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A 19th century physician was crucial to the establishment of 2 medical specialties-anesthesiology and public health. Everyone whose interest in public health has increased in the last year will be amazed at Dr John Snow's career in anesthesiology. Those who recognize him as the first full-time physician anesthetist will be struck by his development of medical mapping during the Cholera Pandemic of 1848, resulting in one of the fundamental techniques of epidemiology and public health that has continued through today. Snow's accomplishments in anesthesiology and epidemiology reflected a concatenation of science, focus, and creativity. His training in the early 19th century integrated science, medicine, and his keen interest in respiratory physiology. His early clinical exposure to colliery workers in Newcastle was likely influenced by the earlier development of pneumatic medicine. He was committed to the notion that chemistry, especially the use of medicinal gases, would be transformative for medicine. Thus, he was "primed" when the news of the American anodyne ether reached London in 1846. When the third cholera pandemic reached London shortly thereafter, in the fall of 1848, his academic and practical understanding of gas chemistry and pharmacology, respiratory physiology, and anesthetic agents led him to question the popularly promulgated miasma-based theories of transmission. His methodical investigations, research, and perseverance were mirrored in his scholarly work, numerous presentations, and public advocacy. He articulated many scientific principles essential to the early practice of anesthesia-anesthetic potency, quantitative dosing of anesthetic agents, engineering principles required for conserving the latent heat of vaporization, and minimizing the contribution of anesthetic equipment to airway resistance. He moved easily and methodically between these worlds of physiology, chemistry, engineering, clinical medicine, and public health. In his role as the first medical epidemiologist, Snow understood the power of medical mapping and the graphic presentation of data. He was a pioneer in 2 nascent fields of medicine that were historically and remain contemporarily connected., Competing Interests: The author declares no conflicts of interest., (Copyright © 2021 International Anesthesia Research Society.)

Background The term 'long COVID' describes ongoing symptoms and conditions experienced by people infected with SARS-CoV-2. This paper illustrates how a public health approach was used to influence and inform the development of post-COVID services across two Integrated Care Systems (ICSs). Methods A literature review was conducted between October and December 2020 to identify prevalence estimates for long COVID. The prevalence estimates were applied to locally available data on the susceptible population to estimate the number of people with long COVID. They were also used to develop a dashboard to predict fluctuations in the number of people experiencing persistent symptoms over time. Results A substantial number of people in each ICS may have experienced persistent symptoms or complications as a result of COVID-19. In Lancashire and South Cumbria, it is estimated that 33 000 people may have experienced post-COVID-19 syndrome since the beginning of the pandemic, which will include respiratory or cardiovascular complications. Conclusions The findings have been valuable in informing early service developments, engaging with managers and clinicians, and supporting applications for funding at a local level. Continued attention to emergent evidence on this topic will be vital in refining estimates and supporting service planning in the longer term. [ABSTRACT FROM AUTHOR]

Introduction: Assaults inflicting penetrating head and neck trauma have potential for serious morbidity or mortality. This paper studies in-depth all cases treated at a level one trauma centre in the North East of England over 10 years. Methods: All patients assaulted with sharp implements to the head and neck treated from 2010 to 2019 were identified using clinical codes. Results: Retrospective data collection were as follows: 214 patients identified (189 male, 25 female). Average age was 31.5 years (range 3–80). The majority presented between 20:00 and 05:00. Knives were the commonest weapon. Fifty-two had scalp, 137 face and 69 neck injuries. Forty-eight percent had additional non-head and neck injuries. Eighty-six percent required admission, 16.6% to intensive care. Oral and maxillofacial and plastic surgeons provided most treatment. One hundred two required treatment under general and 96 local anaesthetic. Sixteen patients had significant vascular injury, 1 brachial plexus injury, 4 facial nerve injuries (of which 3 repaired) and one required parotid duct repair. Mean length of stay was 3.7 days. No mortality was recorded. Incidence significantly increased from 2010 to 2019. Conclusions: Head and neck penetrating injuries occur frequently, often with other injuries and mainly in young males. Incidence of significant vascular or nerve injury was low. This study provides important data for those planning trauma services. [ABSTRACT FROM AUTHOR]

Major Greenwood was the foremost medical statistician of the first half of the 20th century in the U.K. Trained in both medicine and statistics, his career extended over 45 years during which he published eight books, 23 extensive reports and over 200 papers. His classical education extended to Latin and Greek, and he was fluent in German and French. We provide an overview of his life including family background, training and his career subdivided according to the places where he worked. We describe in particular the key role he played with others in the development of medical statistics within the Medical Research Council, the General Register Office, the Department of Health and the Universities. [ABSTRACT FROM AUTHOR]

Wastewater-based epidemiology (WBE) is a valuable tool for monitoring the circulation of COVID-19. However, while variations in population size are recognised as major sources of uncertainty, wastewater SARS-CoV-2 measurements are not routinely population-normalised. This paper aims to determine whether dynamic population normalisation significantly alters SARS-CoV-2 dynamics observed through wastewater monitoring, and whether it is beneficial or necessary to provide an understanding of COVID-19 epidemiology. Data from 394 sites in England are used, and normalisation is implemented based on ammoniacal nitrogen and orthophosphate concentrations. Raw and normalised wastewater SARS-CoV-2 metrics are evaluated at the site and spatially aggregated levels are compared against indicators of prevalence based on the Coronavirus Infection Survey and Test and Trace polymerase chain reaction test results. Normalisation is shown, on average, to have a limited impact on overall temporal trends. However, significant variability in the degree to which it affects local-level trends is observed. This is not evident from previous WBE studies focused on single sites and, critically, demonstrates that while the impact of normalisation on SARSCoV-2 trends is small on average, this may not always be the case. When averaged across many sites, normalisation strengthens the correlation between wastewater SARS-CoV-2 data and prevalence indicators; however, confidence in the improvement is low. [ABSTRACT FROM AUTHOR]

Background: High levels of psychiatric morbidity in prisoners have important implications for services. Assessing Needs for Psychiatric Treatment in Prisoners is an evaluation of representative samples of prisoners in a male and a female prison in London. This paper reports on the prevalence of mental disorders. In a companion paper, we describe how this translates into mental health treatment needs and the extent to which they have been met.Methods: Prisoners were randomly sampled in a sequential procedure based on the Local Inmate Data System. We interviewed roughly equal numbers from the following groups: male remand; male sentenced prisoners (Pentonville prison); and female remand; female sentenced prisoners (Holloway prison). Structured assessments were made of psychosis, common mental disorders, PTSD, personality disorder and substance abuse.Results: We interviewed 197 male and 171 female prisoners. Psychiatric morbidity in male and female, sentenced and remand prisoners far exceeded in prevalence and severity than in equivalent general population surveys. In particular, 12% met criteria for psychosis; 53.8% for depressive disorders; 26.8% for anxiety disorders; 33.1% were dependent on alcohol and 57.1% on illegal drugs; 34.2% had some form of personality disorder; and 69.1% had two disorders or more. Moreover, in the year before imprisonment, 25.3% had used mental health services.Conclusions: These rates of mental ill-health and their similarity in remand and sentenced prisoners indicate that diversion of people with mental health problems from the prison arm of the criminal justice system remains inadequate, with serious consequences for well-being and recidivism. [ABSTRACT FROM AUTHOR]

