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PubMed1999

The 4th quinquennial national community mental health nursing census of England and Wales.

Since 1980, a survey of community mental health nursing has been conducted in the United Kingdom, at five-yearly intervals. These three data sets have been uniquely useful in plotting trends in Community Mental Health Nursing (CMHN) activity over time. Substantial administrative changes to the National Health Service have taken place in England and Wales since 1990, however, and these have impacted on the nature of mental health service provision. These changes have implications for all mental health service personnel and, in particular, the work of community mental health nurses. This article presents selected findings from the national census, conducted between 1996 and 1997. It sets these findings within the context of data derived from the three previous national studies in the series and within the contemporary national policy context and discusses the substantive implications which flow from the changes detected over time in the practice, organisation and management, and education of community mental health nurses in England and Wales.

Community Health Nursing↗
PubMed2000

A cross-national study of differences in the identities of nursing in England and Australia and how this has affected nurses' capacity to respond to hospital reform.

This paper examines similarities and differences in the identity of nursing in England and Australia. In doing this we examine how in each country nursing has developed different ideologies and strategies. Our analysis draws on data derived from a cross-national study of hospital staff in England and Australia. We demonstrate how differences in the occupational identity of nursing in each country are registered in their values, attitudes and beliefs. We suggest that these differences reflect the interplay of factors such as the strategic stances of nursing professional and industrial organisations and how nurses in each country have positioned themselves in responding to recent changes in health policy.

Adaptation, Psychological↗
PubMed2000

Trends in prostate cancer incidence, mortality and survival in England and Wales 1971-1998.

OBJECTIVES: To examine trends in prostate cancer incidence and mortality in England and Wales between 1971 and 1998, using a newly developed and validated national cancer database and the national mortality database. METHODS: Age-standardized incidence and death rates were calculated directly and trends in relative survival rates among men with prostate cancer registered during 1971-1990 were examined. RESULTS: The annual number of new cases of prostate cancer registered in England and Wales increased by 179% between 1971 and 1993, from 6174 to 17 210. Directly age-standardized incidence rates increased by 104% between 1971 and 1993, from 29 to 59 per 100 000. The number of deaths from prostate cancer increased by 113% between 1971 and 1998, from 4027 to 8570. Directly age-standardized death rates increased by 49% between 1971 and 1995 and then decreased by 8% between 1995 and 1998, an overall increase of 38% (20 to 27 per 100 000) between 1971 and 1998. The relative survival rate for prostate cancer among men diagnosed during 1986-1990 was 77% at 1 year and 42% at 5 years, compared with 67% and 33%, respectively, for cases diagnosed during 1971-1975. The increase in survival rates was confined to men diagnosed with prostate cancer up to 1985 and no increase was seen for cases diagnosed after 1985. CONCLUSIONS: Prostate cancer is becoming a growing burden on the health service. The explanation for the large increase in prostate cancer incidence and mortality is unclear and needs further investigation. The lack of any improvement in survival rates in cases diagnosed after 1985 is of concern, and suggests that the current management of prostate cancer in both primary and secondary care may need to be reviewed.

Age Distribution↗
PubMed2003

Recent trends in the use of radical prostatectomy in England: the epidemiology of diffusion.

OBJECTIVE: To describe recent trends in the use of radical prostatectomy (RP) in England, as there is currently no consensus on the most effective treatment for localized prostate cancer, although RP is the treatment of choice among urological surgeons for men aged < 70 years. METHODS: Routine data were assessed to establish the number of RPs performed in England in 1991-99. Age-standardized operation rates were compared by region and socio-economic group, and the geographical spread of use mapped. RESULTS: The number of RPs performed annually increased nearly 20-fold between 1991 and 1999. Rates of surgery were greatest in the London National Health Service (NHS) regions and lowest in the Trent region. Outside London, the risk of surgery in a NHS hospital was significantly greater for men living in the least deprived areas; in London this trend was reversed. CONCLUSION: Rapid increases in the use of RP showed marked regional variations, most likely related to access to prostate-specific antigen testing and the location of surgeons able to carry out radical surgery. By 1999, a third of procedures were still being undertaken in 'low-volume' hospitals, with implications for the quality of care and outcomes. Crucially, these developments occurred in the absence of robust information about the effectiveness of RP. Recent funding of a randomized trial of treatment options in this area is welcome, but wider questions remain about the timing of the evaluation of surgical technologies.

