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1.  Area Differences in Spontaneous Abortion Rates in South Wales and Their Relation to Neural Tube Defect Incidence 
British Medical Journal  1973;4(5883):20-22.
Data are presented from the South Wales Congenital Malformation Survey (92,982 births 1964-6 inclusive) showing that within areas in South Wales there exists an inverse relation between previous spontaneous abortion rate and the prevalence at birth of neural tube defect (anencephaly or spina bifida cystica or both). This relation is independent of social class, parity, and maternal age, and is not likely to be explained by area differences in accuracy of reporting previous spontaneous abortions.
On the basis of these findings a hypothesis is advanced which proposes that the incidence of neural tube defects is uniform throughout South Wales and that the present substantial and relatively stable differences in area prevalence are controlled by small area differences in mortality of malformed embryos. This would seem to suggest that factors initiating the malformation are genetic and that any related environmental factors exert their effect on already abnormal fetuses by influencing, in one way or another, their capacity to survive.
PMCID: PMC1587098  PMID: 4585417
2.  Trace elements in water and congenital malformations of the central nervous system in South Wales. 
The concentrations of 20 trace elements were determined by atomic absorption spectrophotometry on representative samples of tap-water collected from 48 local authority areas in South Wales. The associations between twelve trace elements and central nervous system (CNS) malformation rates for the 48 areas were examined. Significant correlations for four trace elements were observed. Of these, Al was positively correlated while for the remaining three-Ca, Ba, and Cu-negative associations were found. Regression analysis of the data suggested that the relationships between Ba and Cu with CNS malformation rates were improtant than those of Al and Ca.
PMCID: PMC478936  PMID: 949571
3.  Disease Presentation in Relation to Infection Foci for Non-Pregnancy-Associated Human Listeriosis in England and Wales, 2001 to 2007▿  
Journal of Clinical Microbiology  2009;47(10):3301-3307.
Listeriosis is a rare but severe food-borne disease, affecting unborn or newly delivered infants, the elderly, and the immunocompromised. The epidemiology of listeriosis in England and Wales changed between 2001 and 2007, with more patients ≥60 years old presenting with bacteremia (but without central nervous system [CNS] involvement). In order to explain this increase and understand the altered disease presentation, clinical, microbiological, and seasonal data on bacteremic cases of Listeria monocytogenes infection identified through national surveillance were compared with those for patients with CNS infections. Logistic regression analysis was applied while controlling for age. Bacteremic patients, who presented more frequently with gastrointestinal symptoms, were more likely to have underlying medical conditions than CNS patients. This was most marked in patients with malignancies, particularly digestive organ malignancies. Treatment to reduce stomach acid secretion modified the effect of nonmalignant underlying conditions on outcome, i.e., patients with an underlying condition who were not taking acid-suppressing medication were equally likely to have a bacteremic or a CNS infection. However, this type of therapy did not modify the effect of malignancies on the likelihood of having a bacteremic or a CNS infection. The increase in the incidence of human listeriosis among patients ≥60 years old in England and Wales between 2001 and 2007 appears to have occurred in those with cancer or other conditions whose treatment included acid-suppressing medication. Therefore, this vulnerable patient group needs specific dietary advice on avoiding risk factors for listeriosis.
doi:10.1128/JCM.00969-09
PMCID: PMC2756898  PMID: 19675217
4.  Neural tube defects in New South Wales, Australia 
Journal of Medical Genetics  1978;15(5):329-338.
Cases of spina bifida cystica, encephalocele, and anencephaly occurring over a 9-year period, 1965 to 1973, in New South Wales, Australia, were identified. A low frequency of 1·1 for spina bifida and encephalocele (SB) and 0·9 for anencephaly (A) was found.
Secular trends parallel to those observed in the northern hemisphere were noted.
Detailed analysis of 1575 cases showed an excess of births in spring, corresponding with conception in the summer months, after correction for shorter gestation in anencephalus, which varies from the peak of spring conceptions observed in British studies.
