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Biomedical subjects

M J Goldacre

Publications and source records attributed to M J Goldacre.

At least 19 recordsLinked to original sources
PubMed2006

Career choices for radiology: national surveys of graduates of 1974-2002 from UK medical schools.

AIM: To report on trends in career choices for radiology among UK medical graduates. MATERIALS AND METHODS: One and 3 years after graduation, and at longer time intervals thereafter, postal questionnaire surveys were sent to all doctors who graduated from UK medical schools in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002. Doctors were asked to specify their choice of long-term career and to identify factors influencing their choice. Employment details were also collected. Results were analysed using chi(2) statistics and binary logistic regression. RESULTS: Seventy-four percent (24,621/33,412) and 73% (20,720/28,459) of doctors responded 1 and 3 years after graduation. Choices for radiology in year 1 increased significantly over time (1.7% of 1974 graduates to 3.2% of 2002 graduates; chi(2) test for trend=15.3, p<0.001). In particular, there has been a steady increase from the cohorts of 1993 onwards. Thirty-eight percent of those who chose radiology in year 1, and 80% who chose radiology in year 3, were still working in radiology 10 years after graduation. Hours and working conditions influenced long-term career choices more for radiology than for other careers. CONCLUSIONS: The proportion of UK trained junior doctors who want to become radiologists has increased in recent years. However, although medical school intake and the numbers making an early choice for radiology have risen, it is unclear whether sufficient UK graduates will be attracted to radiology to fulfil future service requirements from UK trained graduates alone.

Attitude of Health Personnel↗
PubMed2006

Career choices for obstetrics and gynaecology: national surveys of graduates of 1974-2002 from UK medical schools.

OBJECTIVE: To report the trends in career choices for obstetrics and gynaecology among UK medical graduates. DESIGN: Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974. SETTING: United Kingdom. POPULATION: All graduates from UK medical schools in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002. METHODS: Postal questionnaire surveys. MAIN OUTCOME MEASURES: Career choices for obstetrics and gynaecology and factors influencing career choices for obstetrics and gynaecology. RESULTS: Seventy-four percent (24,623/33,417) and 73% (20,709/28,468) of doctors responded at 1 and 3 years after qualification. Choices for obstetrics and gynaecology fell sharply during the 1990s from 4.2% of 1996 qualifiers to 2.2% of 1999 qualifiers, and rose slightly to 2.8% of 2002 qualifiers. Only 0.8% of male graduates of 2002 chose obstetrics and gynaecology compared with 4.1% of women. Forty-six percent of those who chose obstetrics and gynaecology 1 year after qualification were working in it 10 years after qualifying. Experience of the subject as a student, and the influence of a particular teacher or department, affected long-term career choices more for obstetrics and gynaecology than for other careers. CONCLUSIONS: The unwillingness of young doctors to enter obstetrics and gynaecology may be attributable to concerns about workforce planning and career progression problems, rather than any lack of enthusiasm for the specialty. The number of men choosing obstetrics and gynaecology is now very small; the reasons and the future role of men in the specialty need to be debated.

Attitude of Health Personnel↗
PubMed2006

Risk of multiple sclerosis after head injury: record linkage study.

BACKGROUND: The possibility that head injury may influence the development of multiple sclerosis (MS) has been studied inconclusively in the past. OBJECTIVE: To determine whether head injury is associated with an increased risk of MS. METHOD: Analysis of database of linked hospital and death records, comparing the occurrence of MS in a cohort of people admitted to hospital with head injury and a reference cohort. RESULTS: The rate ratio for MS after head injury, compared with the reference cohort, was 1.1 (95% confidence interval, 0.88 to 1.36). There was no significant increase in the risk of MS at either short or long time periods after head injury. Using length of hospital stay as a proxy for severity of injury, there was no significant increase in the rate ratio for MS after head injuries with hospital stays of less than two days (rate ratio = 1.1 (0.71 to 1.57)), two or more days (rate ratio = 1.0 (0.68 to 1.45)), or seven or more days (rate ratio = 1.3 (0.64 to 2.34)). CONCLUSIONS: The method used, record linkage, ensures that patients' recollection of injury, or any tendency to attribute MS to injury, cannot have influenced the results. Injuries to the head were not associated with either the aetiological initiation or the clinical precipitation of onset of multiple sclerosis.

