Council tax valuation bands (CTVBs) are a categorisation of household property value in Great Bri... more Council tax valuation bands (CTVBs) are a categorisation of household property value in Great Britain. The aim of the study was to assess the CTVB as a measure of socio-economic status by comparing the strength of the associations between selected health and lifestyle outcomes and CTVBs with two measures of socio-economic status: the National Statistics Socio-Economic Classification (NS-SEC) and the 2001 UK census-based Townsend deprivation index. Cross-sectional analysis of data on 12,092 respondents (adjusted response 62.7%) to the Caerphilly Health and Social Needs Study, a postal questionnaire survey undertaken in Caerphilly county borough, south-east Wales, UK. The CTVB was assigned to each individual by matching the sampling frame to the local authority council tax register. Crude and age-gender adjusted odds ratios for each category of CTVB, NS-SEC and fifth of the ward distribution of Townsend scores were estimated for smoking, poor diet, obesity, and limiting long-term illn...
Background Despite the increasing belief that the places where people live influence their health... more Background Despite the increasing belief that the places where people live influence their health, there is surprisingly little consistent evidence for their associations with mental health. We investigated the joint effect of community and individual-level socioeconomic deprivation and social cohesion on individual mental health status. Methods Multilevel analysis of population survey data on 10 653 adults aged 18-74 years nested within the 325 census enumeration districts in Caerphilly county borough, Wales, UK. The outcome measure was the Mental Health Inventory (MHI-5) subscale of the SF-36 instrument. A social cohesion subscale was derived from a factor analysis of responses to the Neighbourhood Cohesion scale and was modelled at individual and area level. Area income deprivation was measured by the percentage of low income households. Results Poor mental health was significantly associated with area-level income deprivation and low social cohesion after adjusting for individual risk factors. High social cohesion significantly modified the association between income deprivation and mental health: the difference between the predicted mean area mental health scores at the 10th and 90th centiles of the low income distribution was 3.7 in the low cohesion group and 0.9 in the high cohesion group (difference of the difference in means ¼ 2.8, 95% CI: 0.2, 5.4). Conclusions Income deprivation and social cohesion measured at community level are potentially important joint determinants of mental health. Further research on the impact of the social environment on mental health should investigate causal pathways in a longitudinal study.
Objective: To evaluate the disease burden of upper respiratory infections in elderly people livin... more Objective: To evaluate the disease burden of upper respiratory infections in elderly people living at home. Design: Prospective surveillance of elderly people. Intervention: None. Setting: Leicestershire, England Subjects: 533 subjects 60 to 90 years of age. Main outcome measures: Pathogens, symptoms, restriction of activity, duration of illness, medical consultations, interval between onset of illness and medical consultation, antibiotic use, admission to hospital, and death. Results: 231 pathogens were identified for 211 (43%) of 497 episodes for which diagnostic specimens were available: 121 (52%) were rhinoviruses, 59 (26%) were coronaviruses, 22 (9.5%) were influenza A or B, 17 (7%) were respiratory syncytial virus, 7 (3%) were parainfluenza viruses, and 3 (1%) were Chlamydia species; an adenovirus and Mycoplasma pneumoniae caused one infection each. Infections occurred at a rate of 1.2 episodes per person per annum (95% confidence interval 1.0 to 1.7; range 0-10) and were clinically indistinguishable. Lower respiratory tract symptoms complicated 65% of upper respiratory infections and increased the medical consultation rate 2.4-fold (2 test P < 0.001). The median interval between onset of illness and medical consultation was 3 days for influenza and 5 days for other infections. Rhinoviruses caused the greatest disease burden overall followed by episodes of unknown aetiology, coronaviruses, influenza A and B, and respiratory syncytial virus. Conclusions: Respiratory viruses cause substantial morbidity in elderly people. Although respiratory syncytial virus and influenza cause considerable individual morbidity, the burden of disease from rhinovirus infections and infections of unknown aetiology seems greater overall. The interval between onset of illness and consultation together with diagnostic difficulties raises concern regarding the role of antiviral drugs in treating influenza.
