Disease In England Research Articles

FRI0393 Long-term trends in clinical characteristics of paget’s disease of bone

BackgroundStudies conducted in different areas have shown a decrease in both the prevalence and severity of Paget’s disease of bone (PDB) in the last few years [1]. It has also...

P195 Withdrawn P196 A new global challenge, nalidixic acid resistance in Salmonella enterica serovar Paratyphi A

Objectives: The main objectives of our study were to determine the factors behind the huge increase in emm /M3 causing severe invasive disease in England by the examination of the phylogenetic characteristics, diversity and ‘evolutionary drift’ of emm /M3 from invasive and superficial disease. Methods: A total of 295 GAS emm/M3 strains from 2001 to 2011 (182 invasive and 113 non-invasive) were examined using whole genome sequencing. Phenotypic experiments were also carried out to determine the expression of the speC gene and the mitogenic activity of this superantigen using western blotting and human blood mononuclear cell proliferation assay techniques. Results: emm /M3 strains were differentiated into three sequence types (STs): ST15 (38%), ST315 (49%) or ST406 (13%). Strains from 2008/2009 period were scattered across all STs and lineages. There appeared to be no significant correlation between emm3 subtypes, clinical features or the invasiveness of emm /M3 strains and clonal lineages. We identified a novel phage (dubbed SpeC phage) which consists of 63 genes, two of which are the exotoxin gene speC and DNAase gene spd1 . This phage is present in 54/295 strains; all of which are 2008/2009 strains within a distinct ST15 clade; 43/54 SpeC phage-containing strains expressed the SPEC protein (1.3–6.3mg/ml). Within the ST15 strains (112/295) SpeC phage-containing strains (54/112) demonstrated significantly greater mitogenic activity than other non-SpeC phage-containing strains. Conclusion: The unusual upsurge in invasive GAS infections could be attributed, in large part, to the emergence of the novel phagecontaining clade of emm /M3 GAS strains within the population. We hypothesise that phage-encoded proteins contributed to this emergence either through biological activity or through reduced population immunity. Prompt molecular analysis of GAS isolates emerging in the UK population could translate into improved advanced public health warning systems for newly emergent invasive strains.

Book Review: Animals Erased: Discourse, Ecology, and Reconnection with the Natural World, by Arran Stibbe

Animals Erased: Discourse, Ecology, and Reconnection with the Natural World. Arran Stibbe. Middletown, CT: Wesleyan University Press, 2013. 214 pp. $70.00 hbk. $25.99 pbk. $19.99 e-bk.Vegetarian leanings aside, I chuckled once at a bumper sticker on a beater car pro- claiming, If we're not supposed to eat animals, why are they made of meat? Animals Erased: Discourse, Ecology, and Reconnection with the Natural World eloquently answers that question. Animals Erased is written by Arran Stibbe of the University of Gloucestershire, who is an important contributor to multidisciplinary research and education into environmental sustainability. Stibbe uses engaged critical models of learning that bring disparate audiences, such as researchers, policy makers, and stu- dents, to a greater awareness of their roles within, impacts on, and responsibilities for the natural environment.Stibbe's expertise is in linguistics and ecology, uniting fields in environmental sci- ences with journalism, public relations, and communication studies, among other dis- ciplines. Animals Erased is a wonderfully vexing book inviting healthy discussions in classes in any of these areas. It should be required reading for anyone working in public policy related to, or public communication on, the food industry nationally and internationally.Animals Erased stems from a variety of thought-provoking journal articles Stibbe published in the 2000s in reaction to tragic agribusiness events in recent years causing unprecedented-and he argues, unnecessary-human brutality leading to epic scale suffering of animals. Stibbe presents compelling moral and ethical arguments that posit animals are sentient beings, a term Tibet's Dalai Lama also uses. Stibbe recounts, for instance, misreporting about a sudden spread of hoof and mouth disease in Britain, which at its nadir led people to massacre and incinerate six million sheep, cattle, and pigs. Stibbe claims such hyped but fundamentally phony crises have global ramifications at all levels. He identifies how language is used to denigrate animals and to rationalize destructive practices that prioritize human desires over needs. He uncov- ers violent, unsustainable policies and procedures on animals. Stibbe maintains that grave human errors comprise prevailing human-animal relationships, extending from the highest government decision makers, to media reporting on food sector issues, to the world's largest animal production operations and food distributors, to smallest-scale rural farmers.The trajectory of the book is purposefully peripatetic. From the outset, Animals Erased defines how humans, particularly in developed nations such as the UK, have long used language, discourse, and visual symbols in everyday metaphors found in interpersonal conversation to books, images, movies, and food industry reports to rationalize how modern meat-eating habits unnecessarily, and unobserved, inflict large-scale trauma on animals.In chapters 1 and 2, Stibbe portrays linguistic and discursive slights capitalistic humans cast on specific animals being used in massive-scale food production. …

