Regional variations in the incidence of upper urinary tract stones in England and Wales.

Data from the Hospital In-patient Enquiry were used to define the regional patterns of hospital discharge rates for upper urinary tract stones and renal colic in England and Wales. By combining the rates for stones and colic, and by distinguishing emergency from planned admissions, the biases produced by repeated admissions of the same patient and by regional variations in diagnosis and coding may be reduced. There are regional variations in incidence of upper urinary tract stones: Wales and the southern regions of England have a generally higher incidence than northern regions. These variations may be related to regional differences in diet or occupation; or they may partly depend on associations between stone incidence and atmospheric temperature, exposure to ultraviolet irradiation, and hardness of drinking water.     

Using chloroplast DNA to trace postglacial migration routes of oaks into Britain

Postglacial migration is a major factor responsible for the patterns of genetic variation we see in natural populations. Fossil pollen data indicate that early postglacial colonists such as oak, were able to take both western and eastern migration routes into Britain. Analysis at a finer level is now permitted by the use of modern molecular techniques. A 13-bp duplication in the chloroplast tRNA^Leul intron occurs in natural populations of East Anglian oaks, but is not found in other parts of Britain or from mainland Europe. The distribution of this marker suggests that the mutation occurred either in southern England, or during migration from the mainland, and became fixed in a source population from which East Anglia was colonized. Planting of non-native trees for roadside boundaries and in the grounds of old houses and estates, explains the absence of the marker from some East Anglian oaks.     

Seasonal variation and time trends in childhood asthma in England and Wales 1975-81.

In England and Wales hospital admissions for childhood asthma almost trebled over the period 1975-81. This may have reflected a true increase in the incidence of acute asthma, a swing from primary to hospital care, or both. The trend was not due to a change in diagnostic fashion. Monthly admissions showed a pronounced seasonal variation with fewest admissions in winter, rising in spring and early summer to peak in the autumn. A deep admission trough was present in August. The monthly admission profile was very similar throughout England and Wales, suggesting that major "trigger" factors were responsible.     

Mortality from asthma: a new epidemic in New Zealand

Trends in mortality attributed to asthma in the 5-34-year age group were examined in New Zealand, Australia, England and Wales, the United States, Canada, and West Germany for the years 1959-79. An epidemic of deaths from asthma occurred in the mid-1960s in New Zealand, Australia, and England and Wales but not in the other countries. In Australia and England and Wales the death rate quickly returned to pre-epidemic levels, but in New Zealand the decline in mortality was slow, and by 1974 the death rate was still almost double the pre-epidemic level. Of great concern was an abrupt increase in reported deaths from asthma in New Zealand after 1976 with the mortality rate during 1977-9 being greater than during the previous epidemic. In contrast, asthma mortality had remained relatively stable in the other populations.The new epidemic in New Zealand was investigated and appeared to be real. It could not be explained by changes in the classification of deaths from asthma, inaccuracies in death certification, or changes in diagnostic fashions. The most likely explanation appeared to be related to the management of asthma in New Zealand, and this is being investigated.     

Age specific trends in asthma mortality in England and Wales, 1983-95: results of an observational study.

OBJECTIVE: To determine trends in asthma mortality by age group in England and Wales during 1983-95. DESIGN: Observational study. SETTING: England and Wales. SUBJECTS: All deaths classified as having an underlying cause of asthma registered from 1 January 1983 to 31 December 1995. MAIN OUTCOME MEASURE: Time trends for age specific asthma deaths. RESULTS: Deaths in the age group 5-14 years showed an irregular downward trend during 1983-95; deaths in the age groups 15-44, 45-64, and 65-74 years peaked before 1989 and then showed a downward trend; and deaths in the age group 75-84 years peaked between 1988 and 1993 and subsequently dropped. Trends were: age group 5-14 years, 6% (95% confidence interval 3% to 9%); 15-44 years, 6% (5% to 7%); 45-64 years, 5% (4% to 6%); 65-74 years, 2% (1% to 3%). Deaths in the 75-84 and 85 and over categories plateaued. CONCLUSIONS: There are downward trends in asthma mortality in Britain, which may be due to increased use of prophylactic treatment.     

