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PubMedDate not supplied

Communication skills of interns in New South Wales.

OBJECTIVE: To assess communication skills of interns practising in New South Wales hospitals. METHODS: Comparisons were made between five groups of interns: those who graduated from the three New South Wales universities (Newcastle, Sydney and NSW); foreign medical graduates; and those from New Zealand and interstate. Subjects were assessed up to five times during the intern year; a supervisor rating scale was used. RESULTS: Newcastle graduates were rated more favourably, and foreign graduates less favourably, than graduates from other medical schools. In addition, women were rated better than men, and younger interns better than older interns. CONCLUSIONS: The data suggest deficits in communication skills of foreign medical graduates, and support the medical education approach at Newcastle medical school, which emphasises communication skills.

Adult↗
PubMed1994

The relative contribution of dental services to the changes and geographical variations in caries status of 5- and 12-year-old children in England and Wales in the 1980s.

The aim of this study was to assess the relative contribution of dental services to the changes and geographical variations in caries status of 5- and 12-year-old children in England and Wales in the 1980s. A secondary aim was to assess the association between caries experience and social factors. An ecological study analysing data at a district health authority level in England and Wales was conducted. Twenty-eight, 43 and 34 per cent of the variations in 5-year-old dmft in 1985, 1987 and 1989 respectively were explained by dental service activity indicators and 53, 62 and 57 per cent by social factors. Twenty-nine per cent of the variation in 12-year-old DMFT in 1988 was explained by dental service activity indicators and 46 per cent by social factors.

Child↗
PubMedDate not supplied

Developing local projects in primary health care in Wales.

The Edwards' report, a review of community nursing in Wales, offered significant pointers to enhancing the contribution of nurses in the community. In this article, the author describes how nurses in Wales, together with other primary health-care team members, responded to the challenge and achieved good results.

Community Health Nursing↗
PubMed1994

Medicolegal postmortem examinations in rural New South Wales. Another rural health problem.

OBJECTIVE: To investigate the quality of coronial postmortem examinations performed in rural New South Wales by Government Medical Officers. METHODS: We reviewed 100 cases, examining the history of the case provided by police officers, referral letters from Government Medical Officers and macroscopic reports of the postmortem findings. Tissue specimens received were correlated with histological findings. RESULTS: Only 11 cases were adequately recorded. Macroscopic description was poor in 42 cases. Major deficiencies identified included illegible hand written reports, inadequate description of organ systems, incorrect description of pathological findings and incorrect formulation of cause of death. Major diagnostic errors were identified in referred tissue samples in 13 cases--most commonly, mistaking postmortem blood clot for massive pulmonary embolism. Often organs were insufficiently or incorrectly dissected. CONCLUSIONS: Coronial postmortem examinations performed by Government Medical Officers in rural New South Wales are generally of a lower standard than should be accepted by the medicolegal community. These examinations should be viewed as specialist procedures and be performed by specialist pathologists only.

Autopsy↗
PubMed1993

A comparison of pathology usage in three New South Wales public hospitals.

Data on pathology testing in New South Wales public hospitals are extremely limited. Pathology laboratory billing files and hospital admissions and transfer files were used to obtain data on the pathology testing frequency and cost of testing at three New South Wales public hospitals. Data were also extracted that allowed a comparison of test ordering frequency and cost of testing for various groups of admitting specialists. A high degree of similarity was found in the test ordering patterns at each hospital with 16 common tests or test groups in the top 20 tests or test groups at each hospital. These 16 tests or test groups accounted for 78, 82 and 88% of the total pathology expenditure at each hospital. The total cost of pathology per occupied bed day was found to be A$26.23, A$34.63 and A$44.66 at each hospital and represented 5.5, 5.2 and 6.8% of the total cost per occupied bed day, respectively, at each hospital. Variation was found between hospitals in the cost per occupied bed day for surgery, medicine, obstetrics and gynaecology and paediatrics. Three major reasons for the variations in pathology costs were identified as variations in outpatient loads, variations in test ordering patterns among medical practitioners and casemix.

Ambulatory Care↗
PubMed1993

The prevalence of tuberculosis infection in New South Wales police recruits, 1987-1990.

