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PubMed2005

Sedentary behaviour, physical activity and weight problems in adolescents in Wales.

OBJECTIVE: We studied the prevalence and stability of overweight and obesity in a cohort of adolescents, and the effects of sedentary behaviour and physical activity on changes in body mass. The study also examined the extent to which physical activity mediated the relationship between sedentary behaviour and body mass. DESIGN: Four-year cohort study. METHODS: The study was part of the Health Behaviour of School-aged Children Study that took place in Wales between 1994 and 1998. Body height and weight measurements and self-report data on sedentary behaviour, physical activity and psychosocial adjustment were collected from 355 adolescents on two occasions 4 years apart. The mean age of the sample at baseline was 12.30 (SD=6.30) years. RESULTS: Weight conditions (underweight, overweight and obesity) and body mass were moderately stable over the interval. Regression analyses showed that sedentary behaviour at Time 1 predicted body mass at Time 2, while physical activity predicted a change in body mass over time. The influence of sedentary behaviour on body mass was not found to be mediated by physical activity. However, weight problems in Year 7 coincided with getting bullied, bullying others, and feeling left out of things. Obesity was also related to snacking and skipping breakfast. CONCLUSIONS: Sedentary behaviour and physical activity in early adolescence both influenced body mass in late adolescence. Results indicated that promoting healthy diets and physical activities may have long-term health benefits for young people.

Adolescent↗
PubMed2005

Analysis of renal service provision in south and mid Wales.

OBJECTIVES: This paper estimates point prevalence of renal replacement therapy (RRT) utilization within population strata defined by geography and deprivation in south and mid Wales. It investigates spatial accessibility of main and satellite renal units by comparing population and patient numbers within bands of travel time. STUDY DESIGN: Prevalence study based on patient registers. METHODS: From a list of patient and renal unit locations, geocoded at the level of unit postcodes, and electoral division-level denominator population data, we calculated RRT point prevalence for the 16 unitary authorities in the study area, fifths of small area deprivation, and three bands of travel time from the nearest main renal unit and any (main or satellite) unit. RESULTS: Overall point prevalence was 633 per million population (pmp) and this varied from 256 to 780 pmp across unitary authorities. RRT prevalence was lower in more deprived areas. Sixty-nine percent of the population and 73% of patients lived within 30 min of a main renal unit. Eighty-four percent of the population and 88% of patients lived within 30 min of a main or satellite renal unit. CONCLUSIONS: The provision of satellite renal units has significantly improved spatial accessibility of RRT services. However, a substantial proportion of the population remains geographically distant from renal units. This has important implications for planning of future provision of RRT, given the inverse relationship between RRT acceptance and travel time, and the impact on quality of life of patients who travel frequently to renal units.

Geography↗
PubMed2005

The relationship between potentially erosive storm energy and daily rainfall quantity in England and Wales.

Erosive storm energy is the primary driver of soil detachment, and hence a major determinant of transfer of sediment and particulate phosphorus (P) to surface waters. Modelling of sediment and P loss at catchment scale, for example for the development of catchment and national mitigation policies, requires a spatially interpolated estimate of variation in erosion risk. To this end we present a method of estimating total rainfall erosivity, as kinetic energy (KE), for any location in England and Wales, from daily rainfall data or monthly climate data. Analysis of detailed, high-resolution records from eleven contrasting sites showed strong predictive correlations between daily rainfall quantity and associated daily total kinetic energy estimated from hourly rainfall intensities. The coefficients showed systematic seasonal variation, with greatest KE per unit of rainfall in late summer and autumn months. In contrast, no systematic spatial variation was found as a function of location or continentality index. The relationships were integrated with probability distributions of rainfall quantity per rain day derived from spatial climate data (monthly rainfall totals and numbers of rain days). The resulting map captures and quantifies the effects of rainfall quantity and intensity patterns on risk of sediment detachment, and as such provides a critical input layer to catchment-scale models of sediment and P transfer.

England↗
PubMed2004

How acceptable are innovative health-care technologies? A survey of public beliefs and attitudes in England and Wales.

