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PubMed2004

Recent trends in diagnoses of HIV and other sexually transmitted infections in England and Wales among men who have sex with men.

OBJECTIVES: To examine trends in rates of diagnoses of HIV and other sexually transmitted infections (STIs) in men who have sex with men (MSM) in England and Wales between 1997 and 2002. METHODS: Estimates of the MSM population living in England and Wales, London and the rest of England and Wales were applied to surveillance data, providing rates of diagnoses of HIV and STIs and age group specific rates for HIV and uncomplicated gonorrhoea. RESULTS: Between 1997 and 2002, rates of diagnoses of HIV and acute STIs in MSM increased substantially. Rates in London were higher than elsewhere. Rises in acute STIs were similar throughout England and Wales, except for uncomplicated gonorrhoea and infectious syphilis, with greater increases outside London. Rates of gonorrhoea diagnoses doubled between 1999 and 2001 (661/100,000, 1271/100,000, p<0.001) in England and Wales followed by a slight decline to 1210/100,000 (p=0.03) in 2002-primarily the result of a decline in diagnoses among men aged 25-34 (1340/100,000, 1128/100,000, p<0.001) and 35-44 (924/100,000, 863/100,000, p=0.03) in London. HIV was the third most common STI diagnosed in MSM in England and Wales and the second in London, with the highest rate (1286/100,000) found among men aged 35-44 in London in 2002. CONCLUSIONS: Rates of diagnosis of HIV and other STIs have increased substantially among MSM in England and Wales. Increases show heterogeneity by infection, geography, and age over time. Rates in London were twice those seen elsewhere, with greatest changes over time. The observed changes reflect concomitant increases in high risk behaviour documented in behavioural surveillance survey programmes.

Adolescent↗
PubMed2005

The dental caries experience of 5-year-old children in England and Wales (2003/4) and in Scotland (2002/3). Surveys co-ordinated by the British Association for the Study of Community Dentistry.

OBJECTIVE: This paper reports the results of standardized clinical caries examinations of 5 year old children from across England and Wales in 2003/4 and Scotland in 2002/3. These co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating strategic health authorities (SHAs), primary care trusts (PCTs) and health boards (HBs). Caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. Data for Jersey and the Isle of Man are also included. RESULTS: The results again demonstrated a wide variation in disease prevalence and care strategies across Great Britain. Mean values for d3mft within the current English Strategic Health Authorities ranged from 0.47 in Maidstone Weald (South) to 3.69 in North Kirklees (North); in Wales mean values ranged from 1.48 in Flintshire (NW) to 3.73 in Merthyr (SE); while in Scotland they ranged from 1.29 in Borders to 3.67 in Argyll & Clyde. Mean d3mft across England was 1.49 (d3t = 1.12, mt = 0.19, ft = 0.18), across Wales it was 2.42 (d3t = 1.70, mt = 0.43, ft = 0.29) and across Scotland values were 2.76 (d3t = 1.87, mt = 0.65, ft = 0.24). Overall, 39.6% of children in England & Wales and 55.4% of children inspected in Scotland had evidence of caries experience in dentine (d3mft > 0, including visual dentine caries). The distribution of caries was highly skewed. Thus the mean caries experience for those with dentinal decay in England and Wales was 3.90, as opposed to the overall mean of 1.55; in Scotland the corresponding values were 4.98 and 2.76. Trends over time demonstrate virtually no change in the overall mean d3mft for England and Wales since 2001/2, although the mean value for those with dentine decay experience increased marginally from 3.83 to 3.90. In Scotland there had been deterioration in the overall mean (2.76 as compared to the 2.55 reported in 1999). The care index has also fallen (for example in England & Wales to 12% from 13.2% in 2001/2002 and 14.3% in 1999/2000). CONCLUSION: There has been no overall improvement in the dental health of 5 year old children over the last 2 years. Geographic variation in oral health is marked at both the local and national levels. Overall, the provision of operative care for those with dentinal decay has again decreased slightly. While many children enjoy good oral health, sizable groups remain within the population of 5 year old children who have a clinically significant burden of preventable dental disease.

