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At least 667 records · Page 37Linked to original sources
PubMed2003

Antibiotic susceptibilities of Gram-positive anaerobic cocci: results of a sentinel study in England and Wales.

OBJECTIVE: A sentinel study was carried out to determine the antimicrobial susceptibilities of Gram-positive anaerobic cocci (GPAC) freshly isolated from clinical material in diagnostic laboratories in England and Wales. METHODS: A total of 113 GPAC isolates consisting predominantly of current or former members of the genus Peptostreptococcus was obtained from 17 sentinel laboratories in England and one in Wales. Minimum inhibitory concentrations (MICs) of 10 antimicrobial agents were determined by the Etest method. The agents tested were: penicillin, tetracycline, erythromycin, cefoxitin, clindamycin, chloramphenicol, imipenem, co-amoxiclav, piperacillin/tazobactam and metronidazole. MIC50 and MIC90 values for each drug-species combination were calculated whenever suitable numbers of each species were obtained. RESULTS: Excellent spectra of activity (0% resistance) against GPAC were seen for metronidazole, piperacillin/tazobactam, cefoxitin, imipenem and chloramphenicol. Low degrees of resistance to co-amoxiclav (3.5%), clindamycin (7.1%), penicillin (7.1%) and significant degrees of resistance to tetracycline (41.6%) and erythromycin (27.4%) were detected. Some examples of putative macrolide-lincosamide linked resistance were noted in seven (6.2%) isolates of GPAC. CONCLUSION: This study is one of the largest susceptibility studies specifically on GPAC carried out to date and the resulting data may be of value to those involved in the empirical treatment of infections involving Gram-positive anaerobic cocci.

Anti-Bacterial Agents↗
PubMed2003

Emergence of a fluoroquinolone-resistant strain of Streptococcus pneumoniae in England.

OBJECTIVE: To determine the epidemiological relationship between pneumococci of serotype 9V, with reduced susceptibility to ciprofloxacin, penicillin and erythromycin, referred to the Reference Laboratory during 1997-2001. METHODS: Isolates were characterized by multilocus sequence typing (MLST), PFGE, and sequencing of parC and gyrA. Relevant clinical data were sought. RESULTS: Forty-eight isolates were received from nine laboratories in England, but 35 (73%) were from one laboratory in Birmingham, and were mostly from elderly patients receiving ofloxacin or ciprofloxacin for respiratory infections. There were two quinolone resistance phenotypes, with ciprofloxacin, moxifloxacin and gemifloxacin MICs of 8-32, 0.5-1 and 0.125-0.25 mg/L, and 64-256, 4-16 and 1-4 mg/L, respectively. Each of three isolates from the former group had mutations in parC, whereas each of nine isolates from the more resistant group had mutations in both parC and gyrA. Several also had increased quinolone efflux. Typing of 27 quinolone-resistant isolates showed that eight were indistinguishable from the epidemic Spain9V-3 (ST156) clone, while the remainder belonged to a novel but related type (ST609), that differed from Spain9V-3 at 2/7 alleles (2 bp changes in aroE and 1 bp change in gdh). Both MLST types were represented among isolates with high- and low-level quinolone resistance. Three of five serotype 9V isolates from Birmingham, with reduced susceptibility to penicillin and erythromycin, and ciprofloxacin MICs of 1-2 mg/L, belonged to MLST type ST609, while another was indistinguishable from the Spain9V-3 clone. Review of records of 32 patients from Birmingham indicated that some isolates were nosocomial, whereas others were acquired in the community. CONCLUSIONS: In the late 1990s, a quinolone-resistant strain, clonally related to Spain9V-3, emerged in England, principally in Birmingham.

Aged↗
PubMed2003

Ciprofloxacin-resistant Escherichia coli from bacteraemias in England; increasingly prevalent and mostly from men.