Aged↗
PubMed1999

Incidence of childhood-onset Type 1 diabetes mellitus in Devon and Cornwall, England, 1975-1996.

AIMS: To determine the incidence of Type 1 diabetes mellitus (DM) in children aged 0-15 years in the far south-west of England between 1975 and 1996. METHODS: Patient information was collected to set up the Cornwall and Plymouth Children's Diabetes Register (CPCDR) through two main data sources; hospitals and the general practitioners in all surgeries in the study region. All children under 16 years living within Cornwall and the Isles of Scilly, and the former Plymouth Health Authorities and diagnosed as having Type 1 DM during the study period were included. The case ascertainment was estimated by a capture-recapture method. Trends and differences in incidence of sex, age, time period and district of diagnosis were analysed by Poisson regression analysis. Roger's method was used to estimate the seasonal variations. RESULTS: A total of 522 subjects aged between 0 and 15 years were identified from 01/01/1975 to 31/12/1996, giving an overall crude incidence of 14.9/ 100 000 population/year. The case ascertainment was 94.4% (95% confidence interval (CI) 91.4- 97.6%) for the whole register. Poisson regression analysis showed that a significant increase of incidence (2.49% per year) was observed throughout the 22-year study period, which was mainly a result of the significant increase in the 0-4 year age-group (6.29% per year). The incidence significantly differed among the 22-years (P = 0.007), the three age groups (0-4, 5-9 and 10-14 years, P<0.001) and different sexes (P=0.049). The significant seasonal variations were detected with peak incidence appearing in autumn and winter. CONCLUSIONS: The first validated childhood-onset diabetes register has been set up in the far south-west of England. The incidence of childhood Type 1 DM in this region has increased significantly over the past two decades, especially in children under 5 years.

Adolescent↗
PubMed2001

Drinking water composition and childhood-onset Type 1 diabetes mellitus in Devon and Cornwall, England.

AIMS: Previous studies have reported inconsistent results on the association between some compositions (e.g. nitrate) in domestic water and the risk of childhood-onset Type 1 diabetes mellitus. This study aimed to examine the relationship between nitrate, zinc and magnesium in drinking water and the risk of childhood-onset Type 1 diabetes mellitus. METHODS: The study covers the Cornwall and the former Plymouth Health Authority Regions in the far south-west of England. Five hundred and seventeen children, aged 0-15 years, diagnosed with Type 1 diabetes mellitus between 1975 and 1996, were identified for inclusion in the study. Domestic water data (nitrate, Zn, Mg, Cu, Al, Ca, Fe and Mn) between 1993 and 1997 were provided by South-west Water Plc, UK, for each of the 40 Water Supply Zones in which the subjects had been resident at the time of diagnosis. The standardized incidence ratio (SIR) of the disease was calculated for each Water Supply Zone using the UK 1991 census population data. The relationship between the SIR of the disease and the water quality indicators in thirds (three strata of low, medium and high concentrations) was examined by chi2 test for trend and Poisson regression analysis. RESULTS: The initial analyses by chi2 test for trend on the relation of SIRs and drinking water compositions suggested that copper, magnesium and nitrate might have some protective effects, but Poisson regression analyses showed that only zinc and magnesium were significant factors. The data suggest that the incidence rate of childhood diabetes is significantly lower when the concentrations of zinc and magnesium in the domestic drinking water are in the range 22.27-27.00 microg/l (incidence rate ratio (IRR), 0.76; 95% CI, 0.59-0.97) and greater than 2.61 mg/l (IRR, 0.72; 95% CI, 0.58-0.91), respectively. CONCLUSIONS: Our findings suggest evidence of a possible association between zinc and magnesium in the domestic drinking water and childhood diabetes in the far south-west of England. However, these possible protective effects of zinc and magnesium in domestic drinking water warrant further confirmation.

