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PubMed2006

Mortality from all cancers and lung, colorectal, breast and prostate cancer by country of birth in England and Wales, 2001-2003.

Mortality from all cancers combined and major cancers among men and women aged 20 years and over was compared by country of birth with that of the whole of England and Wales as the reference group. Population data from the 2001 Census and mortality data for 2001-2003 were used to estimate standardised mortality ratios. Data on approximately 399 000 cancer deaths were available, with at least 400 cancer deaths in each of the smaller populations. Statistically significant differences from the reference group included: higher mortality from all cancers combined, lung and colorectal cancer among people born in Scotland and Ireland, lower mortality for all cancers combined, lung, breast and prostate cancer among people born in Bangladesh (except for lung cancer in men), India, Pakistan or China/Hong Kong, lower lung cancer mortality among people born in West Africa or the West Indies, higher breast cancer mortality among women born in West Africa and higher prostate cancer mortality among men born in West Africa or the West Indies. These data may be relevant to causal hypotheses and in relation to health care and cancer prevention.

Adult↗
PubMed2006

Survival trends for small intestinal cancer in England and Wales, 1971-1990: national population-based study.

This population-based study examines prognostic factors and survival trends among adults (15-99 years) diagnosed with small intestinal cancer in England and Wales during 1971-1990 and followed up to 1995. During this period, the 1- and 5-year age-standardised relative survival rates for small intestinal cancers combined were 42% and 23%, respectively. Duodenal tumours, adenocarcinomas, men, patients with advanced age and the most deprived patients had the poorest prognosis. For all small bowel tumours combined, the excess risk of death fell significantly by 6-9% every 4 years over the 20-year period (adjusted excess hazard ratio (EHR) 0.91 at 1 year after diagnosis, 0.94 at 5 years). For duodenal tumours, the EHR fell by about 14% (95% CI 5-22%) every 4 years between 1979 and 1990, and a similar trend for jejunal tumours was of borderline significance. Further population-based investigations linking survival data to individual data on diagnostic methods and types of treatment are needed.

Adolescent↗
PubMed1999

Estimating relative survival among people registered with cancer in England and Wales.

Because routinely collected survival data for cancer patients in England and Wales do not typically specify cause of death, conventional estimates of survival in cancer patients based on such data are a measure of their mortality from all causes rather than their mortality due to cancer. As a result, trends in survival over time are difficult to interpret because changes in overall survival may well reflect changes in the risk of death from other causes, rather than from the cancer of interest. One way of overcoming this problem is to use some form of 'relative survival' defined as a measure of survival corrected for the effect of other independent causes of death. Since this concept was first introduced, various methods for calculating relative survival have been proposed and this had led to some confusion as to the most appropriate choice of estimate. This paper aims to provide an introduction to the concept of relative survival and reviews some of the suggested methods of estimation. In addition, a particularly simple, but robust approach, is highlighted based on expected and observed mortality. This method is illustrated using preliminary data from the Office for National Statistics on cancer survival in patients born after 1939 and diagnosed with cancer during 1972-84. The examples presented, although limited to analyses on a small number of selected sites, highlight some encouraging trends in survival in people aged under 35 diagnosed with leukaemia, Hodgkin's disease and testicular cancer during this period.

Cohort Studies↗
PubMed1999

Cancer mortality in East and Southeast Asian migrants to New South Wales, Australia, 1975-1995.

Routinely collected data for New South Wales were used to analyse cancer mortality in migrants born in East or Southeast Asia according to duration of residence in Australia. A case-control approach compared deaths from cancer at particular sites with deaths from all other cancers, adjusting for age, sex and calendar period. Compared with the Australian-born, these Asian migrants had a 30-fold higher risk of dying from nasopharyngeal cancer in the first 2 decades of residence, falling to ninefold after 30 years, and for deaths from liver cancer, a 12-fold risk in the first 2 decades, falling to threefold after 30 years. The initial lower risk from colorectal, breast or prostate cancers later converged towards the Australian-born level, the change being apparent in the third decade after migration. The relative risk of dying from lung cancer among these Asian migrants was above unity for each category of duration of stay for women, but at or below unity for men, with no trend in risk over time. An environmental or lifestyle influence for nasopharyngeal and liver cancers is suggested as well as for cancers of colon/rectum, breast and prostate.

