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PubMed1973

Mortality from cancer and cardiovascular diseases in the county boroughs of England and Wales classified according to the sources and hardness of their water supplies, 1958-1967.

Relative rates of proportionate mortality from cancer of six sites based on total cancer deaths and the proportions expected in all towns, and from four types of cardiovascular disease based on total deaths from all causes, have been related in the 80 county boroughs of England and Wales to the sources of water supply and to the average hardness of water in the towns. The sources of water, from upland surfaces, artesian wells and rivers, were classified in eight groups, and significant associations were found for cancers of the stomach, oesophagus, prostate, male bladder and female breast, and for hypertensive and chronic rheumatic heart disease. No associations were apparent with intestinal cancer, vascular disease of the nervous system or arteriosclerotic heart disease. Hardness or softness of the water was classified in seven groups and significant associations were found for the same diseases as for source of water, none being evident for coronary disease.

Adult↗
PubMed1975

Trends in salmonella food poisoning in England and Wales 1941-72.

Cattle and pig herds and flocks of domestic fowl have formed the main reservoir of human salmonella food poisoning in England and Wales from 1941 to 1972. Changes in the incidence of human salmonella food poisoning and in the serotypes of salmonellas isolated from human infections are shown to have been associated with the introduction of new foods, with changes in animal husbandry, and with changes in the relative proportions of flesh food from different species consumed. New foods, dried powdered egg, liquid egg and frozen liquid egg were introduced during the period of food rationing which extended from 1940 to 1953. Changes in animal husbandry, in particular the intensive production of pigs, poultry and eggs, followed the re-establishment of pig herds and fowl flocks after the derationing of animal feed in 1953. The changes in the proportions of flesh foods consumed followed the introduction of frozen oven-ready fowl in the late 1950s and early 1960s which by 1964 became cheaper than traditional flesh foods.

Animals↗
PubMed1978

Poliomyelitis surveillance in England and Wales, 1969-1975.

Poliomyelitis continued to be a rare disease in England and Wales in the period 1969-75. Only 31 paralytic and 44 cases of possible non-paralytic poliomyelitis were recorded during the 7 years. Of the 31 paralytic cases approximately one third were vaccine-associated; 3 were patients who had recently received oral poliovaccine and 7 had been in contact with a vaccinated person. Five of these 7 patients were parents of recently vaccinated children. The rate of vaccine-associated poliomyelitis was estimated in recipients to be 0.2 and in contacts 0.4 per million doses of vaccine given. Marker test results were reported on 555 strains of poliomyelitis virus isolated during 1969-75, using the reproductive capacity temperature test. Forty-eight (8.6%) resembled wild virus in this property, 15 strains being type 1, 8 type 2 and 25 type 3. Most of these isolations of apparently wild virus were from excreters with no symptoms of poliomyelitis, although 3 of the 15 type 1 strains were from patients with paralytic poliomyelitis and 3 from possible cases of non-paralytic poliomyelitis. None of the 8 apparently wild type 2 viruses was from a case of paralytic illness and only 1 of the 39 type 3 strains. Eleven of the 31 paralytic cases were in patients in whom the infection was likely to have been acquired abroad.

Adolescent↗
PubMed1983

Plasmid-determined antibiotic resistance in Shigella flexneri isolated in England and Wales between 1974 and 1978.

The majority of Shigella flexneri strains isolated in England and Wales are from infections contracted abroad. Most of these strains are drug-resistant, over 75% being resistant to streptomycin and sulphonamides, sulphonamides alone or streptomycin, sulphonamides and tetracyclines. A selection of resistant strains was tested for resistance transfer and the plasmids identified were characterized by compatibility grouping. Streptomycin and sulphonamide resistance was usually determined by a non-autotransferring plasmid which may be mobilized by standard transfer factors, or by the plasmid which conferred tetracycline resistance where this was present. The remaining resistant strains were predominantly resistant to four or more drugs. These strains carried autotransferring plasmids of a variety of compatibility groups, of which groups B, I1 and FII were the most common.

Ampicillin↗
PubMed1982

Influenza surveillance in England and Wales using routine statistics. Development of 'cusum' graphs to compare 12 previous winters and to monitor the 1980/81 winter.

