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At least 109 records · Page 6Linked to original sources
PubMed2006

Diabetes management in the USA and England: comparative analysis of national surveys.

OBJECTIVES: To compare diabetes management in adults between England and the United States, particularly focusing on the impact of a universal access health insurance system. DESIGN: Analysis of the nationally-representative surveys Health Survey of England, 2003 (unweighted n =14 057) and the National Health and Nutrition Examination Survey, 2001-2002 (unweighted n =5411). SETTING AND PARTICIPANTS: Adults 20-64 years of age; individuals >65. MAIN OUTCOME MEASURES: Glycaemic, lipid and blood pressure control and medication use among individuals with previously diagnosed diabetes. RESULTS: Among those aged 20-64 the prevalence of diagnosed diabetes was lower in England (2.7%) than in the USA (5.0%). The proportion with diabetes receiving treatment was similar for the two countries. However, the mean HbA1c in England was 7.6%: in the USA it was 7.5% for those with insurance and 8.6% for those without insurance. The proportion of individuals on ACE inhibitors in England was 39%: in USA it was 39% for those with insurance, and 14% for those without. CONCLUSIONS: Individuals in a healthcare system providing universal access have better managed diabetes than those in a market based system once one accounts for insurance.

Adult↗
PubMed2005

Men who have sex with men who are born abroad and diagnosed with HIV in England and Wales: an epidemiological perspective.

Relatively little is known about the sexual health needs of men who have sex with men (MSM) born abroad who reside in the UK. We describe here the epidemiology of HIV among MSM born outside the UK and diagnosed with HIV in England and Wales. Reports of HIV diagnoses in England and Wales received at the Health Protection Agency Centre for Infections were analysed. Between 2000 and 2003, 6386 MSM were diagnosed with HIV in England and Wales. Country of birth was recorded for 3571 (56%). Of those with country of birth reported, 2598 (73%) were born in the UK and 973 (27%) abroad. Of those born abroad (973), 424 (44%) were born in Europe, 141 (15%) in Africa, 104 (11%) in South/Central America and the remainder in other regions. Where reported (949), 69% of MSM born abroad were White, 12% other/mixed, 9% Black Caribbean and 7% Black African. Probable country of infection was reported for 612 MSM born abroad: 52% were infected in the UK, 43% in their region of birth and 5% in another region. Men born abroad represent a significant proportion of HIV diagnoses among MSM in England and Wales. More than half probably acquired their HIV infection in the UK, strengthening the call for targeted HIV prevention and sexual health promotion among MSM who are not born in England and Wales.

Adult↗
PubMed1969

Heart disease mortality in cities of Latin America and in cities and regions of England and Wales.

Death rates from heart disease in cities and regions of England and Wales, based on death certificates for 1963, are compared with death rates from the same causes in 10 Latin American cities, San Francisco, USA, and Bristol, England, derived from the Inter-American Investigation of Mortality which obtained histories and clinical records of fatal illnesses for the years 1962-64 by a sampling method. Death rates in Bristol derived from the 2 sources showed an agreement close enough to justify comparisons between official rates for England and Wales and the data for the Latin American cities.Comparing standardized death rates for males in the Latin American cities with those for the corresponding populations in the English conurbations and cities, the ratio for coronary disease was found to be 0.4; for other degenerative heart disease it was 1.0; for hypertensive heart, 2.2; for other heart disease, 1.5. The corresponding ratios for females were: 0.55, 1.0, 3.0, and 1.7, respectively. When the hospital regions of England and Wales were included, a geographical pattern could be seen, particularly for males, the highest rates for coronary and degenerative heart disease being found in northern England and the lowest rates in central and western cities of Latin America. For hypertensive and other heart disease the pattern was different.Standardized sex ratios for total heart disease mortality at ages from 45 to 74 years in 30 countries are largely affected by the proportions of deaths attributed to arteriosclerotic and degenerative disease but they suggest that geography, country of origin and possibly climate are also factors that differentially affect the sexes and, in consequence, affect the sex ratios.

Adolescent↗
PubMed1994

Malaria in England: a geographical and historical perspective.

