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PubMed2002

The effect of changes in timing of childbearing on measuring fertility in England and Wales.

Changes in the ages at which women give birth to their children mean that fertility measured at a particular point in time (period) may not be a good representation of the ultimate fertility of those women. The common measure of period fertility is the total fertility rate, which in 2001 has fallen to the lowest level since records began in England and Wales. This article presents various methods that have been proposed to adjust period fertility data to take account of changes in the timing of childbearing, applied to England and Wales data. The article concludes that while these adjustment methods provide useful insights, for example, that the total fertility rate has underestimated period quantum fertility since the 1970s, the measures produced are difficult to interpret. This is in part because the concept they are trying to measure, period quantum is itself imprecise. The adjustments do not necessarily provide a reliable indicator of underlying cohort fertility.

Adolescent↗

PubMed2003

How important are intergenerational cycles of teenage motherhood in England and Wales? A comparison with France.

Teenage fertility has fallen substantially in every Western European country except the United Kingdom. This article examines the hypothesis that repetition of teenage motherhood from mother to daughter is a major cause of the UK being the exception. A simple demographic model of fertility across generations is estimated with comparable data from England and Wales and France. The main finding is that mother-daughter repetition can account for only a minor part of the total difference in teenage childbearing between the two countries, especially over the long term. The higher teenage childbearing in England and Wales of those whose mothers began childbearing after their teenage years dominates.

Adolescent↗

PubMed2003

Gestational trophoblastic disease in the Asian population of Northern England and North Wales.

OBJECTIVE: To determine the incidence and trends of gestational trophoblastic disease in the Asian population of Northern England and North Wales.A prospective observational study. SETTING: Trophoblastic Screening and Treatment Centre, Weston Park Hospital. POPULATION: A total of 3660 women registered with gestational trophoblastic disease between 1991 and 1999. MAIN OUTCOME MEASURES: 1. The incidence of gestational trophoblastic disease in Asian and non-Asian population. 2. Trend in incidence over study period. RESULTS: Three hundred and twenty-two Asian patients were registered. The incidence of gestational trophoblastic disease in the northern part of England and Wales averaged 1 per 714 live births. The incidence of gestational trophoblastic disease in the Asian population was 1.95 times higher than in the non-Asian population (1 per 387 live births vs 1 per 752 live births). There was an excess of molar pregnancies in the extreme maternal age groups; the incidence in these women was twice as high as in the whole reproductive cohort. The ratio of partial to complete hydatidiform mole increased from 0.9 in the lower age to 2.6 in the older age group. There appeared to be a slowly rising trend in the incidence of gestational trophoblastic disease; the increase was higher in the Asian than in the non-Asian population. The ratio of partial to complete moles increased with age in both populations. CONCLUSION: Asian women are at increased risk of having molar pregnancies. Molar pregnancies are more common at the extremes of reproductive age. The setting up of regional or national registration centres has helped to provide more accurate estimates of the true incidence of the disease.

Adolescent↗

PubMed1961

The problem of gonorrhoea in England and Wales.

In England and Wales, as in a number of other countries, the incidence of gonorrhoea, having lessened appreciably in the immediate post-war period, has in recent years shown a substantial rise. A variety of epidemiological factors are believed to be responsible for this, including immigration from overseas and apparently increased promiscuity among teenagers. Difficulties in laboratory diagnosis of gonorrhoea, particularly in women, and limitations in smear, culture and complement-fixation techniques also contribute to the present failure to control this disease; and the authors review the efforts being made in the United Kingdom to bring about improvements in technique.The emerging problem of lessened sensitivity of the gonococcus to penicillin is, of course, one of the greatest importance, to which, the authors believe, no more than a temporary solution can be provided by increases in therapeutic dosages.Finally, consideration is given to the preventive measures against the venereal diseases adopted in England and Wales; these are based in the main on the provision of free and confidential facilities for diagnosis and treatment.

