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Background This paper evaluates claims in a recent study that inequalities in small area mortality rates have lessened. We examine the effect of differently estimated populations on time trends in age‐specific mortality rates for Yorkshire and the Humber and East of England. [ABSTRACT FROM PUBLISHER]

Background The continuing identification, assessment and management of risks are key themes for clinical governance. These themes are being integrated into both primary and secondary care practice; however, integration into public health practice appears much slower. This paper describes the recent approach that we have taken in Sheffield, and proposes a model for public health departments to identify, assess and manage risks, which complements other risk management processes and is transferable to other settings. It assumes that public health practice is not a risk‐free activity and holds that the process of identifying, assessing and managing risks is a key component to raising standards. [ABSTRACT FROM PUBLISHER]

This paper discusses the work of Raymond J. Donaldson, who served as Medical Officer of Health (MOH) on Teesside in the North-East of England, 1968-1974, and the professional strategy that he adopted during this period is characterized. It is shown that Donaldson effectively withdrew from areas where the local authority public health department and general practitioners offered the same services, and consciously sought the complete attachment of some grades of staff to general practice. This approach, which was based on the view that in the long term the local authority could not compete successfully with general practitioners, allowed him to develop other activities, notably in the area of action research. 'Progressive realism' will be suggested as a suitable description for Donaldson's professional strategy during his time in Teesside. [ABSTRACT FROM AUTHOR]

Public health practitioners are often faced with the necessity to compare the mortality experience of different geographical areas. Indirect standardization, producing a 'standardized mortality ratio' (SMR) is the most commonly used technique for doing this. However, as we show, indirect standardization is inappropriate for such comparisons, as SMRs for different geographical areas have different denominators. The fact that indirect standardization is usually chosen for this type of comparison is probably based on two beliefs: (1) that direct standardization yields only a rate rather than a more easily interpreted ratio or index; (2) that direct standardization cannot be carried out in many cases because the sub-group specific mortality rates in the groups to be compared are not available or, in at least some age classes, are based upon such small numbers as to be completely unreliable. In this paper we show that a simple index (the comparative mortality figure) can be calculated from the directly standardized rate in most cases. Using a comparison of the overall mortality experience of electoral wards in Sheffield between 1980 and 1987 we demonstrate also that the advantage gained by the smaller standard error of the SMR is outweighed by the bias inherent in its construction. We recommend that the SMR is used only when absolutely necessary, that is, in the rare circumstance when data are not available for the calculation of age- and sex-specific subgroup rates in the study population. [ABSTRACT FROM PUBLISHER]

This paper describes the successful implementation of universal antenatal screening for HIV and hepatitis B in Southampton and South West Hampshire Health Authority. This was achieved through formation of a multi‐disciplinary planning group of clinicians and managers from local trusts. The approach taken in implementing screening is described, key elements of this being the appointment of screening co‐ordinators and consultation with local midwives to ensure their training needs were addressed. Lessons for future work are discussed. [ABSTRACT FROM PUBLISHER]

Background In the United States, an association has been proposed between better access to primary care and lower mortality. This paper reports an ecological analysis that evaluated whether population health was associated with general practitioner (GP) supply in England. [ABSTRACT FROM PUBLISHER]

Background. The aim of the study was to establish the prevalence of urinary symptoms and felt the need in adults. This paper discusses problems with setting thresholds to distinguish cases from non-cases in this field of research. Few studies have provided detailed age- and sex-specific prevalence estimates for felt need in relation to urinary symptoms. [ABSTRACT FROM PUBLISHER]

Background. Recent UK government documents have stated that, within the National Health Service, consumers should be more involved in decision-making. This study considered the technique of discrete choice conjoint analysis (DCCA) for eliciting community views regarding the importance of reducing waiting times. More specifically, the study aimed to establish whether residents living on the Isle of Wight are prepared to travel to the mainland for elective surgery where waiting times are shorter but travel costs may be greater, and, further, if residents are willing to travel, what reduction in waiting time and increase in travel costs would be acceptable. [ABSTRACT FROM PUBLISHER]

