Family Health Services Authority Research Articles

Multiple primary tumors in patients diagnosed with hypopharyngeal cancer.

There have been few series to report on the incidence of multiple primary tumors associated with hypopharyngeal cancer. A unique consecutive patient group in a closed community who were treated by a single surgeon was available. The incidence and effect of multiple primary tumors were unknown. We sought to assess (1) the incidence of multiple primary tumors among patients with hypopharyngeal cancer who were treated at a tertiary center, (2) the incidence of synchronous and metachronous tumors, and (3) the location of these multiple primary tumors and their effect on patient survival. We conducted a retrospective study of case notes of 150 consecutive patients with hypopharyngeal malignancy treated by a single surgeon between 1983 and 1998. Information was compiled from the patients' medical records and death data from the Family Health Services Authority. Thirty-four patients had multiple primary tumors (22.6%). There were 22 men and 12 women; piriform fossa tumor was seen in 21 men and 6 women, and postcricoid space tumor was seen in 6 women and 1 man. Second primary tumors were synchronous in 7 patients, subsequent to hypopharyngeal tumor in 5 patients, and antecedent to hypopharyngeal tumor in 14 patients. Eight patients had 2 primary tumors, of which 4 were synchronous, 4 were subsequent, and 8 were antecedent to hypopharyngeal malignancy. On the last review (2001), 3 patients were alive, and 31 had died: 17 had died from primary malignancy, 11 from another malignancy, and 3 from unrelated causes. The presence of second primary tumors in hypopharyngeal cancer is higher than previously reported, and their presence had a significant effect on the patients' survival.

Determinants of prescribing costs amongst single-handed general practitioners.

To investigate the contribution of patient and doctor characteristics in explaining observed variations in prescribing costs between individual doctors. Secondary analysis of data collected from general practitioners, Family Health Services Authorities, 1991 Census data set and the Prescription Pricing Authority. A multiple regression model with four variables (social class, training status, generic prescribing and length of time in general practice) explained only 16.5% of the variation in costs/ASTRO-PU. This study highlights that very little of the variation in prescribing costs can readily be explained. Further research is needed to document contributing factors.

Mismatch between perceived and actual overweight in diabetic and non-diabetic populations: a comparative study of South Asian and European women

Diabetes is more common in South Asian (defined here as Indian, Pakistani and Bangladeshi origin) populations compared with Europeans. This may be related to their greater abdominal obesity.1Weight loss and...

Measuring performance in primary care: econometric analysis and DEA

We use data from the Health Service Indicators database to compare different methods of measuring the performance of English Family Health Services Authorities (FHSAs) in providing primary care. A variety of regression and data envelopment analysis methods are compared as summary efficiency measures of individual FHSA performance. The correlation of the rankings of FHSAs across DEA and regression methods, across two years of data and across three different specifications of the technology of primary care are examined. Efficiency scores are highly correlated within variants of the two methods, and across years for a given method. Inter method correlations are smaller and correlations across different specifications of the primary care production process are negligible and sometime negative.

Measuring performance in primary care: econometric analysis and DEA

We use data from the Health Service Indicators database to compare different methods of measuring the performance of English Family Health Services Authorities (FHSAs) in providing primary care. A variety of regression and data envelopment analysis methods are compared as summary efficiency measures of individual FHSA performance. The correlation of the rankings of FHSAs across DEA and regression methods, across two years of data and across three different specifications of the technology of primary care are examined. Efficiency scores are highly correlated within variants of the two methods, and across years for a given method. Inter method correlations are smaller and correlations across different specifications of the primary care production process are negligible and sometime negative.