Introducing vaccination against serogroup B meningococcal disease: An economic and mathematical modelling study of potential impact

BackgroundMeningococcal disease remains an important cause of morbidity and mortality worldwide. The first broadly effective vaccine against group B disease (which causes considerable meningococcal disease in Europe, the Americas and Australasia) was licensed in the EU in January 2013; our objective was to estimate the potential impact of introducing such a vaccine in England. MethodsWe developed two models to estimate the impact of introducing a new ‘MenB’ vaccine. The cohort model assumes the vaccine protects against disease only; the transmission dynamic model also allows the vaccine to protect against carriage (accounting for herd effects). We used these, and economic models, to estimate the case reduction and cost-effectiveness of a number of different vaccine strategies. ResultsWe estimate 27% of meningococcal disease cases could be prevented over the lifetime of an English birth cohort by vaccinating infants at 2,3,4 and 12 months of age with a vaccine that prevents disease only; this strategy could be cost-effective at £9 per vaccine dose. Substantial reductions in disease (71%) can be produced after 10 years by routinely vaccinating infants in combination with a large-scale catch-up campaign, using a vaccine which protects against carriage as well as disease; this could be cost-effective at £17 per vaccine dose. ConclusionsNew ‘MenB’ vaccines could substantially reduce disease in England and be cost-effective if competitively priced, particularly if the vaccines can prevent carriage as well as disease. These results are relevant to other countries, with a similar epidemiology to England, considering the introduction of a new ‘MenB’ vaccine.

Influences of farmer and veterinarian behaviour on emerging disease surveillance in England and Wales.

Surveillance for new and re-emerging animal diseases in England and Wales is based on post-mortem and syndromic analysis of laboratory data collated in a central database by the Animal Health and Veterinary Laboratories Agency (AHVLA), with the aim of providing early warning of disease events prior to clinical diagnosis. Understanding the drivers for participation in such systems is critical to the success of attempts to improve surveillance sensitivity. The aim of this study was to investigate the decision-making process governing the submission of biological samples on which this surveillance system is based by use of questionnaires. Data extracted were used to structure and parameterize scenario trees modelling the probability of generating an entry in the surveillance database. The mean probability for database entry per case ranged from 0.085 for neurological disorders to 0.25 for enteric disease. These findings illustrate the importance of on-farm decision making to the generation of surveillance data.

Systemic Amyloidosis in England: an epidemiological study

Epidemiological studies of systemic amyloidosis are scarce and the burden of disease in England has not previously been estimated. In 1999, the National Health Service commissioned the National Amyloidosis Centre (NAC) to provide a national clinical service for all patients with amyloidosis. Data for all individuals referred to the NAC is held on a comprehensive central database, and these were compared with English death certificate data for amyloidosis from 2000 to 2008, obtained from the Office of National Statistics. Amyloidosis was stated on death certificates of 2543 individuals, representing 0·58/1000 recorded deaths. During the same period, 1143 amyloidosis patients followed at the NAC died, 903 (79%) of whom had amyloidosis recorded on their death certificates. The estimated minimum incidence of systemic amyloidosis in the English population in 2008, based on new referrals to the NAC, was 0·4/100 000 population. The incidence peaked at age 60–79 years. Systemic AL amyloidosis was the most common type with an estimated minimum incidence of 0·3/100 000 population. Although there are various limitations to this study, the available data suggest the incidence of systemic amyloidosis in England exceeds 0·8/100 000 of the population.

