The prevalence of hepatitis B and hepatitis C in immigrant communities is unknown. Immigrants from south Asia are common in England and elsewhere, and the burden of viral hepatitis in these communities is unknown. We aimed to determine the prevalence of viral hepatitis in immigrants from south Asia living in England, and we therefore undertook a community-based testing project in such people at five sites in England. A total of 4998 people attending community centres were screened for viral hepatitis using oral fluid testing. The overall prevalence of anti-hepatitis C virus (HCV) in people of south Asian origin was 1.6% but varied by country of birth being 0.4%, 0.2%, 0.6% and 2.7% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. The prevalence of hepatitis B surface antigen was 1.2%-0.2%, 0.1%, 1.5% and 1.8% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. Analysis of risk factors for HCV infection shows that people from the Pakistani Punjab and those who have immigrated recently are at increased risk of infection. Our study suggests that migrants from Pakistan are at highest risk of viral hepatitis, with those from India at low risk. As prevalence varies both by country and region of origin and over time, the prevalence in migrant communities living in western countries cannot be easily predicted from studies in the country of origin.
The community diagnostic ultrasound service offers reduced waiting times compared to the NHS Trust service, and is of comparable quality. This benefit, together with high patient and GP satisfaction levels, may justify the possible reduced cost-effectiveness of the service compared to the NHS Trust service.
Following the introduction of the pneumococcal conjugate vaccination program for children in the UK, a study of General Practitioners in Walsall and Liverpool was undertaken to identify the possible reasons for the delay in implementation of the program. A total of 143 GPs were contacted, of whom 39 responded (response rate = 27%). One-third of the GPs felt that there was 'delay' in the introduction of the program. The main reasons for possible delay in the implementation of the program were 'problems with databases', 'inadequate/unclear information from Primary Care Trust,' 'lack of public awareness' and 'parental delay.' Twelve percent of the respondents said that issue of 'payment' to them was the reason for not implementing the program. Most of the reasons given were 'external' to the practitioners. This being an initial exploratory study of its kind, the authors recommend that the results of this study be used in conjunction with other quantitative data by commissioners of health services in designing the implementation of a new vaccination program.
Editor-Several studies have shown that in small areas-such as across a local authority-a partial smoking ban would be likely to increase health inequalities. We present what we believe is the first evidence that this is indeed the case across England as a whole.We generated a random sample of 500 pubs from a national commercial database of 36 586 English pubs, bars, and inns (Thomson directory) and referenced each pub's postcode to its index of multiple deprivation (IMD) score. 1 We telephoned each pub in our sample and asked whether it served hot food.Our power calculation showed that a sample size of 500 would permit us to contrast any two fifths of deprivation. IMD scores for England are based on an exponential scale, so we log transformed this variable for analysis.We used a t test to test the hypothesis that pubs serving hot food had the same deprivation scores as those not serving food, and repeated this analysis after excluding all town centre pubs.2 This was to deal with the possibility that town centre pubs may serve a wider population than their immediate vicinity.We obtained a response from 483 (96.6%) of the pubs (table).Pubs that serve hot food have lower IMD scores than those that do not (t = − 6.07, difference in mean log IMD score − 0.35, 95% confidence interval − 0.47 to − 0.24; P < 0.0001). This remains significant when pubs in town centres are excluded (n = 382; t = − 5.99, difference in mean log IMD score − 0.42, -0.56 to − 0.28; P < 0.0001).Our nationwide study confirms that the proposed partial smoking ban is set to exacerbate health inequalities from smoking andsecondhand smoke, through a dispro portionate increase in the number of smoke free pubs in affluent areas of England.
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