[Aging report. Observation on geriatric care in England. 12. Various geriatric facilities in England. 8. St. Pancreas Hospital, London].
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Aged↗
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Laparoscopic cholecystectomy in England and Wales: results of an audit by The Royal college of Surgeons of England.
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Cholecystectomy, Laparoscopic↗
North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management angina. North of England Stable Angina Guideline Development Group.
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Adrenergic beta-Agonists↗
Use of the internal mammary artery graft in Northern New England. Northern New England Cardiovascular Disease Study Group.
BACKGROUND: There is evidence that patients who receive an internal mammary artery graft (IMA) during coronary artery bypass surgery have increased long-term survival. However, an IMA is not used in all patients. METHODS AND RESULTS: We studied the use of IMA grafts among 7944 patients undergoing initial, isolated coronary artery bypass surgery in Maine, New Hampshire, and Vermont from 1992 to 1995. Overall, the IMA graft was used in 82% of patients; of these, 97.2% had left IMA grafts. The use of the IMA graft varied considerably by patient and disease factors. Women received an IMA graft significantly less often (76% versus 85% in men, P<.01). Older patients (> or =75 years) were less likely to receive an IMA graft (67% versus 86%, P<.001). Smaller BSA was also associated with lower rates of IMA grafts in both sexes; however, men and women with BSA <1.8 m2 received an IMA graft at about the same rate. In general, more sick and more urgent patients had lower rates of IMA use. Patients with left ventricular ejection fraction <40% received an IMA less often than those with an ejection fraction > or =60% (77% versus 85%, P<.01). Patients with a greater number of diseased coronary vessels received an IMA more often (one, 78%; two, 82%; three, 85%). IMA use varied significantly by priority of surgery, with elective patients receiving an IMA 88% of the time, urgent 83%, and emergent 51% (Ptrend<.01). The use of the IMA graft varied from 42% to 95% among individual surgeons. Surgeons were consistent in their patterns of IMA graft use for specific risk groups. All surgeons had lower rates of IMA use among older patients, lower rates of IMA among women, and lower rates of IMA use among emergent or urgent patients. However, "low-use" surgeons had consistently lower rates of use within these patient groups. The overall rate of IMA graft use increased from 76% in 1992 to 86% in 1995 (Ptrend<.001). IMA graft use increased in all five centers and in all patient subgroups. The largest increases in use were seen among women (from 69% to 83%), among patients older than 75 years (from 55% to 75%), and in emergent patients (from 40% to 72%). CONCLUSIONS: This regional prospective study of IMA graft use in initial coronary artery bypass surgery describes substantial variability in patient groups receiving an IMA as well as increasing IMA graft use over time. It also suggests that the practice patterns of surgeons are an important determinant of IMA use. These data indicate that even more patients could benefit from the use of this technique.
Aged↗
A comparative review of gynecological day case surgery between England and Wales, France, and Germany.
A comparison was made of gynecological day case surgery between England and Wales, France, and Germany. Hospital In-Patient Enquiry statistics (1979-1985) as well as Department of Health statistics (after 1985) and the Audit Commission Reports (1990-1992) were used for England and Wales; the Baudelocque Hospital Audit (Paris) between 1985 and 1990 was used for France; the Niedersachsen Regional Audit between 1989 and 1990 was used for Germany. These are the only available statistics for all three countries. A retrospective analysis of these statistics of gynecological day case surgery produced estimates of its rate for common gynecological operations in the three countries. It showed that England and Wales performed significantly more (18 per cent) gynecological procedures as day cases than either France (less than 5 per cent) or Germany (11 per cent). Additional specific comparisons were made for certain procedures between England and Wales and France (TOP) and between England and Wales and Germany (D&C, laparoscopy, TOP, ERPC, and cone biopsy). day case surgery was performed in hospitals in England and Wales and in France whereas it was performed in freestanding units in specialists surgeries in Germany. Furthermore, there seemed to be a wide regional variation in the rate in England and Wales and in Germany. Waiting lists were significant in England and Wales and nonexistent in France and in Germany. However, medical unemployment was almost nonexistent in England and Wales whereas it was alarming in France and in Germany. The methods of financing of the health care systems appear to explain the intercountry variation.
