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Poor engagement in HIV care is associated with poorer health outcomes and increased mortality. Our survey examined experiential and circumstantial factors associated with clinic attendance among women (n = 250) and men (n = 106) in London with heterosexually-acquired HIV. While no associations were found for women, among men, sub-optimal attendance was associated with insecure immigration status (25.6% vs. 1.8%), unstable housing (32.6% vs. 10.2%) and reported effect of HIV on daily activities (58.7% vs. 40.0%). Among women and men on ART, it was associated with missing doses of ART (OR = 2.96, 95% CI:1.74–5.02), less belief in the necessity of ART (OR = 0.56, 95% CI:0.35–0.90) and more concern about ART (OR = 3.63, 95% CI:1.45–9.09). Not wanting to think about being HIV positive was the top reason for ever missing clinic appointments. It is important to tackle stigma and the underlying social determinants of health to improve HIV prevention, and the health and well-being of people living with HIV. [ABSTRACT FROM AUTHOR]

Background: Reducing unintended teenage pregnancy and promoting adolescent sexual health remains a priority in England. Both whole-school and social-marketing interventions are promising approaches to addressing these aims. However, such interventions have not been rigorously trialled in the UK and it is unclear if they are appropriate for delivery in English secondary schools. We developed and pilot trialled Positive Choices, a new whole-school social marketing intervention to address unintended teenage pregnancy and promote sexual health. Our aim was to assess the feasibility and acceptability of the intervention and trial methods in English secondary schools against pre-defined progression criteria (relating to randomisation, survey follow-up, intervention fidelity and acceptability and linkage to birth/abortion records) prior to carrying out a phase III trial of effectiveness and cost-effectiveness. Methods: Pilot RCT with integral process evaluation involving four intervention and two control schools in south-east England. The intervention comprised a student needs survey; a student/staff-led school health promotion council; a classroom curriculum for year-9 students (aged 13–14); whole-school student-led social-marketing activities; parent information; and a review of local and school-based sexual health services. Baseline surveys were conducted with year 8 (aged 12–13) in June 2018. Follow-up surveys were completed 12 months later. Process evaluation data included audio recording of staff training, surveys of trained staff, staff log books and researcher observations of intervention activities. Survey data from female students were linked to records of births and abortions to assess the feasibility of these constituting a phase III primary outcome. Results: All six schools were successfully randomised and retained in the trial. Response rates to the survey were above 80% in both arms at both baseline and follow-up. With the exception of the parent materials, the fidelity target for implementation of essential elements in three out of four schools was achieved. Student surveys indicated 80% acceptability among those who reported awareness of the programme and interviews with staff suggested strong acceptability. Linkage to birth/abortion records was feasible although none occurred among participants. Conclusions: The criteria for progression to a phase III trial were met. Our data suggest that a whole-school social-marketing approach may be appropriate for topics that are clearly prioritised by schools. A phase III trial of this intervention is now warranted to establish effectiveness and cost-effectiveness. Births and terminations are not an appropriate primary outcome measure for such a trial. Trial registration: ISRCTN65324176. [ABSTRACT FROM AUTHOR]

Summary: During a 15‐year period, the incidence of type 1 diabetes has doubled in Lithuania, while increasing by a third in England; however, England still has a higher incidence. Analysis of sera collected from non‐diabetic schoolchildren from Lithuania and England more than 20 years ago showed a similar number of multiple autoantibody‐positive schoolchildren between the populations, but a higher prevalence of islet antigen‐2 autoantibodies (IA‐2A) in English schoolchildren. We aimed to use recently developed, more specific islet autoantibody tests to characterize differences in humoral autoimmunity between these two general population cohorts in greater detail. Samples from 88 Lithuanian and 133 English schoolchildren previously found islet autoantibody‐positive were selected for measurement of additional islet autoantibodies by radioimmunoassay. Samples were tested for autoantibodies to zinc transporter 8 (ZnT8A), GAD (96–585), the protein tyrosine phosphatase region of islet antigen‐2 (PTPA) and the related IA‐2βA, while autoantibodies to IA‐2A were reassayed using the current harmonized method. IA‐2‐related autoantibodies PTPA (0·13 versus 0·45%, P = 0·027) and IA‐2βA (0 versus 0·35%, P < 0·001), but not IA‐2A measured using the harmonized method, were less common in Lithuanian compared to English schoolchildren. Lithuanian schoolchildren who were islet autoantibody‐positive were positive for fewer biochemical autoantibodies compared with English schoolchildren (P = 0·043). Background rates of islet autoimmunity in childhood differ subtly between countries, which have different incidences of type 1 diabetes. The optimal screening strategy (age and combination of markers) for detection of islet autoimmunity may vary between countries, dependent upon the pattern of autoantibodies found in the general population. [ABSTRACT FROM AUTHOR]