There has been a continuing debate about the extent to which the public finds health-care technological innovation acceptable. The public's ambivalence about scientific medicine may have been exacerbated, more recently, by developments such as the introduction of the 'new genetics' with their associated ethical and social implications and the claims that public trust in health care and practitioners and, more widely, in society has been eroded. The aim of this paper is to examine public attitudes to a range of innovative health-care technologies to see whether (i) certain technologies are perceived as particularly problematic, and (ii) attitudes to new health-care technologies are associated more broadly with beliefs about science, trust in health care and social trust, and perceptions of the benefits and risks of complementary and alternative medicine versus orthodox (technological) medicine. These questions are examined through a statistical analysis of data collected in a national, postal survey of the adult population (n = 1187) in England and Wales. The results showed public ambivalence about new health-care technologies, although genetic technologies, as a whole, were not seen to be problematic and their acceptability depended on their ability to control serious diseases. However, there was a level of consistency in attitude across the different technologies. Those consistently against new health-care technologies were also more likely to be suspicious of science, and doubtful about the benefits of other established, orthodox technologies (screening; medications) and to have less trust in health and health-care practitioners.

Adolescent↗
PubMed2006

Effects of socioeconomic and geographic variations on survival for adult glioma in England and Wales.

BACKGROUND: To investigate the effects of SES and geographic variations on survival for adult patients with glioma, we analyzed data from 30489 patients from the Cancer Registry in England and Wales. METHODS: Median survival and CSRs for 8 variables (age, sex, morphology, World Health Organization [WHO] grade, tumor site, SES, geographic regions, and periods of diagnosis) are calculated using the Kaplan-Meier method. Distributions among different variables are compared using chi(2) test. Cox regressions are performed for estimating HRs to death. RESULTS: The median survival and the 1-, 5-, and 10-year CSR in this population are 0.42 years, 29.1%, 12.0%, and 7.7%, respectively. There is a gradient in SES from the south to the north (chi(2) test, P < .001) and a gradual increment in higher SES from the early to the recent period (chi(2) test, P < .001). Mono- and multivariate analyses reveal that all the 8 variables influenced the survival (P < .05). Age (HR, 1.04 per year from 15 years, P < .001), WHO grade (1.21 per grade from grade I, P < .001), and morphology (HR from 1.23 to 1.89, compared with ependymoma, P < .05) are the most influential factors. However, there are also independent effects from SES (HR, 1.03 per quintile of deprivation, P < .001) and geographic regions (HR, 1.10 for outside southern England; P < .001) on the survival. CONCLUSIONS: Although age and tumor characteristics (morphology, WHO grade, tumor site) are well-known prognostic factors, SES and geographic variations also play a slight but significant role, and for more cost-effective allocation of health resources, alleviation on these 2 modifiable factors should be considered.

Adult↗
PubMed2005

Cyanobacteria and prawn farming in northern New South Wales, Australia--a case study on cyanobacteria diversity and hepatotoxin bioaccumulation.

Harmful cyanobacteria pose a hazard to aquatic ecosystems due to toxins (hepatotoxic microcystins, nodularins, and cylindrospermopsin) they produce. The microcystins and nodularins are potent toxins, which are also tumor promoters. The microcystins and nodularins may accumulate into aquatic organisms and be transferred to higher trophic levels, and eventually affect vector animals and consumers. Prawn farming is a rapidly growing industry in Australia. Because information regarding effects of cyanobacteria at prawn farms was lacking, we examined diversity of cyanobacteria and toxin production plus bioaccumulation into black tiger prawns (Penaeus monodon) under both field (northern New South Wales, Australia, December 2001-April 2002) and laboratory conditions. Samples were analyzed for hepatotoxins using enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC). The maximum density of cyanobacteria (1 x 10(6) to 4 x 10(6) cells/l) was reached in April. Cyanobacteria encountered were Oscillatoria sp. (up to 4 x 10(6) cells/l), Pseudanabaena sp. (up to 1.8 x 10(6) cells/l), Microcystis sp. (up to 3.5 x 10(4) cells/l), and Aphanocapsa sp. (up to 2 x 10(4) cells/l). An uncommon cyanobacterium, Romeria sp. (up to 2.2 x 10(6) cells/l), was also observed. Contrasting earlier indications, toxic Nodularia spumigena was absent. Despite that both Oscillatoria sp. and Microcystis sp. are potentially hepatotoxic, hepatotoxin levels in phytoplankton samples remained low (up to 0.5-1.2 mg/kg dw; ELISA) in 2001-2002. ELISA was found suitable not only for phytoplankton but prawn tissues as well. Enzymatic pretreatment improved extractability of hepatotoxin from cyanobacteria (nodularin from N. spumigena as an example), but did not generally increase toxin recovery from prawn hepatopancreas. There were slightly increasing hepatotoxin concentrations in prawn hepatopancreas (from 6-20 to 20-80 microg/kg dw; ELISA) during the study. Hepatotoxin concentrations in surface sediment remained low (<5 microg/kg dw; ELISA) throughout the study. Laboratory experiments indicated that prawn hepatopancreas, heart, and brain were primary organs for hepatotoxin bioaccumulation. Toxin concentration in other organs, including muscle, was less effective. Orally administered nodularin levels in hepatopancreas rapidly decreased from initial 830 to 250 microg/kg dw in 96 h. Similarly, concentration of microcystin-LR injected in prawns decreased from 130 to 30 microg/kg dw (hepatopancreas) in 2 h. These results demonstrate that potential risks caused by cyanobacteria in prawn farming (farmers, prawns, and consumers) were not substantial in 2001-2002. Although prawns may act as vectors for toxin transfer, they did not accumulate alerting amounts of hepatotoxins and were able to effectively detoxify them. Because bloom toxicity may vary, low-frequency toxin monitoring is recommended.

