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PubMed2005

Where not to live: a geo-demographic classification of mortality for England and Wales, 1981-2000.

The aim of this paper is to pilot a method for geo-demographic classification for mortality patterns in Britain. Age and sex directly standardised mortality ratios (DSMRs) for 100 grouped International Classification of Disease series 9 causes of death (ICD-9) were calculated. The 84 European Parliamentary (EP) constituencies as defined in 1999 were used as the spatial basis of this study to allow regional comparisons to be made while comparing units of similar population sizes. Scotland was excluded from the final analysis, leaving 76 regions. This paper is a preliminary investigation of the patterns of the causes of death over time and space in England and Wales using cluster analysis to summarise some of the structure in the data. Seven major and three minor cluster profiles were developed.

Cause of Death↗

PubMed2006

Microbiological quality of randomly selected ready-to-eat foods sampled between 2003 and 2005 in Wales, UK.

Since 1995, the publicly funded ready-to-eat food sampling and examination activities in Wales have been coordinated and structured, using a novel approach for the identification of samples and premises. The latest set of data from this surveillance system reports the results from 3391 ready-to-eat foods sampled between November 2003 and March 2005. During this seventeen-month period all samples were examined for aerobic colony count, Escherichia coli, Listeria spp., Bacillus cereus, Salmonella, Staphylococcus aureus and Listeria monocytogenes. The food types with the poorest microbiological quality were cream cakes, custard slices and egg mayonnaise sandwiches. The food type with the best microbiological quality was dried fruit. In conclusion, the results indicate that, in general terms, the ready-to-eat food types sampled and examined in this period posed little bacterial hazard to consumers.

Bacillus cereus↗

PubMed2006

Balancing autonomy and risk: a failure of nerve in England and Wales?

Specialised mental health legislation typically provides for the hospitalisation and treatment of those with mental disorders in the absence of their consent. The article examines the possible justifications for the existence of these special powers and argues that two of the most common justifications, the protection of the patient and the protection of others, do discriminate against those with a mental, as opposed to a physical, disorder. The relationship between mental health and mental capacity, or guardianship, legislation is then considered and possible ways forward are discussed with particular reference to the current reform debate in England and Wales.

Commitment of Persons with Psychiatric Disorders↗

PubMed2006

Service implications from a comparison of the evidence on the effectiveness and a survey of provision in England and Wales of COPD specialist nurse services in the community.

STUDY BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of mortality worldwide and is a burden on healthcare resources. Therefore, implementing the right care model(s) for patients with COPD is a priority. Nurses, particularly those with specialist roles, are often the principal health professionals involved in new service models. NEW SERVICES: for patients in the community with COPD are increasing in many countries. Two main types of initiatives have been evaluated; those designed to transfer acute care out of hospital and into the community, and those offering chronic disease management. The extent and nature of such specialist services in the UK and internationally are unknown. OBJECTIVES: To present the results of the first survey of specialist nurse service provision for patients in the community with COPD in England and Wales. To combine the survey findings with systematic review evidence to explore to what extent provision is supported by evidence of effectiveness. METHODS: A postal survey of respiratory healthcare professionals undertaken concurrently with a review of the evidence of the effectiveness of nurse COPD services (review findings are reported fully elsewhere). RESULTS: Two hundred and thirty four specialist nurse services were identified; 71% involved chronic disease management, of which 47% also provided acute care. Seventeen per cent of services involved acute care only. The review identified evidence to support the provision of acute services but data on chronic disease management services are sparse and there is currently little evidence to support these services. Those interventions that have been evaluated to date differed from many of the services provided. CONCLUSIONS: This study identifies a considerable mismatch between existing evidence around effectiveness and services provision for patients with COPD. It clearly highlights the need for greater interaction between what happens in practice and research. This is an issue that has relevance across all healthcare practice, both nationally and internationally.

Acute Disease↗

PubMed2005

The increasing burden of pelvic fractures in older people, New South Wales, Australia.