OBJECTIVE: To determine the prevalence of tuberculosis (TB) infection and to determine the rate of conversion to a positive Mantoux test result after BCG vaccination in a subgroup of the Australian population. DESIGN: A descriptive and retrospective study. SETTING: The Police Academy, Goulburn, New South Wales. PARTICIPANTS: 4704 recruits to the New South Wales Police Service between 1987 and 1990. MAIN OUTCOME MEASURES: Rates of positive Mantoux test results before and after administration of BCG. RESULTS: Eleven per cent of Police Cadets were Mantoux positive. Of those who had never been vaccinated with BCG, 7% were positive. Statistically significant differences in Mantoux positivity were found in relation to age, sex and country of birth. There was also a significant difference in the frequency of positive Mantoux reactions between the group vaccinated with BCG at the Academy and those who were vaccinated earlier in life. CONCLUSIONS: Routine Mantoux testing of population subgroups provides a useful source of information on the prevalence of TB infection. However, without testing for the "booster phenomenon" only a minimum estimation of the infection rate can be determined. The National Health and Medical Research Council recommendation that a Mantoux reaction of 5-9 mm be considered positive in the southern States of Australia is supported. The low rate of conversion to a positive Mantoux test result after administration of BCG vaccine at the Police Academy indicates that Mantoux testing after vaccination is not useful.

Adult↗
PubMed1995

Legionnaires' disease surveillance: England and Wales 1994.

One hundred and sixty cases of legionnaires' disease in England and Wales were reported to the PHLS Communicable Disease Surveillance Centre in 1994, a rate of 3.1 cases per million population. Twenty-seven cases died. Eighty-nine cases (56%) were associated with travel, either in the United Kingdom (UK) or abroad, and six with a stay in hospital; the remaining cases were presumed to have acquired infection in the community. Seven outbreaks were detected in England and Wales: one was associated with a holiday centre, one with a hotel in London, two with industrial sites, and three occurred in the community. A further four clusters were associated with travel abroad: Spain, Ibiza, the Channel Islands, and a Mediterranean cruise. One hundred and twenty-eight of the 160 cases (79%) were sporadic--that is, not known to be associated with outbreaks--43 of which (34%) were not associated with travel nor acquired in hospital.

Adult↗
PubMed1995

Coronary heart disease mortality trends in England and Wales, 1952-1991.

BACKGROUND: The 'programming' hypothesis for the causation of heart disease suggests that there are critical periods of development in early life during which a stimulus or insult has permanent effects on the subject's organ or tissue structure and physiology. Exposure to such effects might be expected to be linked to year of birth and produce cohort (generation) effects in heart disease death rates. Evidence is sought for such effects in data from England and Wales. METHODS: The age- and period-specific heart disease death rates for men and women aged 30-69 in England and Wales have declined recently in both men and women. The trends have two components. The first is described by a peak in rates during 1977-1981 that applies to both sexes and all age-groups. This is consistent with risk conferred by adult diet and lifestyle. The second component required to explain the trends also applies to both sexes and is described by a risk that is lower in each successive year of birth. This is consistent with risk linked to poor growth in early life. CONCLUSION: Poor early growth has become less common as maternal health, physique and nutritional status have improved through the century. The trends are therefore consistent with the'programming' hypothesis for the causation of coronary heart disease.

Adult↗
PubMed1996

Epidemiological, virological, and clinical features of an epidemic of hand, foot, and mouth disease in England and Wales.

We describe the epidemiological, virological, and clinical features of an epidemic of hand, foot, and mouth disease, attributed to coxsackie A virus serotype 16, that occurred throughout England and Wales in the last quarter of 1994. Nine hundred and fifty-two cases were reported by spotter practices that make weekly returns to the Royal College of General Practitioners, which made this the largest epidemic of hand, foot, and mouth disease in England and Wales reported to date. Most patients were aged 1 to 4 years and lived in central or southern regions. Clinical features were unavailable from the weekly returns but were described in detail for 39 patients, mostly by means of a questionnaire to general practitioners near the PHLS Coxsackie Reference Laboratory. All cases had a rash on their hands and 23 also had rashes on their feet and in their mouths. Most cases were mild. Severity was associated with the degree of mouth involvement. Secondary cases in family members were rare. Data from the Royal College of General Practitioners since 1963 reveal a period between epidemics of two to three years. The epidemics in 1988 and 1990 also occurred in the last quarters of these years and cases were concentrated in the central and southern regions.

Adolescent↗
PubMed1993

Awareness and needs of dental implants by patients in New South Wales.

An exploratory cross-sectional analytical study of patients presenting for prosthodontic treatment to private general dental practices and public hospitals in New South Wales was completed. Significantly more patients attending private dentists had 'heard' of dental implants compared with the hospital group (G2=79.404; df=1; p<0.001) and significantly more of the former patients were aware that dental implant treatment is available in New South Wales (G2=32.823; df=1; p<0.001). Of the patients attending private practice 19.2% felt that it is likely that they may require dental implant treatment in the future and 14.1% of their current treatment requests involved implants. These figures may be considered moderately high whereas the corresponding figures for the patients attending public hospitals were low.

Attitude to Health↗
PubMed1996

General outbreaks of vero cytotoxin producing Escherichia coli O157 in England and Wales from 1992 to 1994.

