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PubMed1987

National survey of tuberculosis notifications in England and Wales in 1983: characteristics of disease. Report from the Medical Research Council Tuberculosis and Chest Diseases Unit.

The number of newly notified, previously untreated patients in a survey of notifications of tuberculosis in England and Wales conducted by the MRC in 1983 was 26% lower than in the previous MRC survey in 1978/79. In both surveys the great majority of patients were of White (about half) or Indian subcontinent (Indian, Pakistani or Bangladeshi) ethnic origin (just over a third). The notification rates in the Indian subcontinent (ISC) ethnic groups were much higher than for the White group and were highest in those most recently arrived in the UK. There were a number of differences in the findings for the White and the ISC ethnic groups. Nearly two-thirds of the White patients but less than half of the ISC patients were male and the White patients were, on average, older, about half aged 55 years or more compared with 14% of the ISC patients. Respiratory disease occurred in 82% of the White patients compared with 66% of the ISC patients. Radiographically, at independent assessment, more of the White patients had pulmonary lesions, 88% compared with 63% and these were, on average, more extensive and cavitated than in the ISC patients. Isolated mediastinal lymphadenopathy, however, was more common in the ISC patients. The diagnosis was confirmed bacteriologically on culture of a respiratory specimen in a higher proportion of the White than the ISC patients (65% and 41% respectively) and more were positive on smear as well (45% and 25% respectively). The level of initial drug resistance was lower in the White patients: only 10 (1.6%) of the 623 strains tested were resistant compared to 23 (12.8%) of the 179 from ISC patients. In both White and ISC ethnic groups the commonest non-respiratory lesion was peripheral lymph node involvement, namely 37% of the 369 White and 53% of the 503 ISC patients with non-respiratory disease. The diagnosis was confirmed by bacteriological examination of the lymph node in 47% of the ISC patients compared with 29% of the White patients with a lesion. Bone or joint disease occurred in 11% of the White and 20% of the ISC patients; the commonest site in both groups was the spine. Genitourinary disease was present in 98 (27%) of White and 24 (5%) of ISC patients with a non-respiratory lesion. There were 61 patients with tuberculosis involving the central nervous system, including 55 with meningitis, the proportions being similar for the White and the ISC ethnic groups, 7% and 5% respectively.

Adult↗

PubMed1992

Longitudinal Gompertzian analysis of ALS mortality in England and Wales, 1963-1989: estimates of susceptibility in the general population.

Mortality statistics in amyotrophic lateral sclerosis (ALS), which is more commonly and generally termed motoneurone disease (MND) in the United Kingdom, have been shown to reflect the incidence of previously diagnosed cases of the disease in a more complete way than in other conditions [1,2]. An analysis of changing patterns of mortality may therefore be a particularly appropriate way of tracing the underlying trends in the disease and is in principle a useful way of investigating the relationship between environmental and genetically controlled factors in the genesis of the condition. The majority of analyses so far have concentrated on the crude rise in reported mortality rates evident in recent decades in a number of countries [2-5], on the uneven geographical distribution [6,7] and on the complex range of plausible causes for these reported rises. Debates have centred on whether the increases represent 'real' or 'artifactual' changes, with no apparent resolution of the issue [8,3]. Recently Riggs [9] proposed a novel way of analysing this issue by using a Gompertzian model and provided evidence of the existence of an inherently susceptible subset of the US population. Riggs indicated that while the rise in ALS mortality is real, it is for the most part the result of an increase in the size of this inherently susceptible sub-population due to greater longevity. In order to examine the wider applicability of a Gompertzian model to ALS the technique has been replicated with the mortality rates for England and Wales for the 27-year period from 1963 to 1989. The technique has been developed and extended to produce an estimate of the size of the inherently susceptible sub-population (both male and female) over the entire period.

Adolescent↗

PubMed1986

The Chernobyl accident--radionuclide fallout in S.W. England.

Initial fallout data from the nuclear reactor accident at Chernobyl is presented for the Plymouth region of Devon S.W. England which received low levels of radioactivity. During the period of maximum fallout the overall gross gamma activity for the Plymouth area was approximately 10% higher than levels recorded prior to the Chernobyl accident. The increase in levels of radioactivity were within the variability of natural background found in local houses.

