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PubMed1999

Mortality, long-term illness and deprivation in rural and metropolitan wards of England and Wales.

The relationships between mortality, limiting long-term illness and indicators of social deprivation were investigated using regression analysis on data for rural wards, metropolitan wards and the remaining wards in England and Wales. Regional differences were controlled. In rural wards, people had better health than average and slightly better health than would be expected from their deprivation scores. Average levels of health in rural areas were only weakly related to deprivation, which was partly but not fully due to the restricted range of average deprivation values in rural wards. In metropolitan areas, relatively poor levels of health were largely explained by social deprivation, but people in Inner London were healthier than might be expected from measures of deprivation. The relationship between health and social deprivation is therefore not uniform over England and Wales, but varies between geographical types of area. One consequence is that resource allocation on the basis of social deprivation would put the populations of rural areas and Inner London at an advantage.

Adolescent↗

PubMed1971

Multiple sclerosis distribution in England and Wales and parts of Europe.

Scotland and Ireland have the highest death rates from multiple sclerosis and high rates are recorded in an area extending south-eastward from Britain through central Europe. The rates tend to diminish with rising latitude and longitude. In England and Wales the county boroughs with notably high rates during 1958-67 were mostly textile towns with cotton and wool mills, situated in the area recording the lowest average levels of sunshine. In the London area mortality from multiple sclerosis was high in those western boroughs and adjacent counties most exposed to the noise of aircraft using the airports of London. The geographical pattern in England suggests that noise and vibration of particular kinds may be a factor in causation along with a climatic factor, but this hypothesis is speculative until further evidence is found to support it.

Adolescent↗

PubMed1986

The epidemiology of hydatid disease in England and Wales.

The epidemiology of hydatid disease in man in England and Wales, based on the data collected between 1981 and 1983 at the Hydatid Reference Laboratory of the Public Health Laboratory Service, is presented. The incidence of hydatid disease was 42 cases per annum, with 2 cases per million population occurring in Wales and 0.2 per million in England. The highest prevalence was in London amongst the immigrant population. The incidence in the indigenous population was 15.5 cases per annum, with 5.6 cases per million occurring in South Powys, parts of South Wales and Herefordshire. The population most at risk is the rural, farming community in that area, but the West Midlands is also an apparent focus of the disease.

Adolescent↗

PubMed1984

Distribution of immunity to pertussis in the population of England and Wales.

This paper presents three different methods of estimating the number and age distribution of individuals susceptible to pertussis in England and Wales. The first approach is an extrapolation from data in the prevaccine era, the second is based upon theoretical consideration of the transmission dynamics of pertussis, and the third is a detailed cohort analysis of available notification and vaccination data. Each of these analyses suggests that the total number of people susceptible to pertussis infection in England and Wales has remained at 3-4 million for the past 40 years, despite the increase and changes in numbers vaccinated. The effect of vaccination has been to reduce the incidence of infection and disease, but not to reduce the number of susceptibles. These findings, which are consistent with 'mass action theory', could be tested by an appropriately designed seroepidemiological survey.

Adolescent↗

PubMed2006

Parental satisfaction with health services provided to children with Down syndrome in north-west England: an ENT perspective.

AIMS: To evaluate parents' satisfaction with medical and allied health services provided to children with Down syndrome in north-west England, comparing ENT and its allied services with other areas of health service provision. METHODS: A questionnaire survey of parents attending a north-west England Down syndrome association conference. Demographic data, departments visited, satisfaction with each service (scored one to five), waiting times for each service (scored one to five), service need (scored one to three) and accessibility (scored one to three) were recorded. RESULTS: Otolaryngology had been used by 50 per cent of children, with a satisfaction of 2.63 (the second worst score). Speech and language therapy was used by 90 per cent of the children, with a satisfaction of 3.26 (the worst score). The service felt to be most needed and also most difficult to access was speech and language therapy. CONCLUSION: Otorhinolaryngology departments should assess how they can improve their service to this population with specific ENT needs. Speech and language services for children with Down syndrome should be expanded.

Adolescent↗

PubMed1981

Psychological symptom levels in Indian immigrants to England--a comparison with native English.

