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PubMed1996

Cancer mortality among local authority pest control officers in England and Wales.

OBJECTIVE: To examine cancer mortality by tumour site among local authority pest control officers. METHODS: Prospective mortality study, and follow up to the end of 1994, of 1485 male pest control officers aged between 17 and 69 and employed in 296 local authorities in England and Wales for at least six months between January 1980 and April 1984. Observed numbers of deaths were compared with those expected on the basis of the rates for relevant calendar year, cause, sex, and age specific groups for England and Wales. RESULTS: 200 deaths occurred during the follow up period of which 65 were certified as due to malignant neoplasms. No tumour type showed significantly more deaths than expected. Total all cause, lung cancer, and respiratory disease mortality were significantly lower than expected. CONCLUSIONS: 15 year follow up of a group of men handling a wide range of pesticides did not show any significant risk of cancer. This may be partially explained by the healthy worker effect and also the limited power of the study to detect significant increases in the less common tumours. Further long term follow up of this cohort will continue. Chemical control of pests that can cause human disease and can contaminate food and water has been, and will continue to be, a major public health measure. It is important to ensure that the health of those applying pesticides is not at excess risk. Negative results are important.

Adolescent↗
PubMed2006

Factors associated with heterosexual transmission of HIV to individuals without a major risk within England, Wales, and Northern Ireland: a comparison with national probability surveys.

OBJECTIVE: To compare the prevalence of HIV risk behaviours reported by heterosexuals without major risks for HIV acquisition diagnosed with HIV in England, Wales, and Northern Ireland, with those of the heterosexual general population. METHODS: Demographic and sexual behaviour data for heterosexuals (without major risks for HIV) aged 16-44 from the British National Surveys of Sexual Attitudes and Lifestyles in 1990 and 2000 were compared to 139 HIV infected individuals without major risks for HIV aged 16+ at diagnosis, interviewed between December 1987 and March 2003. Comparisons were made overall and separately for the early and late 1990s. RESULTS: HIV infected heterosexual men without major risks were significantly more likely to report first heterosexual intercourse before age 16 (adjusted odds ratio (AOR): 2.75; 95% confidence interval (CI),1.65 to 4.57), while both HIV infected heterosexual men and women reported greater partner numbers (AOR: men 2.44; CI, 1.4 to 4.05; AOR women 2.17; CI, 1.28 to 3.66) and never using condoms (AOR: men 7.97; CI,4.78 to 13.3; AOR women 3.95; CI, 2.30 to 6.80) than the heterosexual general population. There is evidence to suggest that the two groups were more similar in their reporting of partner numbers in the late 1990s relative to the early 1990s. CONCLUSION: Heterosexual HIV infected individuals without major risks for HIV acquisition in England, Wales, and Northern Ireland are significantly more likely to report high risk sexual behaviours relative to the British heterosexual general population. However, these differences may have decreased over time, at least for the number of partners. Effective sexual health promotion, including the continued promotion of condom use, would impact on the rising rates of STI diagnoses and also prevent HIV transmission among the heterosexual general population.

Adolescent↗
PubMed2006

Monitoring the effectiveness of HIV and STI prevention initiatives in England, Wales, and Northern Ireland: where are we now?

Primary and secondary prevention are essential components of the response to HIV and sexually transmitted infections (STIs). We present findings from nationally implemented HIV/STI prevention interventions. In 2003, of those attending STI clinics at least 64% of men who have sex with men (MSM) and 55% of heterosexuals accepted a confidential HIV test; 88% of all HIV infections in women giving birth in England were diagnosed before delivery; 85% of MSM eligible for hepatitis B vaccination received a first dose of vaccine at their first STI clinic attendance; 74% of STI clinic attendees for emergency appointments, and 20% of those for routine appointments were seen within 48 hours of initiating an appointment; the National Chlamydia Screening Programme in England found a positivity of 10% and 13% among young asymptomatic women and men, respectively. Prevention initiatives have seen recent successes in limiting further HIV/STI transmission. However, more work is required if current levels of transmission are to be reduced.

Adult↗
PubMed2001

Assessing the impact of national anti-HIV sexual health campaigns: trends in the transmission of HIV and other sexually transmitted infections in England.