Aim: To analyse trends in admission and surgery for rectal prolapse in adults in England between 2001 and 2012 as well as prolapse reoperation rates. Method: Analysis of data derived from a comparative longitudinal population‐based cohort study using Hospital Episode Statistics (HES). Results: During the study period, a total of 25 238 adults, of median age 73 [interquartile range (IQR: 58–83] years, underwent a total of 29 379 operations for rectal prolapse (mean: 2662 per annum). The female to male ratio of this group of patients was 7:1. Median length of hospital stay was 3 (IQR: 1–7) days with an overall in‐hospital mortality rate of 0.9%. Total number of admissions (4950 in 2001/2002 vs 8927 in 2011/2012) and of patients undergoing prolapse surgery (2230 in 2001/2002 vs 2808 in 2011/2012) significantly increased over the study period (P < 0.001 for trends). The overall increase in prolapse surgery (of 33% overall and of 44% for elective procedures) was dwarfed by an increase in popularity of laparoscopic surgery (of 15‐fold). Overall prolapse reoperation rate was 12.7%. The lowest recurrence rate was observed for elective open resection (9.1%) but this had the highest mortality (1.9%). Laparoscopic and perineal fixations were also associated with low reoperation rates (< 11%) and the lowest mortality rates, of 0.3%, when these procedures were elective. These data refute a trend towards subspecialization (by surgeon or hospital) during the study period. Conclusion: Admissions for rectal prolapse increased in England between 2001 and 2012, together with increases in rectal prolapse surgery. Surgical decision making has changed over this period and may be reflected in outcome. [ABSTRACT FROM AUTHOR]

Aims: To describe the nature and causes of patient safety incidents relating to care at home for children with enteral feeding devices.Methods: We analysed incident data relating to paediatric nasogastric, gastrostomy or jejunostomy feeding at home from England and Wales' National Reporting and Learning System between August 2012 and July 2017. Manual screening by two authors identified 274 incidents which met the inclusion criteria. Each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome.Results: The most common problems in care related to equipment and devices (n=98, 28%), procedures and treatments (n=86, 24%), information, training and support needs of families (n=54, 15%), feeds (n=52, 15%) and discharge from hospital (n=31, 9%). There was a clearly stated harm to the child in 52 incidents (19%). Contributory factors included staff/service availability, communication between services and the circumstances of the family carer.Conclusions: There are increasing numbers of children who require specialist medical care at home, yet little is known about safety in this context. This study identifies a range of safety concerns relating to enteral feeding which need further investigation and action. Priorities for improvement are handovers between hospital and community services, the training of family carers, the provision and expertise of services in the community, and the availability and reliability of equipment. Incident reports capture a tiny subset of the total number of adverse events occurring, meaning the scale of problems will be greater than the numbers suggest. [ABSTRACT FROM AUTHOR]

The article presents a study conducted by students from the Polytechnic of North London in England in 1977 that examined dental needs of elderly people. The study involved 192 elderly people in the Islington District of the Camden and Islington Area Health Authority. The oral and dental status of the patients were recorded and the treatment needed was assessed. Results have shown that 80% of the patients were edentulous, while 32% require dentures. It is also found that only few wore partial dentures and that only 19% of all classes of dentures were totally satisfactory.

Background: Indeterminate pulmonary nodules in patients diagnosed with osteosarcoma present a challenge for accurate staging and prognosis. The aim of this study was to explore the significance of this finding.Methods: A retrospective cohort study of 120 patients with osteosarcoma was performed in the North East of England. Chest computed tomographies (CTs) at presentation were reviewed and the incidence of 'indeterminate' nodules recorded. Follow-up scans were reviewed and survival as well as prognostic features were analysed.Results: 25% of our cohort presented with indeterminate nodules. Of these, 33% were subsequently confirmed as metastases, the majority within a year. Kaplan-Meier survival analysis showed that patients with indeterminate nodules fared better than those with frank metastatic disease, and similar to those who presented with a normal chest CT. We found no radiographic features that predicted survival.Conclusions: Indeterminate nodules remain a clinical and diagnostic dilemma. Close monitoring of patients is advised during the first year from presentation, and there is potential for indeterminate nodules to develop into frank metastases later than five years from presentation. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.Design/methodology/approach Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.Findings While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.Research limitations/implications There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.Practical implications While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.Originality/value Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs. [ABSTRACT FROM AUTHOR]

Introduction: The majority of severely injured children in England have a significant head injury and will be seen in Major Trauma Centers (MTCs). The period following brain injury represents an opportunity to influence recovery of neurological function. The study sought to determine whether children who had sustained a head injury were referred for neurorehabilitation.Method: The study was conducted over one year at one center. Children sustaining a moderate or severe head injury were identified and compared to those referred for neurorehabilitation.Results: A total of 41 patients were identified; 16/41 (39%) were referred for neurorehabilitation. Group comparison revealed significant associations between referral status and age (X2(3) = 8.35,p= 0.039), injury mechanism (X2(1) = 8.12,p= 0.017), injury severity (X2(1) = 21.3,p< 0.000), and imaging findings (X2(1) = 11.71,p= 0.001).Discussion: Data reveal concerns for access to neurorehabilitation. Improved access to neurorehabilitation permitting long-term follow-up is required. The establishment of MTCs provides an opportunity to enact this. [ABSTRACT FROM AUTHOR]

Background: GPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable.Aim: To gather an in-depth understanding of GPs' perceptions and attitudes towards workload.Design and Setting: All GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached.Method: Semi-structured, qualitative interviews were conducted. Data were analysed thematically.Results: In total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload.Conclusion: This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved. [ABSTRACT FROM AUTHOR]