Adolescent↗
PubMed2002

Space-time clustering of childhood Type 1 diabetes in Devon and Cornwall, England.

AIMS: Several studies on space-time clustering have been reported in childhood diabetes, but the findings are conflicting. The present study was undertaken to examine whether such clustering could be detected at either birth or the time of diagnosis in the far South-west of England. METHODS: A cohort of 518 children aged 0-15 years and diagnosed with Type 1 diabetes from 1975 to 1996 contained in the population-based Cornwall and Plymouth Children's Diabetes Register (CPCDR) were included in the analyses. The case ascertainment for this register is estimated to be 94.4% complete. Mantel's modification of Knox's method was employed. A method based on K-function was also used, for the first time, to investigate the space-time clustering of diabetes. RESULTS: Significant space-time clustering at diagnosis was found by the Knox's test in the following combinations of critical cut-off thresholds: 25, 35 and 50 km and 90, 270 and 360 days (all P < 0.05), with the highest significance found at 35 km and 360 days (P = 0.0011). K-function analysis also confirmed the overall clustering (P = 0.013). CONCLUSIONS: There is strong evidence of space-time clustering in the onset of childhood Type 1 diabetes in Devon and Cornwall, England. These results lend some support to the hypothesis that viral infections and some unknown localized environmental factors play a role in the development of childhood Type 1 diabetes.

Adolescent↗
PubMed2002

A postmarketing surveillance study of gabapentin as add-on therapy for 3,100 patients in England.

PURPOSE: Our aim was to monitor the use of gabapentin (GBP) by patients prescribed this drug by primary care physicians in England soon after it was marketed in the United Kingdom. METHODS: A noninterventional observational cohort study was conducted by using the technique of prescription-event monitoring. Patients were identified from dispensed National Health Service prescriptions. Outcome data were obtained from questionnaires sent to the doctor approximately 6 months after the initial prescription. These data included demographic information, events reported since starting GBP, and reason for stopping the drug, if it was stopped. Incidence rates were calculated for given periods for all events reported. Additional information was requested for selected events of medical interest, including pregnancies. Standardised mortality ratio (SMR) was calculated. RESULTS: The cohort comprised 3,100 patients, of whom 136 (4%) were children. The median duration of treatment was 8.1 months. The most frequently reported adverse events reported during the first month of treatment, drowsiness/sedation, dizziness, and malaise/lassitude, also were the commonest reasons for discontinuing GBP and reported as suspected adverse drug reactions (ADRs). There were no congenital anomalies in the 11 babies born to women who used GBP during the first trimester of pregnancy. Crude mortality rate was 5 times that in general population but similar to that in other published studies. CONCLUSIONS: Neurologic-related events were the most frequently reported adverse events. They also were the commonest reasons for discontinuing treatment and reported as suspected ADRs. No previously unrecognised adverse events were detected in this large cohort of patients who were among the first treated with gabapentin in England.

Acetates↗
PubMed2002

Transfusion transmission of HCV infection before anti-HCV testing of blood donations in England: results of the national HCV lookback program.

BACKGROUND: An HCV lookback program started in England in 1995. STUDY DESIGN AND METHODS: Data from all English blood centers were collated to describe the outcomes of the HCV lookback program in England and to create a retrospective cohort for study. Numbers of recipients identified, numbers that were tested, and numbers that were found to be HCV infected were summarized. The data set created was used to describe the outcomes of the lookback and the HCV infections detected. RESULTS: A total of 4424 recipients of 9222 blood components made before donation testing for anti-HCV from the donations of 1286 donors found, on subsequent testing, to be anti-HCV positive or indeterminate were identified. Of these, 1351 blood recipients were reported as having been traced for testing. Fifty percent of tested recipients were found to be HCV infected. Factors positively associated with HCV infection in tested recipients were more recent year of transfusion and PCR positivity of the donor at the time of their testing. CONCLUSIONS: The majority of components entering lookback did not result in a tested recipient. However, this lookback has identified a large group of HCV-infected individuals. Follow-up of this group for disease progression will inform the natural history of HCV infection.