Is London overbedded?

OBJECTIVE--To examine whether there are too many hospital beds in London. DESIGN--Analysis of data from the Hospital In-Patient Enquiry, Mental Health Enquiry, health service indicators, and Emergency Bed Service. SETTING--England, London, and inner London. RESULTS--Hospital admission rates for acute plus geriatric services for London residents were very similar to the national values in all age groups. In the special case considered in the Tomlinson report--acute services in inner London--the admission rate was 22% above the value for England. However, the admission rate of inner deprived Londoners was 9% below that of comparable areas outside London. For psychiatry, admission rates in London roughly equalled those in comparable areas. When special health authorities were excluded, in 1990-1 there were 4% more acute plus geriatric beds available per resident in London than in England. Bed provision has been reduced more rapidly in London than nationally. Extrapolating the trend of bed closures forward indicates that beds (all and acute) per resident in London are now at about the national average. Data from the Emergency Bed Service indicate that the pressure on available hospital beds in London has been increasing since 1985. CONCLUSIONS--Data regarding bed provision and utilisation for all specialties by London residents do not provide a case for reducing the total hospital bed stock in London at a rate faster than elsewhere. Bed closures should take account of London''s relatively poorer social and primary health care circumstances, longer hospital waiting lists, poorer provision of residential homes, and evidence from the Emergency Bed Service of increasing pressure on beds. Higher average costs in London, some unavoidable, are forcing hospital beds to be closed at a faster rate in London than nationally.     

Variation in rates of hospital admission for appendicitis in Wales.

In a study designed to investigate the variations in rates of admission to hospital for appendicitis in Wales Hospital Activity Analysis listings were analysed according to the sex and age of the patients and the month and day of the week of admission. The incidence of hospitalisation was greatest among boys aged 10-14 and girls aged 15-19. The number of admissions was higher on weekdays than at weekends, but there were no seasonal variations. Durations of stay differed between the 17 health districts. We conclude that admission rates vary mainly because of differing hospital admission policies. Admission is not wholly governed by the sudden onset of abdominal pain; other factors include the threshold of consultation of each patient, the referral habits of general practitioners, the availability of hospital beds, and the degree to which doctors and patients expect admission.     

Temperature-driven Campylobacter seasonality in England and Wales

Campylobacter incidence in England and Wales between 1990 and 1999 was examined in conjunction with weather conditions. Over the 10-year interval, the average annual rate was determined to be 78.4 +/- 15.0 cases per 100,000, with an upward trend. Rates were higher in males than in females, regardless of age, and highest in children less than 5 years old. Major regional differences were detected, with the highest rates in Wales and the southwest and the lowest in the southeast. The disease displayed a seasonal pattern, and increased campylobacter rates were found to be correlated with temperature. The most marked seasonal effect was observed for children under the age of 5. The seasonal pattern of campylobacter infections indicated a linkage with environmental factors rather than food sources. Therefore, public health interventions should not be restricted to food-borne approaches, and the epidemiology of the seasonal peak in human campylobacter infections may best be understood through studies in young children.     

The behaviour of populations of potato cyst eelworm Heterodera rostochiensis Woll. Towards resistant potato varieties derived from Solarium tuberosum ssp. andigena Juz & Buk

Many populations of Heterodera rostochiensis mostly from the main potato growing areas of England and Wales, were tested with eelworm-resistant potato varieties (andigena hybrids). Except in the Eastern Region, where resistant varieties were planted alongside commercial varieties in infested fields, tests were done in pots inoculated with a standard number of cysts extracted from a single soil sample from each field. The tests showed that England and Wales could be divided into areas according to the percentage of cysts(< 10%, 11–70%,> 70%) produced on the resistant compared with a commercial non-resistant variety. On the peat soils of the East Anglian fens and in Bedfordshire, Essex and Kent (area A) most populations produce few cysts on resistant varieties. In much of the East Midlands and Yorkshire (area D), populations produce many cysts on resistant varieties which behave much as ordinary susceptible potatoes. Populations in the rest of England and Wales (areas B, C) vary and in many districts every field must be tested separately. If the pathotypes occurring in Britain had separate origins in South America, the present distribution in England and Wales is probably due to chance introductions dispersed with seed and following the patterns of trade in seed potatoes. As all commercial varieties, before the release of eelworm-resistant ones, were about equally susceptible to the different pathotypes, the varieties themselves probably played little part in determining the present distribution of pathotypes.     

