To examine trends in alcohol-attributable morbidity (AAMorb) (2000/01-2009/10) and mortality (AAMort) (2000-07) by age, sex and region.
Time-series analyses of population data for Victoria, Australia. We used joinpoint regression to quantify trends by estimating quarterly percent change (QPC) for rates of morbidity and mortality. We present the average QPC (AQPC) as a weighted average of QPCs. A test of parallelism was used to examine pairwise differences.
AAMorb increased significantly over time for Victoria (AQPC = 1.0%, 95% confidence interval 0.8-1.2). While females (1.6, 1.1-2.0), age groups 25-44 (1.0, 0.9-1.1) and 45-64 (1.2, 0.2-2.2), and metropolitan population (1.2, 0.5-1.9) were broad subgroups more at risk, multivariate analysis detected specific increases for metropolitan females aged 15-44 (1.8, 1.0-2.6) and 45+ (1.6, 0.2-3.0). Relatively greater increases in morbidity among metropolitan subgroups were widespread. AAMort remained stable for Victoria and for most subgroups, although significant declines in mortality were specifically experienced by metropolitan 15-24 (-2.0, -2.9 to -1.0) and 25-44 (-1.0, -1.7 to -0.3) age groups, and by regional males aged 45+ (-0.8, -1.3 to -0.3). Metropolitan males aged 45+ were a special high-risk population.DiscussionOur study has identified overlooked subgroups as being at increasing risk for alcohol-attributable chronic harm necessitating their inclusion in future policies for harm reduction.
Sickle cell disease (SCD) is a rising cause of mortality and morbidity in England and consequently an important policy issue for the National Health Service. There has been no previous study that has examined SCD admission rates in England.
Data from Hospital Episode Statistics were analysed for all hospital episodes (2001/10) in England with a primary diagnosis of sickle cell anaemia with crisis (D57.0) or without crisis (D57.1). Secondary and tertiary diagnoses were examined among those patients admitted with either of these codes as their primary diagnosis.
The overall SCD admission rate per 100 000 has risen from 21.2 in 2001/02 to 33.5 in 2009/10, a rise of over 50%. London accounts for 74.9% of all SCD admissions in England. 57.9% of patients admitted are discharged within 24 h. The largest rise in admission rates was seen among males aged 40-49 years where admission rates per 100 000 increased from 7.6 to 26.8 over the study period.
Our data show that SCD admissions are rising in England, particularly in London. Over half of patients admitted with SCD were discharged within 24 h, suggesting that some of these admissions could be prevented through better ambulatory care of patients.
Getting incapacity benefit (IB) claimants into work has become a focus for policy makers. Strategies to help this group depend on an understanding of the reasons for claiming benefit at a local level where variations from a national strategy may be needed.
Data supplied by the Department for Work and Pensions (DWP) was analysed to establish reasons for claiming benefit in Scotland and Glasgow between 2000 and 2007.
There has been a continuing rise in mental health diagnosis and a corresponding fall in musculoskeletal diagnosis during this period. More people were claiming because of mental health problems in Glasgow than in Scotland. Also those with a poor employment history (credits-only claimants) are more likely to claim IB because of a mental health problem. This study has shown a breakdown into 25 categories those claiming IB because of a mental health problem.
DWP data can be used to provide important insights into the trends in reasons for claiming IB, in particular those claiming because of mental health problems. This study also highlighted the growing importance of problems caused by alcohol and drug-abuse claimants, a subset of the mental health category. DWP data should be used at a local as well as a national level to guide and evaluate interventions to help this vulnerable group.
Routinely collected data from patients registered with general practices participating in the General Practice Research Database (GPRD) were used to analyse influenza vaccine uptake and distribution in England and Wales between 1989/90 and 1996/97. Major changes to influenza immunization policy were introduced in 1998 and 2000 when immunization of the elderly became age related rather than risk related. This new study examines trends in vaccine uptake for high- and low-risk patients and the impact of the policy changes on uptake in the elderly.
Between 0.5 and 2.7 million patients registered with practices participating in the GPRD from 1989 to 2004 were included. Data were examined by age group, medical risk group and evidence of vaccination per study year.
Vaccine uptake among high-risk persons aged 65 or more increased from 36.7 per cent in 1989/90 to 72.1 per cent in 2003/04. For the same period, uptake rates for high-risk persons under 65 years increased from 10.8 to 24.3 per cent. For those at high risk, uptake by females was higher in all age groups up to 65 years. Of those that were vaccinated, a higher proportion of the 65 and over were vaccinated in October each year compared with the high risk under 65 (p < 0.001).
Coverage among high-risk patients in younger age groups continues to fall well below satisfactory levels, especially among the youngest groups. Government policy should now focus on ways to improve uptake in these patients.
Child obesity has unclear determinants and consequences. A precautionary approach requires best-guess interventions and large-scale surveillance. This study was to determine the current measurement activities and the information systems required for child obesity surveillance.
Primary Care Trusts (PCTs) in United Kingdom.
Two hundred and forty-seven (82%) PCTs in 2004 and 240 (79%) in 2006.
Children's ages at which height and weight are routinely measured, the type of personnel taking the measurements, arrangements for recording data, information systems and uses of the data.
PCTs measure height/length and weight most commonly at 6 weeks (74%) and 5 years (74%)-also at 6-12 months (58%), 1.5-2.5 years (50%), 2.5-4 years (40%), 11 years (18%) and 7 years (11%). Seventy-seven per cent of PCTs transferred the measurements to a database-26 different information systems were named. Six per cent of PCTs in 2004, rising to 34% in 2006, used the data to produce public health reports.
Body mass index (BMI) surveillance requires new arrangements in 25% of PCTs at school entry and 80% at transfer to senior school. Important aspects of child obesity surveillance not yet addressed are pre-school measurement, longitudinal assessment and the public health requirements of (child) electronic health records.
Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992-93.
Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006-07.