Child, Preschool↗
PubMed1993

Thyroid cancer epidemiology in England and Wales: time trends and geographical distribution.

Thyroid cancer incidence has been increasing in many countries, whereas mortality has been falling due to better survival. Radiation is the best-established risk factor and there has been concern that recent rises in incidence might be related to fallout radiation from atmospheric nuclear weapon tests. We examined thyroid cancer time trends and geographical distribution in England and Wales and possible interpretations of these. During 1962-84, there were significant increases in incidence (P < 0.001) in each sex at ages under 45. Cohort analysis by single year of birth showed an overall increase in incidence risks in women aged 0-44 born since 1920, with a sudden rise in risk for the birth years 1952-55 followed by a lower risk for the more recent cohorts. In men, there was an overall increase in risk at ages 0-44 in successive birth cohorts, but the pattern was irregular. In each sex, the risk in persons aged 45 and over decreased slightly in successive generations. Geographically, highest incidence risks were in countries in North and Mid Wales, in which the risk was almost twice that in the rest of the country. This pattern was present only at ages 45 and over and was most clear in rural areas. The peak of thyroid cancer risk in women born in 1952-55 is consistent with a carcinogenic effect of fallout radiation, since these women were children in the late 1950s and early 1960s when fallout radiation was greatest in England and Wales. The focus of high thyroid cancer risks in Wales was in areas with high levels of fallout radiation. However, thyroid cancer risks in Wales were not high for more recent cohorts (the ones who were exposed to fallout early in life), and a focus on high risk of benign thyroid diseases was present in Wales well before nuclear weapons existed. The distributions of these benign thyroid diseases, or of factors causing them, seem more likely than fallout to explain the high risk areas for thyroid cancer in the country.

Adolescent↗
PubMed2005

Radiopharmaceutical maladministrations in New South Wales.

BACKGROUND: Errors in medicine are being increasingly highlighted. There is potential for harm in nuclear medicine. AIM: To evaluate the frequency, type, causes and adverse effects of nuclear medicine radiopharmaceutical maladministrations reported to the New South Wales Environment Protection Authority. METHODS: We reviewed reports received by the New South Wales Environment Protection Authority over a 5-year period. The number and type of maladministrations, contributing factors and any adverse effects were recorded. Comparison was made with the total number of medicare-paid diagnostic and therapeutic nuclear medicine services undertaken in New South Wales for the same period. RESULTS: Fifty-seven maladministrations were reported to the New South Wales Environment Protection Authority. There were 666 179 nuclear medicine procedures recorded in New South Wales for the same period. Of the 57 reported maladministrations, the majority (n=34; 61%) were a result of incorrect radiopharmaceutical dispensing. Incorrect reading of labels attached to the syringe (n=8; 14%) and incorrect patient identification (n=7; 12%) accounted for most of the rest of the accidents. Most (n=48; 84%) involved 99mTc-based radiopharmaceuticals for diagnostic use, with three cases involving I for therapeutic use. In 96% of cases - those which involved diagnostic radiopharmaceuticals - there were no immediate adverse clinical outcomes. However, one subject developed unintended hypothyroidism as a result of the maladministration of 131I for therapy. CONCLUSION: Nuclear medicine maladministrations in New South Wales are uncommon, with approximately 8-9 incidents per 100 000 procedures. Most maladministrations are the consequence of incorrect radiopharmaceutical dispensing. All those which involved diagnostic radiopharmaceuticals resulted in no immediate adverse effects from the radiation exposure.

Adverse Drug Reaction Reporting Systems↗
PubMed1997

Surgical treatment of breast cancer in New South Wales 1991, 1992.