Toxocara infection occurs through ingestion of parasite eggs excreted by dogs and cats, and can cause severe morbidity. The burden of disease in England and Wales is not well described, and the impact of public health campaigns conducted in the mid-1990s is uncertain. This paper uses data from two extensive databases to explore the trends in this disease in England and Wales from the 1970s to 2009. [ABSTRACT FROM AUTHOR]

Background Deaths and injuries related to fires are largely preventable events. In the UK, a plethora of community-based fire safety initiatives have been introduced over the last 25 years, often led by fire and rescue services, to address this issue. This paper focuses on one such initiative—home safety assessments (HSAs). Cheshire Fire and Rescue Service (in England) implemented a uniquely large-scale HSA intervention. This paper assesses its effectiveness. Methods The impact of HSAs was assessed in relation to three outcomes: accidental dwelling fires (ADFs), ADFs contained and injuries arising from ADFs. A two-period comparison in fire-related rates of incidences in Cheshire between 2002 and 2011 was implemented, using Poisson regression and adjusting for the national temporal trend using a control group comprising the 37 other English non-metropolitan fire-services. Results Significant reductions were observed in rates of ADFs [incidence rate ratios (IRR): 0.79, 95% confidence interval (CI): 0.74–0.83, P < 0.001, 2002/03–2007/08 versus 2008/09–2010/11] and associated injuries (IRR: 0.49, 95% CI: 0.39–0.60, P < 0.001, 2002/03–2006/07 versus 2007/08–2010/11), but not in the proportion of fires contained to room of origin. Conclusions There is strong evidence to suggest that the intervention was successful in reducing domestic fires and related injuries. [ABSTRACT FROM PUBLISHER]

Asthma is a global public health problem and the most common chronic disease among children. The factors associated with the condition are diverse, and environmental factors appear to be the leading cause of asthma exacerbation and its worsening disease burden. However, it remains unknown how changes in the environment affect asthma over time, and how temporal or environmental factors predict asthma events. The methodologies for forecasting asthma and other similar chronic conditions are not comprehensively documented anywhere to account for semistructured noncausal forecasting approaches. This paper highlights and discusses practical issues associated with asthma and the environment, and suggests possible approaches for developing decision-making tools in the form of semistructured black-box models, which is relatively new for asthma. Two statistical methods which can potentially be used in predictive modeling and health forecasting for both anticipated and peak events are suggested. Importantly, this paper attempts to bridge the areas of epidemiology, environmental medicine and exposure risks, and health services provision. The ideas discussed herein will support the development and implementation of early warning systems for chronic respiratory conditions in large populations, and ultimately lead to better decision-making tools for improving health service delivery. [ABSTRACT FROM AUTHOR]

A correction to this paper has been published: https://doi.org/10.1007/s00134-021-06413-2 [ABSTRACT FROM AUTHOR]

Background: Increasing age is the biggest risk factor for dementia, of which Alzheimer's disease is the commonest cause. The pathological changes underpinning Alzheimer's disease are thought to develop at least a decade prior to the onset of symptoms. Molecular positron emission tomography and multi-modal magnetic resonance imaging allow key pathological processes underpinning cognitive impairment - including β-amyloid depostion, vascular disease, network breakdown and atrophy - to be assessed repeatedly and non-invasively. This enables potential determinants of dementia to be delineated earlier, and therefore opens a pre-symptomatic window where intervention may prevent the onset of cognitive symptoms.Methods/design: This paper outlines the clinical, cognitive and imaging protocol of "Insight 46", a neuroscience sub-study of the MRC National Survey of Health and Development. This is one of the oldest British birth cohort studies and has followed 5362 individuals since their birth in England, Scotland and Wales during one week in March 1946. These individuals have been tracked in 24 waves of data collection incorporating a wide range of health and functional measures, including repeat measures of cognitive function. Now aged 71 years, a small fraction have overt dementia, but estimates suggest that ~1/3 of individuals in this age group may be in the preclinical stages of Alzheimer's disease. Insight 46 is recruiting 500 study members selected at random from those who attended a clinical visit at 60-64 years and on whom relevant lifecourse data are available. We describe the sub-study design and protocol which involves a prospective two time-point (0, 24 month) data collection covering clinical, neuropsychological, β-amyloid positron emission tomography and magnetic resonance imaging, biomarker and genetic information. Data collection started in 2015 (age 69) and aims to be completed in 2019 (age 73).Discussion: Through the integration of data on the socioeconomic environment and on physical, psychological and cognitive function from 0 to 69 years, coupled with genetics, structural and molecular imaging, and intensive cognitive and neurological phenotyping, Insight 46 aims to identify lifetime factors which influence brain health and cognitive ageing, with particular focus on Alzheimer's disease and cerebrovascular disease. This will provide an evidence base for the rational design of disease-modifying trials. [ABSTRACT FROM AUTHOR]

John Snow, the London doctor who studied cholera in the 1840s and 1850s, argued in Snow (1856) that water exerted an "overwhelming influence" on mortality in a region of south London during the 1854 outbreak. In a paper re-assessing Snow's analysis, Koch and Denike (2006) claim that "Snow made not merely minor arithmetic errors but more importantly critical, conceptual mistakes that adversely affected his results." The claim of errors and mistakes is incorrect and due to a misreading or misunderstanding of Snow's data and analysis. Koch and Denike apply an inappropriate statistical test to Snow's original data (and do so incorrectly). More importantly, due to the misreading of the historical record they alter the underlying primary-source data, rendering their results invalid. Analysis of the data following Snow's approach but with modern statistical tools strongly supports Snow's claim for the primacy of water in accounting for variation in cholera mortality. • Review a 2006 critique of John Snow's methodology in his 1856 analysis of south London. • Apply modern statistical techniques to re-examine John Snow's south London analysis. • Conclude that Snow's work did not suffer from the claimed methodological problems. • Support and confirm Snow's conclusion that water had an overwhelming effect on mortality. [ABSTRACT FROM AUTHOR]

Introduction: Women are on average diagnosed with diabetes mellitus at later age than men but have higher mortality. As the diagnosis of diabetes mellitus is primarily based on HbA1c, the use of a non-specific reference range and cut point for diabetes mellitus that does not account for gender differences in diabetes could potentially lead to underdiagnosis of diabetes mellitus in women and missed opportunities for intervention. We investigated whether a contributing factor to the later diagnosis in women may be a difference in distribution of HbA1c in premenopausal women versus men of the same age by comparing HbA1c values in men and women across multiple sites in the UK. Methods: We analysed the HbA1c levels of 146,907 individuals who underwent single testing only and had HbA1c ≤ 50 mmol/mol between 2012 and 2019 in one laboratory (cohort 1). This was replicated in six laboratories with 938,678 individuals tested between 2019 and 2021 (cohort 2). Results: In cohort 1, women < 50 years old had an HbA1c distribution markedly lower than that in men by a mean of 1.6 mmol/mol (p < 0.0001), while the difference in the distribution of HbA1c for individuals aged ≥ 50 years was less pronounced (mean difference 0.9 mmol/mol, p < 0.0001). For individuals under the age of 50, HbA1c in women lagged by up to 10 years compared to men. Similar findings were found in cohort 2. We estimated an additional 17% (n = 34,953) of undiagnosed women aged < 50 years in England and Wales could be reclassified to have diabetes mellitus, which may contribute to up to 64% of the difference in mortality rates between men/women with diabetes mellitus aged 16–50 years. Conclusion: The HbA1c cut point for diagnosis of diabetes mellitus may need to be re-evaluated in women under the age of 50 years. Early identification of diabetes mellitus in women has the potential to improve women's health outcomes in the longer term. [ABSTRACT FROM AUTHOR]