Despite their significant health burden, epidemiological information regarding pelvic fractures is scarce. In this study, we examine trends in admission for pelvic fractures to acute hospitals in New South Wales, Australia, between July 1988 and June 2000, using routinely collected hospital separations statistics. Over this period, the number of admissions for pelvic fractures among those aged 50 years and over increased by 58.4% in men and 110.8% in women. Age-specific rates of admissions per 100,000 population for pelvic fracture also rose significantly, particularly for those aged at least 75 years. The number and proportion of transport related pelvic fractures fell significantly for both men (chi(2)=23.82, d.f.=1, p<0.001) and women (chi(2)=49.26, d.f.=1, p<0.001) while those resulting from falls increased significantly over the 12-year-period. Falls are increasingly becoming the single most important cause of pelvic injuries in older people, suggesting that preventive measures aimed at reducing the risk of falls need to be pursued. Factors contributing to the rise of fall-related pelvic fractures need to be investigated to inform strategies aimed at reversing the observed increase in the number and age-specific rates of pelvic fractures in older people.

Accidental Falls↗

PubMed2005

Outcome of direct restorations placed within the general dental services in England and Wales (Part 2): variation by patients' characteristics.

AIM: It is the purpose of this paper to investigate the outcome of direct-placement restorations provided within the General Dental Services in England and Wales, and to identify the patient factors which may affect this using a database derived from patient treatment data at the Dental Practice Board. METHODS: For this work, survival of a restoration was considered to be the time between the date of completion of the course of treatment in which it was placed and the date of acceptance of the course of treatment when the next tooth-specific treatment was carried out on the same tooth. A modified version of Kaplan-Meier statistical methodology was used to plot survival curves for restorations in different subgroups of patients within the population of patients for whom data were available. RESULTS: The results indicated that patients' gender was of little significance in the long-term survival of restorations, but patient age had a significant effect, with the restorations of older patients surviving less well than those of younger patients (P<0.001). The charge-paying status of the patient had a statistically significant but small effect (P<0.001), with survival for charge-payers being slightly higher throughout the observation period. There was a strong relationship between attendance frequency and survival time, with restorations of more frequent attenders performing less well than those of less frequent attenders (P<0.001). CONCLUSIONS: Patient factors such as age, charge-paying status, interval between courses of treatment, continuity of care by one dentist, and annual gross fees incurred, have all been found to influence the survival of directly placed restorations.

Adolescent↗

PubMed2005

Outcome of direct restorations placed within the general dental services in England and Wales (Part 3): variation by dentist factors.

AIM: It is the aim of this paper to investigate the survival of direct-placement restorations provided within the General Dental Services in England and Wales, in relation to the dentist factors which may affect this. METHODS: For this work, survival of a restoration was considered to be the time between the date of completion of the course of treatment in which it was placed and the date of acceptance of the course of treatment when the next tooth-specific treatment was carried out on the same tooth. A modified version of Kaplan-Meier statistical methodology was used to plot survival curves for restorations placed by different subgroups of dentists. RESULTS: The age and experience of the dentist who placed the original restoration were found to be related to restoration survival, with older dentists having shorter intervals from placement of restorations to re-intervention (P<0.001). Country of qualification seems not to be relevant within Europe in terms of restoration survival, but dentists who qualified outside Europe achieve different restoration survival times for the restorations that they place. Dentist's gender has no relationship with time from restoration to re-intervention. CONCLUSIONS: Dentist factors such as age, country of qualification, and employment status, but not the gender of the dentist, have been found to influence the survival of directly placed restorations.

Adult↗

PubMed2004

Estimating the opportunity costs of biodiversity protection in the Brigalow Belt, New South Wales.

The New South Wales Government recently introduced the Native Vegetation Conservation Act to protect the native grassland and woodland of the state. The Act protects biodiversity by preventing farmers from clearing such vegetation on their properties but, as a consequence, reduces farm incomes and land values. An economic model of the relationship between land value and percentage of farm in native vegetation is integrated with an ecological model of the relationship between species lost and percentage of the farms in native vegetation. The integrated framework is applied to estimate the opportunity costs of the Act for one important agricultural area of the state, the northern part of the Brigalow Belt South Bio-Region. If all the vegetation were protected, the reduction in land value would be at least 14.3%, which is an opportunity cost of at least 148.5 dollars m for the area. Both the benefits and costs of biodiversity protection must be accounted for, so risk simulations are then combined with benefit-cost analysis to compare the benefits of biodiversity protection to these costs.

