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Biomedical subjects

Michael J Goldacre

Publications and source records attributed to Michael J Goldacre.

At least 19 recordsLinked to original sources
PubMed2006

Self-harm and depression in women with urinary incontinence: a record-linkage study.

OBJECTIVE: To investigate the association between self-harm and urinary incontinence (UI), and between depression and UI, in women. PATIENTS AND METHODS: The incidence of self-harm in women with UI is not well documented. We analysed a statistical database that includes hospital contact data for UI and for self-harm and depression. We calculated rate ratios for self-harm and depression in a cohort of women admitted for UI, and rate ratios for UI in cohorts of women admitted with self-harm or depression, compared with a control cohort. RESULTS: After admission for UI, self-harm was significantly high in young women (aged < 45 years: rate ratio 1.73, 95% confidence intervals 1.37-2.14) but not in older women. Depression was associated with UI in all age groups, e.g. after admission for depression the rate ratio for UI within 5 years was 1.46 (1.33-1.75); and for UI at > or = 5 years after admission for depression, it was 1.20 (1.05-1.35). CONCLUSIONS: Young women with UI are at risk of self-harm. For all age groups studied, depression was more common in women with UI than in others. Depression might be a consequence of UI, but the increase in risk at long intervals before admission with UI suggests that they might share underlying causal mechanisms.

Adult↗
PubMed2006

Changes in safety on England's roads: analysis of hospital statistics.

OBJECTIVE: To compare trends in the numbers of people with serious traffic injuries according to police statistics and hospital episode statistics (HES). DESIGN: Descriptive study based on two independent population based data sources. SETTING: Police statistics and hospital episode statistics in England. MAIN OUTCOME MEASURES: Rates of injury and death and their change over time reported in each data source, for 1996 to 2004. RESULTS: According to police statistics, rates of people killed or seriously injured on the roads fell consistently from 85.9 per 100,000 in 1996 to 59.4 per 100,000 in 2004. Over the same time, however, hospital admission rates for traffic injuries were almost unchanged at 90.0 in 1996 and 91.1 in 2004. Both datasets showed a significant reduction in rates of injury in children aged < or = 15, but the reduction in hospital admission rates was substantially less than the reduction shown in the police statistics. The definition of serious injury in police statistics includes every hospital admission; in each year, none the less, the number of admissions exceeded the number of injuries reported in the police system. CONCLUSIONS: The overall fall seen in police statistics for non-fatal road traffic injuries probably represents a fall in completeness of reporting of these injuries.

Accidents, Traffic↗
PubMed2006

Psychiatric disorders certified on death certificates in an English population.

BACKGROUND: Psychiatric disorders are sometimes certified on death certificates, but seldom selected as the underlying cause of death. The majority of deaths with a certified psychiatric cause are usually omitted from official mortality statistics, which are typically based on the underlying cause alone. AIM: To report on death rates for psychiatric disorders, as certified on death certificates, including all mentioned causes as well as the underlying cause of death. METHOD: Analysis of database including all certified causes of death in 1979-1999, in three time periods defined by coding rule changes. RESULTS: Statistics on the underlying cause of death grossly under-estimated certified psychiatric disorders. For example, in the first period of our study they missed 88% of deaths in which schizophrenia was a certified cause, 98% of affective psychosis, and 96% of depression. Over time, considering all certified causes, age-standardised death rates for schizophrenia declined, those for affective psychosis showed no change, and those for depression and dementia increased. CONCLUSION: The decline in mortality rates for schizophrenia, and the increase for depression and dementia, may reflect real changes over time in disease prevalence at death, although other explanations are possible and are discussed.

Age Distribution↗
PubMed2006

Reasons why some UK medical graduates who initially choose psychiatry do not pursue it as a long-term career.