In 2006-07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion.
The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.
The aim of the study is to investigate in-patient admission trends for assaults in Northern Ireland. Of particular interest was whether trends in the hospital data increased in line with police statistics, or decreased in line with the Northern Ireland Crime Survey, and paramilitary style punishment attacks.
Time-series analysis of Northern Ireland hospital inpatient data, 1 April 1996 until 31 March 2009, obtained from the Northern Ireland Department of Health, Social Services and Public Safety was performed. For comparative purposes, police data for 'wounding/grievous bodily harm with intent' and punishment attacks were obtained from the Police Service of Northern Ireland. Data were standardized using rate per 100 000 people.
The hospital in-patient data set comprised a total of 25 412 cases, over the period of 1 April 1996-31 March 2009. Inpatient admissions for assault-related injuries peaked in 2001/02 (n = 2297). The majority of assaults treated over the entire period was from bodily force (62%, n = 15 874). A 23% decline was observed for hospital admission rates for assault-related injuries. This decreasing trend was found for all types of assaults. The greatest decline was for assault by firearm discharge (55%).
The decline in assault-related hospital admissions is in contrast to the increase reported police data, supporting findings from previous studies. Similar decreasing trends in the hospital and punishment attack data are also identifiable, particularly for Belfast.
Several important socio-behavioral public health problems either peak or start during the second decade of life contribute to young people's mortality. The aim of this study was to explore patterns, rates, trends and regional variations of external-cause (due to environmental events/circumstances) mortality among young people aged 10-24 years in Greece, over the decade 2000-09.
Data were electronically derived from the database of the Hellenic Statistical Authority to study general and specific mortality rates by major causes of death.
Road traffic crashes (RTCs), illicit drug use and suicide accounted for 65.8, 14.7 and 4.8%, of total external-cause mortality, respectively. Mortality rates (deaths per 100 000) did not exhibit intra-country variability, were higher in young adults than in adolescents, in males than in females and decreased by 39%, from 33.6 in 2000 to 20.4 in 2009 (P < 0.001), due to declines in mortality from RTCs (from 21.3 to 14.3; P = 0.001), substance abuse (from 5.1 to 2.1; P = 0.003) and suicides (from 2.0 to 0.9; P = 0.003).
External causes of young people's mortality were mainly psychosocial and behavioral in origin. Despite improvement over the decade, young people in Greece still have unmet health-care needs and may further benefit from a multipronged public health approach through improved youth-friendly health services.
Outbreaks of measles in Gypsy-Traveller communities are well recognized. Their contribution to the overall burden of disease is less clear.
Measles case-management information was collated retrospectively for the Thames Valley population comprising 2.2 million people over the 4-year period from 2006 to 09. Suspected cases notified by general practitioners and hospital clinicians were sent a saliva testing kit. Cases were defined as those whose measles IgM was positive. Risk factor information was collected and collated including vaccination and membership of the Gypsy-Traveller communities.
Of 142 cases of laboratory confirmed measles, 63% were in Gypsy-Traveller communities. These included 10 family clusters and outbreaks confined to the Gypsy-Traveller communities and one with a wider spread. The pattern was consistent across the 4 years studied. Among the Gypsy-Traveller communities 27 of 55 cases eligible for measles, mumps and rubella (MMR) vaccination had received one MMR vaccination. Overall seven cases were admitted to hospital with either pneumonia or dehydration.
These findings showed a more than 100-fold higher incidence in the Gypsy-Traveller communities than the rest of the population. The high burden of disease in the Gypsy-Traveller communities highlights the importance of targeting immunization resources towards these communities.
Physical activity independent of adult supervision is an important component of youth physical activity. This study examined parental attitudes to independent activity, factors that limit licence to be independently active and parental strategies to facilitate independent activity.
In-depth phone interviews were conducted with 24 parents (4 males) of 10-11-year-old children recruited from six primary schools in Bristol.
Parents perceived that a lack of appropriate spaces in which to be active, safety, traffic, the proximity of friends and older children affected children's ability to be independently physically active. The final year of primary school was perceived as a period when children should be afforded increased licence. Parents managed physical activity licence by placing time limits on activity, restricting activity to close to home, only allowing activity in groups or under adult supervision.
Strategies are needed to build children's licence to be independently active; this could be achieved by developing parental self-efficacy to allow children to be active and developing structures such as safe routes to parks and safer play areas. Future programmes could make use of traffic-calming programmes as catalysts for safe independent physical activity.
Links between diet in childhood and the prevention of disease in adulthood have been established. This longitudinal dietary survey provided quantitative evidence of dietary change from adolescence to adulthood, in Northumberland, England.
To report longitudinal dietary change in 198 respondents between the ages of 12 and 33 years, to explore dietary 'tracking' between the same time points and to describe the effects of gender, socio-economic status and location on dietary change.
A longitudinal study recorded dietary change from adolescence to adulthood. Two 3-day food diaries were collected in 1980 and 2000 from the same 198 respondents. Foods consumed were assigned to the five categories in the Balance of Good Health (BGH). Demographic and socio-economic information were obtained in 1980 and 2000.
Intakes of foods containing fat and/ or sugar and milk and dairy foods decreased (p < 0.01 and p < 0.031, respectively), while intakes of fruits and vegetables increased (p < 0.01). Intakes of bread, other cereals and potatoes (p = 0.002, r = +0.219); fruits and vegetables (p < 0.01, r = +0.256) and meat, fish and alternatives (p = 0.026, r = +0.158) 'tracked' from adolescence to adulthood. Men had increased intake from meat, fish and alternatives and decreased milk and dairy foods more than female respondents (p = 0.003 and p = 0.019). Respondents who had moved away from Northumberland had a greater increase in intake of fruits and vegetables compared with those who remained in the local (p = 0.010). Individuals who had moved to a lower socio-economic group had increased their intake of bread, other cereals and potatoes (p = 0.040).