Ambulatory Surgical Procedures↗
Salmonella in pigs and animal feeding stuffs in England and Wales and in Denmark.
A comparison has been made between the incidence of salmonellas in pigs and feeding stuffs in England and Wales and in Denmark. In Denmark there is veterinary legislation requiring the sterilization of imported and home produced feed ingredients of animal origin. There is no such legislation in England and Wales. In Denmark 0.3% of resterilized imported meat and bone meal was contaminated with salmonellas. This compared with 23% of meat and bone meal in England and Wales and 20-27% of other ingredients of animal origin. In England and Wales salmonellas were isolated from 7% of caecal samples and 6% of lymph node samples, while in Denmark they were isolated from 3% of caecal samples and 4% of lymph node samples. In England and Wales 25 serotypes were found in both pigs and feeds and these included nearly all the most prevalent human pathogens. In Denmark four of the six serotypes in pigs had been found in resterilized feed. One notable difference between the two studies was the very wide range of serotypes found in pigs in England and Wales and the narrow range in Denmark. A second was that Salmonella typhimurium formed 15% of all Salmonella strains isolated from pigs in England and Wales, and 60% of those in Denmark.It is concluded that sterilization of animal raw ingredients in Denmark has reduced pig infections with types other than S. typhimurium that are found in England and Wales, but not with S. typhimurium. It is possible that this is because S. typhimurium once introduced into pigs is able to establish itself more easily than other serotypes.
Animal Feed↗
Cancer incidence in England and Wales and New Zealand and in migrants between the two countries.
Risks of cancer incidence in people born in England and Wales and New Zealand (non-Maoris) living in their home countries, and after migration between the two countries, were analysed using data from their national cancer registries. Since these populations are of similar genetic origin, any real differences in cancer incidence between them are likely to reflect the action of environmental or behavioural risk factors. The greatest differences in risk between the countries were for cutaneous melanoma and lip cancer. In each sex, relative risks of these malignancies were 4 or greater for the New Zealand-born in New Zealand compared with English and Welsh natives in their home country, and risks for migrants in each direction were generally intermediate between those born in the home country in the two countries. Sizeable significantly raised risks in the New Zealand-born in New Zealand compared with English and Welsh natives in England and Wales also occurred for cancers of the mouth, small intestine, colon, thymus, eye and thyroid, and non-Hodgkin's lymphoma in each sex, and for cancer of the prostate. For all of these sites except mouth, small intestine and colon there were also risks around or above New Zealand-born levels for English and Welsh migrants to New Zealand; for colon cancer these migrants had risks close to those in England and Wales. New Zealand migrants to England and Wales had risks of cancers of the colon and prostate that were similar to or above New Zealand levels. Risks of cancers of the stomach, lung, pleura and bladder, and Hodgkin's disease in each sex, and cancers of the cervix, ovary and scrotum and penis, were substantially and significantly lower in the New Zealand-born living in New Zealand than in English and Welsh natives in England and Wales. In English and Welsh migrants to New Zealand risks of bladder cancer in each sex, and of scrotal and penile and pleural cancer in males, approximated to England and Wales risks; cervical cancer risk approximated to the New Zealand risk; and stomach, lung and ovarian cancers showed intermediate risks. Migrants from New Zealand to England and Wales did not gain the lung cancer or clearly the stomach cancer risk of their host country, but did have bladder cancer risks approximating to those in England and Wales.(ABSTRACT TRUNCATED AT 400 WORDS)
Breast Neoplasms↗
A comparison of the prevalence of rheumatoid arthritis and other rheumatic diseases amongst Pakistanis living in England and Pakistan.
