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At least 19 recordsLinked to original sources
PubMed1999

Susceptibility of gonococci isolated in London to therapeutic antibiotics: establishment of a London surveillance programme. London Gonococcal Working Group.

OBJECTIVES: To establish the in vitro susceptibility of gonococci isolated in the London area to antibiotics in current therapeutic use and to establish a sentinel surveillance system for monitoring trends in antibiotic resistant gonorrhoea in London. METHODS: Isolates of Neisseria gonorrhoeae from consecutive patients attending genitourinary medicine clinics at 10 hospitals in the London area were collected over a 3 month period, May to July 1997. The susceptibility to penicillin, ciprofloxacin, tetracycline, and spectinomycin was determined for each isolate. Isolates exhibiting either plasmid or chromosomally mediated resistance were additionally tested for susceptibility to agents used as alternative treatments including azithromycin, ceftriazone, and ofloxacin. The resistant isolates were also tested for plasmid profiles (penicillinase producing N gonorrhoeae, PPNG), type of tetM determinant (tetracycline resistant N gonorrhoeae, TRNG), and presence of gyrA and parC mutations (quinolone resistant N gonorrhoeae, QRNG). RESULTS: A total of 1133 isolates were collected which represents > 95% of the total gonococci isolated in the 3 months. Plasmid mediated resistance was exhibited by 48 (4.2%) isolates; six (0.5%) were PPNG, 15 (1.3%) were PP/TRNG, and 27 (2.4%) were TRNG. The majority of PPNG (18 of 20 tested) carried the 3.2 MDa penicillinase plasmid whereas the two types of tetM determinant were more evenly distributed. High level resistance to ciprofloxacin was detected in four (0.4%) isolates and double mutations were found in the quinolone resistance determining region (QRDR) of the gyrA gene in three QRNG with MICs of 16 mg/l and a single mutation in one isolate with a MIC of 1 mg/l to ciprofloxacin. No parC mutations were found. Of the remaining 1081 isolates, 86 (8.0%) were chromosomally mediated resistant N gonorrhoeae (CMRNG). CONCLUSIONS: A unique collection of gonococcal isolates has been established which can be used as a baseline for surveillance of susceptibility to antibiotics and for epidemiological purposes.

Adolescent↗
PubMed2002

Did the London Initiative Zone investment programme affect general practice structure and performance in East London? A time series analysis of cervical screening coverage and asthma prescribing.

A programme of incentives was set up in the London Initiative Zones to improve primary care in inner London based on the findings of the Tomlinson Enquiry in 1992. This descriptive study is a 4-y time series analysis of changes in general practice structure in East London as the result of London Initiative Zone investment, and an exploration of the possible effect of investment on practice performance. We used routinely available administrative data for the whole analysis. General practice characteristics and two selected performance indicators: the asthma prophylaxis to bronchodilator ratio and cervical cytology screening rate, for all practices in the East London and the City Health Authority for 4 y, 1993-1996, were used. Both reflect practice efficiency, but relate to different aspects of practice performance. The prescribing indicator is more indicative of the quality of clinical practise, whereas cervical screening coverage relates more to the characteristics of the practice population and to practice organisation. Repeated measures analyses were used to identify trends and to explore the relationship between changes in practice characteristics and performance. Graphical methods were used to compare East London trends with the rest of England. There were significant improvements in practice structure as the consequence of London Initiative Zone investment. There was a positive association with improvements in practice performance, but East London still lagged some way behind national patterns. The findings suggest that while improvements in asthma prescribing follow the national trend, practices have difficulty in achieving and sustaining the 80% target for cervical cytology screening, and that an overall population coverage of 80% may be in doubt.Increased investment in practice staffing may be influential in improving some aspects of performance. However, in common with other inner cities, a greater effort and more innovative strategies may be needed to achieve a standard of performance equal to the best.

