Showing papers in "Health bulletin in 1991"

Cervical cancer screening: women's knowledge, attitudes and preferences.

Abstract: Screening status of women aged 20-64 registered with a large group practice was determined using laboratory and general practice records. A postal survey was carried out on 1,416 women divided into: 1. 'Non-attenders'--never had a smear. 2. 'Defaulters'--smear more than five years ago. 3. 'Attenders'--smear in last five years. Screening status was related to social class and education. Single and nulliparous women were less likely to have been screened. Knowledge of the test was poor in all three groups. Most women were willing to have a smear performed and previous non-attendance might have been overcome by a call/recall system. The woman's general practitioner was the preferred taker of smears, regardless of sex. Of those willing to have the test 95% would attend the general practitioner if no alternative was provided. Improved uptake depends on an organised call/recall system with smear taking based in primary care, and on improved health education.

Glasgow patients' attitude to doctors' dress and appearance.

Abstract: Three hundred out patients were surveyed by questionnaire to determine their views of doctors' dress and appearance. The majority felt that this was important. Most patients did not mind a male doctor with an earring, a women in trousers or a man without a tie. A majority preferred their doctors to wear a white coat, be free of political badges and for men to have conventional length hair. Older patients are stricter than young patients. Most strict patients would accept more relaxed standards at night and during the weekend.

The history of the International Classification of Diseases.

Abstract: A major purpose for gathering descriptive statistics is to allow comparisons of data over time and among different places. In the case of public health it has been particularly important to make such comparisons utilising diagnostic information. Without a standard measuring tool which remains fixed for periods of time and which is applied uniformly from place to place, meaningful comparative analyses of diagnostic information would not be possible. The International Classification of Diseases is such a standard tool. This presentation briefly traces the history of the development and revision of various versions of this International Classification of Diseases and presents the background leading to the current activities associated with the Tenth Revision of this important health statistical and epidemiological disease classification.

The establishment of a centralised referral service leads to earlier abortion.

Abstract: In 1988 a centralised referral service for termination of pregnancy was established in Edinburgh. This has led to a significant reduction in the time women who have requested termination wait to see a gynaecologist (mean 4.7 days) and in the time it takes before suction termination of pregnancy is undertaken (total wait 10.2 days). In 1988 only 40% of induced abortions in Edinburgh were carried out at 9 weeks gestation or before while in 1989 that figure had risen to 60%. In 1989 less than 10% of pregnancies were terminated at or after 12 weeks gestation, compared with 21% in 1988. Reasons for delays in obtaining an abortion are multifactorial but rapid referral once a woman has made the decision to seek help will be essential if she is to avail herself of the advantages of medical termination--only available until eight weeks of pregnancy.

Accidents, poisoning and violence as a cause of hospital admissions in children.

Abstract: A study has been carried out to assess the pattern of child admissions to Tayside Hospitals as a result of accidents, poisoning and violence (hereafter referred to simply as 'accidents') during 1989, and to determine if any major changes have taken place since 1980. The length of stay resulting from each class of accident was used as an approximate indicator of severity and the consumption of Health Service resources. In 1989, 1,388 of Tayside's 70,609 children were admitted to hospital as a result of accidents. With a total of 4,140 days spent in hospital, an average of 11.3 beds are constantly occupied by child accident victims (not including the long-term disabled). Falls resulted in the largest number of admissions to hospital, with poisoning, and having been accidentally struck by persons or objects, in second and third place. Analysis of bed usage, however, revealed a different pattern. While falls remained the biggest consumer of bed days, these were now followed by motor vehicle traffic accidents (MVTAs) and scalds. The average length of stay for MVTAs and scalds was 9.1 and 9.0 days respectively compared with an average of 2.8 days for all types of accident. Poisoning and scalds showed a remarkable age dependence with 81% of children admitted for poisoning or suspected poisoning being in the 1-3 year age group, and 63% admitted for scalds under the age of two. Language: en

A new Pick based computer thyroid register based on the national SAFUR requirements for local usage.

Abstract: Patients with thyroid disease require lifelong surveillance to detect late onset hypothyroidism and to monitor thyroid replacement therapy. This is best achieved by a shared-care computer system. We describe the introduction to Tayside (Ninewells Hospital) of a new computerised thyroid follow-up programme based on the Patient Record System under a Pick operating system, run on a Honeywell-Bull minicomputer. This new programme has allowed the transfer of patients from the previous Aberdeen based SAFUR centralised service to a locally based unit, offering an improved, updated and cost effective method for thyroid disease surveillance. Audit, clinical and financial, may now be more efficiently achieved, allowing local needs to direct the service provision.

