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PubMed1993

The ability of Salmonella enteritidis isolated from chicks imported from England to cause transovarian infection.

S. Enteritidis HY-1 isolated during quarantine from chicks imported from England was used. Laying hens at the age of 34 weeks were inoculated orally with 10(10) organisms (10 birds), intramuscularly with 10(9) (5 birds), and intravenously with 10(9) (5 birds). Egg production did not change in hens infected orally, although it was reduced in hens infected intramuscularly for 2-3 weeks post inoculation. For one month, internally infected eggs of which the shells were not contaminated were found: one out of 65 eggs in hens infected orally and three out of 36 eggs in hens infected intramuscularly. This experiment demonstrated the ability of S. Enteritidis isolated from chicks imported from England to cause transovarian infection.

Animals↗
PubMed2003

Transitions to supported environments in England and Wales among elderly widowed and divorced women: the changing balance between co-residence with family and institutional care.

In this article we examine changes in the proportion of older widowed and divorced women in England and Wales moving from 'independent' to two kinds of 'supported' household--supported private households and institutions--during the decades 1971-81 and 1981-91. Our main aim was to see whether observed increases in institutionalisation over this period were the result of a decreased propensity to move to the households of relatives. We used the ONS Longitudinal Study, a record linkage study including individual level data from the 1971, 1981 and 1991 censuses of England and Wales. A multinomial logit model was used to investigate the correlates of transitions from independent to supported private households versus institutions among elderly widowed and divorced women. While the overall rate of transitions to join either supported private households or institutions was largely the same in the two decades, the balance between the two shifted markedly in favour of transitions to institutions. In terms of the limited range of covariates it was possible to consider, owner-occupiers were significantly more likely than tenants to move to supported private households than to institutions.

Aged↗
PubMed2003

Management of primary and recurrent inguinal hernia by surgeons from the South West of England.

BACKGROUND: The National Institute of Clinical Excellence (NICE) has advocated open mesh repair for primary hernia but suggested laparoscopic repair may be considered for recurrent hernias. AIM: To establish current surgical practice by surgeons from the South West of England. METHODS: A postal survey was distributed to 121 consultant surgeons and a response rate of 75% was achieved. RESULTS: The majority (86%) of the surgeons surveyed performed hernia repairs, and most (95%) of these used open mesh repair as standard for primary inguinal hernia. Only 8% used laparoscopic repair routinely for primary hernias. Few consultants (only 28%) were able to quote formally audited hernia recurrence rates. A total of 90% of respondents still employed open mesh repair routinely for recurrent hernias; however, if mesh had been used for the primary repair, this figure fell to 55%. Some 7% of respondents recommended laparoscopic repair for recurrent hernia, but this increased to 17% if the primary repair was done with mesh. All laparoscopic surgeons in the South West employed the totally extraperitoneal approach (TEP). There was a range of opinion on the technical demands of repair of a recurrent hernia previously mended with mesh; the commonest cause of mesh failure was thought to be a medial direct recurrence (insufficient mesh medially). CONCLUSIONS: Current surgical practice for primary hernias in the South West England reflects NICE guidelines although many surgeons continue to manage recurrent hernias by further open repair. In this survey, there was anecdotal evidence to suggest that hernia recurrence can be managed effectively by open repair.

Consultants↗
PubMed2006

A study of the prescription of radiographs for children by a group of general dental practitioners in the South West of England.

OBJECTIVE: This study aimed to assess the familiarity of general dental practitioners (GDPs) in the South West of England with the guidelines in the first edition of the then Faculty of General Dental Practitioners (UK) "good practice guidelines" publication Selection Criteria for Dental Radiography (henceforth referred to as "the guidelines") by studying the prescription of radiographs for children in two case scenarios. METHOD: A single mailshot of questionnaires containing questions relating to the guidelines and the two case scenarios was sent to 136 GDPs in the South West of England. Their recommendations for the prescription of radiographs for the children in the two scenarios were then compared with the guidelines. RESULTS: There was a 60% response rate. Of the respondents, 48% reported that they had access to the guidelines. Of those who responded to the question, 66% said that they found the guidelines easy to use. Seventy per cent of respondents reported that they preferred the concept of guidelines to that of protocols. The results from the case scenarios revealed an under-prescription of radiographs for patients presenting with developmental problems or trauma when compared to the recommendations in the guidelines. There was good correlation for the prescription of radiographs for caries but little consensus on radiographic review times. CONCLUSIONS: The study highlighted (a) areas within the guidelines that require further clarification and research and (b) that in the group studied half did not have access to the guidelines.