A national community survey of psychological symptom levels among samples of Indian immigrants and natives is reported. Using a quasi-random sampling procedure, a sample of 200 Indian-born residents of large towns in England was selected to match the age and sex structure of the total Indian immigrant population. An indigenous population, selected in the same way, was matched with the immigrants for comparison purposes. Psychological disturbance was measured with the Langner 22-Item Scale which has previously been specifically validated for use in this context. Other indices were constructed to test specific hypotheses. The pattern revealed by mental hospital admission statistics was strongly supported by the survey. Indian immigrants as a group experience far less psychological disorder than natives, despite the experiences of migration and of being an immigrant. On other measures Indians also manifested an adjustment superior to that of natives. Among the Indian sample stable psychological adjustment was related to being young at migration, being acculturated to life in England and being socially integrated. A subgroup of higher social status, Indian females who had been upwardly socially mobile, emerged as the only group with a higher than average symptom level. However, even this group was at least as well adjusted as its English counterpart.

Acculturation↗

PubMed2001

Changes in rates of suicide by car exhaust asphyxiation in England and Wales.

BACKGROUND: Self-asphyxiation using car exhaust gas is a common method of suicide in England and Wales, particularly in young males. The introduction of catalytic converters has reduced the toxicity of car exhausts. The main aims of the study were: to seek evidence of a fall in car exhaust suicides in the general population and in age and gender groups; to relate any fall to changes in car exhaust systems, particularly since legislation on car exhaust emissions in 1993; and to examine rates of suicide by other methods for evidence of method substitution. METHODS: Population study in England and Wales using national suicide statistics for 1987 to 1998. RESULTS: There was a fall in suicide by car exhaust asphyxiation in all age and gender groups. This change was most marked after 1993. The overall population suicide rate (all methods) also fell but there was no overall change in suicides by young males or females. In these groups suicide by hanging increased. CONCLUSIONS: Legislation on catalytic converters appears to have contributed to a fall in car exhaust suicides. However, the effect on overall suicide rates in young people has been reduced by method substitution.

Adolescent↗

PubMed2004

Common mental disorders and ethnicity in England: the EMPIRIC study.

BACKGROUND: There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview. METHOD: Cross-sectional survey of 4281 adults aged 16-74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview. RESULTS: Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2.09, 95% CI 1.16-2.95, p = 0.02] and Pakistani (adjusted RR 2.38, 95 % CI 1.25-3.53, p = 0.02) men aged 35-54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55-74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples. CONCLUSIONS: Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation.

Adolescent↗

PubMed2005

Racism, psychosis and common mental disorder among ethnic minority groups in England.

BACKGROUND: The aim of this study was to explore the relationship between risk of psychosis, common mental disorder (CMD) and indicators of racism among ethnic minority groups in England and how this relationship may vary by particular ethnic groups. METHOD: A multivariate analysis was carried out of quantitative, cross-sectional data from a nationally representative community sample of people aged between 16 and 74 years from the largest ethnic minority groups in England: those of Caribbean, Indian, Pakistani, Bangladeshi and Irish origin. RESULTS: Experience of interpersonal racism and perceiving racism in the wider society each have independent effects on the risk of CMD and psychosis, after controlling for the effects of gender, age and socio-economic status. There was some variation in the findings when they were conducted for separate ethnic and gender groups. CONCLUSIONS: An understanding of the relationship between racism and mental health may go some way towards explaining the ethnic variations found in both CMD and, particularly, psychosis.

Adolescent↗

PubMed1998

Cognitive function and dementia in six areas of England and Wales: the distribution of MMSE and prevalence of GMS organicity level in the MRC CFA Study. The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).

BACKGROUND: This two-stage prevalence survey involved geographically delimited areas, four urban (Liverpool, Newcastle, Nottingham and Oxford) and two rural (Cambridgeshire and Gwynedd), including institutions. METHODS: Stratified random population samples of people in their 65th year and above, from Family Health Service Authorities were studied. The sample was stratified (65-74 years and > or = 75) to provide equal numbers. In Liverpool equal numbers in 5 year age groups were taken. After an initial screening interview, approximately 20% were selected on the basis of age, AGECAT organicity confidence level and MMSE score to proceed to a detailed assessment interview from which the full AGECAT organicity confidence level could be derived. RESULTS: Major influences on MMSE were confirmed as age, sex, social class and educational level. Estimates of prevalence of AGECAT O3 and above for each centre and the entire sample according to age are given, based on 1991 Census population structure, and suggest that around half a million (543,400) people in England and Wales would be defined as case level by this method. The five centres employing the same methodology showed no heterogeneity in prevalence. CONCLUSIONS: Prevalence of cognitive impairment and dementia appear not to vary widely across the centres examined in this study, which provides stable estimates by age and sex for AGECAT O3 and above, and norms for MMSE. Using these estimates as an indication of the size of the population affected, around 550,000 individuals in England and Wales would be expected to be suffering from dementia of mild or greater severity.

