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Introduction: From 85348 inmates in England and Wales, over 26,000 incidents of assault and 40,000 of self-harm were reported from within prisons in 2016. This study focuses primarily on burn injuries in prison, determining the predominant aetiology as well as clinical outcomes of these injuries.Methods: Data was retrieved retrospectively and a case series performed, including all burns referred from regional prisons to our centre from 2007 to 2017 and comprising patient demographics, mechanism of injury, total body surface area affected, management, and outcome. Cost analysis of care was conducted using a previously published framework.Results: 18 cases from three regional prisons were recorded, with 67% from a single prison. Referrals rose exponentially over time, with 44% occurring in 2017. 94% were scald burns, and 56% secondary to assault, primarily through the use of kettles and mostly targeting the face and trunk. The mean TBSA of burn was 2.89% (<1-8%), and 80% received first aid. 72.2% were admitted to hospital for an average of 4 days. All burns were managed nonoperatively with dressings and underwent on average 2 outpatient reviews (1-8).Discussion: The disproportionate spread of referrals across the prisons correlates partly with the respective populations, but may also represent contrasting medical provisions. The recurring method of assault reflects the relative ease of access to hot water as a harmful agent, predominantly presenting with scalds affecting more critical areas, and with concurrent physical trauma in nearly half of cases which presents management challenges.Conclusion: Targeted education is recommended to reduce the incidence and ensure adequate management of burns in prison, referrals for which are demonstrably rising. Accordingly, the Burns Outreach team can provide training to in-house prison health staff and review referrals to specialist Burns services, aiming to ensure equitable care while alleviating costs associated with transfer to and management in hospital. [ABSTRACT FROM AUTHOR]

Abstract: Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign. [Copyright &y& Elsevier]

Background Rates and time trends in mortality from pancreatic cancer vary considerably between countries. Aim To examine trends and patterns in the incidence of, and the survival and mortality from, pancreatic cancer in England and Wales from 1975 to 2000; in particular, whether incidence and survival rates are related to socio-economic deprivation. Methods We calculated annual age-specific and overall age-standardized incidence and mortality rates by sex for pancreatic cancer in total, and by subsite. We also estimated survival by sex and age group and by subsite. Results In males, the age-standardized rate fluctuated in the late 1970s, to peak at 13.0 per 100 000 in 1979, declined steadily by an average of 1.3% per year to around 10.3 per 100 000 in the mid-1990s and then levelled off. For females, the rate peaked at 8.4 per 100 000 in the late 1980s before declining and fluctuating around 7.7 per 100 000 in the late 1990s. Patterns and trends in mortality rates were closely similar to those in incidence, due to the very low survival rates: only 2–3% at 5 years from diagnosis. Survival rates improved only minimally over the period 1971–99. Incidence and mortality rates were slightly higher in both males and females living in the most deprived areas, but survival was not consistently related to socio-economic deprivation. Conclusions The incidence of, and mortality from, pancreatic cancer in England and Wales have fallen from peak levels observed in the 1970s and 1980s, and levelled off in the 1990s for both sexes; survival rates remain very low. [ABSTRACT FROM AUTHOR]

Summary Background : In England and Wales, 7% of cancers diagnosed in 1997 were oesophageal or gastric cancer. Aim : To review the epidemiology of these cancers in England and Wales using cancer registration data from 1971 to 1998 and mortality data from 1971 to 1999. Methods : We calculated age-specific and age-standardised incidence and mortality rates; crude and relative survival by age group; age-standardised relative survival; and relative survival by socio-economic status. Results : The age-standardised incidence of oesophageal cancer increased from 7.6 to 12.8 per 100 000 men and from 4.2 to 5.7 per 100 000 women. The incidence of gastric cancer decreased from 31.8 to 18.9 per 100 000 men and from 15.1 to 7.3 per 100 000 women. For both cancers, the 1- and 5-year age-standardised relative survival improved for men and women from 1971–1975 to 1992–1994; the 5-year age-standardised relative survival was significantly higher in women than in men diagnosed in 1992–1994; for some periods from 1971–1975 to 1986–1990, the 1-year relative survival was significantly higher in the least deprived men than in the most deprived men. Conclusions : Survival improved for both cancers over the study period, but there were unexplained differences related to sex and deprivation. [ABSTRACT FROM AUTHOR]