Adolescent↗

PubMed1960

The diarrhoeal diseases in England and Wales, with special reference to those caused by Salmonella, Escherichia and Shigella.

The diarrhoeal diseases are now a minor cause of death in England and Wales, although they remain a major cause of acute illness in children and of absenteeism among adults. Since the Second World War there has been a general rise in the annual number of Salmonella infections, with, however, a drop in the years 1956 and 1957. Infection with Shigella sonnei-the only member of the dysentery group which causes disease at all commonly in England and Wales-has shown a steady increase. Escherichia coli infection has fallen considerably but continues to be a common cause of infantile diarrhoea.A number of environmental factors are discussed in connexion with these three main agents of diarrhoeal disease; and in a consideration of sources of infection the author suggests that while cases of clinical illness are the most important source of illness due to Sh. sonnei and E. coli, human foods, animal feeding stuffs and fertilizers are also responsible for much infection with the salmonellae. The different serotypes or Salmonella and E. coli are reviewed in relation to the epidemiology of the diseases they give rise to.

Adult↗

PubMed2003

Appropriateness of thresholds currently used to describe influenza activity in England.

The timing and magnitude of influenza virus activity in England each winter remain unpredictable. Nevertheless, it is important to describe levels of activity in a timely manner, using defined 'threshold values'. This informs public health practitioners and the general public of the level of influenza virus circulation, and provides an indication of when sufficient activity is occurring in the community to warrant the use of antiviral drugs. Data presented here suggest that the current numerical thresholds, and their corresponding descriptions, are no longer appropriate for the levels of activity recently observed in England. Based on integrated clinical and virological data, we suggest alternative threshold values of 'baseline' activity (0-30/100,000 population), 'normal seasonal' activity (30-200/100,000) and 'epidemic' activity (> 200/100,000).

England↗

PubMed2003

Secular trends in the occurrence of tuberculosis in an urban community in north west England, 1918-2001: implications for a local tuberculosis control programme.

In recent years enhanced surveillance of tuberculosis has been undertaken for England and Wales to monitor national epidemiological trends. The Chief Medical Officer's strategy for communicable diseases has identified the development of a national strategy for the control of tuberculosis as a priority. Regional and sub-regional variations in the occurrence of tuberculosis require further exploration to inform local implementation of the national strategy. Secular epidemiological trends in tuberculosis for the period 1918-2001 are described for a deprived urban area in the north west of England, and implications for local enhanced surveillance and control measures are discussed. A substantial decline in mortality and morbidity from tuberculosis is shown due to interruption of transmission following improvements to the housing stock and the introduction of chemotherapy and BCG vaccination. The proportion of incident cases of tuberculosis in non-white groups has markedly increased over the period observed. The local tuberculosis control programme now specifically targets recent non-white immigrants. Other urban areas may need to adopt similar measures to improve local control of tuberculosis.

Adolescent↗

PubMed2003

Strategic water planning for south east England: preparing for proposed development.

The South East of England has one of the fastest growing and economically active populations in Europe, with associated significant pressures from development, particularly housing and transport. Sustainable water management has been identified as a major issue for future development of the region. The South East England Regional Assembly and the Environment Agency have carried out a study to investigate the potential constraints that flood risk, water resources, and water quality may pose on development. The study aims to improve understanding in order to inform the revision of regional planning polices and suggest practical guidance for local authorities to implement such policies. Wide technical consultation was carried out with the Environment Agency, local planning authorities and development agencies. Threshold Assessment was investigated as a technique to assess the potential impacts on the environment of various levels of forecast growth within selected parts of the region. Initial results indicate the need for more strategic and better integrated planning which recognises environmental and development boundaries.

Conservation of Natural Resources↗

PubMed2004

Decreasing tuberculosis case fatality in England and Wales, 1988-2001.

