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At least 1,045 records · Page 58Linked to original sources
PubMed1996

Sex differences in time trends of colorectal cancer in England and Wales: the possible effect of female hormonal factors.

Differences between the sexes in time trends of colorectal cancer incidence 1962-87 and mortality 1960-91 in England and Wales are examined in relation to changes in female hormonal factors. There was a trend in the sex ratio of this tumour, particularly marked for the descending colon, whereby the female excess in risk at young ages has almost disappeared but the male excess at older ages has increased. This trend started for cohorts born since the 1920s and coincided with the increase in the use of oral contraceptives and, to a lesser extent, with increases in fertility. The decline has been particularly pronounced for women at young ages born since 1935-39, coinciding with the spread of oral contraceptive use to younger age groups. These results are consistent with the hypothesis that female hormonal factors may play a role in the aetiology of colorectal cancer and with the possibility that oral contraceptive use might exert a protective effect in the descending colon.

Adolescent↗
PubMed1996

Non-melanoma skin cancer and solar keratoses. I. Methods and descriptive results of the South Wales Skin Cancer Study.

This study aimed to describe the prevalence and incidence of solar keratoses and skin cancers and the natural history of solar keratoses in a random population sample. It was a cross-sectional study, with follow-up, conducted in South Wales, and involved 1034 subjects aged 60 years and over drawn from the Family Health Services Authority register. The main outcome measures were detection of the presence of solar keratoses and skin cancers on sun-exposed skin and photographic validation of solar keratoses and biopsy confirmation of cancers wherever possible. We found that solar keratosis prevalence was 23% (95% confidence interval 19.5-26.5) and that of skin cancer (all types) 2% (95% confidence interval 1.0-3.5). The incidence rate of solar keratoses was 149 lesions per 1000 person-years and of non-melanoma skin cancer 9 per 1000 person-years. In all 21% (95% CL 16-26) of solar keratoses regressed spontaneously during follow-up. None underwent malignant change. We believe that the failure of individuals to seek medical advice and the variable under-registration of non-melanoma skin cancer makes population-based study important. The high prevalence and incidence of malignant and pre-malignant skin lesions in this random sample raise major public health concerns. The high rate of spontaneous regression of solar keratoses and the low rate of malignant change challenges conventional views about the need for routine treatment of these lesions.

Adult↗
PubMed1996

Non-melanoma skin cancer and solar keratoses II analytical results of the South Wales Skin Cancer Study.

This study aimed to identify risk markers for prevalent solar keratoses (SKs) and squamous cell carcinomata (SCC) combined, for incident SKs and for spontaneous remission of SKs and to evaluate primary preventative measures. It was a cross-sectional study, with follow-up, conducted in South Wales, and involved 1034 subjects aged 60 years and over. The main outcome measures were the presence of and changes in SKs, and presence of skin cancers, on sun-exposed skin, and risk factors for prevalent SKs/SCCs and for incidence and remission of SKs. We found that variables independently associated with prevalent SKs/SCCs were: age [80 + years vs 60-64 years, odds ratio (OR) 3.7]; sex (male vs female OR 2.2); cumulative sun exposure (top quintile vs bottom quintile OR 3.3) and skin type (skin type 1 vs 4 OR 12.4). Use of sunscreen or protective clothing was not protective after controlling for confounders. Males and those who sunbathe infrequently showed greater remission of SKs. Older subjects and those spending most time in the sun in the preceeding 2 years were most likely to develop new SKs. We conclude that the risk factors identified are consistent with results from sunnier countries. The failure of sunscreen or clothing to emerge as protective raises doubts as to whether these measures are as effective in routine use in the general population as theoretical considerations and the limited trial evidence would predict. Recently reported sun exposure appears to influence the risk of developing new SKs.

Aged↗
PubMed1997

Geographical variation in the standardized years of potential life lost ratio (SYPLR) in women dying from malignancies of the breast in England and Wales.

