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PubMed1998

Legionnaires' disease in residents of England and Wales: 1997.

Two hundred and twenty-six residents of England and Wales who developed legionnaires' disease with onset of infection in 1997 were reported to the PHLS Communicable Disease Surveillance Centre. Twenty-eight cases (12%) were reported to have died. Half of the reported cases (114) were associated with travel, either abroad or in the United Kingdom. Six cases acquired infection in hospital and the remaining 106 were presumed to have acquired infection in the community. Nineteen cases were linked to industrial or community associated outbreaks or clusters in England, two cases to a hospital outbreak, and 25 cases to outbreaks or clusters abroad. The remaining 180 cases (80%) were reported as single cases. The proportion of cases diagnosed by detection of urinary antigen has continued to increase. In 1997 this method of diagnosis was included for 60% of confirmed cases and in 46% of all cases.

Adolescent↗
PubMed1998

Results of a survey of diagnosed HIV infections prevalent in 1996 in England and Wales.

This paper describes a survey undertaken to assess the caseload of HIV infected patients who received medical care from statutory service providers in England and Wales in 1996 in order to inform health authorities about the size and composition of their resident population of such patients. A total of 13,670 HIV infected patients were identified as living in England and Wales, 70% of whom lived in the Thames NHS executive regions. Over half the total caseload received care within their health authority of residence. Regional care centres attracted patients from wider areas, however, particularly in the North West and Thames regions. This survey of prevalent diagnosed HIV infections, one of a series conducted annually, provides public health specialists with information relevant to their localities without compromising patient confidentiality. Along with other data from the surveillance of AIDS cases and HIV infections it contributes to the assessment and projection of demands on health and social services and provides evidence on which to develop and direct national and local health campaigns.

Data Collection↗
PubMed2002

Outcome at 30 days in the New England Medical Center Posterior Circulation Registry.

BACKGROUND: Vertebrobasilar disease is generally considered a condition with a poor prognosis because of high rates of mortality and severe disability. OBJECTIVE: To compare the outcomes of 407 patients entered in the New England Medical Center Posterior Circulation Registry with the reported results of other studies. RESULTS: In contrast, among 407 patients prospectively and consecutively studied in the New England Medical Center Posterior Circulation Registry, we found a low mortality rate at 30 days after onset (3.6%) and relatively low rates of major disability (18% using a Modified Rankin Disability Scale score). Thirty days after stroke, 28% of the patients had no disability and 51% had only a minor disability. Stroke location, stroke mechanism, and arteries involved predicted outcome. Basilar artery involvement, embolic stroke mechanism, and multiple posterior circulation intracranial territory involvement correlated with poor outcome. Patients with lesions in the basilar artery were 5 times more likely to have a poor outcome independent of other factors. Lesions in the middle and distal territories were each associated with a poor outcome in one third of the patients. CONCLUSION: In contrast with previous reports, we found that vertebrobasilar occlusive disease consists of a variety of different stroke mechanisms and vascular lesions, many with a good prognosis.

Aged↗
PubMed1990

Low prevalence of antibody to hepatitis C virus in north east England.

The prevalence of antibodies to hepatitis C virus (anti-HCV) was studied in North East England in blood donors, local multiply transfused patients, local high risk individuals, and chronic liver disease patients. Anti-HCV was detected by enzyme-linked immunosorbent assay (ELISA) in 2/1120 (0.18%) blood donors; 1/84 chronic renal failure patients on haemodialysis who had received 1,992 units of blood (seroconversion rate of 0.05% per unit transfused), 1/207 cardiac patients 6 months post cardiac surgery transfused with 1,403 units of blood (1 anti-HCV pre-operatively, seroconversion rate 0.07%), 40/50 haemophilia A patients treated with commercial factor VIII, and 38/100 intravenous drug users. In addition anti-HCV was detected by ELISA in 5/35 cryptogenic chronic liver disease patients, 5/5 confirmed by recombinant immunoblot assay (RIBA) (14%); 3/30 patients with autoimmune chronic active hepatitis, 2/3 by RIBA (7%); 2/50 primary biliary cirrhosis patients, 1/2 by RIBA (2%); 0/30 alcoholic cirrhosis patients; and 2/9 patients with hepatocellular carcinoma, 1/2 by RIBA (11%). HCV is uncommon in North East England; it may be implicated in the aetiology of a minority of cases of cryptogenic liver disease and less than 5% of autoimmune chronic active hepatitis and primary biliary cirrhosis.

