Trends in suicide in England and Wales, 1982-96

This article, the first of two, updates previous analyses of suicides published in Population Trends. Suicide trends in England and Wales are analysed by age and sex. Analyses by method and occupation suggest a link between suicide rates and easy access to effective means of committing suicide. The steadily growing number of cars with catalytic converters may go some way to explain the decreasing suicide rates from 'other gas poisoning' for both men and women since the early 1990s. Indeed, it may also explain to some extent the decline in overall suicide rates for men since this time.     

Cytomegalovirus infection in England and Wales: 1992 and 1993

Cytomegalovirus causes illness through primary infection but also remains latent within the host and may be reactivated, especially if immunity is impaired. We have examined reports of cytomegalovirus infection from laboratories in England and Wales received by the PHLS Communicable Disease Surveillance Centre in 1992 and 1993. A total of 2938 reports were received, and 103 people had recurrent infections within the study period. The age distribution had peaks in infants (< 1 year of age) and in people aged 25 to 34 years. In almost a half of the patients (1371; 49%) factors were reported that indicated impaired immunity. Eighty-three of the 103 with recurrent infection (81%) were also reported to have impaired immunity. Children under 5 years accounted for 18% (543/2938) of reports. There were 930 reports of infections in people over 5 years of age who were not reported as immunocompromised. The data presented confirm that cytomegalovirus causes substantial morbidity in young children and people with impaired immunity. Cytomegalovirus infection causes considerable morbidity, especially hepatic, in patients whose immunity is thought to be normal.     

Monitoring trends in prenatal diagnosis of Down''s syndrome in England and Wales, 1989-92

A prospective and multicenter study was performed to determine the efficacy and tolerance of ursodeoxycholic acid (UDCA) in the treatment of gallstones and biliary sludge. Criteria for entry into the trial were radiolucent gallbladder stones; until 20 mm of size and visualization of the gallbladder by oral cholecystography. Too were treatment the patients with persistent biliary sludge (PBS) defined by the persistence of the biliary sludge in two consecutive echography along three months. Without severe gallbladder disease. Then daily UDCA doses of 600 mg were suminstred divided in two postprandial times for a six months period. The control to the treatment were: basal ultrasonography (US) of the gallbladder and by follow-up gallbladder US for six months; clinical examination every month and cholecystography before and after the treatment. Of 110 admitted patients, 19 (17%) stopped the treatment for no-medical reasons and 91 (83%) arrived to the and point. After six months of treatment, complete dissolution was observed in 50% of the patients (46/91), partial in the 43% (39/91) and failed the treatment in 6.5% (6/91) who presented high density stones for computed tomography, CT (greater than 60 UH). According to pattern of lithiasis dissolution was complete in 100% (22/22) of the patients with PBS; 71.4% (10/14) in microlithiasis and 25% (14/55) in macrolithiasis. Minor adverse effects were acidism in the 7.7% (7/91) and diarrhea in the 1.1% (1/91). In the other hand, one patient presented acute pancreatitis (1/91; 1.1%), it must be discussed if was a complication of the lithiasis or an therapeutic effect. The UDCA was a safe and effective treatment without lethality in PBS and in microlithiasis while in case of macrolithiasis must be standardized response criterion, for example density stones for CT.     

Tuberculosis mortality in England and Wales during 1982-1992: its association with poverty, ethnicity and AIDS

A linear DNA with partial sequence redundancy can be recircularized in cells by either nonhomologous end joining (NEJ) or by homologous recombination (HR). We have studied the relative contributions of these processes in zygotes or early embryos of species that serve as model organisms for developmental genetics. Thus, we have microinjected a linearized plasmid substrate into zygotes of zebrafish (Danio rerio) or into the posterior end of Drosophila melanogaster early embryos before pole cell formation. Similar to the situation observed previously in Xenopus zygotes/early embryos, we detected a large preponderance of DNA-end joining over homologous recombination. A comparison of end-joined junctions revealed that from the three species tested, zebrafish introduced the least number of sequence distortions upon DNA-end joining, while Drosophila produced the largest deletions (average 14 bp) with occasional nucleotide patch insertions, reminiscent of the N nucleotides at V(D)J junctions in mammalian immune receptor genes. Double-strand gap repair by homologous sequences ('homologous recombination') involving a bimolecular reaction was readily detectable in both zebrafish and Drosophila. This involved specifically designed recombination substrates consisting of a mutagenized linear plasmid and DNA fragments carrying the wild-type sequence. Our results show that the basic machinery for homologous recombination is present at early developmental stages of these two genetic model organisms. However, it seems that for any experimental exploitation, such as targeted gene disruption, one would have to inhibit or bypass the overwhelming DNA-end joining activity.     

Trends in eye cancer mortality among adults in the USA and England and Wales

Trends in eye cancer mortality are presented for the USA and England and Wales during the period 1955-89. Mortality rates have fallen by 58% in the USA during this period. The fall in mortality is paralleled by an equal fall in incidence rates in the USA. In England and Wales, mortality rates and incidence rates have remained relatively constant during the last three decades. The explanation for these differences between the USA and England and Wales is unknown.     