Anti-Asthmatic Agents↗
PubMed1995

Tuberculosis in London: a review, and an account of the work of the London Consultants in Communicable Disease Control Group Working Party.

Tuberculosis (TB) has been recorded in London for centuries but reports have declined over the last 100 years, with a 10-fold decrease between 1948 and 1987. However, from 1987-1993 notifications of TB in London rose by 34%, compared with 15% nationally. This rise, together with concerns about undernotification and the emergence of multi-drug resistance in New York, led to establishment of a London Consultants in Communicable Disease Control Working Party on TB to review current surveillance data. Notifications to the Office of Population Censuses and Surveys from the London Boroughs declined by approximately 6.5% per year from 1982-1987. If this had continued until 1993 there would have been 3579 fewer notifications than actually received. The proportion of cases in the 15-44 age group rose markedly in males. The proportion of notifications in those aged 65 and above was higher in the Thames Regions outside London, where the total TB notifications declined by 3.5% over the same period. Recommendations were made to improve TB surveillance in London; and a city-wide surveillance function was established in 1994 to collate and monitor data on TB.

Adolescent↗
PubMed2005

Psychological and behavioural reactions to the bombings in London on 7 July 2005: cross sectional survey of a representative sample of Londoners.

OBJECTIVES: To assess the impact of the bombings in London on 7 July on stress levels and travel intentions in London's population. DESIGN: A cross sectional telephone survey using random digit dialling was conducted to contact a representative sample of adults. Respondents were asked to participate in an interview enquiring about current levels of stress and travel intentions. SETTING: Interviews took place between 18 and 20 July. PARTICIPANTS: 1010 participants (10% of the eligible people we contacted) completed the interviews. MAIN OUTCOME MEASURES: Main outcomes were presence of substantial stress, measured by using an identical tool to that used to assess the emotional impact of 11 September 2001 in the US population, and intention to travel less on tubes, trains, and buses, or into central London, once the transport network had returned to normal. RESULTS: 31% of Londoners reported substantial stress and 32% reported an intention to travel less. Among other things, having difficulty contacting friends or family by mobile phone (odds ratio 1.7, 95% confidence interval 1.1 to 2.7), having thought you could have been injured or killed (3.8, 2.4 to 6.2), and being Muslim (4.0, 2.5 to 6.6) were associated with a greater presence of substantial stress, whereas being white (0.3, 0.2 to 0.4) and having previous experience of terrorism (0.6, 0.5 to 0.9) were associated with reduced stress. Only 12 participants (1%) felt that they needed professional help to deal with their emotional response to the attacks. CONCLUSIONS: Although the psychological needs of those intimately caught up in the attacks will require further assessment, we found no evidence of a widespread desire for professional counselling. The attacks have inflicted disproportionately high levels of distress among non-white and Muslim Londoners.

Adolescent↗
PubMed1998

Primary care. LIZ (London Initiative Zone): a legacy for London.

More than half the LIZ funding has been spent on improving GP premises and practice staffing. But many premises are still below standard. The programme has had no effect on reducing the number of GPs over 65 working in London. In some areas of London the proportion has increased. Almost half (46 per cent) of practices in London still consist of a doctor working alone. Nationally, the figure is 30 per cent. London GPs' lists are significantly higher than in the rest of the country. Further improvements in London's primary care are vital.

Age Distribution↗
PubMedDate not supplied

The prevalence of hepatitis-B antigen (HB S Ag) and its antibody (Anti-HB S) among London hemophiliacs and blood donors from London and two tropical areas.