BACKGROUND: The purpose of this study was to examine existing data on women diagnosed with breast cancer in New South Wales in 1991 and 1992 and to describe surgical treatments received on an inpatient basis. METHODS: Analyses were based on the linkage of two databases: the New South Wales Central Cancer Registry and the New South Wales Health Department's Inpatient Statistics Collection. Data were limited to women who were resident and treated in New South Wales. Main analyses were restricted to definitive surgical procedures. RESULTS: Thirty-six per cent of women treated surgically for breast cancer in 1991 had breast-conserving therapy. This had increased to 39% in 1992. There were substantial geographical variations in the use of breast-conserving therapy in New South Wales which could not be explained by patient characteristics. Age, degree of spread at diagnosis, and area health service/ health region were all found to have an independent association with the probability of having a mastectomy. CONCLUSIONS: Women with a localized degree of spread living in non-metropolitan areas (Health Regions) were almost twice as likely to have a mastectomy as compared with similar women who were resident in metropolitan areas (Area Health Services). The concentration of radiotherapy services may have contributed to the urban/rural variation in breast-conserving therapy in New South Wales, but it is also likely that some of the variations that were observed may be a reflection of the failure of clinicians to use best current practice.

Adult↗
PubMed1998

Excess mortality in England and Wales, and in Greater London, during the 1995 heatwave.

STUDY OBJECTIVE: To assess the impact on mortality of the heatwave in England and Wales during July and August 1995 and to describe any difference in mortality impact between the Greater London urban population and the national population. DESIGN: Analysis of variation in daily mortality in England and Wales and in Greater London during a five day heatwave in July and August 1995, by age, sex, and cause. SETTING: England and Wales, and Greater London. MAIN RESULTS: An estimated 619 extra deaths (8.9% increase, approximate 95% confidence interval 6.4, 11.3%) were observed during this heatwave in England and Wales, relative to the expected number of deaths based on the 31-day moving average for that period. Excess deaths were apparent in all age groups, most noticeably in women and for deaths from respiratory and cerebrovascular disease. Using published daily mortality risk coefficients for air pollutants in London, it was estimated that up to 62% of the excess mortality in England and Wales during the heatwave may be attributable to concurrent increases in air pollution. In Greater London itself, where daytime temperatures were higher (and with lesser falls at night), mortality increased by 16.1% during the heatwave. Using the same risk coefficients to estimate the excess mortality apparently attributable to air pollution, more than 60% of the total excess in London was apparently attributable to the effects of heat. CONCLUSION: Analysis of this episode shows that exceptionally high temperatures in England and Wales, though rare, do cause increases in daily mortality.

Adolescent↗
PubMed1975

Maternal deaths in Australia compared with England and Wales from 1967 to 1969.

A comparison of the main causes of maternal death in Australia and in England and Wales over the same three-year period from 1967 to 1969 was undertaken, based on the trienneal reports from the two countires. In this triennium the maternal mortality rates (maternal deaths due to pregnancy and childbirth and not including associated maternal deaths) of the two countries were very similar, that of Australia being 0.23 per 1,000 and that of England and Wales being 0.21 per 1,000. These figures include death due to abortion, and both show an improvement from the previous triennium. Comparison of the figures still reveals higher death rates from haemorrhage, pulmonary embolism and preeclampsia in Australia than in England and Wales, but this is largely balanced by the higher death rate from abortion in England and Wales. In 1972 Neil and Townsend compared the first report on maternal deaths in the Commonwealth of Australia with the fifth report on maternal deaths in England and Wales, covering the triennium 1964 to 1966. The purpose of this article is to compare the reports on the triennium 1967 to 1969 (Beischer et alii, 1972); Report on Confidential Enquiries into Maternal Deaths in England and Wales, 1967-1969) and to comment on the improvements which have occurred in this triennium.

Abortion, Illegal↗
PubMedDate not supplied

Homelessness--on the health agenda in Wales?

