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PubMed2001

Surveillance of sexually transmitted infections in England and Wales.

Surveillance of sexually transmitted infections (STIs) in England and Wales has, in the past, relied principally on aggregated statistical data submitted by all genitourinary medicine clinics to the Communicable Disease Surveillance Centre, supplemented by various laboratory reporting systems. Although these systems provide comparatively robust surveillance data, they do not provide sufficient information on risk factors to target STI control and prevention programmes appropriately. Over recent years, substantial rises in STIs, the emergence of numerous outbreaks of STIs, and changes in gonococcal resistance patterns have necessitated the introduction of more sophisticated surveillance mechanisms. This article describes current STI surveillance systems in England and Wales, including new systems that have recently been introduced or are currently being developed to meet the need for enhanced STI surveillance data.

Chlamydia Infections↗
PubMed1996

Delivery of medication to psychiatric patients in community health services in New South Wales.

OBJECTIVE: We investigated the supply and monitoring of medication to patients who attend community mental health services in NSW. METHOD: The staff at four metropolitan and one rural community centre health service were interviewed. Information sought included policies and procedures concerning medication, the delivery of medication to patients, and staff reports concerning their knowledge and practice related to the legal requirements of the New South Wales Poisons Act 1966. RESULTS: Sixty-five (62%) of 104 coordinators, medical officers and staff who were responsible for case managing patients were interviewed. The centres all differed in their existing policies and practices and the extent to which they were supported by their local hospital and retail pharmacies. Only one centre had a designated pharmacist and this was a part-time position. CONCLUSIONS: The delivery of medication at most centres is a fairly ad hoc arrangement with staff organising medication as best as they can. At times the supply of medication to patients fails to comply with legal and New South Wales Department of Health requirements.

Community Mental Health Services↗
PubMed1991

Causes of death amongst a population of gastric ulcer patients in New South Wales, Australia.

The purpose of this study was to investigate whether any specific causes of death were more frequent than expected in an Australian group of 305 gastric ulcer patients (131 men, 174 women) who had died in New South Wales between 1 January 1974 and 31 December 1983. The distribution of causes of death among the ulcer population deaths was compared with that among the New South Wales population deaths, after adjusting for sex, 5-year age group, and time period of death (1974-1978, 1979-1983). Causes of death were ascertained from death certificates. Deaths due to peptic ulcer, liver cirrhosis, and diffuse pulmonary disease were more frequent than expected (p less than 0.05). The associations found with these other diseases accord with those found in previous surveys on causes of death in gastric ulcer patients and in studies of living gastric ulcer populations. Overall, the combined evidence suggests that liver cirrhosis and diffuse pulmonary disease are associated with gastric ulcer.

Adult↗
PubMed1989

An epidemiological survey of primary tumours of the brain and spinal cord in South East Wales.

This survey is founded on 526 patients who presented with a primary tumour of the brain, spinal cord or their coverings over a seven year period. The patients resided in one of the three counties comprising South East Wales, which has a population of about 1.3 million. Each tumour type is classified according to age, sex and area of residence of the patient. Age and sex adjusted annual incidence rates were calculated for each tumour type. All types of glioma have a higher incidence in males, while meningiomas are twice as common in females. Gliomas are the most commonly occurring tumour with an average annual incidence of 3.6 per 100,000 and a peak incidence for malignant astrocytomas of 7.6 in the 55 to 64 year age group. The low grade astrocytoma is the most common tumour of childhood. Oligodendrogliomas occur most commonly in adults between the ages of 35 and 44 years. In this survey there is an unexplained relatively high incidence of oligodendrogliomas. The majority of primary tumours arose in the brain, but there were 24 tumours of the spinal cord, nerve sheath and meninges. Comment is made on the presence and possible aetiological significance of chemical industries within South East Wales.

Adolescent↗
PubMed1993

Morbidity registration and the fourth general practice morbidity survey in England and Wales.