Schools are identified as a key setting for health promotion in the UK Government's consultation report on the public health strategy for England. The concept of the 'healthy' or 'health promoting school' provides the basis for a broad settings approach to health promotion in schools. The approach extends beyond the formal health education curriculum to include a consideration of the physical and social environment of schools and their links and partnerships with parents and the wider community, in pursuit of better health. There is growing evidence that the health promoting school approach is effective in influencing outcomes related to health and education. Initiatives in the form of projects and schemes are commonly used by Health Promotion Specialist services and health partnerships, to stimulate and support the adoption of the approach by schools. A national healthy school scheme is to be launched alongside these local initiatives in 1999. The paper reviews research and practice in this area and makes recommendations to inform the future development of schools as health promoting organizations. [ABSTRACT FROM PUBLISHER]

Background: Smoking behaviour is of central concern to enhanced population health and there is a recognized need for detailed information concerning many different aspects of this behaviour. This paper assesses the utility of three large-scale national surveys according to their ability to provide such information. These are the General Household Survey (GHS), the British Household Panel Survey (BHPS) and the Health Survey for England (HSE). [ABSTRACT FROM PUBLISHER]

The article discusses the ineffectivity of population screening on the prevention and control of tuberculosis (TB) in Croydon, England which emphasizes that it should be replaced with early diagnosis. It notes that only one case of TB is diagnosed by TB screening per 951 entrants screened and the three patients diagnosed are non-infectious. It furthers that close links with the agencies which are involved in the management of direct referral to TB nurses must be developed.

Background Data are available on the prevalence of smoking states (never, current and ex). However, data on behaviour change rates (starting – never to current, quitting – current to ex and lapsing – ex to current) are not readily available and cannot be simply derived from or related to prevalence data. [ABSTRACT FROM PUBLISHER]

Background The aim of this study was to determine whether the risk of congenital anomalies in a population resident close to a waste combustion plant located at Byker in the city of Newcastle upon Tyne, United Kingdom, was higher than in a population resident further away. [ABSTRACT FROM PUBLISHER]

Background The aims of this study were to develop ischaemic heart disease (IHD) registers in three primary care groups (PCGs) in SW London; to determine what proportion of patients with IHD were already identified; and to estimate the workload in producing an IHD disease register. [ABSTRACT FROM PUBLISHER]

Until recently, national coding and analysis of routine mortality statistics in most countries included only underlying cause of death. There were changes in the rules for selection and coding of underlying cause in England in 1984 and 1993. We report on trends in mortality rates in an English region from 1979 to 1998, comparing multiple‐cause and underlying‐cause coded rates, for individual diseases that were affected by coding changes. Among many others, these include pneumonia, venous thromboembolism, heart failure, respiratory distress syndrome, tuberculosis, diabetes, dementia, alcohol and drug abuse, epilepsy, multiple sclerosis, stroke, asthma, peptic ulcer, appendicitis, and cancers of the breast, colon and prostate. Comparisons over time of mortality rates based on underlying cause alone will be misleading when the time‐period crosses years in which rules changed for selecting underlying cause. [ABSTRACT FROM PUBLISHER]

Background Over 90 per cent of local housing authorities in England allocate medical priority for rehousing (MPR) to applicants with medical or care needs but very few studies have been undertaken to investigate the health effects of this practice. This longitudinal study compares the change in health status of adult applicants for MPR who were rehoused with applicants who were not rehoused. [ABSTRACT FROM PUBLISHER]

The article reports on the action plan updates of various common communicable diseases in England and Wales from April to June 2002. The Department of Health remarked that the implementation of national sexual health strategy in sexually transmitted infections (STIs) is highly recommended to reduce unintended pregnancy rates. In addition, the prevalence of B streptococcal disease (GBS) is found the leading cause of serious bacterial infection in young infants.