SETTING: Despite declining tuberculosis mortality per head of population, there was little change in tuberculosis case fatality in England and Wales from 1974 to 1987. OBJECTIVE: To determine the trend in tuberculosis case fatality for England and Wales from 1988 to 2001. DESIGN: Annual deaths to notifications ratios (DNRs) for tuberculosis were calculated using published notification and mortality data, and analysed by age group and three disease sites (central nervous system [CNS], respiratory and other). DNRs for seven disease sites (miliary, bone and joint, CNS, respiratory, genitourinary, gastrointestinal and other) were calculated for 1998 and 1999 combined, using additional data from the enhanced tuberculosis surveillance programme. RESULTS: DNR for all ages and disease sites combined fell from 9.26% in 1988 to 5.59% in 2001 (r = -0.90; 95%CI -0.97 - -0.70). DNRs for 1998-1999 combined were 41% for miliary disease, 17% for bone and joint disease, 8% for CNS disease, 7% for respiratory disease, 2% for genitourinary and gastrointestinal disease and 0.6% for other disease. CONCLUSIONS: Some of the decrease in DNRs may be due to improving notification rates. True declines in overall case fatality reflect increases in the proportion of tuberculosis patients in younger age groups and with low mortality extra-pulmonary disease.

Adolescent↗

PubMed2004

Distribution of NHS resources for children's dental care in general dental practice in England.

OBJECTIVE: To determine the relationship between the distribution of NHS resources in general dental practice and dental need and access to services for the population in England under the age of 18 in different socio-economic areas. BASIC RESEARCH DESIGN: A proxy for the oral health of under 18 year olds was made from prevalence surveys undertaken on five year old children in each health authority area in 1999/2000. The level of spending per head of the population was ascertained from Dental Practice Board data. Health authorities were grouped according to the eleven United Kingdom Office of National Statistics socio-economic groups. Access was measured by using registration levels of children. SETTING: General dental practices providing National Health Service treatment for children aged 0-18 in England. RESULTS: There was no correlation (r = -0.03) between increasing need for dental care using mean dmft as a proxy and increasing spending per head of the population for each health authority. There was a correlation (r = 0.38) between increasing registration rates and increased spending per head. The populations under 18 had more spent on their oral health care living in areas classified as Mixed Economies, Services and Education and Most Prosperous. Those in Inner London, Manufacturing, Ports and Industry had proportionately the least. The difference between the highest and lowest group was 33%. The groups of Authorities were not homogenous in their level of resources with variations between Authorities in the same groups. CONCLUSIONS: The distribution of NHS resources to general dental practice for people under 18 does not reflect population need. The higher the registration rate for children the greater the amount resources deployed in an area.

Adolescent↗

PubMed2004

The maldistribution of general practitioners in England and Wales: 1974-2003.

BACKGROUND: The geographical distribution of general practitioners (GPs) is a persistent policy concern within the National Health Service. Maldistribution across family health service authorities in England and Wales fell between 1974 and the mid-1980s but then remained, at best, constant until the mid-1990s. AIM: To estimate levels of maldistribution over the period 1994-2003 and to examine the long-term trend in maldistribution from 1974-2003. DESIGN: Annual snapshots from the GP census. SETTING: One hundred 2001 'frozen' health authorities in England and Wales for 1994-2003 and 98 family health service authorities for 1974-1995. METHOD: Ratios of GPs to raw and need-adjusted populations were calculated for each health authority for each year using four methods of need adjustment: age-related capitation payments, national age- and sex-specific consultation rates, national age- and sex-specific limiting long-term illness rates, and health authority-specific mortality. Three summary measures of maldistribution across health authorities in the GP to population ratio--the decile ratio, the Gini coefficient, and the Atkinson index--were calculated for each year. RESULTS: Maldistribution of GPs as measured by the Gini coefficient and Atkinson index increased from the mid-1980s to 2003, but the decile ratio showed little change over the entire 1974-2003 period. Unrestricted GP principals and equivalents were more equitably distributed than other types of GP. CONCLUSION: The 20% increase in the number of unrestricted GPs between 1985 and 2003 did not lead to a more equal distribution.

Demography↗

PubMed2004

Who cares in England and Wales? The Positive Care Law: cross-sectional study.

