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Biomedical subjects

L Willocks

Publications and source records attributed to L Willocks.

At least 19 recordsLinked to original sources
PubMed2006

Can syndromic surveillance data detect local outbreaks of communicable disease? A model using a historical cryptosporidiosis outbreak.

A national UK surveillance system currently uses data from a health helpline (NHS Direct) in an attempt to provide early warning of a bio-terrorist attack, or an outbreak caused by a more common infection. To test this syndromic surveillance system we superimposed data from a historical outbreak of cryptosporidiosis onto a statistical model of NHS Direct call data. We modelled whether calls about diarrhoea (a proxy for cryptosporidiosis) exceeded a statistical threshold, thus alerting the surveillance team to the outbreak. On the date that the public health team were first notified of the outbreak our model predicted a 4% chance of detection when we assumed that one-twentieth of cryptosporidiosis cases telephoned the helpline. This rose to a 72% chance when we assumed nine-tenths of cases telephoned. The NHS Direct surveillance system is currently unlikely to detect an event similar to the cryptosporidiosis outbreak used here and may be most suited to detecting more widespread rises in syndromes in the community, as previously demonstrated. However, the expected rise in NHS Direct call rates, should improve early warning of outbreaks using call data.

Communicable Disease Control↗
PubMed2004

Monitoring the uptake of HIV testing among first attendees at GUM clinics in the East of England region.

This study was conducted to determine the extent to which genitourinary medicine clinics in the East of England region are monitoring the uptake of HIV testing. Ninety-four per cent of GUM clinics in the region offer HIV testing to all new patients. The uptake varied around the region, but all clinics are able to monitor uptake and the majority of clinics can audit uptake. The overall regional uptake has already exceeded the target for 2004.

Ambulatory Care Facilities↗
PubMed2000

Outcome of invasive pneumococcal disease: a UK based study. Oxford Pneumococcal Surveillance Group.

METHODS: The records of 106 children aged less than 5 years with invasive disease caused by Streptococcus pneumoniae were reviewed. RESULTS: The clinical manifestations were meningitis (37%), upper respiratory tract infection (24%), pneumonia (19%), and occult bacteraemia (18%). One child died and seven had persisting neurological impairment. Five serotypes caused 83% of disease and 92% of the serotypes are included in the seven valent conjugate vaccines which are undergoing trials. CONCLUSIONS: These data suggest that S pneumoniae infection is associated with a low case fatality rate but substantial morbidity in the UK.

Child, Preschool↗
PubMed1998

A large outbreak of cryptosporidiosis associated with a public water supply from a deep chalk borehole. Outbreak Investigation Team.

Three hundred and forty-five confirmed cases were reported in a large waterborne outbreak of cryptosporidiosis in North Thames in the spring of 1997. The descriptive epidemiology, attack rates, a case control study, and the detection of oocysts in the water suggested strongly that the outbreak was associated with drinking unboiled tap water that originated from one deep chalk borehole. The 746,000 people living in the water distribution area were advised to boil their drinking water. Investigations did not reveal how oocysts entered the borehole. This is the first published report of a cryptosporidium outbreak caused by filtered borehole water and we believe it to be the largest outbreak due to groundwater to have been reported. Borehole supplies are regarded as relatively pure sources of water and this outbreak has implications for the future monitoring and treatment of drinking water extracted from boreholes.

Adolescent↗
PubMed1994

Out-patient medical care in Edinburgh for IDU-related HIV.

Using combined medical and drug clinics, by the end of 1990 we had initiated contact with 511 HIV positive individuals, 75% injection drug use (IDU) related. We have previously reported a significant reduction in the number of missed appointments from 1985-89 following the introduction of methadone and an all day clinic, but between 1989 and 1990 the appointment default rate rose from 17 to 25%. A significant percentage increase in missed appointments was, however, only seen in those not attending the all day clinic (chi 2(3) = 121.3, p < 0.001). An analysis of the patients missing appointments during 1989-90 revealed that 36-45% of patients attending each year missed only 1 or 2 appointments, that the majority of missed appointments each year were accounted for by less than 20% of the patients, around 60% of these patients missed appointments in both years and that only 2% of patients attending both years consistently miss 3 or more appointments per year. Laboratory monitoring of HIV, that is at least one sampling episode in a year, was achieved, however, in 92-95% of the patients attending each year. The annual number of patients lost to follow-up varied between 7 and 11% per year, but did not change significantly over time, whilst the cumulative number of HIV infected individuals lost to follow-up after 5 years was only 14%. Between 1986 and 1990 self-reported reduction in IDU was more likely in HIV positive than negative individuals; the number of HIV positive individuals who reported injecting for more than 50% of the year fell from 40 to 5% (chi 2(4) = 15.23, p < 0.01) whilst the number who reported at least one injection per year fell from 51 to 23% (chi 2(4) = 62.06, p < 0.001). By comparison amongst non-HIV-infected patients the percentage who reported opiate use for more than 50% of the visits during a year rose from 54% in 1986 to a peak of 70% in 1989 (chi 2(4) = 10.22, p < 0.05) and those who reported opiate use at least once during the year rose from 57% in 1986 to a peak of 75% in 1989 (chi 2(4) = 14.3, p = 0.006). Combined medical and drug clinics from 1986 to 1990 together with a multi-disciplinary team approach to medical care was successful in delivering health care to HIV-infected injection drug users.(ABSTRACT TRUNCATED AT 400 WORDS)

