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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↗

PubMed1989

Human papillomavirus type 31 infection of the uterine cervix in England.

A total of 452 uterine cervical scrapes, from two centres in England, has been examined by dot blot hybridisation for the presence of human papilloma virus (HPV) types 6, 11, 16, 18 and 31. HPV DNA was found in 36.5% samples. Twenty-nine of the women were infected with more than one type. Of those with detectable HPV, 14.5% had HPV type 31 infections. This type appears to cause significant infection of the genital tract in England.

Cervix Uteri↗

PubMed1997

Postnatal depression in Japanese women who have given birth in England.

A total of 98 Japanese mothers who became pregnant in England were monitored from 36 weeks gestation to 3 months postpartum. Psychiatric status was assessed by self-report, using a Japanese translation of the Edinburgh Postnatal Depression Scale (EPDS) and by an interview with Japanese psychiatrists, using Japanese translations of the Schedule for Affective Disorders and Schizophrenia (SADS) and Research Diagnostic Criteria (RDC). Rates of depression were similar to those observed in Japanese women having babies in Japan. Twelve mothers (12%) were categorised as having new onsets of depression (six major and six minor depressive disorder) during the 3 months following delivery. Depression was associated with having had a stressful life event or obstetric but without grandmothers' support-depressed and non-depressed women were equally likely to have had their mothers visit England to attend the delivery. Women who became depressed had significantly higher EPDS scores at 1 month postpartum than those who remained well. However, depressions were not detected when the EPDS was used as a screening instrument. With an EPDS cut-off of greater than 12, the criterion used in western samples, sensitivity was zero. Lowering the criterion to improve the instrument's sensitivity merely reduced its specificity. These results suggest that Japanese women may be less likely to express depressive symptoms by self-report, at least when instruments designed for western samples are used.

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↗

PubMed2003

Influenza vaccine uptake in the elderly: results from a rapid assessment of the effectiveness of new government policy in England for the winters 2000/2001 and 2001/2002.

Immunisation against influenza is an important means of reducing morbidity and mortality amongst high-risk groups, and especially the elderly. Although immunisation has been recommended for these groups for many years, no timely or comprehensive monitoring at the national level was carried out in England before the beginning of this century. Annual numbers of doses administered were available, but not to whom they were given. This paper describes the results of a national rapid reporting scheme for England that was introduced by the Department of Health (DH) and PHLS Communicable Disease Surveillance Centre (CDSC). The scheme collected monthly data on influenza immunisation uptake among people aged 65 or more during the winters of 2000/2001 and 2001/2002. Results showed that DH annual targets of 60 and 65%, respectively were both met, although considerable variation occurred at the local levels. The feasibility of this method of monitoring immunisation uptake in the elderly is discussed.

Aged↗

PubMed2003

The impact of the establishment of a midwife managed unit on women in a rural setting in England.

OBJECTIVE: to determine what impact the changes from consultant-led care to midwife-led care in a local maternity service have had on women using that service. DESIGN: case study, data were collected by postal questionnaire, semi-structured, tape-recorded interviews, observations and scrutiny of records. SETTING: a small town in rural England. PARTICIPANTS: all pregnant women eligible for a midwife-managed unit (MMU) birth in a small rural town in England. FINDINGS: the women using the MMU were satisfied with the care they received and the MMU style of care. Women giving birth at the MMU and at home required less pain relief and were more likely to have an intact perineum than a similar group of women giving birth in hospital. Continuity of carer did not appear to be an issue for women as long as they felt supported by a known team of midwives. Transfer for complications during the birthing process was a cause for anxiety and stress for women and their partners. Women, whilst satisfied with the MMU, would prefer the consultant-led maternity hospital to be re-established in the town. The home-birth rate rose by 28% when the consultant unit closed. IMPLICATIONS FOR PRACTICE: while the establishment of a midwife-managed unit has provided increased choice for a minority of women, the removal of the consultant unit in the town has disadvantaged the majority of pregnant women. While guidelines are needed when establishing these units the application of restrictive inclusion and exclusion criteria can sometimes force women to make less appropriate birth choices.

