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PubMed1998

Stress in farmers: a survey of farmers in England and Wales.

OBJECTIVES: To investigate potential sources of stress for farmers in England and Wales METHOD: A postal questionnaire was sent to a randomly selected group of 800 members of the National Farmers' Union and 200 members of the Farmers' Union of Wales. RESULTS: 500 questionnaires (51%) were returned completed between October 1995 and March 1996. Farmers had problems with record keeping and paperwork (62%), difficulty understanding forms (56%), and problems arising from the effects of new legislation and regulations (49%). Nearly a quarter (23%) reported financial problems and most worried about money (79%). Very few were socially isolated, with over 90% having at least one confidant. 70% worked > 10 hours a day, and 31% had health problems which interfered with their work, including more than a quarter of those < 50. 16% of the sheep farmers reported symptoms which they attributed to organophosphate poisoning. The farmers most vulnerable to financial and other problems were those with small farms and mixed farming operations. Farmers in Wales also seemed more vulnerable than those in England, but a lower response rate from members of the Farmers' Union of Wales means this difference should be interpreted cautiously. CONCLUSION: The survey confirms findings from several regional studies that many farmers are experiencing considerable stress from various causes. Local and national initiatives to assist farmers, including outreach programmes, should be encouraged. Policy makers should be aware of the potential impact of legislation, particularly on the more vulnerable groups.

Adult↗
PubMed2001

Tuberculosis at the end of the 20th century in England and Wales: results of a national survey in 1998.

BACKGROUND: A national survey of tuberculosis was conducted in England and Wales in 1998 to obtain detailed information on the occurrence of the disease and recent trends. This survey also piloted the methodology for enhanced tuberculosis surveillance in England and Wales and investigated the prevalence of HIV infection in adults with tuberculosis. METHODS: Clinical and demographic data for all cases diagnosed during 1998 were obtained, together with microbiological data where available. Annual incidence rates in the population were estimated by age, sex, ethnic group, and geographical region using denominators from the 1998 Labour Force Survey. Incidence rates in different subgroups of the population were compared with the rates observed in previous surveys. The tuberculosis survey database for 1998 was matched against the Communicable Disease Surveillance Centre HIV/AIDS database to estimate the prevalence of HIV co-infection in adult patients with tuberculosis. RESULTS: A total of 5658 patients with tuberculosis were included in the survey in England and Wales (94% of all formally notified cases during the same period), giving an annual rate of 10.93 per 100 000 population (95% CI 10.87 to 10.99). This represented an increase of 11% in the number of cases since the survey in 1993 and 21% since 1988. In many regions case numbers have remained little changed since 1988, but in London an increase of 71% was observed. The number of children with tuberculosis has decreased by 10% since 1993. Annual rates of tuberculosis per 100 000 population have continued to decline among the white population (4.38) and those from the Indian subcontinent, although the rate for the latter has remained high at 121 per 100 000. Annual rates per 100 000 have increased in all other ethnic groups, especially among those of black African (210) and Chinese (77.3) origin. Over 50% of all patients were born outside the UK. Recent entrants to the UK had higher rates of the disease than those who had been in the country for more than 5 years or who had been born in the UK. An estimated 3.3% of all adults with tuberculosis were co-infected with HIV. CONCLUSIONS: The epidemiology of tuberculosis continues to change in England and Wales and the annual number of cases is rising. More than one third of cases now occur in young adults and rates are particularly high in those recently arrived from high prevalence areas of the world. The geographical distribution is uneven with urban centres having the highest rates. The increase in the number of cases in London is particularly large. Tuberculosis in patients co-infected with HIV makes a small but important contribution to the overall increase, particularly in London. To be most effective and to make the most efficient use of resources, tuberculosis prevention and control measures must be based on accurate and timely information on the occurrence of disease. A new system of continuous enhanced tuberculosis surveillance was introduced in 1999, based on the methodology developed in this national survey.

AIDS-Related Opportunistic Infections↗
PubMed1981

Respiratory morbidity and lung function in schoolchildren aged 7 to 11 years in South Wales and the West of England.

