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PubMed1996

Underprivileged area score, ethnicity, social factors and general mortality in district health authorities in England and Wales.

OBJECTIVE: To analyse the relation of ethnicity, social deprivation (Underprivileged area, UPA-score), social class V, unemployment and overcrowding on age- and sex-standardized mortality ratio (SMR). DESIGN: This ecological study used the SMR for people under the age of 65 years as dependent variable. Mortality data for 1983, classified by total population of country of birth (New Commonwealth and Pakistan), unskilled (social class V), unemployed, and overcrowded (>1/room) population with data from 1981 censuses. Underprivileged Area (UPA) score was applied in this study, an index widely used in the UK to identify underprivileged residential areas, calculated from information combining eight variables derived from the decennial census. The data were analysed by multiple regression (least square estimation) with SMR as dependent variable and the other social factors as independent variables. SETTING: All 192 district health authorities in England and Wales. RESULTS: There was a significant association between UPA-score and SMR (R-square = 0.53, p = 0.0001). The second model included the four variables: % unskilled, % unemployed of economically active population, % of residents living in overcrowded households, and % of population from New Commonwealth and Pakistan. This model explained about 77% of the variance. All variables were significant. All coefficients except ethnicity were positive, i.e. the higher the coefficients, the higher the SMR. CONCLUSION: This paper shows that social deprivation, unemployment and overcrowding were related to mortality in district health authorities in England and Wales. The finding that ethnicity was inversely related to general mortality might be important and needs to be further analysed.

Adolescent↗
PubMed2004

Sporadic cryptosporidiosis, North Cumbria, England, 1996-2000.

Risk factors for sporadic cryptosporidiosis were determined in 152 patients and 466 unmatched controls who resided in two local government districts in North Cumbria, North West England, from March 1, 1996, to February 29, 2000. Risk was associated with the usual daily volume of cold unboiled tap water drunk (odds ratio [OR] 1.40, 95% confidence intervals [CI] 1.14 to 1.71 per pint consumed per day [p = 0.001]) and short visits to farms (OR 2.02, 95% CI 1.04 to 3.90, p = 0.04). Fifty-six (84%) of 67 fecal specimens from patients obtained from January 1, 1998, and February 29, 2000, were Cryptosporidium parvum genotype 2 (animal and human strain). Livestock fecal pollution of water sources appears to be the leading cause of human sporadic cryptosporidiosis in this population and shows the need for better protection of water catchments from livestock and improved drinking water treatment in this area of England.

Adolescent↗
PubMedDate not supplied

From Shakespeare to Defoe: malaria in England in the Little Ice Age.

Present global temperatures are in a warming phase that began 200 to 300 years ago. Some climate models suggest that human activities may have exacerbated this phase by raising the atmospheric concentration of carbon dioxide and other greenhouse gases. Discussions of the potential effects of the weather include predictions that malaria will emerge from the tropics and become established in Europe and North America. The complex ecology and transmission dynamics of the disease, as well as accounts of its early history, refute such predictions. Until the second half of the 20th century, malaria was endemic and widespread in many temperate regions, with major epidemics as far north as the Arctic Circle. From 1564 to the 1730s the coldest period of the Little Ice Age malaria was an important cause of illness and death in several parts of England. Transmission began to decline only in the 19th century, when the present warming trend was well under way. The history of the disease in England underscores the role of factors other than temperature in malaria transmission.

England↗
PubMed2003

Viral encephalitis in England, 1989-1998: what did we miss?

We analyzed hospitalizations in England from April 1, 1989, to March 31, 1998, and identified approximately 700 cases, 46 fatal, from viral encephalitis that occurred during each year; most (60%) were of unknown etiology. Of cases with a diagnosis, the largest proportion was herpes simplex encephalitis. Using normal and Poisson regression, we identified six possible clusters of unknown etiology. Over 75% of hospitalizations are not reported through the routine laboratory and clinical notification systems, resulting in underdiagnosis of viral encephalitis in England. Current surveillance greatly underascertains incidence of the disease and existence of clusters; in general, outbreaks are undetected. Surveillance systems must be adapted to detect major changes in epidemiology so that timely control measures can be implemented.

Adult↗
PubMed2005

An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales.