Surveillance of influenza in England and Wales is made by monitoring weekly data. Principal indices are deaths, sickness-benefit claims (SBC), laboratory reports and observations from general practitioners (GPs). The 12 winter 1968/9 to 1979/80 have been studied to see which indices best described size and timing of influenza epidemics. A method of plotting the data (called cusums) is suggested which makes it easier to see the effect of small epidemics. Cusums for GP statistics and respiratory deaths were found to be the most helpful indices for describing both size and timing of the epidemics, followed by total deaths and SBC, which were less specific to influenza, and influenza deaths, which lagged behind other indices. Deaths certified as pneumonia have been increasing over these years, whereas bronchitis deaths have been decreasing and these indices should not be used separately for monitoring. The laboratory reporting system is important. It confirms the presence of influenza virus in the community and indicates prevalent strains. Because it is a voluntary system with no defined population base the reports are not reliable numerically for estimating relative size of epidemics or for developing cusums. Cusum plots were unanimous in describing the winter of 1980/1 as one of little influenza activity.

Data Collection↗
PubMed1993

Some traditional treatments of hearing problems in Brittany and Wales.

The traditions of the healing of deafness associated with the Celtic saints in Brittany and Wales are discussed. Many more have survived in Brittany because of the religious continuity in that country. Three Saints Cadoc (of Welsh origin), Egarec (of Irish origin) and Meriadec (of Breton origin) are associated with such traditions in a number of different locations.

France↗
PubMed1985

Suicides by opium and its derivatives, in England and Wales, 1850-1950.

In the mid-nineteenth century opium and its derivatives, such as laudanum and morphine, were the most common poisons in suicides in England and Wales. With legislative restrictions on these 'dangerous drugs' such a use declined. This study attempts to show this trend and indicates the large variety of these opium-related suicides.

England↗
PubMed1981

Suicide by burning as an epidemic phenomenon: an analysis of 82 deaths and inquests in England and Wales in 1978-9.

An epidemic of suicide by burning in England and Wales occurred during the one-year period October 1978 to October 1979, following a widely publicized political suicide. For the 82 cases, death certificates were obtained and coroners' inquest reports sought. The victims were predominantly young single men or older married women; both groups had strong psychiatric histories; and there were no suicides which had political overtones, apart from the index case. Compared with suicides by this method in the past, a higher proportion of victims were born in the UK. It is proposed that a code of practice for the reporting of suicides by the media is required.

Adolescent↗
PubMed1981

Suicide in England and Wales: an analysis of 100 years, 1876-1975.

The variations in suicide mortality in England and Wales over a 100-year period (1876-1975) are explained by the development of a descriptive model. The model used in a stepwise linear regression using 5 variables including toxic gas production. The variables give a good description of the observed changes in suicide mortality. The limitations of the method and the data are discussed. Despite the limitations of the method, it can be concluded that toxic gas production affected total suicide mortality.

England↗
PubMed2001

Deaths from antidepressants in England and Wales 1993-1997: analysis of a new national database.

BACKGROUND: The prescription of antidepressants has increased substantially over the last 10 years. It is therefore timely to examine trends in mortality associated with overdoses of antidepressants and to compare the relative mortality associated with different antidepressants. METHODS: Data were derived from a newly developed national database of deaths from overdose and poisoning in England and Wales between 1993 and 1997. Age and sex specific death rates associated with overdose and poisoning with antidepressants were calculated together with numbers of deaths per 100,000 prescriptions of individual antidepressants. RESULTS: Twenty per cent (2,503) of all deaths from overdose or poisoning were antidepressant related. The number of deaths increased by 18% between 1993 and 1997. Ninety-five per cent of deaths from antidepressants were associated with tricyclic antidepressants, particularly dothiepin and amitriptyline. Tricyclic antidepressants were associated with 5.3 deaths per 100,000 prescriptions, 4.4 for monoamine oxidase inhibitors and 0.4 for selective serotonin reuptake inhibitors. Annual death rates were highest in men aged 30-44 years (18.2 per million) and women aged 45-59 years (14.8). Death rates from antidepressants were 2.5 times higher in the most deprived fifth than in the least deprived fifth of enumeration districts. CONCLUSIONS: Antidepressants are an important cause of death from poisoning and overdose. SSRIs and newer antidepressants are associated with <10% of the risk of death than the older antidepressants. There is a strong association between area deprivation and deaths from antidepressants.