Summary Background : The incidence of adenocarcinoma of the oesophagus and gastric cardia has increased in many countries. Aim : To describe the trends in the subsite and morphology of oesophageal and gastric cancer using cancer registry data from 1971 to 1998. Methods : We calculated the overall age-standardised incidence in each year; the age-standardised incidence by subsite, by morphology and by subsite and morphology; and the ratio of the rates in men and women in 1971 and 1998. Results : The incidence of oesophageal adenocarcinoma increased from 1.5 to 7.0 per 100 000 men and from 0.4 to 1.5 per 100 000 women. The incidence of cancer at the cardia also increased, from 2.0 to 5.4 per 100 000 men and from 0.6 to 1.4 per 100 000 women, but the incidence of gastric cancer without a specified subsite decreased markedly from 21.3 to 9.3 per 100 000 men and from 10.7 to 4.2 per 100 000 women. Conclusions : Although some of the increase in the incidence of adenocarcinoma of the gastric cardia is probably real, this interpretation is limited by the proportion of cancers without specified subsites or morphologies. [ABSTRACT FROM AUTHOR]

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

Background: Paracetamol (acetaminophen) poisoning is the leading cause of acute liver failure in Great Britain and the United States. Successful interventions to reduced harm from paracetamol poisoning are needed. To achieve this, the government of the United Kingdom introduced legislation in 1998 limiting the pack size of paracetamol sold in shops. Several studies have reported recent decreases in fatal poisonings involving paracetamol. We use interrupted time-series analysis to evaluate whether the recent fall in the number of paracetamol deaths is different to trends in fatal poisoning involving aspirin, paracetamol compounds, antidepressants, or nondrug poisoning suicide. Methods and Findings: We calculated directly age-standardised mortality rates for paracetamol poisoning in England and Wales from 1993 to 2004. We used an ordinary least-squares regression model divided into pre- and postintervention segments at 1999. The model included a term for autocorrelation within the time series. We tested for changes in the level and slope between the pre- and postintervention segments. To assess whether observed changes in the time series were unique to paracetamol, we compared against poisoning deaths involving compound paracetamol (not covered by the regulations), aspirin, antidepressants, and nonpoisoning suicide deaths. We did this comparison by calculating a ratio of each comparison series with paracetamol and applying a segmented regression model to the ratios. No change in the ratio level or slope indicated no difference compared to the control series. There were about 2,200 deaths involving paracetamol. The age-standardised mortality rate rose from 8.1 per million in 1993 to 8.8 per million in 1997, subsequently falling to about 5.3 per million in 2004. After the regulations were introduced, deaths dropped by 2.69 per million (p = 0.003). Trends in the age-standardised mortality rate for paracetamol compounds, aspirin, and antidepressants were broadly similar to paracetamol, increasing until 1997 and then declining. Nondrug poisoning suicide also declined during the study period, but was highest in 1993. The segmented regression models showed that the age-standardised mortality rate for compound paracetamol dropped less after the regulations (p = 0.012) but declined more rapidly afterward (p = 0.031). However, age-standardised rates for aspirin and antidepressants fell in a similar way to paracetamol after the regulations. Nondrug poisoning suicide declined at a similar rate to paracetamol after the regulations were introduced. Conclusions: Introduction of regulations to limit availability of paracetamol coincided with a decrease in paracetamol-poisoning mortality. However, fatal poisoning involving aspirin, antidepressants, and to a lesser degree, paracetamol compounds, also showed similar trends. This raises the question whether the decline in paracetamol deaths was due to the regulations or was part of a wider trend in decreasing drug-poisoning mortality. We found little evidence to support the hypothesis that the 1998 regulations limiting pack size resulted in a greater reduction in poisoning deaths involving paracetamol than occurred for other drugs or nondrug poisoning suicide. [ABSTRACT FROM AUTHOR]

The article presents the study "Evaluation of the National Congenital Anomaly System in England and Wales," conducted by T. Misra, N. Dattani and A. Majeed. The objective of the study was to evaluate the National Congenital Anomaly System (NCAS). Findings of the study suggest that the NCAS serves the important function of monitoring birth defects in England and Wales, but is not currently operating in a timely or effective way. It should be adapted to meet its main objectives more effectively. More regional anomaly registers should be instituted and existing registers supported through central funds.