Animals↗
PubMed2006

Cases of typhoid fever imported into England, Scotland and Wales (2000-2003).

Although typhoid fever is no longer endemic in most of the developed world, it remains a major infectious disease in less developed regions and imported cases continue to occur in returning travellers, immigrants or migrant workers. We analysed all 692 isolates of Salmonella enterica subspecies enterica serovar Typhi from cases in England, Scotland and Wales that were sent to the Laboratory of Enteric Pathogens at the Health Protection Agency, Centre for Infections, London, UK between 2000 and 2003. The country of acquisition was known for 416 isolates (60%), and the majority of these (70%) came from India or Pakistan. Overall, 24 countries were listed, mainly in Asia and Africa. A total of 48 phage types were detected, 41% of which were Vi-phage type E1. Antimicrobial susceptibility testing revealed that 22% of isolates were multidrug resistant (MDR) (defined as resistance to chloramphenicol, ampicillin and co-trimoxazole) and 39% were quinolone resistant. A significant number of isolates (n=49) were sensitive to nalidixic acid by disk test but exhibited low-level ciprofloxacin resistance, suggesting a novel mechanism of resistance and reinforcing the need for minimum inhibitory concentration determination. Overall, 13% of isolates were both MDR and likely to show a poor response to a fluoroquinolone. A third-generation cephalosporin (e.g. ceftriaxone) should be considered as empirical therapy in regions of the Indian subcontinent where resistance is now at high levels as well as in patients returning from these areas. This study helps to describe the epidemiology of antimicrobial drug resistance in typhoid fever.

Anti-Bacterial Agents↗
PubMed2005

The detection and characterisation of Dichelobacter nodosus from cases of ovine footrot in England and Wales.

Footrot, caused by the strictly anaerobic bacterium Dichelobacter nodosus, is the most common cause of lameness in sheep in Great Britain but problems exist in association with its diagnosis and control. The fastidious nature of D. nodosus means that complex media and several weeks are required for characterisation. An alternative method to simplify and enhance the detection of D. nodosus in clinical samples is therefore highly desirable. In terms of control, anecdotal evidence from the farming community suggests that the commercially available vaccine, based on Australian isolates of D. nodosus, is not widely employed in this country due to its perceived inefficacy. Seven hundred and six isolates, collected from outbreaks in England and Wales, were therefore used to investigate these issues. A 16S rRNA PCR was adapted to detect D. nodosus in clinical material within 1 day of sampling; a 15% increase in detection compared with culture and less than 1% false negatives were achieved. This represents a major advance in the rapid diagnosis of footrot and will be of great value to practitioners and diagnostic laboratories. Bacterial virulence was tested using protease thermostability and zymogram assays, whilst serogrouping was performed by slide agglutination. All isolates demonstrated virulence patterns previously recorded in Australia and all nine serogroups of D. nodosus (A-I) were represented. Serogroup H was predominant. There was, therefore, no evidence for the presence of novel strains of D. nodosus compared with Australia suggesting the need for further investigation into farmers' views on the use of the commercial vaccine in Great Britain.