Background Adults with intellectual disabilities ( ID) experience a wide range of eating, drinking and/or swallowing ( EDS) problems, for which they receive diverse mealtime support interventions. Previous research has estimated that dysphagia (difficulty swallowing) affects 8% of all adults with ID and that 15% require some form of mealtime support. People with ID (whether they require mealtime support or not) also experience a greater burden of ill health and die younger than their peers in the general population with no ID. Methods Using an exploratory, population-based cohort study design, we set out to examine health-related outcomes in adults with ID who receive mealtime support for any eating, drinking or swallowing problem, by establishing the annual incidence of healthcare use, EDS-related ill health, and all-cause mortality. This study was conducted in two counties in the East of England. Results In 2009, 142 adults with mild to profound ID and a need for any type of mealtime support were recruited for a baseline survey. At follow-up 1 year later, 127 individuals were alive, eight had died and seven could not be contacted. Almost all participants had one or more consultations with a general practitioner ( GP) each year (85-95%) and, in the first year, 20% reportedly had one or more emergency hospitalizations. Although their annual number of GP visits was broadly comparable with that of the general population, one-fifth of this population's primary healthcare use was directly attributable to EDS-related ill health. Respiratory infections were the most common cause of morbidity, and the immediate cause of all eight deaths, while concerns about nutrition and dehydration were surprisingly minor. Our participants had a high annual incidence of death (5%) and, with a standardized mortality ratio of 267, their observed mortality was more than twice that expected in the general population of adults with ID (not selected because of mealtime support for EDS problems). Conclusions All Annual Health Checks now offered to adults with ID should include questions about respiratory infections and EDS functioning, in order to focus attention on EDS problems in this population. This has the potential to reduce life-threatening illness. [ABSTRACT FROM AUTHOR]

Determining the contribution of wood smoke to air pollution in large cities such as London is becoming increasingly important due to the changing nature of domestic heating in urban areas. During winter, biomass burning emissions have been identified as a major cause of exceedances of European air quality limits. The aim of this work was to quantify the contribution of biomass burning in London to concentrations of PM2.5 and determine whether local emissions or regional contributions were the main source of biomass smoke. To achieve this, a number of biomass burning chemical tracers were analysed at a site within central London and two sites in surrounding rural areas. Concentrations of levoglucosan, elemental carbon (EC), organic carbon (OC) and K+ were generally well correlated across the three sites. At all the sites, biomass burning was found to be a source of OC and EC, with the largest contribution of EC from traffic emissions, while for OC the dominant fraction included contributions from secondary organic aerosols, primary biogenic and cooking sources. Source apportionment of the EC and OC was found to give reasonable estimation of the total carbon from non-fossil and fossil fuel sources based upon comparison with estimates derived from 14C analysis. Aethalometer-derived black carbon data were also apportioned into the contributions from biomass burning and traffic and showed trends similar to those observed for EC. Mean wood smoke mass at the sites was estimated to range from 0.78 to 1.0 μg m-3 during the campaign in January-February 2012. Measurements on a 160 m tower in London suggested a similar ratio of brown to black carbon (reflecting wood burning and traffic respectively) in regional and London air. Peaks in the levoglucosan and K+ concentrations were observed to coincide with low ambient temperature, consistent with domestic heating as a major contributing local source in London. Overall, the source of biomass smoke in London was concluded to be a background regional source overlaid by contributions from local domestic burning emissions. This could have implications when considering future emission control strategies during winter and may be the focus of future work in order to better determine the contributing local sources. [ABSTRACT FROM AUTHOR]

Background This paper examines knowledge exchange dynamics in a specialist integrated intellectual (learning) disability service, comprising specialist healthcare provision with social care commissioning and management, and considers their significance in terms of integrated service delivery. Methods A qualitative study focusing on knowledge exchange and integrated services. Semi-structured interviews ( n = 25) were conducted with members of an integrated intellectual disability service in England regarding their perceptions of knowledge exchange within the service and the way in which knowledge exchange impinges on the operation of the integrated service. Results Exchange of 'explicit' (codifiable) knowledge between health and care management components of the service is problematic because of a lack of integrated clinical governance and related factors such as IT and care record systems and office arrangements. Team meetings and workplace interactions allowed for informal exchange of explicit and 'tacit' (non-codifiable) knowledge, but presented challenges in terms of knowledge exchange completeness and sustainability. Conclusions Knowledge exchange processes play an important role in the functioning of integrated services incorporating health and care management components. Managers need to ensure that knowledge exchange processes facilitate both explicit and tacit knowledge exchange and do not rely excessively on informal, ' ad hoc' interactions. Research on integrated services should take account of micro-scale knowledge exchange dynamics and relationships between social dynamics and physical factors. [ABSTRACT FROM AUTHOR]

The study objectives were to ascertain behavioural, access-related, health-seeking factors and sexually transmitted infection (STI) prevalence in young men (,25 years) attending genitourinary (GU) medicine clinics and compare them with older men (_25 years) and young women (,25 years). Between October 2004 and March 2005, 4600 new attendees at seven sociodemographically and geographically contrasting GU medicine clinics across England completed questionnaires, which were linked to routine clinical data. Young men waited significantly less time to be seen in clinic compared with older men and young women. They were less likely to report symptoms than older men (P = 0.021) yet more likely to be diagnosed with chlamydia (P = 0.001) and gonorrhoea (P = 0.007). They were also more likely to be diagnosed with an acute STI relative to young women (P = 0.007). Our data confirm the need to make comprehensive STI screening readily available for young men and to develop effective and innovative screening strategies in different settings. [ABSTRACT FROM AUTHOR]

Contemporary welfare is closely linked to policies designed to foster individual responsibility and self-development. This agenda, however, encounters problems when adults lack the capacity to make decisions about their lives, and/or are unable to protect themselves from the malign actions of their fellow citizens. These problems are addressed by the 2005 Mental Capacity Act (England and Wales) and adult safeguarding procedures. Specifically, the 2005 Mental Capacity Act (England and Wales) (MCA) introduced a statutory advocacy service, which empowers local authorities to appoint an Independent Mental Capacity Advocate (IMCA) to represent the interests of adult lacking capacity to make decisions about adult safeguarding procedures. This paper presents (i) a general overview of the development of adult safeguarding and the introduction of the MCA's IMCA service into these procedures; (ii) findings from a research project investigating the integration of IMCAs into these procedures; and (iii) a discussion of the challenges facing IMCAs involved in adult safeguarding procedures. [ABSTRACT FROM PUBLISHER]