Purpose: Smoking is a risk factor for some autoimmune diseases, but its association with autoimmune hepatitis remains unknown. We conducted a population-based matched case–control study to examine the association between tobacco smoking and the risk of autoimmune hepatitis in England. Patients and Methods: From the Clinical Practice Research Datalink and linked Hospital Episode Statistics, 2005– 2017, we included 987 cases diagnosed with autoimmune hepatitis after age 18 years and up to 10 frequency-matched population controls per case. We used multiple logistic regression to estimate the odds ratio of autoimmune hepatitis in ever-smokers vs never-smokers, adjusting for sex, age, general practice, calendar time of registration with the general practice, and socioeconomic status. Results: The autoimmune hepatitis cases were more likely to be ever-smokers than the controls (44% vs 37%). The ever-smokers had an increased risk of autoimmune hepatitis compared with the never-smokers (adjusted odds ratio = 1.20, 95% confidence interval 1.03– 1.39). Conclusion: Smoking was associated with an increased risk of autoimmune hepatitis. Plain Language Summary: Autoimmune hepatitis is a chronic liver disease associated with genetic variants and environmental exposures, but the causes of autoimmune hepatitis remain unknown. Using registry data, we evaluated the association between tobacco smoking and the risk for autoimmune hepatitis. We found that tobacco smoking was associated with an increased risk of autoimmune hepatitis. [ABSTRACT FROM AUTHOR]

A large-scale multiple surveillance system for infectious disease outbreaks has been in operation in England and Wales since the early 1990s. Changes to the statistical algorithm at the heart of the system were proposed and the purpose of this paper is to compare two new algorithms with the original algorithm. Test data to evaluate performance are created from weekly counts of the number of cases of each of more than 2000 diseases over a twenty-year period. The time series of each disease is separated into one series giving the baseline (background) disease incidence and a second series giving disease outbreaks. One series is shifted forward by twelve months and the two are then recombined, giving a realistic series in which it is known where outbreaks have been added. The metrics used to evaluate performance include a scoring rule that appropriately balances sensitivity against specificity and is sensitive to variation in probabilities near 1. In the context of disease surveillance, a scoring rule can be adapted to reflect the size of outbreaks and this was done. Results indicate that the two new algorithms are comparable to each other and better than the algorithm they were designed to replace. [ABSTRACT FROM AUTHOR]

Smoking has been identified as the second greatest risk factor for global death and disability and has impacts on the oral cavity from aesthetic changes to fatal diseases such as oral cancer. The paper presents a secondary analysis of the National Adult Dental Health Survey (2009). The analysis used descriptive statistics, bivariate analyses and logistic regression models to report the self-reported oral health status and dental attendance of smokers and non-smokers in England. Of the 9,657 participants, 21% reported they were currently smoking. When compared with smokers; non-smokers were more likely to report ‘good oral health’ (75% versus 57% respectively, p<0.05). Smokers were twice as likely to attend the dentist symptomatically (OR = 2.27, CI = 2.02–2.55) compared with non-smoker regardless the deprivation status. Smokers were more likely to attend symptomatically in the most deprived quintiles (OR = 1.99, CI = 1.57–2.52) and perceive they had poorer oral health (OR = 1.77, CI = 1.42–2.20). The present research is consistent with earlier sub-national research and should be considered when planning early diagnosis and management strategies for smoking-related conditions, considering the potential impact dental teams might have on smoking rates. [ABSTRACT FROM AUTHOR]

Background: The Enhanced Matching System (EMS) is a probabilistic record linkage program developed by the tuberculosis section at Public Health England to match data for individuals across two datasets. This paper outlines how EMS works and investigates its accuracy for linkage across public health datasets. Methods: EMS is a configurable Microsoft SQL Server database program. To examine the accuracy of EMS, two public health databases were matched using National Health Service (NHS) numbers as a gold standard unique identifier. Probabilistic linkage was then performed on the same two datasets without inclusion of NHS number. Sensitivity analyses were carried out to examine the effect of varying matching process parameters. Results: Exact matching using NHS number between two datasets (containing 5931 and 1759 records) identified 1071 matched pairs. EMS probabilistic linkage identified 1068 record pairs. The sensitivity of probabilistic linkage was calculated as 99.5% (95%CI: 98.9, 99.8), specificity 100.0% (95%CI: 99.9, 100.0), positive predictive value 99.8% (95%CI: 99.3, 100.0), and negative predictive value 99.9% (95%CI: 99.8, 100.0). Probabilistic matching was most accurate when including address variables and using the automatically generated threshold for determining links with manual review. Conclusion: With the establishment of national electronic datasets across health and social care, EMS enables previously unanswerable research questions to be tackled with confidence in the accuracy of the linkage process. In scenarios where a small sample is being matched into a very large database (such as national records of hospital attendance) then, compared to results presented in this analysis, the positive predictive value or sensitivity may drop according to the prevalence of matches between databases. Despite this possible limitation, probabilistic linkage has great potential to be used where exact matching using a common identifier is not possible, including in low-income settings, and for vulnerable groups such as homeless populations, where the absence of unique identifiers and lower data quality has historically hindered the ability to identify individuals across datasets. [ABSTRACT FROM AUTHOR]

Non-traumatic major lower-extremity amputations (LEA) are a common consequence of long-term diabetes mellitus, with risk factors for LEA including coronary heart disease, cerebrovascular disease or peripheral arterial disease (Crawford et al, 2015). The authors of this systematic review aimed to highlight all epidemiology studies from England that describe the population prevalence of major lower-limb amputation in those with and without diabetes. Time trends across populations are highlighted in those studies where such comparison is possible. [ABSTRACT FROM AUTHOR]

Chickenpox is a common childhood disease caused by varicella-zoster virus (VZV). VZV vaccination is not part of the UK childhood immunisation programme, but its potential inclusion is regularly assessed. It is therefore important to understand the ongoing burden of VZV in the community to inform vaccine policy decisions. General practitioner (GP) chickenpox consultations were studied from 1 September 2016 to 9 December 2022. Over the study period, the mean weekly chickenpox consultation rate per 100,000 population in England was 3.4, with a regular peak occurring between weeks 13 and 15. Overall, rates decreased over time, from a mean weekly rate of 5.5 in 2017 to 4.2 in 2019. The highest mean weekly rates were among children aged 1–4 years. There was no typical epidemic peak during the COVID-19 pandemic, but in 2022, rates were proportionally higher among children aged < 1 year old compared to pre-pandemic years. Chickenpox GP consultation rates decreased in England, continuing a longer-term decline in the community. The COVID-19 pandemic impacted rates, likely caused by the introduction of non-pharmaceutical interventions to prevent SARS-CoV-2 transmission. The lasting impact of the interruption of typical disease transmission remains to be seen, but it is important to monitor the chickenpox burden to inform decisions on vaccine programmes. [ABSTRACT FROM AUTHOR]