Food intake changed considerably in a direction more in the line with current dietary recommendations. Food intake in adolescence was a significant, but not strong, predictor of intake in adulthood. Dietary change is influenced by variables including gender, location and socio-economic status.
Improving the diet of the Scottish population has been a government focus in recent years. Health promotion is known to be more effective in affluent groups. Alongside trends in eating behaviour, changes in socioeconomic inequalities must be monitored.
Eating behaviour data from the 2002, 2006 and 2010 Scotland Health Behaviour in School-Aged Children survey were modelled using multilevel linear modelling.
Fruit and vegetable consumption increased between 2002 and 2010 by 0.26 and 0.27 days per week, respectively, while consumption of sweets, chips and crisps fell by 0.73, 1.25 and 0.99 days per week, respectively. An overall healthy eating score, calculated by summing food item weekly consumption, increased significantly (at 95% level of significance) over this period. Fruit and vegetable consumption was more frequent among children with high family affluence (individual measure of socioeconomic status), while consumption of crisps and chips was less frequent. When an interaction term was added between year and family affluence, this was not significant for any outcome. Variance at the education authority and school levels remained significant for all outcomes.
Adolescent eating behaviours in Scotland have improved over time across the family affluence scale gradient as a whole, with persistent inequalities. Alongside population programmes, initiatives directed at more deprived groups are required.
Sickle cell disease (SCD) is an inherited blood disorder which may result in a broad range of complications including recurring and severe episodes of pain-sickle 'crises'-which require frequent hospitalizations. We assessed the cost of hospitalizations associated with SCD with crisis in England.
Hospital Episodes Statistics data for all hospital episodes in England between 2010 and 2011 recording Sickle Cell Anaemia with Crisis as primary diagnosis were used. The total cost of admissions and exceeded length of stay due to SCD were assessed using Healthcare Resource Groups tariffs. The impact of patients' characteristics on SCD admissions costs and the likelihood of incurring extra bed days were also examined.
In 2010-11, England had 6077 admissions associated with SCD with crisis as primary diagnosis. The total cost for these admissions for commissioners was £18 798 255. The cost of admissions increases with age (children admissions costs 50% less than adults). Patients between 10 and 19 years old are more likely to stay longer in hospital compared with others.
SCD represents a significant cost for commissioners and the NHS. Further work is required to assess how best to manage patients in the community, which could potentially lead to a reduction in hospital admissions and length of stay, and their associated costs.
Over recent years Malta has experienced a growing influx of migrants from Africa. With the aim of defining demographic characteristics and assessing the prevalence of conditions of public health significance among asylum seekers in Malta, a clinical research study was implemented in the framework of the European Union project 'Mare nostrum'.
From August 2010 to June 2011 a dermatologist and an infectious diseases specialist performed general and specialist health assessment of migrants hosted in open centres.
Migrants included in the study were 2216, 82.7% were males, their mean age was 25 years and 70.1% were from Somalia. Out of the total females, 42.5% had undergone some type of Female Genital Mutilation/Cutting. A total of 5077 diagnoses were set, most common were skin diseases (21.9%), respiratory diseases (19.8%) and gastro-enteric diseases (14.2%), whereas 31% of migrants reported good health conditions.
Immigrants have a lower morbidity burden compared with their fellow countrymen living in the origin country. However, living conditions during the journey, in transit countries and after arrival can influence their health status. The present study provides a comprehensive picture of this growing population that is in need for health promotion, mental health services and fair policy planning.
Neural tube defects (NTDs) are associated with deficient maternal folic acid peri-conceptionally. In Ireland, there is no mandatory folic acid food fortification, partly due to declining NTD rates in recent years. The aim of this study was to ascertain the incident rate of NTD during the period 2009-11 and describe epidemiologically NTD in Ireland.METHODS
Cases were ascertained through multiple sources, including three regional congenital anomaly registers, all maternity hospitals nationally and paediatric hospitals providing care for children with spina bifida in the Republic of Ireland during the period 2009-11.RESULTSFrom 225 998 total births, 236 NTDs were identified, giving an incidence of 1.04/1 000 births, increasing from 0.92/1 000 in 2009 to 1.17/1 000 in 2011. Of all cases, 45% (n = 106) had anencephaly, 49% (n = 115) had spina bifida and 6% (n = 15) had an encephalocoele; 78% (n = 184) were liveborn or stillborn and 22% (n = 52) were terminations abroad. Peri-conceptional folic acid supplement intake was 13.7% among the 52.5% (n = 124) of cases whose folic acid supplement intake was known.CONCLUSION
The incidence of NTDs in the Republic of Ireland appears to be increasing. Renewed public health interventions, including mandatory folic acid food fortification, must be considered to reduce the incidence of NTD.
Binge drinking has been highlighted as a growing problem in the UK, particularly amongst females aged 18-25 years. University of Leeds is situated within a population that has one of the highest reported statistics of binge drinking in the UK. In September 2006, the 'Unit 1421' campaign was launched at University of Leeds with the aim to promoted sensible drinking amongst students. The aim of this study is to explore female perspectives on binge drinking and on 'Unit 1421' campaign in the University of Leeds.
Using a purposive sample, two focus groups were conducted with 12 female students aged 18-23 years within university grounds. Participants were recruited via email and poster advertisements on campus.
Four main themes emerged from the data: (i) lay perception of binge drinking; (ii) pressures of matching the drinking patterns of male peers; (iii) student rite of passage; (iv) evaluation of the 'Unit 1421' campaign.
The social context of student life impacts greatly upon students' choices to binge drink. The norms, beliefs and morals governing student culture and the use of alcohol to assert identity should be considered when tailoring health promotion efforts to this target audience. Larger qualitative and ultimately quantitative studies are warranted to extrapolate and test the social pressures on drinking in this age group.
