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PubMed1999

Genetic typing of bovine pestiviruses from England and Wales.

Using RNA purified directly from stored clinical specimens, a collection of 62 pestiviruses were typed by RT-PCR and sequencing within the 5'-untranslated region of the genome. All the specimens had been obtained in 1966/1967 from diary cattle in England and Wales. Eight further pestiviruses, grown in cell culture, were characterised in the same way. Seven of these viruses were representatives of a panel of British isolates, obtained from cattle ten years before. The eighth was the virus used in a British bovine viral diarrhoea (BVD) vaccine. Most of the viruses were genetically unique and were of BVDV type Ia. One recent isolate was BVDV type Ib, two others were intermediate between Ia and Ib. No BVDV type II or border disease virus (BDV) isolates were found. There was no overall association between geographical and phylogenetic clustering, suggesting long-distance virus dispersal, presumably via trading of infected cattle. The sequences of the recently obtained cattle viruses were very similar or, in one case, identical to the older isolates in the region studied. Their close similarity to some previously characterised pestiviruses from British sheep suggests that a common pool of BVDV Ia is shared by these two livestock species, although another pestivirus--BVDV--is confined to sheep. The British cattle viruses were mostly distinct from continental European isolates, but more similar to type Ia isolates from North American cattle.

5' Untranslated Regions↗

PubMed1997

Fatal pulmonary embolism: a comparative study of autopsy incidence in Hong Kong and Cardiff, Wales.

All autopsy reports from 1990-1994 inclusive of the Department of Pathology, University of Hong Kong and the Wales Institute of Forensic Medicine were examined and cases of death due to massive pulmonary embolism were noted. The incidence of this condition was calculated and found to be insignificantly lower in the Hong Kong series than the Welsh series by statistical analysis, both in the crude incidence in all autopsies and when correcting for different case mixes in the two locations. The majority of cases in both locations were in the over-60 age group. The study helps refute the longstanding belief among Hong Kong physicians that fatal massive pulmonary embolism is rare in Hong Kong (with approximately 98% Chinese population) in comparison with a predominantly Caucasian population.

Adolescent↗

PubMed1999

Changing patterns of coronary heart disease in the hunter region of New South Wales, Australia.

A population-based observational study of men and women aged 35-69 years in the Hunter Region of New South Wales, Australia, was conducted to assess the impact of risk-factor modification and increased drug therapy on the trends in major coronary events and case fatality. From 1985 to 1993, there were 3006 coronary deaths and 6450 nonfatal major coronary events. Rates of death and nonfatal myocardial infarction declined, but there was an increase in hospital admissions for prolonged chest pain. Reductions in cigarette smoking, diastolic blood pressure, total cholesterol, and increased use of aspirin can fully explain the 3.3% (95% confidence interval [CI] 2.4, 4.2) average annual reduction in rates of major coronary events for men and the 4.1% (95% CI 2.7, 5.5) reduction for women. In contrast, increased use of aspirin, beta-blockers, fibrinolytic therapy, and angiotensin-converting enzyme inhibitors explain less than half of the 8.9% (95% CI 5.9, 11.8) and 6.9% (95% CI 2.7, 10.9) average annual reduction in case fatality in hospital for men and women, respectively. These trends suggest a decline in severity of coronary heart disease consistent with reductions in risk-factor levels and improved acute medical treatment.

Adult↗

PubMed1991

The management of pulmonary tuberculosis in adults notified in England and Wales in 1988. The British Thoracic Society Research Committee and the Medical Research Council Cardiothoracic Epidemiology Group.

A survey was conducted of the management of adult patients with pulmonary tuberculosis notified in England and Wales in the first 6 months of 1988. Its main aim was to record the current usage of anti-tuberculosis drugs. Information was obtained on 1026 patients (91% of those surveyed), of whom 97% were prescribed rifampicin and isoniazid as principal components of their chemotherapy. Pyrazinamide was prescribed to 80%, which represents a substantial increase on the 19% recorded in a similar survey of patients notified in 1983. Adverse reactions requiring modification of therapy occurred in 15.4% of the 332 patients starting treatment with rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E), and although the percentages were slightly lower in those who started treatment with the other main combinations of drugs, namely HRZ (14.1% of 355 patients) and HRE (12.8% of 125 patients), the differences were clinically unimportant and did not reach statistical significance. Of the patients who were prescribed pyrazinamide, only 29% received therapy approximating to the schedule now recommended as standard in the U.K., namely 2 months of triple or quadruple therapy including pyrazinamide, followed by rifampicin and isoniazid for 4 months more. This low percentage reflects the wide variation in treatment schedules and the fact that many patients continued on therapy for 9 months or more. The findings of this survey highlight the non-uniformity of prescribing practices and some of the difficulties of ensuring that patients with pulmonary tuberculosis complete an appropriate course of therapy.

