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PubMed2003

Reducing psychiatric stigma and discrimination--evaluating an educational intervention with the police force in England.

BACKGROUND: Across the world there are programmes challenging negative stereotypes of people with mental health problems and associated discriminatory behaviours, but the evidence base describing what works in practice is still underdeveloped. This paper evaluates the effectiveness of a mental health training intervention with the police force in England. METHOD: A total of 109 police officers attended training workshops and completed pre- and post-questionnaires detailing knowledge, attitudes and behavioural interventions. RESULTS: Mean attitude scores fell from 2.4 at baseline to 2.3 at follow-up (p < 0.0001) using a 5-point Likert scale. Five key message statements were assessed - 70 % of cases successfully reported more messages at follow-up as compared to baseline; however, the stereotype linking people with mental health problems with violent behaviour overall was not successfully challenged. Positive impacts on police work, particularly improvements in communication between officers and subjects, were reported by a third of cases. CONCLUSIONS: Short educational interventions can produce changes in participants' reported attitudes towards people with mental health problems, and can leave police officers feeling more informed and more confident to support people in mental distress.

Attitude to Health↗
PubMed2004

Suicide risk in small areas in England and Wales, 1991-1993.

BACKGROUND: There is growing evidence that areas characterised by high levels of social fragmentation have higher suicide rates. Previous ecological studies have focused on relatively large geographic areas and/or examined associations in all age groups combined. METHODS: Negative binominal regression was used to assess age- and sex-specific suicide rate ratios for a range of census-derived indicators of the social, health and economic characteristics of small areas (mean population aged > or = 15: 4500) in England and Wales. RESULTS: Indicators of social fragmentation (e. g. proportion of people living alone or population mobility) were most consistently associated with suicide risk. For example, across quartiles of wards ranked according to increasing proportions of single-person households, age- and sex-adjusted suicide rate ratios were: 1.00, 1.05 (1.00, 1.11), 1.14 (1.08, 1.19) and 1.42 (1.36, 1.49). Associations were strongest in 15 to 44 and 45 to 64 year-olds. Associations with social fragmentation persisted after controlling for the effect of other area characteristics. CONCLUSIONS: Targeted mental health promotion and social policy initiatives to reduce area-health inequalities in suicide might usefully focus on areas with high levels of social fragmentation.

Adolescent↗
PubMed2000

A comprehensive clinical database for mental health care in England.

BACKGROUND: Monitoring and researching clinical care calls for comprehensive clinical databases. In mental health care these need to cover all aspects of the care of each patient and to accommodate the complexity of care which may last from weeks to years. This paper describes the pilot work for a mental health clinical database intended to be implemented throughout the English National Health Service. METHODS: In collaboration with three pilot sites, a set of data extracts was defined which could reasonably easily be produced, mostly using existing statistical data collection systems. Software was designed to integrate these extracts into patient-based records describing overall spells of mental health care. These data were extracted from their systems for a 6-month pilot period. RESULTS: Two of the three sites produced data sets, which appeared to give a reasonably complete account of the work undertaken in the pilot period. Known differences in service design and clinical perspective between the two sites were clearly reflected. CONCLUSIONS: The approach to extracting and collating the data is workable within existing resources and produces illuminating data for clinical audit, management and planning. Completeness and accuracy of data is likely to be a continuing problem, as for any routine data capture exercise. However, the process of integrating data from several channels assists this, as inconsistencies become apparent and can be tackled. The approach is now being implemented throughout England.

Adolescent↗
PubMed2001

Managing severe mental illness in the community using the Mental Health Act 1983: a comparison of Supervised Discharge and Guardianship in England.

