A comparison of career satisfaction amongst dental healthcare professionals across three health care systems: comparison of data from the United Kingdom, New Zealand and Trinidad & Tobago

BACKGROUND: The aim of this study was to compare the expressed levels of career satisfaction of three groups of comparable dental healthcare professionals, working in Trinidad, the United Kingdom and New Zealand. METHODS: Three questionnaire surveys were carried out of comparable dental healthcare professionals. Dental nurses in Trinidad and dental therapists in the UK and New Zealand. Questionnaires were sent to all registered dental nurses or dental therapists. RESULTS: Career satisfaction was lowest amongst Dental Therapists working in Trinidad and Tobago. Approximately 59 per cent of the Therapists working in New Zealand reported stated that they felt they were not a valued member of the dental team, the corresponding proportion in the United Kingdom was 32 per cent, and for Trinidad 39 per cent. CONCLUSION: Dental therapists working in different healthcare systems report different levels of satisfaction with their career.

A psychosocial profile of a cohort of African Caribbean patients in the forensic psychiatric service in Britain, 2000

Thirty-two African Caribbean Patients who were Forensic Psychiatric Service-users in England were assessed by a Consultant Psychiatrist during the four-year period of 1996-2000. These patients were the cohort for this study. The study involved a comparison of some of the characteristics of the native-born and migrant African Caribbean patients. Twenty-three patients (71.9 percent of the cohort) were born in Britain while the others were born in the Caribbean. The mean age of the cohort was 34.3 years. Seventy-five percent of the patients were men. According to this study, the place of assessment was associated with the territory of birth. The British-born patients were more likely to have been assessed in a psychiatric or legal institution (e.g. a secure psychiatric hospital or prison). The "companionship status" of each group was not significantly different from the other. When the patients were examined as one group, it was seen that more than a third of the patients (37.5 percent) lived alone. There was a weak association between territory of birth and primary caregivers, with the British-born patients being marginally more likely to have been reared by both parents (under the age of eighteen years) than the Caribbean-born patients. The association between territory of birth and previous social work care was not significant. The majority of patients in both groups had previous social work intervention. The type of accommodation was not significantly different between the groups. The educational level attained by the British-born patients was significantly higher than that of the migrant patients. The employment profiles of the two groups were similar, that is, there was no significant difference between them. There was no association between the forensic charges at the time of assessment and the territory of birth. In this study there was no association between the category of primary psychiatric diagnosis (Psychosis or Personality Disorder) and the territory of birth. The weak association seen between primary caregiver and territory of birth indicates that the British-Born patients are marginally more likely to have had the benefit of a higher educational level, did not confer an advantage over the migrant patients in terms of their rate of developing forensic psychiatric problems. The literature indicates that second-gneration African Caribbean people (those born to migrants) are those with the highest rate of psychosis. ...(AU)

The prevalence of Chlamydia trachomatis in fresh tissue specimens from patients with ectopic pregnancy or tubal factor infertility as determined by PCR and in-situ hybridisation

The prevalence of chlamydial DNA determined by PCR and in-situ hybridisation (ISH) in fresh tissue specimens (endometrium, fallopian tube and ovary) was investigated in 33 women presenting with ectopic pregnancy (EP), 14 women with tubal factor infertility (TFI) and 50 control patients from the UK and the West Indies. In the UK EP group, chlamydial DNA was detected by PCR in 56% of patients; similar results were found in the Trinidad EP group (67%). In the TFI group, chlamydial DNA was detected in (71%) of patients by PCR. The detection of Chlamydia trachomatis DNA by ISH was highest in the TFI group (43%). Women presenting with EP and TFI showed evidence of previous or current genital C. trachomatis infection, underlining the importance of this microorganism in the development of these conditions. Importantly, chlamydial DNA could be detected in DNA preparations from the endometrium, fallopian tube and ovary of EP and TFI patients at the time of surgery.