Child↗
PubMed2000

Contested identities and schisms in groups: opposing the ordination of women as priests in the Church of England.

Schisms constitute a common characteristic of human groups. Nevertheless, they have been neglected by social psychology, mainly because social psychological theories either dismiss group consensus or else depict groups as monolithic. This study proposes a social psychological approach to schism which integrates recent developments of self-categorization theory (SCT) with work on category argumentation. According to SCT, shared group identification leads to a process by which members should reach agreement. However, it is suggested that where members construe the positions of others as fundamentally altering group identity, then consensus is impossible. The corollary of assuming that groups will be consensual is that lack of consensus indicates the existence of different groups. This idea is examined through an analysis of a video and booklet produced for a rally organized by Forward in Faith, an organization opposed to the ordination of women as priests within the Church of England. It is shown that the existence of women priests is construed as changing the essence of the Church both on a structural level (by dividing it from the rest of the Christian community and turning it into a sect) and doctrinally. Such changes are seen as threatening the very existence of the Church of England and therefore demanding all out opposition. However, it is also shown that the decision of whether opponents fight the changes from inside the Church or by splitting from it depends upon the perception of whether they will be accorded the opportunity to advance their position from within. Thus schism is associated with both a perceived 'change of essence' and also with 'lack of voice'.

Attitude↗
PubMed2001

Idiocy and the law in colonial New England.

A review of the laws and records of the courts of colonial New England indicate some ways the early settlers thought about and responded to idiocy. Early Massachusetts laws extended certain rights to idiots: They authorized the transfer of property, exonerated idiots who committed capital crimes, and extended relief to idiots who were impoverished. There is no documentation of the implementation of these laws nor is there direct reference to idiocy in court proceedings. Nevertheless, the court records identify certain individuals with incompetence and atypical behavior suggestive of idiocy. Most of the colonial laws as well as the colonists' ways of thinking about idiocy originated in English common law and custom. The New England colonial laws and records of the courts offer insights into contemporary issues regarding mental retardation.

Criminal Law↗
PubMed2004

Patterns of municipal health expenditure in interwar England and Wales.

This article aims to fill a gap in the history of medical services in England and Wales in the interwar period by focusing on the historiographically neglected municipal sector--a relative neglect that is particularly unjustified given that this sector provided an increasingly wide array of medical services over the period. Focusing on the highly urbanized county boroughs, this article investigates whether and how expenditure on municipal health services changed over the interwar period, and whether these patterns were replicated by boroughs across England and Wales. It is found that many of the largest personal health services were experiencing a common pattern of growing investment over the period, but that county boroughs did not act uniformly in their spending decisions. Considered regionally, the Northeast and the West Midlands were found to perform poorly in expenditure terms compared to the data set as a whole, while the large conurbations of Leeds, Manchester, and Liverpool raised the average performance of the Northwest and Yorkshire. Regional patterns are found to be less consistent in the south of the country, where voluntary provision and demands arising from the boroughs' geographical position (for example, seaside resorts) may have exerted significant influences over levels of expenditure on health.

England↗
PubMed1983

Dental services in England, Wales, and the United States: a comparison of national survey data.

As stated at the outset, the review of the two systems was not intended to determine which approach to provide dental services is better. Rather it has provided an opportunity for both systems to learn from the activities of the other. Thus, the continuing decrease in dental caries rates in the United States, no doubt associated with the extensive fluoridation programs, provides direction for efforts in England and Wales. Similarly, the pronounced changing attitudes to extractions and "wedding present dentures" in England and Wales offer our country some understanding of the needs to change general population attitudes if we are to expand dental services in this country to increasing segments of the nation.

Adolescent↗
PubMed2004

Community-acquired methicillin-resistant Staphylococcus aureus in southern New England children.

