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PubMed1989

Changes in seasonal mortalities with improvement in home heating in England and Wales from 1964 to 1984.

Changes in summer (July-September) and winter (January-March) mortalities of people aged 70-74 in England and Wales from 1964 to 1984 were compared with possible causal factors. Summer mortalities were little affected by annual temperature or influenza epidemics and fell from 1972-1975 for all causes, coronary and respiratory causes, while cerebrovascular mortality fell more rapidly from that time. Cigarette consumption also fell from 1972-1975; falling consumptions of total fat from 1970 and saturated fat from 1972-1975 probably also contributed to the fall in arterial deaths, and likewise falls in prescription rates for tranquillisers and sedatives from 1976-1978 to the fall in respiratory deaths. From 1964 to 1984 use of central heating increased from 13% to 69% of households, domestic fuel consumption increased, and excess mortality in winter from respiratory disease declined by 69%, even relative to summer mortality and when adjusted for varying coldness of winters. The improvement was partly explained by a decline in influenza epidemics. By contrast, excess mortalities in winter from coronary and cerebrovascular disease, although rising in some early influenza epidemics, did not fall significantly as home heating improved. These thrombotic deaths together accounted for 56% of the total excess winter mortality by 1984. The findings support other indications that most of the excess mortality from arterial thrombosis in winter in England and Wales is due to brief excursions outdoors rather than to low indoor temperatures.

Aged↗
PubMed1985

Declining first-marriage rates in England and Wales: a change in timing or a rejection of marriage?

Two different methods devised by Ryder and by Le Bras and Roussel are used "to assess how far the changes in first-marriage rates in England and Wales arise from a shift to marrying at later ages or from a decline in the popularity of formal marriage. The two methods yield consistent results, and indicate that the majority of young people...will continue to marry but that during the 1970s many were postponing marriage. The pattern of cohabitation and prevailing attitudes to marriage are compatible with such a finding. Recent marriage patterns in England and Wales are found to differ from those in France and Sweden." (summary in FRE)

Attitude↗
PubMed1991

Temporal changes in the occurrence of hemorrhoids in the United States and England.

Although numerous etiologic risk factors have been proposed, the pathogenesis of hemorrhoids remains unknown. The present investigation assesses the temporal distribution of hemorrhoids as depicted by physician visits, hospital discharges, and surgical procedures to provide further insight into potential etiologic risk factors. The analysis was based on five data sources: from the United States, the National Disease and Therapeutic Index (NDTI), the National Hospital Discharge Survey (NHDS), and the Commission on Professional Hospital Activities (CPHA); from England and Wales, the Morbidity Statistics from General Practice (MSGP) and the Hospital In-patient Enquiry (HIPE). Results demonstrated a consistent decline in all data sources from the United States. The decrease occurred in males and females similarly and was most striking in those aged 45-64 years. Physician visits and hospital discharges for hemorrhoids in England and Wales likewise declined although the decrease was not as dramatic. The consistency of the temporal distributions among the two countries, as well as among the different sources, suggests that the observed decline may, in fact, reflect an overall decrease in the occurrence of hemorrhoidal disease.

Adolescent↗
PubMed1992

Plasmid profiles demonstrate that an upsurge in Salmonella berta in humans in England and Wales is associated with imported poultry meat.

Sixteen plasmid profile types have been identified in drug-sensitive isolates of Salmonella berta isolated from humans and human food in England and Wales in the ten-year period 1981-1990. Since 1988 six profile types of epidemiological importance have caused infections in widely-separated geographical areas and of these, four types have been identified in S. berta isolated from chicken carcasses imported from Denmark. The findings suggest that imported Danish poultry has substantially contributed to a recent upsurge of S. berta in humans in England and Wales.

Animals↗
PubMed1986

Mortality from Crohn's disease and ulcerative colitis in England-Wales and the U.S. from 1950 to 1983.

As the etiology of inflammatory bowel disease remains unknown, studies of its time trends may provide clues to understanding the underlying mechanisms. This study examines mortality from Crohn's disease and ulcerative colitis in England and Wales and the U.S. during the period 1950 to 1983. Mortality from Crohn's disease and ulcerative colitis changed in both countries similarly. The death rates from Crohn's disease increased until 1970 to 1974 and decreased thereafter. The death rates from ulcerative colitis decreased throughout the observation period. Similar time trends occurred in men and women, and in the U.S. in whites and nonwhites. In the U.S., the death rates from both diseases were twofold higher in whites than nonwhites. The temporal changes suggest that mortality from inflammatory bowel disease is affected by exogenous factors and that these factors are different for Crohn's disease than for ulcerative colitis. These factors seem to have changed similarly in England and in the U.S.