An excess of female cases for each abnormality and a social class effect with a deficit of cases in classes I and II and an excess in classes IV and V and ex-nuptial births were apparent. The first birth rank for younger mothers did not show a significantly increased risk; however, the effect of high birth rank and older maternal age was more significant. Migration studies showed that in migrating from areas of high incidence these parents maintain a higher risk than the Australian population.
The highest risk group was that in which both parents were born in the UK, and the next highest that in which an English-born mother was married to an Australian father.
Mothers from Malta, and either or both parents from Lebanon, Egypt, and Austria were also at high risk.
Part-aboriginal children had a higher risk rate for ASB than white Australian children.
The proportion of older sibs affected was 4·12% of sibs of both sexes of an index case of spina bifida, and 3·19% of an index case of anencephaly. The abnormalities alternate or recur in families. An increased perinatal mortality rate in sibs was shown.
Twin studies showed a higher concordance rate for monochorionic pairs.
A sequential interaction in an excess of opposite sex sib before an index case was apparent.
The results of this study support a multifactorial aetiology for ASB resulting from genetic environmental interaction.
New South Wales is the eastern coastal state of Australia, with an area of 309 433 square miles and a population of 4 640 800 at the 1971 Census. The continent is geographically isolated with a large migrant population, seasonal reversal, and a hot climate.
PMCID: PMC1013727  PMID: 739521
5.  Late entry to antenatal care in New South Wales, Australia 
Aims
This study aimed to assess the prevalence of women who entered antenatal care (ANC) late and to identify factors related to the late entry to ANC in New South Wales (NSW) in 2004.
Methods
The NSW Midwives Data Collection contained data of 85,034 women who gave birth in 2004. Data were downloaded using SAS and transferred to STATA 8.0. Entering ANC after 12 weeks of gestation was classified as late. The Andersen Health Seeking Behaviour Model was used for selection and analyses of related factors. Regression and hierarchical analyses were used to identify significant factors and their relative contributions to the variation of pregnancy duration at entry to ANC.
Results
41% of women commenced ANC after 12 weeks of gestation. Inequality existed between groups of women with predisposing characteristics and enabling resources contributed more to the variation in pregnancy duration at entry to ANC than needs. The groups of women with highest risk were teenagers, migrants from developing countries, women living in Western Sydney, Aboriginal and Torres Strait Islanders, women with three or more previous pregnancies and heavy smokers. The high risk groups with largest number of women were migrants from developing countries and women living in Western Sydney.
Conclusion
A large number of women in NSW entered ANC late in their pregnancies. Efforts to increase early entry to ANC should be targeted on identified high risk groups of women.
doi:10.1186/1742-4755-3-8
PMCID: PMC1562358  PMID: 16916473
6.  Temperature-Driven Campylobacter Seasonality in England and Wales 
Campylobacter incidence in England and Wales between 1990 and 1999 was examined in conjunction with weather conditions. Over the 10-year interval, the average annual rate was determined to be 78.4 ± 15.0 cases per 100,000, with an upward trend. Rates were higher in males than in females, regardless of age, and highest in children less than 5 years old. Major regional differences were detected, with the highest rates in Wales and the southwest and the lowest in the southeast. The disease displayed a seasonal pattern, and increased campylobacter rates were found to be correlated with temperature. The most marked seasonal effect was observed for children under the age of 5. The seasonal pattern of campylobacter infections indicated a linkage with environmental factors rather than food sources. Therefore, public health interventions should not be restricted to food-borne approaches, and the epidemiology of the seasonal peak in human campylobacter infections may best be understood through studies in young children.
doi:10.1128/AEM.71.1.85-92.2005
PMCID: PMC544220  PMID: 15640174
7.  Epidemiology of Influenza-like Illness during Pandemic (H1N1) 2009, New South Wales, Australia 
Emerging Infectious Diseases  2011;17(7):1240-1247.