Analgesia, Obstetrical↗

PubMed2003

A national survey in England of the routine examination of the newborn baby.

OBJECTIVE: To identify current practices for the initial routine examination of healthy newborn babies, and determine the extent to which midwives are carrying out this examination. DESIGN AND PARTICIPANTS: Postal questionnaires were sent to consultant paediatricians and midwifery managers in all maternity units in England. Questionnaires were also sent to the 12 universities in England which run the N96 post-registration course in the examination of the newborn baby. FINDINGS: Questionnaires were returned from 197 (86%) maternity units. Senior house officers examined in 83% (160/193) a median of 92% of babies; 44% (74/167) had at least one midwife (median of two) with qualifications to carry out the examination and in 31% (51/167) some examinations were conducted by a midwife. However, a third of midwives with this qualification carried out no examinations, and nationally only about 2% of babies were examined by a midwife. Rates of referral by midwives and senior house officers were similar. Examinations were carried out between four and 48 hours from birth; most units considered six hours an acceptable minimum. An estimated 1% of babies were transferred home without routine examination; the GP was responsible for most (83-93%) of these babies' examinations; midwives for 10-23%; and senior house officers in hospital for 4-7%. Twelve per cent (23/194) of units carried out a second examination prior to discharge. Most respondents were in favour of midwives carrying out the examinations provided they were adequately trained. CONCLUSIONS: Many of the consultant paediatricians and midwifery managers stated that suitably trained midwives could routinely examine the healthy newborn baby; however, many currently N96 trained midwives were examining few or no babies. An extension of training would be needed were midwife examination to become general policy.

Anecdotes as Topic↗

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↗

PubMed1999

The effect on morbidity of variability in deprivation and population stability in England and Wales: an investigation at small-area level.

We seek to determine whether variability in deprivation at small area level, and population stability, influence standardised morbidity ratios in England and Wales. A regression analysis was conducted with data from the 1991 British Census, in order to explain variation in morbidity. Both an area deprivation score (for electoral wards) and the within-area variability of deprivation scores were examined as possible determinants of morbidity (self-reported, limiting, long-term illness). Particular attention was focused on a spatially-sensitive measure of the variability of deprivation scores within a wider 'locality'. There was a significant, positive relationship between age-standardised limiting, long-term illness and deprivation. The variation in area deprivation scores within the small areas themselves was also significant and positive. However, the variation in deprivation scores calculated for both an electoral ward and its contiguous neighbours (the locality) was slightly more significant. Areas with higher relative levels of in-migration also had significantly lower standardised morbidity ratios. Multivariate models showed that the deprivation score, the variation in deprivation scores for the broader locality, and the measure of migration, were all significant in combination. Residual analysis showed that many areas in London had lower levels of morbidity than expected, while electoral wards in the coal mining valleys of South Wales had higher levels than expected. We conclude that, for small areas (wards) in England and Wales, morbidity is related to deprivation, variation in deprivation within and surrounding each area, and the proportion of the population that are migrants. Variations in deprivation influence standardised morbidity rates, and policies which widen inequalities will influence health outcomes. Resource allocation based simply on measures of deprivation, which ignore population change within the area and variations in deprivation in the locality, may be inefficient.

Censuses↗

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↗

PubMed2003

Recent trends in prostate cancer incidence and mortality in southeast England.

OBJECTIVE: To investigate recent trends in prostate cancer incidence and mortality, with particular reference to changes in diagnostic techniques and treatment. METHODS: The Thames Cancer Registry was used to identify all men, resident in SE England, diagnosed with prostate cancer between 1990 and 1999. Information regarding prostate cancer mortality was obtained from the Office of National Statistics. Other data sources were used to ascertain the number of transurethral resections of the prostate (TURP) and open prostatectomies performed in SE England, and the number of prescriptions issued for the treatment of benign prostatic hyperplasia (BPH). RESULTS: There was a steady increase in the age-standardised incidence of prostate cancer from 1990, which then began to plateau in 1996. The increase was entirely restricted to localised tumours; non-localised tumours showed a slight downward trend over this period. Age-standardised mortality rates have remained constant, with a slight fall in 1997 corresponding to the decline in incidence rates. Medical treatment for BPH has increased, with a corresponding reduction in the number of TURPs. CONCLUSION: The change in occurrence of prostate cancer is entirely due to changes in the incidence of localised cases. Incidence of non-localised cases and mortality remained almost constant. The increasing tendency in incidence of localised prostate cancer is likely to be principally due to increased detection, through increased use of prostate-specific antigen (PSA) testing followed by radical resections of the prostate. The aggregate effect of PSA testing and medical treatment of BPH is a stabilisation in the incidence level of localised cases in recent years.