Accidents↗

PubMed1990

Mercury, cadmium and lead concentrations in five species of freshwater fish from eastern England.

A total of 146 samples of five species of fish were examined between March and November 1986 in four sites from the Rivers Brett and Chelmer in eastern England. Variations in heavy metals concentrations between sites and species were related mainly to size differences of fish. Mercury levels in the flesh were higher than in the liver, while cadmium and lead levels were higher in the liver.

Animals↗

PubMed1993

Impact of organochlorine pesticide residues and PCBs on otters (Lutra lutra) in eastern England.

A study of otter (Lutra lutra) populations and levels of organochlorine (OC) pesticide residues and PCBs in otter faeces (spraints) was made on rivers in East Anglia, England. Population and contaminant levels are compared against target values. It is thought that the native otter population was almost extirpated during the study period. The current population must derive largely, if not entirely, from captive-bred animals introduced since 1983. Its range has expanded little and population levels, measured as an index, were generally low. Concentrations of OC pesticides and PCBs were similar to those of lowland stretches of western rivers; however, samples had a smaller proportion of dieldrin and a greater proportion of PCBs. Overall 44% of samples had concentrations of contaminants exceeding the 'level of concern'. It is considered that contamination, especially by PCBs, remains a factor influencing otter populations, which may not be viable in East Anglia without repeated releases of captive-bred animals.

Animals↗

PubMed1981

The use of official sub-national population projections in England: Phase 1, central government departments and public utilities.

"The use made of the official population projections and the derivative household and labour supply projections has been investigated recently in England through a survey of user and potential user organizations. In view of the rather complex arrangements for producing the official projections, the paper begins by providing a summary of what projections are prepared and by whom.... The main part...presents an analysis of the results of the survey...concerned with who uses the projections, the factors influencing the use and value of projections and the demands for an extension of the current service."

Developed Countries↗

PubMed1993

Haemophilus influenzae type b disease in north-west England.

A study was made in the north-west of England during 1989 in order to ascertain the incidence of serious Haemophilus influenzae infection, its short-term morbidity and certain characteristics of treatment. The incidence of culture-proven infection was 28 per 100,000 children under 5 years of age. Case fatality was 3%, one of the deaths being in a 6-year-old child. Some of the information obtained will help to assess the cost-effectiveness of the new vaccine to be administered to children in the U.K. The mean length of stay in hospital for all cases was 10 days. Of a total of 87 patients, 20 (23%) were admitted to an intensive therapy unit while five were transferred from a district general hospital to a regional paediatric unit. The estimated average cost per episode of acute care was 2700 pounds. Antibiotic regimens varied considerably.

Anti-Bacterial Agents↗

PubMed1992

Practices and beliefs concerning screening family members of patients with melanoma. Results of a survey of New England dermatologists.

BACKGROUND: First-degree relatives of patients with melanoma are roughly two to eight times more likely than the general public to be diagnosed with melanoma. Several organizations recommend regular screening for these and other persons at high risk for melanoma. However, there are no data as to how frequently such persons receive skin cancer examinations. OBJECTIVE: Our purpose was to determine the current screening recommendations and practices of dermatologists regarding family screening for melanoma. METHODS: With a one-page questionnaire, we surveyed dermatologists attending a 1989 meeting of the New England Dermatological Society. RESULTS: Seventy-three dermatologists completed the questionnaire. Most dermatologists (70%) reported that they encouraged screening of family members of patients with melanoma but also reported that family members infrequently appeared for skin examinations. CONCLUSION: Although most dermatologists encouraged screening of first degree relatives of melanoma patients, there appears to be infrequent acceptance by the patient of these recommendations. Recording family screening in the patients' charts, reminders to patients, and distributing literature on familial melanoma may increase acceptance by the patient of these recommendations.

Dermatology↗

PubMed1982

Outbreaks of hospital infection in southwest England caused by gentamicin-resistant Serratia marcescens.

