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PubMed2003

Stroke mortality associated with living near main roads in England and wales: a geographical study.

BACKGROUND AND PURPOSE: Air pollution is associated with stroke, and road traffic is a major source of outdoor air pollution. Using proximity to roads as a proxy for exposure to road traffic pollution, we examined the hypothesis that living near main roads increases the risk of stroke mortality. METHODS: We used a small-area ecological study design based on 113 465 census enumeration districts in England and Wales. Stroke mortality (International Classification of Disease, 9th revision, codes 430 through 438) in England and Wales from 1990 to 1992 for people >or=45 years of age was examined through the use of 1991 population denominators. Exposure was calculated as distance from each enumeration district population centroid to the nearest main road. We adjusted for age, sex, socioeconomic deprivation (using Carstairs index), regional variation, urbanization, and metropolitan area using Poisson regression. RESULTS: The analysis was based on 189 966 stroke deaths and a population of 19 083 979. After adjustment for potential confounders, stroke mortality was 7% (95% confidence interval [CI], 4 to 9) higher in men living within 200 m of a main road compared with men living >or=1000 m away. The corresponding increase in risk for women was 4% (95% CI, 2 to 6) and the risk for men and women combined was 5% (95% CI, 4 to 7). These raised risks diminished with increasing distance from main roads. CONCLUSIONS: Living near main roads is associated with excess risk of mortality from stroke, and if causality were assumed, approximately 990 stroke deaths per year would have been attributable to road traffic pollution.

Age Distribution↗
PubMed1998

Long-term trends in tuberculosis. Comparison of age-cohort data between Hong Kong and England and Wales.

The caseload of tuberculosis in developing countries is increasingly associated with the elderly. This is possibly due to increased longevity today and a change in the lifetime risk of tuberculosis within birth cohorts. Published data for tuberculosis notifications for Hong Kong and England and Wales have been used to calculate age-specific rates of disease by different age groups for different birth cohorts. In Hong Kong, each birth cohort showed a similar pattern of disease by age, with rates peaking in the 25 to 39-yr age groups and gradually declining thereafter. After 1978, regardless of age at that time, all age cohorts showed an increase in tuberculosis rates with increasing age. This trend was more marked in males than females. A similar pattern was seen for birth cohorts in England and Wales except that the peak occurred earlier in life (before 25 yr of age) and the decline with age ceased in 1984. Thereafter, rates increased in males born before 1930 but showed only a leveling off in females. If these data represent a true increase in tuberculosis rates, rather than resulting from a change in reporting accuracy and completeness, the burden of tuberculosis in the elderly is likely to continue to increase substantially.

Adolescent↗
PubMed1999

Assessment of the feasibility of conducting population prevalence studies of chronic renal failure according to ethnic group: a survey of clinical biochemistry laboratories in Greater London and south east England.

The planning of renal replacement therapy is based on assessment of population need for the white population, but uses historical trends in treatment uptake for black and Asian ethnic minority groups, for whom the incidence of chronic renal failure (CRF) is not known. Epidemiological studies of CRF are based upon follow-up of plasma creatinine results obtained from clinical biochemistry laboratories. We conducted a postal questionnaire survey of UK National Health Service (NHS) and private clinical biochemistry laboratories in Greater London and the south east of England to arrange the design and test the feasibility of carrying out a study to determine ethnic-specific rates of CRF. Fifty-five NHS laboratories (90%) and 19 private laboratories (57%) responded. Few pathology computer systems recorded ethnic group, patient post code, or diagnosis; although 31 of the laboratory computers (42%) were linked with the hospital Patient Administration System which could supply these data. Approximately 5.5 million electrolyte profiles and 20 million individual renal function tests are carried out annually in south east England. Ninety per cent of those were performed within NHS laboratories, implying that a study can use NHS sources alone without risk of any undue bias. Sixty laboratories (81%) included creatinine in their routine electrolyte profile, which would be a requirement for any study. Thirty-one laboratories (42%) archived tests within 1 year of entry, which would rule out a retrospective study design. A prospective study is feasible and should be carried out as soon as is practicable.

Clinical Laboratory Information Systems↗
PubMed2002

A prospective survey of section 136 in rural England (Devon and Cornwall).