The fourth morbidity survey in England and Wales is based on a population of 473,000 persons registered in 60 practices and cared for by 241 general practitioners. This presentation traces the evolution of morbidity surveys in England and Wales. That evolution has taken place against a background of advancing computer technology and the drift towards a paperless record. It is motivated by an increasing recognition of the need for data from primary health care an a realisation that a structured record is capable of servicing information needs without intermediary data sheets and coding procedures. The primary objectives of the study include assessment of disease prevalence by region, age-sex and social group; and to study trends over time. Morbidity and social data are collected in the practices and all relevant information stored on practice computers. At the end of the recording year, the computerised record for each patient is copied on to disks in an anonymized but uniquely identified form and transferred to the national Office of Population Censuses & Surveys for analysis. During the year, weekly extracts are taken of new episodes of illness in age and sex groupings which provide the basis of the Weekly Returns Service of the Royal College of General Practitioners.

Data Collection↗
PubMed1996

Underprivileged area score, ethnicity, social factors and general mortality in district health authorities in England and Wales.

OBJECTIVE: To analyse the relation of ethnicity, social deprivation (Underprivileged area, UPA-score), social class V, unemployment and overcrowding on age- and sex-standardized mortality ratio (SMR). DESIGN: This ecological study used the SMR for people under the age of 65 years as dependent variable. Mortality data for 1983, classified by total population of country of birth (New Commonwealth and Pakistan), unskilled (social class V), unemployed, and overcrowded (>1/room) population with data from 1981 censuses. Underprivileged Area (UPA) score was applied in this study, an index widely used in the UK to identify underprivileged residential areas, calculated from information combining eight variables derived from the decennial census. The data were analysed by multiple regression (least square estimation) with SMR as dependent variable and the other social factors as independent variables. SETTING: All 192 district health authorities in England and Wales. RESULTS: There was a significant association between UPA-score and SMR (R-square = 0.53, p = 0.0001). The second model included the four variables: % unskilled, % unemployed of economically active population, % of residents living in overcrowded households, and % of population from New Commonwealth and Pakistan. This model explained about 77% of the variance. All variables were significant. All coefficients except ethnicity were positive, i.e. the higher the coefficients, the higher the SMR. CONCLUSION: This paper shows that social deprivation, unemployment and overcrowding were related to mortality in district health authorities in England and Wales. The finding that ethnicity was inversely related to general mortality might be important and needs to be further analysed.

Adolescent↗
PubMedDate not supplied

The General Practice Morbidity Database Project Wales--a methodology for primary care data extraction.

There is a fundamental need for accurate, timely and relevant information for health service planning; the increasing focus on a primary care led NHS has made the collection of information from general practitioners a priority. A collaborative project between general practitioners and public health physicians in Wales has developed methodologies for the extraction and analysis of routinely collected data from general practices across Wales. Four commonly used computer systems have been investigated. This paper outlines the methodologies used and describes the problems encountered and their solutions.

Computer Communication Networks↗
PubMed2003

Foot and mouth disease in livestock and reduced cryptosporidiosis in humans, England and Wales.

During the 2001 epidemic of foot and mouth disease (FMD) in livestock in England and Wales, we discovered a corresponding decrease in laboratory reports of cryptosporidiosis in humans. Using a regression model of laboratory reports of cryptosporidiosis, we found an estimated 35% (95% confidence interval [CI] 20% to 47%) reduction in reports during the weeks spanning the period from the first and last cases of FMD. The largest reduction occurred in northwest England, where the estimated decrease was 63% (95% CI 31% to 80%). Genotyping a subgroup of human isolates suggested that the proportion of Cryptosporidium genotype 2 strain (animal and human) was lower during the weeks of the FMD epidemic in 2001 compared with the same weeks in 2000. Our observations are consistent with livestock making a substantial contribution to Cryptosporidium infection in humans in England and Wales; our findings have implications for agriculture, visitors to rural areas, water companies, and regulators.

Animals↗
PubMed2005

An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales.