Ambulatory Care↗
PubMed1993

Sudden death in HIV-infected drug users. Presumptive overdose in an HIV-positive narcotic addict.

We report the case of an HIV-positive drug user who was found dead in a room in which were discovered tablets of dihydrocodeine and amitriptyline. There had been past episodes of drug overdose which was suspected of being the cause of death on this occasion. However toxicology analysis did not support this diagnosis and necropsy revealed a severe desquamative interstitial pneumonitis and HIV encephalitis. The need to investigate thoroughly the cause of sudden death in all HIV-positive drug users is emphasised.

Adult↗
PubMed1993

Diagnosis of Pneumocystis carinii pneumonia in a population of HIV-positive drug users, with particular reference to sputum induction and fluorescent antibody techniques.

Between June 1990 and May 1991, 200 sputum inductions were examined by a fluorescent antibody test (FAT) for Pneumocystis carinii (PC). A total of 164 specimens were negative, 36 were positive and a further 20 inductions were unsuccessful. All patients with a positive result, seven of whom had normal chest X-rays and blood gas analyses, were treated for Pneumocystis carinii pneumonia (PCP) with symptomatic response. Two additional patients were diagnosed as PCP during the study period. No patient with a negative or unsuccessful result developed clinical PCP during that admission, although six did develop 10 episodes of PCP (FAT positive for PC on induced sputum samples) within 3 months of a negative result. Sputum induction was well tolerated by patients and not associated with adverse events. Sensitivity of FAT for PC was 95% and specificity was 100%. These results may in part be because most of the patients were injection drug users (IDUs) who often suffer from chronic productive cough, and also because sputum induction in all cases was supervised by an experienced physiotherapist.

Female↗
PubMed1992

The spectrum of chest infections in HIV positive patients in Edinburgh.

In a retrospective analysis of all known HIV-positive patients admitted to the City Hospital before November 1989, 208 patients accounted for 612 admissions, 72% being injection drug users (IDUs). One hundred and eighty admissions (29%) were for chest-related disorders, and this was the commonest reason for admission. Unlike other U.K. centres where more than 50% chest problems are due to Pneumocystis carinii pneumonia (PCP), only 27% of our chest admissions were for PCP. Fifty-four percent of chest admissions were for bacterial chest infections (BCIs), the commonest organism isolated being Haemophilus influenzae. Despite the fact that most (50/97) of these admissions were in patients with 'asymptomatic' HIV disease (CDC classification 2 and 3), 50% had radiological pneumonia, 43% were hypoxic, 28% were hypercapnic and the average duration of hospitalisation was 10 days. BCIs were more common in HIV-positive IDUs when compared with HIV-negative IDUs, other HIV-positive patients and the general age-matched population. Medical provision for IDU-related HIV disease should take into account the high rate of BCIs and of hospital admissions in patients who do not yet have CDC stage 4 disease.

Female↗
PubMed1992

Changing patterns of malaria in south-east Scotland: implications for practitioner awareness and prophylactic advice.

The medical records of all 229 patients with malaria admitted to the Edinburgh City Hospital between 1969 and 1988 were studied retrospectively. A total of 137 were from Africa, 44 from the Indian subcontinent, 19 from the Far East, 18 from New Guinea, 5 from the Middle East and 3 from South America. The number of yearly admissions rose markedly after 1983, mainly due to an increase in Plasmodium falciparum cases. Ninety-four cases (15 with severe parasitaemia) mainly from Kenya and Nigeria were due to P. falciparum infection and 99 to P. vivax. There were no deaths. A seasonal distribution of onset of fever in patients with P. vivax infections originating from the Indian subcontinent showed that most patients presented during the summer. Prophylaxis had generally been irregular or non-existent but many compliant patients may have been receiving an inadequate dose of chloroquine on a mg/kg body weight basis. General practitioners are likely to see at least one case of malaria every 4 years. They are encouraged to seek advice from a specialist unit whenever necessary whether before or after their patient travels abroad. Travellers, in particular to Kenya and Nigeria, and Asian immigrants to the UK returning on holiday to their country of origin should be strongly advised to take regular prophylaxis including on return to the UK.

Adolescent↗