The marshlands of coastal southern and eastern England had unusually high levels of mortality from the sixteenth to the nineteenth century. The unhealthiness of the environment aroused frequent comment during this period and it was attributed to an endemic disease known as "marsh fever" or "ague". Marsh parishes were perceived both as a danger to the local inhabitants and as a deterrent to potential settlers. This paper traces the geography and history of the "marsh fever" in England and shows that the disease was, in fact, malaria transmitted by anopheline mosquitoes. Malaria, once endemic in the coastal marshes of England, had a striking impact on local patterns of disease and death. Yet this study also suggests that the species of malaria endemic in England were vivax and malariae and not the tropical strains of P. falciparum. The paper outlines a number of ways in which "benign" forms of malaria, acting either directly or indirectly, as well as in conjunction with other factors, could have given rise to the unusually high death rates experienced in early modern marshland England. The discussion concludes with an examination of the reasons for the clinical disappearance of malaria during the nineteenth century, its reappearance after the First and Second World Wars and the problem of imported malaria in Britain today.

Adult↗
PubMed1993

Assessment of enamel opacities in children in Sri Lanka and England using a photographic method.

Colour photographs were taken of the labial surface of both maxillary central incisor teeth of children aged 12 years, living in Sri Lanka and England. In each country, children were included who lived in communities receiving drinking water containing 0.1, 0.5 and 1.0 ppm F, and within these communities children were classed as high or low socio-economic (SE) status. The photographs were examined 'blind' by two examiners independently. These pertained to 670 children, 332 in Sri Lanka and 338 in England. The index of Developmental Defects of Enamel (DDE) was used, as modified by Clarkson and O'Mullane (1989), to measure type and extent of opacity. Intra- and inter-examiner agreement was substantial. Prevalence of opacities ranged from about a quarter of teeth in the 0.1 ppm F area in Sri Lanka to over 60 per cent of teeth in the high socio-economic group in the 1.0 ppm F area in England. Higher prevalences of opacities were recorded in: (1) the high SE group than the low SE group in the 1.0 ppm F area in England, (2) the 1.0 ppm F area than in the 0.1 ppm F area in both countries, (3) in Sri Lanka than in England in low SE groups in the 1.0 ppm F areas. The greatest differences occurred in diffuse opacities. When these data were compared with results of clinical examinations of these same tooth-surfaces by one examiner (n = 506) more teeth were graded 'normal' clinically and more teeth graded as having opacities photographically. Both demarcated and diffuse opacities were scored more frequently from photographs than clinically in both countries.

Chi-Square Distribution↗
PubMed1999

Case and control recruitment, and validation of cases for the MICA case-control study in England, Scotland and Wales.

OBJECTIVES: To describe the processes involved in the selection of cases and controls, and the validation of case diagnosis, in a large case-control study on the association between myocardial infarction (MI) and oral contraceptives. DESIGN: Community case-control study in England, Scotland and Wales. SUBJECTS: Cases were women aged 16-44 with a diagnosis of MI. Controls were age and general practice matched women without a diagnosis of MI. RESULTS: The proportion of interviewed cases per number eligible was 19% (95% CI 12-26%) lower in England and Wales than in Scotland. The kappa score for agreement between three cardiologists on diagnostic categories of the potential cases was 0.52 overall ('moderate' agreement). For the 35 cases resubmitted for categorization, the kappa scores for agreement between the first and second classification for the two national committee cardiologists were 0.32 and 0.23 ('fair' agreement). Age matching of controls was better in Scotland than England and Wales, the proportion of the first choice controls being 14% (95% CI 8-19%) higher in Scotland. The mean time to complete a cluster of interviews (one case and four controls) was 36 days in Scotland and 63 days in England and Wales. CONCLUSIONS: Very close age-matching was achieved overall, although the process was more efficient in Scotland than in England and Wales. Some suggestions for improvement in the case validation process are made.

Journal Article↗
PubMedDate not supplied

Continuity of care: is the personal doctor still important? A survey of general practitioners and family physicians in England and Wales, the United States, and The Netherlands.

PURPOSE: We determined the reported value general practitioners/family physicians in 3 different health care systems place on the various types of continuity of care. METHODS: We conducted a postal questionnaire survey in England and Wales, the United States, and The Netherlands. The participants were 1,523 general practitioners/family physicians (568 from England and Wales, 453 from the United States and 502 from The Netherlands). Our main outcome measures were the perceived importance of the types of continuity of care and doctor or practice characteristics that may influence attitudes toward personal continuity of care. RESULTS: The response rates were England and Wales 60% (568/946), United States 47% (453/963) and Netherlands 76% (502/660). The doctors in all 3 countries felt strongly that personal continuity remained an important aspect of good-quality care to their patients. Within a given health care system, doctors' personal and practice characteristics explained only a small part of the variance in attitudes toward the provision of personal continuity of care (England and Wales and The Netherlands r2 = 0.04, United States r2 = 0.01). The doctors in all 3 countries felt that they were currently able to provide all 3 types of continuity of care, although doctors in England and Wales were least positive about the provision of informational and management continuity across the primary-secondary care divide. CONCLUSIONS: General practitioners/family physicians from 3 differing health care systems all place high value on being able to provide personal continuity of care to patients. Personal continuity of care remains a core value of general practice/family medicine and should be taken account of by policy makers when redesigning health care systems.