Building a sustainable and inclusive future for Wales is at the heart of the constitution of the National Assembly for Wales, which means forging a crosscutting approach to social policy. Improving health is a strategic priority within this agenda, and homelessness and housing appear to be at the center of the Assembly Government's vision of developing sustainable and cohesive communities and promoting social inclusion. This article considers the links between homelessness and mental and physical ill health and the importance of combating homelessness and poor housing within the health agenda in Wales. The article cites the links between homelessness and health identified in the United Kingdom and in international research and highlights the growth in homelessness witnessed during the late 1990s and beginning of the 21st Century. The paper considers the significant increase of homelessness and assesses whether, in reality, sufficient practical measures are being taken to combat homelessness as a means of tackling ill health in Wales. The authors conclude that although Wales is making progress toward an integrated approach to health and well-being and that the need to tackle broader health determinants has gained recognition, investment in effectively tackling homelessness and exclusion is needed. Integrating the broader housing, homelessness, and health agendas could contribute to health gains in Wales.

Health Policy↗
PubMed1995

Increasing concentrations of nitrogen dioxide pollution in rural Wales.

Monitoring of nitrogen dioxide pollution was carried out in rural environments throughout Wales during a 1-year survey to quantify any changes in background concentrations and distribution of the pollutant since an earlier survey in 1986. There were 23 sites in the present survey of which 16 had been monitored during the 1986 survey. The remaining 7 sites were based on moorland in mid-Wales within map squares for which critical loads for soil acidification are expected to be exceeded by the year 2005. All sites were chosen so as to be remote from major local sources of NO(2) and the values obtained were deemed to be minimum concentrations for the different regions. Measurements were made using diffusion tubes which aimed to provide mean concentrations of NO(2) for 2-week exposure periods. Concentrations of NO(2) were found to be higher in the winter months for most sites and this is probably related to a greater use of fossil fuels for heating buildings at this time of year. The exception was the high concentrations of NO(2) in May and June for several sites in North Wales, and in July and August for a site on Mount Snowdon. These high summer concentrations in North Wales are thought to be related to increased traffic associated with tourism. It is apparent that there has been a substantial increase in rural concentrations of NO(2) throughout Wales since the earlier survey of 1986. As an average of all 16 sites used in both surveys, there was a 53% increase in the annual mean concentration of NO(2). Also, it is evident that, since 1986, there has been a substantial increase in the area of south-eastern Wales which has a background level in excess of 10 ppb NO(2) and a notable reduction in land area with concentrations below 6 ppb NO(2) as an annual mean concentration. The possible future impact of increasing rural concentrations of NO(2) on Welsh vegetation is discussed with references to estimates of critical levels of NO(2) for adverse effects on plants.

Journal Article↗
PubMed2004

Is NHS dentistry in crisis? 'Traffic light' maps of dentists distribution in England and Wales.

BACKGROUND: 'Traffic light' (red-yellow-green) maps are potentially powerful tools for 'at a glance' problem detection, for optimising resource allocation/reallocation, setting priorities, and targeting interventions to areas most in need. The maps can be also used for administrative area comparisons and performance monitoring over time. Interactive Web versions of the maps can be generated with many handy features to further empower organisations and decision makers. Methodological issues to consider when creating 'traffic light' maps include hue thresholding, data timeliness and stability of administrative boundaries. RESULTS: We used 'traffic light' maps to study the distribution of dentists per 1,000 population in all 304 English Primary Care Trusts (PCTs) and 22 Welsh Local Health Boards (LHBs) using datasets of dentist numbers per PCT (as at 31 December 2002) and LHB (as at 26 February 2004) from the Dental Practice Board, and 2001 Census population figures for PCTs and LHBs from the Office for National Statistics. The overall NHS dentists per 1,000 population figures for England (0.374) and Wales (0.359) are low compared to many other countries, with less than 0.3 dentist per 1,000 people available to 24.1% of the total population of England (81 PCTs or 26.6% of all PCTs) and 26.1% of the total population of Wales (6 LHBs or 27.3% of all LHBs). A general shortage of NHS dentists can be observed at a glance across England and Wales on all the 'traffic light' maps in our study, even on those using a more "tolerant" classification and an additional orange-yellow class. The distribution of NHS dentists in England and Wales was also found to be not uniform, with some PCTs/LHBs, especially those located in some of the deprived or less populated urban and rural communities, suffering significantly more shortage of dentists than others (see http://healthcybermap.org/PCT/dentists/). These results confirm recent media reports of a shortage of NHS dentists in various parts of England and Wales. CONCLUSION: Suitable programmes are urgently needed to increase the numbers of NHS dentists across England and Wales. We have included a set of recommendations to dental health policymakers and planners, in addition to ideas for further work.