The Mental Health Act 1983 gives the police the power to remove those persons who appear to be mentally disordered from a public place to a place of safety. Previous studies have shown conflicting results concerning its use and there have not been any previous studies in a rural area. This study is a prospective survey of the use of Section 136 in SW England and was carried out between October and December 2000 in six custody centres in SW England. Each detainee had a study form completed to examine how the section was being applied, specifically looking at the time taken for the assessment to be complete and the outcome. The results showed that there were 178 detentions under Section 136 over the three-month study period. It took 25 minutes for detainees to arrive at a police custody unit and the assessments took about 8 hours to complete. The longest delay was for the approved social worker to arrive at the custody centre, (3h 25m) which was significantly longer than the arrival time of the Section 12 doctor (2h 10m). After assessment 32% of Section 136 detainees were admitted to hospital. There were differences between the conversion rates between the six custody centres although these were not significant. This study's conclusions suggest that although rural areas meet the statutory maximum time limits for completing Section 136 assessments, greater distances than in inner city areas lead to substantial delays in completing assessments. Also this study found a much lower rate of hospital admission after assessment than has been found previously and this may reflect the differing needs and characteristics of a rural population compared with the inner city populations.

Adolescent↗
PubMed1995

Nutrition and health practices of diabetic and nondiabetic men and women from two southeastern New England communities.

Diabetes occurs in at least 13 million persons in the United States and is a major cause of morbidity and premature mortality. Diet is the cornerstone of diabetes management, and the purpose of this investigation was to examine dietary intakes and health practices among diabetic and nondiabetic individuals from a recently surveyed population-based sample from two communities in southeastern New England. Data were collected during cross-sectional home health surveys conducted in random population samples of two New England communities during 1987-1988, 1989-1990, and 1992-1993. A food frequency questionnaire was completed by 1,897 of 2,077 eligible respondents who made up our study sample. Statistical analyses suggest that diabetic individuals do not appear to be adhering to measures known to improve metabolic control (i.e., weight reduction and physical activity). Furthermore, both diabetic and nondiabetic individuals alike should be targeted for educational programs aimed at improving dietary intakes which lead to a reduction in consumption of total and saturated fatty acid.

Adolescent↗
PubMed2005

Fatal poisoning with antipsychotic drugs, England and Wales 1993-2002.

Prescription of atypical antipsychotics has increased in recent years. There have also been changes in the guidance on using older drugs, particularly the restriction in the use of thioridazine. We analysed deaths due to poisoning involving antipsychotics in England and Wales, 1993-2002, by age, sex, intent, and agents involved. We also studied antipsychotic prescribing in the community and poisoning deaths in England. Deaths attributed to adverse reactions in the course of normal treatment were not studied because these deaths are not classified as 'poisonings'. The number of deaths involving antipsychotics increased from around 55 per year 1993-1998 to 74 in 2000, and then fell to 53 in 2002. Around 25% of deaths had a verdict of accidental death and in about 60% of deaths a verdict of suicide or an open verdict was recorded. There were no deaths involving thioridazine in 2002, following its removal from use in 2001. However, the number of deaths associated with atypicals, most notably olanzapine and clozapine, has increased. Age-specific death rates were highest in those aged 30-39 and 40-49 years, and were very low in those aged under 20 and 70 or over. Death rates in males were greater than in females. For many drugs the proportion mentions either alone or with ethanol, was 25-45%, but for clozapine and olanzapine such mentions totalled 65-69%. Deaths per million prescriptions (clozapine excluded) were highest for quetiapine (31.3 per million), chlorpromazine (29.4 per million) and thioridazine (15.5 per million).

Accidents↗
PubMed2004

Community Service Orders in Hong Kong, England, and Wales: twins or cousins.

Hong Kong's Community Service Order (CSO) is anchored in the probation service and has not had to face problems related to the cultural divide and professional rivalry between community service and probation staff similar to England and Wales. CSOs in both jurisdictions differ in offenders' minimum age and in seeking offenders' consent and have been rarely used for young offenders. They have widened the net of social control, and there have been difficulties in positioning them in the sentencing tariff. Although retributive penal practices might have crept into Hong Kong after China's takeover in 1997, its CSO has retained rehabilitative elements. In England and Wales, the renaming of CSO as the Community Punishment Order reaffirmed its retributive nature, however the Pathfinder projects have taken it back to its origins as a rehabilitative measure. We suggest that CSOs should move further toward restorative justice by the involvement of victims in the choice of community services.

Crime↗
PubMed2006

The dark figure of infanticide in England and Wales: complexities of diagnosis.