BACKGROUND: Two measures in the English Mental Health Act allow requirements to be imposed upon patients living in the community. These are Guardianship (Section 7) and Supervised Discharge (Section 25A). AIMS: The paper aims to compare patients with mental illnesses, made subject to Guardianship or Supervised Discharge. METHOD: Data on patient characteristics, impairment, needs and interventions were collected from keyworkers in a random national sample of Trusts and local authorities. Ratings were obtained on standardised measures of disability, impairment and needs. RESULTS: Patients placed on Supervised Discharge were more likely to have problems of treatment compliance and drug misuse, whilst those on Guardianship were more likely to have problems of social welfare and higher ratings of disability and impairment. Supervised Discharge has a higher proportion of African-Caribbean patients. Interventions delivered are rated as effective for both measures. CONCLUSIONS: Legal changes proposed in England include a single power for supervision in the community. This should not mean a focus on risk management to the neglect of social welfare interventions.

Adult↗
PubMed2003

Factors related to the use of bone densitometry: survey responses of 494 primary care physicians in New England.

Large population-based surveys have shown that approximately 30% of people over age 65 years have osteoporosis and that 17% of the population over 65 years will sustain a fracture during their lifetime. Many people with osteoporosis are never being evaluated even though effective treatments are available. We examined why primary care physicians order few bone mineral density scans. We conducted a cross-sectional survey of primary care physicians practicing in any of the six New England states. Target physician specialties included internal medicine, general practitioners/family physicians, and obstetrician-gynecologists who had a facsimile number listed with the American Medical Association. Demographics, practice characteristics, use of bone densitometry, and attitudes regarding osteoporosis, bone densitometry and health maintenance were assessed by questionnaire. Twelve percent (n=494) of the physicians responded to the questionnaire. Respondents were similar to non-respondents with respect to years of practice, training and geographical state, though they were more likely to be female (p < or =0.05). Respondents had a mean age of 51 years, and 51% were trained in internal medicine, 25% in general practice/family practice and 24% in obstetrics-gynecology. The mean number of self-reported bone densitometry referrals per month was 10+/-11, and 25% of respondents reported that they referred fewer than 4 patients per month. In adjusted logistic models, factors significantly associated with referring fewer than 4 patients per month were: training in internal medicine (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.0-3.9) or general practice/family practice (OR 2.6, 95% CI 1.3-5.2) versus obstetrics-gynecology; practicing in an urban setting (OR 2.5, 95% CI 1.3-4.9) or rural/small town setting (OR 2.2, 95% CI 1.2-4.1) versus a suburban setting; spending less than 50% of professional time in patient care (OR 4.0, 95% CI 1.7-9.5); seeing the lowest proportion of postmenopausal women (OR 2.5., 95% CI 1.2-5.3); the belief that calcium and vitamin D are adequate to treat osteoporosis (OR 2.1, 95% CI 1.0-4.5); and the belief that osteoporosis treatment should not be based on bone density results (OR 3.2, 95% CI 1.7-6.1). Potentially modifiable physician beliefs and a number of practice characteristics are associated with low referral rates for bone densitometry. Educational strategies aimed at improving the use of bone density testing should consider these factors.

Absorptiometry, Photon↗
PubMed2005

Prescription-event monitoring study on 13,164 patients prescribed risedronate in primary care in England.

Risedronate sodium is indicated in postmenopausal women for the prevention and treatment of osteoporosis and for the treatment of Paget's disease. Our aim was to evaluate the safety of risedronate in a large cohort of patients prescribed risedronate by general practitioners (GPs) in England, soon after it was marketed. An observational cohort study was conducted using the technique of prescription-event monitoring (PEM). Exposure data were obtained from dispensed National Health Service prescriptions issued between September 2000 and June 2002. Outcome data were collected by sending questionnaires to prescribing GPs requesting them to report any events that had occurred since starting risedronate, demographic details, indication, start and stop dates, reasons for stopping, suspected adverse drug reactions (ADRs) and causes of death. Event rates calculated as incidence densities (IDs) separately, for Paget's disease group and all other patients (osteoporosis group) were ranked and the difference between IDs in month 1 and months 2-6 calculated. The osteoporosis cohort comprised 13,180 patients (10,934 [83.0%] female); median ages for female and male patients were 73 and 69 years, respectively. The most frequently reported event in the first month of treatment was dyspepsia, being also amongst the most frequently reported reasons for stopping risedronate and suspected ADR. Adverse events assessed as possibly or probably related to risedronate included, six of facial edema and one each of Stevens-Johnson syndrome, swollen tongue, palpitation and episcleritis. Risedronate was fairly well tolerated. Adverse events affecting skin, eye, cardiovascular and immunological systems were identified. Prescribing doctors should be aware of these and monitor their patients accordingly.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Evaluation of the safety of bupropion (Zyban) for smoking cessation from experience gained in general practice use in England in 2000.