OBJECTIVES: To assess ciprofloxacin resistance among Escherichia coli isolates from bacteraemia patients in England in relation to age, sex and Region. METHODS: Routine susceptibility data for bacteraemia isolates were collected from over 90% of hospitals in England. RESULTS: During 1995-2001, the prevalence of ciprofloxacin resistance trebled, from 2.1% to 6.5%. Isolates from men were more frequently resistant than those from women, possibly because infections in men more often involve nosocomial strains. Resistance was rare (<1.5%) in isolates from patients aged <1 year; among older patients, resistance was unrelated to age in isolates from women, but peaked in the 15-44 age group for men. CONCLUSIONS: The prevalence of ciprofloxacin resistance in E. coli from bacteraemia is strongly associated with sex and, to a lesser extent, age.

Adolescent↗
PubMed2005

Real-time PCR detection and frequency of 16S rDNA mutations associated with resistance and reduced susceptibility to tetracycline in Helicobacter pylori from England and Wales.

OBJECTIVES: To investigate the occurrence of 16S rDNA mutations associated with resistance or reduced susceptibility to tetracycline in Helicobacter pylori isolated in England and Wales, and to develop a real-time PCR assay to detect these DNA polymorphisms from culture and gastric biopsies. METHODS: Tetracycline susceptibility was determined by disc diffusion. The MIC of isolates with reduced susceptibility was determined by Etest and agar dilution methods. The 16S rDNA of these isolates was sequenced and resistance-associated mutations identified. A LightCycler assay developed to detect these mutations was applied to DNA extracted from culture and gastric biopsies. RESULTS: From 1006 isolates of H. pylori examined, 18 showed reduced susceptibility to tetracycline. Of these, three were resistant (>or=4 mg/L). Mutations in 16S rDNA were detected in 10 of the reduced susceptibility isolates: one double base mutation of A926T/A928C, one A926C, one A928C; and seven A926G. The first two polymorphisms were novel and had not been reported from clinical isolates previously. The LightCycler assay identified each of the 10 isolates with 16S rDNA mutations, but did not detect polymorphisms in 100 tetracycline-susceptible H. pylori isolates. The assay correctly determined the tetracycline susceptibility of H. pylori in 20 gastric biopsy samples. CONCLUSIONS: Mutations in 16S rDNA were detected in H. pylori isolated in England and Wales with reduced susceptibility to tetracycline, but resistance to this antibiotic was uncommon. We show molecular-based susceptibility testing for tetracycline is possible direct from biopsy material.

DNA, Ribosomal↗
PubMed1997

Predicting the future demand for renal replacement therapy in England using simulation modelling.

BACKGROUND: The purpose of the study was to estimate the future demand for renal replacement therapy in England. Simulation modelling was used to estimate the future demand, under varying assumptions, about the growth in the acceptance rate for renal replacement therapy, patient and treatment survival, and the availability of kidney transplants. METHODS: Data were obtained from the National Renal Review, the European Dialysis and Transplant Registry, and the United Kingdom Transplant Support Services Authority. They were analysed to provide transfer and survival data on patients treated for end-stage renal failure in England and in four exemplary district health authorities. The simulation runs provided estimates of numbers of patients being treated by dialysis and transplantation over the next 15 years. RESULTS: The results indicated that the number under treatment was predicted to rise by between 50 and 100% over the next 15 years, with a disproportionate increase in dialysis of up to 150%. There will be more 'high-risk elderly' people under treatment, particularly amongst the dialysis patients. The growth in numbers will vary between districts depending on their level of need and current service position. CONCLUSION: There will be increasing numbers of patients, particularly elderly patients with associated comorbidity, receiving treatment. Given the shortage of kidneys for transplantation, the demand will fall on haemodialysis and continuous ambulatory peritoneal dialysis facilities. Purchasers are thus faced with steeply rising costs for this patient group, especially in areas of high need, whilst needing to find improvements in their quality of care.

Adolescent↗
PubMed2004

Simulation model of renal replacement therapy: predicting future demand in England.