OBJECTIVE: This study was performed to understand the epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in southern New England children. METHODS: A retrospective review was conducted of the medical records of children 0 to 18 years old with MRSA isolated by the Rhode Island Hospital microbiology laboratory (Providence, RI) between 1997 and 2001. A case was classified as either health care-associated MRSA (HCA-MRSA) or CA-MRSA based on time of culture and other strict criteria. The spectrum of illness of the HCA-MRSA and CA-MRSA cases was compared, as were the antibiotic-susceptibility patterns of their isolates. Risk factors for CA-MRSA acquisition were identified, and molecular subtyping of selected isolates was performed. RESULTS: Between 1997 and 2001, S aureus was isolated from 1063 children. Of these children, 57 had MRSA. During this period, both the absolute number of MRSA cases and the proportion of S aureus cases due to MRSA rose more than threefold due to increases in both CA-MRSA and HCA-MRSA infections. Of the 57 MRSA cases, 23 (40%) were CA-MRSA. CA-MRSA patients were more likely to have skin/soft-tissue infections than HCA-MRSA patients (83% vs 38%). Risk factors for acquisition of MRSA including intrafamilial spread, frequent antibiotic exposure, and child-care attendance were identified in 8 of the 23 (35%) CA-MRSA patients. CA-MRSA isolates were more likely to be susceptible to non-beta-lactam antibiotics than HCA-MRSA isolates. All isolates were vancomycin susceptible. CONCLUSIONS: MRSA accounts for an increasing proportion of all pediatric S aureus infections in southern New England. A significant percentage of these cases are due to CA-MRSA. Pediatricians should have heightened suspicion for CA-MRSA in children with presumed S aureus infections, especially if they have skin/soft-tissue infections or risk factors for MRSA acquisition.

Adolescent↗
PubMed2004

[The practice of forensic psychiatry in England and Brazil: a brief comparison].

The authors make a comparative analysis between the practice of forensic psychiatry in England and in Brazil. The purpose is to stimulate the debate about the conduction of this psychiatric specialization in both countries. It is a study specifically addressed to the criminal area and its approach is carried out based on the legal, clinical, and ethical points of view. The observations made in England may be also applied to Wales, but not to the United Kingdom as a whole, since different legislation is adopted in Scotland and Northern Ireland. It concludes that while in Brazil there is a need for a closer and more integrated relationship between Psychiatry and Law, it is equally significant to clearly define the scope and the boundaries of each of these areas, as ignoring the boundaries between the two specialties could result in the risk of their relationship becoming confused, as appears to be the case in the English context.

Brazil↗
PubMed2006

Biogeography and decline of rare plants in New England: historical evidence and contemporary monitoring.

Detecting range shifts and contractions is critical for determining the conservation priority of rare and declining taxa. However, data on rare species occurrences frequently lack precise information on locations and habitats and may present a biased picture of biogeographic distributions and presumed habitat preferences. Herbarium or museum specimen data, which otherwise could be useful proxies for detecting temporal trends and spatial patterns in species distributions, pose particular challenges. Using data from herbaria and Natural Heritage Programs on numbers of occurrences within individual municipalities (towns, cities, or townships), we quantified temporal changes in the estimated distributions of 110 rare plant species in the six New England (USA) states. We used the partial Solow equation and a nonparametric test to estimate the probability of observing multiple absences (gaps in the collection record) if a given population was actually still extant. Bayes' Theorem was used to estimate the probability that occurrences were misclassified as extinct. Using the probabilities obtained from these three methods, we eliminated taxa with high probabilities of pseudo-absence (that would yield an inaccurate profile of species distributions), narrowing the set for final analysis to 71 taxa. We then expressed occurrences as centroids of town polygons and estimated current and historical range areas (extents of occurrence as defined by alpha-hulls inscribing occurrences), mean distances between occurrences, and latitudinal and longitudinal range boundaries. Using a geographic information system, we modeled first, second, and third circular standard deviational polygons around the mean center of the historical range. Examining the distribution of current occurrences within each standard deviational polygon, we asked whether ranges were collapsing to a center, expanding, fragmenting, or contracting to a margin of the former range. Extant ranges of the species were, on average, almost 67% smaller than their historical ranges, and distances among occurrences decreased. Five New England hotspots were observed to contain >35% of rare plant populations. Extant occurrences were more frequently marginalized at the periphery of the historical range than would be expected by chance. Coarse-grained data on current and historical occurrences can be used to examine large suites of species to prioritize taxa and sites for conservation.