OBJECTIVES: To survey of the structure, processes and organisation of renal satellite units (RSUs) in England and Wales (Phase 1), and to compare the effectiveness, acceptability, accessibility and economic impact of chronic haemodialysis performed in RSUs compared to main renal units (MRUs) (Phase 2). DATA SOURCES: Phase 1: all renal satellite units in England and Wales. Phase 2: haemodialysis patients in a representative sample (based on geography, site, private--public ownership, medical input) of 12 RSUs and their MRUs. REVIEW METHODS: Phase 1 consisted of a questionnaire survey. Semi-structured interviews were held in a representative sample of 24 RSUs with the senior clinician, senior nurse and manager. Phase 2 consisted of a cross-sectional comparison of patients in these RSUs and patients in the parent MRUs deemed suitable for satellite care by senior staff. Clinical information was obtained from medical notes and unit computer systems. Generic and disease specific health-related quality of life (HRQoL) measures were used. Co-morbidity was assessed by the Wright/Khan Index, the Lister/Chandna score, the Modified Charlson Index, and the Karnofsky Performance Score. Statistical analyses compared RSU versus MRU patients and took account of the paired and clustered nature of the data. RESULTS: In Phase 1, responses were received from 74/80 (93%) of RSUs; 2600 patients were being treated in these RSUs. The interviews were generally positive about the impact of RSUs in terms of improved accessibility and a better environment for chronic haemodialysis (HD) patients, and in expanding renal replacement therapy patients (RRT) capacity. In Phase 2, some 82% of eligible patients took part, 394 patients in the 12 RSUs and 342 in the parent MRUs. The response rate was similar in both groups. There were no significant differences in clinical processes of care. Most clinical outcomes were similar, especially after pooled analysis, although a few parameters were statistically significantly different -- notably the proportion achieving Renal Association Standards for adequacy of dialysis as measured by the urea reduction ratio (URR) was higher in the RSU patients. Patient-specific quality of life did not differ except on the patient satisfaction questions from the KDQOL, which were scored higher by the RSU sample. Strength of preference for health status on and off dialysis was very similar between the groups, as were EQ-5D utilities. Major adverse events were not common in the RSU patients, although there were many hypotensive episodes on HD, a proportion of which affected the duration of the HD session. Of the costs measured, the only difference that was statistically significant was for District Nurse visits. Of particular note was that despite the MRU group having a higher proportion of patients hospitalised, this did not translate into a statistically significant budgetary impact in terms of the total cost per patient of hospitalisations or mean cost per patient per hospitalisation. CONCLUSIONS: This study has shown that RSUs are an effective alternative to MRU HD for a wide spectrum of patients. They improve geographic access for more dispersed areas and reduce patients' travel time, and are generally more acceptable to patients on several criteria. There does not seem to be an adverse impact of care in the RSUs although comparative long-term prospective data are lacking. The evidence suggests that satellite development could be successfully expanded; not all MRUs have any satellites and many have only a few. No single RSU model can be recommended but key factors would include local geography, the likely catchment population and the type of patients to be treated. There is a need for more basic budgetary information linking activity and expenditure to be available and more transparent, to perform at least an insightful top-down costing of the two care settings. Other areas suggested for further research include: a comparison of adverse events occurring in MRUs and RSUs with longer duration and larger numbers to identify more severe events, along with the more research into the scope for preventing such events, and a study into the patients deemed ineligible for satellite care. International comparisons of satellite care would also be useful.

Adult↗
PubMed1991

Nursing education, practice, and professional identity: a transcultural course in England.

Students from a baccalaureate program at the University of Delaware participated in a 4-week course in England, exploring nursing's role in the health care system of that country. Students observed and interacted with a variety of clients and nurses in diverse settings; they observed similarities and differences in nursing education, practice, and professional identity between nurses in England and in the United States. The course was timely and valuable--it provided students with the opportunity to enhance their awareness of another culture and it allowed them to recognize nursing's importance in global health concerns.

Attitude of Health Personnel↗
PubMed1998

The contamination of pâté with Listeria monocytogenes--results from the 1994 European Community-Coordinated Food Control Program for England and Wales.

The Listeria monocytogenes contamination of 3,065 pâté products sampled at the point of retail sale in England and Wales was examined. Ninety-seven percent of samples were free of contamination with L. monocytogenes, 2.0% (60) had levels of less than 200 CFU/g, and 0.6% (18) had levels of 200 CFU/g or more. Fish and seafood pâté were significantly more commonly contaminated by L. monocytogenes than other pâté types (chi 2 test, P = 0.001). Pâté obtained from small retail shops was significantly more likely to be contaminated at levels of > or = 200 CFU/g (chi 2 tests, P < 0.0005) than that obtained from supermarkets. L. monocytogenes was isolated significantly more often (chi 2 tests, P < 0.00002) from packs of pâté that were open at the time of collection (3.8%) than those that were sold prepacked (1.2%). There were also significantly more samples (chi 2 test, P = 0.0009) where L. monocytogenes was recovered at higher levels (> or = 200 CFU/g) in opened, as compared to prepacked, samples. There was a significant difference in the rates and levels of contamination of opened samples between shops and supermarkets (chi 2 tests, P < 0.0025). Evidence from this study shows that most of the pâté sold in England and Wales is not contaminated with L. monocytogenes, and we suggest that the main areas of concern are cross-contamination and the length of display of pâté sold from opened packs.