OBJECTIVES: To survey of the structure, processes and organisation of renal satellite units (RSUs) in England and Wales (Phase 1), and to compare the effectiveness, acceptability, accessibility and economic impact of chronic haemodialysis performed in RSUs compared to main renal units (MRUs) (Phase 2). DATA SOURCES: Phase 1: all renal satellite units in England and Wales. Phase 2: haemodialysis patients in a representative sample (based on geography, site, private--public ownership, medical input) of 12 RSUs and their MRUs. REVIEW METHODS: Phase 1 consisted of a questionnaire survey. Semi-structured interviews were held in a representative sample of 24 RSUs with the senior clinician, senior nurse and manager. Phase 2 consisted of a cross-sectional comparison of patients in these RSUs and patients in the parent MRUs deemed suitable for satellite care by senior staff. Clinical information was obtained from medical notes and unit computer systems. Generic and disease specific health-related quality of life (HRQoL) measures were used. Co-morbidity was assessed by the Wright/Khan Index, the Lister/Chandna score, the Modified Charlson Index, and the Karnofsky Performance Score. Statistical analyses compared RSU versus MRU patients and took account of the paired and clustered nature of the data. RESULTS: In Phase 1, responses were received from 74/80 (93%) of RSUs; 2600 patients were being treated in these RSUs. The interviews were generally positive about the impact of RSUs in terms of improved accessibility and a better environment for chronic haemodialysis (HD) patients, and in expanding renal replacement therapy patients (RRT) capacity. In Phase 2, some 82% of eligible patients took part, 394 patients in the 12 RSUs and 342 in the parent MRUs. The response rate was similar in both groups. There were no significant differences in clinical processes of care. Most clinical outcomes were similar, especially after pooled analysis, although a few parameters were statistically significantly different -- notably the proportion achieving Renal Association Standards for adequacy of dialysis as measured by the urea reduction ratio (URR) was higher in the RSU patients. Patient-specific quality of life did not differ except on the patient satisfaction questions from the KDQOL, which were scored higher by the RSU sample. Strength of preference for health status on and off dialysis was very similar between the groups, as were EQ-5D utilities. Major adverse events were not common in the RSU patients, although there were many hypotensive episodes on HD, a proportion of which affected the duration of the HD session. Of the costs measured, the only difference that was statistically significant was for District Nurse visits. Of particular note was that despite the MRU group having a higher proportion of patients hospitalised, this did not translate into a statistically significant budgetary impact in terms of the total cost per patient of hospitalisations or mean cost per patient per hospitalisation. CONCLUSIONS: This study has shown that RSUs are an effective alternative to MRU HD for a wide spectrum of patients. They improve geographic access for more dispersed areas and reduce patients' travel time, and are generally more acceptable to patients on several criteria. There does not seem to be an adverse impact of care in the RSUs although comparative long-term prospective data are lacking. The evidence suggests that satellite development could be successfully expanded; not all MRUs have any satellites and many have only a few. No single RSU model can be recommended but key factors would include local geography, the likely catchment population and the type of patients to be treated. There is a need for more basic budgetary information linking activity and expenditure to be available and more transparent, to perform at least an insightful top-down costing of the two care settings. Other areas suggested for further research include: a comparison of adverse events occurring in MRUs and RSUs with longer duration and larger numbers to identify more severe events, along with the more research into the scope for preventing such events, and a study into the patients deemed ineligible for satellite care. International comparisons of satellite care would also be useful.

Adult↗
PubMed1998

The contamination of pâté with Listeria monocytogenes--results from the 1994 European Community-Coordinated Food Control Program for England and Wales.