The prevalence of hepatitis-B antigen (HB s AG) and its antibody (anti-HBs) among 49 London hemophiliacs was compared with that among women attending an antenatal clinic and healthy blood donors from London and from two parts of the tropics (Mauritius and Zambia). The prevalence of HBsAG and anti-HBs was low in antenatal patients, London blood donors and blood donors from Mauritius. However, a high proportion of hemophiliacs (59%) were anti-HBs positive, this being comparable with Zambian blood donors (53%), although anti-HBs titers in hemophiliacs were much higher (GMT 1:342) than in Zambian blood donors (GMT 1:36). In contrast, HBsAG was detected in 29 of 250 (12%) Zambian donors but in only 3 of 49 (6%) hemophiliacs. Clinically overt hepatitis occurred in only two hemophiliacs. However, the presence of HBsAG-specific IgM in 7 of 29 (24%) anti-HBs-positive hemophiliacs suggests that a proportion of these patients recently experienced subclinical infection by hepatitis-B virus, Anti-HBs-positive hemophiliacs received a significantly higher number of- cryoprecipitate units than did those without anti-HBs(P less than 0.01). Five of seven hemophiliacs with high titers of anti-HBs (greater than 1:4,096) showed a decline in titer after 1972 which may have been associated with the introduction of screening of cryoprecipitate for HBsAG.

Antibodies, Viral↗
PubMed1999

The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario.

OBJECTIVE: To estimate the point prevalence of fibromyalgia syndrome (FM) among noninstitutionalized Canadian adults; and to assess the effect of demographic variables on the odds of having FM. METHODS: A screening questionnaire was administered via telephone to a random community sample of 3395 noninstitutionalized adults residing in London, Ontario. Individuals screening positive were invited to be examined by a rheumatologist to confirm or exclude FM using the 1990 American College of Rheumatology classification criteria. RESULTS: One hundred confirmed cases of FM were identified, of whom 86 were women. Mean age among FM cases was 49.2 years among women, 39.3 years among men (p < 0.02). FM affects an estimated 4.9% (95% CI 4.7%, 5.1%) of adult women and 1.6% (1.3%, 1.9%) of adult men in London, for a female to male ratio of roughly 3 to one. In women, prevalence rises steadily with age from < 1% in women aged 18-30 to almost 8% in women 55-64. Thereafter, it declines. The peak prevalence in men also appears to be in middle age (2.5%; 1.1%, 5.7%). FM affects 3.3% (3.2%, 3.4%) of noninstitutionalized adults in London. Female sex, middle age, less education, lower household income, being divorced, and being disabled are associated with increased odds of having FM. CONCLUSION: FM is a common musculoskeletal disorder among Canadian adults, especially among women and persons of lower socioeconomic status.

Adolescent↗
PubMed2003

Assertive outreach teams in London: models of operation. Pan-London Assertive Outreach Study, part 1.

BACKGROUND: Assertive outreach teams have been introduced in the UK, based on the assertive community treatment (ACT) model. It is unclear how models of community care translate from one culture to another or the degree of adaptation that may result. AIMS: To characterise London assertive outreach teams and determine whether there are distinct groups within them. METHOD: Semi-structured interviews with team managers plus one month's prospective process of care data collection were used to test for 'model fidelity' to ACT and, by cluster analysis, to identify groupings. RESULTS: Fidelity varied widely, with four teams (out of 24 studied) rated 'high fidelity' and three teams rated 'low fidelity' by US standards and 17 rated 'ACT-like'. Three clusters were identified, with voluntary sector teams being the most distinct group. CONCLUSIONS: There is wide variation in the practice of assertive outreach in London. The role of the voluntary sector requires increased attention. Heterogeneity in practice is a clinical challenge but a research opportunity in distinguishing effective from redundant components of the approach.

Adult↗
PubMed2003

Assertive outreach teams in London: staff experiences and perceptions. Pan-London Assertive Outreach Study, part 2.