Background Achieving high human papillomavirus (HPV) vaccine coverage may reduce inequalities in cervical cancer prevention by mitigating the inequalities seen in the cervical screening programme. This paper assesses whether the same sociodemographic factors are associated with both cervical screening and HPV vaccination. Methods Girls' HPV vaccination records were linked by address to cervical screening records for their mothers in the North West of England. Index of Multiple Deprivation scores (2010) and census ethnicity data (2001) were used to investigate the association between deprivation and ethnic composition of area of residence with HPV vaccination and cervical screening uptake, along with potential differences between Primary Care Trusts (PCTs), which were responsible for vaccine delivery. Results Deprivation was not associated with routine (12-13-year-olds) vaccination initiation, but girls living in the most deprived quintile were significantly less likely to complete the three vaccine doses (OR 0.75; 95% CI 0.63 to 0.88). Mother-daughter pairs failing to engage in either screening or vaccination were also more likely to live in deprived areas (routine vaccination OR for most deprived quintile: 2.35; 95% CI 2.00 to 2.77). There were differences between PCTs after controlling for demographic effects (OR 1.35; 95% CI 1.23 to 1.52). Conclusions Ensuring completion of the vaccine schedule is critical for organisations responsible for vaccine delivery in order to reduce cancer risk among girls living in deprived areas. There remains a small minority of mothers and daughters from disadvantaged backgrounds who do not participate in either cervical screening or HPV vaccination. [ABSTRACT FROM AUTHOR]

Objectives: To extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions. Methods: We used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity). Results: Findings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA. Conclusions: This paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability. [ABSTRACT FROM AUTHOR]

Purpose – This paper aimed to characterize the nutrition and health of Brazilians living in Bournemouth, England, and changes in lifestyle after migration. Design/methodology/approach – This is a descriptive study conducted with adult residents of Bournemouth for over a year, selected through a snowball sample. We obtained demographic and food data through a structured questionnaire. An anthropometric evaluation gathered weight, height and waist circumference data. Findings – The final sample consisted of 111 immigrants, 57.7 percent female, with a mean age of 33.02 (±9.58) years. We found evidence that despite the existence of the health immigrant effect, health and nutritional benefits in immigrants erode over time. They reported weight gain post migration, and changes in diet, with increased consumption of food rich in calories and low in nutrients. We found a high proportion of obesity and risk of metabolic complications, which increased with time living in England because of reduced physical activity and worsening dietary habits. Originality/value – The number of people migrating to other countries has been increasing, resulting in interference in the processes of integration and acculturation of lifestyle, including those related to diet and physical activity. But there is little about its impact on Brazilians living abroad. This study showed that health behaviors of migrants were negatively altered by migration. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Malin G, Tonks A, Morris R, Gardosi J, Kilby M. Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG 2012;119:1455-1464. Objective To determine the prevalence and outcome of lower urinary tract obstruction (LUTO), including the sensitivity of antenatal diagnosis. Design A retrospective population-based study. Setting Regional population-based congenital anomalies register (WMCAR). Population Fetuses affected by LUTO delivered between 1995 and 2007 to women resident in the West Midlands. Methods Cases were selected from the WMCAR using codes and keyword terms from the International Classification of Diseases, tenth revision (ICD10). Diagnoses were validated using additional data sets from Regional Fetal Medicine, Perinatal Pathology and Paediatric services. Main outcome measures Rates of prevalence, prenatal diagnosis and mortality, with trends. Results There were 284 LUTO cases in 851 419 births during the study period, representing a total prevalence of 3.34 (2.95 -3.72) per 10 000 births, and this prevalence did not change significantly over time. The prevalence of LUTO was significantly higher in Black and minority ethnic groups when compared with white Europeans (OR 2.38; 95% CI 1.87 -3.03), and are associated with area-based deprivation measures ( P < 0.01). Of all LUTO cases, 221 (77.8%) were isolated, and the remainder were associated with other structural or chromosomal anomalies. The most common subtype was posterior urethral valves (PUVs; n = 179, 63%). In total there were 211 (74.3%) cases of isolated, non-female, singleton fetuses that fitted the referral criteria for in utero vesico-amniotic shunting, giving a prevalence of 2.48 (2.14-2.81) per 10 000 live births. Within this group, the prenatal diagnosis rate was 46.9% (99/211). Conclusion This is the largest population-based study of LUTO that has been performed to date, and provides accurate estimates for prevalence. The low prevalence and relatively low rate of antenatal detection limit the number of cases amenable to prenatal surgical intervention. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG 2012;119:1324-1333. Objective To assess the frequency and risk factors for surgical site infection following caesarean section. Design Prospective multicentre cohort study. Setting Fourteen NHS hospitals in England, April to September 2009. Population Women who underwent caesarean section at participating hospitals during designated study periods. Methods Infections that met standard case definitions were identified through active follow up by healthcare staff during the hospital stay, on return to hospital, during midwife home visits and through self-completed patient questionnaires. Main outcome measure Surgical site infection within 30 days of operation. Results Altogether, 9.6% (394/4107) of women in the study developed a postsurgical infection following caesarean section with 0.6% (23/4107) readmitted for treatment of the infection. Being overweight (body mass index [BMI] 25-30 kg/m2 odds ratio [OR] 1.6, 95% confidence interval [95% CI] 1.2-2.2) or obese (BMI 30-35 kg/m2 OR 2.4, 95% CI 1.7-3.4; BMI > 35 kg/m2 OR 3.7, 95% CI 2.6-5.2) were major independent risk factors for infection (compared with BMI 18.5-25 kg/m2). There was a suggestion that younger women, and operations performed by associate specialist and staff grade surgeons had a greater odds of developing surgical site infection with OR 1.9, 95% CI 1.1-3.4 (<20 years versus 25-30 years), and OR 1.6, 95% CI 1.0-2.4 (versus consultants), respectively. Conclusions This study identified high rates of postsurgical infection following caesarean section. Given the number of women delivering by caesarean section in the UK, substantial costs will be incurred as a result of these infections. Prevention of these infections should be a clinical and public health priority. [ABSTRACT FROM AUTHOR]