Adolescent↗
PubMed2005

Career choices for anaesthesia: national surveys of graduates of 1974-2002 from UK medical schools.

BACKGROUND: Knowledge about UK doctors' career intentions and pathways is essential for understanding future workforce requirements. The aim of this study was to report career choices for and career progression in anaesthesia in the UK. METHODS: Postal questionnaire surveys were undertaken of qualifiers from all UK medical schools in nine qualification years since 1974. RESULTS: 74% (24623/33417) and 73% (20709/28468) of doctors responded at 1 and 3 yr after qualification. At 1 and 3 yr after qualification, on average, 8% of doctors chose anaesthesia. Between 1974 and 2002 the percentage of doctors choosing anaesthesia, 1 yr after qualification, increased from 5 to 12%. A majority of doctors who chose anaesthesia 1 and 3 yr after qualification were working in anaesthesia 10 yr after qualification. In addition to doctors' enthusiasm for the specialty, career choices for anaesthesia were positively influenced by their perception of working hours, conditions of work, and career and promotion prospects. CONCLUSIONS: Anaesthesia has become increasingly popular as a career choice in the UK. Training numbers could be increased in the short term to speed up the process of providing a consultant-delivered service.

Adult↗
PubMed2005

Trends in mortality after hospital admission for liver cirrhosis in an English population from 1968 to 1999.

BACKGROUND: Population based mortality rates from liver cirrhosis, and alcohol consumption, have increased sharply in Britain in the past 35 years. Little is known about the long term trends over time in mortality rates after hospital admission for liver cirrhosis. AIMS: To analyse time trends in mortality in the year after admission for liver cirrhosis from 1968 to 1999. SUBJECTS: A total of 8192 people who were admitted to hospital in a defined population of Southern England. METHODS: Analysis of hospital discharge statistics linked to death certificate data. The main outcome measures were case fatality rates (CFRs) and standardised mortality ratios (SMRs). RESULTS: At 30 days after admission, CFR was 15.9% and the SMR was 93 (86 in men and 102 in women, compared with 1 in the general population). At one year, the overall CFR was 33.6% and SMR was 16.3. There was no improvement from 1968 to 1999 in mortality rates. SMRs were highest for alcoholic cirrhosis of the liver (27.4 at one year) but lower for biliary cirrhosis (11.4) and chronic hepatitis (10.0). Mortality from most of the main causes of death, including accidents and suicides, was increased. CONCLUSIONS: The high mortality rates after hospital admission, and the fact that they have not fallen in the past 30 years, show that liver cirrhosis remains a disease with a very poor prognosis. Increased mortality from accidents, suicides, and mental disorders, particularly among those with alcoholic cirrhoses, indicates that prognosis is influenced by behavioural as well as by physical pathology.

Adult↗
PubMed2005

Cancer after cholecystectomy: record-linkage cohort study.

We investigated whether cholecystectomy is associated with subsequent cancer and, if so, whether the association is likely to be causal, by undertaking a retrospective cohort study using linked medical statistics, comprising a cholecystectomy group (n=39 254) and a reference cohort admitted for a range of other medical and surgical conditions (n=334 813). We found a short-term significant elevation of rates of cancers of the colon, pancreas, liver, and stomach after cholecystectomy, but no long-term elevation. Excluding colon cancers within 2 years of admission to hospital, the rate ratio for colon cancer after cholecystectomy, compared with the reference cohort, was 1.01 (95% confidence interval 0.90-1.12) and after 10 years or more follow-up it was 0.94 (0.79-1.10). It is highly improbable that the short-term associations between cholecystectomy and gastrointestinal cancers are causal, and we conclude that cholecystectomy does not cause cancer.

Adult↗
PubMed2005

Cancer following hip and knee arthroplasty: record linkage study.