Schizophrenia sans frontieres: concepts of schizophrenia among French and British psychiatrists.

OBJECTIVE--To compare the first admission rates for schizophrenia in England and France, and to compare the concept of schizophrenia held by practising British and French psychiatrists. DESIGN--Comparative study of incidence rates in England and France; and postal questionnaire survey of a sample of about 1 in 30 psychiatrists in the United Kingdom and in l''Aquitaine, France. SUBJECTS--All first admissions for schizophrenia to psychiatric hospitals in England and France 1973-82; 92 psychiatrists in the United Kingdom and 69 in France. MAIN OUTCOME MEASURES--Age adjusted first admission rates for schizophrenia between 1973-82; and opinions on the aetiology, diagnosis, and management of schizophrenia. RESULTS--First admission rates were much higher in France than in England before the age of 45, but lower after that age. Rates were falling in England over the 10 year period, while they were rising in France. In the questionnaire study English and French psychiatrists showed prominent differences of opinion for 31 out of 38 statements. The French sample did not diagnose schizophrenia after the age of 45 and endorsed psychoanalytical concepts. CONCLUSIONS--British and French psychiatrists use different diagnostic criteria and contrasting methods of treatment for schizophrenia. Differences in diagnostic criteria probably contribute towards the disparity in administrative incidence rates and time trends for schizophrenia in the two countries. Doctors in the European Community can now work in any country. Further work is needed to ensure psychiatrists are talking a common language.     

Modelling the predicted geographic and economic response of UK cropping systems to climate change scenarios: the case of sugar beet

Geographical changes in suitability for the cultivation of sugar beet in England and Wales were predicted for climate change scenarios for 2023 and 2065 by integrating a climate database (1951-80) with climate-driven crop growth models. Initially, the outputs were produced as point values (at meteorological site locations) of predicted potential yields for current production. The outputs were validated statistically using actual crop yield figures collated from bibliographic analysis. The most suitable model was run again incorporating projected temperature and precipitation changes for 2023 and 2065. The outputs were mapped using a Geographical Information System and used to predict possible economic changes in farm profitability (and general market trends). Results indicated that the area of suitability for the growth of the crop moves westward with an increase in production in the West Midlands of approximately 5% (2 t ha^-1 fresh weight) by 2023 and 13% (6 t ha^-1 fresh weight) by 2065. The reduction in production in East Anglia coupled with the increase in production in the West does not align well with the current location of processing factories     

Trends in perinatal mortality attributed to congenital malformations in England and Wales during 1974-81: a study of the variations among regional health authority areas

Analysis of perinatal mortality attributed to congenital malformations in England and Wales, using data from birth and death registration over the years 1974-81 showed significant declines in England and Wales as a whole and in the individual Regional Health Authority (RHA) areas. A greater decrease in death rate from congenital malformations, particularly central nervous system malformations, was seen among stillbirths than among early neonatal deaths. There were marked regional differences in perinatal mortality due to central nervous system malformations over the period but not in cardiovascular system malformations or in other malformations. The highest mortality rates due to central nervous system malformations occurred in the North, North-West, West and South-West of England and in Wales, and the lowest rates in the South and South-East. The larger percentage reductions in the mortality rates were found in most of the regions which had had the highest rates. Possible explanations for the decline in regional rates are suggested.     

Hospital admissions for asthma in east London: associations with characteristics of local general practices,prescribing, and population.