Adolescent↗
PubMed2006

Driving to work and overweight and obesity: findings from the 2003 New South Wales Health Survey, Australia.

OBJECTIVES: To examine possible associations between driving to work, physical activity and overweight and obesity. DESIGN: Secondary analysis of cross-sectional data from a representative sample of the 2003 New South Wales Adult Health Survey, Australia. SUBJECTS: A total of 6810 respondents aged 16 years or over. MEASUREMENTS: Self-reported height and weight, modes of transport to work, level of physical activity, fruit and vegetable intake and social-economic status. RESULTS: Almost half of the respondents (49%) were overweight. The main mode of transport to work was driving a car (69%), 15% used public transport, 7% walked, 2% cycled and 6% worked at home. People who drove to work were less likely to achieve recommended levels of physical activity compared to non-car users (56.3 vs 44.3%, chi2 = 82.5, P<0.0001). Driving to work was associated with being overweight or obese (adjusted odds ratio = 1.13 (95% CI 1.01-1.27), P = 0.047). Inadequate level of physical activity was independently associated with overweight or obesity. Socially and economically disadvantaged people were also more likely to be overweight and obese. In addition, being female or never married or having higher level of education was associated with a significantly reduced odds ratio of being overweight or obese, as was speaking a language other than English at home. No association was found between weight status and recommended vegetable or fruit intake. CONCLUSIONS: Driving to work is the dominant mode of commuting in a modern society and its impact on health requires scrutiny. The association found in this study between driving to work and overweight and obesity warrants further investigation to establish whether this relationship is causal. If proved as such, then promoting active transport modes such as walking, cycling and public transport should form a key component of global obesity prevention efforts.

Adolescent↗
PubMed2006

Real-time measurement of short-term peaks in environmental CO concentrations in the homes of the elderly in South Wales.

In order to determine whether short-term World Health Organization (WHO) guideline limits for carbon monoxide (CO) are exceeded in the home environment, a number of sensors were constructed capable of real-time measurement. These were deployed for a period of 7 days to continuously monitor CO concentrations in 44 non-smoking households using either gas, coal, electricity, liquid propane gas, or oil for heating fuel in South Wales. The mean environmental concentrations over the period monitored were less than 1 p.p.m and WHO short-term limits were not exceeded in any household. In another 20 homes containing a smoker the mean concentrations measured over a period of 2 days ranged from 0.1 to 21 p.p.m and WHO short-term limits were exceeded in one household.

Aged↗
PubMed2002

Increasing incidence and descriptive epidemiology of extranodal non-Hodgkin lymphoma in parts of England and Wales.

INTRODUCTION: The incidence of non-Hodgkin lymphoma (NHL) arising from extranodal tissue has been reported to be increasing in Western countries and yet the epidemiology of this heterogeneous disease has been poorly described. PATIENTS AND METHODS: : Cases of extranodal NHL were reported to a specialist population-based registry covering neoplastic hematological conditions in parts of England and Wales from 1986 to 1993. RESULTS: Nearly one third of all NHL, 3556 cases, were extranodal in origin giving a world standardised incidence rate of 1.9/10(5) per year. The most common sites were the skin, stomach and small intestine and high-grade malignancies were predominant. An excess in male incidence was observed for extranodal NHL overall, at all ages, and for most sites. Time-trend analyses indicated significant increases in incidence for all extranodal NHL and NHL of the gastrointestinal tract, skin, central nervous system and male genital organs. Incidence rates increased proportionally more for middle-aged persons, especially females, and for skin lymphomas excluding mycosis fungoides and Sezary disease. CONCLUSION: These results suggest that the rise in incidence of extranodal NHL may be due, at least in part, to an increase specifically in B-cell skin lymphomas and that particular environmental factors such as sunlight might be involved rather than the increases being the results of improvements in diagnostic practices.

Adolescent↗
PubMed2003

Delivery of singleton preterm infants in New South Wales, 1990-1997.