Factor VIII↗
PubMed1995

High bladder cancer mortality in rural New England (United States): an etiologic study.

An interview study of next-of-kin of 325 persons who died of bladder cancer and 673 individuals who died of other causes in Vermont and New Hampshire (United States) was conducted to assess reasons for the persistent pattern of elevated bladder cancer mortality for both genders in rural New England. There are some evidence of elevated risks for both leather and textile workers that rose to over twofold for workers who also lived near these industries and for persons with French-Canadian ancestry. Occupational exposures in the textile and leather industry may explain at least a portion of the excess bladder cancer risk in rural New England.

Case-Control Studies↗
PubMed1987

Biochemical and immunological characterization of structural proteins from retrovirus-D/New England and comparison to Mason-Pfizer monkey virus and permanent human fibroblast virus.

Biochemical and immunological properties of retrovirus-D/New England (here referred as R-D/NE) recently isolated at the New England Regional Primate Research Center, Southborough, Ma, from a rhesus monkey with acquired immune deficiency syndrome were investigated and compared to the prototype type D retroviruses Mason-Pfizer monkey virus (MPMV) and permanent human fibroblast virus (PMFV) isolated from a breast carcinoma of a rhesus monkey and a continuous human cell line, respectively. The polypeptide composition of R-D/NE propagated in a human lymphoid B cell line (Raji cells) has been investigated using SDS-polyacrylamide gel electrophoresis. Staining with Coomassie blue and labelling with 14C amino acids revealed seven viral polypeptides with molecular weights of 4,000, 10,000, 12,000, 15,000, 18,000, 27,000, and 80,000 Da which were also shared by MPMV and PMFV. The 80,000 Da protein was shown to be a glycoprotein by incorporation of 3H glucosamine. The 18,000 Da protein was identified as a phosphoprotein of R-D/NE. p18 structural proteins of MPMV and PMFV represent phosphoproteins of their respective viruses as well. All three phosphorylated proteins contain O-phosphoserine as major phosphoamino acid. The comparison of tryptic peptide maps of the major internal structural proteins of R-D/NE, MPMV, and PMFV revealed a striking similarity among p 10/p 12 and p 15. proteins. A minor difference was detected among the tryptic peptide digests of p 4 and p 27 proteins. Antiserum against p 15 of MPMV showed a significantly weaker binding to R-D/NE than to MPMV and PMFV at high dilutions.

Amino Acid Sequence↗
PubMed1989

Migration and labour supply in New England.

The author links changes in regional employment with demographic changes in New England during the relative economic boom that occurred in the region during the 1980s. It is noted that during this period, "New England had a very slow rate of natural population growth. The relatively high rate of growth in jobs coupled with the relatively stable population has produced labour shortages in parts of the region. It is demonstrated that the labour supply has become dependent on migrants from other regions. If the economic expansion continues, the region must significantly increase its net migration gains. If immigration to the region remains sluggish, the revival will be short-lived." This is a revised version of a paper originally presented at the 1988 Annual Meeting of the Population Association of America (see Population Index, Vol. 54, No. 3, Fall 1988, p. 428).

Americas↗
PubMed1995

Health promotion in primary health care: the situation in England.

National policy, including changes to the management of the National Health Service, is intended to increase the amount of primary and secondary prevention in primary health care in England. The growth of financial power of general practitioners makes them key decision-makers in planning and delivering health promotion. The vast majority of people in contact with their family doctor could benefit from making appropriate lifestyle modifications. However, the level and quality of health promotion activity in primary care is variable, with many patients not receiving interventions. A review of research indicates that both skepticism about the relationship between behaviour and risk factor, and lack of confidence in efficacy of health promotion in changing patient behaviour act as barriers to general practitioners taking on more health promotion activity. For prevention work to increase, therefore, general practitioners require more evidence of effective replicable interventions, and appropriate training on the design and implementation of programmes. The role of the Health Education Authority, the national agency for health promotion in England, in meeting these needs is described. The paper also includes a brief discussion of evaluation methods for assessing the success of health promotion interventions.

Family Practice↗
PubMed2005

"We are not completely Westernised": dual medical systems and pathways to health care among Chinese migrant women in England.