Journal Article↗
PubMed2002

The dental caries experience of 12-year-old children in England and Wales. Surveys coordinated by the British Association for the Study of Community Dentistry in 2000/2001.

DESIGN: This paper reports the results of standardised clinical caries examinations of 106,694 twelve-year-old children from England, Wales, the Isle of Man and Jersey. These 2000/01 coordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards, and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: Once again a wide variation in caries prevalence across the United Kingdom was demonstrated, with mean values for D3MFT for the English 'regions' (of the National Health Service) and Wales ranging from 0.63 in the West Midlands to 1.31 in Wales. The mean value for DMFT across England Wales was 0.89 (D3T=0.39, MT=0.07, FT=0.43). Overall, 38% of children had evidence of caries experience at the dentinal level of detection (D3MFT>0), although the means ranged between 30% (West Midlands) and 51% (Wales). The mean D3MFT for those with disease at this threshold was 2.35. Trends over time demonstrate an improvement of 11% in overall D3MFT since 1996/97, compared to the 15% seen over the previous four year period. FT and care index fell. The number of fillings provided in 2000/01 and thus the care index, remained low. On average across England and Wales, only 48% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual districts: 30% to 78%). The use of the SiC index highlights dental health inequalities. CONCLUSION: Taken together, these findings demonstrate the continuing need for more effective preventive strategies and treatment services for this important age group.

Child↗
PubMed2005

New cases of diabetes mellitus in England and Wales, 1994-1998: database study.

OBJECTIVE: The objective of this study was to estimate the annual rate of diagnosis of new cases of diabetes mellitus in England and Wales, and the number of new cases in each year. STUDY DESIGN: Cohort study. METHOD: Analysis of electronic patient records from the General Practice Research Database, using 208 general practices with a total list size of 1.3 million patients. RESULTS: We estimate that the national rate of diagnosis of new cases of diabetes in England and Wales was 17.5 [95% confidence intervals (CI) 16.6--18.4] per 10,000 person-years in 1994 and 22.1 (95%CI 21.2--23.0) per 10,000 person-years in 1998. We estimate that there were 87,642 new cases of diabetes mellitus in England and Wales in 1994 and 111,345 in 1998. CONCLUSIONS: We estimate that the rate at which new cases of diabetes were diagnosed rose by about 26% in England and Wales from 1994 to 1998. This conclusion was unchanged when we took account of the ageing of the national populations between the beginning and end of the study period. We estimate that the number of new cases of diabetes diagnosed each year in England and Wales also increased by one-quarter over the same period. If the number of cases and the rate at which they are diagnosed continues to increase, this will need to be considered by those planning services for people with diabetes.

Adolescent↗
PubMed1999

All Wales surveillance of methicillin-resistant Staphylococcus aureus (MRSA): the first year's results.

