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PubMed1997

HIV partner notification policy and practice within GUM clinics in England: where are we now?

OBJECTIVES: To evaluate the extent to which larger genitourinary medicine (GUM) clinics in England have established local clinic policies for HIV Partner Notification (PN) and to describe the process of HIV PN within this setting. DESIGN: A cross-sectional survey of HIV PN policies and practices within GUM clinics. SUBJECTS AND SETTING: Senior consultants in 59 GUM clinics in England. MAIN OUTCOME MEASURES: The presence of clinic policies for HIV PN, indicators of HIV PN activity (that is, its initiation, documentation, performance and evaluation) and factors hindering the acceptance of HIV PN into clinical practice. RESULTS: Only 18% (10/57) of respondents stated that their clinics had developed their own local policies for HIV PN. Fifteen percent (9/58) of clinics had audited HIV PN activity, 15% had provided specific HIV PN training for doctors and 47% (27/58) for health advisers. Within GUM clinics, health advisers play a key role in the HIV PN process, being responsible for initiating the discussion of partners, patient follow-up and documenting HIV PN activity in patients' notes. Notifying partners was primarily seen as the responsibility of the newly diagnosed HIV positive patient. Although 77% (43/56) of responding consultants believed that HIV PN had become an accepted part of their clinics' practice, the perceived unacceptability of HIV PN to patients and health care workers were seen as important limiting factors. CONCLUSION: In many GUM clinics, local policies on HIV PN have yet to be established and appropriate training for the health personnel provided. Nevertheless, there appears to be wide-spread acceptance of HIV PN in clinical practice with an acknowledgement of its limiting factors. Further research into the acceptability of HIV PN to health care workers and patients in this setting should be undertaken.

Attitude of Health Personnel↗

PubMed1997

Epidemiology of genital Chlamydia trachomatis in England and Wales.

OBJECTIVE: To describe the recent epidemiology of genital Chlamydia trachomatis infection in England and Wales. DESIGN: Retrospective study of routinely available surveillance datasets and ad hoc prevalence studies. METHODS: Numbers of new cases of genital C trachomatis infection, obtained from the Department of Health and Welsh Office, were combined with the estimated mid-year resident population of England and Wales. Rates were analysed for trend over time using a log linear age period model in GLIM4. Ad hoc prevalence and case finding studies carried out over the past 20 years were critically assessed in terms of study design and testing methodologies. RESULTS: Attendance rates at genitourinary medicine (GUM) clinics were higher for women than men over the period 1989 to 1994 as were the number of laboratory reports. The highest rate of attendance (GUM clinic data) was for women aged 16 to 19 years. There was an overall significant linear decrease in the attendance rates over time for both men (p = 0.0172) and women (p = 0.0000) between 1989 and 1994. There was considerable variation in the prevalence of genital C trachomatis infection detected within different clinical settings, together with a substantial level of asymptomatic infection. CONCLUSIONS: Genital C trachomatis infection is broadly distributed throughout the sexually active population, with a substantial reservoir of asymptomatic infection among those generally perceived to be at low risk of a sexually transmitted infection. Young people, particularly women aged 16 to 19 years, are at highest risk of genital C trachomatis infection. This is of concern since younger women are more susceptible than older women to developing complications of chlamydial infection, such as pelvic inflammatory disease. The broad distribution of infection across all sexually active health service attenders and the high level of asymptomatic infection suggest that a new, screening based, approach to the control of genital C trachomatis infection is required. Recommendations are made as to the epidemiological research required to guide such work.

Adolescent↗

PubMed1997

Direct estimates of prevalent HIV infection in adults in England and Wales for 1991 and 1993: an improved method.

OBJECTIVE: To estimate the number of prevalent HIV infections in England and Wales at the end of 1991 and 1993. METHOD: A direct method was used whereby population estimates derived from the National Survey of Sexual Attitudes and Lifestyle (NATSAL) and prevalence data from the Unlinked Anonymous HIV Prevalence Monitoring Programme (UAPMP) were combined to produce estimates of the number of adults infected and alive in the population. RESULTS: In the population of England and Wales the numbers of prevalent infections for defined transmission categories, at the end of 1993, were as follows: 12,600 through sex between men, 2500 through injecting drug use, and 6900 through heterosexual intercourse. The overall estimate was 22,800 HIV seropositive individuals. CONCLUSIONS: The direct method attempts to provide an estimate of the number of HIV infections using population based survey data. These estimates are consistent with other approaches using independent methods. Such methods are essential for inferring recent HIV incidence, projecting future AIDS cases, and for healthcare planning.