Adult↗
PubMed1982

A decade of surgery in Canada, England and Wales, and the United States.

Between 1966 and 1976, overall surgical rates in Canada remained relatively unchanged and consistently 60% higher than those in England and Wales. Overall United States rates were the highest of the three countries and increased 25% over the ten years. Numbers of surgeons per capita increased in both Canada and England and Wales but overall surgical rates in the two operative rates increased. During the decade, Canada had more hospital beds per capita than the United States while England and Wales had the fewest. Since 1970, the percentage of gross national product spent on health care has been greatest in the United States, intermediate in Canada, and lowest in England and Wales. These expenditures may better reflect national priorities and value and, thus be more important than per capita numbers of hospital beds or surgeons in explaining the cross-national difference in rates of surgery.

Aged↗
PubMed2005

Comparison of suicide in people aged 65-74 and 75+ by gender in England and Wales and the major Western countries 1979-1999.

BACKGROUND: The factors most strongly associated with suicide are age and gender--more men than women, and, more people over 65 kill themselves. As a number of Governments have targets to reduce suicide levels we compare elderly suicide rates over a 20-year period in England and Wales. And the major Western countries focusing upon age and gender. METHOD: WHO mortality data were used to calculate three-year average General Population Suicide Rates (GPSR) for 1979-1981 to 1997-1999 and rates of people aged 65-74 and 75+ suicide by gender to provide ratios of change and a statistical comparison of England and Wales and the Major Western countries over the period. RESULTS: Male GSPR: '65-74' suicide ratios fell significantly in six countries and in three for the '75+'. Female GSPR: '65-74' suicide ratios fell in every country except Spain. Proportionately, there were more suicides in the over 65s in countries with an 'extended family' tradition, Spain, Italy, Germany, France and Japan, than in the five 'secular' countries. England and Wales male '65-74' suicide fell significantly more than Canada, France, Germany, Italy, Japan, Spain, Netherlands and the USA, and did significantly better than the other countries for all female senior citizen suicides. CONCLUSION: Suicide of the over-65s has improved in seven countries, especially in England and Wales, who had the greatest proportional reduction, which reflects well upon the psycho-geriatric and community services. However, in all countries, male 65-74 rates did not match the female out so extra efforts are needed to improve male rates.

Age Distribution↗
PubMed2002

Access rights for outdoor recreation in New Zealand: some lessons for open country in England and Wales.

Access opportunities for outdoor recreation in New Zealand and England and Wales are classified according to their conformity with collective, citizenship or exclusion rights and their degrees of permanence. Alternative criteria for the apportionment of access rights are considered in the context of this classification. Different criteria for rights apportionment are found to be appropriate according to different circumstances in the context of pluralist provision. Policy developments in New Zealand are compared with those in England. After 150 years of a dominance of collective rights in New Zealand current policy is shifting provision towards exclusionary rights. In England, there is a policy shift in the other direction, towards collective rights. Lessons for the development of collective rights in England are drawn from the New Zealand experience in relation to styles of governance, public preferences, public cost, insurance liability and the potential of markets.

Civil Rights↗
PubMed1985

Comparative study of chronic hepatitis: histological differences between Japan and England.

A comparative study of chronic hepatitis in two hospitals in Japan and England is reported. Patients seen in England came from a variety of countries and races. Type B chronic hepatitis was common in both hospitals. While CPH, CLH, and mild CAH were more frequently seen in cases from England, two thirds of the cases from Japan showed moderate or severe CAH. The most striking differences among the histological features were plasma cell infiltration and lymphoid follicle formation. The former was more frequent and conspicuous in cases from England, and the latter in non-A non-B cases from Japan. The incidence of bile duct damage and granulomatous lesions was different in the two hospitals. It was concluded that geographical differences should be taken into account when pathogenesis, histological definition, treatment and many other aspects of chronic hepatitis are assessed.

Adult↗
PubMed1999

The geographical distribution of suicides in farmers in England and Wales.

