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PubMed2006

Leading causes of certification for blindness and partial sight in England & Wales.

BACKGROUND: Prevention of visual impairment is an international priority agreed at the World Health Assembly of 2002--yet many countries lack contemporary data about incidence and causes from which priorities for prevention, treatment and management can be identified. METHODS: Registration as blind or partially-sighted in England and Wales is voluntary and is initiated by certification by a consultant ophthalmologist. From all certificates completed during the year April 1999 to March 2000, the main cause of visual loss was ascertained where possible and here we present information on the leading causes observed and comment on changes in the three leading causes since the last analysis conducted for 1990-1991 data. RESULTS: 13,788 people were certified as blind, 19107 were certified as partially sighted. The majority of certifications were in the older age groups. The most commonly recorded main cause of certifications for both blindness (57.2 %) and partial sight (56 %) was degeneration of the macula and posterior pole which largely comprises age-related macular degeneration. Glaucoma and diabetic retinopathy were the next most commonly recorded main causes. Overall, the age specific incidence of all three leading causes has increased since 1990-1991--with changes in diabetic retinopathy being the most marked--particularly in the over 65's where figures have more than doubled. CONCLUSION: The numbers of individuals per 100,000 population being certified blind or partially sighted due to the three leading causes--AMD, diabetic retinopathy and glaucoma have increased since 1990. This may to some extent be explained by improved ascertainment. The process of registration for severe visual impairment in England and Wales is currently undergoing review. Efforts must be made to ensure that routine collection of data on causes of severe visual impairment is continued, particularly in this age of improved technology, to allow such trends to be monitored and changes in policy to be informed.

Adolescent↗
PubMed2006

The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database.

INTRODUCTION: To evaluate the impact of recent evidence-based treatments for severe sepsis in routine clinical care requires an understanding of the underlying epidemiology, particularly with regard to trends over time. We interrogated a high quality clinical database to examine trends in the incidence and mortality of severe sepsis over a nine-year period. METHODS: Admissions with severe sepsis occurring at any time within 24 hours of admission to critical care were identified to an established methodology using raw physiological data from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database, containing data from 343,860 admissions to 172 adult, general critical care units in England, Wales and Northern Ireland between December 1995 and January 2005. Generalised linear models were used to assess changes in the incidence, case mix, outcomes and activity of these admissions. RESULTS: In total, 92,672 admissions (27.0%) were identified as having severe sepsis in the first 24 hours following admission. The percentage of admissions with severe sepsis during the first 24 hours rose from 23.5% in 1996 to 28.7% in 2004. This represents an increase from an estimated 18,500 to 31,000 admissions to all 240 adult, general critical care units in England, Wales and Northern Ireland. Hospital mortality for admissions with severe sepsis decreased from 48.3% in 1996 to 44.7% in 2004, but the total number of deaths increased from an estimated 9,000 to 14,000. The treated incidence of severe sepsis per 100,000 population rose from 46 in 1996 to 66 in 2003, with the associated number of hospital deaths per 100,000 population rising from 23 to 30. CONCLUSION: The population incidence of critical care admission with severe sepsis during the first 24 hours and associated hospital deaths are increasing. These baseline data provide essential information to those wishing to evaluate the introduction of the Surviving Sepsis Campaign care bundles in UK hospitals.

Databases, Factual↗
PubMed2001

Regional variations in stroke care in England, Wales and Northern Ireland: results from the National Sentinel Audit of Stroke. Royal College of Physicians Intercollegiate Stroke Working Party.

STUDY OBJECTIVE: To identify the variations between regions in England, Wales and Northern Ireland in the case-mix, organization and process of care for stroke. DESIGN: Retrospective audit of case notes and service organization. SETTING: Two hundred and ten Trust sites from 197 Trusts in 10 Health Regions in England, Wales and Northern Ireland. PATIENTS: The 6894 consecutive stroke patients admitted between 1 January and 31 March 1998 (up to 40 per Trust). Audit tool: The Intercollegiate Stroke Audit. RESULTS: There are significant differences in stroke care between regions that cannot be explained by known case-mix or clinical variables. The proportion of patients spending more than half their hospital stay in stroke unit care varied between regions from 10% to 27%. Thirty-day mortality in different regions ranged between 21% and 33%. Institutionalization rates for those admitted from home varied between 6% and 19%. Similar variations existed in discharge disability and length of stay. CONCLUSIONS: There were widespread variations in specialist service provision for stroke in different regions. Regional variation in 30-day mortality and in institutionalization after stroke is not explained by clinical factors and therefore may represent different local health care policies and expectations.

Aged↗
PubMed1975

A further investigation of differences in the suicide rates of England and Wales and of Scotland.