Conservation of Natural Resources↗
PubMed2001

Prevalence of hepatitis C among injection drug users in England and Wales: is harm reduction working?

OBJECTIVES: This study sought to establish the prevalence of hepatitis C antibodies (anti-HCV) and hepatitis B antibodies (anti-HBc) among injection drug users in England and Wales. METHODS: A voluntary cross-sectional survey collected oral fluid samples and behavioral information; 2203 injectors were recruited through drug agencies, and 758 were recruited in the community. RESULTS: Prevalence was 30% for anti-HCV, 21% for anti-HBc, and 0.9% for HIV antibodies. Anti-HCV prevalence rates were significantly greater among those with longer injecting careers, those in older age groups, those residing in London, those recruited in drug agencies, those positive for anti-HBc, and those with a previous voluntary HIV test. CONCLUSIONS: Anti-HCV prevalence rates among injectors in England and Wales, where comprehensive harm reduction programs exist, are lower than rates in other industrialized countries.

Adult↗
PubMed2003

The pharmacovigilance of pantoprazole: the results of postmarketing surveillance on 11 541 patients in England.

OBJECTIVE: To conduct a postmarketing surveillance study involving patients treated with pantoprazole in general practice in the 6-month period following the launch of this drug in November 1996. Prescription-event monitoring (PEM) provides data on a large cohort of patients in 'real life' settings. The aim was to monitor the safety of pantoprazole as used in general practice. It was the third proton pump inhibitor launched in the UK. METHODS: Patients were identified by data from dispensed prescriptions (FP10s) written by general practitioners (GPs) in England for pantoprazole. Green forms were posted to GPs approximately 6 months following the first prescription identified. GPs were asked to list events that occurred during and after treatment. The incidence density of each event was calculated, ranked and the difference between the incidence of each event in the first and subsequent months of exposure was tested by constructing confidence intervals. RESULTS: Data were collected for 11 541 patients. The major indications for treatment were oesophageal reflux (22.7%) and dyspepsia (16.9%). Of GPs expressing an opinion, 81.9% reported pantoprazole to be effective. GPs reported 107 events as adverse drug reactions. The most frequent reason given for stopping was diarrhoea (106 patients), which corresponded with the adverse event with the highest incidence density. CONCLUSION: This PEM study has defined the reported safety profile of pantoprazole as used in general practice in England. The commonest adverse events found in this study have already been reported in the Summary of Product Characteristics.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1975

A local maternity care system in South West England under review.

Since the Cranbrook Report in 1959 there has been a steady increase in the proportion of institutional confinements in England and Wales and a steady decrease in perinatal mortality. This association should not be regarded as evidence of cause and effect nor as justification for continuing the Cranbrook policies for the provision of maternity care throughout the 1970s. Due weight must be given to other factors, including improvements in the general health and education of the population and advances in standards of medical care affecting all parts of the maternity services. The present study examines current performance of a local maternity care system and analyzes some 3700 confinements which took place in a Health Care District (formerly a Hospital Management Committee area) in South West England during 1970. The local resources consisted of a consultant obstetric unit, a Special Care Baby Unit, five general practitioner units and the associated medical and nursing staff, and two Local Authority domiciliary midwife services. An expectant mother may call upon a variety of resources in pregnancy, during delivery, and in the puerperium. The concept is developed of the "stream" of care received by the mother and the case histories are analyzed in these terms. The deliveries are classified in terms of nonintervention and intervention at delivery. Perinatal mortality is not in itself an adequate measure of the overall performance of a local maternity care system so other performance indices are used. These are based upon the extent to which the resources available diverge between booking and actual usage. Results obtained indicate that existing policies may be less than optimal and alternatives ought to be considered.

Delivery of Health Care↗
PubMed2004

Marital status and the risk of suicide: experience from England and Wales, 1982-1996.