Outcome of first contact schizophrenia in Jamaica

Several previous studies have identified high incidence rates, high relapse rates and poor short term outcome for schizophrenia in African-Caribbeans in the United Kingdom (UK). Studies in the Caribbean have found the incidence of schizophrenia to be within worldwide levels, and one-year outcome to be much lower than that reported for African Caribbean patients in the UK. First contact patients with schizophrenia identified prospectively by the Present Status Examination were followed prospectively for one year. The main outcome measures which were collected from case notes included: clinical status and medication usage at contact with clinical service, employment status, outpatient clinic compliance, relapse rate and in-patient hospital status, after 12 months. Three hundred and seventeen patients between ages 15 and 55 years who had made first contact with the psychiatric service in Jamaica in 1992 received a computer diagnostic programme for the present status examination (CATEGO) diagnosis of schizophrenia. The majority 197 (62 percent) were treated at home, and 120 (38 percent) were admitted to hospital for treatment. Two hundred and sixty four (83 percent) were still being seen after one year. The relapse rate was 13 percent (41 patients), higher for admissions (24, 20 percent) than for those treated at home (17, 9 percent; p<0.001). The relapse rate was higher for patients brought into care by the police and mental health officers (p<0.005). One hundred and thirty five (43 percent) were in gainful employment within the 12 month period of follow up, contrasted with the 40 percent unemployment rate for the 2.4 million population of the island (chi square = 39.322, p<0.001). There was a self-reported use of medication in 213 (67 percent) patients, with 142 (45 percent) on monthly intramuscular depot medication. The low relapse rates and good outcome measures after 12 months of first srevice contact with schizophrenia are related to high levels of gainful employment and good intramuscular medication compliance. The favourable short term outcome in Jamaica does not correspond to the high relapse rate for this condition found in African Caribbeans in the UK. (AU)

Red cell antibodies in patients with homozygous sickle cell disease: a comparison of patients in Jamaica and the United Kingdom

The transfusion history and frequency of red cell antibodies in patients with homozygous sickle cell (SS) disease have been compared in 190 subjects from the Jamaican cohort study and 37 patients attending a sickle cell clinic in Manchester, England. The proportion of patients transfused did not differ between the groups although the number of units transfused and the frequency of red cell antibodies were significantly greater in the Manchester group. Immune antibodies occurred in three Jamaicans (2.6 percent of those transfused) and 16 UK subjects (76 percent of those transfused). Multiple antibodies occurred in 10 (63 percent) UK subjects but in no Jamaicans. Indications for transfusion also differed between the groups, Jamaican patients typically receiving 1-2 units for acute anaemia or acute chest syndrome, whereas UK patients frequently had multiple transfusions in preoperative exchange or prophylaxis programmes. The greater red cell alloimmunization among UK patients probably reflects both the greater use of transfusion and the disparity between donor and recipient populations in the UK. (AU)

Chlamydia pneumoniae infection and ethnic origin

OBJECTIVES: To test the association of Chlamydia pneumoniae infection with ethnic origin. DESIGN: A prospective study by micro-immunofluorescence of antibodies to C. pnuemoniae in patients admitted to one hospital with a variety of non-pulmonary, non-cardiovascular disorders. SETTING: A large district general hospital serving a multi-ethnic inner-city population in Birmingham, UK. SUBJECTS: There were 1518 patients, 1061 of whom were Caucasian, 290 Asian and 167 Afro-Caribbean. Each of 169 Asian and 141 Afro-Caribbeans was matched with two Caucasians for age, sex, smoking habit, steriod medication and date of admission, and logistic regression methods were used to compared the effects on C. pneumoniae antibody levels of ethnic origin, these confounding variables, diabetes mellitus and social deprivation. OUTCOME MEASURES: Serological evidence of acute C. pnuemoniae infection or reinfection (defined by titres of IgM > or = 8, a four-fold rise in IgG or IgG > or = 512) and previous infection (IgG 64-256 or IgA > or = 8). RESULTS: Results showed 4.8 percent of Caucasians, 6.6 percent of Asians and 10.2 percent of Afro-Caribbeans had antibody titres suggesting acute (re) infection; and 11.2 percent of Caucasians, 13.4 percent Asians and 21.0 percent of Afro-Caribbeans had titres suggesting previous infection. On chi 2 analysis, the distributions of the three possible serological outcomes (acute, previous and no infection) differed significantly (p < 0.05) between the Afro-Caribbean and Caucasian groups, but not between Asians and Caucasians or between Afro-Caribbeans and Asians. After adjusting for possible confounding variables, odds ratios for Afro-Caribbean versus Caucasian origin were 5.5 (95 percent confidence intervals 2.0-15.0) for acute (re) infection and 1.9 (1.0-3.7) for previous infection. CONCLUSION: Our results suggest that C. pneumoniae infection may be more prevalent among Afro-Caribbean than among Caucasian people, and that Asians may lie somewhere them in this respect. The behaviour of this pathogen in different ethnic groups deserve further investigation. Future studies of this organism should give due attention to the ethnic origins of patients.(AU)