BACKGROUND: Some doctors who initially choose psychiatry do not pursue it as a long-term career. The study seeks to identify reasons for leaving psychiatry. METHOD: Postal questionnaire survey of UK medical graduates of 1988, 1993, 1996 and 1999 identified as having left psychiatry; for comparison, doctors who left general practice or trauma and orthopaedics. RESULTS: Response rate was 74% (572/778); 488 respondents satisfied study criteria (59 psychiatry, 318 general practice, 111 trauma and orthopaedics). The speciality's poor public image, perceived lack of respect from medical peers, perceived threat of violence from patients, under-resourcing and low morale were problems for psychiatry leavers. Job stress, self-assessed unsuitability, and concerns about the lack of evidence-based treatments also influenced decisions to leave psychiatry. CONCLUSIONS: Early exposure to psychiatry may help trainees assess their suitability. Negative perceptions of workforce issues (e.g. low morale) and of clinical issues (e.g. perceived lack of ability to improve prognosis) need addressing to increase retention.

Adult↗
PubMed2006

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

In the past 10 years there has been increasing concern about recruitment of junior doctors into pathology, particularly histopathology, in the UK. In this study, we report on career choices for pathology, derived from postal questionnaire surveys of all qualifiers from all UK medical schools in nine qualification years since 1974. 74% (24,623/33,417) and 73% (20,709/28,468) of doctors responded at 1 and 3 years after qualification. The percentage of doctors choosing pathology 1 year after qualification has fallen sharply in recent years: between 1974 and 1983 it was 4.5% (95% confidence interval 4.1-4.9%) and between 1993 and 2002 it was 2.3% (CI 2.0-2.5%). 57% of doctors who chose pathology 1 year after qualification were still working in pathology at year 10. Hours and conditions of work, the doctor's personal assessment of their aptitudes, and their experience of the subject as a student influenced long-term career choices for pathology. Recruitment of UK graduates into the pathology specialties must increase to meet demand in the new and expanding subspecialties. This depends on developing innovative ways of raising the profile of pathology to medical students and junior hospital doctors.

Adult↗
PubMed2006

Career choices of United Kingdom medical graduates of 2002: questionnaire survey.

OBJECTIVES: To report the specialty choices of UK medical graduates of 2002, and to compare their choices with those of qualifiers in previous years and with the profile of career grade doctors in different specialties in England. METHODS: We carried out a postal questionnaire survey in the UK and drew comparisons with official data for numbers of specialists. RESULTS: The response rate was 65.3% (2778/4257). A total of 22.7% of the medical graduates of 2002 (28.1% of women, 14.5% of men) expressed a preference for a longterm career in general practice, compared with 25.3% of 1999 and 2000 graduates combined. A total of 31.1% of men and 11.9% of women chose surgical specialties; 0.7% of men and 3.4% of women chose obstetrics and gynaecology; 3.4% of men and 7.9% of women chose paediatrics. There was a large mismatch between the percentage choosing each specialty group and the percentage of senior National Health Service doctors working in the same specialty group. In all, 71% of graduates regarded their career choice as definite or probable and 80% definitely or probably intended to pursue a longterm career in medicine in the UK, compared with 75% of qualifiers in 1999 and 2000. CONCLUSIONS: Career choices for general practice remain low: only 1 in 4 women and 1 in 7 men now choose general practice at this career stage. Very few men choose obstetrics and gynaecology, despite a recent increase in training opportunities. There is no evidence of an increase, compared with recent previous cohorts, in the percentage of junior doctors who do not want a longterm career in British medicine.

Career Choice↗
PubMed2006

Doctors' views about their first postgraduate year in UK medical practice: House officers in 2003.