Farmers in England and Wales have an elevated risk of suicide. The aim of this study was to investigate the geographical distribution of suicides in farmers. Rates of suicide (including suicide and open verdicts) of farmers in England and Wales between 1981 and 1993 were calculated on a county basis. Trends in rates and differences in rates between counties, regions and England and Wales were then analysed. There were 719 suicides (634 suicide verdicts and 85 open verdicts). There was evidence of a decline in annual rates of suicide in farmers during the study period in England but not Wales. There was no evidence of geographical heterogeneity of farming suicides according to counties, but a relatively high rate for Devon (N = 62 suicides). County farming suicide rates did not appear to be related to local general population suicide rates, density of farmers or type of farm holding. While identification of counties with relatively large numbers of farming suicides should assist targeting of local preventive programmes, it is clear that any significant prevention strategies should be implemented on a national basis.

Adolescent↗
PubMed1985

Mortality rates for farmers and fishermen in Japan compared with England and Wales.

Life tables for all causes of death for farmers and fishermen in Japan have been compared with those for England and Wales. Considering all causes of death, there are no occupational differences between farmers and fishermen in Japan. On the other hand, there are large occupational differences indicating that fishermen are worse off than farmers in England and Wales. Standardized mortality ratios (SMR) for each disease in terms of occupation have also been compared in the two countries. The SMRs for leading causes of death in Japan, such as cerebrovascular disease, are significantly lower for fishermen than for farmers in Japan. On the contrary, SMRs for leading causes of death in England and Wales, such as ischemic heart disease and lung cancer, are significantly higher for fishermen than for farmers in England and Wales. However the SMRs for ischemic heart disease and lung cancer are significantly higher for fishermen than for farmers in both countries.

Actuarial Analysis↗
PubMed1990

Paediatric burn injuries in New England, USA.

The authors analysed a subset of data from the New England Regional Burn Program (NERBP) to describe the epidemiology of burn injuries for children aged from birth to 19 years in the six-state New England area of the USA. The subset of the NERBP data analysed pertained to residents of the six New England states who were admitted to hospital for the treatment of a burn injury sustained between 1 July 1978 and 30 June 1979. Analysis of the data revealed that 1128 (41 per cent) of the 2742 hospitalized burns identified occurred to persons between the ages of birth and 19 years, yielding an overall burn incidence rate of 30.7 burns per 100,000 person-years. Children aged from birth to 2 years sustained a higher burn rate, 96.7 burns per 100,000 child-years, than did children in any other age category. The burn rate for males was higher than the rate for females in each age category, as were the rates for black children compared to white children. Children in Massachusetts experienced the highest overall burn rate among the six New England states; the lowest rate occurred in New Hampshire. Overall, 63 per cent of the burns occurred in a residential setting. The most common activities related to burn injury were food preparation and food consumption, which accounted for 471 (42 per cent) of the burn injuries.

Accidents, Home↗
PubMed2025

Whole-genome sequencing, strain composition, and predicted antimicrobial resistance of Streptococcus pneumoniae causing invasive disease in England in 2017-20: a prospective national surveillance study.

BACKGROUND: Surveillance of the invasive disease burden caused by Streptococcus pneumoniae in England is performed by the UK Health Security Agency (UKHSA). In 2017, UKHSA switched from phenotypic methods to whole-genome sequencing (WGS) approaches for pneumococcal surveillance. Here, we present the first results of national WGS surveillance, up to the start of the COVID-19 pandemic, with the aim of describing the population genomics of this important pathogen. METHODS: We examined prospective national surveillance data from England, using bacterial isolates from cases of invasive pneumococcal disease (IPD) submitted to the national reference laboratory at UKHSA. A bioinformatic pipeline was developed to quality control WGS data and routinely report species and serotype. We assembled isolate data, assigned global pneumococcal sequencing clusters (GPSCs), and predicted antimicrobial resistance (AMR) profiles for isolates that passed further quality control. We collected additional data on patient outcomes and characteristics using enhanced surveillance questionnaires completed by patients' general practitioners. We used logistic regression analysis to assess the effects of various genomic and patient characteristics on the outcomes of IPD. FINDINGS: In England, between July 1, 2017, and Feb 29, 2020, there were 15 400 cases of IPD. From these cases, 13 749 (89·3%) isolates were sequenced, passed quality control, and were included in analyses. Serotype diversity was high during the study period, with 2751 (20%) isolates serotyped as 13-valent pneumococcal conjugate vaccine (PCV13) types, whereas serotype 8 was the most prevalent serotype (n=3074 [22·4%]) overall. There were 157 GPSCs within the collection, with GSPC3 the most common, encompassing 98·7% (3033 of 3074) of serotype 8 isolates. Most isolates (n=10 198 [74·2%]) did not contain AMR-associated genes. Resistance to co-trimoxazole was the most frequently predicted resistance (n=2331 [17%]), followed by resistance to tetracycline (n=1199 [8·7%]) and β-lactams (n=1149 [8·4%]). Logistic regression analysis found the presence of AMR-associated genes significantly increased the odds of patient death (odds ratio 1·18, 95% CI 1·01-1·38). Some GPSCs were also associated with a significant increase in the odds of patient death, such as GPSC12 (1·88, 1·48-2·38). Isolates from 2018 were associated with a significant increase in the odds of patient death (1·12, 1·00-1·25), whereas younger patient age was significantly associated with a reduction in the odds of patient death compared with being aged 85 years or older. INTERPRETATION: WGS-based surveillance has allowed us to interrogate country-wide population dynamics driving changes in pneumococcal serotype frequency. Here, we observe a stable but diverse population before the COVID-19 pandemic restrictions were enforced in England, with low rates of AMR. These findings will provide the baseline for pandemic and post-pandemic data, to collectively inform implementation and development of the vaccination programme within the country. FUNDING: None.