BACKGROUND: The demand for renal replacement therapy (RRT) in England has risen steadily, although from a lower base than many other developed countries. Predicting the future demand for RRT and the impact of factors such as the acceptance rate, transplant supply and patient survival, is required in order to inform the planning of such services. METHODS: A discrete event simulation model estimates the future demand for RRT in England in 2010 for a range of scenarios. The model uses current prevalence and current and projected future acceptance rates, survival rates and the transitions between modalities to predict future patient numbers. National population and mortality data, published literature and data from the UK Renal Registry and UK Transplant, are used to estimate unmet need for RRT, the impact of changing demography and incidence of Type 2 diabetes, patient haemodialysis (HD) survival and transplant supply. RESULTS: By 2010 the predicted prevalence will have increased from about 30,000 in 2000 to between 42 and 51,000 (900-1000 p.m.p.), an average annual growth of 4.5-6%. Changing transplant supply has a small effect on overall numbers but changes the proportion of patients with functioning graft by up to 8%. Even with an optimistic increase in transplant supply (11% p.a. for 5 years), numbers on HD will continue to rise substantially, especially in the elderly. The factors most influencing future patient numbers are the acceptance rate and dialysis survival. CONCLUSION: This model predicts a substantial growth in the RRT population to 2010 to a rate approaching 1000 p.m.p., particularly in the elderly and those on HD, with a steady state not being reached for at least 25 years.

Adolescent↗
PubMed2002

Effectiveness of community-based salaried orthodontic services provided in England and Wales.

OBJECTIVES: To assess the effectiveness of the salaried Community Orthodontic Services in England and Wales, using occlusal indices, and to determine the predictors of treatment outcome. DESIGN: A retrospective investigation. A random stratified sample of districts where Community Orthodontic Services are provided was selected and visited during 1997. METHOD: All community orthodontists in England and Wales, and CDS managers who could be identified were asked to take part in this study. A stratified random sample of 15 per cent of the districts where community orthodontic services were provided was selected and a sample of the records of treated patients was examined. RESULTS: The orthodontists in the sample were providing treatment for patients clearly in need of treatment. There were, however, some variations between districts. Similarly, when the effectiveness of treatment in terms of dento-alveolar change was evaluated, the mean change in PAR and percentage PAR reduction was high. Again, there were variations between the districts. CONCLUSIONS: The Community Orthodontic Service provides effective orthodontic treatment to many individuals clearly in need of that treatment. The most significant predictor of treatment outcome was the use of two-arch fixed appliances, which produced the best treatment outcome

Bias↗
PubMed2000

Trends in epilepsy mortality in England and Wales and the United States, 1950-1994.

The aim of this study was to analyze time trends in epilepsy mortality in England and Wales and the United States between 1950 and 1994. The authors calculated age- and sex-specific epilepsy mortality rates for the nine quinquennia from 1950-1954 to 1990-1994. Mortality rates were modeled as a function of age, period of death, and cohort of birth by using Poisson regression techniques. From 1950 to 1994, there were more than 110,000 deaths from epilepsy in the two countries. The secular trends in mortality were similar for both sexes and in both countries. Among people younger than age 20 years, epilepsy mortality declined steeply after 1950. For young and middle-aged adults, the rate of decline was lower. In the geriatric population, mortality declined between 1950 and 1974 but then increased. The Poisson model showed pronounced birth cohort effects. In the United States, epilepsy mortality fell with each successive birth cohort after 1905. In England and Wales, there was a similar decline in birth cohort mortality after 1905 for women but not until after 1950 for men. The pronounced birth cohort effect supports explanations that focus on antenatal and developmental factors as the cause for the decline in epilepsy mortality in all but the oldest age groups between 1950 and 1994.

Adolescent↗
PubMed1985

Declining fertility in England and Wales as a major cause of the twentieth century decline in mortality. The role of changing family size and age structure in infectious disease mortality in infancy.

The decline in infectious disease mortality in England and Wales beginning about 1880 has been attributed to improved nutrition, hygiene, and sanitation. Such an explanation does not adequately explain the lack of improvement in infant and diarrheal disease mortality before 1900 nor the abrupt subsequent decline. A hypothesis was proposed that the decline in fertility rate was a major cause of the decline in infant mortality by raising the median age at infection. The hypothesis could only be tested indirectly. A review of morbidity data demonstrates the importance of family characteristics on the median age at infection for measles, pertussis, and common respiratory illness. The association of parity with infectious disease mortality supports the hypothesis. A method was developed for estimating the change in birth order distribution resulting from declining fertility. Using 1949-1950 data, it was shown that declining fertility could account for at least a 24% decline in postneonatal mortality due to bronchitis and pneumonia. Age-specific measles mortality rates are consistent, with an increase in age at infection. Declining fertility appears to have played a major role in the decline in infectious disease mortality in England and Wales by increasing the median age at infection.