AIM: To report house officers' views in 2003 of their first postgraduate year, and to compare their responses with those of house officers 2 and 3 years previously. METHODS: Postal questionnaires to all house officers in 2003 who graduated from UK medical schools in 2002. RESULTS: The response rate was 65.3% (2778/4257). The house officers of 2003 enjoyed the year more than those of 2000-1. A total of 78% of respondents in 2003 scored 7-10 in reply to the question 'How much have you enjoyed the house officer year overall?', scored from 0 (no enjoyment) to 10 (enjoyed it greatly), compared with 70% of 2000-1 house officers. They were more satisfied with leisure time available to them (51% scoring 6-10 in 2003; 35% in 2000-1). There were significant improvements in almost every aspect of doctors' experience. Hospital medical posts were rated more highly than surgical posts, and general practice posts higher still. Overall, 38% of respondents regarded their training as having been of a high standard, and 37% felt that they received constructive feedback on their performance. Differences between men and women in their views about their jobs were small. DISCUSSION: The house officers of 2003 reported more positively on their experiences than did those of 2000-1. Although a substantial percentage were negative about specific aspects of clinical support and training, particularly in surgical posts, almost all the responses covering training and clinical support moved in a favourable direction over time.

Attitude of Health Personnel↗
PubMed2006

Pregnancy outcome among twins conceived after subfertility treatment compared with natural twins: A population-based study.

Pregnancy outcome and characteristics of women who conceive following subfertility treatment remains a subject of great interest. We analyzed these variables among 199 women who delivered a registerable twin birth compared with 1773 women who delivered a naturally conceived twin birth in a population-based obstetric cohort drawn from around Oxford, England. Treatment was restricted to conceptions involving simple ovulation induction only. Treated mothers were of significantly higher social class and older, more likely to deliver girls and to be delivered by cesarean section, and significantly less likely to be smokers at the time of antenatal booking and to have delivered previous pregnancies. Pregnancy outcome was similar between the two groups for most measures, with the exception of birthweight which was lower in treated twins, though not significantly so. Overall the results are reassuring with respect to outcome in twin pregnancies following simple ovulation induction.

Adult↗
PubMed2005

Hospital admission for selected single virus infections prior to diabetes mellitus.

AIMS: To determine whether hospital admission for a range of specified virus infections was followed by a raised admission rate for diabetes mellitus; and, if raised, whether the increase is compatible with the hypothesis that virus infection is a cause of diabetes. METHODS: Analysis of a database of hospital statistics including admissions for people with diabetes mellitus before the age of 30 years. RESULTS: There was no evidence of excess risk of diabetes after measles, mumps, rubella, infectious mononucleosis, influenza, infectious hepatitis, varicella and herpes zoster, herpes simplex, aseptic meningitis or bronchiolitis. For example, of 1433 patients admitted for measles, 6 were later admitted with diabetes (risk ratio 1.32; 95% confidence interval 0.5-2.9); of 866 patients admitted for mumps, 2 were later admitted for diabetes (risk ratio 0.74; 0.1-2.7). Numbers of people with diabetes subsequent to infection were too few, however, to rule out the possibility of small effects. CONCLUSIONS: Our findings do not support the hypothesis that any of these virus infections initiate the processes that lead to the development of diabetes, or that these infections act as a trigger to precipitate active disease in those whose diabetes is already present but latent.

Cohort Studies↗
PubMed2005

Cancer and cardiovascular disease after vasectomy: an epidemiological database study.

OBJECTIVE: To determine whether vasectomy is associated with an increased long-term risk of cancer or cardiovascular disease. DESIGN: Analysis of database of linked statistical records of hospital admissions and deaths. SETTING: Health region in southern England. PATIENT(S): Men aged 20-59 years who were admitted to a hospital for vasectomy. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rates of cancer and cardiovascular disease compared with the corresponding rates in a reference cohort, expressed as a rate ratio. RESULT(S): We found no elevation of risk, after vasectomy, of prostate cancer (rate ratio 0.74, 95% confidence interval [CI] 0.45-1.14) or other cancers. The rate ratio for coronary heart disease overall after vasectomy was 0.95 (95% CI 0.88-1.02); and the rate ratio > or =20 years after vasectomy was 0.98 (95% CI 0.80-1.19). CONCLUSION(S): Our findings add to the evidence that vasectomy is not associated with an increase in the long-term risk of these diseases.

