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PubMed2003

Prenatal screening for Down syndrome in England and Wales and population-based birth outcomes.

OBJECTIVE: Whether the introduction of antenatal screening for Down syndrome in England and Wales with serum biochemistry or ultrasound has led to improvements in patient outcomes is unknown. The purpose of this study was to relate pregnancy outcomes to the dominant method used for prenatal Down syndrome screening. STUDY DESIGN: For the years 1989 through 1999, England and Wales were divided into geographically defined areas where specific hospitals, health authorities, and cytogenetic laboratories provided maternity care for well-defined populations. For each year from 1989 through 1999, the dominant Down syndrome screening method that was used in each area was determined. Outcomes for area-years that used serum biochemistry or ultrasound (first or second trimester) were compared with area-years that used advanced maternal age as the dominant screening method. The percent of Down syndrome cases that were diagnosed prenatally (effectiveness) and the number of invasive prenatal tests that were performed to diagnose each Down syndrome case prenatally (efficiency) were compared. RESULTS: There were 5,980,519 births and 335,184 referrals for prenatal karyotyping (amniocentesis and chorionic villus sampling) that occurred in the area-years studied, of which 12,047 pregnancies were diagnosed as Down syndrome; 5393 cases of Down syndrome (45%) were diagnosed prenatally. Invasive testing increased from 4.4% of pregnancies in 1989 to 6.4% in 1997 and declined slightly in 1999 (5.8%). Prenatal diagnosis of Down syndrome cases rose from 28% in 1989 to 53% in 1999, and the number of invasive tests that were performed to diagnose each Down syndrome case fell from 89.7 to 47.7 (P [for trend]<.0001). Areas with serum or ultrasound as the dominant screening method detected 50% more Down syndrome cases in prenatally (52% and 53% vs 36%; P<.0001) and performed fewer invasive procedures to diagnose each Down syndrome case (60.7 and 52.0 vs 88.0; P<.0001) compared with areas in which advanced maternal age screening was dominant, despite serving populations with similar mean/median maternal ages. CONCLUSION: In clinical practice, screening programs for Down syndrome that were based on maternal serum biochemistry or ultrasound were more effective and efficient than the screening programs that used advanced maternal age alone.

Amniocentesis↗

PubMed1983

Analysis of gross migration profiles in England and Wales: some developments in classification.

"In this paper [the authors] describe the development and application of two approaches to the analysis of age and sex specific interarea migration. The data relate to local authority areas in England and Wales. These approaches are developments of established migration profile-fitting and cluster analytic methods. The paper shows how these methods have been used to develop complementary classifications from which potentially valuable criteria for migration analysis can emerge. The work described is part of a wider project concerned with the development of methods to improve the official estimation of internal migration in England in the context of local area population forecasting."

Age Factors↗

PubMed2002

Anthropogenic modification of New England salt marsh landscapes.

Salt marshes play a critical role in the ecology and geology of wave-protected shorelines in the Western Atlantic, but as many as 80% of the marshes that once occurred in New England have already been lost to human development. Here we present data that suggest that the remaining salt marshes in southern New England are being rapidly degraded by shoreline development and eutrophication. On the seaward border of these marshes, nitrogen eutrophication stimulated by local shoreline development is shifting the competitive balance among marsh plants by releasing plants from nutrient competition. This shift is leading to the displacement of natural high marsh plants by low marsh cordgrass. On the terrestrial border of these same marshes, shoreline development is also precipitating the invasion of the common reed, Phragmites, by means of nitrogen eutrophication caused by the removal of the woody vegetation buffer between terrestrial and salt marsh communities. As a consequence of these human impacts, traditional salt marsh plant communities and the plants and animals that are dependent on these habitats are being displaced by monocultures of weedy species.

Ecology↗

PubMed1997

Comparison of urinary 5-L-oxoproline (L-pyroglutamate) during normal pregnancy in women in England and Jamaica.

Urinary 5-L-oxoproline was measured during normal pregnancies in Southampton, England and Kingston, Jamaica. The CV of 5-L-oxoproline excretion in urine, determined over 7 d in a non-pregnant woman and three pregnant women, was 10-36%. Compared with non-pregnant women, urinary 5-L-oxoproline increased three to four times from early pregnancy in women in Southampton, a highly significant difference, and remained elevated at similar levels during mid and late pregnancy. For women in Kingston, the excretion of 5-L-oxoproline was similar to that of Southampton women in the non-pregnant group and during early pregnancy. However, there was a progressive increase in the excretion of 5-L-oxoproline as pregnancy advanced and by late pregnancy excretion was from three to ten times greater than the average for the non-pregnant women. There was a significant difference between the women in Southampton and the women in Kingston during mid and late pregnancy, with women in Kingston excreting twice as much 5-L-oxoproline during late pregnancy. If the excretion of 5-L-oxoproline is a measure of glycine insufficiency, the results would indicate that in some pregnancies the ability of the mother to provide glycine for herself and the developing fetus is marginal or inadequate and the constraint appears more marked in Jamaica than in England.