This report describes the investigation and public health management of a community-based outbreak of severe adenovirus serotype 14p1 respiratory infection affecting the Tayside area during 2011. It is the first report of an adenovirus outbreak involving prisons.
An outbreak-based/incident management approach was carried out. Alerts were sent out to local doctors, general practitioners, prison healthcare staff and consultants so that cases could be identified prospectively. Sequencing of hexon, fibre and E1A regions of adenovirus were carried out to genotype the viruses.
Fifteen cases were identified in total, including 13 confirmed cases and 2 possible cases. There were 3 deaths amongst the 13 confirmed cases, with a case fatality rate of 23%. Eight of the cases had a direct association with one of the two prisons in the area.
We advise that surveillance measures for adenovirus infection and guidelines for the management of critically ill patients should be developed in order to identify outbreaks at an early stage and allow patients to receive appropriate treatment. Adenovirus infection should be borne in mind as a cause of severe pneumonia in closed settings such as prisons.
SettingBlackburn, Hyndburn and Ribble Valley Local Government areas of England and Wales, the former a high tuberculosis (TB) prevalence district.
The incidence of tuberculosis in new entrants aged 16-34 with positive tuberculin skin tests but normal chest X-rays after initial entry is not definitely known, and was previously estimated from cross-sectional national surveys and derived data for the 2006 and 2011 NICE economic appraisals of new entrant TB screening.
New entrants aged 16-34 years predominantly from South Asia (India, Pakistan and Bangladesh), with tuberculin tests inappropriately positive for their BCG history were identified for the years 1989-2001 inclusive from a new entrant database. These entrants were compared with the current GP registration database to see if local residence could be confirmed and the local TB notification database to October 2008. Survival analysis was carried out using Kaplan-Meier survival curves and a Cox Regression model.
Four hundred and seventy-nine such new entrants with normal initial chest X-rays were identified. Of these 402 (84%) registered with a General Practitioner in East Lancashire for a period of time and could be followed up by this study. The crude incidence density of active TB amongst these individuals with latent disease was 1297 per 100 000 person-years (95% CI; 991-1698 per 100 000 person-years). After 10 and 15 years of follow-up 13.5 and 16.3% of individuals, respectively, had progressed on to active disease.
This patient-derived, rather than estimated, data shows a minimum risk of TB disease of 16.3% at 15 years. The 2006 NICE economic appraisal, suggested that treatment for latent TB infection (LTBI) was cost-effective when the incidence of clinical TB over 15 years surpassed 18% in these populations. The 2011 NICE economic appraisal reduced this to 12% active TB over 15 years, and showed that at 16% active TB over 15 years a single interferon gamma release assay was the most cost-effective strategy. Further cohort studies are urgently needed to confirm or revise the assumptions behind the 2011 NICE economic appraisal.
A randomized control trial completed in the Hamilton-Wentworth and Halton regions of Ontario, Canada, was created to assess the effects and expense of age-appropriate provider-initiated and subsidized versus self-directed and self-financed methods of recreation. Upon completion, this study proved that the annual per-person expenditure for the subsidized, quality recreation paid for itself by children's lower use of healthcare and social services. The children within the subsidized recreation group had lower use of physician, physiotherapy, probation, children's aid society, social work, psychologist and services in comparison with those in the non-subsidized group. The subsidized group also proved to be beneficial for the parents as well. The use of health and social services, by the parents in the subsidized group, was also decreased in comparison with those of the self-financed group. This group also proved to have improvement of the global socioeconomic status, with a 10% greater exit from the social assistance program within 1 year.
This study estimates the concurrent and longitudinal effects of perceived economic strain and socioeconomic status (SES) on well-being of older adults in Taiwan.
This study uses data from the Taiwan Longitudinal Study on Aging, a nationally representative sample (n= 3602) of older adults aged 60 and above. Participants were interviewed and followed for 18 years. Individual well-being is measured by self-reported life satisfaction, psychological distress and perceived health status. Generalized linear modeling with the generalized estimating equation estimates is used to predict the relationships between perceived economic strain, SES and well-being cross-sectionally and longitudinally, controlling for individual background characteristics, physical health and survival status.
Older adults who experienced economic strain had significantly poorer well-being in comparison to older adults without strain, both cross-sectionally and longitudinally, controlling for SES and other covariates. In contrast, SES indicators did not consistently predict well-being in the cross-sectional and longitudinal analyses.
These findings suggest a strong, cumulative, negative effect of perceived economic strain on well-being among older adults. Health-care initiatives aiming at promoting well-being among older adults should consider the impact of economic strain, which may increase at the end of the life course and threaten health and functioning.
Whether the higher coronary mortality in South Asians compared with White populations is due to a higher incidence of disease is not known. This study assessed cumulative incidence of chest pain in South Asians and Whites, and prognosis of chest pain.
Over seven phases of 18-year follow-up of the Whitehall-II study (9,775 civil servants: 9,195 White, 580 South Asian), chest pain was assessed using the Rose questionnaire. Coronary death/non-fatal myocardial infarction was examined comparing those with chest pain to those with no chest pain at baseline.
South Asians had higher cumulative frequencies of typical angina by Phase 7 (17.0 versus 11.3%, P < 0.001) and exertional chest pain (15.4 versus 8.5%, P < 0.001) compared with Whites. Typical angina and exertional chest pain at baseline were associated with a worse prognosis compared with those with no chest pain in both groups (typical angina, South Asians: HR, 4.67 and 95% CI, 2.12-0.30; Whites: HR, 3.56 95% CI, 2.59-4.88). Baseline non-exertional chest pain did not confer a worse prognosis. Across all types of pain, prognosis was worse in South Asians.
South Asians had higher cumulative incidence of angina than Whites. In both, typical angina and exertional chest pain were associated with worse prognosis compared with those with no chest pain.
To explore the motivations, experiences and views of female regular sunbed users aged 15-17 and consider the implications of legislation seeking to restrict sunbed use among the under-18s. Design Qualitative study of 12 focus groups.