OBJECTIVE: To assess the impact of the sexual component of AIDS and HIV campaigns on transmission of HIV and other sexually transmitted infections (STIs). DESIGN: Comparison of time series data. SETTING: England, 1971-1999. OUTCOME MEASURES: HIV transmission and diagnoses among men who have sex with men (MSMs), rates of attendances and specific STI diagnoses (per 100 000 total population) at genitourinary medicine (GUM) clinics. RESULTS: Awareness of AIDS and campaigns in 1983-4 among homosexual men coincided with substantial declines in transmission of HIV and diagnoses of syphilis among MSMs. During general population campaigns in 1986-7 new GUM clinic attendances requiring treatment fell by 117/10(5) in men and 42/10(5) in women. Rates for gonorrhoea fell by 81/10(5) and 43/10(5) and genital herpes by 6/10(5) and 4/10(5), respectively. Previous rises in genital wart rates were interrupted, while rates of attendances not requiring treatment (the "worried well") increased by 47/10(5) and 58/10(5) for men and women, respectively. Since 1987 diagnoses of HIV among MSMs have not declined, averaging 1300-1400 annually. Following a period of unchanging rates there have been substantial increases in GUM attendances requiring treatment, notably for gonorrhoea, syphilis, and viral STIs since 1995. CONCLUSIONS: Self help initiatives and awareness among homosexual men in 1983-4 contributed significantly to a fall in HIV transmission among MSMs, and the general campaigns of 1986-7 were associated with similar effects on all STI transmission. Both effects seem to have occurred through changing sexual behaviour, and probably contributed to the UK's low national HIV prevalence. Bacterial STI incidence has increased significantly since 1995 and there is no evidence that recent prevention initiatives have reduced HIV transmission among MSMs, hence sexual health initiatives need to be comprehensively reinvigorated in England.

Condylomata Acuminata↗
PubMed2000

Modelling the short term consequences of smoking cessation in England on the hospitalisation rates for acute myocardial infarction and stroke.

OBJECTIVES: To estimate the short term event and cost consequences of achieving two smoking cessation targets for England among a cohort of 35-64 year olds, in terms of the number of hospitalised acute myocardial infarctions (AMIs) and strokes avoided. DESIGN: A spreadsheet model based on previous work and using data for England was constructed to simulate the effects of achieving the target set out in the government's tobacco white paper (target 1). We also examined the consequence of achieving the intensive smoking reduction witnessed in California (target 2). RESULTS: Target 1 would result in 347 AMI and 214 stroke hospitalisations avoided in the year 2000, and by 2010 this would be 6386 AMI and 4964 strokes avoided. Achieving target 2 would result in 739 AMI and 455 stroke hospitalisations avoided in 2000, and 14 554 AMI and 11 304 strokes avoided by 2010. Achieving target 1 would save pound524 million ( pound423 million discounted at a rate of 2.67% for stroke and 2.31% for AMI) and target 2 would save pound1.14 billion ( pound921 million discounted) in terms of National Health Service costs. CONCLUSION: In the short term (11 years), reductions in the prevalence of smoking will produce sizeable reductions in both events and hospital costs.

Adult↗
PubMed1994

Deaths from pesticide poisoning in England and Wales: 1945-1989.

1. Data on deaths from pesticide poisoning occurring in England and Wales between 1945 and 1989 (no data are available for 1954) have been collated; pesticides were responsible for only 1012 (1.1%) of the 87,385 deaths from poisoning (excluding those due to carbon monoxide) occurring over this 44 year period. At least 73% of all pesticide fatalities were due to suicide and overall there was a predominance of males (male:female ratio 2.4:1). No deaths from pesticide poisoning in children under 10 years have been reported since 1974 although almost 50% of suspected pesticide poisoning incidents involve this age group. 2. Herbicides were responsible for 787 (78%) fatal poisonings, 110 (11%) were caused by insecticides, 69 (6.8%) by rodenticides, 30 (3.0%) by wood preservatives and 16 (1.6%) by other pesticides. 3. The herbicide, paraquat, was responsible for 570 of 1012 (56%) deaths and, although there has been a progressive decline in the annual number of deaths from paraquat poisoning since 1982, paraquat remains the most common cause of fatal pesticide poisoning in England and Wales. 4. Sodium chlorate caused 113 (11.2%) deaths, most of these fatalities occurring between 1965 and 1983; only one death has been recorded since 1984. The phenoxyacetate herbicides resulted in 50 deaths; 2,4-D was implicated most commonly. Sixty-eight deaths were due to organophosphorus insecticides; demeton-S-methyl, malathion and mevinphos were involved most frequently. Only eight deaths resulted from organochlorine insecticides and two of these also involved an organophosphorus insecticide.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Prevalence and descriptors of aspirin use as an antiplatelet agent in two New England communities.