Streptococcus pneumoniae↗
PubMed2004

Understanding the physical and environmental consequences of dredged material disposal: history in New England and current perspectives.

Thirty-five years of research in New England indicates that ocean disposal of dredged material has minimal environmental impacts when carefully managed. This paper summarizes research efforts and resulting conclusions by the US Army Corps of Engineers, New England District, beginning with the Scientific Report Series and continuing with the Disposal Area Monitoring System (DAMOS). Using a tiered approach to monitoring and a wide range of tools, the DAMOS program has monitored short- and long-term physical and biological effects of disposal at designated disposal sites throughout New England waters. The DAMOS program has also helped develop new techniques for safe ocean disposal of contaminated sediments, including capping and confined aquatic disposal (CAD) cells. Monitoring conducted at many sites in New England and around the world has shown that impacts are typically near-field and short-term. Findings such as these need to be disseminated to the general public, whose perception of dredged material disposal is generally negative and is not strongly rooted in current science.

Atlantic Ocean↗
PubMed2000

Cancer survival rates and GDP expenditure on health: a comparison of England and Wales and the USA, Denmark, Netherlands, Finland, France, Germany, Italy, Spain and Switzerland in the 1990s.

Health funding is central to public health planning and clinical practice, hence this comparison of GDP health expenditure and five year post-diagnostic cancer survival rates of England and Wales with the USA and eight European countries. The three lowest proportional GDP health expenditures over the period 1980-1990 were Denmark, England and Wales, and Spain. The USA had the highest proportional GDP expenditure, followed by France, Germany, and The Netherlands. Overall the USA had the best cancer survival rates in the 14 sites reviewed, followed by Switzerland, The Netherlands, and Germany. The least successful were Spain, England and Wales, and Italy. In respect to the high incidence cancers, colorectal, lung, and female breast cancers, England and Wales survival rates were the poorest of all ten countries, followed by Denmark and Spain. Higher GDP health expenditure and longer survival rates for each gender were significantly correlated indicating a possible association between fiscal input and clinical outcomes, which poses problems for the development of effective public health.

Denmark↗
PubMed2001

Reasons for extraction by dental practitioners in England and Wales: a comparison with 1986 and variations between regions.

OBJECTIVES: To compare reasons for extraction in 1997 and 1986, and to consider regional variations for the 1997 data. METHODS: Random samples of general dental practitioners (GDPs) completed questionnaires for all extractions for 4 weeks in 1986 and in 1997. Reasons for extraction by region were compared for the 1997 data. RESULTS: 220 and 562 GDPs participated in 1986 and 1997, respectively, averaging 24 extractions in 1986 and 20 in 1997. 'Caries' remained the commonest reason for < or =50-year-olds (excluding 'ortho'), but peaked a decade later than in 1986. One-third of 'perio' extractions in both studies were for 51-60-year-olds, but in 1997 there were fewer such extractions for < or =40-year-olds and more for >70-year-olds than in 1986. In 1997 'caries' and 'perio' extractions remained equally common for patients >50 years, but there were far more extractions for both reasons for >80-year-olds. Patients < or =30 years in S. England and in the Midlands/E. Anglia had more 'ortho' than 'caries' extractions, whereas 'caries' predominated in N. England and in Wales. 'Caries' exceeded 'perio' for patients >40 years in Wales, whereas in the three English regions the two reasons were equally frequent. CONCLUSIONS: Comparisons of results of two studies conducted a decade apart indicate that there have been some changes in reasons for extraction. Overall, mean number of extractions per dentist has declined, and it appears that the trend is for extractions due to the common dental diseases to be carried out later in life. The 1997 data also suggest that young patients in Wales and N. England are relatively disadvantaged, having more caries and less orthodontic treatment than those in other parts of England.

Adolescent↗