Public knowledge of the symptoms of myocardial infarction: a street survey in Birmingham, England.

BACKGROUND: Myocardial infarction (MI) is a leading cause of death in the UK. A good clinical outcome depends on rapid treatment following the onset of symptoms. A person's knowledge of typical symptoms determines how quickly they present to the medical services. OBJECTIVES: To investigate knowledge of MI symptoms among the general population and the relationship between age, gender and socio-economic status with knowledge. METHODS: Street survey of 302 participants in Birmingham, UK, using an interviewer-assisted questionnaire. RESULTS: Of seven symptoms accepted in the medical literature as typical of an MI, central chest pain was the most frequently identified (75% of the sample), followed by arm pain or numbness (40%), shortness of breath (35%), fainting or dizziness (21%) and sweating (21%). Feeling or being sick and neck or jaw pain were mentioned by 8.1% and 5.9%, respectively, while an atypical or inapplicable symptom, collapse (9.9%) was mentioned more often than these. Over half the sample knew only two or fewer MI symptoms. The mean number of typical symptoms identified was 2.2 (SD = 1.28). Respondents from professional occupations and those with previous experience of MI, whether direct or indirect, showed better awareness. CONCLUSIONS: The study demonstrated a paucity of knowledge of MI symptoms among the general public. Such findings provide a baseline to guide public health campaigns targeting awareness of MI.

Safety with access scaffolds: development of a prototype decision aid based on accident analysis.

PROBLEM: Accidents involving temporary access systems, particularly temporary scaffolds, account for a large proportion of injuries in the construction industry worldwide. METHOD: This paper outlines the development of a prototype decision aid (SCAFPASS, an abbreviation for Scaffold Planning Aid for System Safety) to promote access scaffold safety. It was guided by an examination of the root-causes and management deficiencies apparent in: (a) paper-based files of 186 access-related incidents held by the Health and Safety Executive (HSE) in the UK; and (b) computer-based files of 2,910 incidents appearing in the HSE database between 1997 to 2000. RESULTS: The more frequent root-causes included the fitting of defective components, unauthorized modification of the structure, omission of barriers, and errors resulting in simple, readily detectable structural faults. Common managerial deficiencies included failure to control risk, unsafe methods and procedures, and inadequate training and supervision. IMPACT ON INDUSTRY: SCAFPASS aims to avoid these root-causes by improving safety management from the outset and throughout all phases of a project.

Improving weekend handover between junior doctors on medical and surgical wards.

Poor weekend handover has been implicated as one of the causes of observed higher mortality rates at weekends in UK hospitals. In a large teaching hospital we, a group of junior doctors, set about improving the quality and effectiveness of weekend handover. We used the Model for Improvement to implement a weekend handover sticker through an iterative process using multiple Plan/Do/Study/Act (PDSA) cycles. Over the 16 week study period the number of completed weekend tasks increased by 30% and the number of patients with a documented weekend handover increased by nearly 50%. Junior doctors are well positioned to notice the quality and safety shortcomings within hospitals, and by using effective improvement methods they can improve these systems at little or no cost.

Preventing violent conflict: a revised mandate for the public health professional?

Violent conflict disrupts livelihoods, healthcare systems, and food security, with dire public health consequences. My intention in this article is to conceptualise violent conflict as a public health hazard and delineate the strategies public health professionals might adopt to minimise that hazard. There is continued support among commentators for the role of the public health professional in addressing the underlying causes of conflict. Importantly, there has been a trend for foreign donors to design public health initiatives in ways that meet socio-political criteria deemed important to preventing conflict. The underlying causes of conflict can be mitigated by specific strategies employed by public health professionals and they should be key players in preventing the public health disaster that is violent conflict.