The Listeria monocytogenes contamination of 3,065 pâté products sampled at the point of retail sale in England and Wales was examined. Ninety-seven percent of samples were free of contamination with L. monocytogenes, 2.0% (60) had levels of less than 200 CFU/g, and 0.6% (18) had levels of 200 CFU/g or more. Fish and seafood pâté were significantly more commonly contaminated by L. monocytogenes than other pâté types (chi 2 test, P = 0.001). Pâté obtained from small retail shops was significantly more likely to be contaminated at levels of > or = 200 CFU/g (chi 2 tests, P < 0.0005) than that obtained from supermarkets. L. monocytogenes was isolated significantly more often (chi 2 tests, P < 0.00002) from packs of pâté that were open at the time of collection (3.8%) than those that were sold prepacked (1.2%). There were also significantly more samples (chi 2 test, P = 0.0009) where L. monocytogenes was recovered at higher levels (> or = 200 CFU/g) in opened, as compared to prepacked, samples. There was a significant difference in the rates and levels of contamination of opened samples between shops and supermarkets (chi 2 tests, P < 0.0025). Evidence from this study shows that most of the pâté sold in England and Wales is not contaminated with L. monocytogenes, and we suggest that the main areas of concern are cross-contamination and the length of display of pâté sold from opened packs.

Animals↗
PubMed1991

Improving surveillance of infectious diseases in New South Wales.

OBJECTIVE: To determine the feasibility of laboratory reporting of infectious diseases and to compare the value of this system with the existing medical practitioner notification system. DESIGN: A sample of notifications was selected from medical practitioner notifications and was compared for both completeness and timeliness of notification with a sample of notifications obtained through the Laboratory Infectious Diseases Surveillance Project. SETTING: The New South Wales Health Department and the Public Health Unit of the Eastern Sydney Area Health Service. PARTICIPANTS: Medical practitioners forwarding notifications of infectious diseases to the New South Wales Health Department and laboratories participating in the Laboratory Infectious Diseases Surveillance Project. MAIN OUTCOME MEASURES: We counted the number of infectious diseases reported by medical practitioners and participating laboratories and estimated the proportion of these diseases which were common to both sources of data. We also estimated the time taken between the diagnosis of a notifiable infectious disease and the receipt of the notification by the Medical Officer of Health. RESULTS: There was substantial underreporting of notifiable infectious diseases by medical practitioners. During the study there were 461 cases of a notifiable disease reported by either medical practitioners or by participating laboratories. Of these cases, 75% were reported only by laboratory staff, 20.2% were reported by medical practitioners alone and 4.8% of cases were reported by both laboratory staff and medical practitioners. The Medical Officer of Health received the reports from the participating laboratories within a significantly shorter time than the notifications from medical practitioners. CONCLUSION: The use of infectious disease notifications by laboratories can substantially improve the surveillance of infectious diseases.

Communicable Disease Control↗
PubMed1996

Hospitalisations for rotavirus gastroenteritis among children under five years of age in New South Wales.

OBJECTIVE: To estimate the number of children under five years of age hospitalised for rotavirus gastroenteritis in New South Wales. DESIGN: Retrospective survey with comparison of patterns of hospital admissions for acute gastroenteritis in children under five with laboratory reports of rotavirus infection. SETTING: New South Wales, January 1991-December 1993. OUTCOME MEASURES: Laboratory reports of rotavirus infection to the Eastern Sydney Laboratory Surveillance Program (a voluntary laboratory reporting scheme) and hospital admissions of children under five with principal diagnosis classified under international classification of diseases, 9th revision, clinical modification (ICD-9-CM) codes 008.6, 008.8, 009.0-009.3 and 558.9 from NSW Inpatient Statistics Collection. RESULTS: Rotavirus infections were reported throughout each year (mean, 57 reports per month), with incidence peaks in August or September. Admissions for gastroenteritis showed the same seasonal pattern (correlation coefficient, 0.93). About 3700 children under five were admitted for rotavirus gastroenteritis annually in NSW at an estimated annual cost of 4.6 million dollars. Annual rates were highest for children aged 12-23 months (1800 per 100000 population in age group), intermediate for those aged 0-11 and 24-35 months (810 and 1000 per 100000 in age group, respectively) and lowest for those aged 36-47 and 48-59 months (450 and 190 per 100000 population, respectively, in age group). CONCLUSIONS: Rotavirus is a major cause of morbidity among young children in NSW. Routine infant vaccination against rotavirus could reduce this morbidity and the resulting health costs.