BACKGROUND: The inverse care law proposing that medical services are distributed inversely to population health needs, and that this law operates more completely where medical care is most exposed to market forces, was first suggested by Tudor Hart in 1971. This paper considers whether an inverse care law can be observed for the provision of informal care as well as for medical care. AIM: Using data from the 2001 census we sought to investigate the contemporary relevance of the inverse care law. DESIGN OF STUDY: Cross-sectional study. SETTING: England and Wales. METHOD: Data from the 2001 census for the population of England and Wales were analysed at the county, unitary, or former metropolitan authority level. The prevalence of the conjunction of general health status and limiting long-term illness was correlated with the percentage of the local population who were working as qualified healthcare workers (nurses, qualified medical practitioners, dentists, and other health professionals and therapists) and with the percentage of the population providing 50 or more hours of unpaid care per week. RESULTS: In 2001, 7.6% of people reported that their health was not good and that they had a limiting long-term illness (the need for care). Over one million people reported providing 50 or more hours of unpaid care per week. An inverse care law was found at the ecological level between the need for care and the proportion of the population who were working as qualified medical practitioners, dentists, and other health professionals. Informal care was almost perfectly positively correlated with the need for care (r = 0.97). These relationships were more marked for areas in the north of the country compared with the south. In the north more people provide unpaid care as more people need that care and because there are fewer working qualified medical professionals, other than nurses, providing such care per head. CONCLUSIONS: Medical care is distributed inversely to need, whereas the provision of informal care is positively related to need--where care is most needed, informal care is most likely to be provided. The greater the market forces that are allowed to intervene in the relationships between the need for care and its provision, the more likely the inverse care law is to be found to apply. Where no market forces apply, where people give up their time for free to provide care, an almost perfectly positive care law is found to apply.

Adolescent↗

PubMed2004

Trends in live births by mother's country of birth and other factors affecting low birthweight in England and Wales, 1983-2001.

This article investigates trends in low birthweight singleton live births by mother's country of birth. 11.4 million birth records from registration data in England and Wales from 1983 to 2001 were used. The analysis focuses on births to mothers born in the UK and countries that contribute to the main ethnic minority groups in England and Wales. The results show that the prevalence of low birthweight babies varies by mother's country of birth. Important differentials also exist by mother's age at birth, multiplicity and registration status.

Adolescent↗

PubMed1992

Knowledge of drug costs: a comparison of general practitioners in Scotland and England.

The implementation of drug budgets will make it essential that general practitioners are aware of prescribing costs. A previous study of general practitioners in Scotland found that their knowledge of drug costs was often inaccurate. At the time of the Scottish study, doctors received very limited information on prescribing costs. By contrast, general practitioners in England have been receiving much more detailed information on their prescribing costs since the introduction of PACT (prescribing analyses and cost) in 1988/89. This study examines whether, as a result, doctors in England are more aware of drug costs. The results suggest that they are not; indeed, doctors in Scotland had marginally better knowledge of drug costs. There is a continuing need to improve the cost information available to general practitioners.

Awareness↗

PubMed2005

The prescribing of methadone and other opioids to addicts: national survey of GPs in England and Wales.

