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Objective: To evaluate the accuracy of the risk of malignancy index (RMI) which combines serum CA-125 levels, ultrasound score, and menopausal state, in discriminating between benign and malignant adnexal masses in the Welsh population. Materials and methods: Two hundred and forty-seven women with pelvic masses discussed consecutively at the South West Wales Gynaecological Oncology multidisciplinary meeting between January 2010 and June 2011 were included in this retrospective study. The main outcomes were surgical and pathological findings. Results: The sensitivity and specificity of CA-125 at 35kU/L were 76% and 67%, respectively. CA-125 was found to be a relevant predictor of malignancy but the area under the receiver operating characteristic curve for each of the risk of malignancy indices was greater than the area for the CA-125 serum levels alone. Each of the RMIs has a different optimal threshold, however using a threshold of 200, RMI 1 had a sensitivity of 66% and a specificity of 91%; RMI 2 had a sensitivity of 74% and a specificity of 79%; and RMI 3 had a sensitivity of 68% and a specificity of 85%. Conclusion: This is the first study in Wales to evaluate the RMI in triaging women with pelvic masses. Overall, RMI 1 and RMI 2 are better malignancy predictors than RMI 3. It would be recommended that RMI 1 and RMI 2 be compared in a head-to-head prospective study, although we suspect that RMI 1 is likely to be the overall best malignancy predictor.

Wales is the first country in the United Kingdom to have introduced a charge for single-use carrier bags. A 2x2 quasi-experimental field study was set up to evaluate the effectiveness and further attitudinal and behavioural impacts of the charge. Independent nationally representative quota samples were interviewed before and after the introduction of the carrier bag charge in Wales and at the same times in England (n=500 each). England, where no carrier bag charge was introduced, served as the comparator for the study. The study found increases in own bag use in both countries. However, the increase was much greater in Wales than in England. The study also found evidence for the policy becoming more popular after its implementation in Wales. While support for the carrier bag charge was already high before its introduction, the Welsh population became even more supportive afterwards. Although no support was found for positive behavioural spillover, the study found changes in self-reported environmental identity that could produce positive spillover effects in the longer term. The theoretical and policy implications of the findings are discussed.

From the beginning of the genre, women writers have made a major contribution to the development of industrial writing. Although prevented from gaining first-hand experience of the coalface, Welsh women writers were amongst the first to try to fictionalize those heavy industries—coal and metal in the south, and slate in the north—which dominated the lives of the majority of the late nineteenth-century Welsh population. Treatment of industrial matter is generally fragmentary in this early women's writing; industrial imagery and metaphor may be used in novels that are not primarily “about” industry at all. Yet from c. 1880–1910, Welsh women writers made a significant—and hitherto critically neglected—attempt to make sense in literature of contemporary industrial Wales in powerful and innovative ways. This essay maps their contribution and considers anglophone Welsh women writers' adaptations and innovations of form (particularly romance) as they try to find a way of representing industrial landscapes, communities and the daily realities of industrial labour. It identifies the genesis in women's writing of tropes that would become central to later industrial fiction, including depictions of industrial accident, injury, death and disability. And it explores the representation of social relations (class, gender, ethnicity, sexuality) and conflict on this tumultuous, dangerous new stage.

Summary Background: Demand for dialysis, particularly, in-centre haemodialysis (HD), is growing, and more units will be needed. Travel time to treatment is consistently a major area of concern for patients. Aim: To analyse access to current dialysis facilities in Wales, and use the data to help plan for new dialysis units. Methods: We analysed a combination of UK Renal Registry, Welsh population census data, the Welsh Index of Multiple Deprivation 2005 (WIMD), travel time and geographical information systems. Results: Prevalence of HD fell significantly with increasing travel time from units. This was not influenced by the WIMD. Prior to the opening of a new HD unit in Aberystwyth, prevalence in the surrounding area was significantly lower than for Wales as whole, but within 2 years, prevalence had risen to approximate national levels. In Haverfordwest, an area 430 min drive from any current facility, prevalence is consistently and significantly lower than for Wales as a whole, and has not shown the growth seen elsewhere in the country. Discussion: The ability to combine data has enabled modelling of the likely immediate impact of opening a new unit in Haverfordwest, and also provided an estimate of its required capacity. This multidisciplinary approach to demand analysis should help to highlight areas of under-provision, and facilitate the planning of the sites and sizes of new dialysis units in Wales.

Objectives: Partin tables are widely used to select and counsel patients prior to radical surgery for prostate cancer. However, Partin tables have been developed in the USA which has a different ethnic mixture from that of North Wales. We aimed to assess Partin tables’ predictive ability in a Welsh population. Materials and Methods: 193 patients underwent radical retropubic prostatectomy for clinically localized carcinoma of the prostate between April 1993 and July 2004 in a single institution in North Wales. Complete preoperative clinical staging information was available in 177 patients. Receiver operating characteristic curve analysis was used. Results: The mean patient age was 64 (48–73) years. Preoperative clinical staging distribution was: T1c 46.6% and T2 53.4%. 75% had organ-confined disease (TNM 1992). Extracapsular extension without seminal vesicle or lymph node involvement was seen in 13.5%. Nine percent had seminal vesicle invasion without lymph node involvement. Lymph node metastasis was found in 2.2%. The predictive effectiveness of the Partin table was high with an area under ROC curve of 0.733 for organ confinement, 0.738 for seminal vesicle invasion and 0.780 for lymph node involvement (CI 95%). Conclusion: Our study demonstrated that the predictive ability of Partin tables for prostate cancer is also applicable to a Welsh population.