Adenocarcinoma↗

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↗

PubMed1999

Survey of knowledge of simple pulmonary function tests (PFTs) amongst trainee doctors in England.

The understanding of and interpretation skills for simple pulmonary function tests (PFTs) are increasingly required in the everyday practice of medicine. This knowledge was evaluated amongst the trainee hospital doctors in the north-east of England. Three-hundred questionnaire sets were sent in the post to the relevant junior doctors working in the north-east of England and sixty-nine completed sets were returned: a raw response rate of 23% and a corrected response rate of 27%. There were deficits in knowledge and confidence in most tests except for those which were most commonly used, and this was noted across the different grades of junior doctors. The respondents were aware of the deficiency and most would like further teaching and input during their hospital career. An appropriate plan for improvement should be formulated and implemented.

Clinical Competence↗

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↗

PubMed2003

Repair of post-infarct ventricular septal defect with or without coronary artery bypass grafting in the northwest of England: a 5-year multi-institutional experience.

OBJECTIVE: To present the 5-year experience of the northwest of England's surgical repair of post myocardial infarction (MI) ventricular septal defects (VSD). Our primary aim was to evaluate the effect of concomitant coronary artery bypass grafting (CABG) on mid-term survival and also to identify prognostic indicators. METHODS: A multi-centre regional observational study involving clinical data from 65 consecutive patients who underwent post MI VSD repair in the northwest of England between April 1997 and March 2002. Both prospective and retrospective collection of preoperative, operative and postoperative information was performed. Patient follow-up was performed by linking their records to the National Strategic Tracing Service database. Multivariate logistic regression and Cox proportional hazards analyses were used to identify independent risk factors for poor prognosis. RESULTS: Of the 65 patients included in the study, 42 (64.6%) underwent concomitant CABG with a median of two grafts. The majority of patients who had their coronary arteries grafted had multivessel disease (92.9%). Overall 30-day mortality was 23.1%. Predictors of poor prognosis included preoperative inotropes (P<0.001) and total occlusion of infarct related artery (P=0.03). The crude hazard ratio (HR) of mid-term mortality for concomitant CABG patients was 0.82 [95% confidence interval (CI) 0.38-1.78; P=0.62]. After adjustment for differences in patient and disease characteristics, the adjusted HR of mid-term mortality for concomitant CABG patients was 0.17 (95% CI 0.04-0.74; P=0.019). The adjusted freedom from death in the concomitant CABG patients at 30 days, 1, 2, and 4 years was 96.2%, 91.6%, 88.8%, and 82.8%, respectively, compared with 79.1%, 58.8%, 49.1%, and 32.2% for the non-concomitant CABG patients. CONCLUSION: These data provide evidence that concomitant CABG is significantly beneficial to mid-term mortality rates. We recommend that patients who present with post MI VSD who have multivessel disease should be routinely revascularised.

Aged↗

PubMed1998

Geographical change in residential care provision for the elderly in England, 1988-93.

This paper offers an investigation of the spatial consequences of changes in the structural organization of residential care in England between 1988 and 1993. Data from various government publications were analysed using descriptive and spatial statistical methods. While the study period witnessed an overall levelling of residential care growth, the independent (i.e. private and voluntary) sector's share of all elderly residents in England increased from 56% to 73%. At both national and intra-regional scales, the structural changes resulted in an increasing geographical concentration of public sector residents and a moderate trend towards a more uniform spatial distribution of private residents.

Aged↗