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PubMed1960

The diarrhoeal diseases in England and Wales, with special reference to those caused by Salmonella, Escherichia and Shigella.

The diarrhoeal diseases are now a minor cause of death in England and Wales, although they remain a major cause of acute illness in children and of absenteeism among adults. Since the Second World War there has been a general rise in the annual number of Salmonella infections, with, however, a drop in the years 1956 and 1957. Infection with Shigella sonnei-the only member of the dysentery group which causes disease at all commonly in England and Wales-has shown a steady increase. Escherichia coli infection has fallen considerably but continues to be a common cause of infantile diarrhoea.A number of environmental factors are discussed in connexion with these three main agents of diarrhoeal disease; and in a consideration of sources of infection the author suggests that while cases of clinical illness are the most important source of illness due to Sh. sonnei and E. coli, human foods, animal feeding stuffs and fertilizers are also responsible for much infection with the salmonellae. The different serotypes or Salmonella and E. coli are reviewed in relation to the epidemiology of the diseases they give rise to.

Adult↗

PubMed2004

Class, gender and insanity in nineteenth-century Wales.

This chapter shows how class and gender defined the experiences of patients admitted to the North Wales Lunatic Asylum during the late-nineteenth and early-twentieth centuries. Although not lending support to the notion that the asylum was predominantly an instrument of class and gender oppression, it does illustrate how threats of banishment to the asylum could be utilised to reinforce norms of social behaviour outside the institution in far-flung communities across north Wales. It suggests that lay rather than professional encounters were critical in the social construction of madness and the enforcement of social control.

Female↗

PubMed2004

Decreasing tuberculosis case fatality in England and Wales, 1988-2001.

SETTING: Despite declining tuberculosis mortality per head of population, there was little change in tuberculosis case fatality in England and Wales from 1974 to 1987. OBJECTIVE: To determine the trend in tuberculosis case fatality for England and Wales from 1988 to 2001. DESIGN: Annual deaths to notifications ratios (DNRs) for tuberculosis were calculated using published notification and mortality data, and analysed by age group and three disease sites (central nervous system [CNS], respiratory and other). DNRs for seven disease sites (miliary, bone and joint, CNS, respiratory, genitourinary, gastrointestinal and other) were calculated for 1998 and 1999 combined, using additional data from the enhanced tuberculosis surveillance programme. RESULTS: DNR for all ages and disease sites combined fell from 9.26% in 1988 to 5.59% in 2001 (r = -0.90; 95%CI -0.97 - -0.70). DNRs for 1998-1999 combined were 41% for miliary disease, 17% for bone and joint disease, 8% for CNS disease, 7% for respiratory disease, 2% for genitourinary and gastrointestinal disease and 0.6% for other disease. CONCLUSIONS: Some of the decrease in DNRs may be due to improving notification rates. True declines in overall case fatality reflect increases in the proportion of tuberculosis patients in younger age groups and with low mortality extra-pulmonary disease.

Adolescent↗

PubMed2004

A retrospective study of dental general anaesthesia carried out in children living in North Wales 1995-1998.

OBJECTIVES: To determine the reasons for referral for dental general anaesthesia (DGA) in children in North Wales and to ascertain the level of repeat DGA. RESEARCH DESIGN: Retrospective study of the clinical records for a random sample of 10-year-old children who had a DGA before November 1998. SETTING: DGAs carried out at two centres within the Community Dental Service (CDS) in the former county of Clwyd, North Wales. METHOD: A random sample of children who had a DGA between April 1995 and November 1998 from whose records data was collected regarding the reason for referral and outcome. RESULTS: It was found that 26.6% of children had received an additional DGA, but the total of 203 additional episodes (including third and fourth DGAs) represents a true rate of 31.8%. The General Dental Service (GDS) referred more than double the numbers of children than the CDS but the referral rate per dentist was reversed with the GDS referring an average of 5.2 subjects and the CDS 11.9 subjects. Around half of all referrals did not include a medical history. CONCLUSIONS: The repeat DGA rate was cause for concern as was the quality of referrals.

Adolescent↗

PubMed2004

Hepatitis B and hepatitis C seroprevalence and risk behaviour among community-recruited drug injectors in North West Wales.