Geographical variation in the standardized years of potential life lost ratio (SYPLR) in women aged 20-74 dying from breast cancer has been mapped by local authority district in England and Wales and compared with the variation as described by the standardized mortality ratio (SMR). The geographical distribution of areas of low and high SMRs is similar to that observed some 15 years earlier, showing an increase from north to south. In contrast, the pattern of SYPLRs shows a less obvious trend. Years of life lost because of breast cancer mortality were particularly high in eight of the 401 county districts (SYPLR 1.22-1.48) and particularly low in nine (0.60-0.86). Mapping SYPLRs for breast cancer gives a different pattern from mapping SMRs, and one which is possibly more appropriate for targeting resources in circumstances in which death at younger age will have major social consequences. Care is required in interpreting maps indicating high and low rates in the presence of multiple comparisons. However, the range of values observed is suggestive of the need to investigate districts with contrasting values of SYPLR with respect to the inter-relationships between sociodemographic characteristics, duration of symptoms, clinical presentation and treatment efficacy.

Adult↗
PubMed1998

BRCA1 and BRCA2 in breast cancer families from Wales: moderate mutation frequency and two recurrent mutations in BRCA1.

Mutations in the BRCA1/BRCA2 genes account for varying proportions of breast cancer families studied, and demonstrate considerable variation in mutational spectra coincident with ethnic and geographical diversity. We have screened for mutations in 17 families from Wales with two or more cases of breast cancer under age 50 and/or ovarian cancer. Eight out of 17 (47%) families had demonstrable mutations. Six out of 17 (35%) carried BRCA1 mutations and 2 out of 17 (12%) carried BRCA2 mutations. Two recurrent mutations in BRCA1 were identified, which appear to represent founder mutations in this population. These data support the existence of additional breast and ovarian cancer susceptibility genes.

Adult↗
PubMed1999

Patient presentation at medical practices with dental problems: an analysis of the 1996 General Practice Morbidity Database for Wales.

OBJECTIVE: To describe the characteristics of attendances and patients who present to family medical practitioners with oral or dental problems. DESIGN: Secondary analysis of standard consultation data. SETTING: 30 family medical practices in the General Practice Morbidity Database for Wales. SUBJECTS: All patients who presented at the practices with an oral or dental complaint during 1996. RESULTS: Of the 1,650,882 patient attendances at the 30 medical practices in the study year, 4,891 (0.3%) were for oral/dental problems. The frequency of these attendances varied considerably between practices (ranging from 0.02 to 0.67% of all attendances); 44.2% of the attendances included tooth-related problems, and 42.3% were for diseases of soft tissue, salivary glands or the tongue. On average patients with dental problems attended their doctor twice as frequently as other patients. The majority (75%) of oral/dental attendances were related solely to these problems. Patients with tooth-related dental problems were three times more likely to seek treatment at weekends than patients attending for other reasons. CONCLUSIONS: The rate of attendance for oral/dental problems varies substantially between practices, but is generally low. The higher rate of attendance for tooth-related problems at weekends suggests that some of the attendances for oral problems might be related to a perceived or actual lack of dental services at these times.

Adolescent↗
PubMed1999

A closer look at General Dental Service orthodontics in England and Wales. I: Factors influencing effectiveness.

OBJECTIVE: To evaluate factors influencing effectiveness in General Dental Service (GDS) orthodontics. DESIGN: Retrospective analysis of systematic 2% sample of GDS (England and Wales) cases. METHOD: Records of cases were collected during 1991. Assessment involved occlusal indices and data from National Health Service forms for 1,411 cases. Multivariate analyses were used with Peer Assessment Rating Index (PAR) score at Finish as the outcome indicator. RESULTS: Dual arch fixed appliances: achieved lower Finish PAR scores than other appliances; only 1.5% of the variance was explained, by treatment time and Dental Health Component of the Index of Orthodontic Treatment Need (DHC). Finish PAR was unaffected by Starting PAR. All other appliances: the model explained 25% of the variance for Finish PAR, which varied with Starting PAR and DHC scores. Social class had effects of little clinical significance, but the data suggested availability of orthodontic treatment was poorer in 'manual class' areas. Orthodontic qualifications, number of arches treated and mixed dentition starts had no significant effects when submitted to multivariate analysis. CONCLUSIONS: The importance of appliance selection is reinforced: dual arch fixed appliances are generally more consistent. Lower social class areas may be poorly provided with orthodontic services.