This examination of how Chinese migrant women resident in England engage with Western and Chinese healthcare systems when seeking treatment considers whether medical pluralism can enhance the cultural appropriateness of health care. The paper identifies the extent to which women's pathways to healthcare can be seen as 'Chinese' or as a reflection of the Western culture in which they live. It is based on an analysis of in-depth interviews with 42 women of Chinese origin living in the South East of England. Their use of Western and Chinese medicine is related to explanatory models underpinning health beliefs, treatment barriers encountered and resources drawn upon when seeking treatment. Variation is described, with some women using only Western medicine and others returning to their place of origin for indigenous Chinese medical treatment. Most, however, draw upon both medical systems. Women who are more connected with majority English culture are more successful in their consultations with Western health service practitioners but do not necessarily discontinue using Chinese medicine. We find that recourse to two different systems helps to overcome barriers when accessing health care. The health policy implications of the findings would suggest that a system that acknowledges and embraces medical pluralism would assist the development of culturally appropriate health care provision.

Adult↗
PubMed2003

A survey of non-accidental injury imaging in England, Scotland and Wales.

AIM: To identify the potential national variation in non-accidental injury (NAI) imaging in England, Scotland and Wales. MATERIALS AND METHODS: A postal survey was sent to 323 hospitals with both paediatric and radiology departments. These were identified by a search through the Medical Directory. RESULTS: One hundred and thirteen of 323 postal questionnaires were returned within the study period (35%). Sixteen were excluded from the study because either no NAI imaging was performed at that institution or an incorrect address had been used. The total number of completed questionnaires was 97 (30%). Extensive variation was seen in all aspects of NAI imaging including imaging techniques used, total case numbers, follow-up imaging and those who report the NAI imaging. CONCLUSIONS: There is currently no national protocol that incorporates all aspects of NAI imaging in England, Scotland and Wales. Extensive variation in practice has been shown by this survey. Further standardization of NAI imaging practice is required. The draft BSPR skeletal survey guidelines and routine neurological imaging is recommended.

Child↗
PubMed2004

Using a linked soil model emulator and unsaturated zone leaching model to account for preferential flow when assessing the spatially distributed risk of pesticide leaching to groundwater in England and Wales.

Although macropore flow is recognized as an important process for the transport of pesticides through a wide range of soils, none of the existing spatially distributed methods for assessing the risk of pesticide leaching to groundwater account for this phenomenon. The present paper presents a spatially distributed modelling system for predicting pesticide losses to groundwater through micro- and macropore flow paths. The system combines a meta version of the mechanistic, dual porosity, preferential flow pesticide leaching model MACRO (the MACRO emulator), which describes pesticide transport and attenuation in the soil zone, to an attenuation factor leaching model for the unsaturated zone. The development of the emulator was based on the results of over 4000 MACRO model simulations. Model runs describe pesticide leaching for the range of soil types, climate regimes, pesticide properties and application patterns in England and Wales. Linking the MACRO emulator to existing spatial databases of soil, climate and compound-specific loads allowed the prediction of the concentration of pesticide leaching from the base of the soil profile (at 1 m depth) for a wide range of pesticides. Attenuation and retardation of the pesticide during transit through the unsaturated zone to the watertable was simulated using the substrate attenuation factor model AQUAT. The MACRO emulator simulated pesticide loss in 10 of 12 lysimeter soil-pesticide combinations, for which pesticide leaching was shown to occur and also successfully predicted no loss from 3 soil-pesticide combinations. Although the qualitative aspect of leaching was satisfactorily predicted, actual pesticide concentrations in leachate were relatively poorly predicted. At the national scale, the linked MACRO emulator/AQUAT system was found to predict the relative order of, and realistic regional patterns of, pesticide leaching for atrazine, isoproturon, chlorotoluron and lindane. The methodology provides a first-step assessment of the potential for pesticide leaching to groundwater in England and Wales. Further research is required to improve the modelling concept proposed. The system can be used to refine regional groundwater monitoring system designs and sampling strategies and improve the cost-effectiveness of the measures needed to achieve 'good status' of groundwater quality as required by the Water Framework Directive.

Journal Article↗
PubMed1999

Estimation of spatially resolved road transport emissions for air quality management applications in the north west region of England

Spatially resolved estimates of combustion and non-combustion related emissions of CO, NOx, VOCs and PM from road transport sources have been made for the North West region of England in 1994. These have been generated using detailed emissions models for combustion related emissions of CO, NOx, VOCs and PM which take into account the different emissions profiles associated with particular vehicle groups, different road types and journeys under cold start conditions. Emissions estimates have been generated for a 1 x 1 km grid covering the region's urban and industrial zones and a 5 x 5 km grid for the whole study area. Emissions models have been generated and applied within a Geographical Information System (GIS) environment. Areas of uncertainty in the estimation procedure have been examined and the results compared with alternative data sources. Although the work centres upon the North West region of England, as far as possible the methods and data sources used are intended to be generic, particularly in respect to other administrative areas of the UK. In this way, this work can be considered to be of wider interest than at the local level alone.