Age Distribution↗

PubMed1999

Partners in life and in death: the suicide pact in England and Wales 1988-1992.

BACKGROUND: We describe the epidemiology of suicide pacts in England and Wales and assess the health, circumstances and motivation of those who died in pacts; the first such account for 35 years. METHODS: We have analysed the death certificates, coroners' records and medical notes of all people who died in suicide pacts in England and Wales between 1 January 1988 and 31 December 1992. RESULTS: The 124 suicides in 62 pacts accounted for 0.6% of all suicides giving a rate of 0.6 per million. The average age was 56 years. Poisoning by car exhaust or medicines caused 95% of deaths, both members of each pair using the same method. Forty-eight pacts were between married couples, five between blood relatives. Mental disorder was present in half and medical illness in one-third. Motives were avoiding loss of a partner from ill-health in 26 pacts, euthanasia in nine, thwarted love in four. CONCLUSIONS: The findings are similar to those of 35 years ago except the incidence of pacts is less. Improved management of illness might avoid some pacts especially when partners in an enduring, affectionate relationship, with few social ties, are both ill.

Adolescent↗

PubMed1997

Total hip replacement. The preoperative health status of patients in Japan compared with England and the United States.

To explore the contribution of health care to the excellent health status enjoyed by the Japanese compared with other industrialized populations, the preoperative health status of a retrospective cohort of 256 patients who underwent total hip replacement in Japan was compared with 301 patients in England (and published data from the United States). Patients in Japan had less severe hip disease, less comorbidity (in particular, less cardiovascular disease), and were in better general health. This finding suggests that health care contributes little to explaining the better health of people in Japan compared with England and the United States.

Activities of Daily Living↗

PubMed1998

Outcome of total hip replacement in Japan and England. Comparison of two retrospective cohorts.

Two retrospective cohorts of patients who had undergone a primary total hip replacement (THR) were studied in Japan and England. We analyzed information from hospital case notes and self-administered questionnaires. THR was highly effective in both countries, with significant improvements in morbidity and health status. There were, however, important differences in clinical management and outcome. Japanese patients were more likely to be treated under regional anesthesia by means of an anterior/anterolateral incision, to be transfused, to have a prosthesis implanted without cement, and to stay longer in the hospital. A higher rate of serious in-hospital complications occurred in England, mostly due to the high frequency of hypotension. The incidences of minor complications were consistent with known differences in risks between the two countries. The persistent postoperative perception of limping reported by the English patients was unexpected.

Aged↗

PubMed2003

Comparison of apparent efficiency of haemodialysis satellite units in England and Wales using data envelopment analysis.

OBJECTIVES: To expand care for chronic haemodialysis (HD) patients throughout England and Wales by studying two aspects of service delivery that are important: to identify relative performance of haemodialysis satellite units (HDSUs), and understand the factors that influence the performance. As a first step toward these aspects, this work reports a study of apparent comparative efficiency in the delivery of HDSUs and demonstrates the potential of data envelopment analysis (DEA). METHODS: DEA was applied to data obtained from a national survey of the organizational structures and processes of delivering care at HDSUs in England and Wales. RESULTS: DEA was found to be a judicious approach for performance assessment of HDSUs, although valid results depend on appropriate model specification and quality of data available. The available data were not of sufficient comprehensiveness or quality to produce definitive results but suggested that overall efficiency could improve; these data suggested by as much as 10% overall (mean efficiency score 90%) and variably within the sample (46 [65%] that HDSUs were potentially inefficient, the lowest unit scoring 38%). CONCLUSIONS: Addressing questions raised by comparative inefficiency could help plans to improve capacity to deal with the growing demand for HD delivered in HDSUs. The application was an important start and needs to be followed by further research to establish model validity and obtain authoritative results.