National samples of case records of suicidal-type deaths from England and Wales and from Scotland were reassessed by officials in the other country. It emerged that similar criteria for suicide existed in both countries, and that there was no age-related tendency to misclassify cases. The lower official suicide rate amongst the old in Scotland was therefore considered not to result from ascertainment differences. It was also concluded that Scottish records were not so briefly documented as to prevent the conclusive ascertainment of cause by England and Wales coroners. Cases which were designated 'undetermined' in Scotland tended to be classified 'accidental' by coroners. Reasons for the lower incidence of suicide in Scotland are discussed.

Adolescent↗
PubMed1990

Suicide in England and Wales and in Scotland. An examination of divergent trends.

The suicide rates in England and Wales and Scotland converged during the late 1960s, and from 1970 were higher in Scotland. The convergence occurred because of differences in the falls in rates of those aged over 45 years and not because of differences in frequency and decline of coal gas suicide. Male suicide increased more rapidly in Scotland during the 1970s. In England and Wales overall female suicide rates fell during 1958-76 whereas in Scotland there was no clear trend. Suicide by car exhaust increased similarly in both countries, but that by hanging and drug poisoning increased more rapidly in Scotland.

Adolescent↗
PubMed1996

Suicides by burning in England and Wales.

BACKGROUND: The aim was to examine suicides by burning (SBB) occurring in England and Wales. METHOD: The method was a retrospective case note examination of death certificates, coroners inquest notes and GP notes for all SBBs registered in 1991 by OPCS in England and Wales, and an examination of SBB statistics from 1979-1992. RESULTS: In 24% of cases the incident involved others either as intended or actual victims or as witnesses, and three distinct groups (Asian-born women, schizophrenics, and homicide-suicides) were over-represented. The majority were not in contact with current psychiatric services, and 43% had never had contact with psychiatric services. There was no trend in SBB compared to other suicides in 1979-1992. CONCLUSIONS: While SBB may be associated with Asian-born women, homicide-suicide and schizophrenia, the majority of cases did not have these characteristics, and the overall psychiatric contact rate was similar to suicide by unspecified means.

Adult↗
PubMed2000

Effect of death of Diana, princess of Wales on suicide and deliberate self-harm.

BACKGROUND: The death of the Princess of Wales in 1997 was followed by widespread public mourning. Such major events may influence suicidal behaviour. AIMS: To assess the impact of the Princess's death on suicide and deliberate self-harm (DSH). METHOD: Analysis, using Poisson regression, of the number of suicides and open verdicts ('suicides') in England and Wales following the Princess's death compared to the 3 months beforehand, and the equivalent periods in 1992-1996. Similar analysis on DSH presentations to a general hospital. RESULTS: Suicides increased during the month following the Princess's funeral (+17.4%). This was particularly marked in females (+33.7%), especially those aged 25-44 years (+45.1%). Suicides did not fall in the week between the death and the funeral. Presentations for DSH increased significantly during the week following the death (+44.3%), especially in females (+65.1%). Examination of case notes suggested that the influence of the death was largely through amplification of personal losses or exacerbation of existing distress. CONCLUSIONS: The death of a major public figure can influence rates of suicidal behaviour. For DSH, the impact may be immediate, but for suicide it may be delayed.

Adolescent↗
PubMed2001

Suicide in children and adolescents in England and Wales 1970-1998.

BACKGROUND: Suicide rates for England and Wales have been decreasing recently, but rates for young adult males remain high. AIMS: To review changes in suicide rates for children and adolescents in England and Wales between 1970 and 1998. METHOD: Rates for suicide, 'accidental' death by causes similar to suicide and 'undetermined' death for 10-14- and 15-19-year-olds are calculated between 1970 and 1998 using suicide data and estimated mid-year populations obtained from the Office for National Statistics. RESULTS: There has been a substantial increase in suicide rate between the 1970s and the 1990s for males aged 15-19 years. This remains true even when 'undetermined' and 'accidental' death rates for causes similar to suicide are examined. The increase was associated with an increase in self-poisoning with vehicle exhaust gas in the 1980s and an increase in hanging which has continued into the 1990s. Although there was a slight decrease in the official suicide rate for females aged 15-19 years, 'undetermined' deaths increased. There is no indication of a major change in suicide rate in 10-14-year-olds. CONCLUSIONS: The substantial increase in suicide rate in 15-19-year-old males may indicate increased psychosocial stress, particularly affecting this group.

Accidents↗
PubMed2005

Mental health inequalities in Wales, UK: multi-level investigation of the effect of area deprivation.