Animals↗
PubMed2006

Seroprevalence of Toxocara canis in sheep in Wales.

Antibody levels to Toxocara canis L2 excretory/secretory antigens were examined by ELISA in 400 serum samples from sheep in Powys and Gwent, Wales. A positive OD value was set at the mean +/-3S.D. of 45 control samples. Seroprevalence increased with age. Seven percent and 13% of 6-month-old sheep showed positive OD values as did 16% of 10-month-old, 27% and 31% of 15-month-old and 47% of cull ewes. Analysis of variance showed a significant increase in ELISA OD values among the seropositive sheep with increasing age of sheep.

Age Factors↗
PubMed2006

Blowfly strike prevalence in domestic rabbits in southwest England and Wales.

The prevalence of blowfly strike in rabbits in southwest England and Wales was investigated using a retrospective postal survey of small animal and mixed veterinary practices. Questionnaires were sent to 474 practices; 219 were returned completed, giving a response rate of 46.2%. The prevalence of blowfly strike was estimated as the percentage of veterinary practices that reporting having treated at least one rabbit for strike between May and September 2005. Overall, 94.5% (+/-2.21) of practices treated at least one case of rabbit strike. Almost half, 49.3% (+/-11.3) of practices reported treating only 1-5 rabbits for blowfly strike in the study period; 32.8% (+/-4.56), 13% (+/-3.27) and 4.8% (+/-2.08) treated 6-10, 11-15 and more than 15 struck rabbits, respectively. In 46.3% (+/-4.84) of the practices most infested rabbits survived. For 40.4% (+/-4.77) of practices, about half the struck rabbits survived. However, for 13.3% (+/-3.30) of practices most struck rabbits were reported to have died. The practices reporting that most animals died were those that saw significantly fewer rabbits and fewer struck rabbits than practices where more animals survived. This suggests that training and experience in the appropriate care of infested rabbits may be critical in ensuring a favorable outcome.

Animals↗
PubMed2001

Factors associated with parental safe road behaviour as a pedestrian with young children in metropolitan New South Wales, Australia.

A cross-sectional population-based randomised telephone survey of parents with children aged between 5 and 12 years was conducted to investigate factors associated with safe road behaviour of parents as pedestrians with their young children in Sydney metropolitan and near by cities in New South Wales, Australia. Parental perception of the road environment as hazardous associated significantly with their safe road behaviour as pedestrian while with their children. This held true even after adjusting for the non-English speaking background and the age of the child. Knowledge of road rules, on the other hand, was not associated with parental safe road behaviour. The results of this study suggested that parental safe road behaviour require much attention in future research and in programme development. The perception of the road environment is a very important factor in motivating safe road behaviour. This should be taken into consideration in designing road safety campaigns.

Accidents, Traffic↗
PubMed1999

Survey of intussusception reduction in England, Scotland and Wales: how and why we could do better.

