Showing papers in "Health bulletin in 1993"

The Scottish Record Linkage System.

Abstract: Howard Newcombe, pioneer and founder of probability matching techniques, has illustrated the continuing dialectic between the theory and the practical craft of linkage. From the point of view of the development of record linkage in Scotland his most valuable contribution, beyond his initial formulation of the principles of probability matching, has been his emphasis on being guided by the characteristics and structure of the data sets in question and close empirical attention to the emergent qualities of each linkage (Newcombe et al. 1959; Newcombe, 1988). Particularly inspiring has been his insistence that probability matching is at heart a simple and intuitive process and should not be turned into a highly specialised procedure isolated from the day to day concerns of the organisation in which it is carried out (Newcombe et al. 1986).

Scotland's health--a more difficult challenge for some? The price and availability of healthy foods in socially contrasting localities in the west of Scotland.

Abstract: The recent White Paper, 'Scotland's Health: A Challenge To Us All', emphasises the importance of lifestyle factors, such as smoking, diet and exercise, in Scotland's poor health record. Targets are to be set for improvements in diet, and individuals will be encouraged to improve their eating habits. In this paper we suggest that attention should be given to the price and availability of healthy foods, particularly in socio-economically deprived areas. To illustrate the possible importance of this, we present findings from a small exploratory study of two socially contrasting and non-contiguous localities in Glasgow which indicates that price disincentives to eating healthy may be greater in poorer than in more affluent areas.

Adolescent meal patterns: grazing habits in the west of Scotland.

Abstract: Concern is frequently expressed that young people are increasingly taking a 'grazing' approach to eating, rather than eating 'proper meals', and that this may have undesirable nutritional and social consequences. As part of a wide ranging study of health and well-being, 1,009 fifteen year olds in the Central Clydeside Conurbation were questioned in 1987 about their eating patterns. They reported an average of 5.5 eating occasions per day (2.7 main meals and 2.8 snacks), these eating occasions being concentrated towards the end of the day. Over 40% reported eating crisps, confectionery or biscuits at least once a day, a much higher proportion than among a cohort of 35 year olds in the same study. We discuss the implications for nutrition education and suggest that the picture is not as bad as is sometimes painted.

Use of a community-based touch-screen public-access health information system.

Abstract: Meeting the demands of patients and the public for health information is now a recognised aim. Healthpoint is a community-based touch-screen public-access health information system which aims to make health information easily accessible by the public and to provide feedback information on this demand. We have assessed Healthpoint in an experiment in three parts. Part one was a survey of 13 Healthpoints for several weeks in various community sites in Glasgow, such as a shopping centre, supermarket, library, and pub, as well as health service sites such as out-patient department and general practice. The number of users and the topics chosen were recorded by the systems. Part two was a survey of ten Healthpoints in one town (Clydebank) over five months, which examined routine information recorded by the system, and interviews with an opportunistic sample of 300 weekday shoppers in the street and a random sample of 271 by telephone. Part three was a survey of one Healthpoint in a general practice for 36 weeks using routine recording by the system and a postal survey of a systematic sample of 250 attenders. Seventy five (25%) out of 300 in the street survey and 45 (22%) of the telephone sample who had visited a site where there was a Healthpoint had used it. Overall, 17% of the telephone sample had used it. Seventy three (27%) out of 200 general practice attenders had used Healthpoint.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation of the personal child health record in Fife.

Abstract: Personal child health records were introduced in Fife in March 1992; an evaluation carried out in November 1992-February 1993 sought the views of both parents and health professionals and examined a sample of the records. All 104 parents who were interviewed considered it important that they hold a copy of their child's health record. The majority made good use of the personal child health record by bringing it regularly to clinics and by reading or completing the appropriate sections. The views of health professionals were mixed and some specific problems were raised. However, there is still relatively limited experience with the record in Fife; it is possible that professional endorsement of it will grow with increasing experience in its use. Suggestions for improvements should be acted upon where possible to encourage regular and correct use. The loose leaf format of the record facilitates the incorporation of amendments. The use of the record in Fife should be promoted by emphasising that, despite individual views of health professionals about the record, the great majority of parents value it and the improved access to the information about their child's health which it represents.