BACKGROUND: Bupropion (Zyban) is the first new pharmacological treatment for smoking cessation to be introduced since nicotine replacement therapy. In smoking cessation trials, it has been associated with minimal side effects. A range of suspected adverse drug reactions (ADRs) were reported via the spontaneous reporting system following its use in smoking cessation. AIM: To examine the safety of bupropion used in general medical practice in England as a treatment for cessation of smoking. OBJECTIVES: To quantify the incidence of events that were reported for patients prescribed bupropion; and to identify any previously unrecognised ADRs. METHODS: A post-marketing observational cohort study was conducted using the methodology of prescription-event monitoring (PEM). Exposure data were derived from the first prescription dispensed for patients whose prescription details were processed by the Prescription Pricing Authority in August 2000. Outcome data were derived from 'green form' questionnaires (GFs) sent to general practitioners (GPs) at least 6 months following the first prescription issued. Incidence densities (IDs) were calculated for events reported per 1000 weeks of patient treatment and ID differences between time periods analysed. Events of interest were followed up by postal questionnaire sent to GPs. All-cause and condition-specific mortality up to 12 weeks after starting bupropion were compared through indirect standardisation between the PEM cohort and Cancer Prevention Study-II (USA) (CPS-II) data. RESULTS: GF response rate was 48.1%, with 11,735 GFs containing useful data - of these patients, 5695 (48.5%) were male (median age 47 years, range 16-88 years) and 6009 (51.2%) were female (median age 47 years, range 16-87 years). Age was recorded for 4092 (34.9%) of the cohort of 11,735 after follow-up. There were 566 events in 350 patients reported by GPs as ADRs to bupropion. GPs reported 10,200 reasons for stopping bupropion among 9056 patients. The highest ranked clinical events (by ID for weeks 1-6 of treatment) were; 'insomnia' ( n=308), 'nausea/vomiting' ( n=243) and 'dizziness' ( n=185). Bupropion was taken in the first trimester of 12 pregnancies and the outcome ascertained in eight cases - five live births (no congenital abnormalities reported), two therapeutic terminations and one intrauterine death (no further details). The standardised mortality ratio (SMR) for all-cause mortality up to 12 weeks after starting bupropion was 0.77 (95% CI: 0.42, 1.28). CONCLUSION: This study describes the safety profile of bupropion (Zyban) as used in the community; a small number of adverse events were reported that were not included on the SmPC. For many events, nicotine withdrawal was a confounding factor. SMR calculations did not provide evidence for a higher rate of mortality (either all-cause or condition-specific) in the PEM cohort relative to smokers from the CPS-II cohort in the USA. While reassuring, the SMR should be interpreted in context with results from other studies on bupropion when used for smoking cessation.

Adolescent↗
PubMed2004

A case control study to examine the pharmacological factors underlying ventricular septal defects in the North of England.

BACKGROUND: Amphetamine exposure is associated with congenital cardiac abnormalities in animals. We previously reported an association between recreational use of 2,4-methylenedioxymethamphetamine (ecstasy, MDMA) and ventricular septal defect in babies born to users. We have carried out a case control study to investigate risks in the occurrence of ventricular septal defect in a cohort of babies born in the North East of England. METHODS: Cases were identified from paediatric cardiology units in Newcastle upon Tyne and Leeds, and controls were recruited from the mothers of babies born in the same hospital as the index case. Research nurses carried out interviews using a structured questionnaire. RESULTS: A total of 296 case control pairs were studied. There was insufficient exposure to ecstasy to test the primary hypothesis. Increased risk of ventricular septal defect was found to be associated with consumption of cough and cold remedies [pre-conception OR 2.2, 95% CI 1.41, 3.51; pregnancy OR 5.1, 95% CI 2.56, 11.27; exposure in either OR 2.83, 95% CI 1.85, 4.45; P<0.005] and in the case of non-steroidals for exposures in pregnancy (OR 4.2, 95% CI 1.54, 14.26; P<0.005). CONCLUSIONS: These findings suggest that ventricular septal defect is associated with consuming the medications identified. They are also compatible with the hypothesis that sympathomimetics (pseudoephedrine, phenylephrine and phenylpropanolamine) present in cough mixtures cause the increased risk, and with our original hypothesis that sympathomimetics and amphetamines are potentially cardiotoxic in utero.