Ethnicity and excess mortality

The study examines and assesses the excess mortality from cerebrovascular disease, ischaemic heart disease, diabetes, hypertensive disease, injury and poisonings in City and Hackney descendents by country of birth used as proxy of ethnicity. The five year specific death rates for descendents aged 35 to 84 yars for England and Wales during the period 1986-90 was used as the standard to celebrate standardised proportional mortality ratios for these diseases. Mortality odds ratios were computed using the United Kingdom born descendents as the comparison group and all causes of death except genitourinary neoplasms, cirrhosis of the liver and the causes of interest as the auxillary (controls) cause of death. African Caribbean groups contribute 95 percent of the excess mortality from hypertensive disease. Caribbean and Indian groups account for over half the excess deaths from diabetes. All three groups contribute the excess deaths from cerebrovascular disease. Indian females appear to have twice the mortality risk of the England and Wales women, but this excess is hidden by the deficits of the Caribbean, British and younger Indian male groups who show deficit deaths from this cause. Mortality differentials are demonstrable by ethnic group at district level and may be greater than other available sources indicate. Standardised mortality odds ratios may be valuable tool for examining data sets lacking denominator data.(AU)

Sick genes, sick individuals, or sick populations with chronic disease? An international example from a standardized study of glucose tolerance and high blood pressure

Intensive searches for genes predisposing to or "causing" chronic disease are based on familial patterns indicating gene based inheritance. Rose's paradigm, less popular with clinical scientist thinking in individuals, is that populations give rise to their extreme values who become patients. For diabetes (NIDDM), population-based twin registers (e.g. Denmark) show little mono-to-di-zygotic difference, a suggesting major hospital ascertainment bias in ascribing a genetic basis to NIDDM. Here we examined geographically dispersed populations of West African origin, or similar genetic background within Cameroon, then between Jamaica and African-Caribbean (AfC) migrants to Britain (70 percent from Jamaica). Carefully representive samples were drawn from local population registers in rural and urban Cameroon, Jamaica and Manchester, UK. Results, on similar genetic backgrounds in the Cameroon, and between Jamaica and Manchester, suggest factors affecting energy balance (intake versus expenditure) rather than gene differences determine diabetes and, probably, hypertension rates in these and, probably, most populations.(AU)

Spectrum of organisms and clinical presentation of tinea capitis presenting to an inner city dermatology practice

Struck by a dramatic rise in the number of cases of scalp ringworm being referred to our practice in the last few years we instituted a prospective study of all cases seen over the period 1995-1996. We have collected material on more than 200 mycologically positive cases. A spectrum of organisms was isolated as follows: Trichophyton tonsurans 69 percent, Trichophyton soudanense 10 percent, Microsporum audouinii 6 percent, Trichophyton violaceum 4 percent, Microsporum rivalieri 2 percent, Microsporum canis 1 percent, Trichophyton gouvilii 0.4 percent and positive microscopy but negative culture 7.6 percent. Clinical presentations were various: grey type 34 percent, moth eaten 25 percent, kerion 20 percent, black dot 13 percent and diffuse scale (seborrhoeic type) 8 percent. The clinical manifestation was also related to organism. Kerions were the most likely variant to be mycologically negative (40 percent) whereas those with the black dot pattern were all positive on culture. This study may reflect a shifting pattern of tinea capitis in Britain with the commonest organism now being Trichophyton tonsurans. Previously Microsporum canis has been the most frequent isolate in Great Britain. The pattern of clinical presentation would seem to influence the ease of isolation of responsible organism. Finally although "grey type" pattern is the most common clinical expression of tinea capitis this study highlights the variety of clinical appearances which may occur and confuse the unaware. (AU)