BACKGROUND: Geographical variation in the prevalence of common mental disorders has not been explained adequately. AIMS: To investigate whether regional mental health differences in Wales would persist after having taken into account the characteristics of individuals and regional social deprivation. METHOD: Data from the 1998 Welsh Health Survey were used. Common mental disorders were assessed with the mental health index included in the Short-Form 36 health survey (SF-36). The data were analysed using a multi-level linear regression model. RESULTS: Of the total variance in the mental health index, 1.47% occurred at regional level (95% CI 0.56-2.38). Adjustment for individual characteristics did not explain the between-region variation. A higher area deprivation score was associated with a higher score on the mental health index. CONCLUSIONS: Mental health differences in Wales are partly explained by the level of regional social deprivation.

Adolescent↗
PubMed2000

National assessment of PID diagnosis, treatment and management in general practice: England and Wales.

A questionnaire based audit was used to evaluate the diagnosis and management of suspected pelvic inflammatory disease (PID) cases by general practitioners (GPs) in England and Wales. Responses were compared against a clinical management 'gold standard' devised by an independent group of GPs and specialists. Two hundred and ninety-seven (38%) of the 781 questionnaires were returned. Only 21 (7%) had all 'gold standard' sections correct. Diagnostic quality was significantly higher when the clinician was female compared with male (odds ratio [OR]=2.34; 95% confidence limits [CL]=1.19-4.63) and diagnostic quality increased with increasing socioeconomic deprivation. This is the first evaluation of the diagnosis and management of PID by GPs in England and Wales. The unusually poor response rate to a Medical Research Council General Practice Research Framework (MRC GPRF) study may reflect low disease awareness and sub-optimal management. This represents a fundamental obstacle to effective intervention and surveillance. Effective intervention will only be possible if diagnostic practice and management are improved substantially.

England↗
PubMed2003

Continued high-risk sexual behaviour among HIV-positive people in Wales.

The study objective was to investigate self-reported sexual practices among HIV-positive people in Wales in order to estimate the extent of unprotected sex and to develop services that assist positive people reduce the risk of sexual spread of HIV. A cross-sectional postal questionnaire survey was conducted between February and July 1999 at all open-access HIV outpatient facilities in Wales. All HIV-positive people attending during the study period were invited to enroll in the study. Data were obtained on 104/141 (74%) enrolled patients including 70 (67%) homo/bisexual men. Most (79/104, 76%) were sexually active and 42% (33/79) had casual partners. One in six (13/79, 16.5%) sexually active people reported unprotected high-risk sex with HIV-negative or unknown status partners, the majority (9/13, 69%) of whom were male homosexuals. It is important that health professionals specifically address issues of sexual behaviour with HIV positive people during consultation. A renewed safer sex campaign targeting men who have sex with men is urgently needed.

Adult↗
PubMed1999

Usefulness of information from the unlinked anonymous prevalence monitoring programme for HIV in England and Wales: survey of planners of HIV/AIDS services.

The aim of this study was to evaluate whether information from the Unlinked Anonymous Prevalence Monitoring Programme for HIV in England and Wales is useful to planners of HIV/AIDS services. The study involved 2 stages: examination of 1997 AIDS Control Act Reports for England and Wales, and a telephone questionnaire survey of local planners of HIV/AIDS services. Forty-eight out of 55 health authorities (87.3%) found information from the programme to be useful in general; 37/55 (67.3%) found the information useful for targeting of health promotion; 35/55 (63.6%) found the information useful for assessing the effectiveness of preventive measures aimed at reducing the spread of HIV; and 28/55 (50.9%) found the information useful for planning of medical or social services. If information from the programme was no longer available, 36/55 (65.5%) said it would make some difference to local planning, although 12/55 (21.8%) said it would make no difference. Local planners were generally supportive of the programme, and complaints were mostly directed at funding and timeliness of the reports.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Transitions to supported environments in England and Wales among elderly widowed and divorced women: the changing balance between co-residence with family and institutional care.

In this article we examine changes in the proportion of older widowed and divorced women in England and Wales moving from 'independent' to two kinds of 'supported' household--supported private households and institutions--during the decades 1971-81 and 1981-91. Our main aim was to see whether observed increases in institutionalisation over this period were the result of a decreased propensity to move to the households of relatives. We used the ONS Longitudinal Study, a record linkage study including individual level data from the 1971, 1981 and 1991 censuses of England and Wales. A multinomial logit model was used to investigate the correlates of transitions from independent to supported private households versus institutions among elderly widowed and divorced women. While the overall rate of transitions to join either supported private households or institutions was largely the same in the two decades, the balance between the two shifted markedly in favour of transitions to institutions. In terms of the limited range of covariates it was possible to consider, owner-occupiers were significantly more likely than tenants to move to supported private households than to institutions.