Adolescent↗
PubMed2007

Adult mental health care in England.

The policy background and current overall provision of mental health services for working age and older adults in England are described. Following the introduction of a new National Service Framework in 1999, an annual service mapping exercise was introduced. Data presented draw heavily on the mapping for 2003. This is supplemented by hospital admission statistics data from the new patient-based mental health minimum data set, introduced from April 2003, and a number of other corroborative sources. Data about services for older people are more restricted in scope and detail. Close attention is given to the extent to which data from these routine sources can be considered accurate.

England↗
PubMed2005

Neonatal meningitis in England and Wales: sequelae at 5 years of age.

UNLABELLED: This study determined the prevalence of serious sequelae among a national cohort of 5-year old children, born in England and Wales in 1996-7, who had had neonatal meningitis. The results were compared with those from two matched control groups. In addition the results from this study were compared with those from a previous 5-year follow-up of children who had had neonatal meningitis in 1985-7. Follow-up questionnaires requesting information about the children's health and development were sent to the general practitioners (GPs) and parents of the index children and controls. Information was collected on 166 of 232 (72%) children who had had meningitis as neonates, 109 general practice controls and 191 hospital controls. At 5 years, 39/166 (23%) index children had a serious disability compared to 2% of GP controls and 7% of hospital controls. There was a 16-fold increase in risk of serious disability compared to GP-matched controls and a 4-fold increase in risk compared to hospital controls. The isolation of bacteria from the CSF was the best single predictor of serious long-term disability. Although there was a 70% fall in acute phase mortality between 1985 (22%) and 1996 (6.6%), the overall incidence of serious disability remained alarmingly high, 25.5% in 1985 compared to 23.5% in 1996. In the present study, however, fewer children had cerebral palsy or seizure disorders. CONCLUSION: Despite the dramatic improvement in acute phase survival following neonatal meningitis, the prevalence of serious sequelae remains alarmingly high.

Child↗
PubMed2003

Recovery of a northern New England salt marsh plant community from winter icing.

High latitude salt marsh plant communities are frequently exposed to conspicuous winter ice disturbances, which trigger secondary succession. In this paper, we document the recovery of a northern New England salt marsh from a severe winter icing event in 1998. Ice disturbances that killed plants but that left the underlying peat intact recovered rapidly. However, ice damage that killed plants and removed the underlying peat, led to areas of physiologically harsh edaphic conditions, specifically waterlogged and anoxic soils that limited plant recolonization. A transplant experiment revealed that only the most stress-tolerant plants were capable of invading the most stressful portions of ice disturbances. A second experiment that artificially dried disturbance patches accelerated patch recovery. These data suggest that recovery from intense ice disturbance is dependent on stress-tolerant plants invading edaphically harsh disturbances, eventually facilitating the recolonization of the community. This process likely takes longer than a decade for full recovery to occur in the areas where both plants and the peat base are removed.

Ecosystem↗
PubMed2005

The mycorrhizal community in a forest chronosequence of Sitka spruce [Picea sitchensis (Bong.) Carr.] in Northern England.

