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At least 973 records · Page 54Linked to original sources
PubMed1996

Epidemiological, virological, and clinical features of an epidemic of hand, foot, and mouth disease in England and Wales.

We describe the epidemiological, virological, and clinical features of an epidemic of hand, foot, and mouth disease, attributed to coxsackie A virus serotype 16, that occurred throughout England and Wales in the last quarter of 1994. Nine hundred and fifty-two cases were reported by spotter practices that make weekly returns to the Royal College of General Practitioners, which made this the largest epidemic of hand, foot, and mouth disease in England and Wales reported to date. Most patients were aged 1 to 4 years and lived in central or southern regions. Clinical features were unavailable from the weekly returns but were described in detail for 39 patients, mostly by means of a questionnaire to general practitioners near the PHLS Coxsackie Reference Laboratory. All cases had a rash on their hands and 23 also had rashes on their feet and in their mouths. Most cases were mild. Severity was associated with the degree of mouth involvement. Secondary cases in family members were rare. Data from the Royal College of General Practitioners since 1963 reveal a period between epidemics of two to three years. The epidemics in 1988 and 1990 also occurred in the last quarters of these years and cases were concentrated in the central and southern regions.

Adolescent↗
PubMed1996

Mental hospital regime in England and Wales.

Although non-private conventional mental hospitals in England and Wales have been in existence for about two centuries, the literature on the actual regimes in those hospitals is not enormous. Since Goffman's Asylums, things have changed in North America, the United Kingdom and elsewhere. However, not much has been written about the present position. This article (based on qualitative data collected over 12 months) describes the regimes in three conventional mental hospitals in S.E. England. It covers hospital policy on the admission of a patient, daily ward routine, the open-door policy, fire precautions, close observation, seclusion, search of patients and their belongings and the handling of patients' correspondence. It concludes that the regimes are reasonable.

Adolescent↗
PubMed1996

General outbreaks of vero cytotoxin producing Escherichia coli O157 in England and Wales from 1992 to 1994.

We have reviewed all general outbreaks of infection due to Vero cytotoxin producing Escherichia coli (VTEC) O157 reported in England and Wales from 1992 to 1994. One hundred and seventy-three people were affected in 18 outbreaks, compared with 76 people in seven outbreaks in the preceding three years (1989 to 1991). Outbreaks occurred throughout England and Wales. Thirty-eight per cent of cases were admitted to hospital, 21% developed haemolytic uraemic syndrome, and 3% died. VTEC O157 infection causes particular concern because of its serious complications--haemorrhagic colitis and haemolytic uraemic syndrome, its capacity to spread from person to person as well as by food and water, and its reservoir in dairy and beef cattle.

Adult↗
PubMed1996

Historical roots of cultural diversity in nursing: the New England Hospital for Women and Children.

This is an historical research about cultural diversity as it first emerged in early American nursing education and practice. The purpose of this research is to explore and analyze the unique philosophy of inclusion at the New England Hospital for Women and Children during the pre- and post-Civil War era. The methodology included the use of primary sources and a site visit to the New England Hospital for Women and Children, renamed the Dimock Health Center. The findings reveal that this institution was an early culturally diverse model for American society, nursing education, and practice. Seen through a prism, this institution provides a continuous source of historical pride in cultural diversity with implications for nursing education, practice, and research.

Cultural Diversity↗
PubMed1996

Epidemiological features of Coxiella burnetii infection in England and Wales: 1984 to 1994.

Q fever is an important zoonosis caused by the rickettsial organism Coxiella burnetii, which can result in life threatening illness, especially in those with an underlying cardiac defect. C. burnetii infections in England and Wales reported to the PHLS Communicable Disease Surveillance Centre between 1984 and 1994 were reviewed. A total of 1117 cases were reported, a third of which came from the South Western region. The annual totals fell over this period. The mean age of cases was 45 years, and 74% were men. Reports peaked in the month of May. Contact with animals, mainly cattle and sheep, was reported in 60 cases. Occupationally acquired infection was reported for 24 cases including abattoir workers, farmers, veterinary surgeons, hide handlers, and butchers. Forty-seven per cent of cases presented with respiratory symptoms, 7% with heart disease, and 5% with hepatitis. Seven per cent of cases reported travel abroad before becoming ill. Joint veterinary and medical investigations should be undertaken to establish the natural history of C. burnetii infection in England and Wales and formulate policies to prevent acute and chronic infections.