OBJECTIVE: To determine the overall prevalence of aspirin use as an antiplatelet agent in a population-based sample of respondents between the ages of 18 and 64 years, and to describe their sociodemographic characteristics. DESIGN: Data were derived from five biennial cross-sectional household surveys conducted between 1981 and 1990 in two southeastern New England communities by the Pawtucket Heart Health Program. Individuals reporting aspirin use as an antiplatelet agent were identified using data from a structured medication interview. RESULTS: The prevalence of aspirin use per 1000 population was 2.5 (95 percent confidence interval [CI] 0.5, 4.4), 5.0 (95 percent CI 2.4, 7.6), 7.8 (95 percent CI 4.6, 11.0), 7.5 (95 percent CI 4.3, 10.6), and 11.8 (95 percent CI 7.1, 16.5) in the first through the fifth survey periods, respectively (p = 0.0002). The prevalence of aspirin use per 1000 men increased from 4.9 (95 percent CI 0.6, 9.1), 8.7 (95 percent CI 3.3, 14.1), 12.3 (95 percent CI 6.1, 18.5), 8.5 (95 percent CI 3.5, 13.5) to 23.2 (95 percent CI 13.4, 32.9) for the first through the fifth survey periods, respectively. The corresponding prevalence rates of aspirin use per 1000 women were 0.7 (95 percent CI 0, 2.1), 2.43 (95 percent CI 0.05, 4.80), 4.6 (95 percent CI 1.4, 7.8), 6.6 (95 percent CI 2.7, 10.6), and 2.7 (95 percent CI 0, 5.7). Both a gender trend (p = 0.0002) and a survey trend (p = 0.0001) were detected. A gender-survey interaction was not found. CONCLUSIONS: In this population, aspirin use was reported primarily by middle-aged men who had coexisting cardiovascular disease as indicated by concurrent medications. Aspirin use as antiplatelet therapy increased in the population-based samples of two New England communities over the past nine years, with slightly more than one percent of the respondents reporting its use in the fifth cross-sectional survey conducted in 1989-1990. This finding may reflect the publication of important clinical trials near the time the survey was performed and subsequent dissemination of the findings both in the professional and lay press.

Adolescent↗
PubMed1991

Health education in England: a five-year strategy for the Health Education Authority.

The Health Education Authority in England has published its first Strategic Plan, covering the years 1990-1995. The origins and functions of the Authority are described, as are the various factors contributing to the Plan. The strategic objective is defined as being "to ensure that by the year 2,000 the people of England are more knowledgeable, better motivated, and more able to acquire and maintain good health," as suggested by six criteria for program effectiveness. Selected programs include HIV/AIDS, coronary heart disease, cancer, smoking, alcohol, nutrition, and family and child health. Complementary delivery methods are examined, such as use of the mass media, the National Health Service, schools and colleges, and the workplace, utilizing partnerships with health, education, and other agencies, promoting professional development, and dissemination of research and local initiative results.

Aged↗
PubMed2000

Changes in suicide in England and Wales, 1960-1997.

BACKGROUND: Methods of suicide and suicide rates in England and Wales have fluctuated considerably since the 1960s. AIMS: To review the changes that have occurred in suicide rates in England and Wales between 1960 and 1997. METHOD: Suicide rates, derived from total annual suicides and the estimated annual resident population, were obtained from the Office for National Statistics. RESULTS: Suicide rates decreased in both genders between the early 1960s and the mid-1970s. The rate for males then increased between 1975 and 1990, while the rate for females continued to fall. Between 1990 and 1997, the rate decreased for males and females in all age groups, particularly for those using motor vehicle exhaust gas; the latter finding is associated with increasing use of catalytic converters. CONCLUSIONS: Following the increase in suicide among males until 1990 there was a decrease for both genders between 1990 and 1997, consistent with the 'Health of the Nation' target.

