS: There were 484 asthma deaths in people aged 0-34 years, and 6337 asthma deaths in people aged 35 years or more. Deaths estimated to occur 40 miles or more from home contributed little (16%) to the summer peak in asthma deaths age 0-34 years, and nothing to the winter peak in asthma deaths age 35 years or more. CONCLUSIONS: Holidays away from home do not play an important part in explaining the seasonal variation of either young or old asthma deaths. Other social or environmental factors are more important.

Adolescent↗
PubMed2001

Malignant melanoma in South Wales: changing trends in presentation (1986-98).

In 1990 we reported the trends in presentation of malignant melanoma (MM) from 1986 to 1988 in a defined population in South Wales. Ten years after this initial study we reassessed the incidence of invasive MM in this defined population over a similar 3 year period. Using the local skin cancer registry we identified 186 cases of MM representing a 74% increase. Age standardization to the world population gives an overall incidence of 11.8 per 100 000 population per annum. This is the highest published standard incidence of MM to date from the UK and certainly one of the highest in Europe. We also have observed a continuing trend for diagnosis of thinner lesions with a better prognosis. Information about mortality for the whole of Wales over the corresponding period is also presented.

Adolescent↗
PubMed2000

Community dental officers' use and knowledge of restorative techniques for primary molars: an audit of two Trusts in Wales.

OBJECTIVE: A baseline audit of current levels of knowledge about, and use of, restorative techniques in children's primary molars. DESIGN: A survey of community dental officers. SETTING: Two large Trusts in Wales. SAMPLE: Eighteen dental officers (five from Trust A and 13 from Trust B) from a total of 23 (six from Trust A and 17 from Trust B). OUTCOME MEASURES: Dental officers' use of restorative materials in primary molars. Dental officers' participation in postgraduate training for restorative techniques. Dental officers' consideration of the research literature on 'best practice' in restorative techniques. RESULTS: Dental officers in these two Trusts were not using stainless steel crowns (SSCs) for restoring primary molars. All 18 dental officers reported using glass ionomer cement (GIC) and amalgam as restorative materials, whilst six reported using GIC exclusively. Only 11 dentists mentioned using stainless steel crowns and this was in conjunction with carrying out a pulpotomy. Fewer dentists had been taught to use GIC than either SSCs or amalgam for restoring primary teeth during undergraduate training. A hands-on, user-friendly, postgraduate training course is considered the most effective way of teaching dentists about restorative techniques. The research evidence on SSCs did not appear to influence these dental officers in their use of restorative materials. CONCLUSIONS: This study offers important baseline data about the acceptability of differing restorative techniques and about the type of intervention that could bring about change in pattern of use by community dental officers in two large Trusts in Wales. If a postgraduate course in the use of stainless steel crowns is to meet dental officers' needs, it should address their concerns about the use of crowns.

Adult↗
PubMed2000

Interprofessional relations between doctors and nurses: perspectives from South Wales.

Interprofessional relations between doctors and nurses: perspectives from South Wales This paper discusses findings from a study of interprofessional relationships between doctors and nurses in medical wards in three provincial general hospitals in south Wales. The aim of the research was to investigate the changing nature of doctor-nurse relations, and in particular, how far the notion of the doctor-nurse game, as developed by Leonard Stein (Stein 1967, 1990), remains relevant to contemporary hospital work. The present paper concentrates on a subset of the findings concerned with doctors' and nurses' accounts of the hospital division of labour and the extent of any overlap in their work activities. Semi-structured interviews were conducted with 20 doctors and 39 nurses in their places of work over a period of 4 months. Inductive analysis of the data indicated that, whilst doctors and nurses perceived their roles in largely traditional terms, there was some recognition of blurring of occupational boundaries, especially when considering work pressures, working at night and differences in practice in more specialized clinical areas. Although nurses were generally reluctant to challenge doctors' authority, some used the notion of patient 'advocacy' to frame and justify their questioning of particular decisions. Whilst doctors valued 'experience' in nurses and saw experienced nurses as the group who might most legitimately move into doctors' territory, nurses valued formal education and saw advanced nursing qualifications as the route to role expansion.