Health and ill-health in the older population in England and Wales. The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).

to provide a profile of disorders and disabilities in the older population. the MRC CFAS drew population samples of people aged 64 years and over from Family Health Service Authority lists at five sites and asked participants about sociodemographic variables, physical and cognitive health and activities of daily living, We calculated the prevalence of co-morbidity from the number of different types of complaint or disability (physical, functional and cognitive), and calculated healthy life expectancies in each of these co-morbid states. three urban (Newcastle, Nottingham and Oxford) and two rural sites (Cambridgeshire and Gwynedd). the prevalence of morbidity is low at the youngest ages, as is co-morbidity. Women have consistently greater morbidity than men. Morbidity increases sharply with age, with a more dramatic rise in women. Life expectancy without any morbidity is short at all ages over 64, with the number of years expected with two or more areas affected virtually constant up to 90 years. As a proportion of remaining life expectancy, the period of time spent with two or more areas affected rises by the age of 90 to 30% in men and 60% in women. preventive programmes for the older population should take into account the large differences between the young old, the middle old and the old old. Our study provides a baseline against which to compare future changes in health in older populations, as well as benchmark expectancies for the UK population.

Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards

OBJECTIVETo investigate the characteristics and outcomes of older patients with pelvic fracture admitted to medical and geriatric wards.METHODSAll patients admitted to medical and geriatric wards with a pelvic fracture over...

Women's education level as an influence on hormone replacement therapy being suggested at the menopause

This research investigates the extent to which a woman's education level both influences information-seeking about hormone replacement therapy (HRT) and whether or not HRT is suggested as a treatment when presenting to the GP with a range of menopausal symptoms. A random sample of 1200 women was generated from family health services authority records and a questionnaire distributed. The questionnaire inquired about the participant's information-seeking strategies about HRT, her recent menopausal symptoms, whether a GP had been consulted, and whether HRT had been suggested. Results indicate that participants who had more educational qualifications were more successful in finding information about HRT. Furthermore, although there were no significant differences in the number of reported symptoms, GPs were significantly more likely to suggest HRT to the less educated women. The implications for health centre practice are discussed.

Uptake of breast cancer screening in older women.

to determine breast screening uptake in older women and to ascertain from previous non-attenders whether they would accept screening if invited. a random sample of older women randomly selected from three Family Health Service Authorities were interviewed in their homes. 1604 women aged 65 years and over living at home, a response rate of 94%. 120 respondents (8%) had previously been screened. Rates were higher among those who were married, separated or divorced than those who were single (P < 0.01). Of those who had not previously been screened, 742 (50%) reported that they would attend if invited. Age influenced potential attendance: 67% of those aged 65-69 would accept compared with 27% of those aged 80 and over (P < 0.0001). Future attenders were significantly more likely to belong to the upper social class and to be currently married, and were significantly less likely to be disabled or depressed, but more likely to be anxious (P < 0.05). it is unjustifiable to exclude women over 65 from breast screening on the basis of assumed low uptake rates. Certain categories of women--such as those who were physically disabled, depressed, single or from lower social classes--could be targeted to achieve maximum uptake rates.

Exposure to power-frequency magnetic fields and the risk of childhood cancer

<h2>Summary</h2><h3>Background</h3> Previous studies have suggested an association between exposure to power-frequency electromagnetic fields (EMF) and the development of childhood malignant disease, especially leukaemia and tumours of the central nervous system. We investigated the relation between all childhood cancer and exposure to power-frequency magnetic fields. <h3>Methods</h3> The UK Childhood Cancer Study was a population case-control study covering the whole of England, Wales, and Scotland. All children with a confirmed malignant disorder were potentially eligible. For each case, we matched two controls on date of birth and sex, randomly chosen from the list of the Family Health Services Authority in England and Wales or Health Board in Scotland. In the main study, 3838 cases and 7629 controls were interviewed. The EMF part of the study included only one control per case, and household EMF measurements and school measurements where relevant were taken on 2226 matched pairs. These measurements, adjusted for historical line load and appliance fields, were used to estimate average exposure in the year before the date of diagnosis, or an equivalent date for controls. Analyses were by conditional logistic regression, incorporating a census-derived deprivation index used as a measure of socioeconomic status. <h3>Findings</h3> For children with mean exposures of more than 0·2 μT compared with children with mean exposures of less than 0·1 μT, the adjusted odds ratios were 0·92 (95% CI 0·47–1·79) for acute lymphoblastic leukaemia, 0·90 (0·49–1·63) for all leukaemia, 0·46 (0·11–1·86) for central-nervous-system tumours, 0·97 (0·46–2·05) for other malignant disease, and 0·87 (0·56–1·35) for all malignant disease combined. Higher exposures (>0·4 μT) were recorded for only 17 (<0·4%) individuals (eight cases, nine controls). <h3>Interpretation</h3> This study provides no evidence that exposure to magnetic fields associated with the electricity supply in the UK increases risks for childhood leukaemia, cancers of the central nervous system, or any other childhood cancer.