Aged↗
PubMed2002

Suicide in female nurses in England and Wales.

BACKGROUND: Female nurses appear to have an increased risk of suicide but the reasons are unknown. METHOD: We have concluded a study of nurse suicides (N = 106) in England and Wales, including a psychological autopsy study (N = 42) and case-control comparison with living nurses (N = 84). RESULTS: Nearly three-quarters of the nurse suicides had previous contact with psychiatric services and almost half had been psychiatric in-patients in the past. There were particularly marked differences between the cases and controls for current psychiatric disorder (90.5% v. 7.1%, OR = 68.5), personality disorder (38.1% v. 12%, OR = 32), and history of deliberate self-harm (71.4% v. 2.4%, OR = 58.5). Family background and social factors (especially concerning interpersonal relationships) also distinguished the two groups. Smoking and serious alcohol abuse were much more frequent in the suicides. There was some indication that while many of the suicides were in contact with psychiatric services, care may not have been optimal in some cases. CONCLUSIONS: The most important strategies for suicide prevention in nurses are in prevention, detection and management of psychiatric disorders. In assessing suicide risk a history of DSH and the presence of comorbid psychiatric and personality disorders are particularly important.

Adult↗
PubMed1997

Changes in classification of suicide in England and Wales: time trends and associations with coroners' professional backgrounds.

BACKGROUND: The legal definition of suicide in England and Wales (E & W) gives rise to a high proportion of open verdicts and an underestimated suicide rate. We examined whether the ratio between open and suicide verdicts in E & W has changed between 1974 and 1991 and whether it varies according to coroners' qualifications. METHODS: Temporal changes of the ratio of open and suicide verdicts were examined using logistic regression adjusting for confounders such as changing age and gender distributions of suicide victims and the methods they use. RESULTS: Adjusted for age at death and suicide method, the ratio between open and suicide verdicts had, over successive 3-year time periods, increased with a factor 1.21 (95% CI 1.20-1.23) for male and 1.15 (95% CI 1.14-1.17) for female deaths. Medical coroners were 1.25 (1.08-1.44) times more likely than non-medical coroners to return open rather than suicide verdicts. CONCLUSIONS: As a likely result of factors in the death registration system, the ratio between open and suicide verdicts has increased substantially in E & W since the early 70s. In 1990 it was higher than in any other comparable country. This has important implications for comparisons of time trends in suicide between E & W and other countries.

Adolescent↗
PubMed1998

Is the decline in diagnoses of schizophrenia caused by the disappearance of a seasonal aetiological agent? An epidemiological study in England and Wales.

BACKGROUND: Studies from several countries have shown a decline, in the last few decades, of the number of admissions with a diagnosis of schizophrenia. This could be due to a fall in the incidence of schizophrenia, but it also could be due to confounding factors. The hypothesis tested in the study is that the incidence of schizophrenia is actually falling because of a decrease in the presence of a seasonal aetiological agent. METHODS: The hypothesis was tested by analysing the dates of birth of the patients discharged with a diagnosis of schizophrenia from NHS hospitals in England and Wales and would be confirmed by an appropriate change in the seasonality of the births over time. RESULTS: Evidence of seasonality has been observed in the schizophrenic births, but with no significant change over time. CONCLUSIONS: The fall in first admissions with a diagnosis of schizophrenia does not seem to be due to a change in the prevalence of a seasonal aetiological factor. Therefore, either there has been a reduction in incidence due to a change in a non-seasonal agent, or the incidence of schizophrenia is not changing and the fall in first admissions is due to confounding factors.

Age Factors↗
PubMed1989

Community care for the mentally ill in England and Wales: myths, assumptions and reality.

