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Objectives: Increasing walking and cycling, and reducing motorised transport, are health and environmental priorities. This paper examines levels and trends in the use of different commute modes in England and Wales, both overall and with respect to small-area deprivation. It also investigates whether commute modal share can serve as a proxy for travel behaviour more generally. Methods: 23.7 million adult commuters reported their usual main mode of travelling to work in the 2011 census in England and Wales; similar data were available for 1971–2001. Indices of Multiple Deprivation were used to characterise socio-economic patterning. The National Travel Survey (2002–2010) was used to examine correlations between commute modal share and modal share of total travel time. These correlations were calculated across 150 non-overlapping populations defined by region, year band and income. Results: Among commuters in 2011, 67.1% used private motorised transport as their usual main commute mode (−1.8 percentage-point change since 2001); 17.8% used public transport (+1.8% change); 10.9% walked (−0.1% change); and 3.1% cycled (+0.1% change). Walking and, to a marginal extent, cycling were more common among those from deprived areas, but these gradients had flattened over the previous decade to the point of having essentially disappeared for cycling. In the National Travel Survey, commute modal share and total modal share were reasonably highly correlated for private motorised transport (r = 0.94), public transport (r = 0.96), walking (r = 0.88 excluding London) and cycling (r = 0.77). Conclusions: England and Wales remain car-dependent, but the trends are slightly more encouraging. Unlike many health behaviours, it is more common for socio-economically disadvantaged groups to commute using physically active modes. This association is, however, weakening and may soon reverse for cycling. At a population level, commute modal share provides a reasonable proxy for broader travel patterns, enhancing the value of the census in characterising background trends and evaluating interventions. [ABSTRACT FROM AUTHOR]

The challenge for the twenty-first century for oral health is to reduce the social inequality observed in populations. This challenge has been made explicit by the Department of Health (DH) in England. Turning rhetoric into reality is difficult for all concerned whatever field or profession. A cohesive model that embraces philosophical ideals can help individuals achieve change as it provides structure on which to develop ideas. This paper describes a model of care in general dental practice that fits the requirements of the DoH in addressing social inequalities, in the context of developing general dental services. [ABSTRACT FROM AUTHOR]

Objective To investigate trainee doctors' and trainers' perceptions of the validity of the Annual Review of Competence Progression (ARCP) using Messick's conceptualisation of construct validity. Design Qualitative semi-structured focus groups and interviews with trainees and trainers. Setting Postgraduate medical training in London, Kent Surrey and Sussex, Yorkshire and Humber, and Wales in November/December 2015. Part of a larger study about the fairness of postgraduate medical training. Participants Ninety-six trainees and 41 trainers, comprising UK and international medical graduates from Foundation, General Practice, Medicine, Obstetrics and Gynaecology, Psychiatry, Radiology, and Surgery, at all levels of training. Main outcome measures Trainee and trainer perceptions of the validity of the ARCP as an assessment tool. Results Participants recognised the need for assessment, but were generally dissatisfied with ARCPs, especially UK graduate trainees. Participants criticised the perceived tick-box nature of ARCPs as measuring clerical rather than clinical ability, and which they found detrimental to learning. Trainees described being able to populate their e-portfolios with just positive feedback; they also experienced difficulty getting assessments signed off by supervisors. ARCPs were perceived as poor at identifying struggling trainees and/or as discouraging excellence by focussing on minimal competency. Positive experiences of ARCPs arose when trainees could discuss their progress with interested supervisors. Conclusions Trainee and trainer criticisms of ARCPs can be conceptualised as evidence that ARCPs lack validity as an assessment tool. Ongoing reforms to workplace-based assessments could address negative perceptions of the 'tick-box' elements, encourage constructive input from seniors and allow trainees to demonstrate excellence as well as minimal competency, while keeping patients safe. [ABSTRACT FROM AUTHOR]

The importance of wild bird populations as a reservoir of zoonotic pathogens is well established. Salmonellosis is a frequently diagnosed infectious cause of mortality of garden birds in England and Wales, predominantly caused by Salmonella enterica subspecies enterica serovar Typhimurium definitive phage types 40, 56(v) and 160. In Britain, these phage types are considered highly host-adapted with a high degree of genetic similarity amongst isolates, and in some instances are clonal. Pulsed field gel electrophoresis, however, demonstrated minimal variation amongst matched DT40 and DT56(v) isolates derived from passerine and human incidents of salmonellosis across England in 2000–2007. Also, during the period 1993–2012, similar temporal and spatial trends of infection with these S. Typhimurium phage types occurred in both the British garden bird and human populations; 1.6% of all S. Typhimurium (0.2% of all Salmonella) isolates from humans in England and Wales over the period 2000–2010. These findings support the hypothesis that garden birds act as the primary reservoir of infection for these zoonotic bacteria. Most passerine salmonellosis outbreaks identified occurred at and around feeding stations, which are likely sites of public exposure to sick or dead garden birds and their faeces. We, therefore, advise the public to practise routine personal hygiene measures when feeding wild birds and especially when handling sick wild birds. [ABSTRACT FROM AUTHOR]

