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PubMed2003

Social mobility and self-reported limiting long-term illness among West Indian and South Asian migrants living in England and Wales.

This study examined the relationship between social mobility and self-reported limiting long-term illness (LLTI) in West Indian and South Asian migrants in England and Wales present at the 1971, 1981 and 1991 Censuses in the Office for National Statistics Longitudinal Study. Most people remained in the same social position regardless of migrant status and those who remained most disadvantaged reported more LLTI than those who remained least disadvantaged. Amongst those who were mobile, upward mobility was more common than downward mobility for South Asians and West Indians but not for all other study members. The findings for the impact of downward mobility on LLTI were particularly striking. Migrants who were downwardly mobile reported more LLTI than all other study members. All other study members who were downwardly mobile reported more LLTI than people who remained in the least disadvantaged group they left but less than those who remained in the most disadvantaged group they joined. Downwardly mobile South Asians reported more LLTI than those of the least disadvantaged group but this was not significantly different from the most disadvantaged group they joined. Downwardly mobile West Indians reported also more LLTI than the least disadvantaged group they left but, in contrast, to the South Asians this appeared to be more than that of the disadvantaged group they joined. Empirical studies are needed to understand the context of social mobility and how this affects health-related behaviours and specific diseases among migrants. In a situation where migrants do not have established economic or social support, the loss of resources or self-esteem could have a disproportionate negative effect on their health.

Asia, Southeastern↗
PubMed2003

Stigma revisited, disclosure of emotional problems in primary care consultations in Wales.

The nature and effects of stigma have been widely discussed in the context of mental illness, and references to stigma are commonly used to explain a wide array of social processes. For example, it is often claimed that stigmatisation affects aspects of personal identity, that it underpins unjust and discriminatory behaviour, and that it is responsible for a reluctance among members of the lay public to disclose the presence of treatable psychiatric symptoms and problems to health professionals. A widespread reluctance to disclose symptoms of 'emotional problems' to health professionals is in fact well documented. Yet the reasons for such patterns of behaviour are far from clear. However, in this paper, on the basis of qualitative data collected from primary care attendees in Wales (N=127), the authors suggest that appeals to stigma are inadequate to explain the phenomenon. More likely, it seems, is that members of the lay public have markedly different images from health professionals of what constitutes a mild to moderate psychiatric problem. Consequently, it is argued that the phenomenon of non-disclosure could be viewed more accurately as a problem of alternative taxonomic systems than of fear of stigma. The implications of the argument for health practice and theory are outlined.

Adolescent↗
PubMed2003

Why are suicide rates rising in young men but falling in the elderly?-- a time-series analysis of trends in England and Wales 1950-1998.

Suicide rates doubled in males aged <45 in England and Wales between 1950 and 1998, in contrast rates declined in older males and females of all ages. Explanations for these divergent trends are largely speculative, but social changes are likely to have played an important role. We undertook a time-series analysis using routinely available age- and sex-specific suicide, social, economic and health data, focussing on the two age groups in which trends have diverged most-25-34 and 60+ year olds. Between 1950 and 1998 there were unfavourable trends in many of the risk factors for suicide: rises in divorce, unemployment and substance misuse and declines in births and marriage. Whilst economic prosperity has increased, so too has income inequality. Trends in suicide risk factors were generally similar in both age-sex groups, although the rises in divorce and markers of substance misuse were most marked in 25-34 year olds and young males experienced the lowest rise in antidepressant prescribing. Statistical modelling indicates that no single factor can be identified as underlying recent trends. The factors most consistently associated with the rises in young male suicide are increases in divorce, declines in marriage and increases in income inequality. These changes have had little effect on suicide in young females. This may be because the drugs commonly used in overdose-their favoured method of suicide-have become less toxic or because they are less affected by the factors underlying the rise in male suicide. In older people declines in suicide were associated with increases in gross domestic product, the size of the female workforce, marriage and the prescribing of antidepressants. Recent population trends in suicide appear to be associated with by a range of social and health related factors. It is possible that some of the patterns observed are due to declining levels of social integration, but such effects do not appear to have adversely influenced patterns in older generations.