Adult↗
PubMed2005

Mortality from heart failure in an English population, 1979-2003: study of death certification.

OBJECTIVE: It is widely held that there will be an epidemic of heart failure in Europe and North America as a result of increased survival from myocardial infarction and other coronary heart disease. The study objective was to discover if the decline in mortality from coronary heart disease has been accompanied by a rise in mortality from heart failure in the study population. DESIGN: Analysis of database of mortality records including all certified causes of death, not just the underlying cause, from 1979-2003. SETTING: Former Oxford NHS Region, England. PATIENTS: Data from death certificates of all who died in the population covered. MAIN RESULTS: Mortality rates for heart failure fell at very similar rates as those from coronary heart disease. In men, the average annual fall in mortality from coronary heart disease was -2.7% (95% confidence intervals -2.8 to -2.5) and that from heart failure was -2.9% (-3.2 to -2.5). In women, the average annual fall in mortality from coronary heart disease was -2.3% (-2.6 to -2.1) and that from heart failure was -2.6% (-3.0 to -2.3). CONCLUSIONS: The decline in mortality from coronary heart disease has not been accompanied by a rise in mortality from heart failure. A future epidemic of heart failure, as a consequence of the decline in mortality from coronary heart disease, seems unlikely.

Age Distribution↗
PubMed2005

Career choices for psychiatry: national surveys of graduates of 1974-2000 from UK medical schools.

BACKGROUND: Concerns continue about recruitment levels of junior doctors into psychiatry in the UK. AIMS: To report career choices for and career progression in psychiatry. METHOD: Postal questionnaire surveys of qualifiers from all UK medical schools in eight qualification years since 1974. RESULTS: Totals of 75% (21,845 out of 28,980) and 74% (17,741 out of 24,044) of doctors responded at one and three years after qualification. One and three years after qualification, 4-5% of doctors chose psychiatry. This has changed very little between 1974 and 2000. Most doctors who chose psychiatry one and three years after qualification were working in psychiatry at year 10. Hours and conditions of work, the doctor's personal assessment of their aptitudes and skills and their experience of the subject as a student influenced long-term career choices for psychiatry. CONCLUSIONS: Greater exposure to psychiatry for clinical students and in junior hospital jobs might improve recruitment.

Career Choice↗
PubMed2005

Schizophrenia and cancer: an epidemiological study.

BACKGROUND: For decades there has been interest in the possibility that people with schizophrenia might have some protection against cancer, and that, if this were so, it might hold clues about aetiological mechanisms in schizophrenia. AIMS: To study cancer incidence in schizophrenia. METHOD: Cohort analysis of linked hospital and death records was used to compare cancer rates in people with schizophrenia with a reference cohort. RESULTS: We did not find a reduced risk for cancer overall (rate ratio 0.99,95% CI 0.90-1.08) or for most individual cancers. There was, however, a significantly low rate ratio for skin cancer (0.56,95% CI 0.36-0.83). CONCLUSIONS: We found no evidence that schizophrenia confers protection against cancer in general. Low rates of cancer are consistent with the hypothesis that sun exposure may influence the development of schizophrenia, although other explanations are also possible.

Adolescent↗
PubMed2004

Reasons for considering leaving UK medicine: questionnaire study of junior doctors' comments.