The present study tests the suggestion that the respiratory morbidity of children resident in South Wales is substantially higher than that among children resident in some other areas of the United Kingdom. A case control survey was carried out among 2228 children aged 7 to 11 years in schools matched for size and socioeconomic characteristics in urban and rural areas in South Wales and the West of England. The survey confirmed that respiratory morbidity was higher among children in South Wales and that this excess could not readily be dismissed as being caused by over-reporting. However, objective measurements of the children's respiratory health did not detect any consistent difference in the lung function of children in South Wales compared with that of children in the West of England.

Child↗
PubMed1991

Prevalence of asthma among 12 year old children in New Zealand and South Wales: a comparative survey.

A survey of 12 year old schoolchildren was carried out in New Zealand and South Wales, the same questionnaire and exercise provocation test being used. The prevalence of a history of asthma at any time was higher in New Zealand (147/873, 17%) than in South Wales (116/965, 12%). The New Zealand children were also more likely than the Welsh children to have a history of "wheeze ever" (27% versus 22%), and wheeze brought on by running (15% versus 10.5%). The sex ratio of asthmatic and wheezy children was very similar in the two countries. A history of hospital admission for chest trouble was twice as common in New Zealand as in South Wales. An exercise test produced a fall in peak expiratory flow rate of 15% or more in more New Zealand children (12.2%) than Welsh children (7.7%). These results suggest that the prevalence of childhood asthma is higher in New Zealand than in South Wales.

Animals↗
PubMed1998

Geographical distribution of tuberculosis notifications in national surveys of England and Wales in 1988 and 1993: report of the Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group.

BACKGROUND: The geographical distribution of tuberculosis in England and Wales and changes since 1983 were examined using data from the 1988 and 1993 national surveys of tuberculosis notifications. METHODS: Notification rates for England and Wales in 1988 and 1993 were calculated for geographical areas using Office for National Statistics (ONS) mid year population estimates. Those for the standard regions and the Greater London boroughs were calculated for the main ethnic groups. Those for the counties and local authorities were calculated for all ethnic groups combined. These were compared using data from the 1983 national survey as a baseline. RESULTS: Wide regional variations in notification rates persist with Greater London having the highest rates. Rates in the ethnic group from the Indian subcontinent (ISC) were high in all regions, whilst those of the white ethnic group varied fourfold. Twenty seven of the 33 London boroughs showed increased rates in 1993 compared with 1988. In general, those local authority areas with high rates had high proportions of notifications in individuals of ISC ethnic origin, emphasising the continuing important contribution of ethnic minority groups to local tuberculosis rates. The number of local authority areas with notification rates four times the national average increased, but the number of areas with low or zero rates increased even more. CONCLUSIONS: The distribution of tuberculosis in England and Wales continues to vary markedly by geographical area. The distribution is becoming increasingly polarised with a growth in the number of areas with very high rates of notifications and a greater increase in the number of areas with very few notifications. Patients from ethnic minorities continued to contribute a substantial and increasing proportion of all reported tuberculosis cases in most regions in 1988 and 1993. These findings have important implications for the provision of tuberculosis services in England and Wales.

Demography↗
PubMed2007

An overview of neurological disorders in Wales.

This pragmatic work was undertaken to assist commissioners of health services in Wales in their planning for future provision of services for neurological and neurosurgical patients. A literature search, which was carried out to ascertain the epidemiology of neurological and neurosurgical disorders in Wales, revealed limited epidemiological surveys of patients in Wales, while other literatures although outdated were still relevant. More recent national reports, published by professional bodies and patients' organisations, were also identified. These disorders were also grouped according to their aetiology and symptoms into 13 groups. Using all the available literature, total estimates of annual incidence and point prevalence of these disorders were arrived at. We can conclude that approximately 5.8% of the population in Wales are affected by neurological and neurosurgical disorders that include headaches, traumatic and infectious diseases of the nervous system.

Age Factors↗
PubMed2003

Prenatal influences on stroke mortality in England and Wales.