To rapidly describe the epidemiology of influenza-like illness (ILI) during the 2009 winter epidemic of pandemic (H1N1) 2009 virus in New South Wales, Australia, we used results of a continuous population health survey. During July–September 2009, ILI was experienced by 23% of the population. Among these persons, 51% were unable to undertake normal duties for <3 days, 55% sought care at a general practice, and 5% went to a hospital. Factors independently associated with ILI were younger age, daily smoking, and obesity. Effectiveness of prepandemic seasonal vaccine was ≈20%. The high prevalence of risk factors associated with a substantially increased risk for ILI deserves greater recognition.
doi:10.3201/eid1707.101173
PMCID: PMC3381394  PMID: 21762578
data collection; population; influenza; human; disease outbreaks; viruses; influenza-like illness; Australia; pandemic (H1N1) 2009; research
8.  Trends in teenage pregnancy in England and Wales: how can we explain them? 
Teenage pregnancy is associated with adverse social and physical outcomes for both mother and child. We drew on various sources--birth and abortion statistics from the Office for National Statistics, data from the National Survey of Sexual Attitudes and Lifestyles, and routinely collected data from family planning clinics--to identify trends in England and Wales and their possible determinants. The rate of teenage sexual activity has increased steadily and consistently over the past four decades, whilst the rate of teenage fertility has shown greater variation. When the teenage fertility rate is calculated against the denominator of sexually active women, rather than the total sample of teenage women, the underlying trend in teenage fertility over the past four decades has been downwards, though not consistently so. Fluctuations in the teenage fertility rate seem to track intervention-related factors such as access to, and use of, contraceptive services and the general climate surrounding the sexual health of young people.
PMCID: PMC1297204  PMID: 10472279
9.  Seasonal variation and time trends in childhood asthma in England and Wales 1975-81. 
In England and Wales hospital admissions for childhood asthma almost trebled over the period 1975-81. This may have reflected a true increase in the incidence of acute asthma, a swing from primary to hospital care, or both. The trend was not due to a change in diagnostic fashion. Monthly admissions showed a pronounced seasonal variation with fewest admissions in winter, rising in spring and early summer to peak in the autumn. A deep admission trough was present in August. The monthly admission profile was very similar throughout England and Wales, suggesting that major "trigger" factors were responsible.
PMCID: PMC1442312  PMID: 6430420
10.  Acanthamoeba keratitis in England and Wales: incidence, outcome, and risk factors 
AUTHOR:e-mail address please Aim: To determine the incidence, regional variation in frequency, outcome, and risk factors for acanthamoeba keratitis (AK) in England and Wales.
Methods: AK cases presenting from 1 October 1997 to 30 September 1999 were identified by the British Ophthalmic Surveillance Unit active reporting system. Clinical and patient postal questionnaire data were analysed.
Results: 106 reported cases met study criteria. The annual incidence for the 2 years was 1.26 and 1.13 per million adults and, for contact lens (CL) wearers, 21.14 and 17.53 per million. There was marked regional variation in incidence (0 to 85.13 per million adult CL wearers), with CL wearers in the south having a ninefold increased risk of AK compared with those resident in the north (95% confidence limits: 2.2–38.9, p<0.0001), and a threefold increased risk with hard as opposed to soft domestic water (95% confidence limits: 1.73 to 6.58, p<0.001). Treatment and outcome data were similar to those previously reported. 93/106 (88%) patients were CL wearers. Among these, 46/77 (60%) were disinfecting irregularly, and 20/63 (32%) had been swimming in CLs. One step hydrogen peroxide and chlorine release soft CL (SCL) disinfection systems were significantly over-represented among the cases. Among SCL users, one or more previously established risk factors for AK were identified in 50/55 (91%) patients.
Conclusions: The incidence was considerably higher than most previous estimates, and was static. The geographical variation in incidence may be partly related to the increase in risk associated with hard water. The fact that water quality can have such an effect on the risk of AK suggests that many CL wearers must be letting tapwater come into contact with their lenses or storage cases. Improved education for CL wearers and practitioners about hygiene practice and the variable efficacy of contact lens systems could be expected to reduce the incidence of this disease.