OBJECTIVES: To study the reasons given by junior doctors trained in the United Kingdom for considering leaving UK medicine. DESIGN: Analysis of replies to postal questionnaire surveys. SETTING: United Kingdom. PARTICIPANTS: 1326 doctors who qualified in 1999. MAIN OUTCOME MEASURE: Reasons for considering leaving. RESULTS: Of 1047 doctors who indicated that they would stay in medicine but not necessarily in the United Kingdom, 65% (682) gave reasons for leaving that concerned lifestyle, such as a preference for living outside the United Kingdom; 41% (433) gave reasons concerning working conditions in UK medicine; and 18% (184) gave positive work related reasons, such as wanting to work in developing countries. Of 279 doctors considering leaving medicine, 75% (210) cited working conditions, 23% (63) cited lifestyle reasons, and 9% (24) cited positive interests in a different career. Of the 169 doctors who said that they would probably or definitely leave the United Kingdom but remain in medicine, 78% (132) specified lifestyle reasons. Of the 42 who said that they would probably or definitely leave medicine, 67% (28) cited working conditions. CONCLUSIONS: The wish to work abroad, but to stay in medicine, was more common than the wish to leave medicine. The preference for a different lifestyle, particularly to live outside the United Kingdom, is not readily amenable to policy changes to the medical working environment. The smaller numbers of doctors who gave work experience as a reason for considering leaving medicine might be influenced to stay by improvements in working lives.

Attitude of Health Personnel↗
PubMed2004

Country of training and ethnic origin of UK doctors: database and survey studies.

OBJECTIVES: To report on the country of training and ethnicity of consultants in different specialties in the NHS, on trends in intake to UK medical schools by ethnicity, and on the specialty choices made by UK medical graduates in different ethnic groups. DESIGN: Analysis of official databases of consultants and of students accepted to study medicine; survey data about career choices made by newly qualified doctors. SETTING AND SUBJECTS: England and Wales (consultants), United Kingdom (students and newly qualified doctors). RESULTS: Of consultants appointed before 1992, 15% had trained abroad; of those appointed in 1992-2001, 24% had trained abroad. The percentage of consultants who had trained abroad and were non-white was significantly high, compared with their overall percentage among consultants, in geriatric medicine, genitourinary medicine, paediatrics, old age psychiatry, and learning disability. UK trained non-white doctors had specialty destinations similar to those of UK trained white doctors. The percentage of UK medical graduates who are non-white has increased substantially from about 2% in 1974 and will approach 30% by 2005. White men now comprise little more than a quarter of all UK medical students. White and non-white UK graduates make similar choices of specialty. CONCLUSIONS: Specialist medical practice in the NHS has been heavily dependent on doctors who have trained abroad, particularly in specialties where posts have been hard to fill. By contrast, UK trained doctors from ethnic minorities are not over-represented in the less popular specialties. Ethnic minorities are well represented in UK medical school intakes; and white men, but not white women, are now substantially under-represented.

Career Choice↗
PubMed2004

Hospital admission for acute pancreatitis in an English population, 1963-98: database study of incidence and mortality.

OBJECTIVES: To investigate trends in the incidence of acute pancreatitis resulting in admission to hospital, and mortality after admission, from 1963 to 1998. DESIGN: Analysis of hospital inpatient statistics for acute pancreatitis, linked to data from death certificates. SETTING: Southern England. SUBJECTS: 5312 people admitted to hospital with acute pancreatitis. MAIN OUTCOME MEASURES: Incidence rates for admission to hospital, case fatality rates at 0-29 and 30-364 days after admission, and standardised mortality ratios at monthly intervals up to one year after admission. RESULTS: The incidence of acute pancreatitis with admission to hospital increased from 1963-98: age standardised incidence rates were 4.9 per 100,000 population in 1963-74, 7.7 in 1975-86, and 9.8 in 1987-98. Age standardised case fatality rates within 30 days of admission were 14.2% in 1963-74, 7.6% in 1975-86, and 6.7% in 1987-98. From 1975-98, standardised mortality ratios at 30 days were 30 in men and 31 in women (compared with the general population of equivalent age in the same period = 1), and they remained significantly increased until month 5 for men and month 6 for women. CONCLUSIONS: Incidence rates for acute pancreatitis with admission to hospital rose in both men and women from 1963 to 1998, particularly among younger age groups. This probably reflects, at least in part, an increase in alcoholic pancreatitis. Mortality after admission has not declined since the 1970s. This presumably reflects the fact that no major innovations in the treatment of acute pancreatitis have been introduced. Pancreatitis remains a disease with a poor prognosis during the acute phase.

Acute Disease↗