Overweight and obese people appear to be at greater risk of suboptimal vitamin and mineral status compared with people of a healthy weight. Nutrients most affected include vitamin D, vitamin B, carotenoids, folate, vitamin C and iron. The reasons are unknown but may be caused by poor diets, increased requirements or obesity-related changes to nutrient absorption, excretion or metabolism, or a combination of these. Sequestration of fat-soluble vitamins by adipose tissues is also a major factor. Although dietary assessment in obese populations is hampered by under-reporting, there is evidence that dietary patterns characterised by energy-dense, processed foods are more common in groups with a higher body mass index. Dieting practices, bariatric surgery and the use of anti-obesity drugs may compound the risk of nutrient inadequacy, although sustained weight loss helps to improve vitamin D status. A poor nutrient status could accentuate the risk of chronic diseases already experienced by overweight people on account of their excessive fat mass. There is evidence that the use of dietary supplements can improve nutrient status and have a favourable impact on disease risk markers such as lipid profiles and insulin resistance. Whether currently dieting or not, overweight people may benefit from safeguarding vitamin and mineral adequacy by taking a multi-nutrient supplement alongside an increased intake of nutrient-rich foods. [ABSTRACT FROM AUTHOR]

We compare attitudes, experiences of learning about sex and first intercourse among Indians (n = 393) and Pakistanis (n = 365) using a probability survey of Britain's general population aged 16-44 years conducted during 1999-2001 (n = 12,110). Higher proportions of Pakistanis (64.6%) and Indians (28.1%) reported religion as 'very important' versus 6.2% of other ethnicities. Pakistanis were more conservative in their attitudes, e.g. reporting premarital sex as wrong (adjusted odds ratios [AORs] for sociodemographic differences, 4.71 [men] and 6.59 [women]). Pakistanis were more likely to be married at first sex (AORs 6.2 [men] and 9.53 [women]), yet men were more likely than women to be in non-marital relationships at this time (69.4% versus 25.2%). Pakistani men and women and Indian women were more likely to report not using reliable contraception at first sex relative to others (AORs 2.33, 3.16 and 1.90, respectively). Pakistani and Indian women were more likely than others to report school lessons as their main source of sex education (AORs 2.23 and 1.77) and not discussing sex with their parents during adolescence (AORs 2.04 and 2.62). These unique data have implications for ensuring that sex and relationship education and health promotion messages are appropriately planned, targeted and delivered to benefit Pakistanis and Indians. [ABSTRACT FROM AUTHOR]

Background In England and Wales, the Mental Capacity Act 2005 ( MCA) provides a new legal framework to regulate substitute decision-making relating to the welfare of adults who lack the capacity to make one or more autonomous decisions about their care and support. Any substitute decision made on behalf of an adult lacking capacity must be in his/her ‘best interests’. However, the value of adopting established principles and procedures for substitute decision-making in practice is uncertain, and little is known about the legal or ethical dynamics of social care support, including the day-to-day residential support provided to adults with intellectual disabilities (ID). Methods This paper reports a qualitative, grounded theory analysis of 21 interviews with support workers working in residential care homes for adults with ID, and observations of care practices. Results In contrast to the narrow legal responsibilities placed upon them, it is argued that support workers interpret substitute decision-making within a broad moral account of their care role, orientating their support towards helping residents to live ‘a life like ours’. In so doing, support workers describe how they draw on their own values and life experiences to shape the substitute decisions that they make on behalf of residents. Conclusions Support workers' accounts reveal clear discrepancies between the legal regulation of substitute decision-making and the ways that these support workers make sense of their work. Such discrepancies have implications both for the implementation of the MCA, and for the role of support workers' values in the conceptualisation and delivery of ‘good’ care. [ABSTRACT FROM AUTHOR]

Data collected as a part of a survey on radon concentrations from about 40 000 dwellings in England for six contrasting geological units were analysed to evaluate the impact of house-specific factors (building characteristics and construction dates) and of proximity to geological boundaries. After adjusting for temperature and outdoor radon, geological unit, house type, double glazing and date of building were found to have a statistically significant influence on indoor radon concentrations and explained about 29 % of the total variation between dwellings in logarithmically transformed radon values. In addition, there were statistically significant differences in radon concentrations according to proximity to geological boundaries categories for most of the geological units, but no consistent pattern could be detected. [ABSTRACT FROM AUTHOR]

We carried out an audit of antenatal screening for Down's syndrome using the Integrated test (which provides a single screening result from information collected in the late first and early second trimesters of pregnancy) which was introduced into routine antenatal care at two London hospitals, University College Hospital (UCH) and St Mary's Hospital, in 2003-4. The audit was based on 15,888 women who accepted screening and booked in the first trimester. The Down's syndrome detection rate was 87% (95% confidence interval [CI], 74-95) consistent with an expected detection rate of 89% based on applying the estimates of screening performance of the Serum, Urine and Ultrasound Screening Study (SURUSS) to the maternal age distribution of women who were screened at UCH and St Mary's. The observed false-positive rate was 2.1% (95% CI, 1.9-2.3), compared with an expected of 2.5% for women of the same age. An audit trail (conducted at UCH) indicated that 98% (10,746/10,961) of women accepted integrated screening (2% having a first trimester test) and of these, 94% (10,116) completed both stages of the test. The audit demonstrated that it is feasible to conduct integrated screening within the NHS with a high acceptance rate and a screening performance consistent with that determined from previous research studies. [ABSTRACT FROM AUTHOR]