Concerns have been raised that degradation of implants used in hip and knee arthroplasty may lead to an increased risk of some cancers, particularly those of the haematopoietic, lymphatic and urinary systems. We used linked statistical records of hospital admissions and deaths to compare cancer rates in cohorts of people who had undergone hip or knee arthroplasty with a comparison cohort. We did not find an elevated risk for cancer, overall, in either the hip or knee cohort or in both combined (rate ratio for both combined 0.99; 95% confidence intervals 0.95-1.02), or for haematopoietic, lymphatic or urinary system cancers. There was also no elevation in risk of cancer more than 10 years after arthroplasty. Our findings add to the evidence that arthroplasty is safe in respect of cancer risk.

Adult↗
PubMed2005

Trends in mortality and hospital admission rates for abdominal aortic aneurysm in England and Wales, 1979-1999.

BACKGROUND: The aim of this study was to investigate trends in population-based mortality, hospital admission and case fatality rates for abdominal aortic aneurysm (AAA) from 1979 to 1999. METHODS: This was an analysis of routine statistics from 79 495 death certificates in England and Wales and 3217 hospital inpatient admissions in the Oxford Region. RESULTS: Mortality rates for all AAAs increased between 1979 and 1999 from 13 to 25 per million in women and from 80 to 115 per million in men. Admission rates increased in the same time interval from three to 22 admissions per million per year in women, and from 52 to 149 per million per year in men. Case fatality rates for all non-ruptured AAAs that were operated on decreased from 25.8 to 9.0 per cent and for all ruptured AAAs from 69.9 to 54.4 per cent. CONCLUSION: Mortality rates and hospital admission rates for AAA rose in men and even more so in women between 1979 and 1999. Perioperative mortality for ruptured AAA declined a little during the study but nonetheless was still very high at the end. This reinforces the importance of detecting and treating AAA before rupture occurs.

Aortic Aneurysm, Abdominal↗
PubMed2005

Progression of junior doctors into higher specialist training.

OBJECTIVES: To report on the transition of junior doctors into higher specialist training in the UK, following the Calman reforms and recent initiatives to promote training in general practice. Design and setting Postal questionnaire survey carried out in the UK. PARTICIPANTS: All graduates of 1996 from UK medical schools were surveyed in 2002. MAIN OUTCOME MEASURES: Outcome measures were considered to be details of applications, outcomes of applications, intentions to apply for specialist training, and career plans with regard to such issues as flexible training and work. RESULTS: Of 2312 responders, 39% had applied for specialist registrar (SpR) training and 35% for general practice (GP) training. Of applicants for SpR training, 68% were successful; 24% failed, almost all of whom intended to reapply, many after gaining research experience; 4% awaited a decision, and 4% had had another outcome (e.g. they withdrew their application). A sixth of responders intended to apply but had not yet done so. Of applicants for GP training, 95% had been successful. A further 2% intended to apply but had not yet done so. Responders viewed flexible and part-time training and work opportunities, and information about available posts, as being more widely available in general practice than in hospital practice. Half of the responders did not agree that their postgraduate training had been of a high standard. CONCLUSIONS: Progression into GP training seemed to have been a smoother and less protracted process than that into SpR training. Delayed applications for SpR training were common, and many of those who had applied had not been accepted. The use of research experience to strengthen a re-application was common.

Career Choice↗
PubMed2004

Trends in mortality for cancers, comparing multiple- and underlying-cause rates, in an English population 1979-1999.

In compiling official mortality statistics, rules for selecting the underlying cause of death have changed twice in the last 20 years in England. Mortality statistics for most types of cancer were not greatly affected, but there were significant effects on coding for cancers of colon, liver, breast, prostate, testis and bladder, and for lymphoma and leukaemia.

Cause of Death↗
PubMed2004

Trends in mortality rates for death-certificate-coded diabetes mellitus in an English population 1979-99.