Adult↗
PubMed2001

Current trends in colorectal cancer: site, incidence, mortality and survival in England and Wales.

The objective was to examine trends in colorectal cancer (CRC) incidence and mortality in England and Wales over the last 30 years. Age-standardized incidence, mortality and survival rates for CRC, based on data from the National Cancer Intelligence Centre at the Office for National Statistics, were calculated and trends assessed. Between 1971 and 1997 the total number of cases of CRC increased by 42%, from 20,400 to 28,900. The site distribution of CRC between 1971 and 1994 was: rectum 38%, sigmoid 29%, caecum 15%, transverse colon and flexures 10%, ascending colon 5%, and descending colon 3%. Between 1971 and 1997 the direct age-standardized incidence increased by 20% in males and by 5% in females. The direct age-standardized mortality fell by 24% in males and by 37% in females. Age-standardized relative 5-year survival in adults improved from 22%-27% for patients diagnosed during 1971-1975 to over 40% for those diagnosed during the period 1991-1993. In conclusion, the incidence of CRC in England and Wales has been steadily rising. It is more common in males and has increased more rapidly in males than in females. The reasons for these trends remain unclear. Five-year survival has improved substantially, but rates are still below those in comparable countries elsewhere in Europe and in the USA.

Adolescent↗
PubMed2006

Exploring the differences in epidemiology of treated ESRD between Germany and England and Wales.

BACKGROUND: The aim of this study is to investigate reasons for the large reported differences in renal replacement therapy (RRT) incidence between Germany and England and Wales (E&W). METHODS: Age- and sex-standardized incidence rates were calculated at day 0, day 90, and day 180 by using registry data, and early RRT mortality was studied as an indicator of ascertainment differences. Nationally representative health survey data were analyzed to provide general population prevalence data for major chronic kidney disease risk factors: hypertension, diabetes, vascular disease, obesity, and smoking. Resource data were collected from routine sources and national surveys, and literature searches were performed to explore variation in chronic kidney disease prevalence, late referral, early start, and nondialytic therapy. RESULTS: The gap in RRT incidence between Germany and E&W increased after adjusting for differences in early mortality. The standardized day-90 incidence rate ratio was 1.79 (193.0 per million of the adult population [pmap] in Germany and 107.5 pmap in E&W) diabetes and vascular disease explained 79% of this difference. Diabetes, ischemic heart disease, and hypertension were 1.85-, 1.24-, and 1.18-fold more prevalent in Germany, whereas rates of hypertension control were 0.54-fold lower (20% versus 37% in England). Ischemic heart disease mortality rates were lower in Germany. CONCLUSION: Much of the difference in RRT incidence between Germany and E&W is explained by a greater prevalence of diabetes, hypertension, and vascular disease in the German general population, particularly those older than 65 years, and lower competing mortality risk.

Adolescent↗
PubMed2002

Genotyping of Enterocytozoon bieneusi in AIDS patients from the north west of England.

OBJECTIVES: In this study Enterocytozoon bieneusi -positive faeces samples from AIDS patients in the north west of England were investigated by polymerase chain reaction (PCR) and DNA sequencing for potential zoonotic origins. METHODS: The ITS and flanking regions of the rDNA was amplified by PCR and product sequenced. Sequences were compared with those held on GenBank to ascribe known genotypes. RESULTS: Of 13 E. bieneusi -positive samples tested, all gave a 508 bp amplification product by PCR. The samples yielded the following: genotypes B (n=11; so far only been found in humans), D (n=1; has been reported from humans and a laboratory macaque) and K (n=1; previously identified only from a cat). CONCLUSIONS: A possible zoonotic link with cats has been demonstrated for one human case. The origin of the majority of cases in the north west of England is unknown and may indicate that genotype B is solely a human pathogen.