Ambulatory Care Facilities↗

PubMed2004

Health technology assessment in England and Wales.

In this study, we describe the current state of the Health Technology Assessment (HTA) system in England and Wales. This system rests on a distinction between assessment and appraisal and has three main strands: researcher-led HTA, the research and development program, and the HTA-NICE (National Institute for Clinical Excellence) process. We outline the pressures for HTA and how it has evolved in the British National Health Service. We discuss how HTA priorities are chosen, how HTA information is collected and assessed, how HTA evidence is used, and we make some observations about its impact. In our discussion, we consider some limitations of the HTA system, its possible divergence from evidence-based health care, its centralization, and some of the key challenges for managing HTA-driven policy. But we remain hopeful that HTA can contribute to better and more explicit decision-making within England and Wales.

England↗

PubMed2004

Diffusion of thrombolysis for acute myocardial infarction from 1981 to 2000 in England: trend analysis and comparison with need.

OBJECTIVES: To describe the adoption and take up of thrombolytic agents for acute myocardial infarction since 1980 in England and compare use with the estimated ceiling of need. METHODS: Data on national sales and use of thrombolysis since 1980 (supplied by IMS Health) was used to draw an adoption and diffusion curve. The epidemiological ceiling of acute myocardial infarction, from hospital activity statistics, was modified to an estimated clinical need by accounting for diagnostic difficulty and contraindications using information from published surveys of thrombolysis use in the United Kingdom. RESULTS: There was a rapid uptake of thrombolytic agents in the first 2 years after availability in 1987, then a plateau, followed by a rise to a peak use in 1995. The shortfall in doses resulting from the difference between estimated ceiling of clinical need and doses purchased and provided in the 14 years since availability is estimated as 167,800 (95 percent confidence range 94,000 to 241,700). CONCLUSIONS: Although there was a rapid initial uptake of thrombolysis in England, usage took 8 years to reach the ceiling of clinical need of 65 percent of patients with acute myocardial infarction, with many patients missing the opportunity to benefit. Monitoring of uptake of innovations known to be cost-effective is required to identify those developments that need additional stimulus for change to ensure that patients do not miss out on the opportunity to benefit.

Diffusion of Innovation↗

PubMed1992

An outbreak of Salmonella dublin infection in England and Wales associated with a soft unpasteurized cows' milk cheese.

An outbreak of Salmonella dublin infection occurred in England and Wales in October to December 1989. Forty-two people were affected, mainly adults, and most lived in south-east England. Microbiological and epidemiological investigations implicated an imported Irish soft unpasteurized cows' milk cheese as the vehicle of infection. A case-control study showed a statistically significant association between infection and consumption of the suspect cheese (p = 0.001). Salmonella dublin was subsequently isolated from cheeses obtained from the manufacturer's premises. Initial control measures included the withdrawal of the cheese from retail sale and a Food Hazard Warning to Environmental Health Departments, as well as a press release, from the Department of Health. Subsequently, a decision was taken by the manufacturer to pasteurize milk used in the production of cheese for the UK market and importation of the cheese resumed in June 1990.

Adolescent↗

PubMed1995

Predicting the impact of measles vaccination in England and Wales: model validation and analysis of policy options.

Measles incidence in England and Wales has fallen to an all-time low. Attention is now focused on preventing local outbreaks, and, in the long run, on the elimination of indigenous measles. A realistic age-structured (RAS) mathematical model of measles transmission is used to reconstruct the impact of measles vaccination in England and Wales from 1968 to the present and to evaluate the merits of future policy options. In general, the predictions of the model show good agreement with long-term age stratified case reports and seroprevalence surveys. The model underestimates the proportion of cases that are notified in 0-2-year-old children. However, recent work suggests a high degree of misdiagnosis in this age group. Projections on the basis of the existing vaccination strategy in the UK suggest that the present level of measles vaccine coverage will be insufficient to eliminate small seasonal outbreaks of measles. This result is, however, sensitive to the assumed level of vaccine efficacy. Explorations of a variety of changes to current vaccination strategy favour a 2-dose schedule with the second dose administered at age 4 years irrespective of vaccination history. A vaccination campaign in school-age children, to reduce deficits in herd immunity, would accelerate progress towards measles elimination.

Adolescent↗