Adult↗
PubMed1997

Results of a survey to determine whether Neospora is a significant cause of ovine abortion in England and Wales.

Between January and April 1995, the brains and hearts of 281 aborted lambs derived from 209 submissions to veterinary investigation centres in England and Wales were examined histologically. One-hundred-and-seventy-nine samples of fetal pleural fluid from these lambs and 141 from lambs not examined histologically were examined for antibodies to Neospora by an indirect fluorescent antibody test. Non-suppurative myocarditis and encephalitis were present in nine lambs. Immunocytochemistry using antisera against Neospora caninum and Sarcocystis species resulted in no labelling but anti-sera to Toxoplasma gondii revealed labelled organisms in four lambs. No significant antibody titres against Neospora were detected in any of the samples of fetal pleural fluid. These results suggest that Neospora infection is not associated with significant numbers of abortions in sheep in England and Wales.

Abortion, Veterinary↗
PubMed1997

Population structure of Mya arenaria along the New England coastline.

Sequences of the internal transcribed spacer (ITS-1) ribosomal DNA region were compared among 88 soft-shell clams (Mya arenaria) from 12 sites (within three general areas) along the New England coast to determine whether populations were genetically heterogeneous. Two sequence variants were observed, with type 1 having a 3-nucleotide insertion and one point mutation relative to type 2. Allele-specific polymerase chain reaction (PCR); using primers specific to each sequence type, was performed to determine the distribution of individuals who had both allelic forms. DNA from soft-shell clams collected from three areas (Cobscook Bay, Maine; Gulf of Maine; and southern New England) were compared chi 2 analyses of allele-specific PCR results revealed no significant heterogeneity among the three population distributions.

Alleles↗
PubMed1997

Analysis of influenza A H3N2 strains isolated in England during 1995-1996 using polymerase chain reaction restriction.

A polymerase chain reaction-restriction (PCR-restriction) endonuclease assay was developed to allow rapid analysis of influenza A H3N2 viruses circulating in England during 1995-1996. Restriction endonuclease digestion with two enzymes of amplicons derived from PCR of the HA1 portion of the influenza haemagglutinin (HA) gene was able to differentiate antigenically similar influenza strains into two groups. Group I variants were similar genetically to the 1995/96 vaccine strain, A/Johannesburg/33/94, whereas the HA sequences of Group II variants were similar genetically to the reference virus A/Thessaloniki/1/95. Of the 700 England A H3N2 strains isolated between February 1995 and the end of April 1996, 384 were analysed by this method. PCR-restriction analysis of sequential influenza isolates revealed a temporal alteration in prevalence of two variants. Groups I and II variants cocirculated with equal frequency during a period of sporadic influenza activity, but following the onset of epidemic influenza activity in 1995, only Group II variants were detected. PCR- restriction analysis was found to be a rapid method for studying genetic variation which could be applied to a large number of samples and provide information about the direction of genetic drift in the HA gene of influenza virus.

Animals↗
PubMed1997

Results from the 1995 survey of prevalent clinically diagnosed HIV infection in England, Wales, and Northern Ireland.

Health districts in England, Wales, and Northern Ireland were surveyed in 1996 to collect summary information about people with diagnosed HIV infection who received care under the statutory services in 1995. The survey provided demographic and epidemiological information about the prevalent caseload by area of residence, and the extent to which patients with diagnosed HIV infection travelled to obtain care related to it. A total of 13362 people with diagnosed HIV infection were reported to be resident and treated in England, Wales, or Northern Ireland in 1995. Forty-four per cent of these were treated outside the health district where they lived, with regional specialist centres attracting patients from wider areas. At least 13% received care from more than one treatment centre. This national survey of prevalent diagnosed HIV infections provided public health specialists with information relevant to their own localities without compromising confidentiality. This information complements surveillance data from confidential AIDS case diagnosis reports, laboratory reports of HIV infections, and the unlinked anonymous HIV prevalence monitoring programme, all of which contribute to the assessment and projection of demands on health and social services, and provide evidence on which to develop and direct national and local health campaigns.