Adolescent↗
PubMed1991

Immigrant suicide in Australia, Canada, England and Wales, and the United States.

"Factors influencing the suicide rates of numerous immigrants in groups in Australia, Canada, England and Wales, and the United States during the period 1959-73 were examined.... For males, the foreign-born in England and Wales had the lowest suicide rates and the foreign-born in the United States the highest. For females the variation was smaller, with immigrants in the United States having the lowest rates, and those in Australia the highest.... In each destination significant correlations existed between the suicide rates of the immigrants and those of the origin populations, indicating that the suicide rates for individual immigrant groups were to some extent predisposed by their experiences in the origin countries. Factors in the destination country also influenced immigrant suicide rates, as the rates of the majority of the immigrant groups converged towards the rates of the destination native-born.... The analyses also suggested that migration is more deleterious for females than males."

Americas↗
PubMed2002

Poverty, poor services, and compulsory psychiatric admission in England.

BACKGROUND: Compulsory admission is a central feature of psychiatric systems internationally but the factors determining its use within different legal systems are not understood. Numbers of compulsory psychiatric admissions vary widely between areas in England. We examined the hypothesis that variation in rates of detention is related to social deprivation and also to the functioning of local mental health services. METHODS: Rates of detention under sections 2 and 3 of the Mental Health Act (1983) in 1998/9 were obtained in 34 mental health sectors in eight Trusts in England. Measures of socio-economic deprivation and measures of service function were used to conduct an ecological analysis. RESULTS: Compulsory admission is associated with measures of deprivation but there is unexplained variation. The range in rates is higher than allowed for by the resource allocation formula. Some indicators of service quality are independently associated with rates of detention. CONCLUSIONS: Variation in detention rates and its relation to service function need further explanation if the use of compulsion is to be reduced.

Adolescent↗
PubMed2003

Interventions and outcomes of health and social care service provision for people with severe mental illness in England.

BACKGROUND: Mental health policy in England is undergoing radical change involving the integration of services aimed at improving outcomes for patients. At the same time, there is limited evidence about how conventional services are performing. The present paper reports data on the services provided and short-term outcomes achieved in eight community services in England. METHOD: A survey of caseloads of nurses and social workers was undertaken using a single-page assessment tool (MARC1) (n = 3024). After 5 months a random sample of psychotic cases was followed up (n = 393). RESULTS: A tendency was observed for health and social care practitioners to use the services available from within their own organisation. Over time, in the most severe cases, there was a substantial increase in provision of the services of the other organisation. Outcomes in terms of changes in HoNOS, GAS and MARC1 scores were similar for both professional groups, and both reported similar amounts of met and unmet need (and in the same categories) at follow-up. CONCLUSION: The most likely explanation for the change in service provision is the separate operation of different professional groups acting as gatekeepers for their own resources.

Community Mental Health Services↗
PubMed2004

A needs index for mental health care in England based on updatable data.

BACKGROUND: Mathematical models relating rates of mental health care use to population characteristics such as social deprivation are widely used in both planning and researching mental health services. The models currently in wide use in England are based on data mostly derived from the 10-yearly population censuses. These are perceived to be out of date many years before new census data are available for their replacement. A new set of government deprivation monitoring statistics based mainly on annually updatable data has recently been developed. This study set out to produce a mental illness needs index based on these new data. METHODS: A series of regression models were tested using individual domain scores from the DETR Index of Multiple Deprivation and the Office of National Statistics area-type classification as independent variables to predict 1998/9 psychiatric admission rates for broad diagnostic groups for 8251 of the 8414 electoral wards in England as dependent variables. RESULTS: The distribution of admission numbers in wards showed a pattern of over-dispersion with an excessive number of zero values for conventional regression approaches. A two-stage 'hurdle' model was, thus, adopted, predicting first the likelihood that wards would produce any admissions and second the probable number. This produced satisfactory predictive power, with residual variance showing strong geographical patterns associated with administrative areas, probably arising from differential resourcing or idiosyncratic clinical practice. CONCLUSIONS: A website providing data on the various indicators has been provided and its uses are indicated.