Agriculture↗

PubMed2005

Cosmogenic 7Be deposition in North Wales: 7Be concentrations in sheep faeces in relation to altitude and precipitation.

Beryllium-7 (7Be) is a cosmogenic radionuclide with a half-life of 53.3 days produced mostly in the stratosphere by cosmic ray spallation of nitrogen and oxygen and entering the lower troposphere by atmospheric circulation processes. Most of the nuclide is removed by rainout during precipitation, so given that rainfall generally increases with altitude, it was considered probable that 7Be deposition would also be greater at higher altitudes. The aim of this study was to determine if there is any relationship between 7Be concentrations, altitude and precipitation by measuring 7Be activity within sheep faeces. An area of North Wales and Northwest England was selected for study, extending from the Dee Estuary at sea level to Snowdon at 1065 m. The results obtained showed a significant increase in 7Be activity with increasing altitude and precipitation consistent with predictions based on the existing literature.

Altitude↗

PubMed2005

A Mid-Upper Palaeolithic human humerus from Eel Point, South Wales, UK.

We report here on a human humerus directly dated to 24,470 +/- 110 BP, placing it within the Gravettian, or Mid-Upper Palaeolithic. The partial humerus is an isolated find and can be attributed (with some caution) to the Pleistocene 'bone cave' of Eel Point on Caldey Island, Wales (UK). The humerus is probably male, similar in robusticity to other Gravettian right humeri. The apparent absence of stone tools and presence of hyaena bone and coprolites suggest that the element may not derive from an intentional burial. After a maxilla from Kent's Cavern and the Gravettian Paviland 1, Eel Point represents the third oldest anatomically modern human known from Britain. Stable carbon and nitrogen isotope measurements do not support certain use of marine foods but highlight the need for more research on contemporary faunal remains in order to better interpret human values from this period.

Adult↗

PubMed2004

The role of manual occupation in the aetiology of Dupuytren's disease in men in England and Wales.

We compared the incidence of significant Dupuytren's disease in men across occupational social classes in England and Wales, using data from the National Morbidity Survey. We found that manual occupational social class was not associated with an increased incidence of Dupuytren's disease. In fact, the incidence rates of Dupuytren's disease in the elderly were higher in non-manual than in manual social classes.

Adult↗

PubMed2006

A population-based study of congenital diaphragmatic hernia outcome in New South Wales and the Australian Capital Territory, Australia, 1992-2001.

PURPOSE: The aim of the study was to describe the incidence and survival of infants born with congenital diaphragmatic hernia (CDH) in the state of New South Wales (NSW) and the Australian Capital Territory (ACT), Australia. METHODS: A population-based cohort study of all infants inclusive up to 1 month of age diagnosed with CDH in NSW and the ACT between 1992 and 2001 was conducted. Data sources were the NSW and ACT Neonatal Intensive Care Data Collection (Neonatal Intensive Care Units Study), NSW Birth Defects Register, Population Health Research Centre of ACT Health, and NSW Midwives Data Collection. Individual risk factors for mortality were assessed using the chi(2) test with P < .05 being considered statistically significant. Multivariate analysis was performed using logistic regression to adjust for potential confounding variables. RESULTS: From the databases used, the incidence of CDH in NSW and the ACT was 1 per 3800 births. Of 242 infants identified with CDH, 8% underwent termination of pregnancy, 10% were stillborn after 20 weeks' gestation, and 82% were liveborn. Most liveborn infants (70%) were delivered at term with a 64% survival, whereas 30% were preterm with a 35% survival. For liveborn infants, the overall preoperative mortality was 35% with 56% surviving to discharge. Logistic regression identified a low 5-minute Apgar score, prematurity, and air leak as independent risk factors for mortality. CONCLUSIONS: This population-based study of CDH provides us with baseline data for our states. Mortality is high in preterm infants and in the preoperative period. Avoiding preterm delivery and improving preoperative stabilization are the measures most likely to improve survival.