AIDS-Related Opportunistic Infections↗
PubMed2003

Enhanced surveillance of campylobacter infection in the North West of England 1997-1999.

OBJECTIVES: To identify sources and routes of infection for sporadic cases of campylobacter infection in the North West of England. METHODS: Standard, structured questionnaires were used to gather epidemiological information from cases of campylobacter infection in the North West Region of England between 1997 and 1999. The strains of campylobacter isolated from these cases were identified and typed using serotyping and phage typing methods. Analysis of combined serotype and epidemiological data is presented. RESULTS AND CONCLUSIONS: Human campylobacter infection in the North West is seasonal and a new observation was a peak in cases in March each year. Drinking bird-pecked milk was a highly seasonal exposure that might be an indicator of environmental contamination with campylobacter. A possible environmental basis for seasonality of infection is discussed. Frequencies of risk exposures related to serotypes of cases are described and a potential association was demonstrated between Campylobacter jejuni HS6 and consumption of bird-pecked milk. Also, Campylobacter coli infections were more commonly associated with travel abroad than C. jejuni and a decreased proportion of C. jejuni HS2 and C. jejuni HS11 reported consumption of meat and unpasteurised milk (respectively). Contact with a sick animal may be a significant risk exposure in younger age groups and in those who do not consume poultry or meat. It is clear from this and other studies that the sources and vehicles of human campylobacter infection are numerous and interventions that target a single risk factor are unlikely to impact significantly on the overall burden of disease.

Adolescent↗
PubMed2001

Survival patterns in biliary atresia and comparison of quality of life of long-term survivors in Japan and England.

BACKGROUND/PURPOSE: Portoenterostomy is an accepted method of achieving bile drainage in biliary atresia, but there is a paucity of data, including formal quality-of-life (QoL) studies, on long-term survivors. This report includes survival analysis and QoL studies from the world's largest series of cases treated in Japan (1951 to 1998). The Japanese QoL results are compared with a matched group of UK patients from King's College Hospital, London. METHODS: One hundred fifteen Japanese surviving portoenterostomy patients were studied and comparison of trends in survival calculated from 6-year period cohorts. Liver function and hematologic status in a group of 30 long-term survivors (14 to 24 years) were compared with 25 patients from England, (14 to 23 years). Twenty-five Japanese and 21 UK patients (SF-36) completed a QoL questionnaire. RESULTS: Median survival times in Japanese patients before 1975 were less than 1 year but increased to 18 years after 1975. Hematologic and liver function test results did not show any significant differences between the Japanese and UK patients. QoL studies in the UK patients showed no significant difference from normative, general population data. Japanese patients underperformed in general health (P = .01), role emotional (P = .05) and role physical (P = .07) but, overall, there was no significant difference between the Japanese and UK patients except for marginal differences in indices of general health and vitality (P = .06 and .04, respectively). CONCLUSIONS: Long-term survival rate in the Japanese patients increased dramatically from 1 year to 17 years after 1975. The QoL of survivors was comparable in Japan and England. The satisfactory comparison with normative population data suggests that we should continue to use portoenterostomy as the primary treatment for biliary atresia. J Pediatr Surg 36:892-897.

Adolescent↗
PubMed2001

The attitude of courts in England to compensation for post-traumatic epilepsy.

The attitudes of courts in England to the assessment of damages for post-traumatic epilepsy have dramatically changed over the last 20-30 years. In assessing damages for post-traumatic epilepsy the courts are faced with a number of considerations: epilepsy can appear several years after the injury; epilepsy is not a homogeneous condition; the eventual prognosis is unknown; the epilepsy may not have been directly due to the trauma; and epilepsy affects life expectancy and employment. Damages were originally fixed at the point of compensation, and these rather crude calculations led to both over- and under-compensation. This situation was improved in 1985, when courts were permitted to award damages on the assumption that epilepsy would not occur or worsen, and further damages should these assumptions prove to be incorrect. The courts in England still depend, however, upon the evidence of expert witnesses chosen by the plaintiff and defendant. A tension thus exists between the duty of expert witnesses to the court and the understandable inclination of expert witnesses to support the party that has instructed them. The Woolf report has led to changes in the responsibilities of expert witnesses, and will hopefully remedy many of the inconsistencies and inequities that occur.

