Drug misuse is a significant public health issue in England and Wales. This article examines geographical variations in drug misuse mortality in England and Wales over the period 1993 t 2006. ...Geographical variations in deaths related to drug misuse have generally persisted over this period, one of substantial change in these deaths (with a peak in 2001 and numbers in 2006 being almost double those in 1993), although there were some significant changes to the regional level pattern. The regions with the highest mortality rates aggregated over the whole time period were the North West, Yorkshire and The Humber, and London, although by 2004/06 the rate in London was among the lowest and the rate in the North East was higher than the North West. Three Drug Action Teams (DATs), Brighton and Hove, Blackpool, and Camden, consistently had the highest drug misuse mortality rates. Urban areas tended to have the highest rates, but the rate in the most sparsely populated areas was similar to those of towns. The mortality rate in the most deprived parts of England and Wales was five times the rate in the least deprived areas. Areas with low rates were generally large, mostly rural areas, as well as areas in outer London and the south east of England.
This article describes the pattern of mortality by day of the week in deaths from suicide and drug-related poisoning. An increased proportion of suicides occurred on Mondays, while the single day on ...which the largest number of suicides occurred was 1st January 2000, a Saturday. Together these suggest an effect of entering a new time period. The pattern for drug-related poisonings varied according to the coroner's verdict. An increased proportion of deaths from drug abuse/dependence and accidental drug-related poisoning deaths occurred on Saturdays among males, while the most common day of death for drug-related poisoning deaths with a suicide verdict was Monday for both sexes.
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.
This article examines changes in deaths assigned to malignant and non-malignant neoplasms resulting from the introduction of ICD-10 in England and Wales. In particular the Government's target of ...reducing mortality rates from malignant cancers on those aged under 75. The main changes are highlighted and the article explains how data can be adjusted to take account of these changes so that trends in mortality rates over time can be analysed.
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Summary Background Biomarkers to improve the risk–benefit of extended adjuvant endocrine therapy for late recurrence in patients with oestrogen-receptor-positive breast cancer would be clinically ...valuable. We compared the prognostic ability of the breast-cancer index (BCI) assay, 21-gene recurrence score (Oncotype DX), and an immunohistochemical prognostic model (IHC4) for both early and late recurrence in patients with oestrogen-receptor-positive, node-negative (N0) disease who took part in the Arimidex, Tamoxifen, Alone or in Combination (ATAC) clinical trial. Methods In this prospective comparison study, we obtained archival tumour blocks from the TransATAC tissue bank from all postmenopausal patients with oestrogen-receptor-positive breast cancer from whom the 21-gene recurrence score and IHC4 values had already been derived. We did BCI analysis in matched samples with sufficient residual RNA using two BCI models—cubic (BCI-C) and linear (BCI-L)—using previously validated cutoffs. We assessed prognostic ability of BCI for distant recurrence over 10 years (the primary endpoint) and compared it with that of the 21-gene recurrence score and IHC4. We also tested the ability of the assays to predict early (0–5 years) and late (5–10 years) distant recurrence. To assess the ability of the biomarkers to predict recurrence beyond standard clinicopathological variables, we calculated the change in the likelihood-ratio χ2 (LR-Δχ2 ) from Cox proportional hazards models. Findings Suitable tissue was available from 665 patients with oestrogen-receptor-positive, N0 breast cancer for BCI analysis. The primary analysis showed significant differences in risk of distant recurrence over 10 years in the categorical BCI-C risk groups (p<0·0001) with 6·8% (95% CI 4·4–10·0) of patients in the low-risk group, 17·3% (12·0–24·7) in the intermediate group, and 22·2% (15·3–31·5) in the high-risk group having distant recurrence. The secondary analysis showed that BCI-L was a much stronger predictor for overall (0–10 year) distant recurrence compared with BCI-C (interquartile HR 2·30 95% CI 1·62–3·27; LR-Δχ2 =22·69; p<0·0001). When compared with BCI-L, the 21-gene recurrence score was less predictive (HR 1·48 95% CI 1·22–1·78; LR-Δχ2 =13·68; p=0·0002) and IHC4 was similar (HR 1·69 95% CI 1·51–2·56; LR-Δχ2 =22·83; p<0·0001). All further analyses were done with the BCI-L model. In a multivariable analysis, all assays had significant prognostic ability for early distant recurrence (BCI-L HR 2·77 95% CI 1·63–4·70, LR-Δχ2 =15·42, p<0·0001; 21-gene recurrence score HR 1·80 1·42–2·29, LR-Δχ2 =18·48, p<0·0001; IHC4 HR 2·90 2·01–4·18, LR-Δχ2 =29·14, p<0·0001); however, only BCI-L was significant for late distant recurrence (BCI-L HR 1·95 95% CI 1·22–3·14, LR-Δχ2 =7·97, p=0·0048; 21-gene recurrence score HR 1·13 0·82–1·56, LR-Δχ2 =0·48, p=0·47; IHC4 HR 1·30 0·88–1·94, LR-Δχ2 =1·59, p=0·20). Interpretation BCI-L was the only significant prognostic test for risk of both early and late distant recurrence and identified two risk populations for each timeframe. It could help to identify patients at high risk for late distant recurrence who might benefit from extended endocrine or other therapy. Funding Avon Foundation, National Institutes of Health, Breast Cancer Foundation, US Department of Defense Breast Cancer Research Program, Susan G Komen for the Cure, Breakthrough Breast Cancer through the Mary-Jean Mitchell Green Foundation, AstraZeneca, Cancer Research UK, and the National Institute for Health Research Biomedical Research Centre at the Royal Marsden (London, UK).
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•9 recommendations digest recent developments in regulatory environmental risk assessment.•Efforts are necessary to make the translation of ecotoxicology into regulatory decisions ...more open and transparent.•They require concerted and sustained action from a variety of sectors and stakeholders.•Better evidence will lead to better decisions, sustainable innovation and a healthier environment.
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