We have reviewed all general outbreaks of infection due to Vero cytotoxin producing Escherichia coli (VTEC) O157 reported in England and Wales from 1992 to 1994. One hundred and seventy-three people were affected in 18 outbreaks, compared with 76 people in seven outbreaks in the preceding three years (1989 to 1991). Outbreaks occurred throughout England and Wales. Thirty-eight per cent of cases were admitted to hospital, 21% developed haemolytic uraemic syndrome, and 3% died. VTEC O157 infection causes particular concern because of its serious complications--haemorrhagic colitis and haemolytic uraemic syndrome, its capacity to spread from person to person as well as by food and water, and its reservoir in dairy and beef cattle.

Adult↗
PubMed1996

Epidemiological features of Coxiella burnetii infection in England and Wales: 1984 to 1994.

Q fever is an important zoonosis caused by the rickettsial organism Coxiella burnetii, which can result in life threatening illness, especially in those with an underlying cardiac defect. C. burnetii infections in England and Wales reported to the PHLS Communicable Disease Surveillance Centre between 1984 and 1994 were reviewed. A total of 1117 cases were reported, a third of which came from the South Western region. The annual totals fell over this period. The mean age of cases was 45 years, and 74% were men. Reports peaked in the month of May. Contact with animals, mainly cattle and sheep, was reported in 60 cases. Occupationally acquired infection was reported for 24 cases including abattoir workers, farmers, veterinary surgeons, hide handlers, and butchers. Forty-seven per cent of cases presented with respiratory symptoms, 7% with heart disease, and 5% with hepatitis. Seven per cent of cases reported travel abroad before becoming ill. Joint veterinary and medical investigations should be undertaken to establish the natural history of C. burnetii infection in England and Wales and formulate policies to prevent acute and chronic infections.

Adult↗
PubMed1996

Outbreaks of foodborne viral gastroenteritis in England and Wales: 1992 to 1994.

Outbreaks of foodborne viral gastroenteritis in England and Wales from 1992 to 1994 have been analysed using data from the national surveillance scheme for general outbreaks of infectious intestinal disease. The cause was virologically confirmed for 389 (31%) of the 1280 outbreaks for which a minimum set of data were collected. Forty-seven of the 389 were attributed to foodborne transmission, 41 of which were caused by small round structured viruses (SRSV). An infected food handler was suspected to be a contributing factor in 14 and the consumption of oysters in eight of these 41 foodborne SRSV outbreaks. No seasonal pattern emerged. The highest incidences occurred in Wales, West Midlands, and South Western regional health authorities. The annual rate of outbreaks did not increase during the three year period (Chi square for linear trend 0.6; p = 0.4). Much remains to be discovered about the epidemiology of foodborne viruses, and outbreaks present an opportunity to enhance our knowledge. As molecular diagnostic techniques become routinely available, it is likely that the role of viruses in foodborne outbreaks will be increasingly recognised.

Data Collection↗
PubMed1996

Influenza surveillance in England and Wales: October 1995 to June 1996.

This report summarises information collected for the surveillance of influenza virus infection in England and Wales from October 1995 to June 1996 (weeks 40/95 to 25/96). Total respiratory disease' activity, as reported by the Birmingham Research Unit of the Royal College of General Practitioners, rose to peaks in weeks 48/95, 51/95, and 01/96. The first peak coincided with a peak in "influenza and flu-like illness'. The subsequent peaks were accounted for by an increase in reports of acute bronchitis, including bronchiolitis, and may have been associated with the annual rise in infections with respiratory syncytial virus. Influenza A virus was responsible for most infections, with moderate activity occurring in the early part of the winter, peaking in December (week 48/95). Influenza A subtype H3N2 predominated until week 07/96, after which subtype H1N1 accounted for most infections. Influenza activity was first seen in central and northern England, followed by the south of England, Wales, and Scotland. Circulating influenza viruses were antigenically similar to the components of the 1995/96 vaccine. International surveillance during 1995/96 has led to a different H3N2 component being included in the influenza vaccine recommended for 1996/97.

Adolescent↗
PubMed1997

Results of a survey to determine whether Neospora is a significant cause of ovine abortion in England and Wales.

Between January and April 1995, the brains and hearts of 281 aborted lambs derived from 209 submissions to veterinary investigation centres in England and Wales were examined histologically. One-hundred-and-seventy-nine samples of fetal pleural fluid from these lambs and 141 from lambs not examined histologically were examined for antibodies to Neospora by an indirect fluorescent antibody test. Non-suppurative myocarditis and encephalitis were present in nine lambs. Immunocytochemistry using antisera against Neospora caninum and Sarcocystis species resulted in no labelling but anti-sera to Toxoplasma gondii revealed labelled organisms in four lambs. No significant antibody titres against Neospora were detected in any of the samples of fetal pleural fluid. These results suggest that Neospora infection is not associated with significant numbers of abortions in sheep in England and Wales.