Demography and fungal diversity of the belowground ectomycorrhizal community in a chronosequence of Sitka spruce [Picea sitchensis (Bong.) Carr.] in Northumberland, Northern England, were analysed; mycorrhizal root samples were taken from 6-, 12-, 30- and 40-year-old stands, and fungal fruiting bodies were collected in autumn to complement the survey. Naturally germinated seedlings less than 1 year of age (taken from the 30-year-old stand) were also examined. A total of 118,000 mycorrhizal root tips were extracted from 40 soil cores (ten per age class) and from the complete root systems of 25 seedlings and separated into active and senescent root tips according to their morphology and anatomy. Active tips were distinguished according to their mycobionts which were characterised and identified microscopically. Although almost 100% of all fine roots were mycorrhizal, EM fungal diversity throughout the chronosequence was low, consisting of a total of 16 species of which three were only found as fruiting bodies. Of the six mycobionts found most regularly below ground, Tylospora fibrillosa was the most common, colonising about 70% of all root tips and more than 90% of those of seedlings and young trees. Root density and mycorrhizal diversity increased, but percentage of vital root tips decreased with increasing tree age, levelling off in the 30- and 40-year-old stand. Among the five subdominant fungal species, Dermocybe crocea was found to have its peak of distribution in the 12-year-old stand and Russula emetica, Lactarius rufus, Hymenoscyphus ericae agg. and the unidentified Piceirhiza sulfo-incrustata in the 30- and 40-year-old stands. The possible correlations between the mycorrhizal community structure and biotic and abiotic factors are discussed.

Biodiversity↗
PubMed1997

Genetic characterisation of an influenza A virus of unusual subtype (H1N7) isolated from pigs in England.

An H1N7 influenza A virus, isolated from pigs in England in 1992, was examined genetically to determine the characteristics and probable origin of the eight gene segments. Six of the RNA segments encoding PB2, PB1, PA, HA, NP and NS were related most closely to those of human viruses, whilst two of the RNA segments (NA and M) were related most closely to those of equine viruses. The HA gene was most similar to that of A/USSR/90/77 (H1N1) but amino acid differences suggested independent genetic drift. In contrast, there were relatively few changes in the NA and M genes compared to those of A/equine/Prague/1/56 (H7N7).

Animals↗
PubMed2005

Incidence and outcome of pneumococcal meningitis in northern England.

Since pneumococcal meningitis continues to have high mortality and morbidity, and may be under-reported to national surveillance systems, the present study was conducted to assess the incidence, features, and outcomes of microbiologically confirmed cases of pneumococcal meningitis in North Yorkshire, England, between 1997 and 2002. The review revealed 50 cases, which accounted for an incidence of 1.1. per 100,000 per year. The incidence was markedly seasonal, with 76% of cases occurring in the winter months. Mortality was 28%, and 28% of the survivors suffered long-term sequelae. A high Glasgow Coma Score on hospital admission was significantly associated with survival. There were 12 children in the study, aged 2 months to 2 years, and none of them would have been classified as candidates for conjugate pneumococcal vaccination according to UK recommendations.

England↗
PubMed2004

Genetic variation in the enzyme esterase, bioaccumulation and life history traits in the earthworm Lumbricus rubellus from a metal contaminated area, Avonmouth, England.

Earthworms, Lumbricus rubellus, were collected in three successive years, 1997, 1998 and 1999 from 5, 6 and 4 sites, respectively, along a metal gradient near a smelter at Avonmouth, England. In total 271 worms were collected, 47 in 1997, 97 in 1998, and 127 in 1999. The worms were analysed for the enzyme esterase by means of agarose electrophoresis and for internal metal concentration. At one site collected in three successive years, 64 individuals of 66 were heterozygous for the esterase enzyme. The metal concentrations (Cu and Zn) in worms were significantly correlated with the total concentration and the CaCl2 extractable fraction of the metal in the soil. One of the homozygous esterase genotypes was significantly correlated with distance from the smelter, the extractable fraction of metals from soil, and the metal concentration in the worms. The other homozygous genotype was correlated with the CaCl2 extractable Cu and the Cu concentration in the worms. The internal levels of Cd, Cu, and Zn showed a higher classification potential (Discriminant Analysis) for 50 of 127 individuals, collected in 1999, when based on the original habitat of the earthworms than on the esterase genotype. The remaining 77 specimens, representing three sites, were exposed for 30 days in the laboratory to soils from four sites. For the individuals in this transplantation experiment, parameters measured were the esterase phenotype, internal metal concentration (Cd, Cu, and Zn), mortality, wet weight change, cocoon production, and cocoon hatching success. Cocoon production was highest among the worms from the most contaminated area, while worms from the least contaminated area had the highest hatching success. Neither the metal concentrations, in soil or internal, nor the life-history parameters could fully explain the genotypic distribution of esterase along the gradient. The internal concentrations of Cd, Cu and Zn in the worms used for the transplantation experiment showed the highest classification potential (Discriminant Analysis) when the prediction was based on the original habitat of the earthworms. The classification potential was less strong when based on esterase genotype and least on the transplantation conditions. Including life history traits did not enhance the prediction potential.