Background: Coronary heart disease (CHD) remains a major public health burden, causing 80,000 deaths annually in England and Wales, with major inequalities. However, there are no recent analyses of age-specific socioeconomic trends in mortality. We analysed annual trends in inequalities in age-specific CHD mortality rates in small areas in England, grouped into deprivation quintiles. Methods: We calculated CHD mortality rates for 10-year age groups (from 35 to ≥85 years) using three year moving averages between 1982 and 2006. We used Joinpoint regression to identify significant turning points in age- sex- and deprivation-specific time trends. We also analysed trends in absolute and relative inequalities in age-standardised rates between the least and most deprived areas. Results: Between 1982 and 2006, CHD mortality fell by 62.2% in men and 59.7% in women. Falls were largest for the most deprived areas with the highest initial level of CHD mortality. However, a social gradient in the pace of fall was apparent, being steepest in the least deprived quintile. Thus, while absolute inequalities narrowed over the period, relative inequalities increased. From 2000, declines in mortality rates slowed or levelled off in the youngest groups, notably in women aged 45–54 in the least deprived groups. In contrast, from age 55 years and older, rates of fall in CHD mortality accelerated in the 2000s, likewise falling fastest in the least deprived quintile. Conclusions: Age-standardised CHD mortality rates have declined substantially in England, with the steepest falls in the most affluent quintiles. However, this concealed contrasting patterns in underlying age-specific rates. From 2000, mortality rates levelled off in the youngest groups but accelerated in middle aged and older groups. Mortality analyses by small areas could provide potentially valuable insights into possible drivers of inequalities, and thus inform future strategies to reduce CHD mortality across all social groups. [ABSTRACT FROM AUTHOR]

The French medical accident compensation scheme, introduced in 2002, guarantees full compensation to the victims of serious medical accidents, irrespective of fault. Eight years after the scheme's inception, this article assesses the success of the redress regime so far, focusing in particular on the extent to which the regime has succeeded in achieving an appropriate balance between compensation and limiting cost, accountability and the promotion of openness. It argues that whilst the scheme facilitates the compensation of certain victims of medical accidents, retains the accountability of the medical profession and offers a less acrimonious redress mechanism than a traditional court action, these advantages have to be weighed against the resulting increased cost burden on the State, the fact that the scheme is unlikely to have a great impact on the reporting of accidents, and the increased overall complexity of the compensation and liability system in France. The article also considers to what extent the French experience is relevant in the broader European context. With cross-border patient movement increasing, differences in national solutions raise concerns as to disparities in redress rules depending on where the patient is treated. The issues with respect to medical accident redress which arise as a result of the European Commission's proposed directive on patient rights in cross-border health care are therefore briefly considered. [ABSTRACT FROM AUTHOR]

The medical historiography of Wales is dominated by two themes: industrialisation and medical folklore. For the early modern period, this academic concentration on folklore has served to posit an unbalanced rural caricature with an over-emphasis on magical healing. Welsh medicine was actually a diverse mix of traditional and orthodox beliefs under one general model of understanding, affected by various factors including religion and urban growth. The study of the medical history of early modern Wales may also have wider implications, such as the importance of regionalism, rural and urban variations and the spread of alternative medical ideas such as Helmontianism. The interdependence of town and countryside also serves to highlight the ways in which medical information could be disseminated. Wales was not a rural enclave, and was part of a wider medical network. Many sources exist which can be used to shed light on early modern Welsh medical culture and such work could contribute to a better understanding of wider medical milieux by exploring variations as well as similarities. Further, such research would address a wider need for more rural studies and lead to a better understanding of the role played by distinct regions such as Wales. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine to what extent GP registrars used quality research evidence in their summative assessment audit projects. A further aim was to uncover reasons for the GP registrars' observed literature use and their attitudes to evidence-based medicine (EBM). The sample was carried out in 2001 and comprised GP registrars in Wales. Of the 51 contacted, 29 consented to analysis of their audit project, and 25 of those were interviewed. Findings indicated that randomised control trials (RCTs) were cited, but less use was made of systematic reviews or high-quality web- based resources in the projects. Most GP registrars could not clearly articulate their reasons for relevancy of sources cited. The literature search training received by GP registrars varied widely. The study concluded that critical appraisal training within the vocational training scheme (VTS) needs to provide genuinely transfer- able skills. [ABSTRACT FROM AUTHOR]

Background: Rising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. However, intra-professional boundaries and silos within the medical profession may challenge holistic approaches to patient care. Methods: We used Q methodology to examine how postgraduate trainees (n = 38) on a range of different specialty programmes in England and Wales could be grouped based on their rankings of 40 statements about 'being a good doctor'. Themes covered in the Q-set include: generalism (breadth) and specialism (depth), interdisciplinarity and multidisciplinary team working, patient-centredness, and managing complex care needs. Results: A by-person factor analysis enabled us to map distinct perspectives within our participant group (P-set). Despite high levels of overall commonality, three groups of trainees emerged, each with a clear perspective on being a good doctor. We describe the first group as 'generalists': team-players with a collegial and patient-centred approach to their role. The second group of 'general specialists' aspired to be specialists but with a generalist and patient-centred approach to care within their specialty area. Both these two groups can be contrasted to those in the third 'specialist' group, who had a more singular focus on how their specialty can help the patient. Conclusions: Whilst distinct, the priorities and values of trainees in this study share some important aspects. The results of our Q-sort analysis suggest that it may be helpful to understand the relationship between generalism and specialism as less of a dichotomy and more of a continuum that transcends primary and secondary care settings. A nuanced understanding of trainee views on being a good doctor, across different specialties, may help us to bridge gaps and foster interdisciplinary working. [ABSTRACT FROM AUTHOR]

The Welsh Paediatric Surveillance Unit was established in 1994 to monitor the incidence and prevalence of a number of uncommon disorders of childhood in Wales. Its work complements that of the British Paediatric Surveillance Unit. Information from consultant paediatricians is obtained by means of a monthly card return system; return rate is over 90%. [ABSTRACT FROM AUTHOR]