Adolescent↗
PubMed1993

Estimating the variance of standardized rates of recurrent events, with application to hospitalizations among the elderly in New England.

Usual approaches for estimating the variance of a standardized rate may not be applicable to rates of recurrent events. Where individuals are prone to repeated health events, Greenwood and Yule (J R Stat Soc [A], 1920;83:255-79) advocated use of the negative binomial distribution to account for departures from the assumption of randomness of recurrent events required by the Poisson distribution. In this paper, the authors implemented the negative binomial distribution in the computation of annual hospitalization rates within certain hospital market areas. Data used were from 1,549,915 New England residents aged 65 years or more who were enrolled in Medicare between October 1, 1988, and September 30, 1989, and who had 458,593 hospital admissions during that year. New England was partitioned into 170 hospital market areas ranging in population size from 162 to 70,821 elderly Medicare enrollees. The negative binomial distribution demonstrated substantially better fits than the Poisson distribution to the numbers of hospitalizations within hospital market areas. Estimated standard errors for indirectly standardized rates based on the negative binomial distribution were 25-51 percent higher than estimated standard errors that assumed an underlying Poisson distribution. Using regression analysis to smooth overdispersion parameters across hospital market areas produced similar results. The approach described in this paper may be useful in estimation of confidence intervals for standardized rates of recurrent events when these events do not recur randomly.

Age Factors↗
PubMedDate not supplied

Racial and ethnic identification practices in public health data systems in New England.

OBJECTIVE: Efforts are underway to standardize "racial" and "ethnic" identification in public health data systems under the Revised Minimum Standards for the Classification of Federal Data on Race and Ethnicity issued in 1997. This study analyzed the racial and ethnic constructs and labels used in public health data systems maintained by the six New England states in light of these standards. METHODS: The authors surveyed public health officials responsible for ongoing individual-level data systems and reviewed relevant documents. RESULTS: Information was obtained on 169 of 170 identified data systems. Ninety-one systems (54%) conformed to the federal standard in having separate "race" and "ethnicity" fields, yet many of these did not conform to the standard in other respects. Fifty-five systems had only a race field; of these, 20 included no identifiers corresponding to Hispanic and/or Latino ethnicity. Three systems used only an ethnicity field. The systems used various lists of racial and/or ethnic categories, and overlapping but not fully comparable labels. Few systems allowed for identification of ancestry groups not included in the revised federal guidelines but with large populations in New England, such as Brazilians. Some definitions and coding instructions seemed inconsistent with social and geographic reality. CONCLUSIONS: These public health data systems used inconsistent methods for classifying people by race and ethnicity. Standardization according to federal standards would improve comparability, but would limit options for defining and including some ethnic groups while forcing other groups to be aggregated in single race categories, perhaps inappropriately. Fundamental reconsideration of racial and ethnic categorization is called for.

Censuses↗
PubMed2000

Patients and procedures in short-stay independent hospitals in England and Wales, 1997-1998.

BACKGROUND: Private hospitals' activities are not routinely reported, so what services they provide and for whom is not known. This study describes the clientele and case-mix of independent hospitals in England and Wales in 1997-1998. METHOD: Person, clinical and funding data were collected on samples of patients admitted to 215 of 221 independent hospitals open in 1997-1998. Sample numbers were weighted to reflect sampling duration, region, season and non-response. RESULTS: A total of 37,434 sampled records represented 828,422 admissions: 406,843 in-patients (5 per cent fewer than in 1992-1993) and 421,580 day cases (69 per cent more); 806,509 were residents of England and Wales (up 24 per cent); 16,628 came from overseas (down 20 per cent). Numbers increased in all age groups except children; 25 per cent were 65 or over (18 per cent in 1992-1993). The commonest procedures were abortion (11 per cent), endoscopy of the gastro-intestinal tract (10 per cent) or joints (5 per cent), lens operations (5 per cent), hernia repairs (3 per cent), and other common National Health Service (NHS) elective operations. The NHS funded 84,561 patients (11 per cent of the total) including 41,942 non-abortion cases (6 per cent). A total of 540,996 (76 per cent) paid through insurance; 119,101 (17 per cent) were self-funded including 30 per cent of the over-75s. Ninety-five per cent of patients went home, 0.3 per cent died and 0.2 per cent were transferred to NHS hospitals. CONCLUSIONS: Demand for short-stay independent hospital care is rising. The clientele is becoming older, and readier to pay out of pocket. Clinical activity is mainly surgical and similar to NHS elective surgical demand. One year's caseload equals 10 weeks' elective admissions to NHS hospitals, in that sense relieving the NHS. The scale of transfer to NHS hospitals (three per day) is small.