Animals↗
PubMed2005

Integrated mental health services in England: a policy paradox.

PURPOSE: The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. DATA SOURCES: Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. CONCLUSION: We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. DISCUSSION: We conclude with suggestions for strategies that may facilitate more integrated working.

Journal Article↗
PubMed2006

The development of the National Reporting and Learning System in England and Wales, 2001-2005.

In 2001, the National Patient Safety Agency (NPSA) was created as part of a wider reform process to improve quality of care for patients in the National Health Services of England and Wales. The NPSA was charged with developing and implementing a national system for collecting and learning from reported patient safety incidents. Between 2003 and 2005, 303 447 incidents were reported from a wide range of health care settings. As a result, a range of interventions have been developed to improve safety. A number of lessons have been distilled from the experience of England and Wales, including that: clinical risk management system characteristics should be aligned with those of the national reporting system; and safety culture and information dissemination must be addressed at the same time as any new reporting system is implemented. These lessons should be of use to other countries implementing similar patient safety strategies.

Communication↗
PubMed1979

Legionnaires' disease in Nottingham, England.

Legionnaires' disease bacterium was identified as the cause of severe pneumonia in some Nottingham, England, patients in 1977. Laboratory studies were not restricted to Nottingham but included several other areas in England. The 41 cases identified were evenly divided between areas; they also accounted for about one half of all cases for the entire country. No source of infection has been identified in these sporadic cases. There was no contact between patients, and only a few had travelled abroad before their illnesses. Serologic sampling of populations in Nottingham did not reveal a large background of infection. Only 31 of 2023 sera tested had low titer antibody to the Pontiac antigen used. Guinea-pig antisera to two positive lung extracts showed an antigenic relation to the Pontiac but not to the Togus strain,suggesting strain variation.

Antibodies, Bacterial↗
PubMed2006

Registered children's nurses in emergency departments in England: an exploratory survey.

UNLABELLED: Recent reports suggest that emergency departments in England are some way from achieving universal provision of specific facilities for children and young people staffed by practitioners with appropriate qualifications. In 1998, 74 per cent of emergency departments employed children's nurses, but only 8 per cent employed them in sufficient numbers to provide 24-hour cover (Smith 1998). AIM: To establish whether there has been an increase in the number of children's nurses employed within emergency departments and to identify their specific roles and responsibilities. METHOD: A postal questionnaire was sent to senior managers of 99 general emergency departments in England with annual new attendance figures of between 45,000 and 100,000. Specific paediatric emergency departments and general departments in the London region were excluded. RESULTS: Analysis of data from the 52 valid responses suggest that although children comprise around 25 per cent of workload, registered children's nurses make up 10 per cent of the workforce in general emergency departments. The number employed in each department varied from one to 13 whole time equivalents (WTEs), and three departments did not employ any at all. In 11 of the 52 departments children's nurses were employed to specifically care for children; in other departments their main responsibilities were training other staff and developing and implementing policies and protocols. Fifty one of the 52 departments employed emergency nurse practitioners (ENPs). Children's nurses were employed as ENPs in 30 of the departments (total 46), a mean of 1.5 WTE per department. A quarter of the ENPs who were not registered children's nurses were reported to have received no additional training before being deemed competent to assess and treat children. CONCLUSION: There has been an increase in the numbers of children's nurses employed in general emergency departments but the numbers are still too low to comply with policy requirements. Managers should ensure that the skills of children's nurses are used to the full, and ENPs need to consider legal and accountability issues if they are asked to assess and treat children without having accessed appropriate training.

Emergency Nursing↗
PubMedDate not supplied

Safety and quality in healthcare: what can England and Australia learn from each other?

Australia and England have similar healthcare systems. They are affordable and accessible to all; both are blessed with health professionals of great skill. Anybody who falls ill in either country can expect a high standard of care. And yet, all is not well. The care we give our patients is not as safe as it should be and the community is becoming well aware of this. Our public healthcare systems never seem to have enough resources; our public hospitals show varying degrees of dilapidation. Access to care, while universal, is too often delayed. The medical workforce is understaffed, maldistributed (or both) and the shortage of nurses is of great concern. In both professions, morale is fragile. What, then, can be done to improve the safety and quality of healthcare in Australia and England?

Australia↗
PubMed1991

General management in the NHS: comparisons and contrasts between Scotland and England.