Estimates of the number of prevalent human immunodeficiency virus infections are used in England and Wales to monitor development of the human immunodeficiency virus–acquired immune deficiency syndrome epidemic and for planning purposes. The population is split into risk groups, and estimates of risk group size and of risk group prevalence and diagnosis rates are combined to derive estimates of the number of undiagnosed infections and of the overall number of infected individuals. In traditional approaches, each risk group size, prevalence or diagnosis rate parameter must be informed by just one summary statistic. Yet a rich array of surveillance and other data is available, providing information on parameters and on functions of parameters, and raising the possibility of inconsistency between sources of evidence in some parts of the parameter space. We develop a Bayesian framework for synthesis of surveillance and other information, implemented through Markov chain Monte Carlo methods. The sources of data are found to be inconsistent under their accepted interpretation, but the inconsistencies can be resolved by introducing additional ‘bias adjustment’ parameters. The best-fitting model incorporates a hierarchical structure to spread information more evenly over the parameter space. We suggest that multiparameter evidence synthesis opens new avenues in epidemiology based on the coherent summary of available data, assessment of consistency and bias modelling. [ABSTRACT FROM AUTHOR]

Background In England and Wales, if a person is thought to lack capacity to make a decision to undergo a sterilisation operation, a specific process occurs. A Judge sitting in the Family Division of the High Court receives evidence from relevant parties including psychiatric and gynaecological experts and subsequently decides on the lawfulness of the sterilisation operation. We have investigated who was referred and by whom, the reasons given, and the outcomes of the legal process during an 11-year period. Methods A retrospective case note study was undertaken of all referrals to the Official Solicitor’s Office for sterilisation between 1988 and 1999. Using an established protocol, information was obtained from legal and clinical notes relating to the initial referral to the Official Solicitor, the opinions of experts, the court proceedings and the outcome. Results Seventy-three people, only three (5%) of whom were men, were referred over the 11 years. They were aged between 12 and 41 years. All but one had an intellectual disability (ID). Seventy-five per cent were living at home and did not have partners. Full applications were made for 50 of the 73 (68.5%), 39 proceeding to a court hearing. For 31 of the 39 (79.5%) cases, the court ruled that sterilisation would be in the person’s ‘best interests’. An additional six women probably had operations resulting in sterilisation without court authorization. Conclusions Referrals for sterilisation are almost always for people with IDs. In the case of the majority, it was thought that it was unlikely that they had had or will have in the future a sexual relationship. Care needs to be taken in interpreting the results in this case note study. We hypothesize that the request for sterilisation is the consequence of a complex process reflecting concerns about the future, but in the context of other family issues. The relationship between lacking the capacity to consent to sterilisation and the capacity to consent to sexual intercourse needs further exploration. Future studies including interviews with those involved are required. [ABSTRACT FROM AUTHOR]

Objectives: To explore the changing pattern of condom use from 1990 to 2000; to identify sociodemographic and behavioural factors associated with condom use; and reasons for condom use in 2000.Methods: Large probability sample surveys administered among those resident in Britain aged 16-44 (n = 13 765 in 1990, n = 11 161 in 2000). Face to face interviews with self completion components collected sociodemographic, behavioural, and attitudinal data.Results: Condom use in the past year among sexually active 16-24 year old men increased from 61.0% in 1990 to 82.1% in 2000 (p<0.0001), and from 42.0% to 63.2% (p<0.0001) among women of the same age, with smaller increases among older age groups. Among individuals reporting at least two partners in the previous 4 week period, approximately two thirds reported inconsistent or no condom use (63.1% (95% CI 55.9% to 69.8%) of the men and 68.5% (95% CI 57.6% to 77.7%) of the women).Conclusions: Rates of condom use increased substantially between 1990 and 2000, particularly among young people. However, inconsistent condom use by individuals with high rates of partner acquisition may contribute significantly to the recent resurgence in STIs. This group is an important target for intensive and specific sexual health interventions. [ABSTRACT FROM AUTHOR]

In a long-term study of the effects on soil fertility and microbial activity of heavy metals contained in sewage sludges, metal-amended liquid sludges each with elevated Zn, Cu or Cd concentrations were applied over a 3-year period (1995–1997) to three sites in England. The experiments were sited adjacent to experimental plots receiving metal-rich sludge cakes enabling comparisons to be made between the effects of heavy metal additions in metal-amended liquid sludges and sludge cakes. The liquid sludge additions were regarded as ‘worst case’ treatments in terms of likely metal availability, akin to a long-term situation following sewage sludge additions where organic matter levels had declined and stabilised. The aim was to establish individual Zn (50–425 mg kg−1), Cu (15–195 mg kg−1) and Cd (0.3–4.0 mg kg−1) metal dose–response treatments at each site, but with significantly smaller levels of organic matter addition than the corresponding sludge cake experiments. There were no differences ( P > 0.05) in soil respiration rates, biomass carbon concentrations or most probable numbers of clover Rhizobium between the treatments at any of the sites at the end of the liquid sludge application programme. Soil heavy metal extractability differed between the metal-amended liquid sludge and metal-rich sludge cake treatments; Zn and Cd extractabilities were higher from the liquid sludge additions, whereas Cu extractability was higher from the sludge cake application. These differences in metal extractability in the treated soil samples reflected the contrasting NH4NO3 extractable metal contents of the metal-amended liquid sludges and sludge cakes that were originally applied. [ABSTRACT FROM AUTHOR]