Trends in hospital admissions for sickle cell disease in England

Sirs, The recent paper by AlJuburi et al.1 draws attention to the issue of hospital admissions for sickle cell disease. We would like to raise several points in response. AlJuburi et al. suggest that the increased prevalence of sickle cell disease (SCD) in England through domestic growth of the current at-risk population' is the most important factor contributing to the increase in SCD admissions. Data collected by the NHS Sickle Cell and Thalassaemia Screening Programme show that in England the birth prevalence of screen-positive babies for SCD (comprising FS, FSC, FS-other and FE screening positive results) has been stable between 2005 and 2011 (0.52–0.56/1000 babies screened), with about 360 screen-positive babies per year.2 This demonstrates that there has not been a dramatic increase in the prevalence of (SCD) in England through domestic growth of the current at-risk population, although migration in older children has been reported by some clinics. The authors' analysis gives an indication of the burden of hospital utilization from SCD in England. However, evidence on readmissions and multiple admissions in the same patient are better measures of quality of clinical and community care and are required to gain better understanding of the quality and efficiency of the SCD service rather than simply burden of disease. The NHS Atlas of Variation in Healthcare for Children and Young People reported (a nearly 2-fold) variation in emergency hospital admissions for SCD per individual patient aged 0–17 years by PCT in the 3 year period from 2007 to 2010.3 Highest readmission rates are seen in areas with less expertise in managing SCD, and in areas which have newly arrived populations, many areas in London with high rates of admission do not have high repeat admission rates. Data collected by the NHS Sickle Cell and Thalassaemia Programme shows that the highest birth prevalence is in London South East.2 However, analysis in AlJuburi's study show that five PCTs with highest admission rates are not in South East London. This could be explained with quality of care in above PCTs. We also think that it would be useful to compare the rise of SCD admissions to the overall rise of all hospital admissions. The National Haemoglobinopathy Project has reported a 70% increase in D57 code admissions in the period 1997–2007, while total admissions for all diagnoses rose by only 28% over a similar period.4 Finally, the authors might have considered a cohort effect in the high-risk population (Black African and Black Caribbean)5 and the impact of the changing age structure of those populations on the increase in SCD admissions in older age groups, with patient survival also increasing and thus larger cohorts moving up through the age groupings.

Trends in hospital admissions for sickle cell disease in England

Trends in hospital admissions for sickle cell disease in England

Informatics as Tool for Quality Improvement: Rapid Implementation of Guidance for the Management of Chronic Kidney Disease in England as an Exemplar

ObjectivesChronic kidney disease (CKD) is an important cause of excess cardiovascular mortality and morbidity; as well as being associated with progression to end stage renal disease. This condition was largely unheard of in English primary care prior to the introduction of pay-for-performance targets for management in 2006. A realist review of how informatics has been a mechanism for national implementation of guidance for the improved management of CKD.MethodsRealist review of context, the English National Health Service with a drive to implement explicit national quality standards; mechanism, the informatics infrastructure and its alignment with policy objectives; and outcomes are describe at the micro-data and messaging, meso-patient care and quality improvement initiatives, and marco-national policy levels.ResultsAt the micro-level computerised medical records can be used to reliably identify people with CKD; though differences in creatinine assays, fluctuation in renal function, and errors in diabetes coding were less well understood. At the meso-level more aggressive management of blood pressure (BP) in individual patients appears to slow or reverse decline in renal function; technology can support case finding and quality improvement at the general practice level. At the macro-level informaticians can help ensure that leverage from informatics is incorporated in policy, and ecological investigations inform if there is any association with improved health outcomes.ConclusionsIn the right policy context informatics appears to be an enabler of rapid quality improvement. However, a causal relationship or generalisability of these findings has not been demonstrated.