Background Although long-term trends in local labour market conditions are likely to influence health, few studies have assessed whether this is so. This paper examines whether (1) trends in local employment rates have relevance for mortality and morbidity outcomes in England and (2) trends are stronger predictors of these outcomes than employment rates measured at one point in time. Methods Using latent class growth models, local areas were classified into eight groups following distinct trends in employment rates between 1981 and 2008. Areas were also categorised in 'octile' groups by rank of employment rates in 2001. These area groupings were linked to a sample of 207 959 individuals from the Office of National Statistics Longitudinal Study. Associations between area groupings and risk of all-cause mortality and of reporting a limiting long-term illness at the end of the period were measured using logistic regression. Models were adjusted for individuals' socio-demographic characteristics measured in 1981 and for their residential mobility between 1981 and 2001. Results Compared to areas with continuously high employment rates over the period, risk of mortality and morbidity was higher in areas with persistently low or declining employment rates. Findings suggest that longterm trends in local employment rates are useful as predictors of mortality and morbidity differences. These are not so clearly distinguished by only considering employment rates at one point in time. Conclusion Poor health outcomes are associated with long-term economic disadvantage in some areas of England, reflected in employment rates, underlining the importance of efforts to improve health in areas with especially 'deep-seated' deprivation. [ABSTRACT FROM AUTHOR]

Objective: Care homes are a common place of death for older adults, especially those with complex health needs or dementia. Representative, internationally comparable data on care home facilities and their residents is needed to monitor health and wellbeing in this population. Identification and collection of data from care homes can be challenging and often underreported. This paper draws on the experiences of the PACE study, a cross sectional mortality follow back study conducted in six European countries. Results: Multiple challenges were encountered in creating a sampling framework and contacting, recruiting and retaining care homes in the PACE study. Recruiting a randomly identified, representative cohort from a stratified sampling framework was problematic, as was engaging with care homes to ensure high response rates. Variation in the funding of care homes across the six countries involved in the study may explain the additional challenges encountered in England. Awareness of the challenges encountered in England in implementing an international study in care homes can inform the design and implementation of future studies within care homes. Further discussion is needed to determine the barriers and facilitators to conducting research in care homes, and how this is shaped by the focus of the study. [ABSTRACT FROM AUTHOR]

This paper reports the findings of research on relationships between depression and participation in learning using data from a large sample of older adults. The objective was to establish whether learning can reduce the risk of depression. Data were obtained from the English Longitudinal Study of Ageing, a nationally-representative sample of adults aged 50 and above. The eight-item Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms. Participation in learning covered the acquisition of qualifications; taking formal training courses, learning at arts, music or evening classes; and participation in gym/exercise classes. Multiple regression analyses were conducted with the change in the measure of depressive symptoms between two waves of the longitudinal survey as the response variable. There was limited evidence that participation in learning reduced the risk of depression in later life. Only learning leading to qualifications was significantly associated with the outcome after controlling other factors. But learning leading to qualifications was undertaken only by a small minority of the sample, mainly the youngest and most highly educated. Other types of learning were not significantly associated with depression. It appears that learning has, at best, a small role to play in addressing the risk of depression in later life. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate-to-heavy (10+ CPD) smokers in England. Design Cross-sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 23 245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6-month follow-up. Measurements We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow-up. Findings Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9-32.8%). Compared with moderate-to-heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio-economic background. They were more motivated to quit and enjoyed smoking less. During the 6-month follow-up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate-to-heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate-to-heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over-the-counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Conclusions Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree. [ABSTRACT FROM AUTHOR]

BackgroundEvidence for an effect of work stressors on common mental disorders (CMD) has increased over the past decade. However, studies have not considered whether the effects of work stressors on CMD remain after taking co-occurring non-work stressors into account.MethodData were from the 2007 Adult Psychiatric Morbidity Survey, a national population survey of participants ⩾16 years living in private households in England. This paper analyses data from employed working age participants (N=3383: 1804 males; 1579 females). ICD-10 diagnoses for depressive episode, generalized anxiety disorder, obsessive compulsive disorder, agoraphobia, social phobia, panic or mixed anxiety and depression in the past week were derived using a structured diagnostic interview. Questionnaires assessed self-reported work stressors and non-work stressors.ResultsThe effects of work stressors on CMD were not explained by co-existing non-work stressors. We found independent effects of work and non-work stressors on CMD. Job stress, whether conceptualized as job strain or effort–reward imbalance, together with lower levels of social support at work, recent stressful life events, domestic violence, caring responsibilities, lower levels of non-work social support, debt and poor housing quality were all independently associated with CMD. Social support at home and debt did not influence the effect of work stressors on CMD.ConclusionsNon-work stressors do not appear to make people more susceptible to work stressors; both contribute to CMD. Tackling workplace stress is likely to benefit employee psychological health even if the employee's home life is stressful but interventions incorporating non-work stressors may also be effective. [ABSTRACT FROM PUBLISHER]

Introduction Unintentional injuries to children in the outdoors have a significant impact on child mortality, development and healthcare costs. This paper presents the findings of a systematic review about the effectiveness of programs that provided information, advice or education about the prevention of unintentional injuries to children under 15 years during outdoor play and leisure. Methods A structured search strategy was conducted in a range of databases. All report titles and abstracts were screened using pre-defined criteria. Included reports were quality appraised using a modified Graphical Appraisal Tool for Epidemiological studies (GATE) tool. All quality appraisals and data extraction were checked by a second reviewer. If not provided in the original reports, ORs and mean differences were calculated, where sufficient data were available. Results Twenty-three studies met the inclusion criteria. There was a paucity of robust study designs. The majority of studies only reported a short-term follow-up of intermediate outcome measures. Only two studies measured injury rates; both reported a reduction, but both studies also had considerable methodological weaknesses. The five studies that measured the use of protective equipment reported mixed results, although there is some evidence that suggests that more extensive educational programs (such as health fairs and media campaigns) increase their use. The 20 studies that measured behaviour, attitude or knowledge outcomes reported highly mixed results. Discussion Methodological weaknesses of the included studies limit support for a particular course of action. To better inform policy and practice, future research should (1) use robust study designs and (2) not rely on short-term proxy outcome measures. [ABSTRACT FROM AUTHOR]

BackgroundEvidence is accumulating that child sexual abuse (CSA) is associated with many psychiatric disorders in adulthood. This paper uses the detailed information available from the 2007 Adult Psychiatric Morbidity Survey of England (APMS 2007) to quantify links between CSA and a range of psychiatric conditions.MethodThe prevalence of psychiatric disorder was established in a random sample of the English household population (n=7403), which also provided sociodemographic and experiential information.ResultsWe analyzed six types of common mental disorder, alcohol abuse and drug abuse, and people who screened positively for post-traumatic stress disorder (PTSD) and eating disorders. All were strongly and highly significantly associated with CSA, particularly if non-consensual sexual intercourse was involved, for which odds ratios (ORs) ranged from 3.7 to 12.1. These disorders were also related to adult sexual abuse (ASA), although the likelihood of reverse causality is then increased. Revictimization in adulthood was common, and increased the association of CSA with disorder. For several disorders, the relative odds were higher in females but formal tests for moderation by gender were significant only for common mental disorders and only in relation to non-consensual sexual intercourse. The population attributable fraction (PAF) was higher in females in all cases.ConclusionsThe detailed and high-quality data in APMS 2007 provided important confirmation both of the strength of association of CSA with psychiatric disorder and of its relative non-specificity. Our results have major implications at the public health level and the individual level, in particular the need for better recognition and treatment of the sequelae of CSA. [ABSTRACT FROM PUBLISHER]