Adult↗

PubMed1999

Lichen planus is not associated with hepatitis C virus infection in patients from north west England.

It has been suggested that infection with hepatitis C virus may be associated with the development of lichen planus and that geographical area may be an important factor affecting the relative risk. The present 2-centre, prospective, epidemiological study investigates this possible association in north west England. A total of 45 patients with classical and/or erosive mucous membrane lichen planus and 32 controls were tested for seropositivity to hepatitis C virus. None of the patients with lichen planus and only 1 of the control patients had serological evidence of infection with hepatitis C. Whilst there may be an important association between these 2 diseases in other countries, this study suggests that this does not appear to be the case in north west England and, furthermore, provides no evidence to advise routine investigation to exclude hepatitis C in patients with lichen planus in this region.

Adolescent↗

PubMed2005

Timing effects on first marriage: twentieth-century experience in England and Wales and the USA.

Recent substantial declines in first marriage in Western countries have been accompanied by increases in the average age at first marriage. Since the period proportion ever marrying, PEM, is sensitive to cohort tempo changes, the recent fall in the PEM may simply reflect cohort delays in marriage. The importance of timing factors is examined in the light of twentieth-century experience of first marriage in England and Wales and the USA. Using a variant of the Timing Index developed in research on fertility, we measure cohort timing effects for marriage and calculate an adjusted PEM. After examining twentieth-century trends in nuptiality for men and women, we find substantial tempo effects on the period PEM. Adjusted PEM values show a real decline in marriage for cohorts, but that decline is considerably smaller than the one shown by the unadjusted figures. This is especially true for England and Wales, where the decline in marriage was much greater.

Cohort Studies↗

PubMed2005

The measurement of historical trends in fetal mortality in England and Wales.

This paper critically discusses recent attempts to estimate long-term trends in the stillbirth rate for England and Wales. It assesses the available historical evidence for the level of late-fetal mortality, drawing especially on examples from Norway, Sweden, and Denmark. A theoretical fetal-infant life table for a high-mortality population is also outlined as a means of analysing the relationship between segments of the conception-to-first-birthday mortality curve. Finally, new estimates of the stillbirth rate for England and Wales are proposed, based on variations in the early neonatal and maternal mortality rates during the 1930s. These estimates are substantially lower than the earlier estimates and are more in keeping with the available evidence from northern Europe. The implications of the revised estimates for interpretations of historical changes in mortality patterns are also considered.

England↗

PubMed2000

Reforming primary care in England--again. Plans for improving the quality of care.

An extensive programme of health service reform has begun in England. Improvement in the quality of care is a key objective of the reforms, and several initiatives are being introduced in response. These include systems to provide national guidance about appropriate treatment and services, a local system to support quality improvement and arrangements to monitor performance, including a new performance framework, an inspection agency and an annual survey of patients. The local quality improvement system has features of particular interest. These include arrangements for setting objectives for quality improvement, the use of various quality improvement methods tailored to local needs and a new system to provide accountability to both the health service and the public. The introduction of clinical governance and all the other reforms presents primary care practitioners with a major challenge. However, if sufficient time is allowed and adequate resources are made available, the reforms do have the potential to improve health care in England.

Decision Making, Organizational↗

PubMedDate not supplied

Sitting height and subischial leg length centile curves for boys and girls from Southeast England.

PRIMARY OBJECTIVES: The only reference centile curves currently available for body proportions of children in the UK were constructed more than 20 years ago by Tanner and Whitehouse. The current study was designed to produce up-to-date sitting height and subischial leg length centile curves for boys and girls in Southeast England. RESEARCH DESIGN AND METHODS: A convenience sample of 1424 boys and 1208 girls aged under 25 years from Southeast England was measured by a single observer in 1995-1996. Using Cole's LMS method, centile curves were constructed for sitting height and subischial leg length, and the medians by age and sex were then scaled to sum to the corresponding median height of the British 1990 reference. RESULTS: The new centile curves for boys and girls are presented. They differ significantly from those of Tanner and Whitehouse in leg length (boys p < 0.001; girls p < 0.01), but not in sitting height. CONCLUSIONS: The Tanner and Whitehouse reference curves for body segment length are not suitable for contemporary British children, whose legs are longer than they were a generation ago. It is proposed that the curves presented here be adopted provisionally as the new British reference.