Trends in stimulation and induction of labor 1989-1995

Between 1989 and 1995 the rates for stimulation and induction of labor rose every year, representing a 48 and 77 percent, respectively, total rise over the time period. In 1995 the rate of stimulation was 161 per 1,000 live births and of induction 160. Two percent, or 74,167, of the 3,899,589 births in 1995 had both procedures performed. While rates of stimulation decline with advancing maternal age, the induction rates tend to be higher for older women. Rates for both procedures increased between 1989 and 1995 for both black and white women in all age categories. Women whose pregnancies have extended beyond the expected gestation of 37 weeks consistently had much higher rates of both stimulation and induction. Rates for both procedures rose for doctors of medicine (MD's), doctors of osteopathy (DO's) and certified nurse-midwives (CNM's). DO's had the greatest increases in both stimulation and induction rates. Declines in the cesarean section rate were greater for births that were stimulated or induced than for those without either of these procedures. The rates for stimulated or induced vaginal birth after cesarean (VBAC) were double those of VBACs without such procedures.     

Nosocomial Legionnaires' disease in England and Wales, 1980-92

Two hundred and eighteen nosocomial cases of Legionnaires' disease with 68 deaths were reported to the National Surveillance Scheme for Legionnaires Disease between 1980 and 1992, representing 15% of the reported infections acquired in England and Wales. Twenty-two nosocomial outbreaks accounted for 135 (62%) of these cases, the remainder occurring as single cases either in hospitals where other single cases or outbreaks had been reported in different years or as 'sporadic' cases in hospitals from which no other cases were reported. A clinical history prior to onset of Legionnaires' disease was available for 124 patients, 61 of whom had undergone recent transplant therapy or were immunosuppressed for other reasons. Sixty cases (27%) were diagnosed by culture of the organism and isolates from 56 patients were typed; 25 (42%) were non L. pneumophila serogroup 1 infections. Methods for prevention and control of nosocomial outbreaks are discussed, in particular the susceptibility to Legionnaires' disease of certain groups of hospital patients.     

Meningococcal disease in England and Wales: 1995

The number of laboratory confirmed cases of meningococcal infection in England and Wales rose in 1995 for the first time since 1990. Culture confirmed cases rose to 1459, an increase of 29% over the 1994 total, due largely to increased disease activity in the last quarter of 1995. Cases diagnosed by non-culture methods totalled 431, giving a total of 1890 laboratory confirmed cases. Notifications reported to the Office of Population Censuses and Surveys also increased to a similar extent. Northern regions generally had higher rates of disease activity and greater increases in rates. Meningococcal disease caused by serogroup C strains accounted for the main increase in culture confirmed cases and made up 32% of the total in 1995. Disease caused by C2a strains showed a particularly large increase. A change in the age distribution was noted with a greater proportion of patients in older age groups. Among group B isolates, B4 P1.4 strains continued to be identified most commonly.     

Trends in mortality from tuberculosis in England and Wales: effect of age on deaths from non-respiratory disease

BACKGROUND: Although mortality from tuberculosis has continued to fall in recent years, there has been little change in the case fatality rate for tuberculosis over the same period. This has previously been shown to be due to the increasing proportion of cases of tuberculosis occurring in the elderly. Tuberculosis mortality and case fatality were therefore analysed to determine if this disappointing trend in case fatality rate has occurred from disease in all or only certain sites. METHODS: A retrospective analysis of the tuberculosis mortality and case fatality rates in England and Wales for the period 1972-92 was carried out. The average annual percentage change in tuberculosis was calculated for each disease site and by age group and the results were compared. RESULTS: The analysis showed that, although the mortality rate fell steadily by 5.6% per annum, the case fatality rate decreased by only 0.9% (95% CI -1.7 to -0.1) per annum. The case fatality rate for respiratory and central nervous system disease declined, but no decline in tuberculosis at "other" sites was observed (1.01% (+2.2 to -0.2) for all age groups combined). In the group aged 75 and over, however, the proportion of deaths due to disease at other sites increased by 3.2% (2.2 to 4.3) per annum whilst in the other age groups the mortality rate declined. CONCLUSIONS: This analysis suggests that clinicians may be becoming less able to recognise non-respiratory presentations of tuberculosis, particularly in the elderly, and underlines the need to consider tuberculosis as a diagnosis to avoid delay in treatment.     

Birth statistics: recent trends in England and Wales

This article summarises recent trends in birth statistics in England and Wales. Particular attention is given to the characteristics of conceptions in 1996 and births in 1997, the latest years for which figures are available. The article examines changes in the number of births outside marriage, the age women become mothers and the number of women expected to remain childless throughout their lives. It also analyses differences in the timing of childbearing between women from different social classes or living in different regions of the UK. Finally it describes changes in the overall and underage conception rates between 1995 and 1996.     