Five geographically separate outbreaks of hospital acquired infection caused by gentamicin-resistant strains of Serratia marcescens occurred in the period October 1977 to January 1980 in southwest England. The patients affected were in wards for general or urological surgery, or in neurosurgical, cardiothoracic or general intensive therapy units. Asymptomatic colonization was more common than symptomatic infection, although deaths and serious infections occurred. Control of spread of the bacteria proved difficult. Most strains were resistant to many currently available antibiotics besides gentamicin; only one strain became resistant to amikacin. Representative isolates where characterized by O serotype, bacteriophage type, antibiotic sensitivity pattern, production of beta-lactamases and amino-glycoside-aminocyclitol (ACAG)-modifying enzymes, and plasmid visualization. Plasmid studies provided information that complemented conventional typing methods in determining epidemiological relationships among the outbreaks.

Adolescent↗

PubMed1988

Infection control organization in hospitals in England and Wales, 1986. Report of a survey undertaken by a Hospital Infection Society working party.

Questionnaires were distributed to hospitals in order to obtain information regarding arrangements for infection control. Returns were obtained from 180 of 200 (90%) health districts in England and Wales covering 95% of 'acute' and 85% of 'other' hospital beds listed in the Hospitals Year Book. The results demonstrated that some form of infection control organization was present in all districts, 98% had control of infection officers and 92% control of infection committees. The proportion of health districts with an infection control nurse had risen from 64% in 1979 to 89%, and the regional variation seen in 1979 was no longer marked. The major commitment of medical microbiologists to infection control was underlined.

Cross Infection↗

PubMed1990

A survey of methicillin-resistant Staphylococcus aureus affecting patients in England and Wales.

For a six-month period between October 1987 and March 1988, 660 isolates of methicillin-resistant Staphylococcus aureus (MRSA) from 570 patients were sent to the Staphylococcus Reference Laboratory at Colindale to supplement the National reporting survey of MRSA in England and Wales. The isolates were characterized by phage typing, antibiotic susceptibility and by selected biochemical tests. Patient details were also surveyed. Fourteen strains affected more than one hospital and were called multi-hospital epidemic strains. One strain, EMRSA-1, accounted for more than 40% of isolates and of patients. Other epidemic strains were defined. Ten additional strains were restricted to single hospitals. Only 25 primary isolates were non-typable but 67 sporadic typable strains occurred. The patients affected were approximately equally either infected or colonized. The sexes were represented equally. Orthopaedic and geriatric wards were over-represented. Epidemic strains were clumping factor positive while some sporadic strains were weak producers. Urea alkalinization and protein A production could supplement phage typing and antibiotic resistance in strain recognition.

Adult↗

PubMed1991

Surveillance of methicillin-resistant Staphylococcus aureus in England and Wales, 1986-1990.

The incidence of methicillin-resistant Staphylococcus aureus in England and Wales was monitored by a weekly reporting scheme from early 1986 to March 1990. Potential coverage was approximately two-thirds of hospital beds. Reporting centres fell from a peak of 210 in 1986 to a low of 101 centres early in 1989 with later recovery. There were 2367 positive reports in 1986, 2174 in 1987, 1700 in 1988, 1701 in 1989 and 632 in the first quarter of 1990. Colonizations outnumbered infections by 2:1. There were marked regional differences: North-East Thames was dominant in 1986 and 1987, and then declined; South-East Thames showed a dramatic increase in 1988 which continued. Other regions showed less significant changes but there were continuing problems in the South-Western Region and in the West Midlands. Some of these changes were related to the decline of EMRSA-1, possibly due to the introduction of effective control measures, and to the emergence of EMRSA-3 in South-East Thames and its spread to Wessex.

Bacteriophage Typing↗

PubMed1993

Methicillin resistant Staphylococcus aureus in three adjacent health districts of south-east England 1986-91.

The experiences with methicillin-resistant Staphylococcus aureus (MRSA) of two contiguous Health Districts during 1986-91 and of a third mutually adjacent District in south-east England during 1989-91 were compared. Although the three Districts were in many ways similar, the nature of the problems posed by MRSA differed. The Districts had dealt with MRSA independently but had evolved similar strategies for coping with the organism. In two Districts a gradual relaxation of case-finding and of infection control precautions applied to individual patients and outbreaks, was followed by a reduction in the number of new patient-isolates identified from routine bacteriology specimens. Standardization of MRSA isolation rates for patient throughput and for length of hospital stay showed the examination of crude total isolates to provide misleading comparisons of relative risks of acquiring MRSA in different specialties. It was also found that patients discharged from specialties with short inpatient stays were more likely to have MRSA detected after discharge by their physicians working in the local community served by the hospitals but there was no evidence of spread outside hospital. It is suggested that good all-round standards of infection control practice are more important than specific radical policies in dealing with endemic MRSA.