Qualitative veterinary risk assessment of the role of wild deer in the likelihood of incursion and the impact on effective disease control of selected exotic notifiable diseases in England

A qualitative risk assessment was undertaken to analyse the likelihood of the incursion of selected exotic infectious disease into deer populations in GB and the potential impacts these animals could have on effective disease control. In order to identify the exposure pathways, it was necessary to consider not only the epidemiology of the pathogens but also to understand the impact of the ecology and behaviour of wild deer on disease transmission. It was concluded that the greatest risk of exotic disease incursion into wild deer in GB was disease incursions occurring in domestic ruminants first then transmitting to wild deer. The qualitative risk assessment considered geographic spread and habitats of wild deer and the susceptibility of wild deer to notifiable exotic diseases of domestic ruminants. Data of some diseases in some deer species is limited and the overall assessment of impact varied between diseases and deer species. Red deer pose the highest risk of the species reviewed. The overall risk assessment of low is primarily influenced by the low risk of incursion of exotic diseases generally into the UK.

Yorkshire's influence on the foundation of British Neurology

In a paper to the Royal Society in 1939, Lord Adrian (1889–1977) described the era between 1870 and 1900 as ‘a classical period in the history of medicine, the period...

Mathematical Modelling Long-Term Effects of Replacing Prevnar7 with Prevnar13 on Invasive Pneumococcal Diseases in England and Wales

IntroductionEngland and Wales recently replaced the 7-valent pneumococcal conjugate vaccine (PCV7) with its 13-valent equivalent (PCV13), partly based on projections from mathematical models of the long-term impact of such a switch compared to ceasing pneumococcal conjugate vaccination altogether.MethodsA compartmental deterministic model was used to estimate parameters governing transmission of infection and competition between different groups of pneumococcal serotypes prior to the introduction of PCV13. The best-fitting parameters were used in an individual based model to describe pneumococcal transmission dynamics and effects of various options for the vaccination programme change in England and Wales. A number of scenarios were conducted using (i) different assumptions about the number of invasive pneumococcal disease cases adjusted for the increasing trend in disease incidence prior to PCV7 introduction in England and Wales, and (ii) a range of values representing serotype replacement induced by vaccination of the additional six serotypes in PCV13.ResultsMost of the scenarios considered suggest that ceasing pneumococcal conjugate vaccine use would cause an increase in invasive pneumococcal disease incidence, while replacing PCV7 with PCV13 would cause an overall decrease. However, the size of this reduction largely depends on the level of competition induced by the additional serotypes in PCV13. The model estimates that over 20 years of PCV13 vaccination, around 5000–62000 IPD cases could be prevented compared to stopping pneumococcal conjugate vaccination altogether.ConclusionDespite inevitable uncertainty around serotype replacement effects following introduction of PCV13, the model suggests a reduction in overall invasive pneumococcal disease incidence in all cases. Our results provide useful evidence on the benefits of PCV13 to countries replacing or considering replacing PCV7 with PCV13, as well as data that can be used to evaluate the cost-effectiveness of such a switch.

O2‐08‐02: Relationship between patient self‐assessed and proxy‐assessed quality of life (QoL) and patient dependence on others as illness progresses in Alzheimer's disease: Results from the Dependence in Alzheimer's Disease in England (DADE) study

O2‐08‐02: Relationship between patient self‐assessed and proxy‐assessed quality of life (QoL) and patient dependence on others as illness progresses in Alzheimer's disease: Results from the Dependence in Alzheimer's Disease in England (DADE) study

O2‐07‐01: Caregiver burden as illness progresses in Alzheimer's disease (AD): Association with patient dependence on others and other factors—Results from the Dependence in Alzheimer's Disease in England (DADE) study

O2‐07‐01: Caregiver burden as illness progresses in Alzheimer's disease (AD): Association with patient dependence on others and other factors—Results from the Dependence in Alzheimer's Disease in England (DADE) study