Over the last five years, hospitals in Wales have experienced difficulties with increasing numbers of isolates of methicillin-resistant Staphylococcus aureus (MRSA). Continuous total population surveillance of MRSA was introduced with the objectives of gaining an understanding of the extent and variation in time and place of its occurrence, the burden of disease and possible risk factors associated with its isolation and resistance to other antibiotics. All first isolates of MRSA from both hospital and community settings and all isolates of methicillin-sensitive Staphylococcus aureus (MSSA) associated with bacteraemia and cerebrospinal fluid (CSF) isolates detected in medical microbiology laboratories in Wales were collected via CoSurv, a set of interconnected data-base modules for communicable disease control. A data set was collected on each isolate and the patient associated with that isolate and compiled centrally at CDSC (Wales) for all-Wales analysis of the MRSA situation. Surveillance started in January 1996 and at the end of the first year, 2700 new isolates of MRSA had been reported from hospital and community settings, giving a rate of 92.43/100,000 population. The incidence of MRSA from bacteraemias and CSF was 5.20/100,000 compared with 12.70/100,000 for MSSA. MRSA from bacteraemia and CSF was significantly more commonly associated with male patients than MSSA. MRSA patients were significantly older. For all MRSA isolates, the highest reporting rate was in men aged 75+ (647.21/100,000). The highest incidence of invasive disease was also in men aged 75+ (45.69/100,000). Isolates from post-surgical patients were more likely to be involved in invasive disease (OR = 2.59), P < 0.001) than strains from other sources. The majority of isolates were resistant to at least two antibiotics in addition to methicillin, most frequently erythromycin and the fluoroquinolones. Very little resistance to fusidic acid, mupirocin or rifampicin was reported. Continuous total population surveillance has provided a minimum incidence of MRSA in Wales and has allowed a simple and intelligible picture of the problem to be determined, which has been fed back to hospitals to assist decisions on control.

Adolescent↗
PubMed2005

Presentation and frequency of catatonia in new admissions to two acute psychiatric admission units in India and Wales.

BACKGROUND: There are no modern cross-cultural comparative studies of the frequency and clinical presentation of catatonia in a Western country and India using standardized rating instruments and diagnostic criteria. METHOD: A total of 104 consecutively admitted patients in Wales and in India were screened for catatonic features using the same standardized rating instrument by the same psychiatrist to generate DSM-IV and other diagnostic criteria for catatonia, and a profile of signs in catatonia. Inter-rater reliability for the ratings made by the research psychiatrist was established with local psychiatrists at each unit. RESULTS: The frequency of DSM-IV criteria catatonia was 13.5% in India versus 9.6% in Wales ( N . S .). The severity of catatonia did not differ between the two units. However, retarded catatonia was more common in India (12.5%) versus Wales ( p <0.05) whereas the frequency of excited catatonia was equally common in both units. Catatonia was found in many different mental disorders not just schizophrenia and affective disorder. CONCLUSIONS: Catatonia is commonly found among psychiatric in-patients with a similar frequency and severity but differing clinical presentations in Wales and India. Some classic signs of catatonia like posturing, catalepsy, staring and stupor were more frequent among psychiatric admissions in India than Wales. The differing clinical presentations may be due to differences in demographic features rather than cultural or aetiological factors.

Catatonia↗
PubMed1987

The changing incidence of human hydatid disease in England and Wales.

The incidence of hospital-diagnosed human hydatid disease acquired in the UK was estimated from a survey based on Hospital Activity Analysis data for the period 1974-83. The average annual incidence in Wales was 0.4 per 100,000 population compared with 0.02 per 100,000 in England. Within Wales, Powys, and particularly Brecknock, had the highest incidence (7 per 100,000 per year). Compared with the period 1953-62, the average annual incidence for Wales fell by half (from 0.8 to 0.4 per 100,000 per year), but in Powys the incidence did not decline, and in Brecknock and Montgomery there was a marginal increase. In comparison with 1953-62, the age-specific incidence in Wales and Powys decreased in each age group with the notable exception of children less than 15 years of age. This finding emphasizes that transmission of Echinococcus granulosus to humans is still occurring at hyper-endemic levels in parts of England and Wales and that control efforts should be intensified.

Adolescent↗
PubMed1979

Cancer mortality in 1970-1972 among Polish-born migrants to England and Wales.