The impact of environmental factors on the causation of rheumatoid arthritis (RA) is thought to be considerable. We explored this by comparing the prevalence of RA amongst Pakistanis living in England, where it is relatively high amongst ethnic English, and in Pakistan. The frequency of other rheumatic diseases was also compared. Information on 2056 adult Pakistanis in England and 4232 in Pakistan was obtained by house-to-house surveys using identical protocols. Positive respondents were examined by the same two clinicians in both countries. Rheumatic complaints increased with age and were more common in females in both communities. The standardized morbidity ratio (SMR) (95% CI) of RA in England was 2.1 (1.1-3.1) compared with Pakistan, a difference that was entirely attributable to females. The SMR (95% CI) for women was 3.0 (0.4-5.6) and for men 0.86 (-0.84 to 2.56). In Pakistan, there was a trend to more reporting of some but not all rheumatic complaints amongst the affluent segment of the population. This was increasingly apparent amongst those resident in England and the possibility of an impact of easier ascertainment amongst the more educated cannot be discounted. Low back pain was significantly more common in England. Furthermore, the colder climate was frequently invoked as a cause of more symptoms in England. Thus, several factors may have influenced the observation that RA is more common amongst Pakistanis in England compared with Pakistan. An environmental factor cannot be excluded. However, the frequency of non-specific musculoskeletal pain was similar. The regions of Pakistan from which the two populations were derived were also different and immunogenetic heterogeneity might also have contributed to the difference in RA prevalence.
Adolescent↗
Organ donation from intensive care units in England and Wales: two year confidential audit of deaths in intensive care.
OBJECTIVES: Quantify possible increases in cadaveric organ donation from intensive care units; identify major sources of regional variation. DESIGN: Confidential audit of all deaths in intensive care units in England in 1989 and 1990 and in Wales in 1990. SETTING: 15 regional and special health authorities in England; Wales. PATIENTS: 24,023 audited deaths in England; 682 in Wales. MAIN OUTCOME MEASURES: Solid organ and corneal donor rates per 100 deaths; solid organ donor rate per 100 confirmed brain stem deaths; regional variation in (a) whether brain stem death was possible diagnosis, (b) general medical contraindications to donation, (c) relatives' refusal. RESULTS: Confirmed brain stem death accounted for 2389 (10%) audited deaths in England. In 438 (18%) there was a general medical contraindication to organ donation, and of 1829 (94%) families asked about donation, 557 (30%) refused. Data for England suggested that among potential donors the heart is suitable for transplantation in 65% of cases, the kidneys in 95%, the liver in 71%, the lungs in 31%, and the corneas in 92%. Reasons for any shortfall in achievement of transplantation varied with organ type. Solid organ and corneal donor rates per 100 deaths were 5.0 and 3.9 respectively in England and 4.3 and 2.1 respectively in Wales. The solid organ donor rate per 100 confirmed brain stem deaths was 50 in England and 41 in Wales. CONCLUSIONS: A 20% increase in number of cadaveric kidney donors from intensive care could be achieved by prompt testing for brain stem death and a quarter reduction in relatives' refusals.
Adult↗
Recent trends in diagnoses of HIV and other sexually transmitted infections in England and Wales among men who have sex with men.
OBJECTIVES: To examine trends in rates of diagnoses of HIV and other sexually transmitted infections (STIs) in men who have sex with men (MSM) in England and Wales between 1997 and 2002. METHODS: Estimates of the MSM population living in England and Wales, London and the rest of England and Wales were applied to surveillance data, providing rates of diagnoses of HIV and STIs and age group specific rates for HIV and uncomplicated gonorrhoea. RESULTS: Between 1997 and 2002, rates of diagnoses of HIV and acute STIs in MSM increased substantially. Rates in London were higher than elsewhere. Rises in acute STIs were similar throughout England and Wales, except for uncomplicated gonorrhoea and infectious syphilis, with greater increases outside London. Rates of gonorrhoea diagnoses doubled between 1999 and 2001 (661/100,000, 1271/100,000, p<0.001) in England and Wales followed by a slight decline to 1210/100,000 (p=0.03) in 2002-primarily the result of a decline in diagnoses among men aged 25-34 (1340/100,000, 1128/100,000, p<0.001) and 35-44 (924/100,000, 863/100,000, p=0.03) in London. HIV was the third most common STI diagnosed in MSM in England and Wales and the second in London, with the highest rate (1286/100,000) found among men aged 35-44 in London in 2002. CONCLUSIONS: Rates of diagnosis of HIV and other STIs have increased substantially among MSM in England and Wales. Increases show heterogeneity by infection, geography, and age over time. Rates in London were twice those seen elsewhere, with greatest changes over time. The observed changes reflect concomitant increases in high risk behaviour documented in behavioural surveillance survey programmes.