Hepatitis C (HCV) is an emerging health concern across the world, with 170 million people chronically infected and at risk of liver cancer, cirrhosis or liver failure. There is no vaccination and so it is important to learn as much as possible about how to prevent future infection. Modes of transmission include intravenous drug use (IDU), blood products, tattooing and, to a lesser extent, sexual intercourse. Homelessness is a risk factor of HCV because of the environments and behaviours associated with homeless communities such as poor hygiene, poor nutrition and high levels of IDU. The aim of this project was to determine the prevalence of HCV and its risk factors amongst the homeless community of Oxford, which is the second largest in the country. Ninety-eight individuals of the Oxford homeless community were interviewed and tested for HCV. The results gave an estimated HCV prevalence of 26.5 per cent. The major risk factors in this population were IDU (past and present), age (over 20 years old) and sharing the paraphernalia used by i.v. drug users (e.g. spoons, foil and filters). With the exception of age, these risk factors could all be targeted in an attempt to reduce this prevalence and combat the major public health concern that HCV poses to the homeless community of Oxford. [ABSTRACT FROM PUBLISHER]

The Royal College of Physicians (London) recently published its latest report on alcohol misuse entitled ‘Alcohol — Can the NHS Afford It?’. Part of this document, encompassing our views, has made specific recommendations for the management of patients in the Accident and Emergency (A&E) Department who may possibly have, or are at risk of developing, Wernicke’s encephalopathy. Patients showing evidence of chronic alcohol misuse and suspected of having a poor diet should be treated at the outset with B vitamins intravenously or intramuscularly, especially when the clinical signs are initially masked by drunkenness at presentation to the A&E Department. This commentary offers a review of the scientific foundations on which these recommendations have been made. [ABSTRACT FROM PUBLISHER]

Summary The administration of general anaesthesia in the UK has generally been carried out by medically qualified staff but there have been instances where this has not been the case. This article describes the role of the ‘Sister Anaesthetists’ who made a significant contribution to the delivery of anaesthesia services at the Norfolk and Norwich Hospital from the end of the First World War until the introduction of the National Health Service in 1948. [ABSTRACT FROM AUTHOR]

The aim of this study was to find the most appropriate method of classification for the Thames intertidal habitat types at Crayford Marsh and Dartford Creek by using Compact Airborne Spectrographic Imager (CASI ) data. Preliminary evaluation of commonly available classification algorithms produced two candidate techniques: the Maximum Likelihood Classifier (MLC) and the Spectral Angle Mapper (SAM). Pre-classification enhancements and the two different classifiers were compared. Ten different dataset combinations were created for two pilot sites: one at Crayford Marsh and one at Dartford Creek. These consisted of the original CASI bandset (15 bands in spatial mode from blue to near-infrared) and nine other combinations resulting from band subsets, Principal Component Analysis (PCA) and Normalized Difference Vegetation Index (NDVI ). Twelve classes were established for each site although only some of these were common to both. Each classified image was accuracy assessed using a combination of field mapping, field photographs and air photograph interpretation as reference data. The most accurate classification (68% for Crayford Marsh and 53% for Dartford Creek) for both sites comprised the use of MLC with a dataset created from PCs 2, 3 and 4 from a PCA carried out on the original 15 band data, combined with an additional NDVI band. CASI data proved useful for the mapping of salt-marsh vegetation and sediments especially in the Crayford Marsh site. In the Dartford Creek site, however, there was significant confusion between some classes. Further work is recommended to test the classification. [ABSTRACT FROM AUTHOR]

Aims To determine the incidence of, and clinically relevant risk factors for, new foot ulceration in a large cohort of diabetic patients in the community healthcare setting. Methods Diabetic patients (n = 9710) underwent foot screening in six districts of North-west England in various healthcare settings. All were assessed at baseline for demographic information, medical and social history, neuropathy symptom score, neuropathy disability score, cutaneous pressure perception (insensitivity to the 10 g monofilament), foot deformities, and peripheral pulses. Two years later, patients were followed up via postal questionnaire to determine the incidence of new foot ulcers. Cox's proportional hazards regression analysis was used to determine the independent, relative risk of baseline variables for new foot ulceration. Results New foot ulcers occurred in 291/6613 patients who completed and returned their 2-year follow-up questionnaire (2.2 % average annual incidence). The following factors were independently related to new foot ulcer risk: ulcer present at baseline (relative risk (95% confidence interval)) 5.32 (3.71-7.64), past history of ulcer 3.05 (2.16-4.31), abnormal neuropathy disability score (≥ 6/10) 2.32 (1.61-3.35), any previous podiatry attendance 2.19 (1.50-3.20), insensitivity to the 10 g monofilament 1.80 (1.36-2.39), reduced pulses 1.80 (1.40-2.32), foot deformities 1.57 (1.22-2.02), abnormal ankle reflexes 1.55 (1.01-2.36) and age 0.99 (0.98-1.00). Conclusions More than 2% of community-based diabetic patients develop new foot ulcers each year. The neuropathy disability score, 10 g monofilament and palpation of foot pulses are recommended as screening tools in general practice. [ABSTRACT FROM AUTHOR]