We estimated the prevalence of markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and injecting risk behaviour, among community-recruited injecting drug users (IDUs) in North West Wales in 2001 and 2002. Sample collection was undertaken by trained current and former IDUs. Oral fluid samples (n = 153) were tested as part of the Unlinked Anonymous Prevalence Monitoring Programme ongoing survey of IDUs. Approximately 12% of the sample reported that they were currently in a drug treatment programme. Of the 153 samples screened 27% (95% CI 20%-34%, 41/153) were anti-HBc positive, and 23% (95% CI 16%-30%, 35/153) were anti-HCV positive. Sixteen per cent (95% CI 10%-22%, 25/ 153) of the samples were positive for both anti-HBc and anti-HCV. Of the subjects 15% (95% CI 9%-20%) knew they had been vaccinated against hepatitis B. Direct sharing of needles and syringes in the 28 days prior to interview was reported by 44% (95% CI 35%-54%), and sharing of any equipment including that used for drug preparation prior to injection was reported by 66% (95% CI 57%-76%). In North West Wales, syringe sharing is a common practice, and a high proportion of IDUs have been exposed to bloodborne viruses. Hepatitis B vaccination coverage within this population appears to be low and needs to be increased. Further efforts are needed to improve the availability of clean injecting equipment.

Adult↗

PubMed2004

The maldistribution of general practitioners in England and Wales: 1974-2003.

BACKGROUND: The geographical distribution of general practitioners (GPs) is a persistent policy concern within the National Health Service. Maldistribution across family health service authorities in England and Wales fell between 1974 and the mid-1980s but then remained, at best, constant until the mid-1990s. AIM: To estimate levels of maldistribution over the period 1994-2003 and to examine the long-term trend in maldistribution from 1974-2003. DESIGN: Annual snapshots from the GP census. SETTING: One hundred 2001 'frozen' health authorities in England and Wales for 1994-2003 and 98 family health service authorities for 1974-1995. METHOD: Ratios of GPs to raw and need-adjusted populations were calculated for each health authority for each year using four methods of need adjustment: age-related capitation payments, national age- and sex-specific consultation rates, national age- and sex-specific limiting long-term illness rates, and health authority-specific mortality. Three summary measures of maldistribution across health authorities in the GP to population ratio--the decile ratio, the Gini coefficient, and the Atkinson index--were calculated for each year. RESULTS: Maldistribution of GPs as measured by the Gini coefficient and Atkinson index increased from the mid-1980s to 2003, but the decile ratio showed little change over the entire 1974-2003 period. Unrestricted GP principals and equivalents were more equitably distributed than other types of GP. CONCLUSION: The 20% increase in the number of unrestricted GPs between 1985 and 2003 did not lead to a more equal distribution.

Demography↗

PubMed2004

Who cares in England and Wales? The Positive Care Law: cross-sectional study.

BACKGROUND: The inverse care law proposing that medical services are distributed inversely to population health needs, and that this law operates more completely where medical care is most exposed to market forces, was first suggested by Tudor Hart in 1971. This paper considers whether an inverse care law can be observed for the provision of informal care as well as for medical care. AIM: Using data from the 2001 census we sought to investigate the contemporary relevance of the inverse care law. DESIGN OF STUDY: Cross-sectional study. SETTING: England and Wales. METHOD: Data from the 2001 census for the population of England and Wales were analysed at the county, unitary, or former metropolitan authority level. The prevalence of the conjunction of general health status and limiting long-term illness was correlated with the percentage of the local population who were working as qualified healthcare workers (nurses, qualified medical practitioners, dentists, and other health professionals and therapists) and with the percentage of the population providing 50 or more hours of unpaid care per week. RESULTS: In 2001, 7.6% of people reported that their health was not good and that they had a limiting long-term illness (the need for care). Over one million people reported providing 50 or more hours of unpaid care per week. An inverse care law was found at the ecological level between the need for care and the proportion of the population who were working as qualified medical practitioners, dentists, and other health professionals. Informal care was almost perfectly positively correlated with the need for care (r = 0.97). These relationships were more marked for areas in the north of the country compared with the south. In the north more people provide unpaid care as more people need that care and because there are fewer working qualified medical professionals, other than nurses, providing such care per head. CONCLUSIONS: Medical care is distributed inversely to need, whereas the provision of informal care is positively related to need--where care is most needed, informal care is most likely to be provided. The greater the market forces that are allowed to intervene in the relationships between the need for care and its provision, the more likely the inverse care law is to be found to apply. Where no market forces apply, where people give up their time for free to provide care, an almost perfectly positive care law is found to apply.

Adolescent↗

PubMed2004

Fatal toxicity of antidepressants in England and Wales, 1993-2002.

This article examines trends in drug poisoning deaths involving antidepressant drugs between 1993 and 2002 in England and Wales as a whole and focuses particularly on the relationship between antidepressant prescribing and deaths in England. Between 1993 and 2002, age-standardised mortality rates in England and Wales decreased from about 9 to 7 per million population for both males and females. However, unlike females, rates in males rose to a peak of 12 per million in 1997 before declining. During the study period, the number of prescription items for antidepressants increased two and a half fold, largely due to increased use of selective serotonin re-uptake inhibitors and other antidepressants. Overall, death rates in England, per million prescription items, declined over the study period, with reductions in the rates for Dothiepin, Amitriptyline and all tricyclic antidepressants. There was no change in the rate for selective serotonin re-uptake inhibitors while rates for other antidepressants increased. Despite these trends, through all the study period rates were highest for tricyclic antidepressants and lowest for selective serotonin re-uptake inhibitors.