Adolescent↗
PubMed2003

Urban-rural differences in suicide trends in young adults: England and Wales, 1981-1998.

Suicide rates amongst young people, particularly males, have increased in many industrialised countries since the 1960s. There is evidence from some countries that the steepest rises have occurred in rural areas. We have investigated whether similar geographical differences in trends in suicide exist in England and Wales by examining patterns of suicide between 1981 and 1998 in relation to rurality. We used two complementary population-based indices of rurality: (1) population density and (2) population potential (a measure of geographic remoteness from large concentrations of population). We used the electoral ward (n=9264, median population aged 15-44: 1829) as the unit of analysis. To assess whether social and economic factors underlie rural-urban differences in trends we used negative binomial regression models to investigate changes in suicide rates between the years for which detailed national census data were available (1981 and 1991). Over the years studied, the most unfavourable trends in suicide in 15-44-year olds generally occurred in areas remote from the main centres of population; this effect was most marked in 15-24-year-old females. Observed patterns were not explained by changes in age- and sex-specific unemployment, socio-economic deprivation or social fragmentation. The mental health of young adults or other factors influencing suicide risk may have deteriorated more in rural than urban areas in recent years. Explanations for these trends require further investigation.

Adolescent↗
PubMed1997

Disadvantage and male cancer incidence and mortality in New South Wales 1985-1993.

Male premature mortality variations from cancers by socioeconomic status and marital status were analysed for the period 1986-1989 and 1990-1993 for New South Wales. Cancer incidence and mortality were also surveyed by statistical local areas within metropolitan Sydney between 1985-1991 and correlation and regression analyses were undertaken with socioeconomic indicators and the modified Jarman 8 disadvantage indicator. Martial status variations were found with most major cancers, with not currently married men being more at risk. Cancers of the oesophagus, oral cavity, pancreas, bladder, kidney, liver and trachea, bronchus and lung were more associated with manual occupations and the disadvantage indicator, while cancer of the colon and melanoma were more associated spatially and occupationally with higher socioeconomic status. An unexpected finding with mortality was an occupational status bipolarity with several cancers, notably with managerial and manual workers. There are implications for the more precise targeting of populations at risk.

Adult↗
PubMed1998

Alfred Haviland's nineteenth-century map analysis of the geographical distribution of diseases in England and Wales.

The nineteenth-century English physician Alfred Haviland used the national mortality statistics for England and Wales to develop an elaborate geographical explanation based on map analysis for the cause of heart, cancer, and tuberculosis deaths. He found that females had higher rates for all three causes of death. However, although his technique was innovative his analysis was flawed.

England↗
PubMed1998

Tuberculosis mortality in England and Wales during 1982-1992: its association with poverty, ethnicity and AIDS.

This paper seeks to establish the strength of association between contemporary tuberculosis (TB) in England and Wales and several potential aetiological factors. It presents an ecological analysis of standardised annual TB mortality rates for the 403 local authority districts between 1982 and 1992, disaggregated by age and sex. Social, demographic and ethnicity measures from the 1981 and 1991 censuses and standardised annual AIDS-related mortality rates for young men are used to calculate Poisson regression models. A strong association was found between all TB mortality groups and overcrowding at the household level. For women, no other measures improved the explanatory power of the models. In multiple regressions, both poverty and AIDS-related mortality explained additional variation in the model for younger men. The link between ethnicity and tuberculosis notifications was not reflected in this analysis of mortality. For all groups no evidence of a positive relationship with ethnicity was found, once overcrowding had been accounted for. The significance of household as opposed to district level crowding suggests that prolonged contact is required for disease transmission. Regression analysis indicates that it is the overcrowding and poverty among ethnic populations that is significant for their tuberculosis mortality. The fact that the relationship between AIDS and TB is confined to the group most typical of AIDS patients provides evidence that AIDS has little influence on the level of tuberculosis mortality in the wider population. Explanations for the observed relationship include preferential certification, migration for treatment and shortcomings in health care provision.

England↗
PubMed1998

Inequalities in the transition of ischaemic heart disease mortality in New South Wales, Australia, 1969-1994.