Journal Article↗
PubMed1986

Communicable disease associated with milk and dairy products in England and Wales: 1983-1984.

During the period 1983-1984 32 outbreaks of disease (II in 1983 and 21 in 1984) associated with consumption of milk and dairy products and affecting at least 714 people were reported from England and Wales. Twenty-seven of the outbreaks were attributed to raw milk, two to contaminated pasteurised milk and one each to cheese, cream and ice-cream. Twenty-two were due to salmonellas, seven to campylobacters and one each to Staphylococcus aureus, Yersinia enterocolitica and Streptococcus zooepidemicus. Two sporadic cases of Corynebacterium ulcerans infection associated with raw milk were also reported. There were eight deaths, all associated with the S. zooepidemicus outbreak. The continuing occurrence of milk-borne outbreaks, and an increasing number of incidents affecting rural communities, emphasises the urgent need for enforcing pasteurisation of milk and dairy products in England and Wales.

Aged↗
PubMed1997

Dietary factors in relation to weight change among men and women from two southeastern New England communities.

OBJECTIVE: Dietary factors, independent of total energy, may be important in promoting obesity. We examined prospectively the relationship between baseline diet composition and weight gain among adult men and women from southeastern New England. DESIGN: The prospective association of nutrient consumption and weight change was examined in a randomly selected cohort examined four years apart. SUBJECTS: Adults aged 18 through 64 years from two communities in Southeastern New England were randomly selected for the study after being interviewed in their homes. The present investigation is based on a subgroup of 465 individuals who completed a food-frequency questionnaire in 1986 or 1987 and were reinterviewed four years later. STATISTICAL ANALYSES: Multiple regression analyses were used to determine the association of weight change with different nutrients and food groups after adjusting for age, smoking status, baseline body mass index, physical activity level, and total energy. RESULTS: Total energy was positively associated with weight gain and age was inversely associated with weight gain. None of the nutrients or food groups were significantly related to weight gain. CONCLUSIONS: These findings indicate that weight gain increased with increasing baseline total energy intake, particularly in the young. Future research is required to determine ways of decreasing energy intake in younger individuals.

Adult↗
PubMed1997

The impact of pregnancy on the long-term weight gain of primiparous women in England.

OBJECTIVES: To investigate the impact of pregnancy on long-term weight gain of primiparous mothers in England, and to identify potential risk factors for maternal obesity. DESIGN: A retrospective, repeat-pregnancy study which examined the change in maternal body weight from the beginning of the first successful pregnancy to the beginning of the second. SUBJECTS: Two hundred and forty-three mothers, all of whom had been weighed during the first trimester of their first and second pregnancies, and none of whom had fallen pregnant less than 12 months after the birth of their first child. MEASUREMENTS: Sociodemographic, behavioural, medical, obstetric and perinatal data, together with antenatal measurements of maternal body weight and height, were extracted from each mother's obstetric notes. A comprehensive survey of weighing scales used at all antenatal clinics was undertaken. RESULTS: After accounting for the effect of ageing, there was no significant long-term increase in mean maternal body weight following the first pregnancy (95% Confidence Intervals: -0.82-0.28kg). While most mothers (70.8%) gained 1.0 kg or less, 24.7% gained more than 1.54 kg. Even after accounting for the maximum error in clinic scales, 14.8% of the mothers gained 1.54 kg or more in association with their first pregnancy. Mothers with higher BMIs at the beginning of their first pregnancy, who gained more weight during pregnancy, gave birth to heavier babies and had longer intervals between their pregnancies, gained significantly more weight from one pregnancy to the next. CONCLUSIONS: Pregnancy has little impact on the mean weight gain of primiparous women from England, who have a low prevalence of obesity (BMI > or = 26.0, 25.5%). Nevertheless, pregnancy may be associated with a permanent increase in maternal body weight simply because it is a period of positive energy balance during which some women gain excessive weight. Other factors, such as prepregnant BMI, determine whether long-term weight gain actually occurs.

Adult↗
PubMed2000

Pharmacy-based needle exchange (PBNX) schemes in south east England: a survey of service providers.

