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PubMed2006

Trends in premature mortality in England and Wales, 1950-2004.

Premature mortality is a major public health concern but there has been little consensus among researchers on how it should be defined and reported. In this article four means of measuring early deaths are considered using four different age thresholds to define prematurity. Using these four indicators, trends in premature mortality are reported for England and Wales from 1950 to 2004. All measures show that, however 'premature' is defined, levels of premature mortality have decreased markedly over time. This article discusses which mortality indicator and age threshold would be most appropriate for a measure of premature mortality for use in national mortality statistics for England and Wales.

Adolescent↗
PubMed2006

Estimated daily mortality during July 2006 in England and Wales.

During July 2006, temperatures in England and Wales triggered the Government to initiate its Heatwave Plan and issue advice to the public on how to keep healthy during hot weather, and guidance to health care professionals on minimising heat-related health risks. This report presents provisional daily mortality during July by age and region, and estimates excess deaths at the hottest times. The high temperatures during July 2006 did not affect mortality in England and Wales to the extent seen in August 2003--the first hot period of July 2006 showed no increase in mortality nationally and there was a 4 per cent increase over baseline mortality in the second hot period (680 excess deaths). This compares to a 16 per cent increase during the August 2003 heat wave.

Cause of Death↗
PubMed1991

Report of the National Commission on Nurse Anesthesia Education. A brief historical report of the development and accomplishments of the New England Assembly of Anesthesia School Faculty.

The new England Assembly of Anesthesia School Faculty evolved from a 1975 meeting convened to discuss implementation of AANA Standards and Guidelines. It has continued to meet regularly since that time to discuss AANA Standards and Guidelines and to address problems confronting schools of nurse anesthesia in New England.

History, 20th Century↗
PubMed1988

Balint work in England: lessons for American family medicine.

The work of Michael and Enid Balint in developing case discussion seminars for general practitioners in England has important implications for the teaching of family medicine in the United States. Focusing on the physician-patient relationship, their seminars evolved from an emphasis on a psychiatric history taken by the physician to a more pragmatic concern with the process of the everyday brief consultation. The leaders of traditional Balint groups guide group members toward open discussion of case material by modeling listening, curiosity, and tolerance for group members. Seminar goals include increasing general practitioners' sensitivity to their patients' emotional problems and expanding the practitioners' repertoire of interventions in the medical interview. With modifications, Balint-type seminars have been incorporated into some general practice and family medicine training settings both in England and in the United States. The unique features of Balint seminars within the context of medical education are their nondidactic, participatory nature, their goals of an emotional change within the physician, and their focus on the physician-patient relationship.

Education, Medical, Continuing↗
PubMed1983

A comparison of socioeconomic differences in mortality between Japan and England and Wales.

Japan and England and Wales have long traditions of publishing mortality rates by occupation. These data have been used in the present study to see how mortality from different causes of death is related to socioeconomic status in each country. In general, males in higher employment grades have been found to have lower mortality from most diseases. However, because mortality from certain diseases such as diabetes mellitus and ischaemic heart disease has been higher in the upper social classes (but is now lower in the upper classes) the relationship is not necessarily consistent. The aim of this study was, by comparing rates for Japan with those for England and Wales, to highlight differences in socioeconomic gradients which may indicate etiological differences between the 2 countries.

Actuarial Analysis↗
PubMed1982

Mortality from byssinosis among New England cotton mill workers, 1905-1912.

Little was known about mortality from byssinosis among American cotton mill workers until recent times. Between 1912 and 1919, the Labor Department published two detailed investigations of mortality by cause of death among cotton mill workers and other residents of several New England mill towns. Statistical tests reveal no significant difference in mortality rates from nontubercular respiratory diseases between cotton textile workers and other mill town residents. Even when ex-mill workers who may have died from mill-related respiratory ailments are added to work-related deaths and subtracted from the control group, mortality rates do not differ significantly. Finally, when mortality rates for workers in the most dusty areas of the mills--picking and carding--are compared with those of other Fall River, Mass., residents, the differences are still not statistically significant. Apparently byssinosis was not a cause of excess mortality among New England cotton mill workers at the turn of the century.