OBJECTIVE: To determine the relative importance of appropriate prescribing for asthma in explaining high rates of hospital admission for asthma among east London general practices. DESIGN: Poisson regression analysis describing relation of each general practice''s admission rates for asthma with prescribing for asthma and characteristics of general practitioners, practices, and practice populations. SETTING: East London, a deprived inner city area with high admission rates for asthma. SUBJECTS: All 163 general practices in East London and the City Health Authority (complete data available for 124 practices). MAIN OUTCOME MEASURES: Admission rates for asthma, excluding readmissions, for ages 5-64 years; ratio of asthma prophylaxis to bronchodilator prescribing; selected characteristics of general practitioners, practices, and practice populations. RESULTS: Median admission rate for asthma was 0.9 (range 0-3.6) per 1000 patients per year. Higher admission rates were most strongly associated with small size of practice partnership: admission rates of singlehanded and two partner practices were higher than those of practices with three or more principals by 1.7 times (95% confidence interval 1.4 to 2.0, P < 0.001) and 1.3 times (1.1 to 1.6, P = 0.001) respectively. Practices with higher rates of night visits also had significantly higher admission rates: an increase in night visiting rate by 10 visits per 1000 patients over two years was associated with an increase in admission rates for asthma by 4% (1% to 7%). These associations were independent of asthma prescribing ratios, measures of practice resources, and characteristics of practice populations. CONCLUSIONS: Higher asthma admission rates in east London practices were most strongly associated with smaller partnership size and higher rates of night visiting. Evaluating ways of helping smaller partnerships develop structured proactive care for asthma patients at high risk of admission is a priority.     

STUDIES ON THE IMPORTANCE OF WILD BEET AS A SOURCE OF PATHOGENS FOR THE SUGAR-BEET CROP

Beet yellows virus, beet mosaic virus, rust ( Uromyces betae (Pers) Lév.), and downy mildew ( Peronospora schachtii Fuckel.) were found to be common in wild beet ( Beta vulgaris s.-sp. maritima L.) growing on the foreshores of south Wales and southern England. The virus diseases were more prevalent in southeast England than in the west, rust more in the west than in the east, and downy mildew is equally prevalent in all regions.
Beet yellows is the most commercially important disease and is more common in sugar-beet crops in East Anglia than elsewhere in Great Britain. There was no evidence that beet yellows spread in East Anglia from wild beet to nearby sugar-beet crops during the springs of 1958 or 1959, and Myzus persicae Sulz., the principal vector of yellows, was rarely found on wild beet growing on the foreshore.
In glasshouse experiments aphids colonized sugar-beet plants watered with tap water in preference to those watered with sea water. Daily watering with sea water made plants unpalatable to aphids within 14 days. Aphids also preferred leaves sprayed with distilled water to those that had been sprayed with sea water. Salt solutions gave results similar to those obtained with sea water.     

Role of the private sector in elective surgery in England and Wales, 1986.

From a sample of 19,000 treatment episodes at 183 of the 193 independent hospitals with operating facilities in England and Wales that were open in 1986 it is estimated that 287,000 residents of England and Wales had elective surgery as inpatients in 1986 (an increase of 77% since 1981) and 72,000 as day cases. From 1985 Hospital In-Patient Enquiry data it was estimated that a further 36,000 similar elective inpatient treatments were undertaken in NHS pay beds (a decrease of 38%) and 21,000 as day cases. Overall, an estimated 16.7% of all residents of England and Wales who had non-abortion elective surgery as inpatients were treated in the private sector, as were 10.5% of all day cases. An estimated 28% of all total hip joint replacements were done privately, and in both the North West and South West Thames regions the proportion of inpatients treated privately for elective surgery was 31%. It is concluded that mainly for reasons of available manpower private sector activity may not be able to grow much more without arresting or reversing the growth of the NHS, in which case some method of calculating NHS resource allocation which takes account of the local strength of the private sector will be needed.     

Y chromosome evidence for Anglo-Saxon mass migration

British history contains several periods of major cultural change. It remains controversial as to how much these periods coincided with substantial immigration from continental Europe, even for those that occurred most recently. In this study, we examine genetic data for evidence of male immigration at particular times into Central England and North Wales. To do this, we used 12 biallelic polymorphisms and six microsatellite markers to define high-resolution Y chromosome haplotypes in a sample of 313 males from seven towns located along an east-west transect from East Anglia to North Wales. The Central English towns were genetically very similar, whereas the two North Welsh towns differed significantly both from each other and from the Central English towns. When we compared our data with an additional 177 samples collected in Friesland and Norway, we found that the Central English and Frisian samples were statistically indistinguishable. Using novel population genetic models that incorporate both mass migration and continuous gene flow, we conclude that these striking patterns are best explained by a substantial migration of Anglo-Saxon Y chromosomes into Central England (contributing 50%-100% to the gene pool at that time) but not into North Wales.     