Standardised comparison of glucose tolerance and diabetes prevalence in four African/African-Caribbean populations in Britain, Jamaica and Cameroon

To study factors promoting the emergence of diabetes in African-Caribbean (AfC) as the second largest ethnic minority in Britain and how these compare with genetically similar populations in Jamaica (origin of 80 percent AfC) and Cameroon, using the same protocol we carried out 75g glucose tolerance tests in representative community samples aged 25-74 years, by WHO criteria. As results were similar by gender, sexes are combined here. [See table] Diabetes prevalence (age-standardised) increased from Africa to the Caribbean to Europe and was highest in Manchester men. Body mass index showed a striking increase from rural to younger urban Cameroonians. Increasing NIDDM prevalence is paralleled across site by changes in nutritional and lifestyle factors, also measured using standardised methods. Even in Cameroon, prevalence approaches rates in whites in Europe.(AU)

The molecular basis for genetic variation in fetal haemoglobin level in sickle cell anaemia

Raised fetal haemoglobin levels ameliorate the clinical severity of sickle cell anaemia. This provides a rationale for therapy and signals the need to elucidate the molecular basis for the variability of HbF level in sickle cell anaemia. Polymorphism within regulatory sites of the globin locus alter the affinity with which transcription factors bind their cogante recognition sites thereby modulating gene expression. A novel chromosomal haplotype utilising polymorphic variation within two enhancers hypersensitive site 2 (HS2) of the locus control region and the pre g y framework and the silencer protein BP1 binding site that spans a 53 kb interval of the globin locus was determined in 205 patients with sickle cell anaemia from the UK and Jamaica. Multiplexed polymerase chain reactions developed to facilitate rapid analysis of polymorphisms within each site allowed individual haplotype construction in a single lane of a single strand conformation polymorphism (SSCP) electrophoresis gel. SSCP banding patterns for the combined polymorphic sites were confirmed as unique chromosomal haplotypes by DNA sequence anaylsis. Three hundred and ten chromosomes with sequence TA7 N 12 TA8, GA and AT(AT)8T4 were designated class 1. Twenty-five class II with sequence TA8 N10 TA11, GG, AC(AT)6T9; 17 class III with TA9 N10 TA10, AG, AC(AT)8T4; 7 class IV with TA10 N10 TA12, AG, AC(AT)9T5 and 13 class Ia haplotype with sequence TA9 N10 TA10, GA, AT(AT)8T4 were identified. The proportion of class I chromosomes in both groups (159/210 UK; 151/200 Jamaican) is identical, however, significantly more chromosomes with sub-classes I and II are present among the Jamaican sample. There is incomplete association between the functional haplotype classes defined and conventional haplotypes based on restriction fragment length polymorphisms. The level of Hbf is significantly higher in patients with functional haplotype classes III and IV compared to those with classes I and II. Both high HbF haplotypes share a high affinity binding motif for the transcription factor GATA-1. This novel approach allows the combined effets of genetic variation in regulatory sequences within the globin locus on HbF level to be defined. (AU)

Sexual mixing patterns of patients with Gonorrhoea: is there a core group?