Participants were recruited opportunistically through community and social networks, around tanning salons, leisure and educational facilities in six English towns and cities. Interviews were transcribed, a thematic framework generated and a validation exercise conducted. Setting Urban communities in England. Participants Sixty-nine female regular sunbed users aged 15-18.
Respondents consistently valued tanning and attached considerable personal and social importance to it. They showed an awareness of the risks of sunbed use that they accepted, downplayed and/or ignored. While experiences and responses to supervision varied, respondents were resistant to any measures that restricted their use and expressed willingness to find ways around such restrictions.
The sunbed users interviewed in this study attached considerable significance to tanning, rationalized the risks of sunbed use and expressed their determination to continue using them. The impact of legislation to limit sunbed access may be weakened without requirements to ensure supervision of salons.
Over the last 100 years, China has experienced the world's three most fatal earthquakes. The Sichuan Earthquake in May 2008 once again reminded us of the huge human toll geological disaster can lead to.
In order to learn lessons about the impact of earthquakes on health in China during the past century, we conducted a bilingual literature search of the publicly available health-related disaster databases published between 1906 and 2007.
Our search found that research was limited and there were major gaps in the published literature about the impact on health in the post-earthquake period. However, the experiences recorded were similar to those of other parts of the world. The available studies provide useful information about preparedness and rapid early response. Gaps identified included care of chronic disease.
Our literature review highlights the paucity of literature on the impact on health post-earthquake in China between 1906 and 2007. Disaster mitigation policies need to reflect the needs not only of the disaster-related impacts on health but also of the ongoing health needs of the chronically ill and to establish safeguards for the well-being of the vulnerable populations.
Postcards were important means of communication in the early 1900s among family and friends in the rural USA. The images and
written words can offer insights into the attitudes and beliefs of the day. One hundred years ago, the comment ‘this is a
pretty place’ was written on a postcard with the image of the largest tin plate manufacturing factory at the time. We examined
this comment in the context of public perceptions in 1910 and what we now know of the impacts of ‘the four Ps’ of industrialization
on public health: politics, population, poverty and pollution.
Media reports of suicide may provoke further 'copy-cat' suicides. Trends in reporting quality and impact of reporting on suicides from a particular 'hot-spot' have not been investigated previously.
Inquest files and death certificates were used to identify suicides from Clifton Suspension Bridge, Bristol, UK, 1974-2007. Copies of local newspaper and television reports within 3 days of death or inquest were obtained. Parametric survival models were used to examine the impact of media reports on subsequent suicides.
Over 34 years, there were 206 suicides and 427 media reports of suicide from the bridge. The number of reports per suicide has declined markedly from 2.8 per suicide in the 1970s to 0.7 per suicide in the 2000s (P<0.001). While some aspects of reporting improved, others deteriorated or remained poorly reported. There has been an increase in sensational reporting (use of images was 5% in the 1970s and 16% in the 2000s) and in information about the suicide method. There was no evidence that media reports provoked further suicides.
Media reporting of suicide from Clifton Suspension Bridge declined over the study period; however, most aspects of the quality of reporting remained poor. There was no evidence of media reports provoking further suicides.
The Alcohol Harm Reduction Strategy for England, recently published, highlights current concerns about alcohol consumption
in this country. We used a database to examine trends in mortality for all deaths certified as effects of alcohol from 1979–1999,
including mentions as well as underlying cause, in a relatively prosperous population in southern England. Mortality, certified
as direct effects of alcohol, tripled during the 21 years of study; and mortality rates based on mentions were about double
those based on underlying cause. The increase in recent years in mortality based on mentions was considerably greater than
that based on underlying cause. Data on age, sex and occupational social class show that people whose alcohol intake kills
them are from a broad cross-section of society.
To determine the degree to which changing patterns of deprivation in Scotland and the rest of Great Britain between 1981 and 2001 explain Scotland's higher mortality rates over that period.
Cross-sectional analyses using population and mortality data from around the 1981, 1991 and 2001 censuses.
Great Britain (GB).
Populations of Great Britain enumerated in the 1981, 1991 and 2001 censuses.
Carstairs deprivation scores derived for wards (England and Wales) and postcode sectors (Scotland). Mortality rates adjusted for age, sex and deprivation decile.
Between 1981 and 2001 Scotland became less deprived relative to the rest of Great Britain. Age and sex standardized all-cause mortality rates decreased by approximately 25% across Great Britain, including Scotland but mortality rates were on average 12% higher in Scotland in 1981 rising to 15% higher in 2001. While over 60% of the excess mortality in 1981 could be explained by differences in deprivation profile, less than half the excess could be explained in 1991 and 2001. After adjusting for age, sex and deprivation, excess mortality in Scotland rose from 4.7% (95% CI: 3.9% to 5.4%) in 1981 to 7.9% (95% CI: 7.2% to 8.7%) in 1991 and 8.2% (95% CI: 7.4% to 9.0%) in 2001. All deprivation deciles showed excess indicating that populations in Scotland living in areas of comparable deprivation to populations in the rest of Great Britain always had higher mortality rates. By 2001 the largest excesses were found in the most deprived areas in Scotland with a 17% higher mortality rate in the most deprived decile compared to similarly deprived areas in England and Wales. Excess mortality in Scotland has increased most among males aged <65 years.
Scotland's relative mortality disadvantage compared to the rest of Great Britain, after allowing for deprivation, is worsening. By 1991 measures of deprivation no longer explained most of the excess mortality in Scotland and the unexplained excess has persisted during the 1990s. More research is required to understand what is causing this 'Scottish effect'.
Homicide rates have been increasing in Scotland, and homicides involving knives are of particular concern.
and results We use mortality and population data from 1981 to 2003 to calculate smoothed, standardized mortality rates for all homicides and homicides involving knives and other sharp objects, for all of Scotland and separately for Glasgow. Over half of homicides where the victim was male involved the use of a knife. Over 20 years, the homicide rate rose 83%, whilst that involving knives increased by 164%.