AIMS: Mortality statistics have customarily been coded and analysed using only one underlying cause of death. Rules for selecting the underlying cause, when more than one cause is certified on a death certificate, have changed twice in England over the past 20 years. We used data from death certificates for 1979-99 to compare mortality rates for diabetes mellitus certified anywhere on death certificates with those certified as the underlying cause. METHODS: Analysis of data from 18,917 death certificates that included diabetes mellitus in the former Oxford health region. RESULTS: Based on the underlying cause of death, mortality rates for diabetes varied substantially between the periods defined by rule changes. Based on mentions of diabetes anywhere on the death record, mortality rates were almost unchanged over time: they showed a non-significant rise of 0.1% per year (95% confidence interval -0.3, 0.6). Circulatory diseases were certified causes of death in 71% of all deaths in people with diabetes. Although mortality rates from circulatory diseases in the general population fell by 2.5% per year, rates for circulatory diseases in combination with diabetes did not fall. CONCLUSIONS: Two explanations are possible for the lack of change in mortality rates for diabetes based on all certified mentions between 1979 and 1999. Increasing prevalence and improved survival may have resulted in no net change; and/or there may have been no improvement in survival for people whose diabetes is associated with life-threatening pathology and in particular with circulatory diseases.

Adult↗
PubMed2004

Cancers and immune related diseases associated with Down's syndrome: a record linkage study.

OBJECTIVE: To determine the risk of cancers and selected immune related diseases in people with Down's syndrome, relative to risk in other people. DESIGN: Cohort analysis of a linked dataset of abstracts of hospital and death records; results expressed as the ratios of rates of disease in people with and without Down's syndrome. SETTING: The former Oxford health region, England, 1963-1999. SUBJECTS: Cohort of 1453 people with Down's syndrome and cohort of 460,000 people with other conditions for comparison. MAIN OUTCOMES: As expected, the rate ratio for leukaemia was substantially elevated in people with Down's syndrome: it was 19-fold higher (95% confidence intervals 10.4 to 31.5) than the rate in the comparison cohort. For other cancers combined, excluding leukaemia, the rate ratio was not significantly elevated (1.2; 0.6 to 2.2). The risk of testicular cancer was increased (12.0; 2.5 to 35.6), although this was based on only three cases in the cohort of subjects with Down's syndrome. Significantly elevated risks were found for coeliac disease (4.7; 1.3 to 12.2), acquired hypothyroidism (9.4; 3.4, 20.5), other thyroid disorders, and type 1 diabetes mellitus (2.8; 1.0 to 6.1). A decreased risk was found for asthma (0.4; 0.2 to 0.6). CONCLUSIONS: Our data add to the body of information on the risks of co-morbidity in people with Down's syndrome. The finding on asthma needs to be confirmed or refuted by other studies.

Adolescent↗
PubMed2004

Skin cancer in people with multiple sclerosis: a record linkage study.

OBJECTIVE: The prevalence of multiple sclerosis (MS) varies with latitude: it increases with distance from the equator in both hemispheres. To seek evidence on whether solar radiation is a protective factor for MS, this study investigated whether skin cancer, as an indicator of solar radiation, is less common in people with MS than in others. DESIGN: Analysis of a database of linked hospital records and death certificates. SETTING: The Oxford Region of the National Health Service, England. SUBJECTS: A cohort comprising all people in the database with MS, and comparison cohorts of people with other diseases. RESULTS: Skin cancer was significantly less common in people with MS than in the main comparison cohort (rate ratio 0.49; 95% confidence interval 0.24 to 0.91). There was no general deficit of cancer in the MS cohort, and no deficit of skin cancer in cohorts of people with other autoimmune or neurological diseases. CONCLUSION: The findings support the hypothesis that solar radiation may have a protective influence on the development of MS.

Adult↗
PubMed2003

Crohn's disease, ulcerative colitis, and measles vaccine in an English population, 1979-1998.

STUDY OBJECTIVE: s: To study the hospitalised incidence of Crohn's disease (CD) and ulcerative colitis (UC) from 1979 to 1998; and to determine whether the introduction of the measles vaccination programme was associated with an increase in the young. DESIGN: Analysis of linked data on hospital admissions; a cohort analysis of the effect of the measles vaccination programme on the incidence of hospitalised CD and UC; and a comparison of these results with those from previous studies on the association between measles vaccine and CD or UC. SETTINGS: Southern England. SUBJECTS: People admitted to hospital with a main diagnosis of CD (1959 people) or UC (2018 people). MAIN RESULTS: Overall, the incidence of hospitalised CD showed no significant change over the 20 year period: the average change per year was 0.08% (95% confidence interval: -0.7% to 0.9%). The relative risk associated with the measles vaccination programme was not significant (0.91: 0.5 to 1.4). The estimate differed significantly from the relative risk of 3.0 obtained in the original study reporting an association, but agreed with the combined estimate from three subsequent studies (0.95: 0.6 to 1.5). The results for UC were similar. CONCLUSIONS: The incidence of hospitalised CD and UC remained stable over the 20 years, 1979 to 1998. Whatever caused the marked increases in CD and UC in the mid-20th century must itself have stabilised in this region. These results, together with those from other studies, provide strong evidence against measles vaccine causing CD or UC.