PMCID: PMC1771120  PMID: 11973250
acanthamoeba; keratitis; England and Wales
11.  Suicide and political regime in New South Wales and Australia during the 20th century 
Study objective: Australia has had a two party parliamentary political system for most of the period since its Federation in 1901, dominated either by a social democratic (Labor) or a conservative ideological perspective. This paper investigates whether such political differences at Federal and State levels have influenced suicide rates in the state of New South Wales (NSW) for the period 1901–1998.
Design: Federal government type, NSW State government type, and combinations of both Federal and NSW State government type were examined. Poisson regression models were stratified by sex and controlled for the effects of age, annual change in gross domestic product, sedative availability, drought, and both world wars.
Results: When both Federal and NSW State governments were conservative the relative risk of suicide for NSW men was 1.17 (p<0.001) and for women 1.40 (p<0.001) compared with both governments being Labor (1.00). A statistically significant linear trend (p<0.001) in suicide risk was evident across the continuum of Federal/State government combinations, from both Labor (lowest), to mixed (intermediate), to both conservative (highest).
Conclusion: Significantly higher suicide risk was associated with conservative government tenures compared with social democratic incumbents. Results are discussed in terms of the differences underpinning conservative and social democratic government programme ideology, and their relevance to Durkheim's theories of suicide, social regulation, and integration.
doi:10.1136/jech.56.10.766
PMCID: PMC1732038  PMID: 12239203
12.  Geographical variation in mortality from leukaemia and other cancers in England and Wales in relation to proximity to nuclear installations, 1969-78. 
British Journal of Cancer  1989;59(3):476-485.
The distribution of mortality from 11 causes of death (lymphoid leukaemia, other leukaemia, leukaemia of all types, Hodgkin's disease, other lymphomas, all lymphomas, multiple myeloma, lung cancer, other malignancies, all malignancies and all other causes) has been examined in three age groups throughout England and Wales over the period 1969-78. The reorganisation of local authority administration in 1974 meant that the smallest areas that could be examined were 400 county districts or (in some cases) approximate county districts formed by aggregating pre-1974 local authority areas. The variation in the numbers of deaths observed about the numbers expected was assessed using log-linear models to estimate the effect on the relative risk in each district associated with social class, rural status, population size, health authority region and proximity to one of 15 nuclear installations. Trends in risk with increasing proximity to an installation (as judged by the proportion of the population resident within 10 miles) were examined after adjustment for the other four variables. The results showed that in districts near to an installation there were significant excess mortalities in persons under 25 years of age from leukaemia (RR = 1.15, P = 0.01) and especially from lymphoid leukaemia (RR 1.21, P = 0.01) and from Hodgkin's disease (RR 1.24, P = 0.05) and a significant deficiency of mortality from lymphoid leukaemia in persons aged 25-64 years. No significant trends were observed with an increasing proportion of the population near to the installations and the greatest excess mortality from lymphoid leukaemia in young persons was observed in the districts with the intermediate proportion of the population (10.0-65.9%) near an installation.
PMCID: PMC2247055  PMID: 2930718
13.  Seasonality of coronary artery deaths in New South Wales, Australia 
Heart  2002;88(1):30-34.
Background: Complex temporal variations in coronary deaths, including diurnal, weekly, and seasonal trends, have been reported worldwide.
Objective: To describe the magnitude of seasonal changes in coronary artery deaths in New South Wales, Australia.
Design: Hospital morbidity data, mortality statistics, and meteorological data were modelled using time series techniques to determine seasonality of coronary deaths. Data were also analysed to determine whether there was an increase in deaths before or after the Christmas and New Year holidays.
Results: A clear seasonality of coronary deaths was shown, with a peak in July. A mean of 2.8 excess coronary deaths per 100 deaths was estimated to occur from June to August each year, with a mean annual excess of 224 winter deaths a year. Mortality data did not show an increase in coronary death ratios before (p = 0.626) or after (p = 0.813) the Christmas and New Year holidays in December.