Phosphodiesterase inhibitors (such as sildenafil) and endothelin receptor antagonist, bosentan, are effective for digital ulcer disease in systemic sclerosis (SSc-DU) and are endorsed in international treatment recommendations. Commissioning of high-cost drugs, such as bosentan, however, differs across devolved nations of the UK. We report a multicentre service evaluation project to examine 'real world' management of SSc-DU before and following the 2015 UK Scleroderma Study Group (UKSSG) guidance, across southwest (SW) England and Wales. Results showed that iloprost and sildenafil use for SSc-DU was higher in patients in Wales prior to 2015. Between 2015-2017, sildenafil use for SSc-DU increased in SW England while remaining stable in Wales. Bosentan use for SSc-DU after 2015 in SW England increased, while remaining stable and proportionately lower in Wales. These findings demonstrate that differing commissioning guidance across devolved nations of the UK seems to contribute to geographic variation in patient care. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to estimate the annual rate of diagnosis of new cases of diabetes mellitus in England and Wales, and the number of new cases in each year. Study design: Cohort study. Method: Analysis of electronic patient records from the General Practice Research Database, using 208 general practices with a total list size of 1.3 million patients. Results: We estimate that the national rate of diagnosis of new cases of diabetes in England and Wales was 17.5 [95% confidence intervals (CI) 16.6-18.4] per 10,000 person-years in 1994 and 22.1 (95%CI 21.2-23.0) per 10,000 person-years in 1998. We estimate that there were 87,642 new cases of diabetes mellitus in England and Wales in 1994 and 111,345 in 1998. Conclusions: We estimate that the rate at which new cases of diabetes were diagnosed rose by about 26% in England and Wales from 1994 to 1998. This conclusion was unchanged when we took account of the ageing of the national populations between the beginning and end of the study period. We estimate that the number of new cases of diabetes diagnosed each year in England and Wales also increased by one-quarter over the same period. If the number of cases and the rate at which they are diagnosed continues to increase, this will need to be considered by those planning services for people with diabetes. [ABSTRACT FROM AUTHOR]

Aims: To determine time trends in hospital admissions for chronic liver disease in England between 1989/1990 and 2002/2003, mortality rates in England and Wales between 1979 and 2005, and the influence of alcohol-related disease on these trends., Methods: Hospital episode statistics for admissions in England were obtained from the Information Center for Health and Social Care and mortality data for England and Wales from the Office for National Statistics., Results: Hospital admission rates for chronic liver disease increased by 71% in males and 43% in females over the study period. This increase was largely due to alcoholic liver disease, admission rates for which more than doubled between 1989/1990 and 2002/2003. While there was a smaller rise for chronic viral hepatitis B and C, admission rates declined for hepatitis A, autoimmune hepatitis, and primary biliary cirrhosis. Mortality rates for chronic liver disease more than doubled between 1979 and 2005. Two thirds of these deaths were attributable to alcohol-related liver disease in 2005. The highest rate of alcoholic liver disease mortality was in the 45-64 age group, and the largest percentage increase between 1979 and 2005 occurred in the 25-34 age group., Conclusions: Hospital admissions and mortality in England from chronic liver disease are increasing. The underlying reasons are complex, but alcohol-induced liver disease makes a major contribution. There are clear social and health implications if the trend continues and addressing alcohol-related liver disease should be a public health priority.

Objective: To ascertain time trends in rates of hospital admission, operations, in-hospital case fatality and general mortality for congenital heart disease (CHD) in England and Wales., Design: Retrospective analysis of Hospital Episodes Statistics for England (April 1995 to March 2004) and mortality statistics for England and Wales (1994-2003)., Population: All NHS patients admitted with a primary diagnosis of CHD to hospitals in England, and all deaths in England and Wales with an underlying cause of CHD., Main Outcome Measures: Age-standardised hospital admission rates, case fatality rates and death rates from congenital heart disease., Results: Between 1995/1996 and 2003/2004 the age-standardised hospital admission rate for CHD increased from 30.7 per 100,000 (95% CI 29.9 to 31.4) to 35.5 per 100,000 (95% CI 34.7 to 36.4) in men and boys and from 28.2 per 100,000 (95% CI 27.4 to 28.9) to 32.8 per 100,000 (95% CI 32.0 to 33.6) in women and girls. Between 1997/1998 and 2003/2004 in-hospital case fatality rates fell from 2.10% (95% CI 1.97 to 2.22) to 0.83% (95% CI 0.74 to 0.92). Population mortality fell steadily over the decade from 1994 to 2003 in men and women, with the largest proportionate decrease in the 1-4-year age group., Conclusion: Admission rates for CHD have increased over the past decade, particularly amongst patients in older age groups. There has also been a significant decrease in both in-hospital case fatality rates and in general population mortality rates. These trends are consistent with improvements in the quality of care for these patients, improvements in survival and the predicted expansion in the number of adults living with CHD.