The current police caution (England and Wales) provides information about the right to silence to suspects in police detention. Though earlier studies, involving other populations, suggest that the caution would be too complex for detainees to understand fully, the issue has not previously been investigated directly among police detainees. Comprehension of the caution was investigated among two groups, police station suspects (N = 30) and individuals (N = 24) attending a job centre in the same area, matched for intellectual ability. In both groups, understanding was very limited and did not relate either to their situation at the time of testing or to self-reported experience of the criminal justice system. Even under optimal experimental conditions, only 11% (six) of the participants were able to demonstrate full understanding of its meaning. Worryingly, though more than 96% (52) claimed to have understood the caution fully after it had been presented to them as it would be by the police, none of them did so. We suggest practical measures to ameliorate the difficulties, but the importance of devising a new, simplified, version of the current caution cannot be over-emphasized; otherwise, miscarriages of justice are likely to occur. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: There is some evidence that patients with renal failure who have arterial procedures may have a poor outcome. This study compared the hospital mortality rate of arterial surgery in patients with chronic renal failure and those with normal renal function. Methods: A consecutive series of 1718 patients undergoing arterial reconstructive surgery (excluding amputation) was entered prospectively on to a computerized database. Chronic renal failure was defined as a serum creatinine level over 400 µmol/l, or dialysis (either peritoneal or haemodialysis), or a successful renal transplant. Mortality was assessed at 30 days or in hospital. Results: There were 69 patients (4·0 per cent) who were defined as having chronic renal failure. The mortality rate in this group was 23 per cent (16 patients) compared with 7·3 per cent (120 patients) of the 1649 patients without renal failure. The mortality rate was highest in patients undergoing urgent or emergency surgery and in those undergoing reconstruction for lower limb occlusive disease. The main causes of death were related to the cardiovascular system. Conclusion: Patients with chronic renal failure undergoing arterial surgery have a poor outcome compared with those with normal renal function. [ABSTRACT FROM AUTHOR]

Background: Several studies have linked air pollution by nitrogen dioxide (NO(2)) with increased hospital admissions for asthma in children. Exacerbations of asthma in children are often precipitated by upper respiratory infections. It is therefore possible that NO(2) increases the risk of airways obstruction when asthmatic children develop upper respiratory infections.Methods: To test this hypothesis a sample of 114 asthmatic children aged 7-12 years were followed for a total of up to 13 months. Probable upper respiratory infections were identified by consensus review of daily symptom diaries, and episodes of airways obstruction from serial records of peak expiratory flow (PEF). Personal exposures to NO(2) were measured with Palmes tubes that were changed weekly. Generalised estimating equations were used to assess the relative risk (RR) of an asthmatic exacerbation starting within seven days of an upper respiratory infection according to estimated NO(2) exposure during the one week period from two days before to four days after the onset of the infection.Results: The children were followed for an average of 34 weeks during which 318 upper respiratory infections and 224 episodes of reduced PEF were diagnosed. PEF episodes were much more likely to occur in the seven days following the onset of an upper respiratory infection than at other times. Estimated exposures to NO(2) at the time of infections were generally low (geometric mean 10.6 microg/m(3)). Compared with exposures of < or = 8 microg/m(3), exposures of >28 microg/m(3) were associated with a RR of 1.9 (95% confidence interval 1.1 to 3.4) for the development of an asthmatic episode within seven days of an infection.Conclusions: The findings give some support to the hypothesis that NO(2) increases the risk of asthmatic exacerbations following respiratory infections, even at relatively low levels of exposure. Further studies in populations with higher exposures would be useful. [ABSTRACT FROM AUTHOR]

Fine needle cytology of palpable head and neck lesions: a comparison of sampling methods with and without suctionPatients attending the ear, nose and throat (ENT) department at St James's University Hospital, Leeds, UK, for evaluation of palpable head and neck lesions have a fine needle cytology (FNC) specimen taken and receive the result at the same out-patient visit. This study was designed to discover if there is a significant difference in the efficiency of the methods with and without suction. The method was chosen randomly on each occasion and the adequacy or otherwise of the specimen was determined taking into account the site and nature of the lesion and the total cellularity of the sample. The level of blood contamination was also compared by each method. When benign and malignant lesions from all sites were analysed together the method with suction produced a significantly higher number of adequate samples than the method without suction. The exception was in the case of samples from lymph node lesions measuring < 1 cm, where adequate specimens were only obtained without suction. The non-suction technique was particularly poor at sampling salivary gland lesions in the 1–1.5 cm category. There was no significant difference in the level of blood contamination between the two methods at any site. These results are at variance with most other similar studies and possible reasons for this are discussed. [ABSTRACT FROM AUTHOR]

The article presents the authors' views on a research paper by E. Page, on the applicability of a model related to central government's control over the expenditures of local authorities in Scotland, on the setup in England and Wales. The author indicates various shortcomings in the simulation of the model, including that concerning individualized guidelines given by the Scottish government. The author concludes that the model can't be replicated under present setup of England and Wales.

The Criminal Justice and Public Order Act 1994 (England and Wales) modified suspects' right to silence during police questioning and required a new police caution. The current 37-word caution was introduced after it was found that a proposed 60-word draft version was too complex. The results of the present study show that, although more succinct, the current caution is no easier to explain. Even under optimal conditions, when the participants could focus on each sentence in turn, only 1 in 10 of the general population (n =15), 6 in 10 of A-level students preparing for university (n =72) and 9 in 10 police officers (n =21) demonstrated their understanding by explaining all three sentences correctly. For all groups, the difficulties were more marked when the caution was presented in its entirety, as would happen in real life. The complexity of the caution has serious implications for suspects in police detention. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Comments on an article by J.A. Chartres on the achievements and growth of land carriage in England in the 17th century. Comments on Chartres' central hypothetical-statistical calculation; Views on Chartres' argument that traffic growth was a lagged response to the amelioration of existing modes of transport; Criticism of Chartres' tables and text pertaining to the structure of the land-transport industry.