This paper examines changes in ischaemic heart disease mortality in New South Wales between 1969 and 1994, with particular reference to the 1969-1973, 1979-1983, 1985-1989 and 1990-1994 periods. Using death certificate data and unit list mortality files, and considering occupational differentials among males, and marital status and regional and intra-metropolitan variations among males and females, the question whether changes in differentials in mortality from heart disease occurred during this mortality transition is asked. Mortality from ischaemic heart disease declined in all marital status and occupational status groups, and in all geographical areas, but it declined more slowly among never married and divorced males, among manual workers, and in lower income areas. Whereas ischaemic heart disease mortality was lower in most rural areas than in metropolitan Sydney at the beginning of the period, in the 1990s it was significantly more elevated in inland small towns and rural areas than in the metropolis. Differentials increased over time, more especially with males.

Adult↗
PubMed1999

Urban and rural suicide differentials in migrants and the Australian-born, New South Wales, Australia 1985--1994.

We estimated risk of suicide in adults in New South Wales (NSW) by sex, country of birth and rural/urban residence, after adjusting for age; we also examined youth suicide (age 15-24 years). The study population was the entire population of NSW, Australia, aged > or =15 years during the period 1985-1994. Poisson regression was used to examine the relationship between predictor variables and the risk of suicide, with the focus on migrant status and area of residence. A significantly higher risk of suicide was found in male migrants from Northern Europe and Eastern Europe/former USSR, compared to Australian-born males; a significantly lower suicide risk occurred in males from Southern Europe, the Middle East and Asia. In female migrants, those from UK/Eire, Northern Europe, Eastern Europe/former USSR and New Zealand exhibited a significantly higher risk of suicide compared to Australian-born females. A significantly lower risk of suicide occurred in females from the Middle East. Male migrants overall were at significantly lower risk of suicide than the Australian-born, while female migrants overall had a significantly higher risk of suicide than Australian-born females. Among migrant males overall, the rural-urban suicide risk differential was significantly higher for those living in non-metropolitan areas (RR = 1.9; 95% CI: 1.7-2.1). Suicide risk was significantly higher in non-metropolitan male immigrants from the UK/Eire (RR = 1.4; 95% CI: 1.1-1.7), Southern Europe (RR = 1.7; 95% CI: 1.2-2.4), Northern/Western Europe (1.5; 95% CI: 1.2-1.9), the Middle East (RR = 3.8; 95% CI: 1.9-7.8), New Zealand (RR = 1.4; 95% CI: 1.0-1.8) and 'other' (RR = 2.6; 95% CI: 1.9-3.5), when compared to their urban counterparts. There was no statistically significant difference in suicide risk between rural and urban Australian-born males. For female suicide, significantly lower risk was found in female immigrants living in non-metropolitan areas who were from Northern/Western Europe (RR = 0.7; 95% CI: 0.4-0.96), as well as the Australian-born (RR = 0.7; 95% CI: 0.6-0.8), when compared to their urban counterparts. The non-metropolitan/metropolitan relative risk for suicide in female migrants overall was not significantly different from one. Among male youth there was a significantly higher suicide risk in non-metropolitan areas, with a relative risk estimate of 1.4 for Australian-born youth (95% CI: 1.2-1.5) and 1.7 for migrant youth (95% CI: 1.2-2.4), when compared with metropolitan counterparts. We conclude that suicide among migrant males living in non-metropolitan areas accounts for most of the excess of male suicide in rural NSW, and the significantly lower risk of suicide for non-metropolitan Australian-born women does not apply to migrant women.

Adolescent↗
PubMed1999

Socio-demographic and spatial aspects of male mortality from HIV-AIDS related diseases in New South Wales, Australia, 1990-1994.