Adolescent↗
Dental health of prisoners in the north west of England in 2000: literature review and dental health survey results.
BACKGROUND: A caries prevalence study of prisoners in the North West of England was conducted to allow comparisons with results of the 1998 United Kingdom Adult Dental Health Survey. METHOD: A random sample of prisoners in the North West of England was interviewed and examined using the same criteria as the 1998 United Kingdom Adult Dental Health Survey. RESULTS: From a random sample of 316 prisoners, 279 (88%) were interviewed and 272 (86%) received a dental examination. Prisoners enter prison with twice as many decayed teeth (mean 4.2) than found in the general population in the North West of England (mean 1.9). Prisoners also have fewer restored teeth. There was little difference between the mean DMFT of adult male prisoners and young offender male prisoners. There was little difference in the mean DMFT of those in prison for more or less than two years. CONCLUSIONS: Prisoners in the North West of England had more decayed or unsound teeth, and fewer restored teeth than both non-institutionalised adults in the North West of England and social classes IV and V in England. Attempts to improve the effectiveness and efficiency of the Prison Dental Service in the North West of England may render the prison population dentally fit more speedily.
Adolescent↗
Vaccination policy against smallpox, 1835-1914: a comparison of England with Prussia and Imperial Germany.
There are three identifiable phases in comparing vaccination policy in England, Prussia and Imperial Germany. (1) Prior to the 1870's the tradition of medical police in Prussia resulted in the vaccination of the population being treated as a State responsibility earlier than in England and provided an appropriate administrative framework. The administrative pressure that could be exerted persuaded the Prussian authorities that legislation to make vaccination compulsory was unnecessary. In contrast, England and Wales lacked both the tradition and administrative structures of a medical police. Legislation (1840, 1853) for free and universal infant vaccination was followed by radical ideological and administrative innovation. (2) From 1875 to 1889 both countries provided free and compulsory vaccination for all. In England this was limited to infants; in Germany including Prussia, it included the re-vaccination of children. (3) After 1889 England and Germany began to diverge more sharply. In England vaccination rates fell and after 1898 conscientious objectors were excused from having to have their children vaccinated. Germany retained compulsory vaccination and rates in the two countries increasingly diverged. England came to rely on the local public health administration for the surveillance and containment of smallpox, including selective vaccination of contacts. Despite these differences smallpox mortality dropped sharply in both countries, although in Germany somewhat earlier. The English reliance on surveillance and containment prefigures that of the WHO in the eradication of smallpox in the Third World. It suggests that the emphasis on the importance of high levels of mass vaccination in the German literature should perhaps be revised.
Germany↗
Retrovirus D/New England and its relation to Mason-Pfizer monkey virus.
Seventeen isolates of retrovirus D/New England have been obtained from three species of macaques at the New England Regional Primate Research Center. Seven of the isolates were obtained from macaques who subsequently died with the macaque immunodeficiency syndrome; other isolates were obtained from macaques with less severe or other forms of illness. Attempts to isolate type D retrovirus from peripheral lymphocytes of 97 apparently healthy macaques have not been successful. Cloned DNA was prepared from Hirt supernatants of cells infected with one of these isolates (D/New England 398). By restriction endonuclease analysis, cloned pD398 DNA represented full-length viral DNA with one long terminal repeat. A detailed restriction endonuclease map of pD398 was derived and compared with a map of the cloned Mason-Pfizer monkey virus genome. Forty-six percent (13 of 28) of restriction endonuclease sites were found to be conserved when these related viruses were compared. Five of the D/New England isolates, including those from three different macaque species, were examined for strain variability by restriction endonuclease typing. Comparison of over 30 restriction endonuclease sites has not distinguished any of these D/New England isolates. It thus appears that a single strain of type D retrovirus is infecting three different species of macaques in the New England colony. Markedly reduced cross-hybridization was observed between cloned pD398 and Mason-Pfizer monkey virus DNAs at high stringency; this reduced cross-hybridization was localized to the pol-env regions of the genome. Only very weak hybridization of D/New England DNA to cloned squirrel monkey type D retrovirus DNA could be detected even at low-stringency conditions. What role type D retrovirus plays in the immunodeficiency syndrome of macaques remains to be determined.