Adolescent↗
PubMed1981

The Black Death in England.

From 1348 to 1350 Europe was devastated by an epidemic of plague, called at the time the Great Mortality and later the Black Death. The epidemic reached southern Europe from the Middle East and spread northward, reaching England in June 1348. Contemporary descriptions leave no doubt of the diagnosis, but estimates of the mortality differ widely owing to lack of contemporary statistics; in England it was probably between one-third and one-half of the population. The Black Death and subsequent plague epidemics in the 14th century had marked social and economic effects, reduced the prestige of the Church and off the medical profession, and were a factor in the social unrest which led to the Renaissance of the Reformation.

China↗
PubMedDate not supplied

Plague mortality and demographic depression in later medieval England.

Both direct and indirect evidence implies that England experienced a lengthy period of stagnant or declining population during the later fourteenth and fifteenth centuries. The Black Death of 1348-1349 had brought about profound changes in England's agrarian economy, and this subsequent demographic depression is most commonly interpreted by historians as the result of plague mortality, recurring in severe outbreaks after the disease's introduction into the country. This paper reviews the evidence and assumptions behind this interpretation, in light of recent research by historical demographers and epidemiologists into bubonic plague epidemics and general mortality crises during the post-medieval period.

Demography↗
PubMedDate not supplied

Cross-sectional relationship between diet and physical activity in two southeastern New England communities.

The hypothesis that health promotive diets associated with higher levels of habitual physical activity confound the relationship between regular physical activity and health has not been well explored in epidemiologic studies. We evaluated self-reported physical activity, Willett Food Frequency dietary data, sociodemographic and physiologic factors cross-sectionally for 2,004 household survey participants in two southeastern New England communities. We compared the dietary habits of sedentary participants (n = 964) to those of moderately active (n = 600) and very active (n = 440) participants after adjusting for age, gender, education, smoking status, year of survey, and total calories. Our results showed that moderately active and very active participants consumed more fiber, less total fat, and less saturated fat than sedentary participants (P < .01). They also consumed more vitamins (A, C, D, E), beta carotene, and calcium, (P < .01), and ate more fruits and vegetables (P < .001) than sedentary participants. We found these relationships in both New England communities studied. This association between regular physical activity and diet suggests that the relationship of habitual physical activity and chronic disease may be confounded by diet.

Adult↗
PubMed1993

Drug resistance in initial isolates of Mycobacterium tuberculosis in England and Wales, 1982-1991.

A total of 1833 out of over 16,000 'initial' isolates of Mycobacterium tuberculosis, submitted by hospital laboratories to the PHLS Regional Tuberculosis Centres in England and Wales between 1982 and 1991, were resistant to one or more first line anti-tuberculosis drugs. Isoniazid resistance was found in 6.1% of these strains, half of which were resistant to isoniazid alone. Resistance to isoniazid and rifampicin, with or without resistance to other drugs, was found in 0.6% of isolates. The proportion of initial isolates resistant to one or more drugs was 9.8%. It ranged from 8.0% to 10.9% between 1982 and 1990, and increased to 14.2% in 1991. The incidence of multiple drug resistance remained very low throughout the period. However, in the light of the problems with tuberculosis and drug resistance emerging elsewhere in the world, vigilance is essential, and enhanced surveillance is being planned in England and Wales.

Adolescent↗
PubMed1994

Legionnaires' disease surveillance: England and Wales, 1993.

One hundred and twenty-nine cases of legionnaires' disease were reported in England and Wales in 1993. Twenty-two of the cases died. Sixty-six cases (51%) were associated with travel (in the United Kingdom or abroad), six were associated with a stay in hospital, and the remaining 57 were thought to have acquired infection in the community. Two community and two hospital outbreaks were recognised in England and Wales and four outbreaks were detected in travellers from the United Kingdom to Spain, Greece, and the United States. One hundred and six cases (82%) were not known to have been associated with outbreaks, and 51 (40%) of these were not associated with travel or hospitals.

Cross-Sectional Studies↗
PubMed1994

Survey of human immunodeficiency virus infection among pregnant women in England and Wales: 1990-93.