Aged↗
PubMed2004

Patterns of municipal health expenditure in interwar England and Wales.

This article aims to fill a gap in the history of medical services in England and Wales in the interwar period by focusing on the historiographically neglected municipal sector--a relative neglect that is particularly unjustified given that this sector provided an increasingly wide array of medical services over the period. Focusing on the highly urbanized county boroughs, this article investigates whether and how expenditure on municipal health services changed over the interwar period, and whether these patterns were replicated by boroughs across England and Wales. It is found that many of the largest personal health services were experiencing a common pattern of growing investment over the period, but that county boroughs did not act uniformly in their spending decisions. Considered regionally, the Northeast and the West Midlands were found to perform poorly in expenditure terms compared to the data set as a whole, while the large conurbations of Leeds, Manchester, and Liverpool raised the average performance of the Northwest and Yorkshire. Regional patterns are found to be less consistent in the south of the country, where voluntary provision and demands arising from the boroughs' geographical position (for example, seaside resorts) may have exerted significant influences over levels of expenditure on health.

England↗
PubMed1983

Dental services in England, Wales, and the United States: a comparison of national survey data.

As stated at the outset, the review of the two systems was not intended to determine which approach to provide dental services is better. Rather it has provided an opportunity for both systems to learn from the activities of the other. Thus, the continuing decrease in dental caries rates in the United States, no doubt associated with the extensive fluoridation programs, provides direction for efforts in England and Wales. Similarly, the pronounced changing attitudes to extractions and "wedding present dentures" in England and Wales offer our country some understanding of the needs to change general population attitudes if we are to expand dental services in this country to increasing segments of the nation.

Adolescent↗
PubMed2001

Prevalence of hepatitis C among injection drug users in England and Wales: is harm reduction working?

OBJECTIVES: This study sought to establish the prevalence of hepatitis C antibodies (anti-HCV) and hepatitis B antibodies (anti-HBc) among injection drug users in England and Wales. METHODS: A voluntary cross-sectional survey collected oral fluid samples and behavioral information; 2203 injectors were recruited through drug agencies, and 758 were recruited in the community. RESULTS: Prevalence was 30% for anti-HCV, 21% for anti-HBc, and 0.9% for HIV antibodies. Anti-HCV prevalence rates were significantly greater among those with longer injecting careers, those in older age groups, those residing in London, those recruited in drug agencies, those positive for anti-HBc, and those with a previous voluntary HIV test. CONCLUSIONS: Anti-HCV prevalence rates among injectors in England and Wales, where comprehensive harm reduction programs exist, are lower than rates in other industrialized countries.

Adult↗
PubMed1994

The incidence of childhood IDDM in New South Wales, Australia.

OBJECTIVE: To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children 0-14 years of age in the state of New South Wales, Australia, which has a total population of 5.73 million. RESEARCH DESIGN AND METHODS: We established a prospective register, identifying 361 incident cases over a 2-year period (1990-1991) with two independent sources of case ascertainment. The primary source was the reporting of newly diagnosed patients by physicians and diabetes educators. The secondary source was a subsidized syringe scheme. RESULTS: Using the capture-recapture method, ascertainment was estimated to be 99.4% complete. The age-standardized incidence rate was 14.5 per 100,000 person-years (95% confidence interval: 13.0-16.0). No significant differences were found when comparing the first and second years of the register, boys and girls, geographical areas, or Aboriginal and non-Aboriginal children. There was seasonal variation in the onset (with more cases in winter), which was evident in the 10- to 14-year age-group (P = 0.01), but not in younger age-groups. A first-degree relative was already affected in 6.9% of the cases. No significant difference was noted in the age at onset when comparing cases with and without an affected first-degree relative. CONCLUSIONS: The incidence of childhood IDDM in New South Wales is similar to rates found in other predominantly Anglo-Saxon populations. IDDM occurs in Aboriginal children with a frequency comparable to that in the rest of the population.

Adolescent↗
PubMed2004

Marital status and the risk of suicide: experience from England and Wales, 1982-1996.

This analysis examined suicide rates by age, sex, and marital status in England and Wales for the period 1982-1996. Never married, widowed, and divorced people had higher rates of suicide than those who were married, for both sexes. Among the widowed ages 20-39 years, both sexes had the highest rate, and the rate decreased with age. The suicide rate for divorced people was similar to those who had never married, except for the younger group ages 20-29 years. The male:female ratios for the relative suicide risk for never married, widowed, and divorced to married for both sexes were statistically significantly different for older adults. The decrease in suicide rates observed for the period 1982-1996 in England and Wales was mainly attributable to the reduction of suicide rates among the widowed and divorced.

Adult↗