Adolescent↗

PubMed1997

Epidemiology of genital warts in England and Wales: 1971 to 1994.

OBJECTIVE: To describe the epidemiology of genital warts in England and Wales over the period 1971 to 1994. METHOD: Retrospective study of available statistics. RESULTS: The rate of attendance for genital warts increased by 390% and 594% for men and women respectively between 1971 and 1994. Most of this increase occurred between 1980 and 1986. From 1986 to 1991 virtually no change occurred, but since 1992 the rate of attendance has risen by 15%. The ratio of male to female cases has declined steadily from 1.85 in 1971 to 1.34 in 1994. Rates of attendance for first attack in men were highest in the 20 to 24 year age group whereas for women it peaked in those aged 16 to 24 years. Regional data indicate that the rate of attendance has increased consistently over England and Wales during this period. CONCLUSIONS: Rates of genital warts have risen substantially over the past 25 years. If these are a reflection of changes in sexual behaviour then the rise since 1992 is of considerable concern particularly for the incidence of cervical cancer in the coming decades.

Adolescent↗

PubMed2002

A postal survey to identify and describe nurse led clinics in genitourinary medicine services across England.

BACKGROUND: Nurses in genitourinary medicine (GUM) services are progressively extending their roles to conduct "comprehensive care" nurse led clinics. In such roles the nurse coordinates the first line, comprehensive care of patients presenting with sexual health conditions and issues. OBJECTIVES: To identify and describe comprehensive care nurse led clinics in GUM services across England. METHODS: A postal questionnaire consisting of 17 closed response questions was sent to 209 GUM services across England. A second questionnaire was sent to non-responders to increase the response rate. Data were single entered and analysed using SPSS. RESULTS: Of the 190 GUM clinic respondents (91% response rate), 44 (23%) reported providing some form of comprehensive care nurse led clinic, 90% of which were initiated since 1995. Key results show staff development featured as the main reason for initiating such services and there was general consistency in the aspects of care undertaken by these nurses. There was evidence of guideline development specific to nurse led care and some patient group direction use for supplying medication. The level of support from medical staff while nurse led clinics were being conducted varied between services. Few services have conducted any audit or research to monitor/evaluate nurse led care. There was little consistency in the clinical experience and educational prerequisites to undertake comprehensive care nurse led clinics. Continuing professional development opportunities also varied between services. CONCLUSIONS: The steady growth of comprehensive care nurse led clinics indicates that the skills of GUM nurses are being recognised. Nurses working in advanced practice roles now require courses and study days reflecting these changes in practice. Locally agreed practice guidelines can define nursing practice boundaries and ensure accountability, as will the development of patient group directions to supply medication. Monitoring and evaluation of nurse led clinics also require attention.

Ambulatory Care Facilities↗

PubMed1975

Survey of the sputum cytology service in England and Wales.

Of the 231 laboratories carrying out sputum cytology in England and Wales, information on the staffing, laboratory procedures, workload, records, and results for the year 1971 was obtained from 228 (98.7%) by means of a questionnaire, which was completed in 1973 in 81% of the laboratories and at the end of 1972 in the remainder. At the time the questionnaire was completed, the number of laboratories per region offering a service ranged from 6 to 25. Most of the processing of specimens was done by technicians and non-medical screeners (technicians without recognized qualifications) and most of the microscopy by pathologists and technicians. Papanicolaou and/or haematoxylin and eosin stains were used in 97% of the laboratories. During 1971, the number of specimens tested per laboratory ranged from 9 to 6000. A median of 381 specimens and 165 patients were tested per laboratory. Almost all specimens were submitted by hospitals and chest clinics and only 1% by general practitioners. An estimated median of 6.5% of all cytological specimens were sputum, most of the remainder being cervical smears. Laboratories varied greatly in their positive (0%-24%) and doubtful positive (0%-27%) rates. An estimated 63 000 patients had their sputum tested in 1971, and about 6300 had positive reports, rather less than one-quarter of all patients diagnosed as having lung cancer in England and Wales in 1971. The cost of the service was estimated to be of the order of pound375 000 at 1974 prices; that is, pound2.50 per specimen or pound6.00 per patient tested. An improved service might best be provided by district general hospital laboratories testing at least 1000 specimens per year so that a high level of accuracy in reporting could be assurred. A large proportion of the microscopy might be done by non-medical graduates and technicians under the supervision of pathologists.