Abstract Background: Influenza vaccine uptake in the United Kingdom has been improving steadily d... more Abstract Background: Influenza vaccine uptake in the United Kingdom has been improving steadily during the 1990s. In late 1998 the government announced that it was revising its guidelines for vaccine use to include all those 75 years and above as well as those in the previous high-risk categories. The author and others have shown that these changes would increase the high-risk pool of individuals, in Wales (population 2.9 million), recommended for vaccination to 15%. This present study builds on previous work on vaccine usage by Welsh general medical practitioners and quantifies the response to the policy change at both a national and practice level. Methods: Using information from the prescription pricing authority for Wales and computerised medical practices, vaccine uptake rates were calculated nationally for Wales, by administrative health regions, with a population of 550,000 on average, and by individual practices in southeast Wales. This data has been available from the early 1990s to the present day and covers the winter of 1998/1999, when policy was changed. Results: Since the 1980s, the uptake of vaccine has risen marginally in Wales from 8.7% of the population being vaccinated in 1993 to 9% in 1998/1999. Despite the change in government policy, no significant increase in response to this was seen at any population level. Less than 50% of those recommended for vaccination received it, with a 10-fold variation in the percentage of the population vaccinated by individual general medical practices. Conclusions: This study demonstrates that changes in government vaccination policy have made little difference to the vaccination practices of individual doctors. There still exists a shortfall between 2% and 6% (assuming that all vaccine doses are given to those who require it) between the vaccine delivered and the pool of the population at risk. In the United Kingdom, a vaccination policy left to individual practices to organise, with little central coordination or funding, leads to wide-scale variation and a large percentage of the population left unprotected.
Background: Influenza is a serious disease, with vaccination the mainstay of control. Children wi... more Background: Influenza is a serious disease, with vaccination the mainstay of control. Children without chronic diseases are not deemed at special risk are recommended for vaccination. The impact of influenza disease in childhood is quantified by using a number of sources of data. Method: Data from published sources, literature from population surveillance networks and population cohort studies and data on the incidence of disease derived from the control arm of randomised, controlled vaccine or influenza antiviral studies were used. In addition, the General Practice Research Database in the United Kingdom, PHLS Wales spotter practice network and the Patient Enquiry Database for Wales (PEDW) were used and results compared with the published findings. Results: Each winter, 1-2% of the under 5 age group suffer influenza severe enough to consult their family physician. On average, annually, 10% of children contract clinical influenza, while a further 20% may be asymptomatic. During epidemics, up to 50% may contract the virus; 30-40% of children in day care suffer with influenza-related otitis media, while one-third of the siblings of children infected with influenza suffer days off from school and 25% of parents lose time from work. During the period 1995-1999, a time of moderate influenza activity, six extra cases per 1000 of the population per annum were admitted to hospital with influenza, with an average age of 2 years. Deaths due to influenza in childhood are an extremely rare event in the healthy population. Conclusions: Influenza is an important disease in childhood that results in a significant impact on children's health, that of their siblings and the economic productivity of their parents. The added benefits to society of targeting this age group for vaccination with live attenuated virus vaccines may help reduce influenza-related consultations in primary care, both directly and in reducing community spread.
Council tax valuation bands (CTVBs) are a categorisation of household property value in Great Bri... more Council tax valuation bands (CTVBs) are a categorisation of household property value in Great Britain. The aim of the study was to assess the CTVB as a measure of socio-economic status by comparing the strength of the associations between selected health and lifestyle outcomes and CTVBs with two measures of socio-economic status: the National Statistics Socio-Economic Classification (NS-SEC) and the 2001 UK census-based Townsend deprivation index. Cross-sectional analysis of data on 12,092 respondents (adjusted response 62.7%) to the Caerphilly Health and Social Needs Study, a postal questionnaire survey undertaken in Caerphilly county borough, south-east Wales, UK. The CTVB was assigned to each individual by matching the sampling frame to the local authority council tax register. Crude and age-gender adjusted odds ratios for each category of CTVB, NS-SEC and fifth of the ward distribution of Townsend scores were estimated for smoking, poor diet, obesity, and limiting long-term illn...
Background Despite the increasing belief that the places where people live influence their health... more Background Despite the increasing belief that the places where people live influence their health, there is surprisingly little consistent evidence for their associations with mental health. We investigated the joint effect of community and individual-level socioeconomic deprivation and social cohesion on individual mental health status. Methods Multilevel analysis of population survey data on 10 653 adults aged 18-74 years nested within the 325 census enumeration districts in Caerphilly county borough, Wales, UK. The outcome measure was the Mental Health Inventory (MHI-5) subscale of the SF-36 instrument. A social cohesion subscale was derived from a factor analysis of responses to the Neighbourhood Cohesion scale and was modelled at individual and area level. Area income deprivation was measured by the percentage of low income households. Results Poor mental health was significantly associated with area-level income deprivation and low social cohesion after adjusting for individual risk factors. High social cohesion significantly modified the association between income deprivation and mental health: the difference between the predicted mean area mental health scores at the 10th and 90th centiles of the low income distribution was 3.7 in the low cohesion group and 0.9 in the high cohesion group (difference of the difference in means ¼ 2.8, 95% CI: 0.2, 5.4). Conclusions Income deprivation and social cohesion measured at community level are potentially important joint determinants of mental health. Further research on the impact of the social environment on mental health should investigate causal pathways in a longitudinal study.