Does publicity about cancer screening raise fear of cancer? Randomised trial of the psychological effect of information about cancer screening

Critics of cancer screening have suggested that the publicity associated with it can provide people with a new health worry.1 After a mass media heart disease campaign in Norway a...

Factors influencing the selection of panoramic radiography in general dental practice

Objectives: To identify factors influencing dentists’ decisions to take panoramic radiographs and to determine dentists’ perceptions of the value of panoramic radiographs in the diagnosis of common dental pathologies. Methods: Questionnaire of dentists with access to panoramic radiography equipment in 22 randomly selected Family Health Service Authorities in England and Wales. Dentists were asked to score 17 factors for their influence upon panoramic use, compare the relative diagnostic value of panoramic and intraoral radiographs for diagnosis of common dental pathologies and state their principal reasons for taking panoramic radiographs. Results: The response rate to the questionnaire was 73.3%. The factors most likely to influence dentists to take a panoramic radiograph were ‘planning oral surgery’, ‘facial trauma’, ‘periodontal disease’, ‘heavily restored dentition’ and ‘patient first attendance’. Dentists’ opinions on the diagnostic usefulness of panoramic radiographs were in broad agreement with those in the scientific literature. The main reasons for taking panoramic radiographs were as a ‘general screen’ and as a ‘view for unerupted or impacted teeth’. Conclusions: There are areas where dentists’ prescription of panoramic radiographs is in disagreement with recent guidelines. Successful implementation of these guidelines would be likely to lead to a substantial reduction in the numbers of panoramic radiographs taken by GDPs.

Social determinants of GHQ score by postal survey.

To develop interventions to reduce the morbidity associated with depression and anxiety, more information is needed about the social and demographic determinants of these disorders and the relative contributions of different potential predictors. Using stratified sampling from the Family Health Services Authority (FHSA) register, postal surveys were sent to 61,000 adults across the North Western Regional Health Authority. Psychological morbidity was assessed using the 12-item General Health Questionnaire (GHQ). Nine potential predictors of morbidity were rated, including socio-demographic details and the presence of longstanding limiting physical illness and of a confidante. Logistic regression analyses were used to consider each of the nine potential predictors separately and in combination. A total of 38,014 questionnaires were returned (63 per cent). After adjustment for all other variables the strongest predictors of a high GHQ score were the absence of a confidante (odds ratio (OR) 3.64), longstanding limiting physical illness (OR 2.93), unemployment (OR 1.91), being a student (OR 1.78), being female (OR 1.64), single parenthood (OR 1.55) and living alone (OR 1.32). GHQ scores were highest in the 18-34 age range. Ethnicity exerted no significant effect after adjustment for other variables. In keeping with other research the data suggest that sociodemographic factors are strong predictors of depression and anxiety. The most vulnerable population groups are those with longstanding limiting physical illness and no-one to talk to. This should help in identifying high-risk individuals and informing preventive strategies.

The struck-off mystery.

Observations on ward rounds suggested that psychiatric patients might be at special risk of removal from their general practitioner's list. Little has been published on why patients are struck off and our first attempt at investigation was by direct appeals for patients. This drew a small and unsatisfactory sample. We then asked two family health services authorities to distribute questionnaires to struck-off patients. One agreed, but later withdrew cooperation. There is a danger that struck-off patients will become an underclass excluded from primary care. We propose anonymous collection of information by health authorities, so that policy can be reviewed if necessary.

Systemic lupus erythematosus (SLE) and hair treatment: a large community based case-control study.