Adolescent↗
PubMed2005

Gunshot suicides in England--a multicentre study based on coroners' records.

BACKGROUND: Gunshot suicides account for 2.5% of suicides in England and Wales. This amounts to more than 100 deaths per year. Information about such deaths may assist in the development of suicide prevention strategies. METHOD: We have examined coroners' inquest records for all gunshot suicides between 1st January 2000 and 31st December 2001 in 24 coroners' jurisdictions in England. RESULTS: Fifty-eight gunshot suicides were identified, including one homicide-suicide. Ninety-three per cent of cases were male. Sport or occupational usage was the main reason for owning the gun. Ten per cent were farmers or farm-workers. In 20% of cases the gun did not belong to the individual who used it for suicide. This was more likely in younger suicides. Seven (12.1%) individuals used illegally owned handguns. Large amounts of alcohol had been consumed before the act in nine cases. Nearly three-quarters (72.9%) of individuals with diagnostic information had a probable diagnosis of depression. However, only 22.4% had ever had contact with psychiatric services. Two shotgun certificate holders were under the care of psychiatric services at the time of their death and two others had a history of previous self-harm. CONCLUSIONS: Strategies to reduce the number of gunshot suicides need to focus on limiting access to guns. These include restricting access to guns by non-certificate holders and those who may be at increased risk of suicide, and holding regular gun amnesties.

Adolescent↗
PubMed2005

A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England.

Expressed emotion (EE) research has been productive in investigating the influence of the interpersonal environment on a range of disorders. The majority of EE research on the influence of carers has been carried out in the west. This is the first EE study of the carers of people with dementia in Japan. The aim of this study was to investigate the relationships between EE status and aspect of burden through cross-cultural comparison of the two countries, Japan and England, with large cultural and linguistic differences. Comparisons were made between samples of EE of carers of dementia and schizophrenic patients. In total, data on 80 carer/relative-patient dyads were collected and examined: (1) 20 Japanese carers of people with dementia (JD), (2) 20 English carers of patients with Alzheimer's disease (ED), (3) 20 Japanese relatives of patients with schizophrenia (JS), and (4) 20 English relatives of patients with schizophrenia (ES). The Camberwell Family Interview was administered in each country to ascertain levels of EE. Large differences between Japan and England were found in the frequency of critical comments, in which ES>ED>JS>JD. EE correlated significantly with burden in the JD sample alone. With an operational cut-off of 2CC (CC, critical comments), EE correlated significantly with cognitive impairment as well as with clinical severity in the JD sample. There was a tendency for lower expression of both positive and negative emotional reactions towards family members in the Japanese sample. The results of this study indicate that EE is an appropriate measure for use with carers of sufferers of dementia and can be utilized across different cultures. However, flexibility with the cut-offs may be required in Eastern cultures. This needs to be tested on larger samples with sensitivity to illness and cross-cultural differences.

Adolescent↗
PubMed2000

Method availability and the prevention of suicide--a re-analysis of secular trends in England and Wales 1950-1975.

BACKGROUND: In England and Wales in the 1960s there were marked declines in suicide rates. These reductions were partly attributable to the detoxification of the domestic gas supplies; however, their extent varied by age and gender, with the most striking effects seen in older men. The objective of this study was to investigate method-specific trends in suicide between 1950 and 1975 to elucidate possible explanations for the patterns seen in different demographic groups. METHODS: An analysis of age-standardised method-specific suicide rates for England and Wales between 1950 and 1975 was carried out using routinely available mortality and population statistics. RESULTS: As has previously been shown, there were marked reductions in suicides by gassing in men and women of all ages between 1960 and 1975. In women and younger men, the effects of these reductions on overall suicide rates were partially offset by rises in drug overdose deaths (method substitution), but there were no immediate increases in the use of other suicide methods. In contrast, in older men, reductions in suicide by gassing were accompanied by only a slight increase in overdose suicides as well as reductions in rates of suicide using all other methods. The modest rise in overdose fatalities in older men occurred despite the fact that they were more often prescribed barbiturates and tricyclic antidepressants than younger men. CONCLUSIONS: Accessibility to and the lethality of particular methods of suicide may have profound effects on overall suicide rates. Such effects appear to depend upon the popularity of the method and the extent to which alternative methods that are acceptable to the individual are available. Social and psychological interpretations of fluctuations in suicide rates should only be made after assessing the possible contribution to these of changes in method availability and lethality.