Temperature-Driven Campylobacter Seasonality in England and Wales

Campylobacter incidence in England and Wales between 1990 and 1999 was examined in conjunction with weather conditions. Over the 10-year interval, the average annual rate was determined to be 78.4 ± 15.0 cases per 100,000, with an upward trend. Rates were higher in males than in females, regardless of age, and highest in children less than 5 years old. Major regional differences were detected, with the highest rates in Wales and the southwest and the lowest in the southeast. The disease displayed a seasonal pattern, and increased campylobacter rates were found to be correlated with temperature. The most marked seasonal effect was observed for children under the age of 5. The seasonal pattern of campylobacter infections indicated a linkage with environmental factors rather than food sources. Therefore, public health interventions should not be restricted to food-borne approaches, and the epidemiology of the seasonal peak in human campylobacter infections may best be understood through studies in young children.     

Seasonal variation and time trends of deaths from asthma in England and Wales 1960-82.

Monthly trends in deaths attributed to asthma in the 5-34 year age group were examined for England and Wales over the period 1960-82. Deaths were most frequent in the third quarter (July to September) and peaked in August. Analysis of the 1970-82 period showed that this variation was present in the three constituent age groups 5-14, 15-24, and 25-34 but was most pronounced in the 5-14 year olds.     

Trends in deliberate self poisoning and self injury in Oxford, 1976-90.

OBJECTIVE--To review trends in deliberate self poisoning and self injury (attempted suicide) over 15 years (1976-90) on the basis of general hospital referrals. DESIGN--Prospective data collection by computerised monitoring system. SETTING--Teaching general hospital. SUBJECTS--All patients aged 15 and over (n = 9605) referred to the hospital after episodes (n = 13,340) of deliberate self poisoning or self injury. MAIN OUTCOME MEASURES--Rates based on population of Oxford city; changes in substances used for self poisoning; history and repetition of attempts; and rates of admission to the hospital and of referral to the psychiatric service. RESULTS--Attempted suicide rates for women declined during the late 1970s and early 1980s but increased again during the late 1980s. Those for men remained relatively steady throughout the period. Highest mean annual rates occurred in women aged 15-19 (711/100,000) and in 20-34 year old men (334/100,000). The proportion of overdoses with paracetamol increased from 14.3% (125/873) in 1976 to 42% (365/869) in 1990 (chi 2 for trend = 481, p less than 0.01). Throughout the period the proportions of referred patients admitted to hospital and of those attempting suicide for the first time (over two thirds) did not decrease. Annual rates of repetition of attempts by women declined from 15.1% (257/1700) in 1976-8 to 11.9% (161/1356) in 1987-9 (chi 2 for trend = 7.8, p less than 0.01). Lower repetition rates occurred in women admitted to hospital and referred to the psychiatric service (431/4585, 9.4%) than in those not referred (42/235, 17.9%; chi 2 = 17.2, p less than 0.0001). CONCLUSIONS--Rates of attempted suicide declined in the 1970s and early 1980s, in women, but there are probably at least 100,000 hospital referrals a year in England and Wales because of this problem. Prevention of paracetamol self poisoning requires urgent attention, and psychosocial assessment should be conducted with as many of those who attempt suicide as possible.     

Field experiments on sugar-beet powdery mildew, Erysiphe betae

Sugar-beet powdery mildew, Erysiphe betae appeared in East Anglia in late July 1976 and became wide-spread in eastern England during August and September but was scarce in crops in the north and west of England. Fentinhydroxide, sulphur, benomyl and ethirimol controlled the disease but benomyl applied once only and ethirimol were less effective than the other materials. In heavily infected crops two sulphur sprays, the first applied at the onset of the mildew attack, increased sugar yield by 13%. A single early sulphur spray increased yield on average by 9% giving a return of six to seven times the cost of treatment. When the first spray was delayed, mildew control was less effective.