BACKGROUND: Epidemics of sexually transmitted infections are maintained by high level transmission amongst `core groups' of individuals, raising the basic reproductive rate to greater than unity. Assortative sexual mixing, that is, choosing partners who are like, rather than unlike, with respect to certain characteristics contributes to the persistent infection with a core group. We have reported high rates of gonorrhoea amongst people from black minority ethnic groups residing in Lambeth, Southwark and Lewisham. OBJECTIVES: To examine assortiveness of sexual mixing according to demographic characteristics of patients with heterosexually acquired gonorrohoea. SETTING: The Caldecot Centre, Department of Genitourinary Medicine, King's Healthcare. SUBJECTS: 287 heterosexual clinic attendees participating in contact tracing interviews for microscopy or culture proven gonorrhoea from 06/03/95 to 12/01/96 MAIN OUTCOME MEASURES: Matrices formed by cross-tabulation of ethnicity, residence and social class of gonorrhoea index cases and their most recent sexual partner. Assortativeness measured by Q1, a value ranging from zero (random mixing) to one (completely assortative). RESULTS: there were 120 (42 percent) female and 167 male respondents. 67 percent of female cases and 74 percent of male cases were of self-reported black Caribbean ethnicity. 48 percent of relationships with the most recent partner were temporarily concurrent with another partnership (48 percent of black cases versus 29 percent of white cases, p=0.19). Values of Q in women and men, respectively were: ethnicity, 0.64 and 0.60: borough of residence, 0.56 and 0.53; social class, 0.39 and 0.35; age group 0.37 and 0.47. CONCLUSIONS: Concurrency of sexual partnerships is common in individuals with gonorrhoea with a trend towards increased concurrency amongst those from black ethnic groups. Assortativeness in the selection of sexual partners is most evident for ethnic group and geographic area. These factors may contribute to the disproportionate number of individuals of black Caribbean ethnicity with gonorrhoea in South East London. Further work is required to examine the attitudes and practices with members of different ethnic groups with respect to sexual relationships and behaviours. Culturally appropriate interventions to reduce the burden of sexually transmitted infections should be targeted to high risk geographic areas.(AU)

The prevalence of atopic dermatitis in black Caribbean children in London and Kingston, Jamaica

It has been suggested that black children of West Indian origin living in London have a higher prevalence of atopic dermatitis (AD) than their counterparts living in the Caribbean. (Williams HC et. al London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol 1995; 32: 212-7). To test this hypothesis, we undertook a colloborative study on the prevalence of atopic dermatitis in school children in Lambeth, London and Kingston, Jamaica. Questionnaires were sent to 2126 and 3957 parents of children aged 4 to 11 years attending seven primary schools in London and six schools in Kingston respectively. The questionnaires requested screening information on symptoms of AD and parentally nominated ethnic group of the child. Children whose parents responded affirmatively to the presence of an itchy rash or the presence of generally dry skin (N=562) were examined during two visits to the schools in London. In Kingston, all children whose parents responded and gave consent were examined (N=3027) by the same dermatologist. Cases of AD were defined using the UK Working Party's Diagnostic Criteria. The overall response rate in London and Kingston was 70.3 percent and 86.2 percent respectively. The overall prevalence of AD was 10.8 percent (162/1495) and 4.9 percent (166/3409) in London and Kingston respectively. The prevalence of AD in black children living in London was 18.9 percent (60/317) compared with 4.6 percent (94/2029). These results suggest that black Caribbean children in London are at an increased risk (odds ratio 4.81, 95 percent confidence interval 3.3 to 6.9, p<0.001) of developing atopic dermatitis when compared to their counterparts living in Jamaica. Possible reasons for these large prevalence differences are currently being investigated. (AU)

African Caribbean men remanded to Brixton prison: psychiatric and forensic characteristics and outcome of final court appearance

AIMS: This study aims to examine the influence of ethnic origin on the range of diagnoses, past psychiatric and forensic contacts, and outcome of final court appearance in a random sample of men remanded in Brixton prison health care centre for a psychiatric assessment. METHOD: 277 men were randomly sampled from all men to HMP Brixton and referred to prison health care centres for a psychiatric assessment over a one year period. Men were interviewed immediately after remand to establish their socio-demographic profiles, their psychiatric diagnoses, alcohol and substance misuse histories, criminality, seriousness of index offence and violence involved in their index offence, past psychiatric and forensic contacts and outcome after court appearance. CONCLUSIONS: In this sample, a greater percentage of black men who were remanded in custody had a diagnoses of schizophrenia. They were remanded despite more stable housing and fewer criminal convictions than the white group. Custodial remands could be avoided if community services (psychiatric diversion) were especially sensitive to the needs of black men with severe mental illness.(AU)

Life events and perceptions of racism in patients with diagnoses of psychotic illness