Adolescent↗
PubMed2002

Appendicectomy, tonsillectomy, and inflammatory bowel disease: a case-control record linkage study.

STUDY OBJECTIVE: To determine whether appendicectomy and tonsillectomy are associated with ulcerative colitis (UC) or Crohn's disease (CD); and, if so, whether the associations are related to age at operation. DESIGN: Nested case-control studies using a longitudinal database of linked hospital and death record abstracts. SETTING: Southern England. PATIENTS: Statistical records of people diagnosed with UC, CD, or a control condition admitted to hospitals in a defined area. MAIN RESULTS: Appendicectomy under the age of 20 years was associated with a significantly reduced subsequent risk of UC (relative risk =0.48, 95% confidence interval 0.30 to 0.73). The association appeared strongest for appendicectomy between 10 and 14 years of age (relative risk =0.29, 95% CI 0.09 to 0.68). Appendicectomy at the age of 20 years and over was associated with an increased subsequent risk of CD (relative risk =1.92, 95% CI 1.58 to 2.32), largely confined to those people whose CD was diagnosed within a year of appendicectomy. Appendicectomy under 20 years of age, undertaken five years or more before case or control conditions, was suggestively associated with a reduced risk of CD (relative risk =0.71, 95% CI 0.47 to 1.03). Prior tonsillectomy was not associated with any increase or decrease of risk of either UC or CD. CONCLUSIONS: Appendicectomy is associated with a reduced risk of UC; and the association is specific to young age groups when the population risk of appendicitis is itself highest. The increased risk of CD after appendicectomy, at short time intervals between the two, is probably attributable to the misdiagnosis of CD as appendicitis.

Adolescent↗
PubMed2001

Childhood cancer incidence in a cohort of twin babies.

We studied childhood cancer incidence in a population-based twin cohort using record linkage to the National Registry of Childhood Tumours. After correcting for mortality, an incidence deficit was observed (Standardized Incidence Ratio (SIR) 79; 95% Confidence Interval (CI) 39-120). Pooled analysis with data from published cohort studies indicates a similar significant incidence reduction (SIR 81, 95% CI 67-96). Further studies are warranted.

Child↗
PubMed2001

Graduate status and age at entry to medical school as predictors of doctors' choice of long-term career.

OBJECTIVE: To determine whether graduate entry to medical school, taking an intercalated degree during medical school, and age at entry to medical school are related to choice of eventual career. DESIGN: Postal questionnaires. SETTING: United Kingdom (UK). SUBJECTS: All doctors who qualified in the UK in 1993 or 1996. RESULTS: We analysed whether graduate status and age on entry to medical school, and taking an intercalated degree during medical school, were predictors of the choice of eventual career, adjusting for differences by sex, year of qualification and medical school. General practice was the career choice of 27.0% (79/293) of graduate entrants and 21.6% (1095/5073) of non-graduate entrants, a difference of borderline significance (P=0.04). Of the non-graduate entrants, general practice was the career choice of 15.3% (319/2081) of doctors who took an intercalated degree and 25.9% (776/2992) of doctors who did not (P < 0.001). Within the hospital specialties, those who took an intercalated degree were more likely than others to choose the hospital medical specialties or pathology. Age alone was not a predictor for choice of any area of practice. CONCLUSIONS: There was no evidence of an association between age at entry to medical school and choice of eventual career. Graduates at entry to medical school were a little more likely than non-graduates to choose general practice but the relationship was not a strong one. In these respects, changing the entry profile of medical students is unlikely to result in major shifts of career choice towards general practice.

Adolescent↗