Animals↗
PubMed2005

Bioaccessibility of arsenic in soils developed over Jurassic ironstones in eastern England.

Jurassic ironstones outcropping over parts of eastern England give rise to soils with arsenic concentrations in excess of the UK soil guideline value of 20 mg kg(-1) for residential areas. Total arsenic concentrations were determined for 73 ironstone derived soils and bioaccessible arsenic determined using an in vitro physiologically based extraction test. The bioaccessible arsenic concentration for these soils was found to be well below the soil guideline value with a mean concentration of 4 mg kg(-1) and a range of 2-17 mg kg(-1). The bioaccessible fraction ranges from 1.2 to 33%. Data from a sequential extraction test based on the use of aqua regia as the main extractant is presented for a subset of 20 of the soils. Chemometric data reduction is used to demonstrate that the bioaccessible arsenic is mainly contained within calcium iron carbonate (sideritic) assemblages and only partially iron aluminosilicates, probably berthierine, and iron oxyhydroxide phases, probably goethite. It is suggested that the bulk of the non-bioaccessible arsenic is bound up with less reactive iron oxide phases.

Aluminum Silicates↗
PubMed2006

Space-time clustering analyses of testicular cancer amongst 15-24-year-olds in Northern England.

There has been speculation that environmental exposures may be involved in the aetiology of testicular cancer in adolescent boys and young men. Indirect evidence for this hypothesis would be provided by the finding of space-time clustering. To examine this we have looked for evidence of space-time clustering using data from a population-based cancer registry from Northern England. All cases of testicular cancer diagnosed in males aged 15-24 years during the period 1968-2002 were included in the study. Tests for space-time interactions between cases were applied with fixed thresholds of close in space and close in time. Addresses at birth and diagnosis were used in the analyses. To adjust for the effect of varying population density tests were repeated replacing fixed geographical distances with nearest neighbour thresholds. A total of 257 cases of testicular cancer were identified for analysis. Overall there was no evidence for space-time clustering. However, there was statistically significant space-time clustering for 15-19-year-old based on time of birth and place of diagnosis (p<0.001). The very limited finding of space-time clustering may provide tentative evidence for an environmental, or infectious component to aetiology. However, it may well be a chance finding. A larger study based on national data is required.

Adolescent↗
PubMed2006

The composition of PM10 as collected by a conventional TEOM, a modified TEOM and a Partisol gravimetric monitor at a kerbside site in the North East of England.

The composition of airborne particulate matter sampled by a conventional TEOM, an experimental modified TEOM, operated at a lower temperature but fitted with a drier to remove moisture and a Partisol, installed at a kerbside site in the North East of England, has been investigated. The results indicate that there is a seasonal variation in the composition of PM(10) as sampled by the three monitors, with chloride concentration being significantly higher in the winter. The Partisol was found to sample a higher mass of chloride and nitrate, however the differences between the monitors was only significant for chloride. Both TEOM's were found to sample a greater mass of sulphate, although the variability in the data collected meant that significance of the results was not proven statistically. The range of artifacts associated with PM(10) monitors is reviewed. Difficulties in the interpretation of results due to the variable nature of airborne particulate matter and the ability of filter based systems to accurately represent the composition of atmospheric particles are considered.

Aerosols↗