AIMS: To describe the activities of service providers with regard to (i) the business operation and policies defining pharmacy-based needle exchange (PBNX) in South East England; (ii) the day-to-day work of PBNX outlets from the provider perspective; and (iii) problems encountered by PBNX providers. DESIGN: (i) Postal self-completion questionnaire to all participating PBNX community pharmacies in South East England; and (ii) postal self-completion questionnaire to needle exchange coordinators. SETTING: Community pharmacy needle exchanges. PARTICIPANTS: Pharmacists in charge of needle exchange; and needle exchange coordinators. FINDINGS: Data were collected (i) from 381/440 (86.7%) participating community pharmacists, and (ii) 32/36 (88.9%) of coordinators. The study found that PBNX was reaching injecting drug users (many of whom used PBNX regularly), and providing a wide range of injecting equipment. Although pharmacists reported that problems such as shoplifting occurred relatively frequently, more serious problems such as violence were relatively rare. However, PBNX pharmacists reported needing further training for themselves and their staff. Suggested improvements included better advertising of services and improving returns rates for used injecting equipment. CONCLUSION: Needle exchange can reasonably be provided by non-specialist health care professionals such as community pharmacists. However, attention should to be paid to the educational needs of service providers who also require adequate support.

Education, Pharmacy↗
PubMed1998

Age and sex distribution of suspected adverse drug reactions to newly marketed drugs in general practice in England: analysis of 48 cohort studies.

AIMS: Little is known about the frequency with which suspected adverse drug reactions are seen by general practitioners after the prescription of newly marketed drugs. We investigated age and sex specific incidence rates of suspected adverse drug reactions recorded by general practitioners in England after the prescription of selected newly marketed drugs. METHODS: Information was collected from 48 national cohort studies of newly marketed drugs studied by prescription-event monitoring. Questionnaires were sent to prescribers asking for details of events and suspected adverse drug reactions recorded in the patients' notes occurring after the drugs were prescribed. RESULTS: During the 48 cohort studies, a total of 513608 patients were investigated, of which 221781 (43.2%) were males and 285862 (55.7%) were females. The overall incidence of suspected adverse drug reactions in males was 12.9 per 10000 patient-months of exposure (95% confidence limits 12.3 to 13.5), and in females was 20.6 per 10000 patient-months of exposure (95% confidence limits 19.9 to 21.3). The overall age-standardised relative risk of an adverse drug reaction in females compared with males was 1.6 (1.5-1.7). This sex difference was significant in all age groups above 19 years of age, and was relatively consistent across all age groups (chi2 test for heterogeneity = 9.2, P=0.3). The highest rate of recording in males was in the 50-59 year age group, and in females was in the 30-39 year age group. CONCLUSIONS: In general practice in England, suspected adverse drug reactions to newly marketed drugs are recorded more often in adults aged between 30 and 59 years of age and are 60% more common in women than in men. The sex difference occurs in all age groups over 19 years of age.

Adult↗
PubMed2002

Widespread insecticide resistance in head lice to the over-the-counter pediculocides in England, and the emergence of carbaryl resistance.

BACKGROUND: Increasing resistance to insecticides used for the control of head lice infestation has been documented over the last decade. Treatment failure and tolerance to insecticides have been validated in a number of studies undertaken in several U.K. centres. OBJECTIVES: To establish the extent of insecticide resistance in head lice and acetylcholinesterase activity in the presence of carbaryl in head lice. METHODS: Head lice were collected from school children in four centres across England (Exmouth, Loughborough, Leeds and South Shields), and tested in their response to the insecticides permethrin, phenothrin, malathion and carbaryl. Data were compared with information collected in Bristol and Bath in 1998 and with susceptible body lice. The activity of louse acetylcholinesterase was measured with and without carbaryl in head lice collected in Bristol, Leeds, Loughborough and in body lice. The efficacy of a 1% carbaryl lotion was compared in children in Bristol and Leeds. RESULTS: Compared with body lice, head lice from all six centres were significantly different in their response (P < 0.0001) to permethrin, phenothrin and malathion after 2-h exposure tests. There were significant differences in louse acetylcholinesterase activity in body lice, and head lice collected in Loughborough and Bristol in the presence or absence of carbaryl (P < 0.001), indicating enzyme inhibition. However, the difference for lice from Leeds was not significant (P = 0.363) suggesting that the enzyme was resistant to carbaryl. Eighty-nine per cent of children treated in Leeds with carbaryl were cured compared with 100% in Bristol. CONCLUSIONS: The data suggest head lice resistance is present in many parts of England to over-the-counter products containing synthetic insecticides (permethrin, phenothrin and malathion). They further suggest that resistance is starting to develop to carbaryl in head lice in Leeds and that extensive use of this product would lead to significant resistance.

Acetylcholinesterase↗