Attitude of Health Personnel↗
PubMed2000

Comparison of integrated and consultation-liaison models for providing mental health care in general practice in New South Wales, Australia.

Comparison of integrated and consultation-liaison models for providing mental health care in general practice in New South Wales, Australia The characteristics of a new service providing integrated mental health care in general practice are described and comparisons made with an earlier consultation-liaison (C-L) psychiatry service in general practice, including the range and severity of psychiatric problems, levels of general practitioner (GP) and psychiatrist involvement, and patterns of care. Clinical audit checklists were completed by two experienced mental health nurses for the first 100 patients referred to the service, which was conducted in conjunction with 8 general practices in the Port Stephens region of New South Wales, Australia. The mean age of the first 100 referrals was 38.05 years, 63.0% were female, and 55.0% were referred from GPs. Outcome measures included: referral information, patients' demographic and diagnostic characteristics, psychosocial functioning, psychotropic medication, management, and number of contacts with the mental health nurses. Relative to the earlier C-L psychiatry service in general practice, the integrated service treated a broader range of diagnostic groups with higher levels of disability. There were higher rates of mood (48.0%) and psychotic (20.0%) disorders and lower rates of adjustment (2.0%) disorders. One-third of patients were seen by an additional agency, other than the mental health nurses or GPs. Patients averaged 4.95 contacts with the mental health nurses, with marked variations according to diagnostic group. To date, the new service has been well received. It is highly accessible, acceptable to GPs and patients, caters for a broad range of psychopathology, including severe mental illness, and appears to be sufficiently versatile to be adaptable to a variety of treatment settings.

Adult↗
PubMed2001

Self-reported medication use for older people in England and Wales.

OBJECTIVES: To describe the patterns of self-reported medication use, including both prescription and non-prescription drugs, for older people in five areas in England and Wales, and to identify the effects of socio-demographic features on medication use. DESIGN: A cross-sectional survey on population random samples of people aged 65 and over. The survey is a part of the screening interviews at the first stage of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) carried out between 1991 and 1994. The sample was stratified to provide equal numbers in the 65-74 years and 75 years and over age groups. SETTING: Three urban (Newcastle, Nottingham and Oxford) and two rural (Cambridgeshire and Gwynedd) centres. Older people living in both the general community and institutions were included. PARTICIPANTS: 12489 older people whose medication data were collected among the 13009 participants of the CFAS, of which the participation rate is 80%. RESULTS: Overall prevalence of medication use was 75% (95% confidence interval 74-76%) for people aged 65-74 and 84% (83-85%) for people aged 75 and over, with a mean number of 2.03 (standard deviation 1.95) and 2.47 (2.02) drugs reported per respondent in each group, respectively. Concurrent use of five or more drugs (polypharmacy) was found in 11% (10-12%) of people in the 65-74 age group and in 15% (14-16%) in the 75 and over age group. People aged 75 and over were more likely to be taking at least one drug than people aged 65-74 (OR=1.69, 1.54-1.85), and women were more likely to be so compared with men (OR=1.43, 1.30-1.56). Centre variation was found but none of the centres consistently showed higher or lower usage of medications across the major drug categories. People living in institutions were more likely to be taking gastrointestinal drugs, central nervous system drugs and experience polypharmacy. The use of respiratory and central nervous system drugs (except hypnotics and anxiolytics) increased in lower social class and decreased in people attending full-time education for 10 years or more. The use of haematology/dietetic drugs (85% of which were vitamin and mineral preparations) decreased in lower social class. CONCLUSION: This study provides representative estimates of medication usage among older people in England and Wales and identified associated factors and regional variations for medication use in a category-specific manner. The findings, suggesting the existence of centre variation and the association between type of accommodation, social class and medication use warrant further investigation.

Age Factors↗
PubMed2000

Community mental health nurses in Wales: self-reported stressors and coping strategies.

