Journal of public health medicine
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J Public Health Med · Mar 1995
Does routine child health surveillance reach children most at risk of accidental injury?
There is currently an increasing emphasis on accident prevention as part of routine child health surveillance, which unlike opportunistic accident prevention has the potential to reach the whole population. However, non-attenders at routine child health surveillance may also be children at higher risk of accidental injury, as there is some evidence that non-attenders may be more likely to live in socio-economic disadvantage, which is a risk factor for accidental injury. ⋯ These findings suggest that non-attenders at routine child health surveillance activities are not at an increased risk of medically attended accidental injury. They also suggest that health visitors can identify those children most at risk of accidental injury using criteria for classifying priorities in caseloads.
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J Public Health Med · Mar 1995
Access to elective surgery at electoral ward level: the impact of the private sector.
Purchasers of health care receive no routine information on the use of the private health sector by their residents, and are consequently unaware of any resulting differentials in access to health services. This information would assist in assessing need for services on a locality basis. ⋯ The private sector did not introduce any inequity of access to surgery within Preston at electoral ward level. However, in districts with higher levels of private sector activity significant differentials in access may exist.
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An outbreak of legionnaires' disease occurred in central London in January and February 1989. An Infection Control Committee was established to investigate the outbreak and institute control measures. The objective of this paper is to describe the investigation and control of the outbreak. ⋯ This outbreak showed the continuing risk of legionnaires' disease posed by wet cooling systems, including cooling towers, and highlighted the need to assess this risk so that appropriate maintenance is carried out. Regulations have recently been introduced, under the Health and Safety at Work Act, requiring notification of all wet cooling systems to the local authority to facilitate the investigation of outbreaks of legionnaires' disease.
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J Public Health Med · Jun 1994
Clinical Trial Controlled Clinical TrialEvaluation of a Hospital at Home scheme for the early discharge of patients with fractured neck of femur.
The community health services in Southern Derbyshire, in conjunction with an acute hospital, established a pilot scheme for the early discharge of fractured neck of femur patients from hospital to their own homes. The scheme was evaluated by prospectively comparing a group of patients using Hospital at Home (HAH) and a group receiving hospital care only. The main outcomes measured were the proportion of hospital admissions for fractured neck of femur using HAH, length of stay, patient satisfaction, general health status at discharge as measured by the Nottingham Health Profile, and three-month mortality and readmission rates. ⋯ In the first year of the scheme, 76 (18 per cent) of the 432 hospital admissions for fractured neck of femur fitted the selection criteria and agreed to admission to HAH. Thirty-four patients were identified who were suitable for HAH but not admitted to it. The comparison of the 76 HAH patients and 34 hospital patients revealed that HAH patients were discharged from hospital an average of 7 days earlier; patients in both groups were satisfied with the care they received; the general health status of the two groups at discharge was similar, with the exception that HAH patients had better emotional health on discharge from care; the three-month mortality rate was similar in both groups (5 per cent); the readmission rate for HAH patients appeared higher than for hospital patients but this difference was not statistically significant (15.8 per cent versus 8.8 per cent, Fisher's exact test, p = 0.187).(ABSTRACT TRUNCATED AT 250 WORDS)
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J Public Health Med · Jun 1994
Attendance at accident and emergency departments: unnecessary or inappropriate?
The proportion of attenders at accident and emergency (A&E) departments who present 'inappropriately' with conditions which could be managed in general practice has been estimated at between 6.7 per cent and 64-89 per cent. These estimates have been based on subjective assessments by clinicians, or on an objective classification developed by the Nuffield Provincial Hospitals Trust (NPHT). This study sought to validate this classification, and to develop and validate other objective systems of classifying A&E attenders. ⋯ This method was applied retrospectively to random samples of 8877 adult self-referrals to 16 English A&E departments, and yielded an estimate that 23 per cent could have been treated in general practice. This approach provides a simple and valid retrospective method for identifying patients who were suitable for care in general practice. The method may be used to identify groups of patients who frequently attend inappropriately, to identify areas in which primary care needs are not being effectively met in general practice, and to form a basis for planning and auditing strategies to meet those needs in a more appropriate setting.