Adolescent↗
PubMed1998

Homing pigeons use olfactory cues for navigation in england

Although the use of olfactory cues in pigeon navigation is well established, the generality of olfactory navigation remains uncertain because of apparent variability in results gained by different researchers in different regions. We report the results of the first experiments investigating the effect of anosmia on homing pigeons reared in a previously uninvestigated region, southern England. In series 1, experienced birds showed little effect of anosmia induced with zinc sulphate at unfamiliar sites 30 km and 39 km from the loft, but treated birds were significantly poorer than controls at homing from an unfamiliar site 66 km distant (and in pooled results). In series 2, naive (untrained) birds, both control and zinc-sulphate-treated, showed poor homing abilities and initial orientation from sites 25 km, 36 km and 39 km from the loft. Nevertheless, in pooled results, controls showed significantly better homeward orientation than anosmic birds and were significantly more likely to home on the day of release. The most likely explanation for our results is that pigeons are able to use olfactory navigation in southern England, but that for some reason the olfactory map is relatively weak.

Journal Article↗
PubMed2002

Reports from the Faculty of Family Planning and Reproductive Health Care AGM, May 2002. Assessing the quality of information leaflets about abortion methods in England and Wales.

This study assessed the quality of written information about abortion methods provided by clinics in England and Wales. Forty-four sets of leaflets were collected. The average leaflet was found to provide only half the possible information about benefits, risks and general procedures. Only half of the leaflets were of standard readability and accessible by 83% of the British population. Therefore, it seems unlikely that most women in England and Wales are in a position to make an informed decision about abortion method.

Abortion Applicants↗
PubMed1991

America's first school of nursing: the New England Hospital for Women and Children.

This is a historical research about America's first school of nursing. The purpose of this research is to explore and analyze the philosophy, training methods, and the setting in which nursing education began in America. The methodology included the use of primary sources and a site visit to the New England Hospital for Women and Children, now known as the Dimock Health Center. The findings reveal that through feminist endeavors, and women physicians as nurse educators, the New England Hospital for Women and Children emerged as a leader in training nurses. In addition, this institution is credited with graduating two prominent historical pioneers who were admitted to Nursing's Hall of Fame.

Boston↗
PubMed1996

Under-registration for dental care of children with heart defects in the north-east of England: a comparative study.

The main aim of this study was to discover the number of children with heart defects registered for dental care under capitation in the north-east of England. Subsidiary aims were to compare percentage registrations of these children with those of a similar age in the general population and to investigate the involvement of the Hospital Dental Service (HDS) and Community Dental Service (CDS) in providing dental care for children with heart defects. A sample of all patients under the age of 18 years attending the northern regional cardiothoracic unit between 1st August 1990 and 31st July 1992 was obtained. Details were sent to the Dental Practice Board for analysis during September 1993. A separate analysis was undertaken to estimate the number of children receiving dental care at the dental hospital, Newcastle upon Tyne and within the CDS. A total of 930 children were identified during the study period. Only 38% of children were currently registered for capitation. Of the 930 patients 56 (6%) were registered at the dental hospital while 9% were estimated to be regularly attending the CDS. It is concluded that in the north-east of England, children with heart defects are registered under capitation at an unacceptably low level. They are less likely to be registered than children without this medical condition and it cannot be demonstrated that other dental services are making good the shortfall.

Adolescent↗
PubMed1991

Red cell distribution width, free erythrocyte protoporphyrin, and England-Fraser index in the differential diagnosis of microcytosis due to iron deficiency or beta-thalassemia trait. A study of 200 cases of microcytic anemia.

Microcytic anemias are often encountered in clinical practice. In most cases they are due to iron deficiency, but in some geographical areas other diagnoses, such as that of beta-thalassemia trait, must be considered. In some cases, the hematological data presented by the automated hemogram may be very similar in both entities, showing moderate anemia, microcytosis, and increased red blood cells. From a practical point of view, it may be important to make an "at-first sight" diagnosis using simple parameters that may readily be obtained from the hemogram or from the laboratory. We have assessed the usefulness of RDW (red cell distribution width), of the England-Fraser index and of free erythrocyte protoporphyrin determination in predicting iron deficiency anemia or beta-thalassemia trait. Our results suggest that the most accurate of these parameters is the England-Fraser index, but that a presumptive diagnosis of beta-thalassemia trait can correctly be made if RDW and FEP values are near normality.

Adolescent↗
PubMed1991

Efficient diagnosis of common complaints: a comparative study in the United States and England.