The contents of eighteenth-century gentlemanly cabinets were seldom well recorded. The museum of Sir Ashton Lever (fl. 1771-1806), noted for Pacific ethnography and natural history, is an exception: the collections were listed in 1784, catalogued for sale 1806, as well as being featured in educational and scientific publications. Most important o fall were the watercolours of 1,000 artefacts and natural history specimens prepared by Sarah Stone. This paper sets out the history of the collection emphasizing the activities of James Parkinson, the second owner, during the 1790s. A series of watercolours of the collection, recently acquired by the British Museum, are then briefly described. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the winter and annual general meeting of the British Ecological Society in the Botany School in Cambridge, England from January 4-5, 1961. In the first paper, titled "Aquatic and Swamp Vegetation in Scotland," D. H. N. Spence discussed the results of a study of lochs. In his presentation, titled "Dormancy in the Freshwater Copepoda," J. P. Smyly explored the function of resting-stages as an ecological adaptation to allow species to survive.

Information about the topics discussed at the Autumn meeting of the British Ecological Society, that was held on September 22-24, 1956 in conjunction with the Botanical Society of the British Isles at Southampton University, is presented. Topics include the micro-evolution of Glyceria, the general ecology of Spartina in Great Britain, and the boring activity of Limnoria tripunctata. The event featured several ecology experts including Dr. M. J. Borrill, C. E. Hubbard, and S. K. Eltringham.

Business correspondence is one of the few historical sources to provide an explicit statement of commercial policy, and an analysis of the grounds upon which such policies were formulated. All too often policies of firms or industries have to be deduced from sources which have only an indirect connection or oblique reference to the problem of policy, and factual gaps are bridged by the assumption that policies are formulated rationally and in accordance with the tenets of economic theory. One excellent source of information about business policy and the organization of marketing is found in the collected correspondence of the firm of M'Connel & Kennedy of Manchester, England, one of the principal cotton spinning firms of the early nineteenth century. It is the purpose of this article to analyze the marketing organization and policy of M'Connel & Kennedy, and to indicate some of the major problems which faced them and determined the nature of their policy. It is further hoped to show that the marketing policy of the firm was an important factor contributing to the considerable success of M'Connel & Kennedy in the cotton industry at a time when so many business ventures failed. It is impossible to assess exactly the extent to which this commercial policy explains the great success of this firm. But the uncertainty of trade suggests that their policy was one likely to be most effective in countering the hazards of commercial life, and it is certain that their marketing organization and selling policy contributed in no small measure to the firm's success.

Our objective was to correlate body mass index (BMI) with mid-arm circumference (MAC) and also to ascertain whether maternal BMI could be calculated from MAC at booking. We approached all Caucasian women who met the inclusion criteria attending the University College Hospital, London between 1 April 1996 and 30 June 1997 and the Rotunda Hospital, Dublin, Ireland between 15 April 2003 and 19 May 2004. A total of 2,912 women agreed to participate in the research. The participants' maternal height and weight were measured. Their BMI was calculated using the formula: BMI == weight (kg) ÷÷ height (m2). The MAC was measured in cm. Statistical analysis was performed using SPSS for Windows version 11 with p < 0.05 as significant. We found that BMI is directly correlated with MAC ( r == 0.836) and estimates of BMI may be calculated from the simple equation BMI == MAC ± 2. Alternatively, a MAC of ≥ 27 cm allowed for a detection rate for overweight patients of 75%, with a false positive rate of 15%. [ABSTRACT FROM AUTHOR]

Information about the topics discussed at the 4th International Conference on polyphenols and health held in Harrogate International Center in Harrogate, Great Britain from December 7-11, 2009 is presented. Topics included are the effects of polyphenols on endothelial function, the occurrence of bilitranslocase and the beneficial effects of flavonoids on the brain. The conference featured several professors, such as Professor Barry Halliwell, Jaap Keijer and Junjii Terao.

The article presents on a study and diagnosis on survival from melanoma of the skin in England and Wales up to 2001. It notes on the clinical background of the cancer that arises from pigmented cells called the melanocytes which when comes in pigmented lesions in the skin will be cutaneous malignant melanoma (CMM), hence, treatments for these ailments are being studied other than surgery. Moreover, it asserts on acquiring further education and prevention campaigns out from clinical studies.

Reviews `Rembrandt by Himself,' an exhibition of Rembrandt's self-portraits showing at the National Gallery in London, England until September 5, 1999 and at the Mauritshuis, The Hague, the Netherlands from September 25, 1999 to January 9, 2000.

This retrospective study of long-term use of transcutaneous electrical nerve stimulation (TENS) at Newcastle Pain Relief Clinic indicates that TENS has been a successful analgesic treatment for 58.6% of 1582 patients attending the clinic over a period of 10 years. A wide range of pain conditions were found to respond to TENS and many patients continued to use the treatment for several years. Most patients not responding to TENS (during a home trial) returned stimulators at the first follow-up-appointment. Thus TENS should be considered as a simple, safe and reusable first line treatment for many pain conditions. [ABSTRACT FROM AUTHOR]