Within published reports, the prevalence of reported hearing difficulties is quite variable. In the present study, we have considered factors that could influence the apparent prevalence of hearing difficulties in the Welsh population, surveyed in a number of different studies. The first important factor to emerge was whether the questions were asked in the context of a general health approach (together with questions about other aspects of health), in which case the prevalence was usually less than 15%. When the same questions were posed in conjunction with a number of other questions on auditory function the prevalence was 20% or greater. Secondly, when a household survey approach is used, with one person being asked to respond on behalf of all members of the household, the prevalence among those reporting is markedly higher than among the other members of the household whose problems they are reporting.

Aims To describe and compare general practice (GP) activity for patients with and without diabetes using a survey of general practices representing over 10% of the Welsh population. Methods The Welsh GP Morbidity Database Project (GPMDP) collected data including demographic and lifestyle information and consultation data such as diagnosis, referral and surgical procedures. These data were analysed to establish the annual period prevalence of diabetes and compare the relative number of consultations and referrals. Results A total of 4182 diabetic patients were recorded (prevalence 1.41%) and accounted for 77 371 (4.4%) consultations. Patients with diabetes were four-times more likely to be referred to community services (relative risk (RR) 4.1, 95% CI 3.7–4.7), in particular district nursing (RR 3.8, 1.9–7.7), optician services (RR 8.9, 5.0–15.7), chiropody (RR 8.2 6.4–10.5) and dietician services (RR 21.2, 17.6–25.5). Patients with diabetes were also more likely to be followed-up in general practice (RR 6.7, 6.2–7.2) both within 1 month (RR 6.7, 6.2–7.2) and 1 month to 1 year (RR 9.7, 8.9–10.7). Emergency admissions were also more likely for patients with diabetes (RR 6.8, 6.2–7.5) as were elective admissions to general medicine (RR 5.6, 4.6–6.7), surgery (RR 1.8, 1.5–2.0) and opthalmology (4.2, 3.4–5.2). Conclusion The increased utilization of health services apparent in secondary care was confirmed in primary care. Further research is required to determine levels of community activity after initial referral.

We compared anthropometric indices in samples of elderly people aged 65 years and over living in two French areas. The samples were divided into four age-groups (65–69, 70–74, 75–79 and over 80 years). We observed interregional differences in women aged 65–69 years and in men aged 65–74 years. Weight and anthropometric variables related to body fat percentage and to muscle mass showed a decline with age as already reported by others. We established anthropometric percentile values according to sex in pooled subjects when no integrated difference was found. The 50th percentile of arm circumference, muscle arm circumference and triceps skinfold was higher, and the 50th percentile of body mass index was lower than the one reported for the same indices from an elderly Welsh population. Our results show that an interregional difference in anthropometric indices exists in the elderly. The differences which are observed between our results and those reported from a British population emphasize the importance of establishing local values for the elderly population.

Relations between English and Welsh in medieval Wales are often contextualized by modern historians in terms of twentieth-century imperialism, as a struggle between two nations, at least one of which was “endowed with a sense of racial superiority.”1 When the English king Edward I conquered north Wales, the last remaining princedom in Wales, in 1282, Wales seemed to have lost all hope of retaining its status as an independent nation. Governed as a provincial outpost of the English empire, the royal lands in north Wales were manacled by chains of castles and towns populated largely by English settlers. The borough towns, most of them newly planted, held a monopoly of trade that excluded the local Welsh population on the grounds that they were “foreigners.” As R. R. Davies observed, “Nowhere was the spirit of conquest and of racial superiority so vigorously and selfishly kept alive as in the Edwardian boroughs.”2

A research project to examine the dressings and wound management materials supplied by pharmacy departments in Wales was carried out. Data were collected from the NHS computer database, which contains information on 17 hospitals, servicing 80-90% of the Welsh population. Over a 12-month period, hospital pharmacy departments throughout Wales issued dressings and related materials costing £2.1m. As not all pharmacy departments supply the full range of dressings used in hospitals, and only one issues surgical sutures, this sum probably represents less than half of the total expenditure in Wales on this commodity group. Existing methods for recording the issue of dressings do not provide reliable information either on the range of products used or the total quantities issued throughout Wales. Despite expectations to the contrary, hospital use of dressings did not appear to have a major influence over prescribing patterns in the primary sector. The amount of cavity wound dressings that are supplied on an outpatient basis suggests a real need for these items to be available in the community. (Since completion of this study, cavity wound dressings have been added to the Drug Tariff.)

When asked to examine a patient in a clinical examination, undergraduates and postgraduates characteristically begin with a painstaking observation of the hands. It was of concern that this is done mainly for the benefit of the examiners and that, in routine clinical practice, examination of the hands receives scant attention. The case notes of 70 general medical and surgical inpatients were reviewed and it was found that in only seven was there any mention of physical examination of the hands; in three of these “no clubbing” was the only entry. However, when the authors carefully examined the hands of 197 patients, at least one clinical sign was found in 87 (44%) cases. Heberden’s nodes, cigarette tar staining, and the spectrum of Dupuytren’s contractures were the most common findings. In this population in the South Wales valleys, coal deposits were also commonly seen in men.

Summary. The prevalence of antibodies to parietal cells, intrinsic factor and thyroid cytoplasm in the Welsh population has been estimated. Women had a higher prevalence of these antibodies than men and their frequency shows a significant increase with age. There is a significant association between the presence of thyroid and gastric autoantibodies in women but not in men. Parietal-cell antibodies are more common in men with low haemoglobin levels. Three out of 506 women were found to have intrinsic-factor antibody.