Background Our aim was to describe the epidemiology of cutaneous malignant melanomas (CMMs) in males and females in the south east of England from 1960 to 1998. Birth cohort effects are important when describing the incidence of CMMs because fashions of dress affect whether different body sites are exposed to sunlight. [ABSTRACT FROM PUBLISHER]

In a modern industrialized society it was essential for humankind to be protected by a strong medical presence, to establish a uniform system for public health everywhere in that society, to make public health independent from the welfare system, and to harmonize the relationship between personal hygienic rules and local authority rules. The society in Japan has developed on the basis of those four philosophical principles of public health, and has enabled the people to have the longest life expectancy in the world. However, the public health system in this society is now in a critical situation resulting from the long life expectancy. How can we rebuild the role of public health in this country? A society with a long life expectancy has to face a wide variety of health conditions. However, the health insurance system in Japan does not generally provide any service for a patient without specific symptoms. Consequently, to help people become aware of their own health condition, comprehensive public services such as general health check‐ups, screening for cancers, and health counselling have been established locally by all 3250 municipal authorities. In promoting those services, people must learn how to draw the boundary‐line between ‘public’ and ‘private’ in affairs of health to understand the importance of ‘hygienic rules based on counsels for personal self‐government’, as Simon suggested 100 years ago, and health professionals must develop a public health system which depends not only on regulatory laws but also on scientific findings, as Rumsey advocated 150 years ago. [ABSTRACT FROM PUBLISHER]

Background In the North West of England, data on drug users are routinely collected from a variety of agencies including specialist treatment centres, police and probation services. However, the covert nature of drug use means that alone, these conventional monitoring systems cannot provide the epidemiology required to target and develop drug treatment and prevention initiatives. [ABSTRACT FROM PUBLISHER]

Background The study examines time trends and socio‐demographic aspects of drug poisoning deaths in England and Wales. [ABSTRACT FROM PUBLISHER]

Background NHS Direct was set up in 1998 and now covers all of England. One site in South East London, which went live in April 1999, has been studied to gain an insight into how NHS Direct is used and by whom. [ABSTRACT FROM PUBLISHER]

Background. In the context of contaminated land, assessing risk involves identifying a source, a pathway and a receptor. We describe how this approach worked in practice following the discovery of high lead levels in the soil of an allotment site in a London borough. [ABSTRACT FROM PUBLISHER]

Background. Little is known about the similarities or differences with which Primary Care Group (PCG) Board members view the relative importance of the three functions with which they are charged, or how representative these views are of local primary care teams in general. This project explores the priorities of medical and nursing PCG Board members in relation to those of local General Practitioners (GPs) and practice nurses they represent. [ABSTRACT FROM PUBLISHER]

Background. Excess winter mortality is higher in England and Wales than in other European countries with similar or lower average winter temperatures. It might be expected that excess winter mortality would be higher in areas with greater socio-economic deprivation, and if this were so preventive interventions could be directed at populations in these areas. The association between deprivation and excess winter mortality has not been adequately investigated in the past. The aim of this study was to look at the association between excess winter mortality and socio-economic deprivation, so that policy decisions to reduce this excess mortality could be appropriately directed. [ABSTRACT FROM PUBLISHER]

Background A sulphur dioxide (SO2) episode occurred in the United Kingdom in 1998. The worst affected area was the city of Nottingham. [ABSTRACT FROM PUBLISHER]

The author reflects on the role of general practitioners (GPs) and other public health specialists to render quality of services at the National Health Services in England. The author emphasized the importance of structural and organizational change and establishing strong relationships among the medical personnel. Information regarding the public health policies based on Primary Care Trusts (PCTs) standard is also considered.

Background. Non-occupational exposure to asbestos has been of increasing interest, but residential exposure to asbestos often focuses on a few high-profile asbestos users. This study aimed to identify industrial sites producing asbestos goods in a given area and time period. [ABSTRACT FROM PUBLISHER]