Adolescent↗
PubMed2001

Hidden need for drug treatment services: measuring levels of problematic drug use in the North West of England.

BACKGROUND: In the North West of England, data on drug users are routinely collected from a variety of agencies including specialist treatment centres, police and probation services. However, the covert nature of drug use means that alone, these conventional monitoring systems cannot provide the epidemiology required to target and develop drug treatment and prevention initiatives. METHODS: Utilizing surveillance data and capture-recapture techniques we estimate the rates of problematic drug users by age and sex in five North West health authorities and one local authority. RESULTS: Analyses show concentrations of problematic drug use in large metropolitan areas (Liverpool and Manchester) with levels as high as 34.5 and 36.5 per 1000 population (ages 15-44), respectively, and, for males, levels exceed 50 per 1000 in three authorities. Patterns of prevalence for those aged 25 and over differed from those in the younger age groups, with disproportionate levels of young users outside metropolitan areas. The proportion of young users already in treatment (21.3 per cent) was lower (older users, 35.3 per cent), with overall proportions in treatment varying between health authorities (range 26.2-46.5 per cent). CONCLUSION: With a multi-agency approach, established monitoring systems can be used to measure hidden populations of drug users. Estimates of the current populations of such users in the North West of England suggest that planned increases of people in treatment by 100 per cent would fail to accommodate even current level of problematic users. A holistic approach to new initiatives must ensure that the high level of relapse once drug users are discharged are reduced and that the needs of young users are addressed before prolonged treatment is required.

Adolescent↗
PubMed2002

Admissions to hospital for deliberate self-harm in England 1995-2000: an analysis of hospital episode statistics.

BACKGROUND: Rates of deliberate self-harm (DSH) were increasing in the United Kingdom during the 1980s and early 1990s, particularly among young adult males. Self-poisoning with paracetamol was the most common means, with overdoses of anti-depressants becoming more frequent. Changes to paracetamol pack size regulations in 1997 have been followed by a reduction in overdoses, and there has been more prescription of anti-depressants less likely to necessitate hospitalization if overdosed. Improved liaison psychiatry services and increased levels of employment are among the factors that would suggest an impact on hospital admissions for self-harm. This study analysed DSH admissions to hospitals in England from 1995/96 to 1999/2000 to examine changes. METHODS: A retrospective analysis of the Hospital Episode Statistics database was carried out. RESULTS: Hospital admissions for DSH rose to 153 per 100000 in 1997/98, then declined to 143 per 100000 in 1999/2000. Paracetamol overdoses decreased from 77 to 67 per 100000. The use of anti-depressants or tranquillizers grew from 56 to 75 per 100000 during the 5 years. Self-injury, narcotics overdoses and the use of alcohol continued to increase over time. CONCLUSIONS: Yearly increases in admissions for DSH to hospitals in England reversed in 1998/99 and stabilized in 1999/ 2000. These changes were most noticeable for the 16-24 years age group. The use of paracetamol decreased, whereas other means of self-harm increased. Regional differences and the relationship between rates of DSH in the community and hospital should be explored further.

Adolescent↗
PubMed2003

Place of death: analysis of cancer deaths in part of North West England.