During 1990-1994, a very high proportion of males aged under 40 who died from HIV-AIDs related diseases in New South Wales were never married. However, a significant minority of men aged 40-64 who died had been married at some stage in their lives and in the cities of Newcastle, Wollongong and in higher income areas of Sydney this proportion approached 40%. AIDS related mortality was over-represented in professional, managerial, paraprofessional and service occupations even though educational levels were higher in these groups and, thus, presumably knowledge about risk behaviour and preventative behaviour. AIDS related mortality was also elevated among men with no stated occupation. Thus, with males, AIDS was in part a disease of affluence, even though the highest proportions of those dying resided in lower income areas, where marginalised persons may also be at risk. The proportion of deaths to men over age 40 was markedly higher than that in Australia in the 1980s. Elevated mortality with the New Zealand and the Americas birthplace groups may reflect overseas travel and exposure to risk in overseas countries, of persons domiciled in Australia. There was a very strong spatial pattern of AIDS-related mortality in the inner and eastern suburbs in Sydney and there is limited evidence of persons having migrated back to places of origin to be cared for by families. The impact on total mortality under age 65 in these localised areas was considerable. Prevention strategies should include the sensitive targeting of bisexual men, men generally having sex with men and those who are both gay and members of the drug sub-culture.

Adult↗
PubMed1999

Health behaviour and the school environment in New South Wales, Australia.

The relationship between the school environment and health has infrequently been examined. This study sought to examine the association between school students' perceptions of their school environment, teachers' and peers' support and their health behaviours. A cross sectional descriptive survey by supervised self-administration was conducted in 1996 based on the international WHO collaborative survey of school children's health and lifestyle (the HBSC Study) and extended in an Australian setting. Randomly sampled primary and secondary schools from Catholic, Independent and Government education sectors throughout New South Wales (NSW), Australia, were invited to participate. The final sample included 3918 school students attending Year 6 (primary school), Year 8 and Year 10 (high school) from 115 schools. The main outcome measures were self-reported health status and 7 health behaviours (tobacco use, alcohol use, physical activity, dental hygiene, nutritional intake, seat belt and bicycle helmet use). Independent variables included student perceptions of the school environment, perceptions of teachers' and peers' support. Girls, Year 6 students and students who have less than $19 a week to spend were significantly more likely to have positive perceptions towards their school environment, teacher(s) and peers. Students who had positive perceptions regarding their school environment and perceived their teachers as supportive were significantly more likely to engage in health promoting behaviours adjusting for age, sex and average weekly pocket money. A supportive peer environment was not associated with positive health behaviour. Health promotion practitioners need to consider the impact of the school environment on health behaviours of school students. In particular, practitioners should consider intervention models that improve the school environment as a key strategy within a health promoting school.

Adolescent↗
PubMed2003

Neuropathological alterations in alcoholic brains. Studies arising from the New South Wales Tissue Resource Centre.

Alcohol dependence and abuse are among the most costly health problems in the world from both social and economic points of view. Patterns of drinking appear to be changing throughout the world with more women and young people drinking heavily. Excessive drinking can lead to impairment of cognitive function and structural brain changes--some permanent, some reversible. Patterns of damage appear to relate to lifetime alcohol consumption but, more importantly, to associated medical complications. The most significant of these is the alcohol-related vitamin deficient state, the Wernicke-Korsakoff syndrome (WKS), which is caused by thiamin deficiency but is seen most commonly in alcoholics. Careful selection and classification of alcoholic cases into those with and without these complications, together with detailed quantitative neuropathological analyses has provided data that gives clues to the most vulnerable regions and cells in the brain. Brain shrinkage is largely accounted for by loss of white matter. Some of this damage appears to be reversible. Alcohol-related neuronal loss has been documented in specific regions of the cerebral cortex (superior frontal association cortex), hypothalamus and cerebellum. No change is found in basal ganglia, nucleus basalis, or serotonergic raphe nuclei. Many of these regions which are normal in uncomplicated alcoholics are damaged in those with the WKS. Dendritic and synaptic changes have been documented in alcoholics and these, together with receptor and transmitter changes, may explain functional changes and cognitive deficits, which precede more severe structural neuronal changes. A resource to provide human brain tissues for these types of studies has been developed at the University of Sydney--the New South Wales Tissue Resource Centre. The aim of this facility is to provide research groups throughout the world with fresh and/or frozen tissues from well-characterized cases of alcohol-related brain damage and matched controls. The development of new technologies in pathology and molecular biology means that many more questions can be addressed using appropriately stored human brain tissues. Examples of the application of some of these techniques, involving neurochemical, neuropharmacological, neuroimaging and gene expression studies are included in this paper. Important public health outcomes have arisen from some of these studies including the enrichment of bread flour with thiamin for the whole of Australia. Researchers with an interest in alcohol studies can access tissues from this brain bank.