Pattern and severity of injury sustained by motorcyclists in road traffic accidents in Edinburgh, Scotland.

Abstract: The pattern, severity and circumstances of injury sustained by 52 motorcyclists admitted as the result of a road traffic accident were prospectively documented. Forty-eight of the patients were drivers and four were pillion passengers. Three of the drivers and all of the pillion passengers were female. Injuries to motorcyclists accounted for 0.4% of the total workload of the department during the course of the study, and for 14% of all injuries seen there arising from road traffic accidents. Eighty-nine per cent of the patients were aged less than 25 years and the oldest patient was aged 44 years. Patients under the age of 21 years were injured more severely than those aged 21 years or more. The majority of injuries (67%) involved the limbs with the right arm and leg being injured twice as often as the left arm and leg. Arms and legs were injured with equal frequency. Head and facial injuries comprised only 9% of the total. Two patients were observed not to be wearing helmets at the time of the accident. Patients admitted between midnight and 05.59 hours sustained injuries of greater severity than those admitted between 06.00 and 23.59. Fifty per cent of patients had an Injury Severity Score of less than five, and only four patients had Injury Severity Score of 25 or more. One third of patients were riding motorcycles with an engine size of 750cc or greater. This group of patients was younger than patients riding less powerful motorcycles and also sustained injuries of greater severity.

The chief scientist reports ... Evaluation of the Scottish shadow fund-holding project: first results.

Abstract: This paper reports preliminary findings from the action research evaluation of the Scottish shadow fund-holding project. Fifty doctors looking after 84,000 patients in six groups negotiated and managed a paper fund for six months, and then a real fund for six months. First analyses of quantitative data suggest that the numbers of prescriptions written, investigations done and referrals made remained stable over the period of study. The length of time spent at consultations varied apparently independently of holding a fund. Patient satisfaction with actions taken by doctors and their feelings of benefit from consultations were high throughout the study, but a consistent and significant shift from very satisfied to satisfied categories was noted in all practices for most variables surveyed during the course of 1990-91. Analyses to explain this are continuing. Qualitative study identified benefits in terms of a greater understanding of the costs of activities, and new working patterns between hospital, general practice and administrative staff have led to progressive work in contracting for quality of patient care. At the same time, the lack of sophistication of fund setting needs to be addressed; equity issues will become relevant as fund-holding reaches a larger proportion of practices. The pressures on those taking leading roles in administration are high, and this is confirmed by parallel quantitative work. Further information is becoming available on both prescribing and the care of selected 'marker' conditions, and these will be the subject of further reports.

Long term follow-up of treated hyperthyroid and hypothyroid patients.

Abstract: The objective was to assess the success rate in patients receiving surgery or radioactive iodine for primary hyperthyroidism and the incidence of subsequent hypothyroidism. A long term follow up of patients on L-thyroxine has also been performed from a cohort of patients on the Tayside Thyroid Register. The case series has been followed-up for up to 21 years. 2,038 patients were registered of whom 90.1% were female. 1,045 had had previous hyperthyroidism and 993 had hypothyroidism. Treatment for thyrotoxicosis varied with age, 80.4% of patients under the age of 40 being treated by thyroidectomy and 72.6% of patients over 50 being given the iodine. Overall 9% of patients required medical therapy alone (carbimazole), and this varied little with age. Compared to radioactive iodine, thyroidectomy was more successful (90.2% vs 82.9%, p 4.0 mU/l). Patients with a suppressed level were taking a higher dose of L-thyroxine than those with a detectable level (114.2 +/- 56.9 micrograms vs 100.4 +/- 45.9 micrograms, p < 0.01), but those with an elevated level were prescribed an even higher mean L-thyroxine dose (137.1 +/- 58.8 micrograms)); many were probably poorly compliant.(ABSTRACT TRUNCATED AT 250 WORDS)

Nurses or doctors: patient choice in family planning.