OBJECTIVE: To examine trends in the maternal characteristics and delivery of singleton preterm infants in an Australian population. DESIGN: Population-based descriptive study. SETTING: New South Wales (NSW), Australia. POPULATION: The population included 37 500 singleton preterm births from 1 January 1990 to 31 December 1997. METHODS: Data were obtained from the NSW Midwives' Data Collection (MDC) and rates over time were calculated. Preterm birth by Caesarean section before the onset of labour or where labour was induced were considered to be medically indicated. MAIN OUTCOME MEASURES: Preterm rates, medically indicated preterm birth rates, mode of delivery andneonatal outcomes, and trends over time. RESULTS: Among singleton infants, there was no significant change over time in the rate of preterm birth (annual average 5.5%), preterm births that were medically indicated (annual average 29.3%) or neonatal outcomes of preterm births. The rate of indicated preterm birth varied by gestational age and was highest (39.7%) at 29-32 weeks' gestation. Instrumental preterm births declined over time from 9.5 to 7.8% with a shift from forceps to vacuum use and episiotomy rates declined from 19.7 to 14.8%. CONCLUSIONS: Increases in the reported overall preterm rate (singletons and multiples) were not due to increased delivery of singleton infants. Changes in the management of singleton preterm births were similar to changes observed in term births such as decreasing forceps and episiotomy usage. It may be to time to reassess whether Australian clinicians would be willing to randomise patients to clinical trials of the best method of delivery for preterm infants.

Adult↗
PubMed2001

High use of complementary therapies in a New South Wales rural community.

In this study a postal questionnaire was used to investigate the use of complementary therapies (CT) in a rural region of New South Wales (NSW). A total of 70.3% of respondents reported using one or more therapies with 62.7% having visited a complementary practitioner. Vitamin/mineral therapy (68.7%), chiropractic (26.1%) and massage therapy (25.1%) were the most frequently used therapies, with the most commonly visited practitioners being chiropractors (55.3%) and those trained in vitamin/mineral therapy (47.9%). Of the vitamins, vitamin C and multivitamins were used most often, with garlic and Echinacea being the most used herbal products. The main source of information were friends (64.5%) with most people indicating that CT could improve quality of life and provide relief of symptoms. Results suggest that CT use in rural communities is high and that, in light of these findings, there is a need for training in CT to be included in the undergraduate and continuing education of health professionals. Furthermore, these professionals should be alert to the potential for increased numbers of herb-drug interactions in rural communities.

Adolescent↗
PubMed2001

Developing better casemix education for rural New South Wales.

Casemix is now an important mechanism for the planning, evaluation and funding of health services in Australia. In New South Wales (NSW) it was believed that while staff from most hospitals in metropolitan Sydney had become both literate and vocal about casemix, staff from rural areas were less familiar and much less likely to participate in casemix initiatives. In conjunction with the NSW Casemix Clinical Committee (NCCC), NSW Health considered a special program of casemix education for rural NSW. Before an education program was attempted, NSW Health inquired into the specific needs for casemix education in rural NSW. Qualitative and quantitative methods of analysis were used. Results of the quantitative analysis indicate that the understanding of casemix classifications is highest among managers. Of concern were the relatively low proportion of Allied Health staff who had more than a vague understanding of the Sub- and Non-Acute Patient (SNAP) classification; the lack of any knowledge of the Mental Health Costing And Service Classification (MH-CASC) by nursing staff; and the lack of any knowledge of the emergency department classification: Urgency, Disposition and Age-related Groups (UDAG), either by clinical or nursing staff. The results of the qualitative analysis show that casemix education for rural areas needs to differ from metropolitan education programs. The analysis also highlights the perception of casemix in rural areas and the special circumstances in rural hospitals that place limits on the ability to use casemix more fully.

Attitude of Health Personnel↗
PubMed1999

The relationship between alcohol sales and assault in New South Wales, Australia.