BACKGROUND AND PURPOSE: Within Britain and the United States there are geographic variations in mortality from stroke that are not explained by differences in adult lifestyle. We report on the geographic distribution of stroke mortality in England and Wales and compare it with that in the United States. METHODS: Data from 4 studies are presented. The geographic distribution of stroke deaths in England and Wales during 1968-1978 is compared with the distribution of (1) other causes of death during the same years, (2) neonatal and maternal mortality during 1911-1925, (3) average adult height, and (4) place of birth. RESULTS: Areas of England and Wales with high stroke mortality were characterized in the past by poor living standards, demonstrated by high infant and maternal mortality rates and short stature in the adult population. People who were born in areas of high stroke mortality rather than migrating into them are at high risk. Stroke mortality is not geographically correlated with past postneonatal mortality independently of neonatal or maternal mortality. The geographic distribution of stroke mortality in the United States and England and Wales has features in common. CONCLUSIONS: Stroke may originate through maternal influences associated with poverty. This conclusion is supported by recent findings that rates of stroke in adult life are higher among people who had low birth weight.

Aged↗
PubMed2004

A case-control study to estimate the impact on breast cancer death of the breast screening programme in Wales.

OBJECTIVES: The aim of this study was to estimate the effect of service screening, as provided by the NHS breast screening programme, on breast cancer mortality in Wales. Furthermore, we wished to ascertain whether a reduction in breast cancer mortality consistent with that observed in the randomised screening trials was being achieved. SETTING: The NHS Breast Screening Programme in Wales, managed by Breast Test Wales, with headquarters in Cardiff. METHODS: A case-control study design with 1:2 matching. The cases were deaths from breast cancer in women aged 50-75 years at diagnosis who were diagnosed after the instigation of screening in 1991 and who died after 1998. The controls were women who had not died of breast cancer or any other condition during the study period. One was from the same GP practice and the other from a different GP practice within the same district, matched by year of birth. RESULTS: Based on 419 cases, the odds ratio for risk of death from breast cancer for women who have attended at least one routine screen compared to those never screened was 0.62 (95% confidence interval [CI] 0.47-0.82, p=0.001). After excluding cases diagnosed prior to 1995 and adjusting for self-selection bias, the estimated mortality reduction was 25% (odds ratio=0.75, 95% CI 0.49-1.14, p=0.09). CONCLUSION: The Breast Test Wales screening programme is achieving a reduction in breast cancer mortality of 25% in women attending for screening, which is consistent with the results of the randomized controlled trials of mammographic screening.

Aged↗
PubMed1999

The supply of dressings by hospital pharmacy departments in Wales.

A research project to examine the dressings and wound management materials supplied by pharmacy departments in Wales was carried out. Data were collected from the NHS computer database, which contains information on 17 hospitals, servicing 80-90% of the Welsh population. Over a 12-month period, hospital pharmacy departments throughout Wales issued dressings and related materials costing 2.1 m Pounds. As not all pharmacy departments supply the full range of dressings used in hospitals, and only one issues surgical sutures, this sum probably represents less than half of the total expenditure in Wales on this commodity group. Existing methods for recording the issue of dressings do not provide reliable information either on the range of products used or the total quantities issued throughout Wales. Despite expectations to the contrary, hospital use of dressings did not appear to have a major influence over prescribing patterns in the primary sector. The amount of cavity wound dressings that are supplied on an outpatient basis suggests a real need for these items to be available in the community. (Since completion of this study, cavity wound dressings have been added to the Drug Tariff.)

Bandages↗
PubMed1996

The regionalization of perinatal care in Wales and Washington State.

OBJECTIVES: The purpose of this study was to compare perinatal regionalization and neonatal mortality in Wales and Washington State. METHODS: The 28 hospitals in Wales and the 80 hospitals in Washington State that offered maternity services and the 218,326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to identify the neonatal technology and the referral policies of each hospital, and linked data from birth and death certificates were used to examine birthweight-specific neonatal mortality rates for all babies born in these hospitals. RESULTS: Welsh district general hospitals (broadly equivalent to Level II perinatal centers in the United States) have more sophisticated neonatal technology than their Washington State counterparts and appear less likely to refer small or preterm babies to regional or subregional centers. Neonatal mortality rates were quite similar in the two settings. CONCLUSIONS: Perinatal care in Wales appears to be less regionalized than in a similar region in the United States. The relative lack of perinatal regionalization in Wales may contribute to duplication and underutilization of expensive neonatal technologies. National health care systems do not, in and of themselves, lead to optimal regionalization of services.