The NHS takes rather different forms in England and Scotland, and comparisons can be instructive. David Hunter and Peter Williamson look at the way general management was evolved in the two countries. If so far it has not flourished in Scotland that may be because it was the adoption of arrangements designed for England, but it may also reflect differences between the two countries.

Administrative Personnel↗
PubMed1980

Health Care Financing Administration--Medicare program; clarification of urban location classification in New England. Notice.

In the final notices published June 1, 1979, establishing limits on hospital inpatient general routine operating costs (44 FR 31806) and home health agency per visit costs (44 FR 31814) and the final notice published August 31, 1979, establishing limits on skilled nursing facility inpatient routine service costs (44 FR 51542) under the Medicare program, HCFA adopted the New England County Metropolitan Area definition of urban location classification in New England. Using this definition, four counties, previously classified as urban locations, were classified as non-urban in the notices. This notice is intended to correct the classification of these four counties to urban areas for purposes of application of cost limits to all types of providers of services.

Catchment Area, Health↗
PubMed1999

A study of infectious intestinal disease in England: plan and methods of data collection.

The Committee on the Microbiological Safety of Food, set up in 1989 by the Department of Health in response to national epidemics of foodborne infection, considered the available evidence and commissioned a study of infectious intestinal disease (IID) in England. Seventy practices (with 489,500) patients overall) recruited from the Medical Research Council's General Practice Research Framework between August 1993 and January 1995 collected data for one year. The practice populations were representative of practices in England by area and urban/rural location, but with fewer small and affluent practices. There were five main components. i) A population cohort of 9776 (40% of those eligible) were enrolled to estimate the incidence and aetiology of IID in the community, and a large proportion were followed up. A median of 10% of patients on practice age-sex registers had moved away or died. ii) A nested case control component based on cases ascertained in the cohort was used to identify risk factors for IID in the community. iii) In a case control component used to identify risk factors and to estimate the incidence and aetiology of IID presenting in 34 general practices 70% of the 4026 cases returned risk factor questionnaires, 75% submitted stools, and matched controls were found for 75% of cases. iv) An enumeration component was used to estimate the incidence of IID presenting to general practitioners (GPs) in 36 practices and the proportion of specimens sent routinely for microbiological examination. v) In a socioeconomic costs component used to estimate the burden of illness of IID in the community and presenting to GPs 63% of those who returned a risk factor questionnaire also returned a socioeconomic questionnaire and were representative by age, sex, and social class. Despite variable enrolment and compliance the study sample had sufficient power for the multivariable analysis. The characteristics associated with low enrollment and compliance must be considered in the interpretation of the main study results.

Case-Control Studies↗
PubMed1999

Leprosy in England and Wales.

This paper reviews cases of leprosy notified in England and Wales to the Central Leprosy Register since its inception in 1951. Leprosy remains a rare condition in England and Wales, with fewer than ten cases notified on average in recent years. No definite case of indigenously acquired leprosy has been reported since the disease became notifiable. Although only a small number of patients present each year, leprosy remains a debilitating disease, and the unfamiliarity of clinicians with this condition can lead to delays in diagnosis and undernotification.

Adult↗
PubMed1999

Can patient registers give an improved measure of internal migration in England and Wales?

This article describes a new source of internal migration data for England and Wales. These data are extracted from the 98 Family Health Service Authority (FHSA) patient registers that hold the details of people in England and Wales who are registered with the National Health Service. Migration estimates are derived from changes in postcodes on the patients' records. The findings presented in the article show that the registers provide high quality estimates of migration into and out of the constituent areas of the FHSAs (as compared to other sources). Where limitations are identified, compensatory adjustments can be introduced to further enhance the quality of the estimates.

England↗
PubMed1999

Poor hepatitis B vaccine coverage in injecting drug users: England, 1995 and 1996.

Self-reported data on vaccination status collected in 1995 and 1996 from seven of the 39 drug agencies in England that took part in the unlinked anonymous HIV prevalence monitoring programme of injecting drug users were analysed to estimate hepatitis B vaccine coverage in this population. Twenty-seven per cent (374/1366) of injecting drug users (IDUs) reported vaccination against hepatitis B and 13% (172) reported having received three doses of vaccine. Eighteen per cent of the IDUs who reported vaccination (66/374) were found to have a marker in their saliva of past/current hepatitis B infection (antibody to hepatitis B core (anti-HBc)) compared with 23% (232/992) of those unvaccinated. Over half (760/1366) of all IDUs tested reported not having been vaccinated against hepatitis B were negative for anti-HBc, and therefore remained susceptible to infection. Targeted vaccination for IDUs against hepatitis B in England has had little success so far, suggesting that enhanced or alternative strategies need to be adopted.

Adolescent↗