Objective: To evaluate the disease burden of upper respiratory infections in elderly people livin... more Objective: To evaluate the disease burden of upper respiratory infections in elderly people living at home. Design: Prospective surveillance of elderly people. Intervention: None. Setting: Leicestershire, England Subjects: 533 subjects 60 to 90 years of age. Main outcome measures: Pathogens, symptoms, restriction of activity, duration of illness, medical consultations, interval between onset of illness and medical consultation, antibiotic use, admission to hospital, and death. Results: 231 pathogens were identified for 211 (43%) of 497 episodes for which diagnostic specimens were available: 121 (52%) were rhinoviruses, 59 (26%) were coronaviruses, 22 (9.5%) were influenza A or B, 17 (7%) were respiratory syncytial virus, 7 (3%) were parainfluenza viruses, and 3 (1%) were Chlamydia species; an adenovirus and Mycoplasma pneumoniae caused one infection each. Infections occurred at a rate of 1.2 episodes per person per annum (95% confidence interval 1.0 to 1.7; range 0-10) and were clinically indistinguishable. Lower respiratory tract symptoms complicated 65% of upper respiratory infections and increased the medical consultation rate 2.4-fold (2 test P < 0.001). The median interval between onset of illness and medical consultation was 3 days for influenza and 5 days for other infections. Rhinoviruses caused the greatest disease burden overall followed by episodes of unknown aetiology, coronaviruses, influenza A and B, and respiratory syncytial virus. Conclusions: Respiratory viruses cause substantial morbidity in elderly people. Although respiratory syncytial virus and influenza cause considerable individual morbidity, the burden of disease from rhinovirus infections and infections of unknown aetiology seems greater overall. The interval between onset of illness and consultation together with diagnostic difficulties raises concern regarding the role of antiviral drugs in treating influenza.
Abstract Background: Influenza vaccine uptake in the United Kingdom has been improving steadily d... more Abstract Background: Influenza vaccine uptake in the United Kingdom has been improving steadily during the 1990s. In late 1998 the government announced that it was revising its guidelines for vaccine use to include all those 75 years and above as well as those in the previous high-risk categories. The author and others have shown that these changes would increase the high-risk pool of individuals, in Wales (population 2.9 million), recommended for vaccination to 15%. This present study builds on previous work on vaccine usage by Welsh general medical practitioners and quantifies the response to the policy change at both a national and practice level. Methods: Using information from the prescription pricing authority for Wales and computerised medical practices, vaccine uptake rates were calculated nationally for Wales, by administrative health regions, with a population of 550,000 on average, and by individual practices in southeast Wales. This data has been available from the early 1990s to the present day and covers the winter of 1998/1999, when policy was changed. Results: Since the 1980s, the uptake of vaccine has risen marginally in Wales from 8.7% of the population being vaccinated in 1993 to 9% in 1998/1999. Despite the change in government policy, no significant increase in response to this was seen at any population level. Less than 50% of those recommended for vaccination received it, with a 10-fold variation in the percentage of the population vaccinated by individual general medical practices. Conclusions: This study demonstrates that changes in government vaccination policy have made little difference to the vaccination practices of individual doctors. There still exists a shortfall between 2% and 6% (assuming that all vaccine doses are given to those who require it) between the vaccine delivered and the pool of the population at risk. In the United Kingdom, a vaccination policy left to individual practices to organise, with little central coordination or funding, leads to wide-scale variation and a large percentage of the population left unprotected.
Background: Influenza is a serious disease, with vaccination the mainstay of control. Children wi... more Background: Influenza is a serious disease, with vaccination the mainstay of control. Children without chronic diseases are not deemed at special risk are recommended for vaccination. The impact of influenza disease in childhood is quantified by using a number of sources of data. Method: Data from published sources, literature from population surveillance networks and population cohort studies and data on the incidence of disease derived from the control arm of randomised, controlled vaccine or influenza antiviral studies were used. In addition, the General Practice Research Database in the United Kingdom, PHLS Wales spotter practice network and the Patient Enquiry Database for Wales (PEDW) were used and results compared with the published findings. Results: Each winter, 1-2% of the under 5 age group suffer influenza severe enough to consult their family physician. On average, annually, 10% of children contract clinical influenza, while a further 20% may be asymptomatic. During epidemics, up to 50% may contract the virus; 30-40% of children in day care suffer with influenza-related otitis media, while one-third of the siblings of children infected with influenza suffer days off from school and 25% of parents lose time from work. During the period 1995-1999, a time of moderate influenza activity, six extra cases per 1000 of the population per annum were admitted to hospital with influenza, with an average age of 2 years. Deaths due to influenza in childhood are an extremely rare event in the healthy population. Conclusions: Influenza is an important disease in childhood that results in a significant impact on children's health, that of their siblings and the economic productivity of their parents. The added benefits to society of targeting this age group for vaccination with live attenuated virus vaccines may help reduce influenza-related consultations in primary care, both directly and in reducing community spread.
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