Birth Certificates↗
PubMed1996

The economic costs of caring for people with HIV infection and AIDS in England and Wales.

The objectives of this study were firstly to estimate total lifetime care costs for an individual with HIV/AIDS, and secondly to estimate the total costs of caring people with HIV infection and AIDS in England and Wales between 1992 and 1997 inclusive. Questionnaires and monthly diaries were used to collate data on healthcare utilisation from patients with HIV infection over a 6-month period. These data were then used to estimate the annual total direct costs of care (stratified by disease stage), total lifetime costs of care, and present and future total national care costs for England and Wales. Costing data were obtained from providers of services throughout Greater London. In total, 235 patients with HIV infection were recruited from 2 clinics in Greater London. All costs were calculated in 1992-93 pounds sterling (pound; 1 pound = $US1.58, December 1995). Annual care costs were estimated at 4515 pounds ($US7134) for a person with asymptomatic HIV disease, 8836 pounds ($US13,961) for a person with symptomatic non-AIDS and 15 268 pounds ($US24,123) for a person with AIDS. Lifetime care costs were estimated at 84,522 pounds ($US133,545) per patient. The total costs of care for England and Wales were forecast to increase from 116,627,400 pounds ($US184,271,300) in 1992 to 162,638,100 pounds ($US256,968,200) in 1997. In conclusion, our study further emphasises the continued shift in hospital services from the inpatient sector to the outpatient sector. The importance of community care and informal care, in terms of the associated direct economic costs, is also highlighted. This emphasises the need for close collaboration between different agencies and strategic coordination of services. Finally, the study forecasts an increase in care costs in England and Wales during the 1990s.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Human hydatidosis in New South Wales and the Australian Capital Territory, 1987-1992.

OBJECTIVE: To determine the prevalence of human hydatidosis in New South Wales and the Australian Capital Territory. METHODS: Data on human hydatid infection occurring between 1987 and 1992 were collected retrospectively from 25 hospitals and 13 health services in New South Wales and four hospitals in the Australian Capital Territory. Mean annual prevalences of human hydatidosis were determined for shires in eastern New South Wales and data on infection in immigrants and Australian-born patients were compared. RESULTS: 321 patients were diagnosed with hydatid disease, 1987-1992; 195 were new cases and 117 readmissions (nine cases were not identified as new or recurrent). Most patients lived in the eastern half of New South Wales (which includes the Australian Capital Territory), half in rural areas and half in the major coastal cities. Most Australian-born rural patients lived in 39 shires in the north-eastern and south-eastern Tablelands. Sixty per cent of the patients in major cities were born overseas. CONCLUSIONS: Hydatid infection occurs more commonly in south-eastern Australia than the official figures suggest. In rural areas of the north-eastern and south-eastern Tablelands hydatid infection is of public health importance. The national notification system must be improved and control campaigns alerting the public to the dangers of hydatid infection promoted.

Adolescent↗
PubMed1989

Geographical variations in persons consulting rates in general practice in England and Wales.

Using data from the Third National Morbidity Study, we have examined annual period prevalence in three large geographical areas of England and Wales--North, Midlands and Wales & South. Standardised persons' consulting ratios (SPCRs) have been obtained by the indirect method using five-year age bands as the basis for standardisation. There were several comparatively small differences between area SPCRs. There was reduced prevalence of diabetes in both sexes in the North; increased prevalence of respiratory disease in the North with the notable exception of asthma: increased prevalence of cardiovascular and cerebrovascular disease in the North which constrasted with increased recognition of hypertension in the South and the Midlands and Wales. There were no area differences in the prevalence of mental disorder; SPCRs for preventive care were relatively high in the North; the SPCR for cervical cytology was low in the Midlands and Wales. Although these differences are statistically significant, they were, in general, of small magnitude and do not suggest any major difference in morbidity between the areas.

Adult↗
PubMed2003

[Comparison of utilization of cardiovascular drugs in the Czech Republic and in Wales].