The rapid increase in homicide involving knives is becoming a public health problem. Proposed changes to legislation are unlikely to halt this rise.
There is strong evidence of a positive secular trend in body mass index (BMI) and the prevalence of obesity has increased substantially over the last several decades. However, no studies on this trend have been reported in Shandong Province, China. The present study assessed the decennial change in BMI in Shandong Province during the past 25 years and the prevalence of overweight and obesity among children and adolescents.
The BMI of children and adolescents aged 7-18 was calculated using data from five national surveys on students' constitution and health carried out by the government in 1985, 1995, 2000, 2005 and 2010 in Shandong Province, China. The distribution of BMI was reported, and the prevalence of overweight and obesity was obtained according to the screening criteria of overweight and obesity for Chinese students using BMI [Working Group on Obesity in China (WGOC) standard]. Overweight and obesity prevalence were also computed using the International Obesity Task Force (IOTF) cutoffs.
In the past 25 years, the P(50) (50th percentile) of BMI increased. The average increments of BMI were 2.18 kg/m(2) for boys and 1.21 kg/m(2) for girls, respectively. The prevalence of overweight and obesity increased rapidly: using WGOC standard, the prevalence of overweight increased from 1.91% for boys and 2.02% for girls in 1985 to 17.34% for boys and 11.97% for girls in 2010, and the prevalence of obesity increased from 0.27% for boys and 0.23% for girls in 1985 to 15.83% for boys and 7.12% for girls in 2010; using IOTF standard, the prevalence of overweight increased from 1.54% for boys and 1.27% for girls in 1985 to 19.06% for boys and 13.42% for girls in 2010, and the prevalence of obesity increased from 0.04% for boys and 0.03% for girls in 1985 to 9.33% for boys and 2.42% for girls in 2010, respectively.
The average value of BMI has increased over time; overweight and obesity among children and adolescents have become a serious public health problem. Comprehensive evidence-based strategies of intervention should be introduced, including periodic monitoring.
Little research has investigated cancer care in UK prisons. We wished to identify the number of new cases and the most common cancer diagnoses occurring each year in London prisoners, and the place of death for those who died from their disease.
Using the database of the Thames Cancer Registry, we identified cancer diagnoses in residents of seven London prisons from 1986 to 2005 and the place of death of patients dying from their disease between 1996 and 2005.
On average, 31 patients were recorded as diagnosed with cancer while in prison within each 5-year period. In women, 83% (85/102) of diagnoses were in situ carcinoma of the cervix, and in men, 19% (11/57) were of lung cancer. None of the 25 patients recorded as dying from their disease died in prison. Most died in hospitals (48%, 12/25) or in hospices (28%, 7/25).
London prisons contribute a small number of patients each year who require NHS cancer care, including those with advanced cancer who are released before death. Future studies should investigate cancer incidence for the national prison population, methods for improving screening coverage and follow-up, the timeliness of access to cancer treatments and end-of-life care, and prisoners' and health professionals' experiences of care.
Previous trend studies have shown large increases in hip fracture incidence rates among the elderly. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates, although for Sweden this remains to be studied.Methods
Data were obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Analysis was performed in three steps. First, age-and sex-specific trends in hip fracture rates per 100 000 and the mean age when sustaining a hip fracture were analysed. Secondly, the annual percentage change was used to compare time periods that helped to quantify changes in secular trends. Finally, linear and Poisson regression models were used to examine the trend data and observed rates.ResultsThe absolute number of hip fractures among the elderly in Sweden has largely remained constant between 1987 and 2009, while incidence rates have decreased for all age-and sex-specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women.Conclusions
This study supports other international studies in showing a decrease in hip fracture incidence rates among the elderly, especially since the mid-1990s.
Following the licensure of 23-valent pneumococcal polysaccharide vaccine (23vPPV) in 1989, a risk-group-only immunization policy was implemented in 1992 in England. The PPV programme was extended in 2003 to include all individuals 65 years and over. In England, this was phased in over 3 years. To ascertain the performance of the risk group policy in those 65 years of age and over and provide a baseline to estimate the impact of the universal elderly programme.
Information was gathered on vaccine uptake for the period 1989-2003 in England from a national survey of general practitioners (GPs) through NHS primary care trusts (PCTs), the prescription cost analysis (PCA) system and the General Practice Research Database (GPRD).
Between 1991 and 2003, 4.5 million doses of PPV were prescribed. The GP survey found that by 2003, 29% of those 65 years and over of age and 36% of those 80 years of age over had received PPV. Sixty-two per cent of general practices had implemented a risk-group-only policy, 14.4% had targeted all those 65 years of age over and 14.2% had targeted all those 75 years of age over. The GPRD study found that 38% of those 65 years over and 41% of those 80 years over fell into one or more high-risk groups. By 2003, 36.6% of the high-risk group and 30.2% of all those 65 years over had ever been vaccinated. Vaccine uptake increased with age, with 52.3% of the high-risk group and 37% of all those 80 years over having ever been vaccinated.
A large proportion of those in risk groups remained unvaccinated with PPV in 2003. Formal evaluation of the impact and effectiveness of the universal elderly immunization programme will be required.
Hospitals experience winter surges in admissions due to respiratory infections. The roles of acute bronchitis and influenza-like illness (ILI) in the timing and severity of these surges are examined over the years 1990-91 to 2004-05.
Respiratory admissions of persons aged > or =65 years in England and Wales were analysed in relation to patients with ILI or acute bronchitis diagnosed by community-based general practitioners from a sentinel surveillance network.