We report on the first four years (1990-93) of a survey within the national HIV prevalence monitoring programme. The survey's objective is to monitor the prevalence of infection with the human immunodeficiency virus (HIV) in pregnant women in London and elsewhere in England. The survey--based in forty centres that offer antenatal care in London, Greater Manchester, West Yorkshire, and adjacent non-metropolitan areas--uses repeated cross sectional serosurveillance for anti-HIV-1 and 2 and the unlinked anonymous test method on blood left over from specimens collected for antenatal screening for immunity to rubella. The seroprevalence of HIV-1 ranged from 0.007% (1 in 14,530) in non-metropolitan areas, to 0.011% (1 in 8790) in metropolitan areas outside London, and 0.23% (1 in 440) in London. Evidence of HIV-2 infection was found in only four specimens, in London (1 in 50,300). The seroprevalence of HIV-1 in London varied more than tenfold between centres, from 0.03% (1 in 3190) to 0.51% (1 in 200). The highest prevalence of infection was in London in women aged between 20 and 30 (0.30%; 1 in 335). The seroprevalence in London centres rose from 0.18% in 1990 (1 in 560) to 0.26% in 1993 (1 in 390) and the rise was significant in all age groups. If voluntary confidential HIV testing (with counselling) among pregnant women in England were to be promoted, its cost effectiveness would be greater if focused on particular centres that provide antenatal care in London.

Adult↗
PubMed1995

Nutritional support in intensive care units in England and Wales: a survey.

OBJECTIVE: To assess current practice in nutritional support in intensive care units (ICUs) in England and Wales. DESIGN: A three-section questionnaire about feeding practice was sent to all adult ICUs in England and Wales; this requested information on nutritional support provided for all patients during a single designated 24-h study period. RESULTS: 66% of the questionnaires were completed and returned. 43% of patients received nutritional support. Of these, 46% received only parenteral nutrition, 34% only enteral nutrition, 4% received sip feeds and the remaining 16% received more than one form of feeding. 81% of patients fed by the nasogastric route had a large-bore tube in place. More than 40% of patients were fed parenterally via the central route, of these 54% had a dedicated feeding line. CONCLUSIONS: Despite the complications of central venous feeding and the advantages of and developments in enteral feeding these findings suggest there could be further improvement in our provision of nutrition for the critically ill patient.

Adult↗
PubMed1994

The relative contribution of dental services to the changes and geographical variations in caries status of 5- and 12-year-old children in England and Wales in the 1980s.

The aim of this study was to assess the relative contribution of dental services to the changes and geographical variations in caries status of 5- and 12-year-old children in England and Wales in the 1980s. A secondary aim was to assess the association between caries experience and social factors. An ecological study analysing data at a district health authority level in England and Wales was conducted. Twenty-eight, 43 and 34 per cent of the variations in 5-year-old dmft in 1985, 1987 and 1989 respectively were explained by dental service activity indicators and 53, 62 and 57 per cent by social factors. Twenty-nine per cent of the variation in 12-year-old DMFT in 1988 was explained by dental service activity indicators and 46 per cent by social factors.

Child↗
PubMed1994

Provision of obstetric care by general practitioners in the south western region of England.

BACKGROUND: Recent government reports have suggested changes to the organization of maternity care in the United Kingdom which may well affect the contribution of general practitioners. AIM: This study set out to document the range of obstetric care provided by general practitioners, their perceived competence at various obstetric procedures, and their beliefs about their role in maternity care. METHOD: A postal questionnaire was sent to a random one in four sample of general practitioners in the South Western Regional Health Authority of England. RESULTS: Of 424 questionnaires sent out, 333 (79%) were returned. Of 303 respondents, 98% provided both antenatal and postnatal care. Of 294 respondents, 45% provided intrapartum care and 27% booked women for home deliveries. Of 117 respondents providing hospital intrapartum care 47% booked 10 or fewer women each year, and most provided little practical intrapartum care. Compared with those providing only antenatal and postnatal care, those who provided intrapartum care believed themselves to be more competent at various obstetric procedures and their perceived competence was significantly correlated to the number of procedures that they performed. Those general practitioners providing intrapartum care made significantly more postnatal visits than those providing only antenatal/postnatal care and were significantly more likely to believe that general practitioners have an important role in labour. CONCLUSION: Many general practitioners in the south western region of England still provide a choice in maternity care for women, and believe that they have an important role in such care. Further work is required to establish what women and their general practitioners believe the latter contribute to maternity care.