Adolescent↗
PubMed2003

External validation of the SAPS II, APACHE II and APACHE III prognostic models in South England: a multicentre study.

OBJECTIVE: External validation of three prognostic models in adult intensive care patients in South England. DESIGN. Prospective cohort study. SETTING: Seventeen intensive care units (ICU) in the South West Thames Region in South England. PATIENTS AND PARTICIPANTS: Data of 16646 patients were analysed. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: We compared directly the predictive accuracy of three prognostic models (SAPS II, APACHE II and III), using formal tests of calibration and discrimination. The external validation showed a similar pattern for all three models tested: good discrimination, but imperfect calibration. The areas under the receiver operating characteristics (ROC) curves, used to test discrimination, were 0.835 and 0.867 for APACHE II and III, and 0.852 for the SAPS II model. Model calibration was assessed by Lemeshow-Hosmer C-statistics and was Chi(2 )=232.1 for APACHE II, Chi(2 )=443.3 for APACHE III and Chi(2 )=287.5 for SAPS II. CONCLUSIONS: Disparity in case mix, a higher prevalence of outcome events and important unmeasured patient mix factors are possible sources for the decay of the models' predictive accuracy in our population. The lack of generalisability of standard prognostic models requires their validation and re-calibration before they can be applied with confidence to new populations. Customisation of existing models may become an important strategy to obtain authentic information on disease severity, which is a prerequisite for reliably measuring and comparing the quality and cost of intensive care.

APACHE↗
PubMed2004

Safety profile of raloxifene as used in general practice in England: results of a prescription-event monitoring study.

Raloxifene, a selective estrogen receptor modulator (SERM) licensed for the prevention of non-traumatic vertebral fractures in postmenopausal women at increased risk of osteoporosis, was launched in the UK in August 1998. The aim of the study was to monitor the safety of raloxifene prescribed in the primary care setting in England using prescription-event monitoring (PEM). Patients were identified by means of prescription data supplied by the Prescription Pricing Authority between September 1998 and November 2000. Demographic and clinical event data were collected from questionnaires posted to primary care physicians (GPs) at least 6 months after the date of the first prescription for each patient. Information on medical events, suspected adverse drug reactions (ADRs), reasons for stopping treatment, pregnancies, and causes of death was requested. Event rates [Incidence Densities (IDs): no. first reports /1000 patient-months of treatment] were calculated. Differences between IDs for events reported in month one (ID(1)) and months 2-6 (ID(2-6)) of treatment were examined. The cohort comprised 13,987 patients [median age 62 years (IQR 55,69); 99.8% female]. The major indication was osteoporosis (40.9%, n=5725). Flushing was the event with the highest ID in month 1 (22.8), reported most frequently by GPs as an ADR to raloxifene (67/461 reports) and as the reason for stopping (700/4592 reports). Events associated with starting treatment included flushing, malaise/lassitude, headache/migraine, nausea/vomiting, sweating, cramp, pain abdomen, dizziness, diarrhea, mastalgia and vaginal hemorrhage. Less common events reported during treatment included deep vein thrombosis (n=13), pulmonary embolism (n=13), thrombophlebitis (n=31) and visual disturbance (n=29). In this study, there were 122 (0.9%) confirmed deaths, of which 32 causes of death were unknown. This study shows that raloxifene is generally well tolerated when used in general practice in England. Potential signals of unrecognised ADRs requiring further evaluation included gastrointestinal adverse symptoms and vaginal hemorrhage. There were also a small number of reports of events associated with venous thromboembolism and visual disorders that require further investigation.

Adverse Drug Reaction Reporting Systems↗
PubMed2001

Evaluation of the safety of fexofenadine from experience gained in general practice use in England in 1997.