Infants aged younger than 12 months have the highest homicide victimization rate of any single age group in England and Wales. In addition, there are good grounds for believing that the official homicide statistics for this particular age group are an underestimate and subject to distortion. At the same time there is evidence mounting in the United Kingdom that some parents have been incorrectly convicted of infanticide. This article first explores all recorded cases of infanticide in England and Wales for the period 1995-2002 (298 cases in total). Characteristics of the offenders, victims, offense, and court outcomes are examined. The second part of the article takes a critical gaze at the complexities involved in distinguishing infanticide from sudden infant death syndrome (SIDS) and other sudden unexplained deaths in infancy (SUDI). The article ends by considering in what ways infant deaths might be more effectively investigated.

Adult↗
PubMed1984

Epidemiology of analgesic overdose in England and Wales.

The number of deaths from acute poisoning in England and Wales has remained constant at approximately 4000 per annum for the last 10 years despite major changes in the agents responsible. Deaths due to carbon monoxide and barbiturate and non-barbiturate hypnotics have fallen, while those due to psychotropic and analgesic drugs have risen. The number of hospital admissions in England and Wales due to analgesics taken in overdose has risen from 15 940 in 1968 to 24 930 in 1980, with aspirin and paracetamol being the preparations most commonly ingested. Currently, the mortality from salicylate intoxication is falling while that due to paracetamol is rising. In 1980, the Office of Population Censuses and Surveys recorded 790 deaths from analgesic poisoning, of which 181 were due to salicylates and 152 to paracetamol alone. A further 269 deaths were attributed to paracetamol and dextropropoxyphene, and an additional 132 deaths were thought to be due to paracetamol in combination with other drugs. An important factor in the changing mortality from salicylate and paracetamol poisoning is the trend observed in the sales and usage of these agents. Since 1979, the number of analgesic tablets containing aspirin sold in the UK (except Northern Ireland), excluding hospital use, has fallen by 326 X 10(6), while sales of those containing paracetamol have increased by 395 X 10(6) tablets.

Acetaminophen↗
PubMed1995

Deaths from pesticide poisoning in England and Wales 1990-1991.

1. Data on deaths from pesticide poisoning occurring in England and Wales in 1990 and 1991 have been collated. Pesticides were responsible for 44 of 3978 deaths from poisoning (excluding carbon monoxide and other gases) over this period. 2. At least 66% of all pesticide fatalities were due to suicide and overall there was a predominance of males (male:female ratio 2.4:1). Eighty per cent of deaths occurred in those more than 44 years old and no child under 10 years old died, although almost 50% of suspected pesticide poisoning incidents involve this age group. 3. Herbicides were responsible for 35 of the 44 deaths; seven were caused by insecticides, one by a molluscicide and one by an unspecified agent. The herbicide, paraquat, was responsible for 33 of 44 deaths (75%) and, although fewer fatalities have occurred from this cause in recent years, paraquat remains the most common cause of fatal pesticide poisoning in England and Wales.

Adolescent↗
PubMed1994

Cross-sectional analysis of the differences between patients with systemic lupus erythematosus in England, Brazil and Sweden.

This study is a cross-sectional analysis of the differences between SLE outpatients seen in Rheumatology departments at University centres in England, Brazil and Sweden, using a standard protocol. The demographic characteristics, extent and activity of disease of 209 patients with SLE were studied; 112 patients were seen in England, 33 in Brazil and 64 in Sweden. The median age of disease onset of Brazilian and English patients was 25 years and of Swedish patients 31.5 years. Disease activity was measured by the BILAG index. In most systems Brazilian patients experienced more activity than English patients and English patients more activity than Swedish patients. Non-Caucasians experienced more active disease than Caucasians. No sex or occupational differences were observed in disease activity. English patients were the most likely to have experienced photosensitivity, oral ulcers and haematological disorders, Brazilian patients renal disorders and Swedish patients discoid rashes. Brazilian patients were the most likely to be prescribed only one drug for treatment of SLE and to be taking steroids and the highest dose of steroids, in contrast to the European patients who were often prescribed steroids and an antimalarial agent or azathioprine. The results of this cross-sectional assessment of disease activity using a standardized instrument indicate that there are real differences in the extent and degree of activity of SLE in different national groups. This reflects a combination of genetic, environmental and social influences on disease expression and has implications for treatment and monitoring of SLE patients.

Adolescent↗
PubMed2006

The proportions of Down's syndrome pregnancies detected prenatally in England and Wales from 1989 to 2004.