England↗
PubMedDate not supplied

Low rate of generic prescribing in the Republic of Ireland compared to England and Northern Ireland: prescribers' concerns.

We compared the level of generic prescribing in the Republic of Ireland, Northern Ireland and England and surveyed the views of Irish College of General Practitioners members. In 1993, generic drugs (pure generics and branded generics together) comprised 17.4% of total dispensing in the General Medical Services Scheme, significantly less than Northern Ireland or England where pure generics alone comprised 25% and 38% respectively of total dispensing in the National Health Services. General practitioners accurately self-estimated their level of generic prescribing but are concerned about the reliability/quality of generic products on the market, possible legal liabilities associated with their use and the fact that pharmacists may legally dispense more expensive proprietary preparations in the case of private prescriptions written generically. Prescribers need reassurance regarding legal and quality assurance aspects of generic prescribing if the level of generic drug use is to increase.

Drug Prescriptions↗
PubMed1997

Access and barriers to mammography in New England community health centers.

BACKGROUND: Historically, screening measures for poor patients have been underemployed. As a result, diagnosis of breast cancer is more likely made at later stages in underserved and minority populations. Regular care in community health centers (CHCs) can mitigate this screening inequity. The purpose of this study was to determine the barriers to and frequency of breast cancer screening in New England CHC women, and to compare our findings with the Healthy People 2000 goal of screening 60% of women aged 50 years and older with mammography every 2 years. METHODS: A consecutive series survey of 3176 women aged 40 years and older was performed between April 1 and August 31, 1995, at 32 CHCs in six states. RESULTS: Completed questionnaires were returned on 2943 patients, including 200 African-American, 2222 white, 370 Hispanic, and 56 Asian women; 932 (32%) were aged 40 to 49 years, and 2011 (68%) were aged 50 and older. Within the preceding 2 years, 2072 (70%) had had a breast examination by a provider. Eighty-seven percent reported that mammography was recommended. More women aged 50 years and older (55%) had had mammography during the last 2 years than women in the 40- to 49-year-old group (45%) (P < .004). The most common reason for not having a mammogram was that the patient thought "the test was not important"; expense and lack of insurance was second. Hispanics had the lowest rates of mammography. CONCLUSIONS: Progress is being made toward Healthy People 2000 goals in New England CHC women. Despite low income status, 55% of women aged > or = 50 years had had mammograms within the past 2 years. Once cost is removed as the greatest barrier, improving patient acceptance promises the largest increase in the use of mammography screening.

Adult↗
PubMed1997

A retrospective survey of clusters of meningococcal disease in England and Wales, 1993 to 1995: estimated risks of further cases in household and educational settings.

Information about the epidemiology of meningococcal disease case clusters and the risk of further cases is sparse. Data on clusters in household and educational settings from 1 January 1993 to 31 March 1995 was requested from consultants in communicable disease control in England and Wales through a retrospective postal survey. Ninety-three per cent (122/131) responded. Of the 114 cases in 45 reported clusters, 77 (67.5%) were microbiologically confirmed. The case fatality rate in index cases was higher than in associated cases (18.2% vs 4.5%; p = 0.02). Five out of 11 clusters in household settings consisted only of index and co-primary cases. No further cases occurred within two weeks after giving chemoprophylaxis to household contacts. The relative risks of further cases in the week after the index case arose were estimated to be 1200 for contacts in the household, 160 in secondary schools, 60 in primary schools, 1.8 in universities/colleges, and 0 in nurseries. Between seven and 30 days the relative risks were lower; 150 in households, and between 0 and 13 in all other settings. Beyond 30 days, the relative risk in the household setting was 8 and lower than this in all other settings. The absolute risk of further cases in the month following the index case was calculated as 210 per 100,000 in household members, 7-10/10(5) in pupils at the same school, and 0.6/10(5) in students at the same university or college. The current policy in England and Wales to recommend chemoprophylaxis for household members may prevent half of the further cases in this setting. Raised awareness may have contributed to the lower case fatality rate among household contacts who developed meningococcal disease, but the number of co-primary cases observed should prompt urgent enquiries about current illness in household contacts of index cases. The relative risk of further cases in preschool groups was low and apparently unaffected by changes in chemoprophylactic policy. The relative risk in school settings was raised in the month following a case, but the absolute risk was still low. Further study to quantify the risk in university settings is needed.