Antitubercular Agents↗

PubMed2003

Long-term survival of women with breast cancer in New South Wales.

Several long-term studies of breast cancer survival have shown continued excess mortality from breast cancer up to 20-40 years following treatment. The purpose of this report was to investigate temporal trends in long-term survival from breast cancer in all New South Wales (NSW) women. Breast cancer cases incident in 1972-1996 (54,228) were derived from the NSW Central Cancer Registry-a population-based registry which began in 1972. All cases of breast cancer not known to be dead were matched against death records. The expected survival for NSW women was derived from published annual life tables. Relative survival analysis compared the survival of cancer cases with the age, sex and period matched mortality of the total population. Cases were considered alive at the end of 1996, except when known to be dead. Proportional hazards regression was employed to model survival on age, period and degree of spread at diagnosis. Survival at 5, 10, 15, 20 and 25 years of follow-up was 76 per cent, 65 per cent, 60 per cent, 57 per cent and 56 per cent. The annual hazard rate for excess mortality was 4.3 per cent in year 1, maximal at 6.5 per cent in year 3, declining to 4.7 per cent in year 5, 2.7 per cent in year 10, 1.4 per cent in year 15, 1.0 per cent for years 16-20, and 0.4 per cent for years 20-25 of follow-up. Relative survival was highest in 40-49 year-olds. Cases diagnosed most recently (1992-1996) had the highest survival, compared with cases diagnosed in previous periods. Five-year survival improved over time, especially from the late 1980s for women in the screening age group (50-69 years). Survival was highest for those with localised cancer at diagnosis: 88.4 per cent, 79.1 per cent, 74.6 per cent, 72.7 per cent and 72.8 per cent at 5, 10, 15, 20 and 25 years follow-up (excluding those aged >or=70 years). There was no significant difference between the survival of the breast cancer cases and the general population at 20-25 years follow-up. Degree of spread was less predictive of survival 5-20 years after diagnosis, compared with 0-5 years after diagnosis, and was not significant at 20-25 years of follow-up. Relative survival from breast cancer in NSW women continues to decrease to 25 years after diagnosis, but there is little excess mortality after 15 years follow-up, especially for those with localised cancer at diagnosis, and the minimal excess mortality at 20-25 years of follow-up is not statistically significant.

Adolescent↗

PubMed1995

Laboratory reports of opportunistic and other mycobacterial infections and their relationship to notifications of tuberculosis in England and Wales.

SETTING: England and Wales, UK. OBJECTIVE: To investigate: (1) whether misclassification of opportunistic mycobacterial disease had contributed to the failure of tuberculosis notifications to continue declining; (2) whether laboratory reports of Mycobacterium tuberculosis complex infections could be used to validate trends in the tuberculosis notification system. DESIGN: Descriptive epidemiological study using laboratory reports of infections to the Public Health Laboratory Service Communicable Disease Surveillance Centre, Medical Research Council National Surveys of Tuberculosis and tuberculosis notifications to the Office of Population Censuses and Surveys. RESULTS: Compared to 1983, an extra 1% of tuberculosis notifications in 1988 were opportunistic mycobacterial disease inappropriately notified as tuberculosis. On the basis of the expected proportion of microbiologically confirmed tuberculosis infections, laboratory reporting was incomplete: for one laboratory report there were four notifications. CONCLUSION: Misclassification of opportunistic mycobacterial infection was estimated to account for only a small proportion of the excess tuberculosis notifications since 1988. This excess of tuberculosis notifications could be due to artefact, for instance because a greater proportion of cases are being notified. Laboratory reports of tuberculosis infections are of limited use in validating the recent trends in tuberculosis notification rate. At present changes in the level of reporting of laboratory isolates are likely to obscure genuine trends.

Diagnostic Errors↗

PubMed2003

Complementary and alternative medicine use by patients with cancer in Wales: a cross sectional survey.