Abortion, Veterinary↗
PubMed1997

Results from the 1995 survey of prevalent clinically diagnosed HIV infection in England, Wales, and Northern Ireland.

Health districts in England, Wales, and Northern Ireland were surveyed in 1996 to collect summary information about people with diagnosed HIV infection who received care under the statutory services in 1995. The survey provided demographic and epidemiological information about the prevalent caseload by area of residence, and the extent to which patients with diagnosed HIV infection travelled to obtain care related to it. A total of 13362 people with diagnosed HIV infection were reported to be resident and treated in England, Wales, or Northern Ireland in 1995. Forty-four per cent of these were treated outside the health district where they lived, with regional specialist centres attracting patients from wider areas. At least 13% received care from more than one treatment centre. This national survey of prevalent diagnosed HIV infections provided public health specialists with information relevant to their own localities without compromising confidentiality. This information complements surveillance data from confidential AIDS case diagnosis reports, laboratory reports of HIV infections, and the unlinked anonymous HIV prevalence monitoring programme, all of which contribute to the assessment and projection of demands on health and social services, and provide evidence on which to develop and direct national and local health campaigns.

England↗
PubMed1997

Progress with cholecystectomy: improving results in England and Wales.

BACKGROUND: The Comparative Audit Service of the Royal College of Surgeons of England studied laparoscopic cholecystectomy in England and Wales during 1990-1991. The follow-on study undertaken during 1994 provides data to assess progress. METHODS: Pro formas were sent to consultant surgeons, requesting data on open and laparoscopic cholecystectomies performed in their units during 1994 with data on mean stay, mortality, complications, and the use of peroperative cholangiography and bile duct exploration. The identity of the consultants was treated confidentially. RESULTS: Data were provided by 110 surgeons on 4823 cholecystectomies (1019 open and 3804 laparoscopic) and outcome was compared with that of 3319 attempted laparoscopic and 8035 open cholecystectomies carried out during 1990-1991. The proportion of cases attempted laparoscopically rose from 27.2 per cent in 1990-1991 to 78.9 per cent in 1994, and conversion to open cholecystectomy rose from 5.3 to 6.7 per cent respectively. During 1994 peroperative cholangiography was undertaken in 22.9 per cent of laparoscopic and 44.6 per cent of open cases. Complication rates were similar in the two study periods, except the number of reported haemorrhagic complications was reduced by 40 per cent and bile duct injuries by fivefold (from 0.33 to 0.07 per cent). CONCLUSION: During 1994 the audit sampled approximately 10 per cent of all cholecystectomies performed in England and Wales. The results suggest progress in surgical techniques compared with findings in 1990-1991.

Cholangiography↗
PubMed1997

A retrospective survey of clusters of meningococcal disease in England and Wales, 1993 to 1995: estimated risks of further cases in household and educational settings.

Information about the epidemiology of meningococcal disease case clusters and the risk of further cases is sparse. Data on clusters in household and educational settings from 1 January 1993 to 31 March 1995 was requested from consultants in communicable disease control in England and Wales through a retrospective postal survey. Ninety-three per cent (122/131) responded. Of the 114 cases in 45 reported clusters, 77 (67.5%) were microbiologically confirmed. The case fatality rate in index cases was higher than in associated cases (18.2% vs 4.5%; p = 0.02). Five out of 11 clusters in household settings consisted only of index and co-primary cases. No further cases occurred within two weeks after giving chemoprophylaxis to household contacts. The relative risks of further cases in the week after the index case arose were estimated to be 1200 for contacts in the household, 160 in secondary schools, 60 in primary schools, 1.8 in universities/colleges, and 0 in nurseries. Between seven and 30 days the relative risks were lower; 150 in households, and between 0 and 13 in all other settings. Beyond 30 days, the relative risk in the household setting was 8 and lower than this in all other settings. The absolute risk of further cases in the month following the index case was calculated as 210 per 100,000 in household members, 7-10/10(5) in pupils at the same school, and 0.6/10(5) in students at the same university or college. The current policy in England and Wales to recommend chemoprophylaxis for household members may prevent half of the further cases in this setting. Raised awareness may have contributed to the lower case fatality rate among household contacts who developed meningococcal disease, but the number of co-primary cases observed should prompt urgent enquiries about current illness in household contacts of index cases. The relative risk of further cases in preschool groups was low and apparently unaffected by changes in chemoprophylactic policy. The relative risk in school settings was raised in the month following a case, but the absolute risk was still low. Further study to quantify the risk in university settings is needed.

Adolescent↗