Age Factors↗
PubMed1999

A closer look at General Dental Service orthodontics in England and Wales. II: What determines appliance selection?

AIM: To elucidate factors that influence choice of appliance type in General Dental Service (GDS) orthodontics in England and Wales. METHOD: Records were obtained for 1527 cases, representing a systematic 2 per cent sample of GDS cases completed during 1990-91. Evaluation involved Discriminant Analysis to find the most influential factors in appliance choice. Factors considered included patient and practitioner characteristics, and features of the malocclusion as assessed by Occlusal Indices. RESULTS: Full data were available for 1217 cases. 24 per cent of treatments included use of dual- and 26 per cent single-arch fixed appliances. Appliance choice was predictable in 55 per cent of cases. Older patients, orthodontically qualified practitioners, high Peer Assessment Rating score at start, permanent dentition, lower grades of the Dental Health Component of the Index of Orthodontic Treatment Need at start, and practitioners with high gross earnings from orthodontics, all tended to be associated with more frequent use of fixed appliances. CONCLUSIONS: Possession of a diploma or membership in orthodontics was associated with more frequent use of both dual- and single-arch fixed appliances. Better appliance selection, and thus more effective treatments in the GDS, may result from a greater availability of practitioners with formal postgraduate training in orthodontics.

Discriminant Analysis↗
PubMed2001

Inequalities in availability of National Health Service general dental practitioners in England and Wales.

AIM: To model the inequalities in availability of National Health Service general dental practitioners in England and Wales in relation to key socio-demographic factors. METHODS: Current estimates of the numbers of NHS general dental practitioners for each health authority were related to data from the 1991 census using Poisson regression models, and generalised estimating equations to allow for correlation between results for neighbouring health authorities. RESULTS: An 'average' health authority, without a dental school, would be expected to have 2,138 residents for every NHS dentist. Controlling for relevant factors, health authorities with higher proportions of the following are associated with lower (better) population to dentist ratios by the amounts shown: each 1% higher female population (-11.8%; 95%CI -19.1%, -3.9% P = 0.004); each 1% greater South Asian population (-1.4%; 95%CI -2.1%, -0.7% P <0.001). A health authority with a dental school is associated with a more favourable ratio compared with one without such a facility (-9.2%; 95%CI -16.2%, -1.6% P = 0.019). Each additional 1% of the following are associated with a worse ratio by the amounts shown: children aged 0 to 14 years old (+5.2%; 95% CI +2.4%, +8.1% P < 0.001); adults aged over 65 years old (+2.8%, 95%CI +1.0%, +4.7% P =0.002); households without a car (+0.8%; 95%CI 0.0%, +1.6% P =0.042). CONCLUSIONS: Ensuring access to dental care may be a more complex issue than simply providing adequate numbers of dentists at a national level. Any manpower planning exercise should additionally consider local factors that may act as incentives or disincentives to those professionals who provide care.

Adolescent↗
PubMed2001

Experiences and perceptions of vocational training reported by the 1999 cohort of vocational dental practitioners and their trainers in England and Wales.

OBJECTIVE: To assess the self-reported confidence of vocational dental practitioners (VDPs) in clinical procedures together with vocational trainers' perceptions of the VDPs confidence in the same procedures, immediately after qualification and towards the end of the vocational training year. DESIGN: A questionnaire-based cohort study. SETTING: A general practice study carried out in 1999. SUBJECTS: Vocational Dental Practitioners and vocational trainers in England and Wales. METHOD: VDPs and trainers were asked on a single occasion to grade the clinical confidence of the VDP at the beginning and near the end of vocational training as high, satisfactory or low. RESULTS: Questionnaires were sent to 531 VDPs and 555 trainers; 82 per cent of VDPs and trainers responded. Approximately half the VDPs were male and 57 per cent were white, whilst 89 per cent of trainers were male and 81 per cent white. A large proportion of both VDPs and trainers reported low confidence in orthodontics, molar endodontics and surgical extractions at the start of the training year. Towards the end of training, both groups reported improved confidence levels in most clinical procedures. However, a higher proportion of trainers reported low confidence than their VDPs in most clinical procedures at both time points (p<0.001). VDPs appeared to gain most from experience and training in administration/management and interpersonal skills. CONCLUSION: Vocational training appears to satisfy its aim to enhance clinical and administrative confidence.