Animals↗
Clinical lead poisoning in England: an analysis of routine sources of data.
OBJECTIVE: To examine the occurrence of clinical lead poisoning in England based on routine sources of data. METHODS: Three routine data sources were examined, over different periods according to availability of data: (a) mortality for England, 1981-96; (b) hospital episode statistics data for England, for the 3 years 1 April 1992-31 March 1995; (c) statutory returns to the Health and Safety Executive under the reporting of injuries, diseases, and dangerous occurrences regulations (RIDDOR), also for the period 1 April 1992-31 March 1995. Also, analyses of blood lead concentrations carried out by the Medical Toxicology Unit, Guy's and St Thomas' Hospital Trust in London during the period 1 January 1991-31 December 1997 were examined. The analyses were performed both for industrial screening purposes and in response to clinicians' requests where lead poisoning was suspected. This is one of several laboratories carrying out such analyses in the United Kingdom. RESULTS: One death, of a 2 year old girl, was coded to lead poisoning in England during 1981-96. Analysis of hospital episode statistics data identified 83 hospital cases (124 admissions) over 3 years with any mention of lead poisoning, excluding two with admissions dating from 1965 and 1969. For these 83 cases the median hospital stay per admission was 3 days (range 0-115 days). Five were coded as having received intravenous treatment. Further clinical details of these cases beyond what is routinely recorded on the hospital episode statistics database were not available, except for blood lead concentrations in cases also identified on the Medical Toxicology Unit database. Eighteen cases (22%) were below 5 years of age of whom 10 (56%) came from the most deprived quintile of electoral wards. There was evidence to suggest spatial clustering of cases (p = 0.02). Six occupational cases were reported under RIDDOR in England during the period of study, two of whom were identified on the hospital episode statistics database. One further occupational case was identified on hospital episode statistics. Blood lead analyses for 4424 people carried out by the Medical Toxicology Unit (estimated at about 5% of such analyses in England over 7 years) found that among 547 children aged 0-4, 45 (8.2%) had a blood lead concentration in excess of 25 micrograms/dl, the action level in the United Kingdom for investigation, or removal of environmental sources of lead. At all ages, there were 419 (9.5%) such people, including 106 adults with no mention of industrial exposure. CONCLUSIONS: Both mortality and hospital admission ascribed to lead poisoning in England are rare, but cases continue to occur and some, at least, seem to be associated with considerable morbidity. Lead poisoning was confirmed as a probable cause of clinical signs and symptoms in only a small proportion of those in whom a blood lead concentration was requested. Where indicated, appropriate remedial action for the safe removal of environmental sources of lead should be taken.
Adolescent↗
Regional variation in the treatment and outcomes of myocardial infarction: investigating New England's advantage.
BACKGROUND: Previous studies have reported that myocardial infarction (MI) treatment in New England differs from that of other regions of the United States. We sought to determine whether regional differences in MI treatment were independent of regional differences in patient, hospital, or physician characteristics, and whether the New England region's practice pattern was associated with better outcomes than those of patients in other regions. METHODS: We evaluated 167,180 patients aged > or =65 years who were hospitalized with MI between 1994 to 1996 to assess regional variations in quality of care. Patients were evaluated for the use of reperfusion therapy, aspirin, and beta-blockers on admission and 30-day mortality rate. Hierarchical logistic regression models were used to determine whether practice patterns specific to New England were independent of regional variations in patient, physician, hospital, or other geographic characteristics. RESULTS: New England had the highest use of beta-blockers (72% vs 52% other regions, P <.001), and aspirin (80% vs 76% other regions, P <.001), a lower use of reperfusion therapy (61% vs 67% other regions, P <.001), and the lowest risk-standardized 30-day mortality rate (15% vs 19% other regions, P <.001). These differences persisted after adjusting for patient, physician, and hospital characteristics. CONCLUSIONS: Patients with MI in New England have higher rates of medical therapy use and lower 30-day mortality rates than patients in other US regions. This pattern is independent of patient or provider characteristics, suggesting other factors likely contribute to better short-term outcomes in New England.
Adrenergic beta-Antagonists↗
Effects of licence change on prescribing and poisons enquiries for antipsychotic agents in England and Scotland.