In this article we report trends in deaths related to drug misuse in England and Wales from 1993 to 2004, looking particularly at the period between 1999 and 2004, for which there was a Government target to reduce these deaths by 20 per cent. Although there was an overall decline in deaths related to drug misuse between 1999 and 2004, the percentage reduction, at 9 per cent, was less than the Government target. There was an increase in deaths between 2003 and 2004, largely accounted for by deaths involving heroin/methadone and morphine. Mortality rates were highest in young adults and an increase in mortality rates within this group appears to have been the driver behind rising mortality trends during the 1990s.

The National Congenital Anomaly System (NCAS) was set up in 1964, following the thalidomide epidemic, as a monitoring system designed to detect changes in the frequency of reporting of malformations. Its original aim was to detect anomalies reported within 7 days of birth. The NCAS is voluntary at all stages and covers all live- and stillbirths. It has two tiers; a 'passive system' receiving congenital anomaly notifications through a standard paper notification form, known as the SD56, and the congenital anomaly registers that send notifications electronically. Congenital anomalies are classified using the International Classification of Diseases codes and 10 monitoring groups. The Office for National Statistics performs a statistical analysis on a monthly, quarterly and annual basis, using the cumulative sum technique, which is the basis upon which surveillance alerts are raised within the system. The NCAS is now an open database where congenital anomalies can be notified whenever they are detected. The aim of this paper is to describe the current operation and uses of the NCAS based on guidelines for the evaluation of public health surveillance systems published by the Centers for Disease Control and Prevention.

This article examines geographical variations in fatal poisoning due to antidepressant drugs in England and Wales between 1993 and 2003. The analysis looks at mortality rates for Government Office Regions and Wales and Strategic Health Authorities in England. Mortality rates were also considered in relation to antidepressant prescribing and deprivation. Throughout England and Wales, mortality rates due to antidepressant poisoning varied by area (Government Office Region and Strategic Health Authority), and were positively associated with area deprivation.

Objective: To evaluate the National Congenital Anomaly System (NCAS)., Methods: The NCAS in England and Wales based at the Office for National Statistics and the various regional registers that exchange data with it were examined, based on guidelines for evaluating public health surveillance systems, published by the Centres for Disease Control (CDC). Data relating to congenital anomaly notifications received from 1991 to 2002 were analysed., Main Outcome Measures: The main outcome measures were based on CDC standards and included the level of usefulness of the system, simplicity, flexibility, data quality, acceptability, sensitivity, representativeness, timeliness, and stability of the system., Results: The NCAS has two main tiers: the "passive" system of voluntary notifications and the anomaly registers, but many reporting sources within these. It receives about 7000 notifications a year. It is inflexible and has variable data quality. The voluntary nature of reporting affects the system's acceptability. The sensitivity as compared with two regional registers (Trent and Wales) is about 33%. The congenital anomaly registers reporting to the NCAS achieve high levels of coverage and completeness. From 2003, they cover 42% of all births and account for the major proportion of the notifications., Conclusions: The NCAS serves the important function of monitoring birth defects in England and Wales, but is not currently operating in a timely or effective way. It should be adapted to meet its main objectives more effectively. More regional anomaly registers should be instituted and existing registers supported through central funds.

Background: About 500 drug poisoning deaths involving paracetamol (acetaminophen) occur every year in England and Wales. To reduce the number of deaths, regulations were introduced in 1998 to restrict the sale of paracetamol. In this paper, we evaluate the impact of these regulations., Methods: Mortality data for England and Wales were provided by the Office for National Statistics. Deaths were defined as due to compound paracetamol (paracetamol in combination with another analgesic, a low dose opioid or other ingredients) or paracetamol only, with or without alcohol or other drugs. The Department of Health provided data on all hospital admissions with a primary diagnosis of paracetamol poisoning., Results: Mortality rates for paracetamol only were similar for males and females, and decreased from about 4.5 to 2.8 per million between 1997 and 1999 and again from about 3.1 to 2.2 per million between 2001 and 2002. These falls may be attributable to random variation in the rates. Deaths involving compound paracetamol, which were not subject to the 1998 regulations, remained relatively constant over the study period. There was evidence of a decreasing trend in paracetamol only mortality rates and this followed overall trends for other drug poisoning excluding opioids and drugs of misuse. Hospital admissions due to paracetamol poisoning increased from about 27 000 to 33 000 between 1995/1996 and 1997/1998 and then decreased to 25 000 in 2001/2002. There were almost 50 per cent more admissions for females than males, with the highest admission rates amongst females aged 15-24 years old., Conclusions: Between 1993 and 2002, mortality rates and hospital admissions due to paracetamol poisoning declined. However, the contribution of the 1998 regulations to this decline is not clear. Paracetamol poisoning continues to be an important public health issue in England and Wales and represents significant workload for the NHS in England.

