Risk of congenital anomalies near the Byker waste combustion plant.

BACKGROUND: The aim of this study was to determine whether the risk of congenital anomalies in a population resident close to a waste combustion plant located at Byker in the city of Newcastle upon Tyne, United Kingdom, was higher than in a population resident further away. METHODS: A geographical study was carried out on the prevalence of congenital anomalies in residents living within 3 km (inner zone) of the Byker combustion plant compared with those living 3-7 km (outer zone) from the plant. There were 81255 live births (1985-1999) and 1508 cases with chromosomal and non-chromosomal congenital anomalies. The cases were identified from the Northern Region Congenital Abnormality Survey. RESULTS: After the site commenced operation the estimated rate ratio (inner versus outer zone) was 1.11 (95 per cent confidence interval (CI) 0.96-1.28) adjusted for socio-economic deprivation. There was significant heterogeneity across years and an increasing trend, of marginal significance (p = 0.07), in the rate ratio. The inner zone rate approached or became significantly higher than that in the outer zone in some of the later years. CONCLUSIONS: No significant overall association between the number of congenital anomalies and proximity of residence to the Byker waste combustion plant has been found in this study. Significantly increased rates near the site during the later years may suggest a possible risk but are difficult to interpret. More comprehensive, multi-site investigations around other waste combustion plants are indicated.

Cost effectiveness of a single-function treatment center for cataract surgery.

PURPOSE: To compare the clinical and cost effectiveness of two models for cataract treatment: a single-function Cataract Treatment Centre (CTC) and a general ophthalmology service. SETTING: Cataract Treatment Centre and the general ophthalmology service at Sunderland Eye Infirmary, Sunderland, United Kingdom. METHODS: Two hundred patients were studied using two models of care: 100 in the CTC and 100 in the general ophthalmology service. Outcome measures were best corrected visual at 3 months postoperatively or at discharge and occurrence of surgery-related complications. All direct costs to the National Health Service were identified, measure, and assessed. RESULTS: Clinical outcomes in the two groups were similar. The average cost per patient was 496.90 pounds ($760.25) at the CTC and 566.34 pounds ($866.50) at the general ophthalmology service. The cost per patient treated as a day case in the general service group was 495.84 pounds ($758.63). Thus, treatment at the CTC was more cost effective than in the mixed service group and as cost effective as in the day case subgroup. CONCLUSIONS: Depending on local circumstances, day care must be delivered more cost effectively in a single-function center than in a general ophthalmology service. We recommend day care using local anesthesia and protocols for assessment, surgery, and follow-up.

Nomenclature of health care organisations: the extent of public understanding.

Health care systems in many parts of the world are undergoing organisational change. In Britain, the establishment of new organisations following the National health Service (NHS) reforms of 1990 has led to a change and a greater diversity in the nomenclature of health bodies. An important but often overlooked consequence of such change is the extent to which the public, as consumers of services, can recognise health organisations by their names. We investigated this in a study in the North east of England in early 1994. Eleven hundred respondents were asked to identify their local health authority, acute hospital and community health service provider. Mean scores for correct identification were: health authorities (or consortia of health authorities) 32%; acute hospitals 36%; community units 19%. Worst performing organisations scored very high 'don't know' responses: worst performing health authority 52%; acute hospitals 59%; community unit 48%. This survey demonstrates that the names chosen for themselves by health care organisations can convey little meaning to the public. This is an area which needs attention if health care systems are to create a culture in which they regard their patients as informed consumers.

Dissemination of the work of public health medicine trainees in peer-reviewed publications: an unfulfilled potential.

OBJECTIVE: To assess the extent to which work undertaken during training in public health medicine was formally disseminated in peer-reviewed publications. SETTING: An English Health Region. METHODS: A postal questionnaire survey of former and current senior trainees. RESULTS: The response rate was 75% (38/51). Thirty per cent (11/37) had no publications arising from any work undertaken during training and specifically 49% (18/37) had no publications arising from submissions made for the Part II examination for Membership of the Faculty of Public Health Medicine. Major perceived barriers to publication were: lack of priority accorded to publication by the training department; lack of time and lack of a supervisor or mentor to facilitate preparation of material. CONCLUSIONS: Overcoming these perceived barriers will require action at trainee, trainer and organisational level. Skills training in writing could be included in academic courses and publication could be identified as a training goal for appropriate pieces of work. Health authorities could be more active in encouraging publication of work undertaken by trainees on their behalf.