Cervix Uteri↗

PubMed1981

Respiratory morbidity and lung function in schoolchildren aged 7 to 11 years in South Wales and the West of England.

The present study tests the suggestion that the respiratory morbidity of children resident in South Wales is substantially higher than that among children resident in some other areas of the United Kingdom. A case control survey was carried out among 2228 children aged 7 to 11 years in schools matched for size and socioeconomic characteristics in urban and rural areas in South Wales and the West of England. The survey confirmed that respiratory morbidity was higher among children in South Wales and that this excess could not readily be dismissed as being caused by over-reporting. However, objective measurements of the children's respiratory health did not detect any consistent difference in the lung function of children in South Wales compared with that of children in the West of England.

Child↗

PubMed1997

Malignant mesothelioma in south east England: clinicopathological experience of 272 cases.

BACKGROUND: Malignant mesothelioma is a rare pleural tumour associated with asbestos exposure. The proportion of malignant mesothelioma unrelated to asbestos exposure, and any differentiating features between exposed and unexposed cases, are not well described. This study describes occupational, clinical, and pathological features in a large cohort of cases of malignant mesothelioma from south east England. METHODS: All 272 cases from this region were studied, either in life or after death when necropsy examination suggested malignant mesothelioma. Detailed information was gathered regarding the occupational history, clinical course, and mode of death. Necropsies were performed in 98% of cases. Lung tissue was examined histologically to confirm the diagnosis, subtype of tumour, presence or absence of asbestosis and asbestos bodies. RESULTS: Exposure to asbestos was documented in 87% of cases, while in the remainder, no asbestos exposure was found nor were asbestos bodies seen; 94.5% were pleural, 5.1% peritoneal, and 0.4% pericardial. Right sided tumours were more common than left sided tumours (ratio 1.6:1). Patients usually presented with breathlessness and chest pain, but 33% presented with pleural effusion in the absence of chest pain. The mean (SD) time from first exposure to asbestos to symptoms was 40 (12) years with a median (interquartile range (IQR) survival of 14 (12.5) months. The median (IQR) survival time in sarcomatous, epithelial, and mixed cell type malignant mesothelioma was 9.4 (10) months, 12.5 (18) months, and 11 (14) months, respectively, and was significantly greater in cases detected by chance. Clinical features were similar in asbestos related and non-asbestos related malignant mesothelioma. CONCLUSIONS: In south east England most cases of malignant mesothelioma are associated with asbestos exposure. Clinical features do not differentiate between asbestos related and non-asbestos related disease.

Adult↗

PubMed1997

Effect of thunderstorms and airborne grass pollen on the incidence of acute asthma in England, 1990-94.

BACKGROUND: Thunderstorms and prior grass pollen counts were investigated as predictors of daily hospital admissions for asthma in England. This study was motivated by reports in the literature of spectacular asthma epidemics associated with thunderstorms, particularly in the grass pollen season. METHODS: Asthma admissions for two age groups (0-14 years and 15 and over) were measured using the Hospital Episodes System (HES) in the 14 regional health authorities (RHAs) in England. Thunderstorms were measured daily in each RHA using densities of sferics (lightning flashes). Relative asthma excesses for moderate positive and exceptionally high sferic densities, with or without previous high grass pollen counts, were measured using log linear autoregression--allowing for weekly, seasonal, and longer term background variation--and pooled over RHAs by calculating geometric means. RESULTS: Relative risks from all RHAs were pooled to form geometric means. Exceptional sferic densities were associated with a relative excess risk of around 25% in both age groups. Moderate sferic densities were associated with a smaller excess, statistically significant in the two age groups taken together. In five RHAs in which grass pollen counts were available, high pollen counts for the previous five days were associated with an amplification of the excess associated with thunderstorms. CONCLUSION: Very large sferic densities are associated with moderate rises in hospital admissions for acute asthma. However, typical thunderstorm days are not associated with spectacular asthma epidemics of the scale previously reported in the literature. Thunderstorm-associated excesses are amplified after a run of high pollen counts.

Acute Disease↗

PubMed1988

131I in the thyroid glands of sheep from Wales and south-west England after the Chernobyl accident.

Radioactive material from the Chernobyl reactor was deposited over the United Kingdom between May 2 and May 4, 1986. In this report, the 131I content of ovine thyroid glands, collected from seven abattoirs in Wales and south-west England is used to monitor the geographical distribution of the contamination. The results indicate that there was considerable local variation in the degree of contamination and suggest that, in addition to the major areas of contamination, deposition of high levels of radioactive material also occurred in isolated areas in the south-west of England. These observations confirm the value of monitoring 131I in the thyroid glands of grazing ruminants as a sensitive index of environmental contamination with the products of nuclear fission.