Acute bronchitis and ILI accounted for 46 and 7% of the variation in respiratory admissions, respectively: when admissions were lagged by 1 week, these estimates were 20 and 14%, respectively. Admissions peaked in weeks 52, 01 or 02 (late December to early January) in 14 of the 15 winters. Acute bronchitis peaked during weeks 01 or 02; ILI exhibited greater variability and peaks ranged from weeks 46 (mid-November) to 07 (mid-February). During winters where acute bronchitis and ILI peaked concurrently, surges on hospitals were most severe.
During each winter acute bronchitis provides a consistent and major contribution to the winter admissions surge in the elderly. The variable incidence of ILI can increase the surge in admissions, especially when ILI and acute bronchitis peak together.
A previous study showed that lung cancer incidence in Leicester's South Asian (SA) population had increased between 1990 and 1999. We expanded the original data set to determine if this increase had continued in recent years.
All patients diagnosed with lung cancer in Leicester between 1990 and 2005 were identified. Ethnicity was assigned using Nam Pechan software, deprivation by Townsend score. Using Poisson regression, incidence rate ratios (IRRs) were calculated to assess variations in incidence by ethnicity, deprivation and period of diagnosis.
Comparing patients diagnosed in 2000-2005 with those in 1990-1994, the risk of lung cancer increased in the SA men (IRR: 1.67 (95% CI: 0.99, 2.78)) whereas in the non-South Asian (NSA) men, it had fallen (IRR: 0.84 (95% CI: 0.76, 0.94)). Comparing patients diagnosed in 2000-2005 with those in 1995-1999 an increase continued in the SA men (IRR: 1.11 (95% CI: 0.71-1.74)). A significant rise was observed in the NSA women comparing those diagnosed from 2000-2005 to 1995-1999 (IRR: 1.16 (95% CI: 1.01, 1.33)).
Lung cancer is an important public health issue amongst SAs in Leicester and has increased significantly since the early 1990s, with rates sustained in the more recent years of 2000-2005. Changes in the rates of lung cancer in SA and NSA populations are likely to be due to changing smoking habits.
Climate change has contributed to increasing temperatures, earlier snowmelts and thinning ice packs in the Arctic, where crossing frozen bodies of water is essential for transportation and subsistence living. In some Arctic communities, anecdotal reports indicate a growing belief that falling-through-the-ice (FTI) are increasing. The objective of this study was to describe the morbidity and mortality associated with unintentional FTIs in Alaska.
We searched newspaper reports to identify FTI events from 1990 to 2010. We also used data from a trauma registry, occupational health and law enforcement registries and vital statistics to supplement the newspaper reports. Morbidity and mortality rates were calculated for Alaska Native (AN) people and all Alaskans.
During the 21-year period, we identified 307 events, affecting at least 449 people. Events ranged from no morbidity to fatalities of five people. More than half of the events involved transportation by snow machine. Mortality rates were markedly higher for AN people than that for all Alaskans.
We provide a numeric estimate of the importance of FTI events in Alaska. FTIs may represent an adverse health outcome related to climate changes in the Arctic, and may be particularly critical for vulnerable populations such as AN people.
To report the trend in prescriptions and cost of antidiabetic drugs and glucose monitoring equipment in England from 1991 to 2004.
We analysed data on all community antidiabetic drug prescriptions in England collated from the Prescription Cost Analysis system.
The total number of diabetes prescriptions (medicines and monitoring) rose from 7,613,000 (1991) to 24,325,640 (2004) (>300% increase). Meanwhile, total costs increased by 650%. Insulins are the biggest contributor to cost followed by monitoring equipment and then oral medications. Three times as many items of oral tablets are prescribed than insulins. Metformin accounts for 40% of all diabetic drug dispensations but only 7% of the costs. More is spent on glitazones now than on either metformin or sulphonylureas.
There has been a substantial increase in the cost of managing diabetes in the community. Costs are likely to continue to rise in the future, as the prevalence of diabetes increases and through more aggressive identification and management of patients with diabetes in the hope of reducing the even more costly complications. The cost implications of glucose monitoring merits further study.
To determine changes in prevalence of parental and childhood asthma in Merseyside between 1991 and 2006.
Four standardized cross-sectional respiratory surveys using a parent-completed questionnaire were completed in 1991 (n = 1171), 1993 (n = 2368) 1998 (n = 1964) and in 2006 (n = 1074) among primary school children attending the same schools in lower socio-economic areas of Merseyside. Main outcome measures were prevalence of doctor diagnosed asthma (DDA) and the symptom triad of cough, wheeze and breathlessness (C+W+B+).
Between 1991 and 1998 prevalence of DDA increased (P < 0.001), but in 2006 this decreased from 29.8 to 19.4% (P < 0.001). Prevalence of C+W+B+ increased from 7.8 to 8.0% by 1998, then decreased to 6.7% in 2006 (P = 0.39). Between 1998 and 2006, childhood hospital admissions for respiratory illness decreased from 11.3 to 9.7% (P = 0.23). During this period paternal asthma prevalence increased from 8.6 to 10.7% (P = 0.001) and maternal asthma from 11.2 to 13.4% (P = 0.09).
An increase in the prevalence of DDA and asthmatic respiratory symptoms occurred in children prior to 1998, but this had decreased by 2006. Prevalence of parental asthma increased during the same period.
To determine the trends in overweight and obesity among White and South Asian children aged 5-7 years born between 1991 and 1999 and included in the East Berkshire Child Health System.
Children were grouped into nine cohorts based on their year of birth. The UK National BMI percentile classification was used to classify the children as overweight and obese and to examine the prevalence and trends by year of birth, sex and ethnicity.