This article examines trends in mortality and hospital admissions associated with epilepsy in England and Wales during the 1990s. Mortality data were analysed for the period 1993 to 2000. Data on hospital admissions where the main diagnosis was epilepsy were obtained from the Hospital Episode Statistics information service of the Department of Health and analysed for the period 1991/92 to 2000/01. There were about 800 deaths per year where epilepsy was the underlying cause and about 37,000 admissions where epilepsy was the main diagnosis. Both mortality and hospital admission rates for epilepsy remained relatively stable during the periods examined.

Background: Little is known about the burden of peptic ulcer in the community., Aims: To examine recent time trends in the period prevalence of peptic ulceration and its drug management, in England and Wales., Methods: For each year between 1994 and 1998, information on patients with a diagnosis of peptic ulceration was extracted from the General Practice Research Database., Results: The annual age-standardized period prevalence of peptic ulceration decreased from 3.3/1000 in 1994 to 1.5/1000 in 1998 for men, and from 1.8/1000 to 0.9/1000 for women. This decline was more evident among younger people, and among males registered with practices located in the most deprived electoral wards compared to those located in the least deprived. The proportion of patients receiving H2 receptor antagonists declined from 68% in 1994 to 41% in 1998. In contrast, the proportion prescribed proton pump inhibitors rose from 46% to 66%., Conclusions: Over a 5-year period, the period prevalence of peptic ulceration has decreased markedly, especially among younger people and those from more deprived areas.

Background: Drug overdose is a common method of suicide in the elderly. Hence, an understanding of current trends in epidemiology of these deaths is important when considering measures to decrease suicide rates., Methods: Analysis of the Office for National Statistics (ONS) database of deaths from overdose and poisoning. Suicide and undetermined deaths from drug overdose between 1993-1999 in the over 65 year olds were studied. Socio-demographic data from the four drug groups most commonly used in overdose were extracted, and age and sex specific mortality rates calculated. Enumeration districts were ranked into five quintiles based on their Carstairs scores, and death rates in each quintile for men and women calculated., Results: There were 1864 deaths from drug overdose during the study period. Suicide and undetermined death rates from drug overdose remained stable between 1993-1999. Drugs most commonly used in overdose were (in order) paracetamol (and related compounds), benzodiazepines, antidepressants, and opiates. Women comprised 62% of deaths. Death rates increased with age, with highest rates in men over 75 (37.7 deaths per million). Benzodiazepines showed the most marked increase with age. Co-proxamol comprised 32% of deaths from paracetamol compounds, and 95% of antidepressant deaths were due to tricyclic antidepressants. There was no association in women between Carstairs area deprivation and suicide rates; in men rates were highest in the most deprived areas., Conclusion: Suicides in the over 65 year olds may be decreased by changes in prescription practice. Paracetamol, co-proxamol, tricyclic antidepressants and benzodiazepines should be prescribed with caution to the elderly with depression or at high risk of depression., (Copyright 2002 John Wiley & Sons, Ltd.)