OBJECTIVES: The proportion of Down's syndrome pregnancies detected prenatally in England and Wales is lower in younger mothers than in older mothers. This paper examines the reasons for this apparent age inequality. METHODS: We used data from the National Down Syndrome Cytogenetic Register (NDSCR) to examine the time trend of the proportion of Down's syndrome pregnancies diagnosed prenatally according to maternal age over the years 1989-2004 in England and Wales. RESULTS: A lower proportion of younger mothers had their Down's syndrome pregnancy detected prenatally than older mothers; however, this gap has been closing over time. For example, for mothers under 25 years of age only 13% of Down's syndrome pregnancies were detected prenatally from 1989 to 1992, with this figure rising to 34% in 2001-2004, compared with proportions of 74% in both periods for mothers over 44 years of age. A lower uptake of screening among younger women could not explain these differences. The differences in detection rates of the screening methods according to maternal age, particularly of the older screening tests, could account for these differences. CONCLUSIONS: The closing gap between the proportions of younger and older women having their affected pregnancy prenatally diagnosed is a confirmation of the improvement of screening methods over time.

Adult↗
PubMed1996

Role of screening in reducing invasive cervical cancer registrations in England.

OBJECTIVE: To estimate the effect of screening on invasive cervical cancer registrations in England. SETTING: The Health of the Nation target for cervical cancer seeks to reduce the incidence of invasive cases (ICD 180) by at least 20% between 1986 and 2000. METHOD: The available area-level statistics on invasive cervical cancer registrations, screening activity, and socioeconomic and behavioural characteristics for 145 district health authorities in England over the period 1985-91 were collected. A multiple regression analysis sought to explain variations in incidence rates by relating screening and socioeconomic and behavioural variables to registration rates. RESULTS: Districts with higher unemployment levels and higher numbers of pregnancies in young women had higher registration rates for invasive cervical cancer. The cervical smear rate for women aged 35-64 in a district was positively related to registrations, whereas the relation was negative for the 20-34 age group. CONCLUSIONS: The higher registration rates for invasive cervical cancer in districts with higher cervical smear rates for women aged 35-64 may reflect historically lower screening cover. The negative relation between the cervical smear rate and invasive cervical cancer registrations in women aged 20-34 is accompanied by high registration rates for preinvasive (CIN III) cervical cancer (ICD 233.1). For the advantages of the Pap test to be fully realised, and for invasive cervical cancer registrations to fall in line with the Health of the Nation targets, a comprehensive screening programme, with a high take up rate is required. The various changes to the screening programme introduced since 1988 should help to achieve this. Public health policy should focus on educating the population about the risk factors for cervical cancer and the significance of screening.

Adolescent↗
PubMed2005

A comparative study of dementia care in England and the Netherlands using neo-institutionalist perspectives.

In this article, the authors compare dementia care in England and the Netherlands. They used qualitative methods to explore recommended standards of service provision and perceived achievements in mainstream care. They found some similarities in recommended standards and in major shortcomings in mainstream services: notably, weaknesses of generic services in supporting patients and carers, and failure to achieve integrated care. Priorities regarding service provision differed. Whereas in England, a social model of care was used to encourage empowerment of both the person with dementia and the carer, Dutch care professionals focused more on "warm care concepts" and on support of the carer rather than the patient. The balance between community care and institutional care also differed. The authors used neo-institutionalist concepts to explore these similarities and differences as embedded in the (historically developed) structural and cultural contexts of the respective health and social care systems.

Delivery of Health Care↗
PubMed1986

The practice of pharmacy in England.

The practice of pharmacy in England is described. Community pharmacies have a contract with the Department of Health and Social Security to fill National Health Service prescriptions. A large proportion of the general public obtain their prescriptions free. Funding for the health service comes from taxes and automatic contributions from employers and employees. Aspects of hospital pharmacy practice and salaries are discussed, e.g., a junior pharmacist may expect to earn between $9000 and $12,000. There is very little unit-dose dispensing, and many hospitals are unable to provide 24-hour services. Hospital pharmacies function with fewer pharmacists than their U.S. counterparts, utilizing larger numbers of technicians. Clinical pharmacy practice centers around drug monitoring (ward pharmacy). Pharmacokinetic services are provided in a few places. Master of science degrees in clinical pharmacy are available. However, the future of clinical pharmacy practice in England depends on staffing levels and competition between and acceptance from other health disciplines.

Community Pharmacy Services↗
PubMed2005

Building and supporting sustainable improvement in cardiac surgery: the Northern New England experience.