Age Distribution↗
PubMed1997

Hepatitis B and C in New South Wales prisons: prevalence and risk factors.

OBJECTIVES: To determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among inmates entering the New South Wales correctional system and to examine risk factors for infection. DESIGN: Cross-sectional survey. SETTING: Reception Centre at Long Bay Correctional Centre, Sydney, New South Wales, June to December 1994. PARTICIPANTS: 408 adult male inmates received at the Reception Centre (28% of the 1450 new inmates eligible for compulsory HIV testing). OUTCOME MEASURES: Presence of HBV core and surface antibody and surface antigen; HCV antibody; risk factors; inmates' knowledge about risk factors. RESULTS: 37% of inmates tested positive for HCV antibody, 31% for HBV core antibody and 3.2% for HBV surface antigen (indicating recent infection or carrier status). Among those who reported a history of injecting illegal drugs, rates rose to 66% for HCV antibody and 43% for HBV core antibody. Prevalence of HBV and HCV antibodies was similar in Aboriginal and non-Aboriginal inmates, but HBV antigen carrier rate was significantly higher among Aboriginals (12% versus 2.2%). Knowledge about hepatitis risk factors was poor (only 20% named injecting drug use), although recidivists were significantly better informed than those new to the correctional system. Multivariate analysis identified injecting drug use, past exposure to hepatitis B virus and previous imprisonments as significant predictors for HCV infection, and age over 25 years and HCV antibodies for HBV infection. CONCLUSIONS: Results suggest that about a third of adult male prisoners entering the NSW correctional system may have been infected with HBV or HCV. Measures such as education about hepatitis risk factors and HBV vaccination are needed to reduce hepatitis transmission in this population.

Acquired Immunodeficiency Syndrome↗
PubMed1999

A population-based study of children with cerebral tuberculosis in New South Wales.

OBJECTIVE: To determine the incidence of childhood cerebral tuberculosis (tuberculous meningitis [TBM] and tuberculoma) in a defined population. DESIGN: Retrospective, population-based study. SETTING AND PARTICIPANTS: All resident children aged up to 14 years in New South Wales diagnosed with cerebral tuberculosis, from 1982 to 1996. MAIN OUTCOME MEASURE: Population-based incidence of childhood TBM. RESULTS: 10 children with TBM and one with tuberculoma were identified in the 15 years. The incidence of TBM was 0.053 (95% CI, 0.025-0.097) per 100,000. Eight of the 10 TBM patients were born in Australia and five were of white European origin. Only one had been vaccinated with BCG vaccine. Three of the children died. CONCLUSIONS: The incidence of childhood TBM in New South Wales is low, and comparable with that in other First World countries.

Adolescent↗
PubMed1999

Mortality associated with New South Wales methadone programs in 1994: lives lost and saved.

OBJECTIVES: To estimate the effects of methadone programs in New South Wales on mortality. DESIGN AND CASES: Retrospective, cross-sectional study of all 1994 New South Wales coronial cases in which methadone was detected in postmortem specimens taken from the deceased. Cases were people we identified as patients in NSW methadone maintenance programs or those whose deaths involved methadone syrup diverted from maintenance programs. OUTCOME MEASURES: Relative risks of fatal, accidental drug toxicity in the first two weeks of treatment and later; the number of lives lost as a result of maintenance treatment; preadmission risks and the number of lives saved by maintenance programs, calculated from data from a previous study. RESULTS: There was very close agreement between this study's classifications and official pathology reports of accidental drug toxicity. The relative risk (RR) of fatal accidental drug toxicity for patients in the first two weeks of methadone maintenance was 6.7 times that of heroin addicts not in treatment (95% CI RR, 3.3-13.9) and 97.8 times that of patients who had been in maintenance more than two weeks (95% CI RR, 36.7-260.5). Despite 10 people dying from iatrogenic methadone toxicity and diverted methadone syrup being involved in 26 fatalities. In 1994, NSW maintenance programs are estimated to have saved 68 lives (adjusted 95% CI, 29-128). CONCLUSIONS: In 1994, untoward events associated with NSW methadone programs cost 36 lives in NSW. To reduce this mortality, doctors should carefully assess and closely monitor patients being admitted to methadone maintenance and limit the use of takeaway doses of methadone.