Accidents↗
PubMed2001

The surgical management of women with ovarian cancer in the south west of England.

The surgical management of epithelial ovarian cancer in the South West of England was studied in the two years 1997-1998 in order to determine the factors that influence the outcome of surgery and to provide a baseline from which to assess the effect of centralisation of cancer services. All hospitals in the South West region of England participating in the Regional Cancer Organisation's longitudinal study of outcomes in gynaecological malignancies are included. Six hundred and eighty-two patients with epithelial ovarian cancer were registered with the RCO in the two-year study period. Five hundred and ninety-five women were offered primary cytoreductive surgery of which 438 were said to be optimally cytoreduced. Applying multivariate models to analyse the outcome of surgery, older patients (OR = 0.82 per 5-year increase in age, P = 0.0003), patients treated in hospitals managing fewer than ten cases of ovarian cancer per year (OR = 1.92, P = 0.02) and patients with FIGO stage 3 (OR = 0.02, P < 0.0001) or 4 (OR = 0.002, P < 0.0001) disease were less likely to be optimally cytoreduced. Gynaecological oncologists were 2.06 times more likely to attain optimal cytoreduction when compared to general gynaecologists and this was statistically significant (P = 0.01). The results from this study support the argument that limiting surgery for ovarian malignancy to specialised surgeons improves the extent of cytoreductive surgery.

Adult↗
PubMed2002

[Comparability of obstetric and perinatal data from England and Germany using standard-primip-groups - maternal and neonatal outcome].

OBJECTIVE: Aim of the study was to assess whether different birth management of an english and german department can influence the maternal and neonatal outcome. MATERIAL AND METHODS: The database consisted of routinely published data from 1986-95 for two clinical units in Solihull (England) and Ibbenbueren (Germany) comprising 34 820 and 9 053 deliveries respectively. In order to standardise the obstetric risk profiles the heterogeneous primary groups were subdivided into "standard primip groups". A statistical comparison using the "binomial confidence interval method" was carried out. RESULTS: In the standardised comparison induction of labour, duration of labour 1-6 hours, vaginal delivery from cephalic presentation, elective caesarean section, both for cephalic and breech presentation, transfer to the childrens hospital were less frequent in Solihull. On the other hand, Solihull showed more frequent oxytocin administration, fetal blood analysis, epidural anaesthesia, episiotomies, duration of labour > 13 hours, forceps, ventouse and emergency caesarean section deliveries from cephalic presentation, vaginal deliveries or emergency caesarean sections from breech presentation, resuscitation of the newborn using mask and/or drugs, maternal blood loss > 1 000 ml as well as abnormalities of placental separation. Despite the different management of the departments being compared no significant differences in the incidence of perinatal hypoxia as determined by Apgar scores at 5 minutes nor in the fetal mortality rate between the units could be identified. CONCLUSION: Using standardised data the quality of obstetric and perinatal care in England and Germany can be reliably compared. Different birth management does not significantly influence the neonatal outcome.

Breech Presentation↗
PubMedDate not supplied

Developing the role of the ophthalmic nurse in England.

The role of the ophthalmic nurse in England has developed during the last 5 years with more nurses working as practitioners who run their own clinics. With the introduction of Working for Patients, the whole ethos of the National Health Service in England has changed. This study uses structured interviews to identify how three Trusts have developed the role of the ophthalmic nurse to meet the changing needs of the National Health Service. Analysis of the data identified that despite numerous problems encountered, ophthalmic nurses are responsible for driving same-day surgery ensuring that patients' needs are met.

Ambulatory Surgical Procedures↗