Clinical Competence↗
PubMed2002

Trends in oral surgery in England and Wales 1991-2000.

OBJECTIVE: To investigate trends in oral surgery in England and Wales 1991-2000. METHODS: Oral surgery procedure data were derived from Dental Practice Board and Department of Health Hospital Episode Statistics. RESULTS: There was a 6% increase in minor oral surgery (MOS) procedures, including ordinary extractions, extractions of special difficulty, apicectomies and third molar removals, carried out in the General Dental Services (GDS) but the number of third molars removed fell by 32% after 1997. General anaesthetics (GA) administered in the GDS fell by 77% and the number of sedations rose 54% after 1998. There was concentration of minor oral surgery in practices: in the year 2000, 88% of practitioners carried out less than five third molar removals. In the Hospital Dental Service (HDS) there was a 98% increase in day surgery, and a 53% decrease in ordinary admissions for minor oral surgery. HDS waiting times remained constant over the ten year period. CONCLUSIONS: The principal trends were substantial decreases in apicectomies, third molar removals after 1997 and GAs after 1998; increases in extractions of special difficulty and concentration of MOS in the GODS. Numbers of ordinary extractions did not change. In the HDS there was a large shift from in-patient to daycase provision which has facilitated expansion of maxillofacial surgery. This is an important example of NHS reconfiguration. Perhaps the most important implication of these changes concerns the place of MOS in vocational training.

Anesthesia, Dental↗
PubMed1991

Glove use in clinical practice: a survey of 2000 dentists in England and Wales.

Attitudes to glove wearing by dentists practising within the NHS Regulations were tested by means of a questionnaire distributed to 2000 dentists in England and Wales. The response was 76.5%. The results indicate that 68% of the respondents wore gloves routinely for all patients and procedures, 3% never wore gloves, while the remainder (29%) wore gloves for only selected patients or selected procedures. Reasons given for not wearing gloves routinely included problems of comfort, loss of tactile sensation and the risk of cross-infection, which was perceived to be small. Of the routine glove wearers, only 12% changed gloves between patients, cost being considered to be a factor by 57% of respondents who used gloves for more than one patient. The results indicate that the respondents practising and personal details had an influence on the pattern of glove wearing, with single-handed practitioners and those who graduated before 1979 being less likely to wear gloves routinely. Comparison with the findings of earlier studies of similar type suggest that there is increased awareness in the dental profession of the necessity for glove wearing, but that there is still a need to encourage routine glove use, especially amongst certain groups of GDPs.

Age Factors↗
PubMed1993

Orthodontics in the general dental service of England and Wales: a critical assessment of standards.

Out of a sample of 1210 orthodontic patients treated within the General Dental Services in England and Wales, a high proportion showed no improvement. Upper and lower fixed appliances had the greatest influence on the outcome of treatment in terms of aesthetics, dental health need and standards. When treatment was analysed according to the appliance used, there were no statistically significant differences in the standard of treatment undertaken by specialist orthodontists and general dental practitioners. Methods for improving British orthodontic standards are considered.

Analysis of Variance↗
PubMed1994

The provision of oral surgery services in England and Wales 1984-1991.

Data from the Department of Health and the Dental Practice Board demonstrate substantial increases in the volume of oral surgery performed in England and Wales both in the General Dental and Hospital Services during the period 1984-1991. In the General Dental Service, although the number of routine extractions decreased by 10%, the number of surgical procedures increased by 20%, with a substantial increase (33%) in the number of third molar extractions in the period 1988-1991. There have been no decreases in the annual rate of extractions of permanent and deciduous teeth in the GDS since 1987. In at least one Regional Health Authority, there was a five-fold increase in the number of oral surgery patients aged 0-9 years treated in the hospital service (1982-1991). Overall, although this study takes no account of extractions carried out in the Community Service, these findings suggest that numbers of deciduous extractions may have actually risen in some areas, particularly after 1987. In the Hospital Service there was a 55% increase in numbers of day-cases, from 30,090 (1984) to 46,499 (1990); a 10% increase in throughput of in-patients and a 13% decrease in numbers of people waiting for in-patient surgery. These changes were in the same direction as those in plastic and ENT surgery; though plastic surgery achieved a greater utilisation of day-care services. The implications of these changes and their possible effect on the future provision of oral and maxillofacial surgery services are discussed.