Conclusions: There is a higher incidence of coronary deaths in winter, which may reflect winter respiratory infections, the direct effect of cold, seasonal changes in lipid concentration, and other factors associated with winter. Hospitals should have contingency plans during the winter months to manage larger numbers of cardiac admissions.
PMCID: PMC1767180  PMID: 12067938
coronary artery disease; mortality; seasonality
14.  Why is chest disease so common in South Wales? Smoking, social class, and lung function: a survey of elderly men in two areas. 
A respiratory survey was conducted in two British towns, one with a high mortality (Caerphilly) and one with a low mortality (Bath) from respiratory disease. A total of 513 men aged 65-74 years were seen. The Caerphilly men had poorer lung function than the Bath men; the overall difference in FEV1 and FVC for men aged 70 and 1.68m tall was 0.16 1 and 0.17 1 respectively. These differences appeared to be largely due to the greater tendency of the Caerphilly men to smoke and to an effect related to social class. Respiratory symptoms were also more common in Caerphilly, principally because of the effects of smoking and occupational group, although when these factors were allowed for there was still a significantly greater prevalence of breathless wheezing in Caerphilly.
PMCID: PMC1052599  PMID: 3655633
15.  Recent trends in incidence of and mortality from breast, ovarian and endometrial cancers in England and Wales and their relation to changing fertility and oral contraceptive use. 
British Journal of Cancer  1995;72(2):485-492.
Reproductive-related factors play a major role in the aetiology of cancers of the breast, ovary and endometrium. Pregnancy history influences the risk of each of these cancers, and oral contraceptive use modifies the risks of ovarian and endometrial cancers, although its effect on breast cancer risk is less certain. We analysed recent time trends in the incidence and mortality of these cancers in England and Wales and assessed whether they can be explained by changes in fertility and oral contraceptive use. During 1962-87, there were significant increases in the overall incidence of breast cancer (0.95% increase per annum) and ovarian cancer (0.76% per annum) but little increase in endometrial cancer (0.13% per annum). At young ages incidence of each of the cancers has declined in recent years, whereas at older ages there have been substantial increases. Mortality data show similar time trends. In analyses by birth cohort, incidence of each of the cancers increased steeply for successive cohorts born before the turn of the century, and more slowly for cohorts thereafter, reaching a maximum for those born in the 1920s, and decreased for those born subsequently. The increases in incidence for women born before the turn of the century paralleled marked declines in their fertility. The fall in risk for women born after the 1920s was not accompanied by significant increases in their fertility, but coincided with the introduction and increase in use of oral contraceptives. For ovarian and endometrial cancers this accords with strong evidence from person-based studies of the protective effect of oral contraceptives. For breast cancer, the reasons for the recent decline are not clear. It would accord with recent suggestions of a long-term protective effect of oral contraceptives, on which further studies are needed. It is also possible, however, that changes in other risk factors such as dietary fat intake and menarcheal age might have contributed to the recent declines in the risk of these cancers.
PMCID: PMC2033995  PMID: 7640237
16.  Mortality from congenital malformations in England and Wales: variations by mother's country of birth. 
Archives of Disease in Childhood  1989;64(10):1457-1462.
Stillbirth and infant mortality from congenital malformations in England and Wales during 1981-5 was investigated according to the mother's country of birth. Significant differences remained after standardising for maternal age and social class. The highest overall mortality was in infants of mothers born in Pakistan (standardised mortality ratio 237), followed by infants of mothers born in India (standardised mortality ratio 134), East Africa (standardised mortality ratio 126), and Bangladesh (standardised mortality ratio 118). Caribbean and West African mothers showed an overall deficit. Mortality was inversely related to social class in all groups except the Afro-Caribbean. Infants of mothers born in Pakistan had the highest mortality in every social class except I, and for most anomalies investigated. Their ratios were particularly high for limb and musculoskeletal anomalies (standardised mortality ratio 362), genitourinary anomalies (standardised mortality ratio 268), and central nervous system anomalies (standardised mortality ratio 239). Our findings highlight the need for further research to identify the causes underlying these differences.