Abstract: For many years at one inner city practice, practice nurses trained in family planning and using an in-house protocol have been providing family planning advice and supplies to patients initially seen by the general practitioner. Two hundred consecutive patients attending the practice nurse or doctor for family planning supplies or advice were invited to complete a questionnaire to assess their preferred career and their overall satisfaction with the services. The patients' perceptions of whom they thought most appropriate to deal with their family planning requirements were explored. The patients who had seen the nurse rather than the doctor claimed to be more up to date with their cervical smear, to have had their blood pressure (BP) checked, and to be generally more satisfied with the consultation. Apart from the initial consultation for oral contraception most patients stated they would prefer to attend the nurse.

Differences in expectation of life between Glasgow and Edinburgh. Implications for health policy in Scotland.

Abstract: Inequality in health is not a minor issue confined to small areas, but a major feature of contemporary Scotland and a massive public health problem. Comparison of mortality rates in Glasgow and Edinburgh is instructive, not only because of the large current difference in mortality rates between the cities, but also because the availability of data for both cities for most of this century provides an opportunity to view current differences from a historical perspective. This shows that current large differences in disease-specific mortality rates are part of a broader pattern of earlier death from all causes which has been established at least by the age of 25 in successive generations. Whether and how this pattern may be reversed and prevented deserves urgent discussion and debate. In the meantime, differences in life expectancy between sections of the Scottish population should be included as part of routine health monitoring. Reduction in differences in life expectancy should also become a national health target.

Asthma in Scotland: epidemiology and clinical management.

Abstract: Asthma in Scotland is briefly reviewed including epidemiology, management and the potential for research, education and audit. Asthma is characterised by variable wheeze and shortness of breath caused by variable narrowing of the bronchial airways secondary to inflammation. Confusion with chronic obstructive airways disease is increasingly common in the elderly and epidemiological studies tend to focus on the age range 5-44 years. Asthma prevalence is critically dependent on the definitions used and exceeds 20% based on questionnaire alone, less if objective measurements of airways obstruction is also used: perhaps 15% in children, 5% in adults in Scotland. Comparisons between studies and countries are therefore potentially hazardous. Routine information sources confirm the high levels of morbidity and use of health services by asthmatic patients. A true increase in the prevalence of asthma in children over the last two decades appears likely. This has been compounded by increased willingness to use the diagnostic label of asthma. Asthma, hayfever and eczema have increased significantly in Aberdeen school children over the last 25 years and asthma symptoms and airways obstruction have increased significantly in South Wales. Similar increases are reported in New Zealand children between 1975 and 1985, the prevalence being significantly higher than in Welsh children using standardised methodology. In Zimbabwe an intriguing strong association has been demonstrated between asthma, urban life style and higher socio economic groups. Most asthma deaths are caused by bronchial narrowing and subsequent asphyxia. Asthma mortality has apparently increased in most industrialised countries but problems of definition remain even when attention is confined to the age span 5-44 years. The epidemic of asthma deaths in mid-60s was undeniable and may have reflected good symptomatic control by bronchodilators, which made doctors and patients neglect the underlying risk of asthma death. A gradual increase in asthma mortality in western countries over the 1970s and 1980s is apparent, including almost 5% annual increase in England and Wales between 1974 and 1984 which then levelled off. This may again reflect excess dependence on bronchodilator treatment and under-usage of steroid treatment. A more dramatic increase in mortality in New Zealand in the early 1980s is likely to have a number of contributory factors. In contrast, the mortality rate in Scotland had been relatively static over the last two decades, although hospital discharge rates have doubled. Emergency asthma self admission schemes developed in Edinburgh are increasing popular and these, along with nebulised bronchodilators in ambulances, may be beneficial.(ABSTRACT TRUNCATED AT 400 WORDS)

Perioperative deaths--detection by linkage of hospital discharge and death registration sub-files.