Adolescent↗
PubMed1997

The prevalence of Enterocytozoon bieneusi in acquired immunodeficiency syndrome (AIDS) patients from the north west of England: 1992-1995.

Microsporidia are increasingly being recognised as important enteric pathogens in patients with advanced human immunodeficiency virus (HIV) disease, i.e. acquired immunodeficiency syndrome (AIDS). The aims of this study were to investigate the frequency of detection of microsporidia associated with diarrhoea in patients with advanced HIV disease in the north west of England, and to determine the species involved and their prevalence. During the period from April 1992 to the end of December 1995, chronic diarrhoea in 88 patients in the late stage of HIV disease was investigated. Duodenal biopsies, duodenal aspirates or jejunal biopsies were received from 38 patients, and stool samples from 63 patients, as part of the routine investigation of possible causes of diarrhoea in these patients. Biopsies and aspirates were examined by thin-section electron microscopy (EM), and stool samples were examined by epi-fluorescence microscopy after staining with Calcofluor. Putative stool positives were confirmed by transmission electron microscopy. CD4-lymphocyte counts were available from all patients who provided samples. Nine out of 63 patients (14.3%) were found to be excreting microsporidial spores on stool examination. The species was confirmed as Enterocytozoon bieneusi. The mean CD4-lymphocyte count for this group was 37 x 10(6)/L (normal range 517-1677 x 10(6)/L). Three out of 38 biopsy specimens (7.9%) were also found to be infected with this microsporidian. The mean CD4-lymphocyte count for this group was 72 x 10(6)/L. Encephalitozoon intestinalis was not found in any samples examined. The prevalence of microsporidial infection in AIDS patients in the north west of England appears to be similar to that of patients in London, but less than that reported in studies from other developed countries.

AIDS-Related Opportunistic Infections↗
PubMed1997

Surveillance of measles in England and Wales: implications of a national saliva testing programme.

The impact of a mass vaccination campaign against measles-rubella in England and Wales was assessed using the results of a saliva test for measles-specific IgM, which was offered to all notified cases of measles. By means of clinical data supplied by the reporting doctors, we estimated the sensitivity and specificity of various clinical case definitions in predicting a confirmed case. A saliva sample was obtained within the appropriate time period for 3442/7574 (45.4%) of notified cases; the proportion confirmed by saliva testing was low and fell from 67/681 (9.8%) at the start of the campaign to 1/373 (0.3%) after 35 weeks. The specificity of all clinical case definitions was low, but was highest at 41.1% (95% confidence interval, 39.2-43.0%) for the definition similar to that recommended in the USA. Extrapolating from cases observed during ongoing surveillance permits estimation of an annual notification rate for nonmeasles rash and fever illness. For countries with good measles control, a clinical case definition is too nonspecific for accurate surveillance. Laboratory confirmation of suspected measles cases is required and saliva testing is an acceptable method. The continued sensitivity of measles surveillance in England and Wales requires that the incidence of notified rash and fever illness and the proportion of cases in which measles infection was excluded by laboratory testing be monitored.

Adolescent↗
PubMed1998

Fruit: comparisons of attitudes knowledge and preferences of primary school children in England and Germany.

Primary school children's fruit consumption and attitudes, knowledge and preferences towards fruit were investigated using interview techniques in schools in England (Nottinghamshire) and Germany (North East) and analysed on the basis of culture, sex and social class. Children from both countries had strong positive attitudes to increase fruit consumption and differed little in their ability to correctly identify five fruits (including tropical fruits). Fruit preferences also showed many similarities with more than 95% of children from both Germany and England choosing apples as fruits they liked, followed closely by strawberries, oranges, pears, grapes, and bananas. Fruit consumption by German children was, however, higher than English children both at breakfast and during the school break. Strategies for increasing fruit consumption in English children are discussed in relation to the findings obtained.