AIM: To compare and describe the trends in the consumption of selected groups of cardiovascular drugs in several districts of the Czech Republic and counties of Wales in the period of 1997-2000. METHODS: A retrospective analysis of prescription data from General Medical Insurance Company (three districts in the Czech Republic) and data from the Health Solutions Wales (3 counties of Wales). The data were analyzed during seven half-year intervals from January 1997 till June 2000. The authors investigated the consumption of antihypertensives, diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, hypolipidemic drugs, digoxin and acetylsalicylic acid classified according to ATC classification. The drug consumption was expressed at defined daily doses (DDD) and standardized per 1,000 insured individuals and day for the Czech districts and per 1,000 inhabitants and day for the Welsh counties (DID). RESULTS: The total consumption of the cardiovascular drugs under study in the last half-year of the investigated period of time (1/00) proved to be highest in CZ2 (40.2 DID), the value being by 40% higher than in CZ1 (348.6 DID) and by 11% higher than in CZ3 (386.9% DID). The rates of consumption in the Welsh counties during this period of time were 338.8 DID (W1), 307.9 DID (W2) and 298.0 DID (W3), respectively. Diuretics proved to be used at the highest rate in both countries. The consumption of thiazides and loop diuretics in the Czech districts during 1/00 represented 67.6% and 16.7% of the all diuretic consumption on the average, whereas the corresponding values in Wales were 42.3% for thiazide preparations and 46.7% for the loop diuretics. An increase in the consumption of new drugs such as ACE inhibitors, calcium channel blockers of 2nd generation and statins was noted in both countries. The statins represented 33.5% of total prescription of hypolipidemic drugs in the Czech districts, whereas their consumption in the Welsh districts represented 88.1% consumption of these drugs. CONCLUSION: The most significant differences were found in the consumption of diuretics and hypolipidemic drugs. The results of consumption studies could highlight the differences in drug utilization and thereby stimulate discussion on optimization of drug selection.

Cardiovascular Agents↗
PubMed1981

Investigations on Babesia motasi isolated from Wales.

A number of observations were carried out on the effect of the newly isolated parasite, Babesia motasi (Wales) on intact and splenectomised sheep and on a splenectomised goat. The parasite was not pathogenic for intact animals but caused fever and anaemia in splenectomised ones. B motasi (Wales) was also studied morphologically, morphometrically and serologically. The common form of the parasite was seen to be a double pyriform, the mean length of one side being 2.23 micrometer. It appeared to be morphometrically and serologically close to the other north European B motasi strains but distinct from B motasi (Turkey). In a limited serological survey, experience of infection with B motasi appeared to be common in sheep grazing in coastal areas of North Wales, but rare in a part of South Wales known to harbour the vector tick Haemaphysalis punctata. Transovarial transmission of B motasi by H punctata took place with facility.

Animals↗
PubMed1980

A comparison of the mortality rates of white South Africans with those of the population of England and Wales.

The health of Whites in South Africa in 1970 was poorer than that of the population of England and Wales, judged by the higher mortality rates (MRs) for all causes of death of White South Africans, for all ages combined and for every age interval from infancy to old age. Two groups of causes of disease were the main reasons for the poorer health of White South Africans: (i) 'diseases of the circulatory system' accounted for 50-60% of the higher MRs for all causes of death; ischaemic heart disease and cerebrovascular disease were the two main causes of circulatory deaths, and MRs for these two diseases were much higher in White South Africans than in England and Wales; (ii) 'accidents, poisonings and violence' accounted for 38% of the higher MRs for all causes of death in males and for 17% of those in females. Motor vehicle accidents and suicide were the main causes of accidental deaths, MRs of White South Africans being much higher than those in England and Wales. These MRs were among the highest in the world. Other diseases which contributed, to a small extent, to the poorer health of White South Africans because of the higher MRs compared with those in England and Wales were cirrhosis of the liver in adults, gastro-enteritis, meningitis and septicaemia in infants and children, and 'other ill-defined and unknown causes of death' in elderly people.

Adolescent↗
PubMed1994

Subacute sclerosing panencephalitis in Wales.