AIMS: To examine the effect of licence change for thioridazine at the end of 2000 on the prescription of antipsychotic drugs in England and Scotland, and investigate changes in poisons information inquiries and, for Edinburgh, poisons admissions. METHODS: Prescription data for antipsychotic drugs were obtained for England and Scotland and quarterly trends examined for 2000 and 2001. Accesses to the UK National Poisons Information Service website TOXBASE for antipsychotic products were examined for the same period. For Scotland telephone enquiry data, and admission data to the Edinburgh Poisons Unit were also evaluated. Trends in poisonings were compared with prescribing change. RESULTS: In England prescriptions for thioridazine fell rapidly in 2001 from approximately 35% of market share to less than 5%, and were replaced by risperidone, chlorpromazine and olanzapine. TOXBASE accesses fell from 39.3% of antipsychotics to 4.4%. Accesses for chlorpromazine, olanzapine and risperidone increased. In Scotland prescribing of thioridazine was similar to changes in England, but it was principally replaced by chlorpromazine. These changes were mirrored by TOXBASE accesses, telephone enquiries and in-patient admissions. The ratio of TOXBASE accesses for thioridazine to prescription numbers for the drug increased after the licence change. CONCLUSIONS: Licence change produced rapid change in prescribing behaviour within 3 months. Prescribing behaviour in England and Scotland was different. Changes in prescribing were mirrored by changes in accesses for poisons information in both England and Scotland, and in Edinburgh by hospital admissions. The increase in the ratio of TOXBASE accesses to prescriptions for thioridazine suggests doctors may have become more aware of its potential toxicity.
Antipsychotic Agents↗
The provision of renal replacement therapy for adults in England and Wales: recent trends and future directions.
We assessed the level of provision of renal replacement therapy for adults in England and Wales. All autonomous main renal units in England (n = 52) and Wales (n = 5) were surveyed in 1996. Data for England were compared to the 1993 National Renal Review. The acceptance rate in England 1995 was 82 (80-85) per million population (p.m.p.) compared with 67 (65-70) p.m.p. in 1991-2. The rate in 1995 in Wales was 109 (98-122) p.m.p. The prevalence rate in England was 476 p.m.p. at end-1995 compared to 393 p.m.p. in 1993, in Wales it was 487 p.m.p. The number of main renal units in England did not rise between 1993 and 1995; capacity was increased by use of more treatment shifts and temporary haemodialysis stations, and by opening more satellite units. The main growth was in hospital haemodialysis. There was an uneven geographical distribution of services. Patients accepted were older with more comorbidity. The use of better-quality processes of dialysis increased. The steady-state position for RRT will not be reached for over a decade. Health authorities will face continued pressure to fund increases in quantity and quality improvements. A stronger evidence base of the effectiveness of therapies, and a national registry to monitor the equity and cost-effectiveness of services are needed.
Adolescent↗
Excess mortality in England and Wales, and in Greater London, during the 1995 heatwave.
STUDY OBJECTIVE: To assess the impact on mortality of the heatwave in England and Wales during July and August 1995 and to describe any difference in mortality impact between the Greater London urban population and the national population. DESIGN: Analysis of variation in daily mortality in England and Wales and in Greater London during a five day heatwave in July and August 1995, by age, sex, and cause. SETTING: England and Wales, and Greater London. MAIN RESULTS: An estimated 619 extra deaths (8.9% increase, approximate 95% confidence interval 6.4, 11.3%) were observed during this heatwave in England and Wales, relative to the expected number of deaths based on the 31-day moving average for that period. Excess deaths were apparent in all age groups, most noticeably in women and for deaths from respiratory and cerebrovascular disease. Using published daily mortality risk coefficients for air pollutants in London, it was estimated that up to 62% of the excess mortality in England and Wales during the heatwave may be attributable to concurrent increases in air pollution. In Greater London itself, where daytime temperatures were higher (and with lesser falls at night), mortality increased by 16.1% during the heatwave. Using the same risk coefficients to estimate the excess mortality apparently attributable to air pollution, more than 60% of the total excess in London was apparently attributable to the effects of heat. CONCLUSION: Analysis of this episode shows that exceptionally high temperatures in England and Wales, though rare, do cause increases in daily mortality.
Adolescent↗