Suicide as a stigmatising issue presents a huge challenge for prevention policy. Also, policy itself is often difficult to turn into action. This research describes the interpretative repertoires found in the suicide prevention strategies of England and Finland, and explores their potential functions and audiences. It was found that the political repertoire was formed from four sub-repertoires: the public health epidemiology, the everyday, the preventive action and the reflective repertoires. This paper discusses the polyphonic and multilayered nature of these policy documents and how different repertoires may be used for various functions. The polyphonic nature of policy documents is necessary to reach a wide readership and to capture suicide as a controversial phenomenon. However, the downside is that the argumentative style may also undermine some of the measures and actions recommended. [ABSTRACT FROM AUTHOR]

Psychiatric morbidity has been shown to be associated with the increased reporting of a range of social problems involving legal rights ('rights problems'). Using a validated measure of psychiatric morbidity, this paper explores the relationship between psychiatric morbidity and rights problems and discusses the implications for the delivery of health and legal services. New representative national survey data from the English and Welsh Civil and Social Justice Survey (CSJS) surveyed 3040 adults in 2007 to explore the relationship between GHQ-12 scores and the self reported incidence of and behaviour surrounding, rights problems. It was found that the prevalence of rights problems increased with psychiatric morbidity, as did the experience of multiple problems. It was also found the likelihood of inaction in the face of problems increased with psychiatric morbidity, while the likelihood of choosing to resolve problems without help decreased. Where advice was obtained, psychiatric morbidity was associated with a greater tendency to obtain a combination of 'legal' and 'general' support, rather than 'legal' advice alone. The results suggest that integrated and 'outreach' services are of particular importance to the effective support of those facing mental illness. [ABSTRACT FROM AUTHOR]

This paper reflects on the dissemination of potentially controversial research evidence about industrial air pollution and health in north-east England. It draws on a participant observation study of the local impact of a four-year epidemiological research programme in Teesside. The difficulties in and obstacles to disseminating research findings are explored. It may thus be described as a study of the impact of a study. We look at institutional resistance (including from the funders of the research) to any evidence indicating adverse health effects from industrial pollution. We also look at the failure of researchers to surmount such resistance and to communicate effectively with those who lived in the vicinity of the major industrial operations. This leads us to consider how conflicting notions of accountability coloured dissemination strategies as well as researchers' judgements. We offer a critique of fashionable and unduly consensual notions of a 'user community', in a context where different 'user communities' had incompatible expectations about the purpose of a piece of research and the significance of the data to emerge from it. The study also highlights the difficulties of disseminating research findings when the topic has the potential to affect economic interests.

In this paper, the authors propose a method for estimating the incidence of heroin use by adjusting reported numbers of heroin users visiting drug treatment agencies for the time lag between onset of heroin use and first treatment request (lag distribution). The adjusted incidence is relative, since it represents the number of individuals beginning heroin use in each year whose cases will be reported within 8 years of starting use. Users with longer lag times or whose cases are never reported are excluded. Utilizing data from southeastern England (1991-1998), the authors analyzed the effects of covariates (sex, age group, ethnic group, route of consumption, and year of onset of drug use) on the lag distribution. Trends in the adjusted incidence of heroin use were very different for injectors and noninjectors: Incidence among injectors seemed to be stable, while in noninjectors it increased twofold between 1991 and 1996-1997. These results must be interpreted cautiously, especially in relation to the wider context of underlying trends in the population. Potential biases derive from underreporting and from changes in the proportion of heroin users in treatment. The lag correction method adds substantially to the value of routine treatment data, at least for heroin use, and is potentially the best method for obtaining estimates of incidence. Am J Epidemiol 2001;153:632-41. [ABSTRACT FROM AUTHOR]

Aim: Proximal and distal colorectal cancers (CRCs) exhibit different clinical, molecular and biological patterns. The aim of this study was to determine temporal trends in the age‐standardized incidence rates (ASIRs) of proximal and distal CRC following the introduction of the English Bowel Cancer Screening Programme (BCSP) in 2006. Method: The National Cancer Registration and Analysis Service database was used to identify incident cases of CRC among adults of screening age (60–74 years) between 2001 and 2017. ASIRs were calculated using the European Standard Population 2013 and incidence trends analysed by anatomical subsite (proximal, caecum to descending colon; distal, sigmoid to rectum), sex and Index of Multiple Deprivation (IMD) quintile using Joinpoint regression software. Results: Between 2001 and 2017, 541 515 incident cases of CRC were diagnosed [236 167 proximal (43.6%) and 305 348 distal (56.4%)]. A marginal reduction in the proximal ASIR was noted from 2008 [annual percentage change (APC) −1.4% (95% CI −2.0% to −0.9%)] compared with a greater reduction in distal ASIR from 2011 to 2014 [APC −6.6% (95% CI −11.5% to −1.5%)] which plateaued thereafter [APC −0.5% (95% CI −3.2% to 2.2%)]. Incidence rates decreased more rapidly in men than women. Adults in IMD quintiles 4–5 experienced the greatest reduction in distal tumours [APC −3.5% (95% CI −4.3% to −2.7%)]. Conclusion: Following the introduction of the English BCSP, the incidence of CRC has subsequently reduced among adults of screening age, with this trend being most pronounced in distal tumours and in men. There is also evidence of a reduction in the deprivation gap for distal tumour incidence. Strategies to improve the detection of proximal tumours are warranted. [ABSTRACT FROM AUTHOR]

Summary: This retrospective cohort study on adults undergoing colectomy from 2010 to 2019 used linked primary (Clinical Practice Research Datalink), and secondary (Hospital Episode Statistics) care data to determine the prevalence of persistent postoperative opioid use following colectomy, stratified by pre‐admission opioid exposure, and identify associated predictors. Based on pre‐admission opioid exposure, patients were categorised as opioid‐naïve, currently exposed (opioid prescription 0–6 months before admission) and previously exposed (opioid prescription within 7–12 months before admission). Persistent postoperative opioid use was defined as requiring an opioid prescription within 90 days of discharge, along with one or more opioid prescriptions 91–180 days after hospital discharge. Multivariable logistic regression analyses were conducted to obtain odds ratios for predictors of persistent postoperative opioid use. Among the 93,262 patients, 15,081 (16.2%) were issued at least one opioid prescription within 90 days of discharge. Of these, 6791 (45.0%) were opioid‐naïve, 7528 (49.9%) were currently exposed and 762 (5.0%) were previously exposed. From the whole cohort, 7540 (8.1%) developed persistent postoperative opioid use. Patients with pre‐operative opioid exposure had the highest persistent use: 5317 (40.4%) from the currently exposed group; 305 (9.8%) from the previously exposed group; and 1918 (2.5%) from the opioid‐naïve group. The odds of developing persistent opioid use were higher among individuals who used long‐acting opioid formulations in the 180 days before colectomy than those who used short‐acting formulations (odds ratio 3.41 (95%CI 3.07–3.77)). Predictors of persistent opioid use included: previous opioid exposure; high deprivation index; multiple comorbidities; use of long‐acting opioids; white race; and open surgery. Minimally invasive surgical approaches were associated with lower odds of persistent opioid use and may represent a modifiable risk factor. [ABSTRACT FROM AUTHOR]