Twenty cases of subacute sclerosing panencephalitis (SSPE) occurring over an 18-year period in Wales are described and used as the basis for a comparison of measles infection, vaccination rates and the incidence of SSPE in England and Wales. Rates of measles infection were higher in Wales in all age groups, and fewer Welsh children were vaccinated, which maintained a high risk of SSPE per case of measles. Following vaccination, there was a more pronounced change in the age distribution of measles infection in Wales than in England, and it is proposed that one contribution to the high frequency of SSPE in the 1980s was the reservoir of measles in unvaccinated 2-4-year-olds, acting as a source of infection for children aged < 2 years, in whom the risk of SSPE following measles is known to be higher than in other groups.

Adolescent↗
PubMed1996

The incidence and prevalence of AIDS and prevalence of other severe HIV disease in England and Wales for 1995 to 1999: projections using data to the end of 1994.

Projections of the future incidence of AIDS cases are needed for planning purposes, to help set research priorities, and to describe the most likely pattern of transmission of HIV infection in the past that underlies the observed and projected incidence of AIDS. Earlier reports of projections for England and Wales were published in 1988, 1990, and 1993. During 1995 a group of experts has worked, using AIDS case reports to the end of December 1994, to make new projections to the end of 1999. The expert group concludes that, after adjustment for underreporting, there will be between 1840 and 2300 new cases of AIDS in England and Wales in 1997, and between 1760 and 2455 new AIDS cases in 1999. For planning purposes, a figure of 2025 new AIDS cases is projected for 1997, and 2010 for 1999. The planning projections for new AIDS cases in 1997 and 1999 among the main exposure categories, after adjustment for underreporting, are as follows: homo/bisexual males 1305 and 1235, people exposed heterosexually 490 and 525, and injecting drug users 140 and 155. Between 1995 and 1999, it is expected that new AIDS cases may fall by 7% in homo/bisexual males, and rise by 25% in the heterosexual exposure category and by 29% in injecting drug users. The incidence of AIDS in the children of mothers infected with HIV is expected to rise steadily from 30 new cases in 1994 to 45 in 1997 and 55 in 1999. New cases in recipients of contaminated blood or blood factors are expected to fall to 35 in 1997 and 30 in 1999, compared with a peak 10 years earlier of over 70 new cases each year. It is projected that 4010 AIDS cases will be alive in England and Wales at the end of 1999, and that the same number of people will be alive with other forms of severe HIV disease. Since 1989 the proportion of reported AIDS cases who live in the NHS Thames regions has remained constant at between 70% and 75%. We expect this concentration of AIDS cases in the south east, particularly within London, to remain unchanged. Compared with the report published in June 1993, the planning projections for 1997 are 37% lower for cases acquired heterosexually, and the upper boundary of the range in this exposure category has fallen from 1140 to 495. The reduction in the planning projection has resulted from a substantial decline in the rate of increase in the number of new AIDS cases arising each year from heterosexual exposure. The range of uncertainty has narrowed largely because more extensive seroprevalence data are now available. For homo/bisexual males, the planning projection for 1997 has fallen by 3%, because the 1993 report presented an over optimistic view of the extent to which patients received treatment and prophylaxis before the onset of AIDS, since such management became available in 1988. Unlike the 1993 working group, the 1995 working group has access to data from several years on the uptake of treatment and prophylaxis given before the diagnosis of AIDS. It is estimated that about 21,900 adults (range 20,400 to 23,400) were infected with HIV in England and Wales at the end of 1993. This total includes 12,350 who had been infected through male homosexual exposure, 2050 men and women infected through injecting drug use, 6800 men and women infected through heterosexual exposure, and about 3000 adults alive with AIDS. Various data indicate that HIV transmission among homo/bisexual men has been substantial since 1989. Use of data from the unlinked anonymous HIV prevalence monitoring programme suggest that between 500 and 1000 HIV infections due to homosexual male exposure occurred each year in 1992 and 1993. Should HIV transmission continue at this level, a high incidence of AIDS within the homo/bisexual male community will be inevitable for many more years. Most HIV infections and AIDS cases due to heterosexual exposure are thought to have been acquired abroad. The future of the epidemic in this exposure category is therefore unclear.

Acquired Immunodeficiency Syndrome↗