O2‐02‐01: Relationship between healthcare and social care costs and patient dependence on others as illness progresses in Alzheimer's disease (AD): Results from the Dependence in Alzheimer's Disease in England (DADE) study

O2‐02‐01: Relationship between healthcare and social care costs and patient dependence on others as illness progresses in Alzheimer's disease (AD): Results from the Dependence in Alzheimer's Disease in England (DADE) study

O3‐01‐06: Relationship between patient dependence on others and clinical measures of cognitive impairment, functional disability and behavioral problems in Alzheimer's disease (AD): Results from the Dependence in Alzheimer's Disease in England (DADE) Study

O3‐01‐06: Relationship between patient dependence on others and clinical measures of cognitive impairment, functional disability and behavioral problems in Alzheimer's disease (AD): Results from the Dependence in Alzheimer's Disease in England (DADE) Study

Germs at Work: Establishing Tuberculosis as an Occupational Disease in Britain, c.1900-1951

In 1951, tuberculosis was added to the statutory list of prescribed occupational diseases in the UK, giving some workers the right to financial compensation. This article explores the long campaign to define TB as an illness linked to employment, investigating an area neglected in the historiography, whilst contributing to our understanding of the role of trade unions in relation to public health. The evidence examined here suggests a complex and changing picture in which a broadly proactive and dynamic union policy implicated the workplace in the TB epidemic and pressed for preventative measures and compensation. Whilst limited in effectiveness before 1939, this campaign was successful in the 1940s as the medical evidence became clearer, debate narrowed to focus on health workers, the capacity of the trade union movement to influence policy making developed and the Trades Union Congress learnt to strategically marshal medical evidence and engage more effectively with the epidemiology.

INCOME‐RELATED INEQUITY IN HEALTHCARE UTILISATION AMONG INDIVIDUALS WITH CARDIOVASCULAR DISEASE IN ENGLAND—ACCOUNTING FOR VERTICAL INEQUITY

Economic analyses of equity which focus solely on horizontal inequity offer a partial assessment of socioeconomic inequity in healthcare use. We analyse income-related inequity in cardiovascular disease-related healthcare utilisation by individuals reporting cardiovascular disease in England, including both horizontal and vertical aspects. For the analysis of vertical inequity, we use target groups to estimate the appropriate relationship between healthcare needs and use. We find that including vertical inequity considerations may lead us to draw different conclusions about the nature and extent of income-related inequity. After accounting for vertical inequity in addition to horizontal inequity, there is no longer evidence of inequity favouring the poor for nurse visits, whereas there is some evidence that doctor visits and inpatient stays are concentrated among richer individuals. The estimates of income-related inequity for outpatient visits, electrocardiography tests and heart surgery become even more pro-rich when accounting for vertical inequity.

Trends in hospital admissions for sickle cell disease in England, 2001/02-2009/10

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.

Care delivery pathways for Chronic Obstructive Pulmonary Disease in England and the Netherlands: a comparative study.

A remarkable difference in care delivery pathways for Chronic Obstructive Pulmonary Disease (COPD) is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. The objective of this paper is to explain this difference. Descriptive COPD statistics and care delivery pathways on all care levels within the institutional context, followed by a comparison of care delivery pathways and an explanation of the difference with regard to hospital-at-home. The Netherlands and England show broad similarities in their care delivery pathways for COPD patients. A major difference is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. Three possible explanations for this difference are presented: differences in the urgency for alternatives (higher urgency for alternative treatment models in England), the differences in funding (funding in England facilitated the development of hospital-at-home) and the differences in the substitution of tasks to nurses (substitution to nurses has taken place to a larger extent in England). The difference between the Netherlands and England regarding hospital-at-home for COPD exacerbations can be explained in three ways. Hospital-at-home has proved to be a safe alternative for hospital care for selected patients, and should be considered as a treatment option for COPD exacerbations in the Netherlands.