Colony Count, Microbial↗

PubMed1986

Osteoradionecrosis: a study of the incidence in the North West of England.

A retrospective survey of 200 patients was carried out to determine the incidence of osteoradionecrosis in the North West of England. The patients all had been treated with radiotherapy for squamous cell carcinoma of the oral cavity. An overall incidence of osteoradionecrosis of 19.6% was found. Cases were designated as having major, moderate or minor osteoradionecrosis. The incidence of major osteoradionecrosis was 8%. Hemimandibulectomy was required for management of the necrosis in 3%. Factors involved in the aetiology are discussed.

Adult↗

PubMed1983

Location--allocation models, social science and health service planning: an example from North East England.

This paper reports on a project carried out by the author to assess strategies for hospital location in the Durham Health District, England. This project was set up in the context of a dispute on hospital strategy between the relevant Regional and Area Health Authorities and so the development of the dispute is outlined. This is followed by a summary of the work carried out in which some reservations about the techniques employed are put forward. The subsequent debates between the Regional and Area Health Authorities are also discussed. The paper concludes by raising more general issues concerning the role of the state and the use of knowledge in planning.

Catchment Area, Health↗

PubMed1985

Extended training of ambulance staff in England.

It has been widely demonstrated that it is possible to teach ambulance staffs to carry out the extended trained skills of endotracheal intubation, intravenous infusion and ventricular defilbrillation. So far in England only a few health authorities have been able to develop courses i advanced ambulance aid. Data on the costs of this training in six authorities presently operating such courses were collected, together with the costs of operating vehicles crewed by extended trained staff. Training and operating costs vary according to the different organisation of the training schemes and the way in which the extended trained staff are deployed on operational duties. Total costs vary between 235 pounds and 878 pounds per trained person per year. The experience of different health authorities in the U.K. and in the U.S.A. operating ambulance services with extended trained staff is then examined to try to identify the benefits of reduced mortality and morbidity which accrued from the introduction of the improved service. Most of this experience is concerned with reduced mortality from the treatment of out-of-hospital cardio-pulmonary arrest, and the estimates of the life-saving potential of the service varied from one area to another. The most conservative estimate was that one fully equipped, permanently available vehicle staffed by extended trained personnel would save 3-4 lives per year. Although there is very little evidence available of reduced mortality and morbidity from trauma and other sudden serious illness, some experience indicated a further 1 or 2 lives could be saved per vehicle per year.(ABSTRACT TRUNCATED AT 250 WORDS)

Allied Health Personnel↗

PubMed1986

Analysing geographic variations in mortality using Poisson regression: the example of ischaemic heart disease in England and Wales 1969-1973.

This paper describes how Poisson regression techniques can be used to examine the relationship between mortality and possible explanatory variables over a series of areas in cases where the number of deaths involved is relatively low. As an example an analysis is carried out on deaths from ischaemic heart disease among young adults in the county boroughs of England and Wales during 1969-1973. The results of the study indicate that the number of deaths was higher for males than females and was positively related to age, the size of the 'at risk' population and crowding, but negatively associated with water hardness and the size of the New Commonwealth population. A comparison of the Poisson and log-normal regression models clearly shows that the latter provides an inferior goodness of fit and unreliable results. It is therefore concluded that when the number of deaths is small there are both theoretical and practical advantages in using Poisson regression to analyse mortality data.

Adolescent↗

PubMed1988

Doctors dispensing medications: contemporary India and 19th century England.

In developing countries the widespread use of medications in ways that are unsafe and inappropriate is a threat to health and a waste of scarce resources. It is possible that doctors contribute to the problem when, as in rural India, the doctor earns a living by selling medications rather than by charging a consultation fee and writing a prescription; the incentive is to medicate irrespective of the diagnosis. In this article, doctor-patient roles and paying for the doctor's services in a South Indian town are described. Similarities between the town and 19th century England in regard to doctor-patient roles are noted and analyzed.

Drug Therapy↗