Abstract: In support of the extension of the National Confidential Enquiry into Perioperative Deaths to Scotland, and in view of increased interest in the use of such deaths as clinical outcome measures in the setting of service contracts, methods have been developed employing the national Hospital Discharge (SMR1) file and Registrar General's Death Registration file on a local microcomputer for the identification of patients who die within 30 days of an operation. Direct interrogation of the SMR1 file for individual records containing both an operation date and date of death yields only those patients who die prior to discharge or transfer. Since in our study these accounted for only 52% of the total perioperative deaths, this may explain previous disillusionment with the potential of computer systems for their identification. By creating each month a SMR1 sub-file of patients having operations and linking this to a second sub-file containing the records of all patients dying in hospital, it was found that 32% of deaths occurred following transfer to a different specialty or hospital, and 8% on re-admission following discharge home. On linking the SMR1 operation sub-file to the death registration file, 8% of the total perioperative deaths were shown to have taken place outside hospital.

An evaluation of counselling for employer-referred problem drinkers.

Abstract: Counselling projects are facing increasing pressure from funders to evaluate their work. This study outlines the methodology adopted by the Employee Counselling Service in seeking to investigate whether the project was achieving its main aim of preventing the dismissal of clients from employment because of alcohol related problems. The results show that the project was successfully meeting this aim, with only 7.7% of their referrals being dismissed because of alcohol related problems. The evaluation also highlighted the benefits of referral for counselling prior to disciplinary procedures and gave evidence of the positive perceptions of the project held by clients and referrers.

Emergency serum creatine kinase MB isoenzyme concentration in patients with suspected acute myocardial infarction.

Abstract: We report the results of the introduction of a service which offered emergency measurement of serum creatine kinase MB isoenzyme concentration in patients admitted to hospital with suspected acute myocardial infarction and a non-diagnostic electrocardiogram. A retrospective study suggested that in such patients, a single admission measurement would have a diagnostic sensitivity of 70% and specificity of 100%. A prospective study employed a protocol which included repeat measurement after two hours where the initial measurement was low in samples taken less than six hours after the onset of symptoms. The prospective study showed that the service was welcomed by physicians, who employed the measurements appropriately as a supplement to, rather than substitute for, clinical judgement. In a continuing audit, 228 patients had an emergency measurement according to the agreed protocol. 79 of these had a discharge diagnosis of acute myocardial infarction. The diagnostic sensitivity and specificity of our emergency strategy were both 94%. The strategy led to the treatment with thrombolytic drugs of 73 patients who would not otherwise have been treated, 69 with a discharge diagnosis of acute myocardial infarction, and four with some other discharge diagnosis. The median time taken from requesting the analysis to reporting the result was 34 minutes. The costs and potential benefits of our strategy are discussed.

Avoidable deaths in countries of the European community and in Scotland.

Abstract: A second edition of the European Community Atlas of Avoidable Death, 1980-84, has recently been published. The data in relation to Scotland are reviewed in detail.

The epidemiology of Haemophilus influenzae invasive disease in Scotland prior to immunisation.

Abstract: Immunisation against Haemophilus influenzae b (Hib) was added to the UK childhood vaccination schedule on 1 October 1992. Based on reports of laboratory isolations from blood and/or CSF, the epidemiology of Haemophilus influenzae invasive disease in Scotland during the last full year before immunisation (1991) is reviewed. In children aged under five years the estimated incidence of infection (25.5 per 100,000) is higher than that previously reported from Scotland, but lower than estimates from Glasgow and other UK studies. However, the age-sex and seasonal distribution is consistent with previous surveys. As in England and Wales, there appears to be regional variation in incidence within Scotland, although this may simply reflect differences in the completeness of laboratory reporting. In addition to 113 laboratory reports of H. influenzae invasive infection, a retrospective search of hospital discharge data and death registrations identified a further 51 and two cases respectively, some of whom may be genuine. In spite of reservations about hospital discharge data, this raises the possibility that there may be an element of under-reporting by laboratories. With the advent of record linkage of hospital discharge data, it would be prudent to monitor the impact of the Hib vaccine programme using this data source in addition to laboratory reports and death registrations.