Adolescent↗

PubMed2004

Trends in live births by mother's country of birth and other factors affecting low birthweight in England and Wales, 1983-2001.

This article investigates trends in low birthweight singleton live births by mother's country of birth. 11.4 million birth records from registration data in England and Wales from 1983 to 2001 were used. The analysis focuses on births to mothers born in the UK and countries that contribute to the main ethnic minority groups in England and Wales. The results show that the prevalence of low birthweight babies varies by mother's country of birth. Important differentials also exist by mother's age at birth, multiplicity and registration status.

Adolescent↗

PubMed2005

The prescribing of methadone and other opioids to addicts: national survey of GPs in England and Wales.

BACKGROUND: GPs occupy a pivotal position in relation to providing services to opiate misusers in the UK, and this is now cited to support initiatives in other countries. AIMS: To investigate GP involvement in the management of opiate misusers; and to examine the nature of this prescribing of methadone and other opioids. DESIGN: GP data collected via self-completion postal questionnaire from a 10% random sample of the 30 000 GPs across England and Wales. Patient prescription data obtained on opiate misusers treated during the preceding 4 weeks. SETTING: Primary healthcare practice in England and Wales in mid-2001. METHOD: A questionnaire was mailed to a random 10% sample of GPs stratified by number of partners in the practice, with three follow-up mailshots. Data on drugs prescribed by these practitioners were also studied, including drug prescribed, form, dose and dispensing arrangements. RESULTS: The response rate was 66%. Opiate misusers had been seen by 51% of GPs in the preceding 4 weeks (mean of 4.1 such patients), of whom 50% had prescribed opiate-substitution drugs. This provided a study sample of 1482 opiate misusers to whom GPs were prescribing methadone (86.7%), dihydrocodeine (8.5%) or buprenorphine (4.4%). Of 1292 methadone prescriptions, mean daily dose was 36.9 mg - 47.9% being for 30 mg or less. Daily interval dispensing was stipulated by 44.6%, while 42.9% permitted weekly take-away supply. CONCLUSIONS: In 2001 nearly three times as many GPs were seeing opiate misusers than was the case in 1985. Half were prescribing substitute-opiate drugs such as methadone (to an estimated 30 000 patients). However, there are grounds for concern about the quality of this prescribing. Most doses were too low to constitute optimal methadone maintenance; widespread disregard of the availability of supervised or interval dispensing increases the risks of diversion to the blackmarket and deaths from methadone overdose. Increased quantity of care has been achieved. Increased quality is now required.

Analgesics, Opioid↗

PubMed2005

The impact of the 2003 heat wave on daily mortality in England and Wales and the use of rapid weekly mortality estimates.

This paper describes a retrospective analysis of the impact of the 2003 heat wave on mortality in England and Wales, and compares this with rapid estimates based on the Office for National Statistics routine weekly deaths reporting system. Daily mortality data for 4 to 13 August 2003, when temperatures were much hotter than normally seen in England, were compared with averages for the same period in years 1998 to 2002. The August 2003 heat wave was associated with a large short-term increase in mortality, particularly in London. Ozone and particulate matter concentrations were also elevated during the heat wave. Overall, there were 2139 (16%) excess deaths in England and Wales. Worst affected were people over the age of 75 years. The impact was greatest in the London region where deaths in those over the age of 75 increased by 59%. Estimated excess mortality was greater than for other recent heat waves in the United Kingdom. The estimated number of deaths registered each week is reported by the Office for National Statistics. The first clear indication of a substantial increase in deaths was published on 21 August 2003. This provided a quick first estimate of the number of deaths attributable to the heat wave and reflected the pattern of daily deaths in relation to the hottest days, but underestimated the excess when compared with the later analysis.

Aged↗

PubMed2006

Estimated daily mortality during July 2006 in England and Wales.

During July 2006, temperatures in England and Wales triggered the Government to initiate its Heatwave Plan and issue advice to the public on how to keep healthy during hot weather, and guidance to health care professionals on minimising heat-related health risks. This report presents provisional daily mortality during July by age and region, and estimates excess deaths at the hottest times. The high temperatures during July 2006 did not affect mortality in England and Wales to the extent seen in August 2003--the first hot period of July 2006 showed no increase in mortality nationally and there was a 4 per cent increase over baseline mortality in the second hot period (680 excess deaths). This compares to a 16 per cent increase during the August 2003 heat wave.