BACKGROUND: Fexofenadine is the active metabolite of the non-sedating anti-histamine terfenadine. Pre-licensing clinical trials in over 6000 patients suggested it was effective and well tolerated. OBJECTIVE: To assess the tolerability and safety of fexofenadine immediately after its availability on the UK market in March 1997. METHODS: Post-marketing non-interventional observational cohort study using the methodology of prescription-event monitoring. Exposure data derived from dispensed prescription details supplied in confidence by the Prescription Pricing Authority. Outcome data derived from questionnaires returned by general practitioners (GPs) in England between March and August 1997. RESULTS: Of the 35,817 questionnaires sent, 18,238 (50.9%) were returned, of which 16,638 contained useful data. These included 40% male (mean age 36+/-19 years) and 59% female (mean age 39+/-19 years). Most common indications were allergic rhinitis (55%), not specified (28%), urticaria, pruritus or rash (10%) and other indications (7%). There were 40 reports of adverse drug reactions in 27 patients. Less than 2% of patients stopped the drug because of side effects. Events reported after exposure to fexofenadine were uncommon and already reported in clinical trials. There were eight reports of possible cardiac side effects (palpitations, three; chest pain, three; arrhythmia, one; and chest tightness, one). None was felt to be serious. There were no drug interactions reported. None of the 30 deaths was related to fexofenadine. None of the three adverse outcomes from the 47 pregnancies reported was related to fexofenadine. CONCLUSION: Within the limitations for an observational cohort study, fexofenadine was found to be well tolerated and safe in 16,638 users in general practice in England.

Adult↗
PubMed2001

Environmental temperatures and the incidence of food poisoning in England and Wales.

The incidence of food poisoning in England and Wales has been increasing for many years and it is now a major public health problem. Superimposed on this general rising trend is a well-established tendency for the number of cases of food poisoning to rise during the summer when warm weather favours the multiplication of pathogenic micro-organisms. This paper shows that weekly notifications of food poisoning in England and Wales are strongly associated with environmental temperatures, but that there are some important time lags in this relationship. The number of cases of food poisoning in a given week was only weakly correlated with the temperature of that week and the one preceding it. This suggests that factors operating close to the point of consumption within or outside the home are not the principal cause of the rise in food poisoning associated with warm summer conditions. There was a much stronger association with temperatures 2-5 weeks earlier, pointing to the importance of factors operating earlier in the food production or distribution system. The results of this study suggest that the food poisoning problem requires action by food producers and distributors as well as by consumers.

England↗
PubMed2006

Safety profile of repaglinide as used in general practice in England: results of a prescription-event monitoring study.

Repaglinide is a prandial glucose regulator indicated for management of type 2 diabetes. This post-marketing study used the observational cohort technique of prescription-event monitoring (PEM) to monitor safety of repaglinide prescribed in primary care in England. Patients were identified from dispensed prescriptions issued by general practitioners (GPs) between December 1998 and January 2001. Demographic and clinical event data were collected from questionnaires posted to GPs at least six months after the date of first prescription for each patient. The cohort consisted of 5731 patients [median age 60 (IQR 51-68), 49.9% male]. Event incidence densities (IDs) [no. 1st reports/1000 patient-months of exposure] were calculated for all events reported. The most frequently recorded clinical events in the first month were diarrhoea (ID(1) 10.3), malaise/lassitude (ID(1) 8.1) and nausea/vomiting (ID(1) 7.9). The most frequently reported reason for stopping was 'not effective' (647), with the most common clinical reasons being diarrhoea (60), malaise/lassitude (55) and intolerance (54). One hundred and thirteen adverse drug reactions (ADRs) were reported, with the most frequently specified being diarrhoea (10), abdominal pain (10) and nausea/vomiting (9). We concluded that repaglinide is generally well tolerated when used in general practice in England and did not identify any serious unrecognised adverse events.

Aged↗
PubMed2000

National survey of hepatitis testing and vaccination services provided by drug services in England and Wales.

Since viral hepatitis among intravenous drug users continues to be a major cause of morbidity and mortality, the present study was conducted to survey drug agencies in England and Wales in order to identify the prevalence of hepatitis B and C testing and vaccination being provided. A postal survey of all 539 drug agencies in England and Wales was thus conducted to assess their current treatment provisions and practices. An analysis of the responses provided by the 373 agencies that returned usable data (69.2% response rate) revealed that only one-quarter (26.6%) of the drug agencies conducted routine hepatitis B testing, and 26.9% did not offer it at all. Just over half (55.7%) of the agencies provided hepatitis B vaccination, but only 21.7% did so routinely. Seventy percent provided hepatitis C testing, but only 24% did so routinely. Nevertheless, the majority of respondents, of whom 40.3% were nurses and 25.1% drug workers, believed that clients and their partners should be offered hepatitis B and C screening. The paucity of hepatitis testing and vaccination services being offered to injecting drug users is unacceptable, with users, their partners and children being needlessly exposed to continued risk. The disparity between recommended policy and current practice needs to be urgently addressed.

Delivery of Health Care↗