Injury surveillance in children--usefulness of a centralised database of accident and emergency attendances.

OBJECTIVE: To assess the usefulness of a centralised injury database in monitoring progress towards nationally set health targets for the reduction of childhood injuries. SETTING: West Glamorgan County, Wales. METHODS: Analysis was undertaken of data held in the West Glamorgan injury database which amalgamates population data with data from the three hospital units covering a population of 370,000. All first attendances due to a new injury in children aged 0-14 occurring in 1993 were analysed, with subgroup analysis for injuries occurring in the home and injuries resulting in fractures. Standardised injury ratios were compared with the distance travelled, car ownership, and Townsend index of deprivation at the ward level, using multiple linear regression. RESULTS: A total of 10,117 first time visits due to injuries were recorded, representing a rate of 182 injuries/1000 children aged 0-14 in West Glamorgan County. Distance from home to the accident and emergency departments was inversely correlated with total injury attendances, and injuries occurring at home, but not with injuries resulting in fractures. Visit rates for any type of injury were not associated with local car ownership rates or deprivation indices. CONCLUSIONS: Proximity to accident and emergency departments is a strong determinant of the use of the service by children with overall injuries, and injuries occurring at home. The lack of a significant association between travel distance and injuries resulting in fractures suggests that it is more meaningful to use a centralised database of accident and emergency department attendances to monitor the more severe spectrum of childhood injuries in assessing progress towards national targets for their reduction. The absence of an association between severe injuries and local socioeconomic factors suggests that national targets for the reduction of socioeconomic differentials in childhood injuries may need to be reassessed. These databases are also useful in generating information to direct preventive strategies and to target resources to areas of greatest need.

Incidence of leukaemia and lymphoma in young people in the vicinity of the petrochemical plant at Baglan Bay, South Wales, 1974 to 1991.

OBJECTIVE: To determine whether there was an increased incidence of leukaemias and lymphomas in young people aged less than 25 years in the locality of a petrochemical plant at Baglan Bay, South Wales. METHODS: Geographical population based study to compare the observed and expected incidence of leukaemia and lymphoma with onset before the age of 25, in the years 1974 to 1991. The population was aged 0-24 years and lived within 1.5 and 3 km of the plant. The observed number of cases in various categories were compared with the expected numbers of cases calculated from the Welsh cancer registration rates. RESULTS: Although the observed numbers were generally greater than would be expected, none of the comparisons showed significant excess of leukaemias or lymphomas for any period of years. CONCLUSIONS: The study shows that the incidence of leukaemias and lymphomas in children and young people in the area around the BP Chemical site at Baglan Bay, South Wales, between the years 1974 and 1991 was not significantly greater than normal.

Measuring health status with the SF-36: the need for regional norms.

BACKGROUND: Normative data on SF-36 scores in populations from Oxford and Aberdeen have recently been published. It has been suggested that such data provide suitable normative values for the UK population. However, other indices of health vary considerably across regions, and tend to be worse in areas such as South Wales. The objective of this study was to determine whether population SF-36 scores in West Glamorgan differ from scores from other parts of the United Kingdom. METHOD: The SF-36 health status questionnaire was administered to two random samples of adults aged 20-89 years, drawn from the West Glamorgan Family Health Services Authority register. One sample (n = 919) received postal questionnaires and those in the other sample (n = 1201) were interviewed in their own homes. Normative data from this study were compared with published data from other areas of the United Kingdom. RESULTS: SF-36 population scores were significantly lower in the two West Glamorgan samples; this was not due to differences in age, sex, social class, or response rates. CONCLUSION: Health status in West Glamorgan, as measured by the SF-36, is lower than in Oxford or Aberdeen. A national study would be required to provide appropriate normative data for the UK population.

Comparative health status of patients with 11 common illnesses in Wales.

OBJECTIVE: To assess the health status of patients with 11 common illnesses--asthma, diabetes, arthritis, back pain, sciatica, hypertension, angina, anxiety, depression, and heart attack and stroke. DESIGN: Face to face interview using a structured questionnaire which contained the Short Form 36 questionnaire (SF-36) and questions on lifestyle, health service utilisation, and self reported conditions treated by physicians. SETTING: Patients' homes, in West Glamorgan, Wales. SUBJECTS: Twelve hundred adults, aged 20-89 years, were randomly selected from the register of the family health services authority. MAIN OUTCOME MEASURES: The eight scales within the SF-36 health profile. RESULTS: The response rate was 82%. Each illness had a distinctive profile; patients with anxiety or depression reported the worst health experience in role limitations because of emotional problems and mental health, while patients with back pain, arthritis, or sciatica registered the three highest negative scores in bodily pain and role limitations due to physical problems. For all disease groups, the general health perceptions of those with the disease was significantly worse than those without it (p < 0.01). CONCLUSIONS: The SF-36 allows comparison of the health status of patients suffering from different conditions. Data such as these can be used to inform better purchasing decisions on how resources might be more effectively deployed and as a bench mark to monitor the effects of multiple health care interventions by conducting serial surveys.

Evidence for the validity of the Short-form 36 Questionnaire (SF-36) in an elderly population.

The objective of this study was to determine whether the Short-form 36 Health Status Questionnaire (SF-36) is suitable for use in an elderly population. The SF-36 was administered by interview to a random sample of 827 adults from West Glamorgan. Among the 216 adults aged 65 and over the data were 98.8% complete. Evidence for a high degree of internal consistency was good with Cronbach's alpha statistic exceeding 0.8 for each parameter. The evidence for construct validity was also good with the SF-36 distinguishing between those with and without markers of poorer health. The SF-36 is suitable for use with an elderly population when used in an interview setting.

Dying to be big: a review of anabolic steroid use.

Anabolic steroids use is commonly perceived to be the domain of the higher echelons of competitive athletes. However, a great deal of anabolic steroid use occurs in private gymnasia (non-local authority) among non-competitive recreational athletes. Our study has attempted to give an insight into the prevalence of the use of these drugs, the hazards associated with it, and the public health responses which we have adopted.

AIDS--a health education approach in West Glamorgan.

An education programme on AIDS has been established in West Glamorgan. It was designed to provide an information network amongst health authority staff which would reach as wide an audience as possible. The programme has been organised on a direct contact approach because of the limitations of other methods of disseminating information to large groups of people. The initial success of the programme has led to its extension among other interested groups in West Glamorgan such as the prison population, drug groups, and members of the gay community. The programme is to continue and be updated on a regular basis.

General-practitioner maternity units.

A study of information available for monitoring care was made during 1974 in 46 general-practitioner maternity units in the South-west of England. The information available did not form an adequate basis for monitoring at area level. Although many deliveries take place in general-practitioner maternity units in the South-west, perinatal mortality rates are low. Transfer of babies to a consultant unit, after the delivery is, however, commoner than elsewhere in England and Wales.