The state of general practice computing in Scotland and the characteristics of computerised practices: a survey of 948 practices.

Abstract: A survey of 1,179 Scottish practices produced an 81% response rate and gathered data about practice size, environment, state of computerisation as well as future plans for the use of computers in the practice. Results show that the majority of practices are already computerised and that over 90% will be computerised soon. A computer in the practice correlates especially with the presence of a practice manager, a practice nurse and training or teaching status. Scotland is unique in having a national software program (GPASS) for general practice administration. We estimate that by mid 1991 over 750 practices will be using GPASS.

A survey of psychiatric patients' views of outpatient clinic facilities.

Abstract: Psychiatric services have been slow to solicit the views of their patients about quality. This study asked attenders at an outpatient clinic at a large psychiatric teaching hospital about their opinions on the referral process, waiting time, access, waiting within the clinic, consultations, and overall satisfaction. Response rates were 86% and 70% for the two parts of an interviewer-administered, structured questionnaire. A range of criticisms and concerns were identified, some of which have since been addressed by practical measures. Overall satisfaction was related to the quality of communication within the consultation and to the length of waiting time from referral to appointment. The study confirms the practicality of consumer studies in a psychiatric setting.

An assessment of computing activity by GPASS users in Scottish general practice.

Abstract: The electronic questionnaire has been developed as a means of collecting data held on computers in Scottish General Practices using the standard national general practice computer system (GPASS). In 1989, data were gathered from 251 computerised Scottish practices using a floppy disc based interrogation program, amalgamated and then analysed. The results of this study are presented and examined in three separate ways: by region, by date of initial computerisation, and by list size per general practitioner (GP).

Alcohol misuse in Scotland--is there a growing health problem?

Abstract: This paper reviews currently available data on alcohol related morbidity and mortality in Scotland. It confirms that admissions to psychiatric hospitals are unlikely to be a reliable indicator of trends in alcohol-related conditions because of the influence of local practice. Discharge rates for general (non-psychiatric) hospitals where an alcohol-related diagnosis has been made are reviewed and even using caution in interpreting the data, the results suggest that there is a worrying increase in rates of discharges with an alcohol-related diagnosis. Finally trends in deaths for both alcoholic liver disease (ICD 571.0-3) and unspecified chronic liver disease (ICD 571.4-9) are examined. It is concluded that other indicators of health related harm should be considered. These might include data from those presently seen in out-patient departments with an alcohol related condition as well as patients misusing alcohol who attend their General Practitioner (GP).

The Chief Scientist reports... The diets of Scottish men and women in relation to nutritional recommendations for health.

Abstract: Diets of middle-aged Scottish men and women were assessed by food frequency questionnaire as part of the Scottish Heart Health Study (a cross-sectional study of risk factors for coronary heart disease (CHD) in 22 regions). The data have allowed evaluation of the diets of different (high CHD risk) sub-groups with respect to nutrient composition and major nutrient sources. This paper summarises the key nutrient source findings by non-manual and manual occupational groups; discusses the Scottish diet in relation to recent recommendations for healthy eating and recommended daily allowances for antioxidant vitamins; and considers ways of achieving dietary change.

Out of hours work in primary care: audit of an urban co-operative deputising service.

Abstract: The White Paper and discussions about the GP contract have reinforced an interest in the audit of the demand for and the quality of out-of-hours cover. We audited deputising service records for the North East Deputising Service in Glasgow over one year. Six thousand eight hundred and thirty-four calls were received from a catchment population of 37,300. A sample of 468 (7%) calls was used to estimate the appropriateness of calls. A classification, based on diagnosis, classified calls as emergency, 'reasonable' or 'unnecessary'. One hundred and eighty-three out-of-hours calls were made per 1,000 patients per year, with 40 of these being at night. Twenty-three per cent of calls were considered unnecessary, 65% reasonable and 12% genuine emergencies. People living in areas of deprivation were more likely to call and more likely to make an inappropriate call. Only 1% of calls ended with telephone advice. Five per cent had to wait more than two hours after calling. The rate of calls in this study was high compared to other studies and the use of telephone advice low. Attempts should be made to make more use of telephone advice and to educate patients to make more appropriate use of services. However, the high demand from areas of deprivation should be borne in mind when calculating GP budgets.