Background: Despite their widespread use, the impact of commissioners' policies for body mass index (BMI) for access to elective surgery is not clear. Policy use varies by locality, and there are concerns that these policies may worsen health inequalities. The aim of this study was to assess the impact of policies for BMI on access to hip replacement surgery in England. Methods: A natural experimental study using interrupted time series and difference-in-differences analysis. We used National Joint Registry data for 480,364 patients who had primary hip replacement surgery in England between January 2009 and December 2019. Clinical commissioning group policies introduced before June 2018 to alter access to hip replacement for patients with overweight or obesity were considered the intervention. The main outcome measures were rate of surgery and patient demographics (BMI, index of multiple deprivation, independently funded surgery) over time. Results: Commissioning localities which introduced a policy had higher surgery rates at baseline than those which did not. Rates of surgery fell after policy introduction, whereas rates rose in localities with no policy. 'Strict' policies mandating a BMI threshold for access to surgery were associated with the sharpest fall in rates (trend change of − 1.39 operations per 100,000 population aged 40 + per quarter-year, 95% confidence interval − 1.81 to − 0.97, P < 0.001). Localities with BMI policies have higher proportions of independently funded surgery and more affluent patients receiving surgery, indicating increasing health inequalities. Policies enforcing extra waiting time before surgery were associated with worsening mean pre-operative symptom scores and rising obesity. Conclusions: Commissioners and policymakers should be aware of the counterproductive effects of BMI policies on patient outcomes and inequalities. We recommend that BMI policies involving extra waiting time or mandatory BMI thresholds are no longer used to reduce access to hip replacement surgery. [ABSTRACT FROM AUTHOR]

Background Few studies describe the epidemiology of childhood acute kidney injury (AKI) nationally. Laboratories in England are required to issue electronic (e-)alerts for AKI based on serum creatinine changes. This study describes a national cohort of children who received an AKI alert and their clinical course. Methods A cross-section of AKI episodes from 2017 are described. Hospital record linkage enabled description of AKI-associated hospitalizations including length of stay (LOS) and critical care requirement. Risk associations with critical care (hospitalized cohort) and 30-day mortality (total cohort) were examined using multivariable logistic regression. Results In 2017, 7788 children (52% male, median age 4.4 years, interquartile range 0.9–11.5 years) experienced 8927 AKI episodes; 8% occurred during birth admissions. Of 5582 children with hospitalized AKI, 25% required critical care. In children experiencing an AKI episode unrelated to their birth admission, Asian ethnicity, young (<1 year) or old (16–<18 years) age (reference 1–<5 years), and high peak AKI stage had higher odds of critical care. LOS was higher with peak AKI stage, irrespective of critical care admission. Overall, 30-day mortality rate was 3% (n =  251); youngest and oldest age groups, hospital-acquired AKI, higher peak stage and critical care requirement had higher odds of death. For children experiencing AKI alerts during their birth admission, no association was seen between higher peak AKI stage and critical care admission. Conclusions Risk associations for adverse AKI outcomes differed among children according to AKI type and whether hospitalization was related to birth. Understanding the factors driving AKI development and progression may help inform interventions to minimize morbidity. [ABSTRACT FROM AUTHOR]

The Liverpool Epidemiology Programme, based in the Liverpool School of Tropical Medicine, has designed a series of computer-based modules for use in distance learning. The purpose of this paper is to highlight the role of computers in training health workers in epidemiology in developing countries. The aim of the modules is to provide health workers with solutions to problems which they face in their everyday work. The modules are written in hypertext software for IBM compatible machines and interact with the epidemiological software Epi Info. Four modules are described: LEP-Nut which deals with nutritional surveillance, LEP-Ref which looks at the role of epidemiology within a refugee health care programme, LEP-Surv dealing with health surveillance and LEP-Rap which introduces the concept of rapid appraisal. They are also easily distributed, particularly with the development of the Internet. The modules are carefully evaluated before and after distribution. Issues related to their evaluation and subsequent revision are discussed, in particular is the content important, adequate, communicated and useful? A major advantage of computer-based learning materials is that they can be easily updated with new advancements of knowledge and experience from the field.

Interactive spatial data analysis involves the use of software environments that permit the visualization, exploration and, perhaps, modelling of geographically-referenced data. Such systems are of obvious value in epidemiological research, both of an environmental and geographical nature. There is an increasing number of such software environments available on a variety of platforms and operating systems. This paper considers the use of the proprietary Geographical Information System, ARC/INFO, in a spatial analysis context, showing how the spatial analytic tools that may be added to it can be exploited by geographical epidemiologists; such tools include those for modelling possible raised incidence of disease around suspected sources of pollution. The paper also reviews the use of systems such as S-Plus and XLISP-STAT, statistical programming environments to which spatial analysis functions or libraries may be added. The use of INFO-MAP, a system designed to aid in the teaching of interactive spatial data analysis, is also highlighted. The various software environments are illustrated with reference to examples concerned with: clustering of childhood leukaemia in part of Lancashire, England; Burkitt's lymphoma in Uganda; larynx cancer in Lancashire; and childhood mortality in Auckland, New Zealand.

This paper describes how and why John Snow's investigation of the transmission of cholera grew into an epidemiologic classic. The evolution of the interpretation of the work of John Snow was first studied in depth in the Dutch medical literature, and thereafter traced more superficially in the bacteriologic, hygienic, and epidemiologic literature of Germany, the United Kingdom, and the United States. From the oral tradition of teaching, as well as from the written sources, it is concluded that US epidemiologist W. H. Frost was responsible for the revival of the work of John Snow in the 1930s. Besides the obvious and enjoyable clarity of thinking and reasoning, epidemiologically and medically, of the writings of John Snow, his example well suited epidemiology of the 1930s since his convictions came very close to the bacteriologic paradigm of the day.

Presents a schedule of activities and abstracts of papers for the 5th meeting of the British Epidermo-Epidemiology Society in Nottingham, England. "How Common Is Non-Melanoma Skin Cancer in the Population and What Are the Future Public Health Priorities?," by Harvey I.; "Epidemiology of Epidermolysis Bullosa in Scotland," by Priestley, G. C., Eady R. A. J., and Tidman, M. J.; "Sunbeds, Sunscreens, Vitamin D and Melanoma Risk - Risk of a Backlash," by Rona M. Mackie.