Adult↗
PubMed1995

Legionnaires' disease surveillance: England and Wales 1994.

One hundred and sixty cases of legionnaires' disease in England and Wales were reported to the PHLS Communicable Disease Surveillance Centre in 1994, a rate of 3.1 cases per million population. Twenty-seven cases died. Eighty-nine cases (56%) were associated with travel, either in the United Kingdom (UK) or abroad, and six with a stay in hospital; the remaining cases were presumed to have acquired infection in the community. Seven outbreaks were detected in England and Wales: one was associated with a holiday centre, one with a hotel in London, two with industrial sites, and three occurred in the community. A further four clusters were associated with travel abroad: Spain, Ibiza, the Channel Islands, and a Mediterranean cruise. One hundred and twenty-eight of the 160 cases (79%) were sporadic--that is, not known to be associated with outbreaks--43 of which (34%) were not associated with travel nor acquired in hospital.

Adult↗
PubMed1995

Coronary heart disease mortality trends in England and Wales, 1952-1991.

BACKGROUND: The 'programming' hypothesis for the causation of heart disease suggests that there are critical periods of development in early life during which a stimulus or insult has permanent effects on the subject's organ or tissue structure and physiology. Exposure to such effects might be expected to be linked to year of birth and produce cohort (generation) effects in heart disease death rates. Evidence is sought for such effects in data from England and Wales. METHODS: The age- and period-specific heart disease death rates for men and women aged 30-69 in England and Wales have declined recently in both men and women. The trends have two components. The first is described by a peak in rates during 1977-1981 that applies to both sexes and all age-groups. This is consistent with risk conferred by adult diet and lifestyle. The second component required to explain the trends also applies to both sexes and is described by a risk that is lower in each successive year of birth. This is consistent with risk linked to poor growth in early life. CONCLUSION: Poor early growth has become less common as maternal health, physique and nutritional status have improved through the century. The trends are therefore consistent with the'programming' hypothesis for the causation of coronary heart disease.

Adult↗
PubMed1995

Variations in the incidence, management and outcome of stroke in residents under the age of 75 in two health districts of southern England.

BACKGROUND: The aim of the study was to determine the incidence, outcome and health service resources consumed by stroke care in defined populations. METHODS: Patients under the age of 75 experiencing their first stroke between August 1989 and July 1991 were assessed at the onset, and at three and 12 months after their stroke. The settings were West Lambeth (WL) and Tunbridge Wells (TW) health authorities in southern England. The main outcome measures used were: age- and sex-specific incidence rates, hospital admission rates, length of stay and use of rehabilitation services. Functional disability was assessed using the Barthel scale. RESULTS: Four hundred and fifty-six strokes were registered. The annual incidence rates/1000 population aged under 75 years old [with 95% confidence interval (CI)] were 0.77 (0.67-0.87) in WL and 0.66 (0.58-0.75) in TW. The age- and sex-standardized incidence ratios were significantly higher in WL (126; 95% CI 110-144) than in TW (84%; 95% CI 74-95) (p < 0.001). There were independent associations of incidence with age group (p < 0.001), sex (p < 0.001) and ethnic group (p < 0.001). One year case-fatality was 36% (80/225). At one year, 11% (14) of surviving patients were moderately to severely disabled and 23% (28) mildly disabled. Seventy-one percent (326) of patients were admitted to hospital and the average health service cost per case was pound 3800 in WL and pound 2650 in TW, 93% of the cost being for in-patient care. CONCLUSION: The study has demonstrated a significantly increased incidence of stroke in an inner-city district compared with a district in rural southern England. It has also established ethnic group as a significant independent risk factor for stroke in the United Kingdom. The cost of care to the health services is considerable, and largely reflects nursing costs in hospital rather than effective treatment packages for stroke.

Adult↗