Patterns of presentation of breast disease over ten years in a specialised clinic.

Abstract: A clinic specialising in breast disease has been surveyed over a decade. Detailed information has been collected on 3,500 women with benign breast disorders and 950 with breast cancer. Over this time, the demand for and utilisation of this facility has increased steadily. Over the ten years, there has been a trend for a higher proportion of breast cancers to be smaller in size and for fewer cancers to be locally advanced or metastatic at presentation. Critical appraisal of referral and consultation patterns indicates that the original aims of establishing this clinic have not been maintained. Paradoxically, this is a result of the success of the exercise. Measures which might lead to a higher proportion of patients with breast cancer being managed at the Breast Clinic rather than a General Surgical Outpatient Clinic are discussed.

The use of anti-D prophylaxis in the management of miscarriage in general practice.

Abstract: Deaths from rhesus (Rh) haemolytic disease dropped steeply after anti-D immunoglobin became available for prophylaxis in Britain in 1969. Nevertheless, Rh incompatibility remains a cause of perinatal mortality and some unregistered fetal deaths before 28 weeks gestation. Some of these deaths are attributed to a failure to administer anti-D immunoglobin in the appropriate circumstances. The prophylactic administration of anti-D immunoglobin to Rh negative women or women whose Rh type was unknown was explored as part of a survey of the management of miscarriage in general practitioner training practices in the West of Scotland. Trainees were found to be the most likely, and general practitioners who had qualified before 1970 the least likely to offer anti-D prophylaxis. The advice of the Health Departments is currently unambiguous about the need to administer anti-D immunoglobin after miscarriage. The findings described here indicate the need to implement this advice more effectively until the question of first trimester sensitisation has been resolved.

Anti-smoking policies and practice in Scottish Health Boards: progress 1985-89. Scottish Tobacco Group.

Abstract: 1. The anti-smoking policies in practice of Scottish Health Boards (HBs) were surveyed in 1989, and the results compared to those of a previous survey in 1985. 2. There has been reasonable to good progress in production of a HB policy document; in smoke-free HB committee meetings; in smoke-free public offices, hospital offices, canteens, hospital outpatient areas, community clinics, health centre waiting rooms and offices: in prohibiting sale of cigarettes on NHS premises; in provision of smoking cessation services; in liaison with other organisations; and in initiatives on National No-Smoking Day. 3. On the other hand progress has been poor in providing a smoke-free environment in acute, maternity and longstay wards, and especially poor in hospital ward sitting up areas. There has been disappointingly little progress in the education of nurses and only minor improvement in that for paramedical and lay staff.

Public knowledge of hospices: a street survey in Glasgow.

Abstract: A street survey was conducted in Glasgow to find out the level of public knowledge of and attitudes to hospices generally and two local hospices. The level of knowledge was not high, though attitudes to hospices were positive. Those few respondents with unfavourable attitudes had little knowledge of hospices generally and knew little about the local hospices. The factors associated with level of knowledge and attitudes were different for the two local hospices. The media and the collection of money for hospices were the main source of knowledge.

Costs of investigative protocols for cerebellopontine angle lesions in Scotland.

Abstract: Efficient use of resources demands evaluation of current practices. This paper presents a prospective evaluation of investigative protocols for cerebellopontine angle lesions. Commonly used protocols vary greatly in their clinical effectiveness and in their costs. The use of appropriate protocols would increase the number of tumours correctly diagnosed each year while also limiting the costs of investigation.

Scotland's changing diet, gastrointestinal disease and dietary therapy.

Abstract: The changes in the Scottish diet over a long period are outlined. The relevance of diet to the origin and therapy of certain gastrointestinal diseases is discussed.

Misplacement in long stay geriatric care, psychogeriatric care and Part IV accommodation.

Abstract: The dependency and behavioural characteristics of 1,461 elderly people in long stay geriatric and psychogeriatric wards and Part IV accommodation were surveyed. Misplacement, defined as having dependency and behaviour characteristics normally associated with admission to another form of care, was widespread, ranging from 5-51% in the different facilities visited. It was greatest in psychogeriatric wards and least in geriatric wards. In Part IV accommodation there was a significant inverse relationship between length of stay and appropriateness of placement.