Fleas in the genus Ctenocephalides are the most clinically important parasitic arthropods of dogs and cats worldwide yet risk factors that might increase the risk of infestation in small animals remains unclear. Here we developed a supervised text mining approach analysing key aspects of flea epidemiology using electronic health records from domestic cats and dogs seen at a sentinel network of 191 voluntary veterinary practices across Great Britain between March 2014 and July 2020. Our methods identified fleas as likely to have been present during 22,276 of 1,902,016 cat consultations (1.17%) and 12,168 of 4,844,850 dog consultations (0.25%). Multivariable logistic regression modelling found that animals originating from areas of least deprivation were associated with 50% reductions in odds of veterinary‐recorded flea infestation compared to the most deprived regions in England. Age of the animal was significantly associated with flea presentation in both cats and dogs, with cases peaking before animals reached 12 months. Cases were recorded through each study years, peaking between July and October, with fluctuations between each year. Our findings can be used towards healthcare messaging for veterinary practitioners and owners. [ABSTRACT FROM AUTHOR]

Iran has the highest prevalence of multiple sclerosis (MS) in the Middle East and Asia. Rate of emigration has been significantly raised among Iranians and though, multiple studies have been published on prevalence of MS among Iranian emigrants. Here we systematically reviewed these publications. We performed a comprehensive literature search was performed on April 30, 2015 in data bases of MEDLINE, EMBASE, Scopus and Google Scholar for the terms 'multiple sclerosis', 'incidence', 'prevalence', 'epidemiology', 'migration', 'emigrant', 'immigrant', 'Iran', 'Parsis' and 'Persian'. Study location, prevalence day or period, and age of at disease onset were recorded for all the included publications. Nine publications from Sweden, Canada, Norway, UK, and India were included. Only three reported age-adjusted prevalence and six reported age of disease onset. MS prevalence among Iranian emigrants varied from 21 per 100,000 people in Bombay, India in 1985 to 433 per 100,000 people in British Columbia, Canada in 2012. Five studies reported the prevalence in the region of interest, ranging from 1.33 in Bombay, India to 240 in British Columbia, Canada. Five studies also reported the prevalence of MS in the population of the destination country, and in all of them, the prevalence of MS was higher in Iranian immigrants compared to native people. Prevalence studies performed in Iran and also on Iranian emigrants indicate roles for both genetic and environmental factors in MS susceptibility. Data might indicate that living in a high-risk area increases the susceptibility to MS. [ABSTRACT FROM AUTHOR]

Background: We compared the risk of death by suicide following hospital presentation for self-harm according to site of self-cut/stab. Method: We included 54 999 self-harm presentations (involving 31 419 individuals) to hospitals in the Multicentre Study of Self-harm in England (1/1/2004–31/12/2014), with mortality follow-up to 31/12/2019. Information on method of self-harm was obtained through monitoring in hospitals. Information about mortality was obtained through linkage with NHS Digital. We assessed the association of site of self-cut with death by suicide using mixed effect models. Results: In total, 10 790 (19.6%) hospital presentations involved self-cutting/stabbing, 7489 of which (69.4%) were due to laceration to the arm/wrist alone, 1846 episodes (17.1%) involved cutting elsewhere on the body, and 1455 (13.5%) were due to laceration to unknown site. Controlling for confounders, presentation to a hospital following self-cut/stab to bodily parts other than wrist/arm was associated with greater chance of subsequent suicide relative to presentation after self-poisoning alone [adjusted odds ratio (aOR) 1.75, 95% confidence interval (CI) 1.03–2.96, p = 0.038]. The likelihood of suicide after presentation for cutting/stabbing the wrist/arm alone was comparable to that of patients who had self-poisoned alone. Presentations after laceration involving the neck were associated with a four-fold greater chance of subsequent suicide relative to self-poisoning (aOR 4.09, 95% CI 1.80–9.30, p = 0.001). Conclusions: Patients who attend hospital after self-cutting/stabbing are a heterogeneous group in terms of characteristics, methods of cutting/stabbing and risk of subsequent suicide. Risk of suicide is greater in individuals who self-cut/stab to parts of the body other than the wrist or arm, especially the neck. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic and associated social distancing measures have profoundly impacted society and social contact patterns, with older people disproportionately affected. Concerns have been raised about a resulting pandemic of loneliness in older people, although the current evidence is mixed. This study provides a unique perspective on the prevalence of loneliness in a population cohort of older people before the pandemic, followed up after the introduction of social restrictions. Methods: Data analysis was conducted using Wave 3 of the longitudinal Cognitive Function and Aging Study II (2018–2019) and a sub‐study focusing on experiences during the COVID‐19 pandemic (2020). The sample comprised 379 adults aged over 75 living in Cambridge, Newcastle, and Nottingham. Multivariable binary logistic regression was conducted to identify correlates of prevalent loneliness, adjusted for confounding covariates, during the pandemic. The prevalence of loneliness during the pandemic was compared to loneliness in 2018–2019. Results: Prevalence of loneliness in this sample during the pandemic was 25.1% (95% CI 20.9%–29.7%) compared to 17.2% (95% CI 13.7%–21.3%) in 2018–2019 (χ2 = 14.1, p < 0.01). Variables associated with increased odds of prevalent loneliness included: prior loneliness, living alone, female gender, living in an area of higher deprivation, frequent pre‐pandemic social contact at community groups, and separation from family during the pandemic, adjusted for age and sex. Weekly technology‐mediated contact using telephone or video calls was associated with lower odds of loneliness. Conclusions: COVID‐19 recovery plans should address loneliness in older people. Target groups should include those who have previously been lonely, people who live alone, those living in deprived areas, and those who had previously been socially active through community groups. [ABSTRACT FROM AUTHOR]

Background: Population‐based administrative data have rarely been used to compare the birth prevalence, risk factors for occurrence, and mortality of congenital diaphragmatic hernia (CDH) subtypes. Objectives: We used a national birth cohort to identify CDH subtypes and compared their birth prevalence, relationship with maternal age after accounting for sociodemographic factors, and 1‐year mortality rates. Methods: Linked hospital admission and death records were used to identify isolated and complex CDH cases (involving additional anomalies) among singleton livebirths in England between 2002 and 2018. The prevalence of each CDH subtype per 10,000 livebirths was estimated overall and by infant, birth and maternal characteristics. The relationship between maternal age and each subtype relative to no CDH was examined using multivariable log‐binomial regression to estimate risk ratios (RRs). One‐year mortality rates were examined using Kaplan–Meier curves and the hazard ratio (HR) of complex versus isolated CDH was calculated using Cox regression. Results: Among 9.5 million livebirths, we identified 1285 with isolated CDH and 1150 with complex CDH. The overall prevalence of isolated and complex CDH was 1.4 (95% confidence interval [CI] 1.3, 1.4) and 1.2 (95% CI 1.1, 1.3) per 10,000 livebirths, respectively. Only complex CDH was associated with maternal age. Compared with maternal age 25–34 years, complex CDH risk was elevated for maternal age < 20 years (RR 1.31, 95% CI 1.00, 1.72). Risk was highest for maternal age ≥ 40 years (RR 1.61, 95% CI 1.21, 2.15) although accounting for chromosomal anomalies attenuated the risk (RR 1.39, 95% CI 1.00, 1.92). The 1‐year mortality rate for complex CDH (33.1%, 95% CI 30.5, 35.9) was slightly higher than for isolated CDH (29.7%, 95% CI 27.3, 32.3) (HR 1.10, 95% CI 0.96, 1.27). Conclusions: Mechanisms of occurrence differed between and within CDH subtypes and 1‐year mortality of complex CDH was slightly higher than for isolated CDH. [ABSTRACT FROM AUTHOR]