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Stephen R Durham

Publications and source records attributed to Stephen R Durham.

40 records · Page 3Linked to original sources
PubMedDate not supplied

Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis.

BACKGROUND: The frequency of asthma varies between countries, and may also vary between ethnic groups in more geographically confined areas. We sought evidence of such ethnic variations in the UK for asthma frequency, morbidity, and health-services use, and to understand possible reasons for any differences. METHODS: We searched MEDLINE, EMBASE, CINAHL, PSYCHInfo, PREMEDLINE, HEALTHSTAR, Cambridge Register of Conference Abstracts, the Dissertation and Thesis Database, and the National Registry of Research. Additionally, we searched the bibliographies of reports identified and websites of health authorities, and contacted experts in this discipline. Our main outcomes were comparisons of asthma rate, morbidity, and health-services use. We did meta-analyses using random-effects models. FINDINGS: 13 studies contained relevant data. All prevalence studies were of children and showed that south Asian children had a lower frequency of symptoms suggestive of asthma compared with black and white children (pooled rate of history of wheeze in the previous 12 months: south Asians 9.6% [95%CI 8.0-11.2%], black people 16.2% [12.8-19.6%], white people 14.6% [11.5-17.8%]). The pooled frequency of clinician-diagnosed asthma in children followed a similar pattern (south Asians 7.6% [3.7-11.4%], black people 15.0% [3.5-26.5%], white people 10.6% [4.6-16.7%]. However, relative to white people, the risk of admission for asthma in children and adults was higher for south Asians (odds ratio 2.9 [2.4-3.4]) and black people (2.1 [1.8-2.5]). INTERPRETATION: The differences in admission are not explained by differences in asthma frequency between groups; they could relate to ethnic variations in asthma severity, differences in health-seeking behaviour, or difficulties in accessing high-quality primary care services.

Asia, Southeastern↗
PubMedDate not supplied

NHS allergy services in the UK: proposals to improve allergy care.

Allergy is common and its prevalence has increased substantially in the last 2-3 decades. There has been a particular increase in severe allergic disease, including anaphylaxis and food, drug and latex rubber allergy. Provision of allergy services in the NHS is poor and there is a huge unmet need. Allergy is a full specialty, but there are few consultants and few trainees: only six centres in the UK offer a full-time specialist service. Most allergy services are provided by doctors--general practitioners and consultants in other specialties--with little or no training in allergy. Whilst specialists in other areas of medicine have a role in the management of allergy, it is no longer adequate to devolve most allergy care to them. The lack of special care leads to morbidity, mortality and substantial cost to the NHS, much of it avoidable. To ensure that adequate standards of care are satisfactory, allergy care must be led by allergy specialists. More consultant posts and training posts in allergy are urgently needed; this requires recognition by trust managers, regional commissioners and the Department of Health. As a first step, we propose the setting up of appropriately staffed regional allergy centres. This could be achieved with a central directive and (relatively minor) pump-priming of funding.

Allergy and Immunology↗