A busy urban geriatric day hospital: analysis of one year's activity.

Abstract: Lightburn Geriatric Day Hospital is a 30-place unit sited adjacent to Geriatric Assessment and Rehabilitation wards and three miles from the local district general hospital in east Glasgow. The service serves an urban population of 25,000 persons aged 65 or more. During 1991 a data capture form was used to prospectively record Day Hospital referral patterns and activity. There were 731 new patient referrals, accounting for a total of 5,780 patient attendances. Thirty-eight per cent of new patients attended without prior screening (unscreened General Practitioner (GP) referrals). Booked occupancy was 85.5%, actual occupancy 76%. The average period of attendance was three weeks (median number of attendances: 7) and 18% of attenders required in-patient care. Specific after-care arrangements were made for 85% of patients on discharge from day hospital. Low rates for re-attendance (within three months of day hospital discharge) and chronic attendance (more than three months) as well as favourable responses from surveys of both GPs and patients suggest effective use of the Day Hospital resource, but more direct measures of Day Hospital effectiveness are required.

Psychiatric emergency clinic attenders: what can we learn from them?

Abstract: Patients attending the Royal Edinburgh Hospital emergency psychiatric clinic over a four month period were assessed by semi-structured interview. General Practitioner and self-referrals were compared with respect to presenting features and subsequent management. Self-referral was associated with young age, male sex, unemployment, poor social cohesion, problem drinking, a forensic history, and mild levels of psychiatric disorder. Only 10% of self-referrals were considered appropriate psychiatric emergencies, but 69% of General Practitioner referrals. Five per cent of self- and 34% of General Practitioner-referrals were admitted. These findings indicate that if the psychiatric emergency clinic is to be of benefit to those it serves, it must not confine itself simply to assessment of mental disorder, but seek to facilitate crisis resolution.

Models of accreditation in health care.

Abstract: Models of accreditation in health care and their origins are briefly described. Current approaches to Quality Management systems used in the United Kingdom are discussed, and a recommendation is made for professional leadership in the independent accreditation of health services.

Survey of out-patient satisfaction in a general hospital.

Abstract: This paper describes a brief questionnaire designed to assess patient satisfaction with outpatient services at a general hospital. Its application in the evaluation of services in a hospital in the Highland Area of Scotland is outlined, demonstrating how it can be used to highlight aspects of services that are satisfactory, and those that require improvement.

Numbers of infant deaths in Scotland, with special reference to sudden infant death syndrome.

Abstract: There has been an increased interest during 1992 in the numbers of deaths from Sudden Infant Death Syndrome, because of reports of reductions in the numbers in several countries where changes in advice on infant care had been made. Numbers of infant deaths in general and of those due to the syndrome in particular are described and analysed by some of the variables which are provided at the time of registration. The decline in the number of deaths from the syndrome reported recently by the Scottish Cot Death Trust is supported by the full figures for 1991. This decline probably started about the latter part of 1990, well before the official letters giving advice on infant care that had been associated with a decline elsewhere. It was more marked in some areas of Scotland than others. There appears to be a cyclical pattern in the time-series of the numbers of deaths from the syndrome. Further investigation, both of the cyclical movement and of the recent decline in relation to other variables, would be worthwhile. Deaths in the neonatal period from the syndrome and those from other causes have both declined markedly during 1990 and 1991, after several years when the movements in their numbers seemed to be in opposite directions.

Purchasing palliative care: availability and cost implications.

Abstract: This paper reports on a survey of the availability of palliative care in Scotland, in the context of the internal market introduced as part of the NHS reforms. It is based on a survey of both the cost and availability of such service, with a discussion of the implications of this information for purchasers of palliative care.

Out of hours emergency dental service provision in Scotland--a survey of Health Boards.