Adolescent↗

PubMedDate not supplied

National Study of Health and Growth: social and biological factors associated with height of children from ethnic groups living in England.

A new surveillance system was initiated on selected growth and nutritional characteristics of children living in inner-city areas and children from ethnic minorities. The heights of Caucasian, Afro-Caribbean and Indo-Pakistani children in this study were compared with those of children in an existing surveillance study, who were chosen to be representative of the English population. Data for this representative sample were collected in 1982 and for the ethnic groups in inner city areas in 1983. The analysis included 13,107 boys and girls aged 5-11 years. Very large differences in height were detected between ethnic groups. The Afro-Caribbean children were the tallest, on average around 3.5 cm taller than the 1982 sample, while the Gujarati children were the shortest, on average about 3 cm below the 1982 sample. Adjustment for a large set of biological and social variables did not eliminate differences in height between ethnic groups. This would indicate that the use of British standards of height based on Caucasian children to assess growth of a child of another ethnic group in England should be interpreted with caution. Multiple regression analyses by ethnic group revealed differences in the pattern of associations between height and social and biological factors among groups. Generalizations from findings in one ethnic group to another in England are not appropriate.

Body Weight↗

PubMedDate not supplied

A spatial analysis of 100 surnames in England and Wales.

Spatial patterns are described and analysed for the 84 most common surnames in England and Wales, as well as 16 others selected for various reasons. At least three-quarters of the surname frequencies show spatial structure and are heterogeneous over the area of study. While they do not exhibit clines extending over the entire area of study, they do divide into four characteristics patterns. Spatial autocorrelation, while significant, is relatively low; similarity in surname frequency does not extend much beyond 100 km. Correlograms could be clustered to yield groups of surfaces denoting partial clines, isolation by distance, and differentiation at far distances. A method for detecting zones of rapid change found 21 such zones, mostly near the periphery of the study area. These boundaries do not indicate barriers to gene flow, but appear to be patterns brought about by historical factors. There are diffusion patterns between areas that differ greatly in surname composition, such as Wales and central England. There is little evidence of long-distance movements involving several surnames. At least three characteristic migration patterns, east-west and north-south diffusion and local dispersal, were found.

England↗

PubMedDate not supplied

Grief and school communities: the impact of social context, a comparison between Australia and England.

This study investigated whether secondary schools in Australia and England had a plan to manage traumatic incidents and to identify practice and programs related to grief education and suicide intervention and prevention. Ninety-four percent of an Australian sample of 145 schools had such plans in place, compared with only 15% of an English sample of 200 schools. Differing policy contexts for grief, and the lack of teacher training and minimal education about grief in England, were discussed as possible explanations for the variation. It is concluded that a more proactive approach will only be achieved when there is system-level policy and training support, as well as school and individual teacher recognition of their potential contribution to young people's well being.

Australia↗

PubMed2001

The law and dementia--issues in England and Wales.

This paper reviews the proposals from the Lord Chancellor's Department for new Mental Incapacity law for England and Wales as they may impact on older people with dementia. Various concerns and issues are raised, particularly from the perspective of health care professionals, and the focus is the interface between such issues and the day-to-day clinical realities for a specialist team dealing with old people with dementia. A brief overview of where problems have arisen with the law in recent times is put in the context of the political/legal structures in England and Wales

Dementia↗

PubMedDate not supplied

Speech and language therapy services to education in England and Wales.

Services for children with speech and language needs in England and Wales are in a period of change. The context is subject to major systemic pressures deriving from government policies. These include the development of inclusive education and encouragement of multiprofessional collaboration in policy development and practice ('joined up thinking'). In addition, structures at local level are changing with the establishment of unitary authorities and the change from Health Trusts to Primary Care Trusts. Professional practice is also changing with a shift from clinical to community settings for speech and language therapists working with children. The present study reports on a survey sponsored by the Department for Education and Employment, Department of Health and the Welsh Assembly to identify the nature of speech and language therapy (SLT) services provided to education in England and Wales. The sample comprised all SLT service managers (n = 133, response rate 74%). The results indicate that services vary greatly in size and in their SLT: child ratio, with a mean of one SLT to 4257 child population. The caseload was highest for the 5-10 age group, and service delivery was targeted at these children, with low levels of work with secondary aged pupils. Most provision in educational settings was made to mainstream schools, but the provision of SLT time per child was substantially higher in specialist language resources. Apart from the preschool phase, most SLT provision was for children with statements of special educational needs. Prioritization of service delivery was usually by severity of need. The provision of bilingual SLT services was very limited, with only 14.0 full-time equivalents SLTs fluent in a community language, other than Welsh, where proportionately availability was much greater. Most LEAs funded SLT posts, although these were usually employed as part of the SLT service, with only about 10% of LEAs employing SLTs direct. However, 55.5% of SLT managers reported that recruitment and retention were problematic, resulting in gaps in the service. These findings are discussed with respect to changes driven by professional judgements on the nature of optimal service delivery, and government policy, with particular reference to inclusion and equity of service delivery.