OBJECTIVES: To determine the prevalence and cost of complementary and alternative medicine (CAM) use, and examine perceived satisfaction and reasons for using CAM. DESIGN AND SETTING: Cross sectional survey of 1697 patients with breast, prostate, lung or neurological cancer registered with a single NHS authority in Wales. PARTICIPANTS: One thousand and seventy-seven (64%) of patients, aged 18 years or over with cancer diagnosis of at least 3 months, returned analysable questionnaires. Thirty patients were interviewed by telephone. MAIN OUTCOME MEASURES: Number and proportion that had used CAM in the past 12 months, the types of CAM used, expenditure, satisfaction, demographic characteristics, and reasons for using CAM. RESULTS: Five hundred and thirty-four, 49.6% (95% CI 46.6-52.6) of participants, reported using at least one type of CAM during the past 12 months: 221, 16.4% (95% CI 14.3-18.8), had consulted a CAM practitioner (average cost per person, 28 lbs. per month); 166, 15.4% (95% CI 13.4-17.7), indicated using CAM techniques (average cost per person, 16 lbs. per month); 456, 42.3% (95% CI 39.4-45.3), reported using over-the-counter diets, remedies or supplements (average cost per person, 10 lbs. per month). Dissatisfaction with CAM use was low, and most users indicated that they represented value for money. CAM users were more likely to be female, younger, better qualified, and to have used CAM before their current illness than non-users. Patients used CAM primarily for symptom relief and relaxation. CONCLUSIONS: Nearly half the cancer patients in this study had used CAM. A co-ordinated approach to quality assurance, information and advice, and the assessment of risk/benefit and cost effectiveness of CAM use is needed.

Adolescent↗

PubMed2000

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home.

PURPOSE: To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia. METHODS: Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns. RESULTS: The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups. CONCLUSIONS: There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.

Adolescent↗

PubMed2003

Nurse manager turnover in New South Wales during the 1990s.

The principal aim of the research reported in this paper was to explore the nature and incidence of various environmental, personal, and work-related factors that are implicated in turnover and retention amongst nurse managers. The study sought to ascertain whether or not turnover patterns during the 1990s were similar for nurse managers working in different specialist areas and settings of health services within New South Wales, and to discover the main reasons why nurse managers change their jobs or stay in their jobs. This paper reports the main findings, and highlights how the factors implicated in nurse manager turnover and retention, whilst not significantly dissimilar across different cohorts of nurse managers, do not parallel those that are implicated in turnover amongst nurses generally. The research has found that the main reason nurse managers change their jobs is for career development, often within the same organisation or, otherwise, the same health sector or geographic area. Second to this is leaving due to dissatisfying aspects of the job and/or work environment. Some differences have been observed in the propensity to change jobs and in the relative importance of particular influences on job changes in certain practice areas and health sectors. Seven per cent of nurse managers would like to quit their present jobs. However, almost 70% are happy to stay either because the job suits their skills and qualifications, the job is personally satisfying/rewarding, they enjoy the company of their coworkers, or their hours of work suit their needs.

Adult↗

PubMed2005

Molecular epidemiology of hepatitis B in England and Wales.

This review focuses on general and molecular features of the epidemiology of incident and prevalent hepatitis B virus (HBV) infections in England and Wales. The situation in Scotland and Northern Ireland will not be reviewed.

Emigration and Immigration↗

PubMed2001

Epidemiology of fractures in England and Wales.

Records from the General Practice Research Database were used to derive age- and gender-specific fracture incidence rates for England and Wales during the period 1988-1998. In total, 103,052 men and 119,317 women in the sample of 5 million adults sustained a fracture over 10.4 million and 11.2 million person-years (py) of follow-up. Among women, the most frequent fracture sites were the radius/ulna (30.2 cases per 10,000 py) and femur/hip (17.0 per 10,000 py). In men, the most common fracture was that of the carpal bones (26.2 per 10,000 py); the incidence of femur/hip fracture was 5.3 per 10,000 py. Varying patterns of fracture incidence were observed with increasing age; whereas some fractures became more common in later life (vertebral, distal forearm, hip, proximal humerus, rib, clavicle, pelvis), others were more frequent in childhood and young adulthood (tibia, fibula, carpus, foot, ankle). The lifetime risk of any fracture was 53.2% at age 50 years among women, and 20.7% at the same age among men. Whereas fractures of the proximal femur and vertebral body were associated with excess mortality over a 5 year period following fracture diagnosis among both men and women, fractures of the distal forearm were associated with only slight excess mortality in men. This study provides robust estimates of fracture incidence that will assist health-care planning and delivery.

Adult↗

PubMed1991

Social and family characteristics of marriage in England and Wales: information derived from marriage registration records.

Information on social and family aspects of marriage was obtained from a sample of over a thousand marriages solemnised in England and Wales in 1979. The data include the standard demographic variables concerning the couple and their marriage and also: the day of the week the marriage was celebrated; whether the fathers or relatives of similar surname to the spouses acted as witnesses; the patterns of name usage by brides; the numbers of forenames of the marriage partners and their fathers; and the frequency of bridegrooms having one or more forenames in common with their fathers. The factors are analysed in terms of social class differences as well as in relation to the distance over which marriages range and other demographic characteristics of the partners and their marriage.