Abortion, Induced↗

PubMed2003

Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups.

Liver transplantation has never been the subject of a randomized controlled trial, and there remains uncertainty about the magnitude of benefit and cost-effectiveness for specific patient groups. This article reports the results of an economic evaluation of adult liver transplantation in England and Wales. Patients placed on the waiting list for a liver transplant were observed over 27 months. The costs and health benefits of a comparison group, representing experience in the absence of liver transplantation, were estimated using a combination of observed data from patients waiting for a transplant and published prognostic models. The analysis focuses on three disease groups, for each of which prognostic models were available: primary biliary cirrhosis (PBC), alcoholic liver disease (ALD), and primary sclerosing cholangitis (PSC). A higher proportion of patients with ALD were assessed for a transplant but not placed on the waiting list. The estimated gain in quality-adjusted life-years from transplantation was positive for each of the disease groups. The mean incremental cost per quality-adjusted life-year (95% bootstrap confidence intervals) from time of listing to 27 months for patients with PBC, ALD, and PSC are pound 29,000 (pounds 1,000 to pounds 59,000), pounds 48,000 (pounds 12,000 to pounds 83,000) and pounds 21,000 (-pounds 23,000 to pounds 60,000), respectively. In conclusion, liver transplantation increases the survival and health-related quality of life of patients with each of three end-stage liver diseases. However, the extent of this increase differs between different disease groups. Cost-effectiveness estimates were poorer for patients with ALD over the 27-month period than for patients with PBC or PSC. This in part reflects the costs of the higher number of ALD patients assessed for each transplant.

Adolescent↗

PubMed2005

Assessment of metals in sediments from Lake Macquarie, New South Wales, Australia, using normalisation models and sediment quality guidelines.

Industrial activity since the 1890s and, more recently catchment development has resulted in significant metal contamination in Lake Macquarie, an estuary in New South Wales, Australia. This paper presents an analysis of metal concentrations in surface sediments from Lake Macquarie using normalisation models to estimate enrichment relative to natural background concentrations and by comparing concentrations with sediment quality guidelines (SQGs) and effects range median quotients to assess the potential for ecological harm. Of the 12 metals examined, cadmium, lead, mercury, selenium, silver and zinc were enriched in surface sediments throughout the lake. The greatest contamination was found in the north of the lake and, for selenium, also in areas adjacent to two power stations. Comparisons with SQGs and effects range median quotients found that sediments from a site in Cockle Bay had concentrations of metals with the highest likelihood of causing adverse effects on sediment associated biota, and that the likelihood adverse decreased with distance from Cockle Bay. Comparisons with historical sediment quality data indicated that there has been a marked reduction in surface metal concentrations throughout the lake over 15 years. Models could not be constructed for all metals due to low background concentrations. For most metals, simple linear regression models were adequate, but for selenium and arsenic a multiple regression model provided a better estimate of background concentrations. SQGs possibly overestimated effects for arsenic, which has naturally high concentrations in the lake and underestimated the potential for ecological effects in coarser sediments.

Environmental Monitoring↗

PubMed2005

Assessing the suitability of OSPAR EcoQOs for eutrophication vs ICES criteria for England and Wales.

This paper provides a preliminary evaluation of the suitability of OSPAR Ecological Quality objectives for eutrophication for coastal and offshore waters of England and Wales on the basis of ICES criteria. In principle, EcoQOs are easy to understand, but responses to nutrient enrichment are complex. Few studies provide unequivocal evidence of links between inputs and response. Monitoring is generally feasible and in place, but needs to be improved. The best EcoQO is winter nutrient concentrations. Chlorophyll concentrations are a good indicator in environments susceptible to nutrient enrichment. The EcoQO for zoobenthos/fish kills potentially meets all criteria for a good indicator; EcoQOs for phytoplankton indicator species, oxygen concentrations and zoobenthos changes do not. Greater emphasis needs to be placed on seasonal effects of nutrient inputs and phytoplankton response, natural susceptibility of different water bodies, differences between coastal and offshore environments, and developing longer time series of data.