BACKGROUND: Relatively little work of a detailed geographical nature has been undertaken on the distribution of place of death. In particular, given evidence that most cancer patients would prefer to die at home there is a need to examine the extent to which this preference is met differentially from place to place. METHODS: Using data on cancer deaths for a single Health Authority in North West England we conducted both small area and individual analyses of place of death, using binomial and binary logistic regression models, respectively. RESULTS: Results from the small area analysis show that in more deprived areas cancer patients are more likely to die in hospital or hospice, and less likely to die at home, but that the effect disappears for home and hospice deaths once other factors are controlled for. At the individual level, the probability of death at home decreases among those living in deprived areas, whereas the probability of death in hospital increases as area deprivation increases. Age, gender, type of cancer, and proximity to hospital or hospice all have some effect on the probability of dying in a particular setting. CONCLUSION: There is significant place-to-place variation in place of death among cancer patients in part of North West England. However, studies of place of death among cancer patients need to consider the full range of settings and, if examining the impact of deprivation or social class, need to adjust for other factors, including proximity to different settings.

Death↗
PubMed2004

Alcohol as a certified cause of death in a 'middle England' population 1979-1999: database study.

The Alcohol Harm Reduction Strategy for England, recently published, highlights current concerns about alcohol consumption in this country. We used a database to examine trends in mortality for all deaths certified as effects of alcohol from 1979-1999, including mentions as well as underlying cause, in a relatively prosperous population in southern England. Mortality, certified as direct effects of alcohol, tripled during the 21 years of study; and mortality rates based on mentions were about double those based on underlying cause. The increase in recent years in mortality based on mentions was considerably greater than that based on underlying cause. Data on age, sex and occupational social class show that people whose alcohol intake kills them are from a broad cross-section of society.

Adolescent↗
PubMed2004

The epidemiology and management of self-harm amongst adults in England.

BACKGROUND: Previous research into the epidemiology and management of self-harm has been largely based in centres with a special interest in this behaviour or focused on hospital admissions only. There are no national data on the characteristics and management of people presenting to hospital following self-harm. METHODS: Data were collected from 8-week service audits carried out in a stratified random sample of 31 general hospitals in England. RESULTS: 4033 episodes of self-harm resulting in presentation to Accident and Emergency Departments were identified. Overdose alone accounted for 79 per cent of episodes, 80 per cent of presentations were outside normal office hours (9 am - 5 pm, Monday to Friday) and the peak period of attendance was from 8 pm to 2 am. In only 56 per cent of episodes was a specialist psychosocial assessment conducted prior to discharge and less than half (46 per cent) led to admission to a hospital bed. Psychiatric admission occurred in 10 per cent. Episodes involving older subjects (>45 years) and those using methods other than laceration or overdose were the most likely to lead to assessment and admission. CONCLUSIONS: Non-fatal self-harm is one of the strongest predictors of suicide, yet nearly half of all hospital attendances in England following self-harm do not lead to a specialist assessment. Patterns of service provision should take account of the observation that most self-harm attendances occur outside normal working hours and those at greatest risk of repetition are the least likely to receive assessments.

Adolescent↗
PubMed2005

Geographical distribution of road traffic deaths in England and Wales: place of accident compared with place of residence.

BACKGROUND: There are two sources of information on road traffic mortality in England and Wales: ONS records giving the place of residence and police records giving the place of the accident. Use of the police records has been limited by the lack of an obvious denominator to control for population at risk. This study compares the two measures and explores the implications of using the same population denominator for both. METHODS: The number of road traffic deaths occurring in 403 local authority districts in England and Wales during 1995-1999 was compared to the number of deaths to residents in the same period. Both numbers were related to the expected number of deaths to residents and selected environmental risk factors using regression techniques. RESULTS: Large differences were found between the number of deaths in each district and the number of deaths to residents. The expected number of deaths to residents was the strongest predictor of both observed totals. The number of deaths in the district and the number divided by expected deaths of residents were highly predictable from road accident risk factors, but the number of deaths to residents and the conventional SMR were not. CONCLUSION: Information on the place of residence of road traffic accident fatalities does not show true variations in accident risk. Police records are better for this purpose. The expected number of deaths to residents estimate provides a partial but effective and unbiased control for population effects.

Accidents, Traffic↗