To investigate the association of hair treatment, including permanent and non-permanent dyes, bleach, highlights and lowlights on the development of systemic lupus erythematosus (SLE). 150 SLE patients and 300 controls from Nottingham, UK were interviewed in a case-control study. Controls were matched to cases for gender and year of birth. All patients met at least four of the American Rheumatology Association criteria for SLE. Controls were randomly selected from the Nottingham Family Health Services Authority register. Information was collected via an interview-administered questionnaire concerning demographic variables and hair treatment. For hair treatment no significant associations were observed between ever using permanent colouring, non-permanent colouring, bleach or lowlights, and disease. Nevertheless a significant association (OR 0.55, 95% CI 0.31-0.95) was observed between 'ever having' used highlights and disease with cases having used highlights less frequently than their healthy counterparts. No significant differences were observed in duration of usage of hair bleach, permanent colouring, non-permanent colouring, highlights and lowlights between cases and controls. Hair treatment or duration of hair treatment usage is not significant in the aetiology of SLE. Although patients with SLE were less likely in this study to have highlights than controls, for all other hair treatments no differences were observed.

Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes

Objective: To investigate the impact of factors outside the control of primary care on performance indicators proposed as measures of the quality of primary care.Design: Multiple regression analysis relating admission...

The effect of doctor ethnicity and country of qualification on prescribing patterns: an ecological study.

To assess the effect of doctor ethnicity and country of qualification on prescribing patterns. Ecological study. 90 Family Health Services Authorities in the U.K. Being an Asian doctor and qualifying from the Indian subcontinent contributes to 5% of the observed variation seen in the frequency of prescribing, but not the cost. The major determinant of variation in prescribing is deprivation, which accounts for 14% of the cost and 32% of the frequency of prescribing. Being an Asian doctor and qualifying from the Indian subcontinent contributes to the frequency, but not the cost of prescribing variation. As this study was at the FHSA level, 'ecological fallacy' exists and further research is advocated at the individual doctor level.

The prevalence of stroke and associated disability.

There are limited data available on the prevalence of stroke in the United Kingdom. Such data are important for the assessment of the health needs of the population. This study aimed to determine the prevalence of stroke and the prevalence of associated dependence in a district of northern England. This was a two-stage point prevalence study. A valid screening questionnaire was used to identify stroke survivors from an age- and sex-stratified sample of the population aged 45 years and over in a family health services authority district. This was followed by assessment of stroke patients with scales of disability and handicap. The overall prevalence of stroke was found to be 17.5/1000 (95 per cent confidence interval (CI) 17.0, 18.0). The prevalence of stroke-associated dependence was 11.7/1000 (95 per cent CI 11.3, 12.1). Self-reported comorbidity was most commonly due to circulatory and musculoskeletal disorders. The prevalence of stroke in this district is considerably higher than current guidelines and previous results suggest. Nevertheless, the result from this study combined with that from a previous study in another district in the United Kingdom should allow those interested in epidemiologically based health needs assessment to make reasonable estimates of the burden of stroke in their area.

Women's symptoms at the menopause and their expectations of hormone replacement therapy

How do women feel about the menopause, and what factors do they consider when deciding whether to take hormone replacement therapy (HRT)? A random sample of 1,200 women aged between 38 and 58 was generated from Family Health Services Authority (FHSA) records. A postal questionnaire, based partly on Ajzen's Theory of Planned Behaviour (Ajzen, 1988) about symptoms, attitudes to and knowledge of the menopause and HRT, and their sources of information, was sent to the women. Respondents were asked about perceived physical and psychological problems in the previous six months and about whether they had consulted a doctor. Results indicate little difference in psychogenic symptoms between those who are taking HRT and those of a similar age who are not. The case for physical symptoms is more complicated, with HRT alleviating hot flushes and night sweats in particular. The most useful source of information was reported as being the media, although satisfaction with information varied between groups. Implications for practice nurses are discussed.

Acute health effects of the Sea Empress oil spill.

STUDY OBJECTIVE: To investigate whether residents in the vicinity of the Sea Empress tanker spill suffered an increase in self reported physical and psychological symptoms, which might be attributable to...