It is widely recognised that there are many problems with the community care policy for the mentally ill which has been in operation in England and Wales since the late 1950s. However, many existing accounts of the development of the policy rest upon a variety of erroneous assumptions about how it has evolved, and which in turn affect our understanding of how it might be changed. Some of these assumptions are examined, and it is argued that frequently they fail to acknowledge how both the rhetoric and the reality of the policy have developed. Taking this critique into account, a more accurate assessment of how to understand community care for the mentally ill is offered.

Community Mental Health Services↗
PubMed1989

Consumer participation in service planning--the AWS (All Wales Strategy) experience.

This paper provides a case study of the involvement of carers in planning services for mentally handicapped people under the All Wales Strategy (AWS). After describing the structure for consumer participation in the AWS in Gwynedd, reasons for the low level of participation found are examined before considering what can be learnt from these early experiences. Major changes in the planning structure implemented after a review of the system are outlined. The paper ends with a discussion of the major operational principles which might underlie an effective system of consumer participation.

Child↗
PubMed1996

Vero cytotoxin-producing Escherichia coli, particularly serogroup O157, associated with human infections in England and Wales: 1992-4.

Investigations were performed by the Laboratory of Enteric Pathogens on Vero cytotoxin-producing Escherichia coli (VTEC) in England and Wales from 1992-4. Bacterial isolates, faeces and sera obtained from patients with diarrhoea, bloody diarrhoea and haemolytic uraemic syndrome were examined. Using serotyping, Vero cytotoxin gene probing and serodiagnostic tests for E. coli O157, evidence of infection was detected in 543, 434 and 491 individuals in 1992, 1993 and 1994 respectively; VTEC of serogroup O157 were isolated from 470, 385 and 411 cases. The O157 VTEC strains belonged to at least 19 different phage types (PT) although 84% belonged to PT2, PT49, PT8, PT1 or PT4. Antibodies to E. coli O157 lipopolysaccharide were detected in 13% of the cases. The average annual rate of infection with O157 VTEC was 0.83/100000 and 12% of the 1458 individuals with evidence of infection with VTEC or E. coli O157 developed haemolytic uraemic syndrome. There were at least 18 general outbreaks and many family outbreaks.

Adolescent↗
PubMed1996

Salmonella virchow PT 26 infection in England and Wales: a case control study investigating an increase in cases during 1994.

An increase in the number of human isolates of Salmonella virchow phage type (PT) 26 in England and Wales during 1994 was investigated. A national case control study was conducted which included 88 cases and 182 controls. The cases were mostly young adults (median age 26) and 13 (15%) were admitted to hospital. Acquisition of S. virchow PT 26 was associated with the consumption of any chicken (OR 2.5, CI 1.1-5.8), of chicken curry from restaurants and take aways (OR 2.9, CI 1.4-6.1), and of some other diverse types of pre-prepared chicken (OR 3.8, CI 1.9-7.6). Halal chicken was associated (P = 0.006) with illness in a subset. There were negative associations with contact with animals (OR 0.47, CI 0.23-0.95) and with the consumption of chicken cooked whole (OR 0.37, CI 0.21-0.66). The increase in S. virchow PT 26 may be due to changing epizoology and may be an indicator of what will become the dominant salmonella strain in poultry in future years. The increasing incidence of S. virchow PT 26 is of particular concern because of its association with more invasive disease in humans.

Adolescent↗
PubMed2000

The role of outbreaks in developing food safety policy: population based surveillance of salmonella outbreaks in Wales 1986-98.

In developing public policy on food safety, systematic identification and thorough investigation of all general outbreaks is necessary in order to avoid bias towards highly publicised outbreaks. In Wales, from 1986 to 1998, 87 general foodborne outbreaks of salmonellosis were identified. Most outbreaks occurred at functions or were associated with small catering outlets such as bakeries and sandwich bars. In 50 outbreaks, a vehicle of infection was confirmed microbiologically and/or epidemiologically. The most common food vehicles were those containing shell eggs. Salmonella enteritidis outbreaks were significantly more likely than outbreaks of other serotypes to be associated with vehicles containing shell eggs, suggesting that eggs were also the source of infection in many outbreaks. The routine use of analytical epidemiological studies to identify vehicles in outbreaks is recommended.

Disease Outbreaks↗