Biodiversity↗

PubMed2006

Mothers' accounts of screening newborn babies in Wales (UK).

OBJECTIVE: To explore mothers' accounts of screening newborn babies to increase our understanding of how they define screening and talk about the process of consent. DESIGN: A purposive sample of mothers, whose newborn babies had recently been screened, were invited to take part in a semi-structured interview. SETTING: Primary and community-care settings in one region of Wales, UK. PARTICIPANTS: Mothers (n=18) who had recently given birth and been offered screening for their newborn babies. FINDINGS: Information giving about newborn screening was reported to be ad hoc, with most women receiving information in the postnatal period. Mothers talked about newborn screening as a routine procedure that 'had' to be done. There was some recognition that consent for screening should have been given, but this was often compromised because the test was being offered by a trusted health professional and a social expectation that responsible mothers should have their babies tested. CONCLUSIONS: Mothers agreed that information about newborn-baby screening should be given during pregnancy. This is in line with recent recommendations from the UK Newborn Screening Programme Centre. This policy urgently needs to be translated effectively into everyday practice. In addition, the nature of consent required for each test needs to be clarified so that midwifery practice is not compromised and mothers are aware that some tests are advisable whereas others, for less treatable diseases, are a matter of individual choice.

Adult↗

PubMed2004

Qualitative risk assessment of routes of transmission of the exotic fish parasite Gyrodactylus salaris between river catchments in England and Wales.

Gyrodactylus salaris is a freshwater, monogenean ecto-parasite of Atlantic-salmon. Infection of its natural host, the Baltic strain of Atlantic-salmon, is inapparent. G. salaris also can infect rainbow-trout (Oncorhynchus mykiss) permanently, and cause infection of < or =50 days in several other species. It is only on Atlantic stocks of Atlantic-salmon (Salmo salar) that the parasite multiplies unchecked by an immune response, causes death in juveniles and dramatic reductions in wild populations. In Norway, the parasite has been introduced into 45 rivers, resulting in reductions in Atlantic-salmon stocks of up to 98%. It is probably the most-important exotic fish-disease threat to the UK. We used risk analysis to assess the most-important routes of spread for G. salaris between rivers in England and Wales. The movement of live rainbow-trout was identified as the most-important route of transmission; this route is likely to lead rapidly to the wide geographic spread of the parasite. The movement of other species of fish (especially from sites holding rainbow-trout) is also an important risk. Other routes of spread (including mechanical transmission on farm equipment and vehicles, angling equipment, canoes, etc.) might allow limited local spread (mainly to neighbouring rivers).

Animals↗

PubMed2005

Investigations of cattle herd breakdowns with bovine tuberculosis in four counties of England and Wales using VETNET data.

Cattle herd breakdown (HBR) with bovine tuberculosis (BTB) was investigated for farms in four counties of England and Wales outside southwest England from 1986 to early 2000. Data from the national database of TB testing history (VETNET) were used. Factors that influenced HBR included calendar time, herd size, number of cattle tested, the test type, the inter-test interval and spatial grouping of farms. Herd tests other than routine herd tests had an increased risk of HBR in all four counties. In all counties, the risk of HBR increased with calendar time and in Shropshire a test interval of 3 years was associated with an increased risk of HBR compared with a 1-year test interval. In Staffordshire and Sussex, a 4-year test interval was associated with a lower risk of HBR compared with a 1-year test interval. There was no evidence of spatial clustering of HBR in West Glamorgan (equal spatial risk in a 15-30 km radius) and weak evidence of spatial clustering in Shropshire (7-15 km) and Sussex (5-10 km). In Staffordshire, there was evidence of spatial (2-4 km) and time (3-4 years) clustering of HBR. The locally increased rate of testing following a confirmed HBR increased the detection of infected herds but did not prevent local spread in two of the four counties (Shropshire and Staffordshire) since the rate of HBR increased linearly from 1988 to 2000. The main conclusion is that there were both local and distant components of spread.

Animals↗