Overall, more boys (10.1%; 9.7-10.6%) than girls (9.1%; 8.7-9.6%) were obese (P < 0.003). South Asian boys were more likely to be overweight (OR 1.92; 95% CI 1.62-2.28; P < 0.01) and obese (OR 1.53; 95% CI 1.28-1.89; P < 0.01) than South Asian girls. Overweight (1.77; 1.56-2.00; P < 0.05) and obesity (1.76; 1.50-2.06; P < 0.05) were significantly higher among South Asian boys compared with their White counterparts (baseline). After adjusting for sex, ethnicity and year of birth, South Asian children were 27% more overweight (P < 0.01) and 45% more obese (P < 0.01) compared with White children, and boys were 6% more overweight (P = 0.04) and 12% more obese (P = 0.003) compared with girls. There was an increasing trend in overweight among boys (P = 0.01) and girls (P = 0.003); and in obesity among boys (P < 0.001) and girls (P = 0.008) in children born from 1991 to 1999.
There is a significant rise in childhood obesity among 5-7-year-old children. Overweight and obesity among South Asian boys are significantly higher than that among South Asian girls. This group may be at greater risk of morbidity and mortality related to obesity and may need to be targeted appropriately for interventions to reduce obesity.
Previous research suggests that the health effects of recessions are mixed and vary spatially between countries. Using the North-South English health divide as an example, this paper examines whether there are also spatial variations within countries.
Cross-sectional data on self-reported 'not good health' was obtained from the British Household Panel Survey and the Health Survey for England from 1991 to 2010. Age-adjusted generalized linear models were used to examine the effects of recessions (1990/91 and 2008/09) on self-reported health in the four English NHS Commissioning Regions (North, South, Midlands and London) with stratification by gender.
Over the 20-year study period, the North had consistently higher rates of 'not good health' than the South [OR 1.50 (1.46-1.55) outside recessions and OR 1.29 (1.19-1.39) during recessions]. However, during periods of recession, this health divide narrowed slightly with a 2% decrease in the prevalence of 'not good health' in the North [OR 0.91 (0.86, 0.96)].
This study is evidence of spatial variations in the health effects of recessions within England and the North-South divide appears to slightly reduce during recessions. Health in the North remains worse than the South.
Increasing the coverage of key maternal, newborn and child health interventions is essential, if India has to attain Millennium Development Goals 4 and 5. This study assesses the coverage gap in maternal and child health services across states in India during 1992-2006 emphasizing the rural-urban disparities. Additionally, association between the coverage gap and under-5 mortality rate across states are illustrated.
The three waves of National Family Health Survey (NFHS) conducted during 1992-1993 (NFHS-1), 1998-1999 (NFHS-2) and 2005-2006 (NFHS-3) were used to construct a composite index of coverage gap in four areas of health-care interventions: family planning, maternal and newborn care, immunization and treatment of sick children.
The central, eastern and northeastern regions of India reported a higher coverage gap in maternal and child health care services during 1992-2006, while the rural-urban difference in the coverage gap has increased in Gujarat, Haryana, Rajasthan and Kerala over the period. The analysis also shows a significant positive relationship between the coverage gap index and under-five mortality rate across states.
Region or area-specific focus in order to increase the coverage of maternal and child health care services in India should be the priority of the policy-makers and programme executors.
In England, the impact of increased use of antidepressant medications is unclear. We examine associations between antidepressant use, suicide and antidepressant poisoning mortality, adjusted for important covariates.
Data on suicide and antidepressant poisoning mortality were provided by the Office for National Statistics. Prescription data were provided by the Department of Health. Age- and sex-specific prescribing rates were estimated from The Health Improvement Network primary care data. We measured the association between prescribing, suicide and poisoning mortality after adjusting for age, sex, calendar year, prescribing rates and use of newer antidepressants drugs.
The prevalence of antidepressant treatment increased during the 1990s for all age and sex groups. Treatment prevalence remained constant from 2002 but declined among children and adolescents. Between 1993 and 2004, age-standardized rates for suicide decreased from 98.2 to 81.3 per million populations and for antidepressants from 9.2 to 7.4 per million populations. Before adjustment, increased antidepressant prescribing was associated with a decrease in suicide (r(s) = -0.90, P < 0.001) and antidepressant poisoning mortality rates (r(s) = -0.65, P = 0.023). This association disappeared after adjustment.
In England, at a population level, there does not appear to be an association between antidepressant prescribing and antidepressant poisoning mortality or suicide.
Previous studies suggest that fatal poisoning deaths involving methadone occur more frequently on the weekends. We assessed changes in the daily pattern of mortality because of methadone poisoning following a review of drug misuse services in 1996 and publication of revised clinical guidelines in 1999. We also compared this to the daily pattern of deaths involving heroin/morphine. The Office for National Statistics provided data on all deaths in England and Wales between 1993 and 2003 for which methadone and heroin/morphine were mentioned on the coroner's certificate of death registration after inquest, with or without alcohol or other drugs. There were 3098 deaths involving methadone. The death rate increased up to 1997 and then declined. Initially, there was a marked excess of deaths occurring on Saturdays. The rate of decline was greatest for deaths occurring on Saturdays. As a result, the Saturday peak disappeared (P = 0.006). There were 6328 deaths involving heroin/morphine. No change in the daily pattern of heroin/morphine deaths was observed during the study period. Although the marked change in the epidemiology of methadone deaths coincided with recommendations for service redevelopment and clinical management of methadone treatment, the contribution of improved prescribing practice or treatment services is unclear.
Since the mid-1990s, there has been a steady decline in coverage rates for cervical screening in the target age group (25–64
years) across England. This article describes the rate of decline from 1995 to 2005 in the old health authority areas of the
North East and the Yorkshire and the Humber (NEYH) regions in relation to age group, deprivation, ethnicity and religion.
The results show that the rate of decline is faster in these northern regions than that in England as a whole, with a very
strong correlation between age and rate of change of coverage rates. Younger age groups experience the fastest rate of decline,
and those over 55 years show an increase in coverage rates. There is an association between the deprivation of the old health
authority areas and the rate of change of coverage rates, with weaker evidence that areas with high proportions of Black or
Mixed ethnicity may have a faster decline. However, the rate of decline is not associated with other ethnic groups or religions.
Therefore, interventions could be targeted at younger women and those who live in deprived areas to prevent the widening of