BACKGROUND: The purpose of this investigation was to compare the diagnostic efficiency of American and British family and general practitioners, as measured by their utilization of health care resources and the average length of the diagnostic interval, in diagnosing common complaints. METHODS: Several hundred charts from teaching practices in the United States and England were identified by computer search and reviewed. The charts were those of patients who had presented between 1978 and 1988 with a complaint of chest pain and were subsequently diagnosed as having angina pectoris or reflux esophagitis, or who presented with a complaint of shortness of breath and were subsequently diagnosed as having heart failure or asthma. RESULTS: The results of this study, which compared teaching family medicine practices in the United States and England, suggest that American family physicians diagnose common complaints such as chest pain and dyspnea in a shorter time with fewer visits and fewer consultations than their English counterparts, but order approximately the same number of diagnostic tests. CONCLUSIONS: This study demonstrates the difficulties in interpreting international (cross-cultural) comparisons. Differences may be due to varying health care systems, economic factors, physician training, and physician practice styles, as well as patient expectations.

Adult↗
PubMed1998

Tuberculosis notifications in England: the relative effects of deprivation and immigration.

SETTING: Metropolitan areas of England, including London boroughs, in 1991. OBJECTIVE: To investigate the relative importance of deprivation, immigration and the elderly in explaining variations in tuberculosis rate. DESIGN: A retrospective study using multiple Poisson regression models to assess the interrelationship between various population parameters. RESULT: Significant differences ere observed between London and other metropolitan districts in the measures of tuberculosis, immigration and the elderly. In addition, all population parameters were significantly intercorrelated in London: areas with a high proportion of immigrants had high levels of deprivation and low proportions of elderly. In other metropolitan districts, only immigration and the Jarman index were significantly associated, and removing the immigration component from the index removed this statistical significance. Multiple Poisson regression models revealed that the immigrant index had the strongest explanatory power in explaining tuberculosis rates, but there were significant interactions between this and measures of urban deprivation indices. That is, there was a greater effect of increasing deprivation at lower levels of immigration than at higher levels. This phenomenon was more pronounced in London boroughs than other metropolitan districts. The elderly index had no significant influence on tuberculosis rates. CONCLUSION: Although the association between tuberculosis and deprivation previously reported for the city of Liverpool is confirmed across all urban areas of England, the immigrant proportion of the population has a greater statistical power in explaining variations in rates of urban tuberculosis. However, tuberculosis notifications can be most accurately predicted by combining both measures than by either one alone.

Aged↗
PubMed2004

Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England.

BACKGROUND: Predicting risk for aortic and mitral valve surgery is important both for informed consent of patients and objective review of surgical outcomes. Development of reliable prediction rules requires large data sets with appropriate risk factors that are available before surgery. METHODS: Data from eight Northern New England Medical Centers in the period January 1991 through December 2001 were analyzed on 8943 heart valve surgery patients aged 30 years and older. There were 5793 cases of aortic valve replacement and 3150 cases of mitral valve surgery (repair or replacement). Logistic regression was used to examine the relationship between risk factors and in-hospital mortality. RESULTS: In the multivariable analysis, 11 variables in the aortic model (older age, lower body surface area, prior cardiac operation, elevated creatinine, prior stroke, New York Heart Association [NYHA] class IV, congestive heart failure [CHF], atrial fibrillation, acuity, year of surgery, and concomitant coronary artery bypass grafting) and 10 variables in the mitral model (female sex, older age, diabetes, coronary artery disease, prior cerebrovascular accident, elevated creatinine, NYHA class IV, CHF, acuity, and valve replacement) remained independent predictors of the outcome. The mathematical models were highly significant predictors of the outcome, in-hospital mortality, and the results are in general agreement with those of others. The area under the receiver operating characteristic curve for the aortic model was 0.75 (95% confidence interval [CI], 0.72 to 0.77), and for the mitral model, 0.79 (95% CI, 0.76 to 0.81). The goodness-of-fit statistic for the aortic model was chi(2) [8 df] = 11.88, p = 0.157, and for the mitral model it was chi(2) [8 df] = 5.45, p = 0.708. CONCLUSIONS: We present results and methods for use in day-to-day practice to calculate patient-specific in-hospital mortality after aortic and mitral valve surgery, by the logistic equation for each model or a simple scoring system with a look-up table for mortality rate.

Adult↗