BACKGROUND: GPs occupy a pivotal position in relation to providing services to opiate misusers in the UK, and this is now cited to support initiatives in other countries. AIMS: To investigate GP involvement in the management of opiate misusers; and to examine the nature of this prescribing of methadone and other opioids. DESIGN: GP data collected via self-completion postal questionnaire from a 10% random sample of the 30 000 GPs across England and Wales. Patient prescription data obtained on opiate misusers treated during the preceding 4 weeks. SETTING: Primary healthcare practice in England and Wales in mid-2001. METHOD: A questionnaire was mailed to a random 10% sample of GPs stratified by number of partners in the practice, with three follow-up mailshots. Data on drugs prescribed by these practitioners were also studied, including drug prescribed, form, dose and dispensing arrangements. RESULTS: The response rate was 66%. Opiate misusers had been seen by 51% of GPs in the preceding 4 weeks (mean of 4.1 such patients), of whom 50% had prescribed opiate-substitution drugs. This provided a study sample of 1482 opiate misusers to whom GPs were prescribing methadone (86.7%), dihydrocodeine (8.5%) or buprenorphine (4.4%). Of 1292 methadone prescriptions, mean daily dose was 36.9 mg - 47.9% being for 30 mg or less. Daily interval dispensing was stipulated by 44.6%, while 42.9% permitted weekly take-away supply. CONCLUSIONS: In 2001 nearly three times as many GPs were seeing opiate misusers than was the case in 1985. Half were prescribing substitute-opiate drugs such as methadone (to an estimated 30 000 patients). However, there are grounds for concern about the quality of this prescribing. Most doses were too low to constitute optimal methadone maintenance; widespread disregard of the availability of supervised or interval dispensing increases the risks of diversion to the blackmarket and deaths from methadone overdose. Increased quantity of care has been achieved. Increased quality is now required.

Analgesics, Opioid↗

PubMed2005

Effect of precipitation on seasonal variability in cryptosporidiosis recorded by the North West England surveillance system in 1990-1999.

The goal of this study was to examine temporal and spatial variability of reported cryptosporidiosis in 15 health authorities in the North West of England using regression modelling. We also examined the role of precipitation as a driving factor for seasonal variation. We separated the time series of the reported cryptosporidiosis into two processes: an endemic process and an epidemic process, and examined the spatial variability of each of these processes. In the North West region of England we observed a strong seasonal pattern that consists of two waves, spring and autumn, during which the weekly rates exceeded the endemic level 3.5 and 3 times, respectively. Health authorities with the high endemic cryptosporidiosis incidence and well-pronounced seasonal patterns exhibited a significant increase in rates of cryptosporidiosis associated with increased precipitation. The endemic level and the magnitude of epidemic peaks were inversely related, which might be indicative of multiple exposures to the pathogen in these localities and the development of some partial immunity.

Animals↗

PubMed2006

Mortality in southern England during the 2003 heat wave by place of death.

More than 2000 deaths were attributed to the August 2003 heat wave in England and Wales. We analysed excess mortality in southern England during the heat wave by place of death. Excess mortality was 33 per cent in those aged 75 and over and 13.5 per cent in the under 75 age group during the 10 day heat wave. Among those aged 75 and over, deaths at home increased by 33 per cent and deaths in nursing homes increased by 42 per cent. Around one quarter of the heat wave attributable deaths occurred in care homes, but this is likely to be an underestimate as some residents may have been admitted to hospital before death. There is a need for further research to assess the risk of heat-related mortality in hospital in-patients and the residents of care homes in order to improve prevention strategies.

Aged↗

PubMed2006

A new genetic variant of La Crosse virus (bunyaviridae) isolated from New England.

La Crosse virus (LACV) is found primarily in the Midwestern and Appalachian regions of the United States where it is a leading cause of mosquito-borne encephalitis in children. To determine whether the distribution of this virus extends further east into New England, we analyzed a bunyavirus that was isolated from a pool of eastern tree-hole mosquitoes, Ochlerotatus triseriatus (= Aedes triseriatus), collected from Fairfield, Connecticut (CT) in 2005. Nucleotide and encoded amino acid sequences from portions of the S, M, and L segments were more similar to the prototype strain of La Crosse virus than that of closely related snowshoe hare virus. Phylogenetic analysis of sequences from the M segment indicated that the CT isolate represents a distinct lineage of La Crosse virus, diverging earliest from other strains found in southeastern, central, and northeastern United States. Despite low sequence homology with other viral strains, the CT isolate was antigenically similar to the prototype strain of LACV by plaque-reduction neutralization tests with polyclonal and monoclonal antibodies. This represents the first isolation of LACV in New England to our knowledge and suggests long-term independent evolution of the CT isolate.

Animals↗