Child↗
PubMed1998

General practitioner turnover and migration in England 1990-94.

BACKGROUND: In tandem with fears about a GP workforce crisis, increasing attention is being focused on the supply and distribution of primary care services: on general practitioners in particular. Differential turnover and migration across health authority boundaries could lead to a maldistribution of GPs, yet comprehensive studies of GP turnover are non-existent. AIM: To quantify general practitioner (GP) turnover and migration in England from 1990 to 1994. METHOD: Yearly data from 1 October 1990 to 1 October 1994 were collected on GPs in England practising full time, including average yearly turnover, rates of entry to and exit from general practice, and net migration among GPs. All were calculated at the family health service authority (now the new health authorities) level. RESULTS: Average yearly GP turnover ranges from 2.9% in Shropshire to 7.8% in Kensington, Chelsea and Westminster; turnover is associated with deprivation and high-need areas. Migration of GPs across health authority borders was rare. Entry and exit rates were also positively related to measures of deprivation and need. Relatively underprovided health authorities lost 23 GPs over the study period as a result of migration; relatively overprovided ones gained three. CONCLUSION: Turnover is driven primarily by exits from general practice and is related to deprivation and high need. Retention appears to be the main problem in ensuring an adequate GP supply in relatively deprived and underprovided health authorities.

England↗
PubMed1998

Reference laboratory surveillance of syphilis in England and Wales, 1994 to 1996.

Routine surveillance of syphilis of public health importance (infectious, congenital, and neurosyphilis) began in England and Wales in 1994, using reports from six PHLS laboratories that undertook serological and other reference work. One hundred and thirty-one cases were reported in the first two years, including 100 cases of infectious syphilis, with all regions reporting some infectious syphilis. Reports from PHLS laboratories represented one sixth of the number of cases seen in genitourinary clinics (KC60 data), but both systems produced comparable results. Laboratory reports provided more data on risk factors, which were not available elsewhere. This study documents the risk in England and Wales from infections originating in eastern Europe, where sexually transmitted infections including syphilis have reached epidemic proportions. Forty-five per cent of cases of infectious syphilis were reported to have been acquired in the United Kingdom (UK) and 59% of people with infectious syphilis were reported to have been born in the UK. Twenty per cent of the infectious cases were associated directly or indirectly with transmission in Russia or elsewhere in eastern Europe. The majority of infectious cases were from the white ethnic group. Eighty-five per cent of cases of infectious syphilis were reported to have been acquired heterosexually; 26% of male cases were reported to have been acquired homosexually. The PHLS laboratory reporting system is now well established, and could usefully be expanded to include other, non PHLS, laboratories that undertake reference work. It has the capacity to detect changes in the national epidemiology of syphilis, including imported infections.

Adult↗
PubMed1998

Adult hernia surgery in Wales revisited: impact of the guidelines of The Royal College of Surgeons of England.

This study investigated the impact of the guidelines of The Royal College of Surgeons of England on the practice of hernia surgery in Wales. This was assessed by means of a postal survey to all consultant general surgeons in Wales in 1996-1997. The areas covered were: awareness of the guidelines of The Royal College of Surgeons of England and the impact of such guidelines on their practice, attendance at hernia courses, operative technique, materials used for repair and skin suture, proportion of day case hernias, length of inpatient stay, thromboembolic (TE) prophylaxis and postoperative advice to patients with regard to light work, heavy work and sport. In all, 79 replies were received (85%). Almost all the surgeons had read the guidelines; this changed the practice of 20% of respondents but did not in 32%. A further 48% did not answer the question. In contrast with our 1993 survey results, in Wales there is now a uniform surgical management of adult inguinal hernias: the most common operation is the Liechtenstein, with monofilament non-absorbable suture to secure the mesh, followed by the Shouldice repair. The Bassini and inguinal darn operations are becoming much less common and none now uses braided or absorbable sutures for the repair. Skin closure is still rather variable, with only 58% of respondents adhering to the recommended absorbable subcuticular suture. Postoperative advice is now uniform and in accordance with the guidelines. A trend towards more TE prophylaxis and more day case hernia surgery is also seen.

England↗