PMCID: PMC1792797  PMID: 2817931
17.  Mind the gap between policy imperatives and service provision: a qualitative study of the process of respiratory service development in England and Wales 
Background
Healthcare systems globally are reconfiguring to address the needs of people with long-term conditions such as respiratory disease. Primary Care Organisations (PCOs) in England and Wales are charged with the task of developing cost-effective patient-centred local models of care. We aimed to investigate how PCOs in England and Wales are reconfiguring their workforce to develop respiratory services, and the background factors influencing service redesign.
Methods
Semi-structured qualitative telephone interviews with the person(s) responsible for driving respiratory service reconfiguration in a purposive sample of 30 PCOs. Interviews were recorded, transcribed, coded and thematically analysed.
Results
We interviewed representatives of 30 PCOs with diverse demographic profiles planning a range of models of care. Although the primary driver was consistently identified as the need to respond to a central policy to shift the delivery of care for people with long-term conditions into the community whilst achieving financial balance, the design and implementation of services were subject to a broad range of local, and at times serendipitous, influences. The focus was almost exclusively on the complex needs of patients at the top of the long-term conditions (LTC) pyramid, with the aim of reducing admissions. Whilst some PCOs seemed able to develop innovative care despite uncertainty and financial restrictions, most highlighted many barriers to progress, describing initiatives suddenly shelved for lack of money, progress impeded by reluctant clinicians, plans thwarted by conflicting policies and a PCO workforce demoralised by job insecurity.
Conclusion
For many of our interviewees there was a large gap between central policy rhetoric driving workforce change, and the practical reality of implementing change within PCOs when faced with the challenges of limited resources, diverse professional attitudes and an uncertain organisational context. Research should concentrate on understanding these complex dynamics in order to inform the policymakers, commissioners, health service managers and professionals.
doi:10.1186/1472-6963-8-248
PMCID: PMC2632662  PMID: 19055843
18.  Comparison of central nervous system malformations in spontaneous absortions in Northern Ireland and south-east England. 
British Medical Journal  1979;1(6175):1395-1397.
A study of 1140 pregnancies ending in spontaneous abortion disclosed a central nervous system (CNS) malformation in 4.9% of all complete conceptuses. Life-table analysis suggested that the incidence of CNS malformations is 16/1000 at the beginning of the eighth week of gestation. It was also estimated that only one-fifth of these infants are born alive, 41% being aborted spontaneously and 38% stillborn. A hypothesis that differences in the incidence of CNS malformations result from area differences in the mortality rate of malformed embryos and fetuses was examined by comparing the findings in Northern Ireland, an area of high incidence, with those in south-east England, an area of low incidence. In Northern Ireland 4.6% of complete conceptuses had a CNS malformation compared with 3.0% in south-east England, but the difference was not statistically significant. There is no evidence that in Northern Ireland a lower mortality rate among malformed fetuses and embryos is responsible for the high incidence of malformation at birth. The geographical variation of CNS malformations in the United Kingdom still awaits explanation.
PMCID: PMC1598902  PMID: 445098
19.  Epidemiology and trends for Caesarean section births in New South Wales, Australia: A population-based study 
Background
Caesarean section (CS) rates around the world have been increasing and in Australia have reached 30% of all births. Robson's Ten-Group Classification System (10-group classification) provides a clinically relevant classification of CS rates that provides a useful basis for international comparisons and trend analyses. This study aimed to investigate trends in CS rates in New South Wales (NSW), including trends in the components of the 10-group classification.
Methods
We undertook a cross-sectional study using data from the Midwives Data Collection, a state-wide surveillance system that monitors patterns of pregnancy care, services and pregnancy outcomes in New South Wales, Australia. The study population included all women giving birth between 1st January 1998 and 31st December 2008. Descriptive statistics are presented including age-standardised CS rates, annual percentage change as well as regression analyses.