The 1970-72 cancer mortality of Polish migrants to England and Wales is compared with the cancer mortality prevailing in England and Wales and in Poland. Small numbers limit the analyses to the most frequent cancer sites only. The main findings are: (a) Compared with mortality rates in both their country of birth and of adoption, Polish migrants displayed intermediate values for cancers of the stomach, intestinal tract, and lung. For age-groups over 74 years, lung-cancer mortality among the migrants appears, however, to be higher than in both Poland and England and Wales. (b) A distinctly higher mortality among Polish migrants than either in Poland or England and Wales was apparent for lymphomas in both sexes, and for leukaemia and oesophageal cancer in males. (c) Female breast-cancer mortality among Polish migrants was much higher than in Poland, being close to the high mortality rates prevailing in England and Wales. The present findings are compared with the results of similar studies of Polish migrants to the United States and Australia and reasons for observed differences are advanced.

Adult↗
PubMed2005

Third molar treatment outcome: a comparison of patients' preferences in Sweden and Wales.

AIM: To elucidate and compare patients' outcome preferences for removal and retention of mandibular third molars in Sweden and Wales. SUBJECTS AND METHOD: The subjects comprised patients referred and scheduled for removal of one or both mandibular third molars in Sweden and Wales. The multi-attribute utility (MAU) methodology was applied to study patients' preferences for outcomes of removal and retention of the mandibular third molar. RESULTS: Relative weighting of domains was similar in the two countries. "Home and social life" received the highest relative weighting in Sweden and "general health and wellbeing" in Wales. "Your appearance" received the lowest relative weighting in both countries. In both Sweden and Wales operative jaw fracture was considered to be the outcome with most impact, and dentigerous cyst and imbricated incisors the least impact. Outcome ranking was similar in both countries and operative outcomes were considered by patients to be more detrimental to health than retention outcomes. CONCLUSIONS: This comparison showed that patients' preferences in Sweden and Wales were similar and that the outcomes of surgery were considered worse after third molar removal than retention. Patient-orientated treatment decisions were less subject to variation than clinician-orientated decisions.

Adolescent↗
PubMed1998

Congenital hypothyroidism in Wales (1982-1993): demographic features, clinical presentation and effects on early neurodevelopment.

OBJECTIVE: Neonatal screening for congenital hypothyroidism (CH) was introduced in Wales in 1982. The aim of the study was to evaluate the demographic features and characteristics of infants identified during the first 12 years of screening and their neurodevelopmental progress in the first 2 years of life. DESIGN: Prospective collection of biochemical and clinical data (including results of Griffiths Mental Development Scales) obtained from questionnaires sent to paediatricians responsible for the ongoing clinical care of children with CH. PATIENTS: In Wales, between 1982 and 1993, 136 infants with primary congenital hypothyroidism (CH) were identified by the neonatal screening programme. RESULTS: Of all new-borns, 99.8% were screened and the prevalence of CH was 1 in 3279 (1 in 2473 girls and 1 in 4770 boys). The prevalence of CH was increased in North Wales. CH was associated with increased birth weight (48.5% of infants weighed greater than 3.5 kg) and an increased prevalence of non-thyroidal congenital abnormalities (8%) and congenital heart disease (3%). Isotope scanning demonstrated an increased prevalence of normal or enlarged thyroid glands and fewer ectopic glands compared to those reported in other studies. The mean developmental quotients (DQs) for individual subsets of intellectual and behavioural functioning in children with CH aged 1 and 2 years were all above 100 (range: 103.5-111.9). In subjects with absent thyroids, these DQs were correlated with the serum concentrations of free thyroxine before treatment. CONCLUSIONS: The demographic features of infants with congenital hypothyroidism born in Wales are similar to those reported from other European studies although there are marked regional variations in prevalence within Wales for which there is no apparent explanation. The median age of starting therapy was 17 days and compares favourably with other screening programmes. The overall mental development of Welsh children aged 1 and 2 years with congenital hypothyroidism identified by neonatal screening is satisfactory.

Congenital Abnormalities↗