Abattoirs↗

PubMed1994

European brown hare syndrome in England.

The livers from 50 brown hares (Lepus europaeus) were examined by electron microscopy for calicivirus-like particles typical of the virus of European brown hare syndrome (EBHS). The virus was visible in 23 of the livers which included four taken from hares which died in 1982 and 1985 and which had been stored at -20 degrees C. The clinical histories, post mortem and other findings associated with these 23 hares were similar to those described in cases of European brown hare syndrome in other European countries. The findings were compared with those associated with viral haemorrhagic disease (VHD) of rabbits which, although it did not occur in the United Kingdom until 1992, is also caused by a calicivirus believed to be related to EBHS virus. The finding of the virus in hares which died from the disease in 1982 is the earliest recorded isolation of the organism and predates the description of VHD virus and VHD in China in 1984. A retrospective review of post mortem reports revealed cases of disease between 1976 and 1977 which may have been due to EBHS and it is considered that the disease has occurred sporadically in England for several years. The results from suspected and confirmed cases of EBHS in England between 1976 and 1990 are reported and the epidemiology and emergence of the disease is considered.

Animals↗

PubMed1995

A survey of the incidence of Neospora caninum infection in aborted and stillborn bovine fetuses in England and Wales.

Selected brains and fetal viscera from 190 aborted or stillborn bovine fetuses submitted to Veterinary Investigation Centres in England and Wales between August 1992 and January 1993 were examined histologically. Non-suppurative inflammation of the brain and/or myocardium and placental cotyledons was identified by light microscopy in 20 (10.5 per cent). An immunocytochemical examination of fixed tissue sections using antisera against Neospora caninum, Toxoplasma gondii and Sarcocystis species revealed positive immunolabelling for N caninum in the brains of eight (4.2 per cent), but no labelling with anti-T gondii or anti-Sarcocystis species antisera was evident. These results suggest that N caninum may be an important cause of reproductive failure in cattle in England and Wales.

Abortion, Veterinary↗

PubMed1999

Prevalence of lice on dairy cattle in England and the bordering counties of Wales.

A postal questionnaire was used to collect information on the prevalence of lice on cattle on a random sample of dairy farms in England and the bordering counties of Wales. Replies were received from 1040 (52.8 per cent) of the 1970 farms which were mailed. Fifty per cent of farmers reported having ever seen or suspected lice in their herds and 29 per cent reported possible infestations in the winter of 1996/97. Visits were made to 24 farms in the south west of England during February 1998. Twelve of the farmers said that they had seen or suspected lice in their herd since October 1997, and that lice were more frequently observed on the adult cattle. However, examination revealed lice on 18 of the 24 farms, and adult cattle were the least likely group to be infested.

Age Distribution↗

PubMed2003

Prevalence of faecal excretion of verocytotoxigenic Escherichia coli O157 in cattle in England and Wales.

During the decade to 1999, the incidence of human infections with the zoonotic pathogen verocytotoxin-producing Escherichia coli O157 (VTEC O157) increased in England and Wales. This paper describes the results of a survey of 75 farms to determine the prevalence of faecal excretion of VTEC O157 by cattle, its primary reservoir host, in England and Wales. Faecal samples were collected from 4663 cattle between June and December 1999. The prevalence of excretion by individual cattle was 4.2 per cent (95 per cent confidence interval [CI] 2.0 to 6.4) and 10.3 per cent (95 per cent CI 5.8 to 14.8) among animals in infected herds. The within-herd prevalence on positive farms ranged from 1.1 to 51.4 per cent. At least one positive animal was identified on 29 (38.7 per cent; 95 per cent CI 28.1 to 50.4) of the farms, including dairy, suckler and fattening herds. The prevalence of excretion was least in the calves under two months of age, peaked in the calves aged between two and six months and declined thereafter. The phage types identified most widely were 4, 34 and 2, which were each found on six of the 29 positive farms.

Animals↗

PubMed2005

Prevalence of Fasciola hepatica in dairy herds in England and Wales measured with an ELISA applied to bulk-tank milk.