Results
From 1998 to 2008 the CS rate in NSW increased from 19.1 to 29.5 per 100 births. There was a significant average annual increase in primary 4.3% (95%CI 3.0-5.7%) and repeat 4.8% (95% CI 3.9-5.7%) CS rates from 1998 to 2008. After adjusting for maternal and pregnancy factors, the increase in CS delivery over time was maintained. When examining CS rates classified according to the 10-group classification, the greatest contributors to the overall CS rate and the largest annual increases occurred among nulliparae at term having elective CS and multipara having elective repeat CS.
Conclusions
Given that the increased CS rate cannot be explained by known and collected maternal or pregnancy characteristics, the increase may be related to differences in clinical decision making or maternal request. Future efforts to reduce the overall CS rate should be focussed on reducing the primary CS rate.
doi:10.1186/1471-2393-11-8
PMCID: PMC3037931  PMID: 21251270
20.  Socio-demographic factors associated with smoking and smoking cessation among 426,344 pregnant women in New South Wales, Australia 
BMC Public Health  2005;5:138.
Background
This study explores the socio-demographic characteristics of pregnant women who continue to smoke during the pregnancy, and identifies the characteristics of the smokers who were likely to quit smoking during the pregnancy period.
Methods
This was secondary analysis of the New South Wales (NSW) Midwives Data Collection (MDC) 1999–2003, a surveillance system covering all births in NSW public and private hospitals, as well as home births. Bivariate and multiple logistic regression analyses were performed to explore the associations between socio-demographic characteristics and smoking behaviour during pregnancy.
Results
Data from 426,344 pregnant women in NSW showed that 17.0% continued to smoke during pregnancy. The smoking rate was higher among teenage mothers, those with an Aboriginal (indigenous) background, and lower among more affluent and overseas-born mothers. This study also found that unbooked confinements, and lack of antenatal care in the first trimester were strongly associated with increased risk of smoking during pregnancy. About 4.0% of the smoking women reported they may quit smoking during their pregnancy. Findings showed that mothers born overseas, of higher socio-economic status, first time mothers and those who attended antenatal care early showed an increased likelihood of smoking cessation during pregnancy. Those who were heavy smokers were less likely to quit during pregnancy.
Conclusion
Although the prevalence of smoking during pregnancy has been declining, it remains a significant public health concern. Smoking cessation programs should target the population subgroups of women at highest risk of smoking and who are least likely to quit. Effective antismoking interventions could reduce the obstetric and perinatal complications of smoking in pregnancy.
doi:10.1186/1471-2458-5-138
PMCID: PMC1352372  PMID: 16371166
21.  Meteorological associations of cerebrovascular disease mortality in England and Wales. 
The recent decline in stroke mortality, and its seasonal variation, have not been satisfactorily explained through any single factor. Nevertheless, several causes might operate through a single mechanism, namely salt loss variation. The increased use of diuretics could explain the trend, and physiological salt loss variations might explain the cycle. The associations between mortality and meteorological variables were therefore examined. The examination was negative in that temperature correlations were equally strong in winter and in summer, with no support for the hypothesis that temperature-dependent salt loss was a contributing cause. It was found in addition, unexpectedly, that stroke mortality showed strong correlations with atmospheric pollution levels, both in winter and in summer. These correlations were strengthened, rather than dissipated, by standardisation for season and for temperature. The pattern for stroke mortality differed, in these respects, from acute myocardial infarction. The pollution correlations of hypertension deaths were similar to those from stroke, and they were jointly more powerful than correlations with deaths from bronchitis.
PMCID: PMC1052162  PMID: 7328383
22.  Myxomatosis in farmland rabbit populations in England and Wales. 
Epidemiology and Infection  1989;103(2):333-357.