Adolescent↗

PubMed1993

Availability of marriage partners in England and Wales: a comparison of three measures.

Measures of partner availability introduced by Goldman, Westoff & Hammerslough (1984) and by Veevers (1988) are described and a new measure of partner availability, the Iterated Availability Ratio, is introduced. The three measures are applied to 1981 Census data for England and Wales and their abilities to predict regional variations in age-specific marriage rates are compared.

Adult↗

PubMed2006

The influence of antenatal and maternal factors on stillbirths and neonatal deaths in New South Wales, Australia.

This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, plurality of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2,000 g) contributed 75.6% of the population-attributable risks to stillbirths and 59.4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77.7% of stillbirths and 87.9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study.

Adult↗

PubMed1984

Some attributes of twin-bearing British Friesian and Canadian Holstein cows recorded in England and Wales.

The production of milk, fat and protein of 37216 mothers of twins was compared with that of 1 691 127 mothers of single calves of Black and White breeds of cattle recorded in England and Wales. At every parity, the mothers of twins produced more milk, fat and protein than the mothers of single calves. The proportion of twin-bearing cows retained increased with parity, from 0.67% at first calving to approximately 40% at the tenth or eleventh calving. More mothers of twins achieved 305 d of lactation subsequently than mothers of single calves, although their inter-calving intervals were not generally longer.

Age Factors↗

PubMed1993

Onchocerciasis in British cattle: a study of the transmission of Onchocerca sp. in north Wales.

The transmission of bovine Onchocerca spp. in Britain was investigated by studying the Ceratopogonidae and Simuliidae which attacked bait cattle between April and October at two sites in North Wales, where either Onchocerca lienalis and O. gutturosa (Cynwyd), or O. lienalis alone (Pentrefoelas) occurred. Based on the relative abundance of each species, their seasonal variation in abundance and preferential feeding sites on cattle, the presence of Onchocerca sp. infective larvae and the development of patent infections in bait cattle, vectors were identified as Simulium ornatum s.1. at Pentrefoelas and S. reptans at Cynwyd (0.5% and 1.5% of parous flies infective, respectively). There was no significant difference between the lengths of the infective larvae from vectors at either site (Pentrefoelas: mean = 543.5 microns, SD = 29.45; Cynwyd: mean = 550.86 microns, SD = 35.26; p > 0.1), which were consistent with descriptions of O. lienalis. The identity of a vector for O. gutturosa was not determined and the role of certain candidates is discussed. In this respect, the absence of Culicoides nubeculosus was notable. Transmission of Onchocerca sp. was limited to a short period of about 8 weeks, by a combination of vector abundance and parasite uptake from dermal skin layers, and a mean daily temperature requirement of 15 degrees C or more for complete parasite development in the vector. The effect of this temperature restriction in relation to the geographical distribution of the two species is discussed.

Animals↗

PubMed1971

Multiple sclerosis distribution in England and Wales and parts of Europe.

Scotland and Ireland have the highest death rates from multiple sclerosis and high rates are recorded in an area extending south-eastward from Britain through central Europe. The rates tend to diminish with rising latitude and longitude. In England and Wales the county boroughs with notably high rates during 1958-67 were mostly textile towns with cotton and wool mills, situated in the area recording the lowest average levels of sunshine. In the London area mortality from multiple sclerosis was high in those western boroughs and adjacent counties most exposed to the noise of aircraft using the airports of London. The geographical pattern in England suggests that noise and vibration of particular kinds may be a factor in causation along with a climatic factor, but this hypothesis is speculative until further evidence is found to support it.

Adolescent↗

PubMed1972

Urban variation in infant mortality from birth injury and atelectasis in England and Wales in 1958-67.

Variations in mortality attributed to birth injury and atelectasis in the 10 years 1958-67 have been investigated for each county borough of England and Wales. It became evident that diagnostic difficulties in separating these two causes must have been such that for statistical purposes they should be combined in a single rate.Variables likely to affect the local rates such as the sex ratio of births, and rates of illegitimacy and immaturity as an ill-defined cause of death appeared to affect the mortality levels in certain towns but not sufficiently to account for the wide variations apparent in those levels. It is concluded that local surveys are necessary in the towns with highest rates to uncover differences in numbers of births in hospital, in obstetric techniques and in quality of medical care.

Asphyxia Neonatorum↗