Adolescent↗

PubMed2000

Invasive pneumococcal disease in England and Wales: vaccination implications.

Knowledge of the epidemiology of invasive pneumococcal disease (IPD) will aid in planning the use of pneumococcal vaccines. A United Kingdom (UK)-based surveillance in England and Wales (1995-1997) of 11,528 individuals with IPD and a local enhanced surveillance in the Oxford (UK) area (1995-1999) have been analyzed. IPD has a high attack rate in children, with 37.1-48.1 cases per 100,000 infants <1 year old per year, and in older persons, with 21.2-36.2 cases per 100,000 persons >65 years old per year, for England, Wales, and Oxford. The 7-valent conjugate vaccine includes serotypes causing < or =79% of IPD in children <5 years old, but only 66% in adults >65 years old. The data also indicate that IPD varies by serotype, age, and country, emphasizing that the epidemiology of IPD is heterogeneous and requires continued surveillance.

Adolescent↗

PubMed2001

Hereditary sensory neuropathy type I: haplotype analysis shows founders in southern England and Europe.

Hereditary sensory neuropathy type I (HSN1) is the most common dominantly inherited degenerative disorder of sensory neurons. The gene mutation was mapped to chromosome 9 in a large Australian family, descended from an ancestor from southern England who was a convict. Dawkins et al. recently reported gene mutations in the SPTLC1 gene, in this and other families. The first description of hereditary sensory neuropathy, by Hicks, was in a family from London and Exeter. To determine if the families in the present study that have SPTLC1 mutations are related to English families with HSN1 and, possibly, to the family studied by Hicks, we performed haplotype analysis of four Australian families of English extraction, four English families, and one Austrian family. Three Australian families of English extraction and three English families (two of whom have been described elsewhere) had the 399T-->G SPTLC1 mutation, the same chromosome 9 haplotype, and the same phenotype. The Australian and English families may therefore have a common founder who, on the basis of historical information, has been determined to have lived in southern England prior to 1800. The sensorimotor neuropathy phenotype caused by the 399T-->G SPTLC1 mutation is the same as that reported by Campbell and Hoffman and, possibly, the same as that originally described by Hicks.

England↗

PubMed2003

Guillain-Barré syndrome associated with Campylobacter jejuni infection in England, 2000-2001.

Guillain-Barré syndrome (GBS) is a rare but serious complication of infectious intestinal disease due to Campylobacter jejuni. To date, estimates of the burden of C. jejuni-associated GBS have been based on limited data regarding the proportion of GBS attributable to this pathogen. In this paper, we combine data obtained from Sweden and a large study of infectious intestinal disease with routine and surveillance data from England to estimate the number and proportion of GBS cases attributable to C. jejuni. We estimate that, between 1 April 2000 and 31 March 2001, symptomatic C. jejuni infection was responsible for 157 cases of GBS, constituting approximately 15% of all GBS cases in England.

Campylobacter Infections↗

PubMed2004

Characterization of group B streptococci recovered from infants with invasive disease in England and Wales.

Group B streptococci (GBS) are a major cause of invasive disease in infants, with enhanced surveillance in England and Wales showing an incidence of 0.74 cases per 1000 live births and a mortality rate of 8%. Among 353 isolates obtained during enhanced surveillance, the predominant serotypes were III (48%), Ia (27%), and V (10%), and the remainder comprised Ib, II, IV, VI, and VII; 3% were not typable. Isolates from patients with early-onset disease had serotypes III (38%), Ia (32%), and V (13%), with late-onset disease having a higher incidence of type III (67%) strains. Patients infected with serotype III strains had a higher rate of meningitis, and those with type V strains had a higher mortality rate. Isolates were susceptible to penicillin and ampicillin, but 4% were resistant to erythromycin, and 91% were resistant to tetracycline. A trivalent vaccine containing capsular polysaccharides III, Ia, and V could theoretically provide coverage against 85% of the cases of GBS disease among infants in England and Wales.

Anti-Bacterial Agents↗