The overall pattern and consequences of myxomatosis in wild rabbit populations were studied at three farmland sites in lowland southern England and upland central Wales between 1971 and 1978. When results from all years were combined, the disease showed a clear two-peaked annual cycle, with a main autumn peak between August and January, and a subsidiary spring peak during February to April. Rabbit fleas, the main vectors of myxomatosis in Britain, were present on full-grown rabbits in sufficient numbers for transmission to occur throughout the year, but the observed seasonal pattern of the disease appeared to be influenced by seasonal mass movements of these fleas. However other factors were also important including the timing and success of the main rabbit breeding season, the proportion of rabbits which had recovered from the disease and the timing and extent of autumn rabbit mortality from other causes. Significantly more males than females, and more adults and immatures than juveniles, were observed to be infected by myxomatosis. Only 25-27% of the total populations were seen to be infected during outbreaks. Using two independent methods of calculation, it was estimated that between 47 and 69% of infected rabbits died from the disease (much lower than the expected 90-95% for fully susceptible rabbits with the partly attenuated virus strains that predominated). Thus it was estimated that 12-19% of the total rabbit populations were known to have died directly or indirectly from myxomatosis. Although the effects of myxomatosis were much less than during the 1950s and 1960s, it continued to be an important mortality factor. It may still have a regulatory effect on rabbit numbers, with autumn/winter peaks of disease reducing the numbers of rabbits present at the start of the breeding season.
PMCID: PMC2249516  PMID: 2806418
23.  The dynamics of scarlet fever epidemics in England and Wales in the 19th century. 
Epidemiology and Infection  1996;117(3):493-499.
There was a marked rise in scarlet fever mortality in England and Wales in the mid-nineteenth century and spectral analysis of the registration details, 1847-80, shows that the interepidemic interval was 5-6 years, but after 1880 the endemic level fell and the fatal epidemics disappeared. The dynamics of the scarlet fever epidemics can be represented by a linearized mathematical model and because the system is lightly damped, it could be driven by an oscillation in susceptibility. Epidemics were significantly correlated with dry conditions in spring/summer (P < 0.001), suggesting that these produced a low amplitude oscillation in susceptibility which drove the system. Epidemics also correlated (P < 0.001) with an oscillation in wheat prices but at a lag of 3 years, suggesting that malnutrition during pregnancy caused increased susceptibility in the subsequent children which interacted synergistically with seasonal dry conditions. Scarlet fever mortality was sharply reduced after 1880 in parallel with falling wheat prices suggesting that the remarkable period of high scarlet fever mortality (1840-80) was dependent on poor nutritive levels during that time.
PMCID: PMC2271647  PMID: 8972674
24.  Congenital malformations and maternal occupation in Finland: multivariate analysis. 
The Finnish Register of Congenital Malformations was used in a multivariate analysis to explore the associations between maternal occupation in industry and children born with central nervous system (CNS) or musculoskeletal or oral cleft malformations. Possible confounding factors were selected in preliminary screening of risk indicators for malformations. These factors included characteristics of the mother, the child, and the family; maternal illnesses; an maternal medication at the time of pregnancy. Tobacco smoking was a confounding factor for all type of malformations; number of children born to the mother, maternal age, malformations in the family, number of rooms occupied by the family, sex of the child, threatened abortion, and continuous medication of the mother during the first trimester confounded the association for certain type of malformations. After adjusting for confounding factors, maternal occupation in industrial trades significantly correlated with CNS, oral cleft, and musculoskeletal malformation in the offspring. Maternal occupation in industry and construction only was significantly associated with CNS malformations in the offspring but the associations with oral cleft and musculoskeletal malformations were not significant.
PMCID: PMC1052111  PMID: 7264533
25.  Urban and Social Origins of Childhood Bronchitis in England and Wales 
British Medical Journal  1970;2(5703):213-217.
A survey of respiratory disease in over 10,000 children aged 6 to 10 years living in contrasting urban and rural areas of England and Wales showed pronounced social class gradient in the frequency of chronic cough, history of bronchitis, and also in disease of ears and nose. A consistent rise in the frequency of chest conditions with increasing local levels of air pollution was clearly seen only among the children of semi-skilled and unskilled workers. No such gradient was obvious for diseases of the ear and nose. These trends in chest disease in children paralleled similar trends in mortal and disabling bronchitis among adults in the same areas. The excess rate for bronchitis in children and adults found in South Wales could not be accounted for by local levels of air pollution.
PMCID: PMC1700070  PMID: 5443408

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