Computer use by dentists and dental team members

Melanocytic naevi on the face and neck of 110 Brisbane secondary school students aged 16-17 years were mapped according to specified regions to investigate the dose-response relationship between ultraviolet (UV) radiation and melanocytic naevi. Highest naevus density occurred in regions receiving a mean UV dose of 0.2-0.4 relative to the vertex while densities were low in minimally and maximally exposed regions. This pattern of naevus distribution was unaffected by sex or phenotypic features such as skin colour or degree of freckling. These findings suggest that there is a narrow dose range over which UV radiation can effectively promote the proliferation of melanocytes. A comparison of the regional distribution of naevi on the face and neck with that of solar keratoses appearing over 1 year on the heads of residents of a neighbouring town has shown them to differ significantly. This study may shed some light on the unknown, yet expectedly complex, relation of UV radiation to melanocytic naevi.     

Age incidence of meningococcal infection England and Wales, 1984-1991

Gene transfer with vectors derived from murine retroviruses is restricted to cells which are proliferating and synthesizing DNA at the time of infection. This suggests that retroviral-mediated gene transfer might permit targeting of gene integration into malignant cells in organs composed mainly of quiescent nonproliferating cells, such as in the brain. Accordingly, selective introduction of genes encoding for susceptibility to otherwise nontoxic drugs ("suicide" genes) into proliferating brain tumors may be used to treat this cancer. We investigated the efficacy and dynamics of in vivo transduction of growing brain tumors with the herpes simplex-thymidine kinase gene followed by administration of the antiviral drug ganciclovir. Ganciclovir is phosphorylated by thymidine kinase to toxic triphosphates that interfere with DNA synthesis, resulting in the preferential death of the transduced tumor cells. Rats inoculated with 4 x 10(4) 9L gliosarcoma cells into the frontal lobe were treated 7 days later with an intratumoral stereotaxic injection of murine fibroblasts (NIH 3T3 cells) that were producing a retroviral vector containing the herpes simplex-thymidine kinase gene. Controls received vector producer and nonproducer NIH 3T3 cell lines containing the Escherichia coli lacZ (beta-galactosidase) gene as well as nonproducer NIH 3T3 cells containing the thymidine kinase gene. The animals were rested for 7 days to allow time for in situ transduction of the proliferating tumor cells with the herpes-thymidine kinase retroviral vector. The animals were then treated with ganciclovir, 15 mg/kg i.p. twice a day for 14 days. Gliomas receiving an injection of 3-5 x 10(6) thymidine kinase producer cells regressed completely in 23 of 30 rats given ganciclovir therapy, while 25 of 26 control rats developed large tumors. Intratumoral injection of a lower concentration of thymidine kinase vector producer cells (1.8 x 10(6)) resulted in a lower frequency of tumor regression (5 of 13 rats). To estimate the efficiency of in vivo gene transfer, 9L brain tumors were given injections of 5 x 10(6) beta-galactosidase vector producer cells. 5-Bromo-4-chloro-3-indolyl-beta-D-galactopyranaside staining revealed maximal staining of beta-galactosidase within the tumor 7-14 days after injection of the vector producer cells. In vivo transduction rates in harvested tumors ranged from 10 to 70%. There was no evidence of transduction of the surrounding normal neural tissue. Occasional blood vessel endothelial cells within or adjacent to the tumor were observed to be 5-bromo-4- chloro-3-indolyl-beta-D-galactopyranaside positive.(ABSTRACT TRUNCATED AT 400 WORDS)     

Comparison of handpiece asepsis among Ohio dentists: 1991 & 1992

In 1991, we found that 23 percent of Ohio dentists sterilized handpieces between patients and 67 percent flushed handpieces between patients. In this study, we chose to investigate the changes in handpiece asepsis within Ohio dental offices for the twelve-month period ending August, 1992. Sixty-two percent of the 730 offices polled responded to the questionnaire. Offices reporting sterilization of handpieces between patients in 1992 is 80 percent compared to 23 percent in 1991. Sixty-nine percent of offices in the 1992 survey reported that they have changed infection control protocol to include heat sterilization of handpieces between patients while 24 percent report disinfection between patients. Back order of equipment, inadequate number of handpieces and fear of damage is cited by the offices using disinfection as the reasons for not sterilizing handpieces. Flushing handpieces between patients is reported by 83 percent of the offices. Previously, only 67 percent flushed between patients. Anti-retraction valves are present in 69 percent of the water lines. Breakdown of handpieces attributed to sterilization was reported by 45 percent of the offices. Two-hundred and three offices (45 percent) report questions from patients regarding office infection control policies. Infection control awareness of the general population and implementation of these procedures by dental professionals is increasing in Ohio.     

A review of induced abortion rates in England and Wales, 1969-1994

This study examines trends in induced abortion rates in England and Wales, from 1969 to 1994. A comparison of the trends between the different age groups shows contrasting changes and interesting features. The only age group to show a continuous increase since 1969 has been females aged 11 to 14 years. This may be due to birth cohort effect, as younger women begin sexual activity in a social environment of higher risk than previous cohorts. These considerations have important implications for the organisation of preventive services particularly health education. In spite of the availability of improved and better contraceptive services and sex education, the cohort analysis suggests that induced abortion rates in each successive cohort was higher than the preceding cohort.