One hundred and forty nine patients (35 white British, 114 non-white or non British) with at least a two year history of psychotic illness, were recruited into a project designed to compare different levels of community care interventions. Patients were interviewed at recruitment into the study (baseline), 12 months later (Year 1) and 24 months after recruitment (Year 2). All patients were administered a Racial Life Event Questionnaire (RLEQ) as part of their assessment. The RLEQ lists 72 events divided into twelve sections covering different areas of life, eg. financial, health, employment. Each event was read aloud to the patient and s/he was asked to indicate whether they had experienced the event in the last three months. At the end of each section if the patients had responded positively to an event having occurred, they were asked whether they believed their ethnicity played a part in the occurrence of the event, ie. whether the event happened because of racial prejudice or discrimination. Results indicate that at baseline non-white and non-British patients believed assault, and housing events were significantly related to racial prejudice and at Year 1 assault and financial events were significantly related to racial prejudices. At Year 2 patients were asked whether "generally speaking" they believed members of their ethnic group were discriminated against and likely to have problems in the areas covered. Results indicate that non-white or non-British patients believe people from their own ethnic group are likely to be discriminated against in the areas of finance, assault, health, housing and legal events. (AU)

Is it necessary to distinguish between first and second generation African-Caribbean populaton in psychiatric research?

In attempting to identify factors responsible for the onset, course and prognosis of an illness, it is necessary to identify differences between generations in order to separate the effects of heritability and environment. Ethnicity and culture can also be examined in this way so that changes in culture occasioned by changes in environment can be assessed in terms of their impact on illness. In our work on the family history of psychoses among the African-Caribbean population in Britain we have found that for schrizophrenia, the relatives of first generation (those born in the Caribbean) and white psychotic patients share similiar risks while the risk is markedly increase in the relatives, particularly siblings of the second generation (those born in Britain to Caribbean parents) psychotic patients. For affective psychoses, we have found that the risk in the relatives of the first generation patients is significantly less than for both the white and the second generation relatives. These differences would have been much less noticeable if the separation between first and second generation patients had not been undertaken and would have been more difficult to interpret. Our findings do suggest that there are factors acting on the second generation making them more susceptible than their first generation counterparts to psychotic illness. This therefore diminishes the likelihood that the increased risk of illness in the second generation is due to a genetic effect and is much more likely to be mediated by some selective environmental effects acting either specifically on those families already afflicted by the disease or more generally on the entire second generation population.(AU)

A study of the ethnicity and the aetiology of schizophrenia - background and objectives

High rates of schizophrenia have been repeatedly reported among the African-Caribbean population in Britain. There has been no satisfactory explanation for these increased rates and while migrants in general are thought to be at increased risk, the incidence of schizophrenia is especially raised among African-Caribbean population that was born in Britain (second generation). Preliminary data from the Caribbean also suggest that there is a specific pathological process occuring in Britain. The available evidence in Britain also suggest that there are environmental factors which are selectively affecting the African-Caribbean population in Britain that are making them more vulnerable to schizophrenia. The study of high risk groups can be very instrumental in the elucidation of the aetiology of disease and therefore the study of this population may shed light on the aetiology of schizophrenia as a whole. In addition, this increased incidence of schizopherenia places a heavy demand both on the families of an already disadvantaged group as well as on the psychiatric services, particularly in the inner cities where the majority of African Caribbean people live in Britain. An understanding of the determinants of this increased risk of schizophrenia would lead to appropriate intervention strategies especially in the areas of prevention and provision of effective care. The study will be a population based case control study of the first contact schizophrenia in African-Caribbeans and the remaining population in three British centres. The research hypotheses are that the African-Caribbeans psychotic patients will show more evidence of risk increasing social factors, in particular adverse life events and a marked discrepancy between expectations and achievement. Their siblings will also show a high risk for psychosis suggesting that certain families are more susceptible to the social adversity associated with migration. The study will combine two strategies; the first to determine the absolute risk of the disorder, and the other to identify the risk factors which mediate the onset and course of the illness. We will also carry out a one year outcome study to examine the needs for mental health care in the African-Caribbean population and the extent to which treatment is appropriate.(AU)