Background: The prescription of antidepressants has increased substantially over the last 10 years. It is therefore timely to examine trends in mortality associated with overdoses of antidepressants and to compare the relative mortality associated with different antidepressants., Methods: Data were derived from a newly developed national database of deaths from overdose and poisoning in England and Wales between 1993 and 1997. Age and sex specific death rates associated with overdose and poisoning with antidepressants were calculated together with numbers of deaths per 100,000 prescriptions of individual antidepressants., Results: Twenty per cent (2,503) of all deaths from overdose or poisoning were antidepressant related. The number of deaths increased by 18% between 1993 and 1997. Ninety-five per cent of deaths from antidepressants were associated with tricyclic antidepressants, particularly dothiepin and amitriptyline. Tricyclic antidepressants were associated with 5.3 deaths per 100,000 prescriptions, 4.4 for monoamine oxidase inhibitors and 0.4 for selective serotonin reuptake inhibitors. Annual death rates were highest in men aged 30-44 years (18.2 per million) and women aged 45-59 years (14.8). Death rates from antidepressants were 2.5 times higher in the most deprived fifth than in the least deprived fifth of enumeration districts., Conclusions: Antidepressants are an important cause of death from poisoning and overdose. SSRIs and newer antidepressants are associated with <10% of the risk of death than the older antidepressants. There is a strong association between area deprivation and deaths from antidepressants.

Objective: To determine the prevalence of atrial fibrillation in England and Wales, and examine trends in its treatment with warfarin and aspirin between 1994 and 1998., Design: Analysis of data from the general practice research database., Setting: England and Wales., Patients: 1.4 million patients registered with 211 general practices., Main Outcome Measures: Age and sex specific prevalence rates of atrial fibrillation; percentage of patients with atrial fibrillation treated with oral anticoagulants or aspirin., Results: The prevalence of atrial fibrillation in 1998 was 12.1/1000 in men and 12.7/1000 in women. Prevalence increased from less than 1/1000 in under 35 year olds to over 100/1000 in those aged 85 years and over. There was a 22% increase in the age standardised prevalence of atrial fibrillation in men and a 14% increase in women between 1994 and 1998. The percentage of patients prescribed oral anticoagulants increased from 20% to 34% in men and from 17% to 25% in women. The percentage of men with atrial fibrillation prescribed aspirin increased from 26% to 36%, and the percentage of women increased from 24% to 36%. Applying the age and sex specific prevalence and treatment rates to the population gives an estimate of around 650 000 cases of atrial fibrillation in England and Wales. The greatest number of cases occurs in the 75-84 year old age group., Conclusions: The number of patients in the community with identified atrial fibrillation is increasing. There has also been a pronounced increase in the percentage of patients with atrial fibrillation prescribed oral anticoagulants or aspirin.

Objectives: To examine incidence, mortality and survival trends in England and Wales for testicular cancer, using the recently developed national cancer and national mortality databases., Methods: The directly age-standardized incidence rates for testicular cancer in England and Wales were calculated for the period 1971-97 and age-standardized mortality for years 1971-99. Trends in the data were then assessed, including the influence of social deprivation on testicular cancer incidence and survival., Results: The number of newly diagnosed cases of testicular carcinoma in 1971-97 in England and Wales increased from almost 650 to 1400. The age-standardized rates were 2.9 per 100000 cases in 1971 and 5.4 per 100000 in 1997, an increase of 88% over 26 years. There was a large decrease in mortality since the mid-1970s, with an age-standardized mortality of < 0.5 per 100000 since 1985. For men with testicular carcinoma diagnosed in 1991-93, the 1-year relative survival was almost 98% and 5-year relative survival almost 95%, compared with 82% and 69%, respectively, for men diagnosed during 1971-75. There is a 'deprivation gap' for the 5-year survival of > 6% in favour of the most affluent socio-economic group, with no significant change over recent years., Conclusions: The incidence of testicular cancer is increasing in England and Wales, consistent with the trend documented in other developed countries. The reduction in mortality has been marked since the mid-1970s, reflecting improved cancer management, in particular the introduction of platinum-based chemotherapy regimens for advanced disease. Survival rates in England and Wales are as good as in other European countries. Further developments in chemotherapy are unlikely to produce such a marked improvement in survival rates again, and minimizing the effect of social status on survival rates should be an important target of future care.

Background: Statins are highly effective in reducing the risk of sudden cardiac death and other acute coronary events in patients with pre-existing ischaemic heart disease or with raised blood cholesterol levels. However, relatively little is known about how statins are used in primary care. The objectives of this study were to investigate age, sex and inter-practice variations in the prescribing of statins., Methods: This was an observational study of statin prescribing rates in 288 general practices in England and Wales that contributed data to the General Practice Research Database in 1996., Results: In 1996, 0.7 per cent of men and 0.5 per cent of women received a prescription for a statin. In the subgroup of patients with a general practitioner (GP) diagnosis of ischaemic heart disease, 13.3 per cent of men and 8.2 per cent of women received a prescription for a statin in 1996. Below the age of 65 years, men with ischaemic heart disease were more likely to be prescribed a statin than were women. Patients aged 75 years and over with ischaemic heart disease were unlikely to be prescribed a statin irrespective of their sex. The percentage of patients prescribed statins in individual practices varied from 0.1 to 2.3 per cent in men and from 0 to 2.3 per cent in women. The recorded prevalence of ischaemic heart disease explained only 12 per cent of this variation in men and 7 per cent in women., Conclusions: There are large age, sex and inter-practice variations in the use of statins in primary care, which are poorly explained by measures of health need. Developing and implementing clinical guidelines to accompany the introduction of new drugs for the management of common chronic disorders should be seen as a priority for GPs, primary care groups and the National Institute of Clinical Excellence.