Adult↗
PubMed2000

Infrastructure for monitoring blood transfusion practice in New South Wales hospitals.

OBJECTIVES: To determine the existing infrastructure for monitoring blood transfusion practices in New South Wales hospitals. DESIGN: A questionnaire survey conducted in August 1998. PARTICIPANTS: All healthcare facilities known to have used blood products from the Australian Red Cross Blood Service--New South Wales in the 12 months before the survey. MAIN OUTCOME MEASURES: Existence of a transfusion committee and policies and procedures to ensure appropriate use and issue of blood products; monitoring expiry rates of red blood cells, platelets and fresh frozen plasma; using a maximum blood ordering schedule (MBOS); and measuring the crossmatch to transfusion ratio (CT ratio). RESULTS: 224 hospitals were surveyed and 144 responses were received (64%). Twenty-five hospitals (17%) had a transfusion committee; 60 (42%) monitored expiry rates of red cells, and 39 (27%) and 42 (29%), respectively, monitored these rates for platelets and fresh frozen plasma. Thirty-three hospitals (23%) used an MBOS and 43 (30%) measured the CT ratio. However, over 70% of the larger hospitals (> 200 beds) had all these aspects of transfusion infrastructure in place, and 35% had transfusion committees. CONCLUSIONS: Our survey showed that, overall, there was a lack of transfusion infrastructure in NSW hospitals. However, most of the hospitals with more than 200 beds had infrastructure in place to monitor transfusion practices, but only a minority had established transfusion committees.

Blood Specimen Collection↗
PubMed2000

Use of "preventer" medications and written asthma management plans among adults with asthma in New South Wales. NSW Health Department Asthma Data Working Group.

OBJECTIVES: (1) To measure the extent of use of preventer medications (ie, inhaled corticosteroids or cromones) and possession of written asthma management plans (AMPs) among people with asthma in New South Wales in 1997. (2) To assess factors associated with underuse of preventer medications and AMPs. DESIGN AND SETTING: A cross-sectional survey by computer-assisted telephone interviews of a stratified random sample of the adult population of New South Wales, Australia. PARTICIPANTS: People aged 16 to 54 years with asthma diagnosed by a doctor and causing symptoms or requiring treatment in the preceding year (n = 1,372). RESULTS: Although 55.2% of survey participants had used preventer medications in the preceding year, only 27.8% had used them regularly. Only 34.7% had a written AMP. Preventer medications were judged to be indicated for 54% of the study population, but only 42.5% of this group had used them regularly (43.1% had a written AMP). Younger adults were less likely to use preventer medications regularly, but there was no difference in use of preventer medications by sex, urban/rural residence, or manner of purchasing reliever medications (either on prescription or "over the counter"). Past smokers used preventers more commonly than current smokers, with never smokers having an intermediate prevalence of regular preventer use. Age, sex, urban/rural residence, and manner of purchasing reliever medications were not related to the possession of an AMP. CONCLUSION: Despite the trend towards increased use of preventer medications and written AMPs during the 1990s, undertreated asthma remains a major public health problem in Australia.

Adolescent↗
PubMed2006

The development of the National Reporting and Learning System in England and Wales, 2001-2005.

In 2001, the National Patient Safety Agency (NPSA) was created as part of a wider reform process to improve quality of care for patients in the National Health Services of England and Wales. The NPSA was charged with developing and implementing a national system for collecting and learning from reported patient safety incidents. Between 2003 and 2005, 303 447 incidents were reported from a wide range of health care settings. As a result, a range of interventions have been developed to improve safety. A number of lessons have been distilled from the experience of England and Wales, including that: clinical risk management system characteristics should be aligned with those of the national reporting system; and safety culture and information dissemination must be addressed at the same time as any new reporting system is implemented. These lessons should be of use to other countries implementing similar patient safety strategies.

Communication↗