Alcoholism↗
PubMed2003

The current and future management of wild mammals hunted with dogs in England and Wales.

There is increasing concern about the use of lethal methods to control wild mammal populations, especially those methods that may have significant impacts on animal welfare. The continued use of dogs to hunt wild mammals in England and Wales, principally foxes (Vulpes vulpes), red deer (Cervus elaphus), brown hares (Lepus europaeus) and mink (Mustela vison), has become a focus for political debate and has been the subject of a recent UK government inquiry. This paper reports the results of a questionnaire study to quantify the use, effectiveness and acceptability of the different methods currently used to manage these four species, and future changes in management following a possible ban on hunting with dogs. There was no straightforward relationship between culling pressure and perceived pest status of the different species from the questionnaire data. For foxes and brown hares, the proportion of land managers (practitioners) carrying out lethal control was higher than that considering these species to be pests. However, the reverse was the case for mink. The most frequently used and effective control methods, which were most acceptable to practitioners and public alike, were various forms of shooting. The general public perceived hunting with dogs as one of the least acceptable means of control for all four species. Practitioners thought that hunting with dogs for red deer and the use of terriers against foxes were among the least acceptable forms of control, but considered hunting with dogs in other situations and for other species to be relatively acceptable. Most practitioners said a ban on hunting with dogs would make no difference to their management of the four species. A ban on hunting with dogs would have minimal impact on populations of foxes, red deer and mink, but it may be of conservation benefit to hares.

Animal Husbandry↗
PubMed2003

Cause and manner of death in drug-related fatality: an analysis of drug-related deaths recorded by coroners in England and Wales in 2000.

This study investigated causes and manner of drug-related fatalities recorded in 2000 in the United Kingdom, measuring the 'masked' manner of death in cases typically recorded as overdose. A retrospective cohort study was used of 1037 cases of accidental drug-related fatalities reported by coroners in England and Wales to the National Programme of Substance Abuse Deaths. Whilst 802 cases were identified as direct acute overdose, representing 77% of the total accidental deaths, 23% of 'overdose' fatalities were caused by asphyxiation (7%), drug-related medical conditions (7%), non-drug-related conditions (4%), traumatic accidents (3%) and infections (2%). Younger people show higher risk of overdose and asphyxiation; older people show higher risk from pre-existing medical conditions. This study not only confirmed the high risk of overdose associated with heroin and polydrug use, but it also identified other high fatality risk factors for heroin/morphine users such as contracting an acute infection leading to septicaemia or endocarditis, or contracting a chronic infection such as HIV, HBV or HCV. In contrast, stimulants particularly featured in traumatic accidents, with amphetamine use most associated with cardio-vascular fatality. These findings highlight the 'masked' manner of death in cases commonly recorded as overdose and demonstrate the need for a more-detailed and systematic method of recording drug-related deaths in order to inform drug education and harm reduction strategies.

Adolescent↗
PubMed2006

Regional differences in injecting practices and other substance use-related behaviour among entrants into opioid maintenance pharmacotherapy treatment in New South Wales, Australia.

BACKGROUND: Investigations of injecting drug users (IDUs) have been conducted largely in urban areas. Those studies that compare rural and urban IDUs often utilise small and possibly unrepresentative samples. AIM: To investigate regional differences in the characteristics of IDUs. METHODS: The study compared the demographic, drug use-related, and treatment characteristics of 1045 urban, 213 regional, and 254 rural opioid maintenance pharmacotherapy (OMP) treatment entrants recruited as part of a feasibility study into the implementation of a state-based treatment outcome monitoring system. RESULTS: Participants from regional and rural New South Wales (NSW) were significantly more likely to report sharing of needles and other injection equipment and higher non-opioid drug use and polydrug use than their urban counterparts. In addition, they were more likely to be living with dependent children, to be unemployed, and to be experiencing greater psychological problems than their urban counterparts. Needle sharing also was independently associated with being younger, female, having been arrested, or having non-opioid drugs of concern. CONCLUSIONS: Reasons for the higher rates of blood-borne virus (BBV) transmission risk-related behaviour among rural and regional IDUs should be investigated further and considered when planning for the targeted provision of harm reduction activities.