BACKGROUND: The job satisfaction, burn-out and work experiences of assertive outreach team staff are likely to be important to the model's sustainability. AIMS: To describe self-reported views and work experiences of staff in London's 24 assertive outreach teams and to compare these with staff in community mental health teams (CMHTs) and between different types of assertive outreach team. METHOD: Confidential staff questionnaires in London's assertive outreach teams (n=187, response rate=89%) and nine randomly selected CMHTs (n=114, response rate=75%). RESULTS: Staff in assertive outreach teams and CMHTs were moderately satisfied with their jobs, with similar sources of satisfaction and stress. Mean scores were low or average for all sub-scales of the Maslach Burnout Inventory for the assertive outreach team and the CMHT staff, with some differences suggesting less burn-out in the assertive outreach teams. Nine of the 24 assertive outreach teams had team means in the high range for emotional exhaustion and there were significant differences between types of assertive outreach team in some components of burn-out and satisfaction. CONCLUSIONS: These findings are encouraging, but repeated investigation is needed when assertive outreach teams have been established for longer.

Adolescent↗
PubMed1998

A chemical gas incident in London: how well prepared are London A & E departments to deal effectively with such an event?

This study aimed to investigate the preparedness of inner London Accident and Emergency (A & E) departments in the event of a major chemical incident. The dimensions of preparedness studied were procedures, facilities and equipment, protective clothing, knowledge, and attitudes towards chemical incidents. A review of the relevant literature will be published in issue 6/3 of this journal, July 1998.

Attitude of Health Personnel↗
PubMed1988

The risks of staying in London: a review of overseas visitors admitted to a London hospital.

A retrospective review of 103 acute admissions of overseas visitors to a central London hospital was performed. Admissions were most commonly due to infection (43 admissions) and to recurrence of preexisting disease (40 admissions). Patients over 60 years were frequently admitted with new diagnoses. Groups at risk of admission were identified and strategies to reduce admissions discussed.

Adolescent↗
PubMed2003

Assertive outreach teams in London: patient characteristics and outcomes. Pan-London Assertive Outreach Study, part 3.

BACKGROUND: Although the model of assertive outreach has been widely adopted, it is unclear who receives assertive outreach in practice and what outcomes can be expected under routine conditions. AIMS: To assess patient characteristics and outcome in routine assertive outreach services in the UK. METHOD: Patients (n=580) were sampled from 24 assertive outreach teams in London. Outcomes--days spent in hospital and compulsory hospitalisation--were assessed over a 9-month follow-up. RESULTS: The 6-month prevalence rate of substance misuse was 29%, and 35% of patients had been physically violent in the past 2 years. During follow-up, 39% were hospitalised and 25% compulsorily admitted. Outcome varied significantly between team types. These differences did not hold true when baseline differences in patient characteristics were controlled for. CONCLUSIONS: Routine assertive outreach serves a wide range of patients with significant rates of substance misuse and violent behaviour. Over a 9-month period an average of 25% of assertive outreach patients can be expected to be hospitalised compulsorily. Differences in outcome between team types can be explained by differences in patient characteristics.

Adult↗
PubMed2000

Rise in gonorrhoea in London, UK. London Gonococcal Working Group.

We report an alarming 34.9% overall increase in the number of gonococcal infections diagnosed during the same 3 month study period during 3 years. Between 1997 and 1998, an increase of 12.1% was detected, with a larger increase between 1998 and 1999, of 20.4%.

Adolescent↗
PubMed1977

A controlled trial of multiphasic screening in middle-age: results of the South-East London Screening Study. The South-East London Screening Study Group.

The results of a controlled trial of multiphasic screening in general practice are presented. In 1967, 7,229 individuals aged between 40 and 64 years were randomly allocated into either a Screening or Control group. The Screening group were invited to attend two screening sessions held about two years apart, while the Control group continued to receive conventional medical care. Both groups were then invited to undergo a health survey in 1972-73 which revealed no significant differences in morbidity between the two groups. Careful follow-up permitted detailed Screening-Control comparisons of various outcome measures--consultation and hospital admission rates, certified sickness absence from work, and mortality. Nine years after the initial screening, no significant differences were found between the two groups in any of the outcome measures. It is estimated that a similar screening programme for the entire middle-aged UK population would cost 142 pounds million at 1976 prices.

Aged↗