AIM: The aim of our study was to assess the variation in technique among hospitals in England, Wales and Scotland. In addition, local in hospital variation among paediatric radiologists at our own institution was assessed. METHOD: Postal questionnaires were distributed to the radiology departments of 301 hospitals. RESULTS: 183 (60.8%) replies were received. 122 institutions reduced intussusceptions and 61 did not. A lack of paediatric surgical and/or anaesthetic cover, and a lack of radiological experience were the major reasons cited by the departments which did not attempt intussusception reduction. Sixty-five hospitals use barium for hydrostatic reduction, 43 employ pneumatic reduction, 10 use water-soluble enemas and four use ultrasound. Of the 65 centres using barium 16 (25%) reported a success rate of less than 50%, 24 (37%) had a 50-70% success rate, seven (11%) reduce greater than 70% of intussusceptions and 18 (27%) did not know. In the 43 institutions employing air reduction, one (2%) had a success rate less than 50%, 20 (47%) had a 50-70% success rate, 17 (40%) a success rate greater than 70% and five (11%) did not know. Overall, of the total number of hospitals which replied to our survey, 28 (23%) reported that they were not aware of their success rates. Within the pneumatic reduction group in particular there was marked variation in the methods and duration of attempted reduction - between different hospitals and within the same institution. In six departments the machine used for pneumatic reduction did not measure intraluminal pressure. CONCLUSIONS: Ultrasound is underutilized despite being a sensitive method in diagnosis. There is almost certainly an over-reliance on plain radiographs and on the use of sedation, antibiotics and anti-spasmodics in general. We believe a 70% or greater success rate should be achievable in most institutions whether by pneumatic or hydrostatic reduction, and all departments should strive to achieve success rates in this range. Less than a quarter of centres who replied currently achieve this standard. Successful reduction rates below 50% are unacceptable in our opinion. Not surprisingly, success rates are generally highest in those centres treating more than 20 cases per annum. Twenty-eight (23%) of hospitals performing intussusception reductions did not know their success rates. Regular audits of intussesception figures should take place in all institutions. Unacceptably wide variations in intussusception reduction techniques currently exist. An accurate pressure release valve at least, and preferably intraluminal pressure monitoring should be an integral component of all pneumatic reduction devices. The British Paediatric Radiology and Imaging Group or the Royal College of Radiology should address these issues and introduce some standardization of practice.

Clinical Medicine↗
PubMed2002

Trends in twin births in New South Wales, Australia, 1990-1999.

OBJECTIVE: To examine trends in gestational age and the mode of delivery of twins. METHOD: All twin births in New South Wales, Australia from 1990 through 1999 were analyzed. RESULTS: Twin births increased from 1922 (2.2%) in 1990 to 2522 (2.9%) in 1999. Twins born preterm (<37 weeks) increased from 40.8 to 48.8%. The increase in preterm twin births was associated with increases in induction of labor and cesareans before labor at 32-36 weeks. The rate of fetal deaths decreased by 49% and Apgar scores <4 at 5 min by 28%. CONCLUSIONS: A greater than expected increase in preterm twins was largely explained by an increase in elective deliveries at 35-36 weeks' gestation. Increasing maternal age does not appear to have contributed to the increase in preterm twin births. Lower rates of fetal death and low Apgar scores were achieved seemingly at the price of delivering more infants before term.

Adult↗
PubMed2001

The Fourth Quinquennial National Community Mental Health Nursing Census of England and Wales.

Within an increasingly articulate policy framework, changes to the United Kingdom National Health Service have taken place and these have impacted on mental health service provision. They have particular implications for the work of community mental health nurses (CMHNs). Since 1980, a five-yearly national census of CMHNs has been conducted. Selected findings from the latest census, commissioned by the Department of Health, are set within the context of data derived from the three previous studies. Substantive implications which flow from the changes detected in the practice, organisation and management, and education of community mental health nurses in England and Wales, are discussed.

Adult↗
PubMed2002

Lived experiences of immigrant nurses in New South Wales, Australia: searching for meaning.

Recognising the potential value of immigrant nurses in multicultural Australia, this study sought to understand immigrant nurses' experiences in order to throw some light on their under representation in the nursing workforce. Using a Heideggerian phenomenological approach the purpose of this study was to explore, describe and analyse the lived experiences of five immigrant nurses, four from non-English-speaking backgrounds, practising in New South Wales, Australia. Through naturalistic open-ended interviews, the everyday experiences of immigrant nurses were described and hermeneutically analysed. The lived experiences, and the meaning of such experiences which emerged from analysis included: professional negation, experienced in lack of support; otherness, experienced in cultural separateness; silencing, experienced in language and communication difficulties and a number of other related experiences and feelings. The study highlights the continuing existence of a social and cultural distance between nurses of the dominant culture and nurses from culturally and linguistically diverse backgrounds.

Communication↗
PubMed2003

Molecular evidence for multiple Toxoplasma gondii infections in individual patients in England and Wales: public health implications.