There is evidence to suggest that community mental health nurses experience stress and burnout related to their work. Previous research has been limited by a number of methodological problems. One of the problems is that studies have tended to have small or unrepresentative samples, and many researchers have only examined mental health nurses as a subset within their research, which limits the generalizability of the findings. The All-Wales Community Mental Health Nurse (CMHN) Stress Study was set up in order to address this issue. The total population of CMHNs in Wales was surveyed (N = 614) and 301 (49%) responded. The questionnaire booklet contained a number of validated instruments to measure stress, burnout, and coping, together with a demographic questionnaire. The demographic questionnaire included three open ended-questions. These questions were asked in order in determine the CMHNs' own views of the sources of stress in the workplace, and to investigate which methods they use to cope. This paper reports the findings from the content analysis of the three questions. The results from the other measures are reported in the companion paper (Edwards et al. 2000). The most frequently cited stressors included perceived workload, excessive paperwork and administration, and a broad spectrum of client-related issues. Coping strategies that CMHNs reported using included peer support, a range of personal strategies such as relaxation, and belief in self and supervision. It appears from the findings that a range of factors such as organizational pressures and factors related to working with patients are important in determining stress levels, and that informal rather than formal support networks are the preferred methods of coping.

Adaptation, Psychological↗
PubMed1999

The 4th quinquennial national community mental health nursing census of England and Wales.

Since 1980, a survey of community mental health nursing has been conducted in the United Kingdom, at five-yearly intervals. These three data sets have been uniquely useful in plotting trends in Community Mental Health Nursing (CMHN) activity over time. Substantial administrative changes to the National Health Service have taken place in England and Wales since 1990, however, and these have impacted on the nature of mental health service provision. These changes have implications for all mental health service personnel and, in particular, the work of community mental health nurses. This article presents selected findings from the national census, conducted between 1996 and 1997. It sets these findings within the context of data derived from the three previous national studies in the series and within the contemporary national policy context and discusses the substantive implications which flow from the changes detected over time in the practice, organisation and management, and education of community mental health nurses in England and Wales.

Community Health Nursing↗
PubMed2000

Prevalence and treatment of pressure ulcers in northern New South Wales.

This paper reports on a small, cross-sectional study of 18 hospitals in northern New South Wales. The objectives of this study were to collect baseline data on: (i) the prevalence and type of pressure ulcers in a variety of rural hospitals; and (ii) the range of nursing and medical interventions that are used to prevent/treat pressure ulcers. Using a cross-sectional design, the study found that pressure ulcer prevalence, which was 6%, was within the range found by previous reports (4-15%). Pressure ulcer prevention and treatment practices were varied, ranging from turning of the patient and occlusive dressings, to such creative methods as exposure to sunshine and airing the wound. This study demonstrates that despite years of attention to pressure sore prevention and treatment, the prevalence of ulcers is still a significant problem in northern New South, Wales hospitals.

Aged↗
PubMed1998

Measles immunity and immunization status in under-5-year-old children in New South Wales: a population-based study.

OBJECTIVE: To estimate the proportion of 1-4-year-old New South Wales children immune to measles and compare the documented immunization history with serologically defined immune status. DESIGN: Population based seroprevalence survey piggybacked onto the National Survey of Lead in Children. Immune status was determined by two different enzyme immunoassays on plasma samples from subjects. SETTING: New South Wales, February-March 1995. OUTCOME MEASURES: Documented measles immunization collected by interview survey and serologically defined immunity. RESULTS: Of 689 survey subjects, 430 (62.4%) provided a blood sample. Adequate plasma remained for both assays for 347 children, of whom 279 (80.4%) were immune by both assays. Parents of 330 stated that their children were immunised, of whom 211 (63.9%) were able to produce corroborating records. Of these 211 subjects, 178 (84.4%) were immune compared to 87 (76.3%) of 114 without records (P = 0.07). CONCLUSIONS: We estimate the prevalence of true measles immunity in 1-4-year-old NSW children to be only 80%, a level inadequate to prevent outbreaks of measles in urban populations. Both long term and immediate strategies are required to increase the prevalence of immunity among NSW children; these may include lowering the age of the routine second measles dose and mounting a mass measles immunisation campaign to include preschool aged children.

Chi-Square Distribution↗