AIMS: This paper explores the relationship between alcohol sales and assault in New South Wales (NSW), Australia. DESIGN: The design was a cross-sectional analysis of the relationship between alcohol sales and assault, taking into account spatial autocorrelation. SETTING: The analyses were carried out separately on data from metropolitan Sydney and country NSW. PARTICIPANTS: The unit of analysis was local government areas (178 in NSW). MEASUREMENTS: The dependent variable was assault rates. The independent variables were overall alcohol sales and sales disaggregated by alcohol and outlet type and relevant demographic and socio-economic factors. FINDINGS: Multiple regression analyses revealed a significant relationship between overall alcohol sales in an area and its incidence of assault for both Sydney and country NSW. There were few effects of outlet or alcohol type for Sydney, but the effect of alcohol sales from hotels and off-licences accounted for most of the alcohol-assault relationship for country NSW. CONCLUSIONS: Although the current research cannot exclude an opportunity account of the role of alcohol in assault, the results are entirely consistent with alcohol consumption as a causal agent.

Alcohol Drinking↗
PubMed2002

Drug use and initiation in prison: results from a national prison survey in England and Wales.

AIMS: To investigate heroin and cocaine use in a sample of British prisoners, and to explore the characteristics of inmates who use these drugs for the first time while in prison. DESIGN, PARTICIPANTS: A cross-sectional survey of all prisons in England and Wales conducted as part of a major national study of psychiatric morbidity. A total of 3142 prisoners (88.2% of those selected) completed a structured interviewer-administered questionnaire. MEASUREMENTS: Interview measures of personal demographics, social history, psychiatric morbidity and drug use. Personality disorders were diagnosed via the Structured Clinical Interview for DSM-IV (SCID-II) and neurotic symptoms were assessed using the revised Clinical Interview Schedule (CIS-R). FINDINGS: More than 60% of the heroin users and cannabis users reported that they had used these drugs in prison compared with less than a quarter of the life-time cocaine users. More than a quarter of the heroin users reported that they had initiated use of this drug in prison. The extent of an individual's experience of prison was related more consistently to heroin and/or cocaine use in and out of prison than other personal background, social history or psychiatric variables assessed. CONCLUSIONS: The findings indicate that prisons are a high-risk environment for heroin and other drug initiation and use. Although related to drug use, psychiatric variables were not generally associated with initiation in prison, which was dominated by prison exposure. There is a need to explore ways of reducing heroin initiation in prison as part of a broader risk-prevention strategy.

Adolescent↗
PubMed2002

Peptic ulceration in general practice in England and Wales 1994-98: period prevalence and drug management.

BACKGROUND: Little is known about the burden of peptic ulcer in the community. AIMS: To examine recent time trends in the period prevalence of peptic ulceration and its drug management, in England and Wales. METHODS: For each year between 1994 and 1998, information on patients with a diagnosis of peptic ulceration was extracted from the General Practice Research Database. RESULTS: The annual age-standardized period prevalence of peptic ulceration decreased from 3.3/1000 in 1994 to 1.5/1000 in 1998 for men, and from 1.8/1000 to 0.9/1000 for women. This decline was more evident among younger people, and among males registered with practices located in the most deprived electoral wards compared to those located in the least deprived. The proportion of patients receiving H2 receptor antagonists declined from 68% in 1994 to 41% in 1998. In contrast, the proportion prescribed proton pump inhibitors rose from 46% to 66%. CONCLUSIONS: Over a 5-year period, the period prevalence of peptic ulceration has decreased markedly, especially among younger people and those from more deprived areas.

Adult↗
PubMed2001

Arterial blood sampling practices in intensive care units in England and Wales.

A postal survey of arterial blood sampling practices in 280 intensive care units throughout England and Wales found that very few measures are taken to reduce diagnostic blood loss in adult intensive care patients from arterial sampling. The average volume of blood withdrawn to clear the arterial line before sampling is 3.2 ml; subsequently returned to the patient in only 18.4% of intensive care units. Specific measures to reduce the blood sample size by the routine use of paediatric sample tubes in adult patients occurs in only 9.3% of intensive care units. In paediatric units, the average volume withdrawn was 1.9 ml and this was routinely returned in 67% of units. Some aspects of arterial blood sampling practices identified in this survey may contribute to iatrogenic anaemia in intensive care patients.