We sought to determine the SAG2 genotypes of Toxoplasma gondii associated with cases of acute human toxoplasmosis in England and Wales. The samples examined were collected from a wide range of cases including congenital infections, AIDS and immunosuppressed patients and were derived from a number of different tissues. Parasite DNA was detected by PCR amplification without the need for prior template purification, and SAG2 genotype was determined by both restriction enzyme analysis and direct DNA sequencing of the PCR amplification products. Parasites of both SAG2 type I and type II genotypes were seen with approximately equal frequency amongst the samples examined. Neither of these genotypes was found to be more frequently associated with a particular clinical presentation or sample tissue. Unexpectedly, we found clear evidence of mixed (SAG2 type I+type II) infections in approximately the same number of samples as were seen to be associated with either type I or II alone. Our use of direct DNA sequencing rather than simple restriction analysis was essential for the detection of mixed infections since incomplete restriction digestion of samples containing a single parasite type was occasionally observed. It is possible that the presence of more than one type of parasite in single samples might be related to our recent demonstration that mixtures of SAG2 type I and type II parasites are present in a significant proportion of commercial meat preparations. Moreover, the presence of mixed infections in single patients might offer a direct molecular method of assessing risk factors for infection.

AIDS-Related Opportunistic Infections↗
PubMed2003

Neonatal surgery in New South Wales--what is performed where?

OBJECTIVES: The aim of this study was to describe what surgical procedures are performed in the neonatal period in New South Wales (NSW) and where they are performed. METHODS: Population-based descriptive study was conducted in NSW in a 2-year period from July 1, 1996 to June 30, 1998, inclusive, using information from the NSW Health Department's Inpatient Statistics Collection. All neonates undergoing major surgery (excluding circumcisions) in NSW. RESULTS: In the first 4 weeks of life, 990 (0.6%) neonates underwent surgery. The most common surgical procedures were gastrointestinal, cardiovascular, hernia, genitourinary, and neurosurgical. Frenotomy accounted for 5% of all surgical procedures. Whereas 75% of neonatal surgery (including 88% of gastrointestinal and 97% cardiovascular surgery) occurs in children's hospitals, only 13% of the babies requiring surgery are born in the co-located obstetric hospitals. Perinatal centers accounted for 5.3% of surgery; urban hospitals for 8.4%; rural hospitals, 5.5%, and private hospitals, 6.4%. The mortality rate in the neonatal period was 3.0% overall. CONCLUSIONS: This is the first review of major neonatal surgery in Australia and provides baseline data for future comparisons. Whereas most neonates had surgery in a children's hospital, few of them were born in the most appropriate place, the co-located obstetric hospital. Parents should be informed of the level of institutional surgical expertise and be involved in the decision-making regarding the place of surgery for their infant. Parents and children have a right to expect the best possible results.

Female↗
PubMed2003

A neglected risky behavior among children and adolescents: underage driving and injury in New South Wales, Australia.

PROBLEM: Among different causes of injury, roads and traffic-related incidents contributed most to all child deaths. The majority of childhood and adolescent traffic-related deaths are young people killed as pedestrians or bicyclists. Underage driving is a particular risky behavior much neglected. This study aimed to describe some characteristics related to motor-vehicle crashes and crash-related injury in which the vehicle was driven by a young person who was under the legal age of obtaining a learner license in New South Wales, Australia. METHODS: Data used in this study were made available from the Roads and Traffic Authority of NSW for the period between 1996 and 2000. Crash information was collected and reported by NSW police at the scene of these motor-vehicle crash incidents. RESULTS: There were 526 crashes involving an underage driver recorded within the study period. The majority (79.5%) of these underage drivers were males with slightly more than half (58.0%) aged 15 years, and nearly 30% aged 14 years. Among these, 83.6% involved the driver of the vehicle being killed or injured. Among the injured or killed passengers, 128 (73.6%) were nonadult passengers under the age of 18 years. Seventy of these crashes occurred while the car was in pursuit by police. The adjusted relative risk of injury to at least one occupant in the vehicle should a crash occur for female underage drivers was two times (OR=2.01, 95% CI=1.27-3.20) as compared to male underage drivers. DISCUSSION: Underage driving poses a serious problem in terms of crash outcomes. Experimental driving and late-night outings for adolescents should be discouraged. Well-designed studies are required to further investigate the relationship between underage driving and on road risk-taking behavior among licensed adolescents. IMPACT ON INDUSTRY: Data obtained from this study indicate that adults, particularly parents, should discourage underage adolescents from experimenting driving and should actively cultivate a positive attitude toward driving.

Accidents, Traffic↗