The Northern New England Cardiovascular Disease Study Group (NNECDSG) was formed as a regional clinical database that would allow clinicians to track outcomes after cardiac interventions. The purpose of the NNECDSG would be to use its database and organizational structure to seek best practices and disseminate information aimed at improving results for patients undergoing cardiovascular interventions. Since 1987, this voluntary regional collaborative of clinicians, hospital administrators, and health care research personnel has tracked consecutive cardiovascular interventions performed throughout Northern New England and reported its findings to the clinicians. Collaboration between NNECDSG institutions has led to progressive refinements in the clinical database, institutional site visits, efforts to understand and standardize ideal processes of care, risk-stratification tools to aid in decision making, and most recently, tools to track and report on appropriateness of interventions based on national criteria. As a result of these efforts, mortality rates after coronary bypass graft surgery have steadily declined and the variation in mortality rates between institutions has disappeared.

Cardiac Output, Low↗
PubMed1997

Informing prescribing allocations at district level in England.

OBJECTIVES: To derive a predictive model based on the morbidity, demographic and socio-economic characteristics of district populations to explain variations in prescribing costs in England. METHOD: Inter-relations between morbidity, demographic, socio-economic, general practice supply characteristics and net ingredient cost per age, sex and temporary resident originated prescribing unit (ASTRO-PU) were explored statistically for 90 districts in England using 1994 cost data. The possibility of mutual inter-relationship between 'supply' and 'demand' was examined; then the associations between a range of factors and prescribing costs were estimated using ordinary least squares regression and the predictive power of the possible models was systematically examined. RESULTS: Whilst there was a relatively weak relationship between the supply factors that were measured, there did not appear to be any reciprocal relationship. Three parsimonious models estimated using ordinary least squares multiple regression techniques based on combinations of permanent sickness, low birth weight and the proportion of general practitioners registered for postgraduate certificate of education were identified. The models explained up to 61% of variation between districts in prescribing costs. CONCLUSIONS: 'Need' and 'supply' characteristics are independently associated with variations in prescribing costs at district level. The negative association between the proportion of general practitioners eligible for postgraduate education allowance and prescribing costs may reflect 'better' prescribing but could not be introduced into a resource allocation formula without introducing perverse incentives. The combination of permanent sickness and low birth weight complement each other by providing a proxy measure of morbidity mostly applicable to adult males (permanent sickness) and mothers (low birth weight being a measure of maternal health). These variables should be considered further for use in the process of allocating resources for prescribing to districts.

Cost Allocation↗
PubMed2006

Modelling the force of infection for hepatitis B and hepatitis C in injecting drug users in England and Wales.

BACKGROUND: Injecting drug use is a key risk factor, for several infections of public health importance, especially hepatitis B (HBV) and hepatitis C (HCV). In England and Wales, where less than 1% of the population are likely to be injecting drug users (IDUs), approximately 38% of laboratory reports of HBV, and 95% of HCV reports are attributed to injecting drug use. METHODS: Voluntary unlinked anonymous surveys have been performed on IDUs in contact with specialist agencies throughout England and Wales. Since 1990 more than 20,000 saliva samples from current IDUs have been tested for markers of infection for HBV, HCV testing has been included since 1998. The analysis here considers those IDUs tested for HBV and HCV (n = 5,682) from 1998-2003. This study derives maximum likelihood estimates of the force of infection (the rate at which susceptible IDUs acquire infection) for HBV and HCV in the IDU population and their trends over time and injecting career length. The presence of individual heterogeneity of risk behaviour and background HBV prevalence due to routes of transmission other than injecting are also considered. RESULTS: For both HBV and HCV, IDUs are at greatest risk from infection in their first year of injecting (Forces of infection in new initiates 1999-2003: HBV = 0.1076 95% C.I: 0.0840-0.1327 HCV = 0.1608 95% C.I: 0.1314-0.1942) compared to experienced IDUs (Force of infection in experienced IDUs 1999-2003: HBV = 0.0353 95% C.I: 0.0198-0.0596, HCV = 0.0526 95% C.I: 0.0310-0.0863) although independently of this there is evidence of heterogeneity of risk behaviour with a small number of IDUs at increased risk of infection. No trends in the FOI over time were detected. There was only limited evidence of background HBV infection due to factors other than injecting. CONCLUSION: The models highlight the need to increase interventions that target new initiates to injecting to reduce the transmission of blood-borne viruses. Although from the evidence here, identification of those individuals that engage in heightened at-risk behaviour may also help in planning effective interventions. The data and methods described here may provide a baseline for monitoring the success of public health interventions.

England↗