An ELISA developed to diagnose Fasciola hepatica infection in cattle by detecting serum antibodies was adapted and validated for use with samples of bulk-tank milk. The prevalence of the infection in 61 dairy herds was established by using serum antibody levels or faecal egg counts measured in a proportion of the cows in each herd. The correlation between the results of the ELISA and the herd seroprevalence was 0.83. Using a cut-off value of 27 per cent positive, the bulk-tank ELISA identified herds in which more than 25 per cent of the cows were infected with a diagnostic sensitivity of 96 per cent (95 per cent confidence interval 89 to 100 per cent) and a diagnostic specificity of 80 per cent (95 per cent confidence interval 66 to 94 per cent). By applying the ELISA to 623 herds in England and 445 herds in Wales, the prevalence of F hepatica infection in England was estimated to be 48 per cent (95 per cent confidence interval 46 to 54 per cent), and in Wales 86 per cent (95 per cent confidence interval 84 to 90 per cent).

Animals↗

PubMed2005

Prevalence, incidence and geographical distribution of serovars of Salmonella on dairy farms in England and Wales.

A study of randomly selected dairy farms in England and Wales was made between October 1999 and February 2001 to estimate the prevalence and incidence of Salmonella serovars. The farms were enrolled through five milk-buying companies, which represented 63 per cent of the dairy farms in England and Wales, and they were sampled on up to four occasions (449 farms at visit 1, 272 farms at visit 2, 251 farms at visit 3 and 243 farms at visit 4). In total, 19,296 samples of pooled faecal pats and slurry were collected. The farm-specific prevalence of all serovars of Salmonella ranged from 12.1 per cent (95 per cent confidence interval [CI] 8.2 to 16.0 per cent) to 24.7 per cent (95 per cent CI 19.4 to 30.1 per cent) at each visit. The most common serovars identified were Salmonella Dublin (3.7 to 6.6 per cent farm-specific prevalence at each visit), Salmonella Agama (1.8 to 7.6 per cent) and Salmonella Typhimurium (2.6 to 4.1 per cent) The prevalence varied by region and month of sampling and increased in late summer. The incidence rate of all serovars of Salmonella was 0.43 (95 per cent CI 0.34 to 0.54) cases per farm-year at risk. There was no significant difference between the incidence rates of the common serovars S Typhimurium (0.07), S Dublin (0.06) and S Agama (0.13). A total of 29 Salmonella serovars were isolated. Few of the isolates were resistant to the 16 antimicrobial agents tested, except the isolates of S Typhimurium dt104, of which 67.9 per cent were resistant to at least five of them.

Animals↗

PubMed2006

Introduction of bovine tuberculosis to north-east England by bought-in cattle.

The source of bovine tuberculosis was investigated in 31 herds in north-east England that experienced confirmed breakdowns between January 2002 and June 2004; nine of the herds had been restocked after the UK outbreak of foot-and-mouth disease in 2001. In all but one of the breakdowns the most likely source of infection was identified as one or more purchased animals. In 17 of the breakdowns, reactor animals were traced to herds from which the same combination of spoligotype and variable number tandem repeats was isolated, and in five breakdowns a different spoligotype was isolated. The most likely sources were located in Wales and the west and north of England, and included a Cheshire herd that was the most likely source of nine of the breakdowns. Three breakdowns were traced to Irish imports. Reactors in five of the breakdowns included homebred as well as purchased animals, providing evidence for the likely spread of the disease within the herds. The lack of geographical clustering of molecular types pointed to the overwhelming source of infection being cattle that had been bought-in.

Animals↗

PubMed1992

The changing mortality from motor neurone disease and multiple sclerosis in England and Wales and the Republic of Ireland.

A study has been undertaken to ascertain the changes in mortality from motor neurone disease (MND) and from multiple sclerosis (MS) in England and Wales and in the Republic of Ireland. During the 20 years 1968-1987, 16,077 deaths were reported as being primarily due to MND in England and Wales with a male/female ratio of 1.22. There has been an increase in MND deaths from 3,185 in 1968-1972 to 5,241 in 1983-1987. The increase occurred in the death rates in both sexes and in all age groups, but particularly over the age of 65. In contrast, there was no increase in MS deaths and the MS death rates fell below the age of 55 but increased over this age, evidence that MS patients are living longer. A similar but more marked increase in MND mortality, and a considerable fall in MS mortality, occurred in the Republic of Ireland. The increase in MND mortality is not due to an increase in the number of neurologists, as there has been little increase in their numbers. The highest MND mortality was in Social Class IIIN males - skilled non-manual workers.

Age Factors↗