Cause of Death↗

PubMed1990

Influenza surveillance--Wales, 1988-89.

Important functions of influenza surveillance include early detection of epidemics-enabling immunization of persons not previously covered by routine immunization programs, notification of health providers to prepare for the possible impact on clinical workloads and hospital admissions, and characterization of prevalent strains to permit the timely production of appropriate vaccines. In 1986, a general-practice-based surveillance system was established in Wales to facilitate reporting of infectious diseases, including influenza and influenza-like illnesses. This report summarizes influenza surveillance findings in Wales for 1988 and 1989.

Adolescent↗

PubMed1986

The dietary intakes of women in Caerphilly, South Wales: a weighted and a photographic method compared.

A representative sample of 49 women (40-59 years) in Caerphilly, South Wales, completed a seven-day weighed dietary record and a similar sample of 48 women photographed all food and drink consumed for seven days. Mean nutrient intakes calculated for the two methods were very similar, indicating that the photographic method is reliable. Mean energy intake for the 97 women was 6.6 MJ/d (1568 Kcals). Mean intakes of protein fat and carbohydrate were 56 g, 72 g and 179 g per day respectively. Intakes were comparable with those reported from another survey in South Wales, but considerably lower than those reported from a study in Cambridgeshire. Possible reasons for these differences were discussed.

Adult↗

PubMed1983

A comparison of socioeconomic differences in mortality between Japan and England and Wales.

Japan and England and Wales have long traditions of publishing mortality rates by occupation. These data have been used in the present study to see how mortality from different causes of death is related to socioeconomic status in each country. In general, males in higher employment grades have been found to have lower mortality from most diseases. However, because mortality from certain diseases such as diabetes mellitus and ischaemic heart disease has been higher in the upper social classes (but is now lower in the upper classes) the relationship is not necessarily consistent. The aim of this study was, by comparing rates for Japan with those for England and Wales, to highlight differences in socioeconomic gradients which may indicate etiological differences between the 2 countries.

Actuarial Analysis↗

PubMed1993

Drug resistance in initial isolates of Mycobacterium tuberculosis in England and Wales, 1982-1991.

A total of 1833 out of over 16,000 'initial' isolates of Mycobacterium tuberculosis, submitted by hospital laboratories to the PHLS Regional Tuberculosis Centres in England and Wales between 1982 and 1991, were resistant to one or more first line anti-tuberculosis drugs. Isoniazid resistance was found in 6.1% of these strains, half of which were resistant to isoniazid alone. Resistance to isoniazid and rifampicin, with or without resistance to other drugs, was found in 0.6% of isolates. The proportion of initial isolates resistant to one or more drugs was 9.8%. It ranged from 8.0% to 10.9% between 1982 and 1990, and increased to 14.2% in 1991. The incidence of multiple drug resistance remained very low throughout the period. However, in the light of the problems with tuberculosis and drug resistance emerging elsewhere in the world, vigilance is essential, and enhanced surveillance is being planned in England and Wales.

Adolescent↗

PubMed1994

Legionnaires' disease surveillance: England and Wales, 1993.

One hundred and twenty-nine cases of legionnaires' disease were reported in England and Wales in 1993. Twenty-two of the cases died. Sixty-six cases (51%) were associated with travel (in the United Kingdom or abroad), six were associated with a stay in hospital, and the remaining 57 were thought to have acquired infection in the community. Two community and two hospital outbreaks were recognised in England and Wales and four outbreaks were detected in travellers from the United Kingdom to Spain, Greece, and the United States. One hundred and six cases (82%) were not known to have been associated with outbreaks, and 51 (40%) of these were not associated with travel or hospitals.

Cross-Sectional Studies↗

PubMed1995

Nutritional support in intensive care units in England and Wales: a survey.

OBJECTIVE: To assess current practice in nutritional support in intensive care units (ICUs) in England and Wales. DESIGN: A three-section questionnaire about feeding practice was sent to all adult ICUs in England and Wales; this requested information on nutritional support provided for all patients during a single designated 24-h study period. RESULTS: 66% of the questionnaires were completed and returned. 43% of patients received nutritional support. Of these, 46% received only parenteral nutrition, 34% only enteral nutrition, 4% received sip feeds and the remaining 16% received more than one form of feeding. 81% of patients fed by the nasogastric route had a large-bore tube in place. More than 40% of patients were fed parenterally via the central route, of these 54% had a dedicated feeding line. CONCLUSIONS: Despite the complications of central venous feeding and the advantages of and developments in enteral feeding these findings suggest there could be further improvement in our provision of nutrition for the critically ill patient.

Adult↗