Adolescent↗
PubMed1999

Property damage and public disorder: their relationship with sales of alcohol in New South Wales, Australia.

It has been suspected for some time that alcohol is involved in the origin of offensive behaviour and property damage incidents. Using regression analyses and a cross-sectional design, this study investigates these relationships for both Sydney and country New South Wales (NSW), whilst controlling for key social and demographic variables. The study found that both offence types occurred more frequently in areas with greater sales of alcohol. The effect of alcohol sales was considerably larger in Sydney than it was in country NSW. There was an interaction between aboriginal population size and alcohol sales for country NSW offensive behaviour data. Overall, these findings are consistent with alcohol consumption playing a causal role in these offences, however, the possibility remains that alcohol sales may be acting as an indicator of criminal opportunity.

Age Factors↗
PubMed2000

Heroin-related deaths in New South Wales, Australia, 1992-1996.

The coronial files of all heroin-related fatalities that occurred in New South Wales (NSW) over the period 1992-1996 were inspected. There were 953 heroin-related fatalities in NSW over the study period. There was a substantial, statistically significant increase in heroin-related fatalities over the study period, from 152 deaths in 1992 to 226 during 1996. The mean age of cases was 31.0 years, 85% were male, and 85% were classified as dependent on heroin at the time of death. There was a significant increase in the age of cases over the study period and the proportion of cases that were employed. Fatalities predominantly occurred in home settings (61%). No intervention occurred in 79% of cases. Fifty deaths (5%) occurred in the month following release from prison, 16 of which occurred the first 24 hours after release. Morphine concentrations rose from 0.24 mg/l in 1992 to 0.38 mg/l in 1996. Seventy six percent of cases involved heroin in combination with other drugs: alcohol (46%), benzodiazepines (27%), antidepressants (7%) and cocaine (7%). In only 24% of cases was morphine the sole drug detected. Males were significantly more likely to have alcohol detected at autopsy (49 vs. 24%), while females were more likely to have benzodiazepines detected (41 vs. 17%). The median blood morphine concentration among cases in which alcohol was detected was significantly lower than other cases (0.27 vs. 0.39 mg/l). It is concluded that heroin-related deaths continued to rise throughout the study period, and that deaths were predominantly among older, untreated males. Despite the rise in blood morphine concentrations, polydrug use remained the predominant toxicological pattern.

Adolescent↗
PubMed2001

Incidence of Mycobacterium paratuberculosis in raw sheep and goats' milk in England, Wales and Northern Ireland.

A blind survey of 104 raw sheep and goats' milk samples (90 goat, 14 sheeps) from bulk tanks on farms throughout England, Wales and Northern Ireland was carried out over a 5-month period (January-May 1998) in order to determine the incidence of Mycobacterium paratuberculosis. Each milk sample (100 ml) was divided into two 50ml portions. One portion was decontaminated with 0.75% hexadecylpyridinium chloride for 5h before culture on slopes of Herrold's egg yolk medium and in BACTEC radiometric medium. The second portion was subjected to immunomagnetic separation followed by IS900 PCR (IMS-PCR). The IMS-PCR assay was employed in order to provide a more rapid indication of the presence of M. paratuberculosis in each milk sample than is possible by culture. Information on the Johne's disease status of the sheep and goat herds that took part in the survey was not sought at the time of milk sampling. However, it subsequently emerged that at least some of the herds whose bulk milk was tested during this study were previously or currently infected with Johne's disease. Overall, during this survey one raw goats' milk sample tested positive for the presence of M. paratuberculosis by IMS-PCR (<1% of milk samples tested) but no viable M. paratuberculosis were isolated by culture. The results of this study suggest that bulk raw sheep and goats' milk from these regions of the UK may not represent significant vehicles of transmission of M. paratuberculosis to humans.

Animals↗