Objectives: To examine trends in prostate cancer incidence and mortality in England and Wales between 1971 and 1998, using a newly developed and validated national cancer database and the national mortality database., Methods: Age-standardized incidence and death rates were calculated directly and trends in relative survival rates among men with prostate cancer registered during 1971-1990 were examined., Results: The annual number of new cases of prostate cancer registered in England and Wales increased by 179% between 1971 and 1993, from 6174 to 17 210. Directly age-standardized incidence rates increased by 104% between 1971 and 1993, from 29 to 59 per 100 000. The number of deaths from prostate cancer increased by 113% between 1971 and 1998, from 4027 to 8570. Directly age-standardized death rates increased by 49% between 1971 and 1995 and then decreased by 8% between 1995 and 1998, an overall increase of 38% (20 to 27 per 100 000) between 1971 and 1998. The relative survival rate for prostate cancer among men diagnosed during 1986-1990 was 77% at 1 year and 42% at 5 years, compared with 67% and 33%, respectively, for cases diagnosed during 1971-1975. The increase in survival rates was confined to men diagnosed with prostate cancer up to 1985 and no increase was seen for cases diagnosed after 1985., Conclusions: Prostate cancer is becoming a growing burden on the health service. The explanation for the large increase in prostate cancer incidence and mortality is unclear and needs further investigation. The lack of any improvement in survival rates in cases diagnosed after 1985 is of concern, and suggests that the current management of prostate cancer in both primary and secondary care may need to be reviewed.

Using data from 288 general practices in England and Wales contributing data to the General Practice Research Database in 1996, we derived age-sex specific antibiotic prescribing and exposure rates. The overall antibiotic prescribing rate was 607 per 1000 in males and 852 per 1000 in females. In both males and females, prescribing rates were highest in children aged 0-4 years and in the elderly. Prescribing rates in young and middle-aged women were substantially higher than in men of the same age. Overall, 29% of males and 39% of females were prescribed antibiotics in 1996. Children under five years of age were most likely to receive a prescription for an antibiotic. Antibiotic prescribing rates for the 288 practices in the study varied nearly five-fold, from 333 to 1616 per 1000. Reducing this variation and overall antibiotic prescribing rates will be major challenges for general practitioners.

Objective: To establish how consultation rates in children for episodes of illness, preventive activities, and home visits vary by social class., Design: Analysis of prospectively collected data from the fourth national survey of morbidity in general practice, carried out between September 1991 and August 1992., Setting: 60 general practices in England and Wales., Subjects: 106 102 children aged 0 to 15 years registered with the participating practices., Main Outcome Measures: Mean overall consultation rates for any reason, illness by severity of underlying disease, preventive episodes, home visits, and specific diagnostic category (infections, asthma, and injuries)., Results: Overall consultation rates increased from registrar general's social classes I-II to classes IV-V in a linear pattern (for IV-V v I-II rate ratio 1.18; 95% confidence interval 1.14 to 1. 22). Children from social classes IV-V consulted more frequently than children from classes I-II for illnesses (rate ratio 1.23; 1.15 to 1.30), including infections, asthma, and injuries and poisonings. They also had significantly higher consultation rates for minor, moderate, and serious illnesses and higher home visiting rates (rate ratio 2.00; 1.81 to 2.18). Consultations for preventive activities were lower in children from social classes IV-V than in children from social classes I-II (rate ratio 0.95; 0.86 to 1.05)., Conclusions: Childhood consultation rates for episodes of illness increase from social classes I-II through to classes IV-V. The findings on severity of underlying illness suggest the health of children from lower social classes is worse than that of children from higher social classes. These results reinforce the need to identify and target children for preventive health care in their socioeconomic context.