This analysis examined suicide rates by age, sex, and marital status in England and Wales for the period 1982-1996. Never married, widowed, and divorced people had higher rates of suicide than those who were married, for both sexes. Among the widowed ages 20-39 years, both sexes had the highest rate, and the rate decreased with age. The suicide rate for divorced people was similar to those who had never married, except for the younger group ages 20-29 years. The male:female ratios for the relative suicide risk for never married, widowed, and divorced to married for both sexes were statistically significantly different for older adults. The decrease in suicide rates observed for the period 1982-1996 in England and Wales was mainly attributable to the reduction of suicide rates among the widowed and divorced.

Adult↗
PubMedDate not supplied

Month of birth and sensitization to dust mites in New England.

Charts from 908 patients born in New England and seen at the Lahey Clinic because of allergic rhinitis or asthma or both were reviewed to ascertain whether or not a relationship existed between month of birth and subsequent development of allergy to house dust mites. Prick/puncture and intradermal skin tests for aeroallergens were performed on all patients. Skin tests for Dermatophagoides farinae (Df) mite were scored very positive (VP) in 451 patients (49.7%), mildly positive (MP) in 234 patients (25.7%), and negative (NEG) in 223 patients (24.6%). No discernible difference in frequency of birth could be identified for any single month for either Df-sensitive or Df-negative patients. Comparisons of 4-month periods (May through August, September through December, and January through April) failed to show a seasonal predilection for month of birth. During the 6-month period of February through July, a slight difference was observed for the overall group of 908 patients: 240 of the VP patients (53.2%), 111 of the MP patients (47.4%), and 105 of the NEG patients (47.1%) were born within this period compared with 211 VP patients (46.8%), 123 MP patients (52.6%), and 118 NEG patients (52.9%) who were born within the period of August through January. The difference among the groups was not statistically different (P = 0.20). Of the 225 children and adolescents who were either VP or MP, 125 patients (55.6%) were born within the period of February through July; of the 83 children and adolescents who were NEG, 37 patients (44.6%) were born within that same period. Although dust-mite allergic patients and, in particular, children and adolescents with asthma or rhinitis or both tended to be born within the period of February through July, no clear-cut statistically significant predilection in month of birth or season could be identified for New England-born adult or pediatric mite-allergic patients with rhinitis or asthma or both.

Adolescent↗
PubMed2001

Surveillance of sexually transmitted infections in England and Wales.

Surveillance of sexually transmitted infections (STIs) in England and Wales has, in the past, relied principally on aggregated statistical data submitted by all genitourinary medicine clinics to the Communicable Disease Surveillance Centre, supplemented by various laboratory reporting systems. Although these systems provide comparatively robust surveillance data, they do not provide sufficient information on risk factors to target STI control and prevention programmes appropriately. Over recent years, substantial rises in STIs, the emergence of numerous outbreaks of STIs, and changes in gonococcal resistance patterns have necessitated the introduction of more sophisticated surveillance mechanisms. This article describes current STI surveillance systems in England and Wales, including new systems that have recently been introduced or are currently being developed to meet the need for enhanced STI surveillance data.

Chlamydia Infections↗
PubMed1993

Morbidity registration and the fourth general practice morbidity survey in England and Wales.

The fourth morbidity survey in England and Wales is based on a population of 473,000 persons registered in 60 practices and cared for by 241 general practitioners. This presentation traces the evolution of morbidity surveys in England and Wales. That evolution has taken place against a background of advancing computer technology and the drift towards a paperless record. It is motivated by an increasing recognition of the need for data from primary health care an a realisation that a structured record is capable of servicing information needs without intermediary data sheets and coding procedures. The primary objectives of the study include assessment of disease prevalence by region, age-sex and social group; and to study trends over time. Morbidity and social data are collected in the practices and all relevant information stored on practice computers. At the end of the recording year, the computerised record for each patient is copied on to disks in an anonymized but uniquely identified form and transferred to the national Office of Population Censuses & Surveys for analysis. During the year, weekly extracts are taken of new episodes of illness in age and sex groupings which provide the basis of the Weekly Returns Service of the Royal College of General Practitioners.

Data Collection↗