Adult↗
PubMed2003

Survey of anaesthetic support staff in obstetric units in England and Wales.

In order to determine the current level of support provided to anaesthetists on the labour suite, a postal questionnaire was sent to the lead consultants of the 257 obstetric units in England and Wales. One hundred and ninety-five replied, a response rate of 76%. Of those who replied, only 1% of units experienced frequent delays to elective obstetric lists due to lack of an anaesthetic assistant and 141 units (72%) had a designated assistant for the labour ward. However, 58 units experienced delays waiting for an anaesthetic assistance in emergency situations (29%). One hundred and sixty-eight units (86%) had an operating department practitioner/nurse (ODP/N) resident on call for the hospital, but not exclusively for the maternity unit. In 76% of units, midwives assisted the anaesthetist when inserting regional blocks in labour. More than one-third of respondents thought that it would be appropriate to have a dedicated ODP/N resident on call for the labour ward who would also assist with labour analgesia blocks.

Analgesia, Epidural↗
PubMed2003

Who to report to the coroner? A survey of intensive care unit directors and Her Majesty's Coroners in England and Wales.

We performed a postal survey to assess the ability of intensive care unit directors and Her Majesty's Coroners to recognise deaths that should be reported to the local coroner. The survey questionnaire consisted of 12 hypothetical case scenarios. Coroners were significantly better at identifying reportable deaths than intensive care unit directors (median correct recognition scores of 11 (interquartile range 9.25-11) vs. 8 (interquartile range 7-10), respectively, p < 0.01). Deaths associated with an accident, medical treatments, industrial disease, neglect and substance abuse were significantly under-reported by intensive care unit directors (p < 0.01). Results show that significant numbers of deaths on intensive care units in England and Wales may not be being referred for further investigation, and that wide variation in local coroners' practices exists. Improvements in postgraduate medicolegal education about deaths reportable to a coroner are required. National regulations need to be more detailed and standardised so that regional variation is eliminated.

Adult↗
PubMed2000

Changing trends in non-melanoma skin cancer in South Wales, 1988-98.

BACKGROUND: In 1988 our department carried out a population-based epidemiological study of non-melanoma skin cancer (NMSC) incidence, over a 6-month period, in West Glamorgan, South Wales. Objectives To reassess the incidence of NMSC in this defined population over a similar 6-month period 10 years after the initial study. METHODS: All cases of basal cell carcinoma and squamous cell carcinoma diagnosed in West Glamorgan are recorded by the local skin cancer registry. All cases for the relevant 6-month period were analysed. RESULTS: Using these figures, we have identified a significant rise in the crude incidence of NMSC from 173.5 10 years ago to 265.4 per 100,000 population per annum. We also applied the world standard population for age to our crude figures, demonstrating a combined male and female world population-corrected rate of 129.9 per 100,000 population. CONCLUSIONS: In our population the crude incidence of NMSC has risen significantly over 10 years. Additionally, the combined male and female world population-corrected rate appears to be the highest published standardized incidence of NMSC to date from any European country.

Adult↗
PubMed2003

Natural rubber latex allergy in a health-care population in Wales.

BACKGROUND: Type 1 natural rubber latex (NRL) allergy prevalence rates quoted vary due to the different populations studied and methodologies used for assessment and investigation of NRL allergy. OBJECTIVES: To investigate the rate of type 1 allergy to NRL in health-care workers (HCWs) in a single NHS trust in Wales. METHODS: A response rate of 3716 of 5548 (67%) of the employees was obtained with a latex allergy questionnaire administered by the occupational health departments. Type 1 NRL allergy was diagnosed by correlating clinical symptoms, skin prick testing and IgE RAST to latex in the dermatology department. RESULTS: The period prevalence (1998-2001) for type 1 clinical latex allergy in HCWs was 25 of 4439 (0.56%). Of the 25 positive HCWs, 18 (72%) were nurses. CONCLUSIONS: The low prevalence rate of type 1 NRL allergy should not lead to underestimating the importance of clinically significant NRL allergy and the risks that need to be minimized.

Gloves, Protective↗