Apicoectomy↗
PubMed1994

Glove use by dentists in England and Wales: results of a 2-year follow-up survey.

This paper reports the findings of a 2-year follow-up study of glove use by dentists practising within the NHS regulations in England and Wales. The questionnaire for this study was distributed in November/December 1991 to 1950 dentists. The response rate was 61.5%. Analysis of the data obtained from the replies indicated that 83% of respondents wore gloves routinely for all patients and all procedures, 15% wore gloves for either selected patients or procedures and 2% never wore gloves. Glove wearing patterns were found to be related to gender, practice type and frequency of attendance at postgraduate courses. Overall, the results indicate increasing levels of compliance with recommendations concerning glove wearing while treating patients.

Adult↗
PubMed1995

The growth of new dental practices established in the North West of England and North Wales between 1985 and 1990.

This study examined the growth of 52 new dental practices established between 1985 and 1990 in the North West of England and North Wales. Growth was measured from the number of estimates (equivalent to a course of treatment) submitted by the practice to the Dental Practice Board since the practice first opened. Values ranged from less than 1000 estimates up to 12,000 estimates during the first 24 months; the modal value was between 2000 and 2999. The number of estimates was not associated with the resident population to dentist ratio for the surrounding locality.

Dental Facilities↗
PubMed2005

Reasons for tooth extraction in four general dental practices in South Wales.

Tooth retention has been one of the main aims of oral care which in turn could have contributed to the social oral health divide. To investigate this issue further, data collected for a group audit was used to study the reasons for tooth extraction for patients attending for routine treatment at four dental practices. The practices served populations in areas with different levels of deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic 5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits per day within the group of dental surgeons varied with three practitioners performing more than three extraction visits per day while one practitioner had only 0.51. These reasons did not significantly depend on levels of deprivation. However, significantly more teeth were extracted for caries in the most deprived group in comparison to the least deprived. Therefore, could there be a case for appropriate extractions in the quest for equitable care?

Adolescent↗
PubMed2004

Living arrangements and place of death of older people with cancer in England and Wales: a record linkage study.

The main objectives of the study were to (1) see whether the household circumstances of people aged 50 years and over with cancer, and trends in these, differ from those of the rest of the population and (2) whether living arrangements and presence and health status of a primary coresident are associated with place of death among older people dying of cancer and those dying from other causes. The design included prospective record linkage study of people aged 50 years and over included in a 1% sample of the population of England and Wales (the Office for National Statistics Longitudinal Study). The main outcome measures comprised family and household type, and death at home. The household circumstances of older people with cancer were very similar to those of the rest of the population of the same age and both showed a large increase in living alone, and decrease in living with relatives, between 1981 and 1991. The primary coresident of cancer sufferers who did not live alone was in most cases a spouse, with much smaller proportions living with a child, sibling or other person. In all, 30% of spouse, and 23% of other, primary coresidents had a limiting long-term illness. Compared with people who lived alone in 1991, odds of a home death among those dying of cancer between 1991 and 1995 were highest for those who lived with a spouse who had no limiting long-term illness (odds ratio (OR) 2.52, 95% confidence interval (CI) 2.15-2.97) and raised for those living with a spouse with a long-term illness (OR 2.14, CI 1.79-2.56) and those living with someone else who was free of long-term illness (OR 2.13, CI 1.69-2.68). Higher socioeconomic status, both individual and area, was positively associated with increased chance of a home death, while older age reduced the chance of dying at home. The changing living arrangements of older people have important implications for planning and provision of care and treatment for cancer sufferers.

Aged↗