Abstract: Dental practitioners are a source of out of hours emergency dental care, but Health Boards in Scotland have been encouraged to make certain additional provision. A survey carried out in July 1991 has shown that ten of the 15 Scottish Health Boards operate a centralised, out of hours emergency dental service. The areas without such a service are mainly rural and with a small population, where setting up a scheme would be expensive and difficult. Only one Health Board operates a weekday service, but all of the Boards which provide a service operate it at weekends and on public holidays. There is considerable variation in the extent and use of the services provided by the different health boards. The greatest use of emergency dental services is in areas where the dentist:population ratio is good.

Conceptions and misconceptions about transmission of HIV/AIDS among the Scottish general public, 1988-1992.

Abstract: Knowledge levels among the Scottish general public about so called 'casual' transmission of the AIDS virus were analysed using data collected by our Unit's survey using computer-assisted telephone interviewing methods. Five cross-sections of data from the period March to May of each year were analysed and compared to provide overall estimates of knowledge on four items relating to casual transmission between respondent groups and to provide an estimate of changes over time in knowledge levels from 1988 to 1992. The data show that significant differences in knowledge exist, with the lowest levels of knowledge found among the older and among the less educated respondents. There is evidence for a continuing increase in knowledge for all items studied and for most respondent groups, but little evidence that disparities in knowledge between respondent groups are lessening over time. Misconceptions about potential risks from donating blood and kissing persist at quite high levels.

Human hydatid disease leading to hospital admission in Scotland 1968-1989

Abstract: An attempt to estimate the impact of hydatid disease upon human health in Scotland between 1968-89 was made by examining Scottish hospital discharge statistics, and death statistics. Because hydatid disease may be asymptomatic, and coding errors are more likely to occur with rare diseases, an assessment was made as to the likelihood of hydatid disease having been responsible for hospital admission. Over the 22 year period a total of 110 hospitalised individuals with a diagnosis of hydatid disease were identified; no deaths were recorded. Inspection of the other diagnoses and operations recorded for each case suggested that hydatid disease was responsible for hospital admission in only 65 individuals (59%). One further individual, who had been admitted to a hospital outside Scotland, was identified from a Western Isles register of cases receiving surgery for hydatid disease. This register was used to assess the completeness of the Scottish hospital statistics; 10/11 Western Isles cases were identified using hospital statistics. Local case registers seem essential for accurate estimates of incidence and prevalence, and to evaluate the need for control programmes. The median age of the 66 individuals considered to have been admitted to hospital because of hydatid disease was 49 years (range 4-85); 38 (58%) were male. A total of 36 cases were managed surgically (55%), and there was a tendency for the use of surgery to increase over the 22 year period. The Health Boards with the highest incidence of clinically apparent infection leading to hospital admission were: Western Isles, Shetland and Highland; with 2.53, 1.23, and 0.21 cases per 100,000 population per year respectively.

Using the Community Health Index, general practitioner records and the National Health Service Central Registry for a 14 year follow-up of a middle-aged cohort in the west of Scotland.

Abstract: Record linkage provides an opportunity for relatively inexpensive follow-up in cohort studies. Most studies have used hospital records. However, the Community Health Index, which is a computer-held list of all patients registered with General Practitioners (GPs), now offers opportunities for measuring morbidity at the primary care level. Searching for patients individually on this computer-held Index, we identified 96% of a middle-aged cohort recruited 14 years earlier in a longitudinal study in the West of Scotland. Of these, information was obtained for 78% through direct postal survey and for 87% through contact with GPs. In total, follow-up information was obtained on 903 (92%) of those thought to be alive. The National Health Service Central Registry records data and cause of death and will pass this information to special studies which have 'flagged' individuals' records. Seven per cent of the deaths in this sample had been missed by this process. This may need to be taken into account in previous studies of mortality for this cohort. New studies could expect successful long-term follow-up through record linkage to the Index or the Registry, and automatic record linkage with the Index would be worth investigating.