Community medicine最新文献

Published regional data show that the Standardized Mortality Ratio (SMR) for the northern half of England has recently increased from 113 to 115 per cent of the SMR for the south, and that the north is at least as disadvantaged in respect of morbidity and material deprivation and uses much less private medical care than the south. It is concluded that the north's share of National Health Service (NHS) resources should not be reduced, as it would be if recent proposals by the NHS Management Board were implemented; that a mortality index which gives different weights to deaths at different ages should possibly be used instead of the simple SMR to weight regional resource allocations for need; and that these allocations should also be weighted by some measure of the extent to which regional populations look to the NHS rather than to the private sector for hospital and specialist care.

The United Kingdom has one of the highest coronary heart disease mortality rates in the world. However, over the last decade there has been a growing impetus in coronary prevention. In 1988 the Faculty of Community Medicine carried out a survey of all health authorities in the UK to assess the progress and problems with coronary prevention. This survey received a 92 per cent response rate and shows some interesting findings. The picture at present reveals a growing momentum in the last couple of years with half the health authorities at present claiming to have a programme. The main hindrances reported are lack of funding rather than lack of interest. The development and difficulties with nutrition and smoking policies, and with blood pressure screening are also described. The regional pattern of development of these programmes and policies is complex. Many authorities favour a general health promotion approach rather than a negative, disease oriented one; this conflict in approach requires further debate.

All district health authorities have recently introduced call and recall schemes for cervical cytology screening. Little attention has been given to the implications of these schemes for diagnostic colposcopy, and treatment services. This paper describes the steps necessary to estimate the likely increase in demand on these services.

Hospital Activity Analysis (HAA) data relating to operations for glue ear and tonsillectomy performed on residents of the North Western Region, aged 0-9 years during the period 1975-1984 were studied. The rate of surgery for glue ear has risen from 45/10,000 to 107/10,000 representing an increase of 137 per cent. The tonsillectomy rate by comparison has undergone a more modest increase of 19 per cent. The study casts doubt on a 'vacuum effect', as has been argued by Black. Marked variation in rates of surgery between Districts in the Region were noted, and the possible explanations discussed. A review of the literature revealed considerable controversy concerning the management of glue ear and the need for a definitive trial is highlighted.

Death certificates of neonates were compared with detailed clinical and pathological information provided for a national neonatal mortality survey. The systematic method of assigning the cause of death to one of seven broad categories in the survey found complete agreement with the underlying cause of death on the death certificate in 83 per cent of cases (274/330). There was only a minor disagreement involving clinical opinion in a further 6.7 per cent (22). The reasons for disagreement in the remaining 10.3 per cent (34) were examined. In the majority of instances, 6.0 per cent (20), the fault lay with the certifying doctor who provided inadequate or inaccurate information on the death certificate or who, in providing all the information, appeared to be ignorant of coding rules. In 1.2 per cent (4) the fault lay with coding inaccuracies or misapplication of coding rules in failing to select the underlying cause in a correct sequence of clinical events. In the remaining 3.0 per cent (10) of cases the rules governing the survey did not follow the WHO coding rules.

This paper describes a programme of projects on health promotion policy carried out by students of St Mary's Hospital Medical School as part of the community medicine course. The programme of work draws together three themes which have recurred in recommendations on the future of medical education: the need to locate health within its social and economic context, the importance of training doctors in health promotion, and the educational value of project work. From a practical service perspective, the information gained thereby has been extremely valuable in assisting the development, implementation and monitoring of local health promotion policies.

About 2.5 per cent of United Kingdom residents are of Asian (or Indian subcontinent) origin though the term 'Asian' hides their internal diversities of languages, religions and national origins. The research on the health of these populations is heavily concentrated in areas of rickets and osteomalacia, tuberculosis, maternal and child health, and mental health, and is mainly dependent on analysis of routinely available morbidity and mortality data. Little has been published on the use of primary care services, racism in health service delivery, quality of care and doctor-patient communication. Also, few of the studies have attempted to interpret their findings against the disadvantaged background of Asian communities. It is implied that differences in health status are due to linguistic and cultural factors alone. The research literature on the health of Asian populations is critically reviewed.

The most important events of the quarter were the preparations for the new childhood immunization programme with the official introduction of measles/mumps/rubella (MMR) vaccine on 1 October 1988, and the revision of the list of the notifiable infectious diseases on the same date.

A study carried out in East Anglia identified a number of aspects of the lives of elderly people living alone and some of these are reported here. A sample of 2000 elderly people from 20 general practitioner practices was selected for interview. Overall, there was a response rate of 88 per cent. Of those age 75 and over, 43 per cent lived alone, this proportion being higher in urban areas, in council, privately rented and sheltered housing and amongst women. There is a high level of informal support for elderly people living alone, although there is also a large number who do not have regular frequent visitors. Of the statutory services, home helps visit nearly a quarter of those aged 75 and over living alone, on a weekly basis. In terms of at least one activity of daily living, shopping, those living alone exhibit a higher level of independence than those living with others, but nearly a quarter of those aged 75 and over living alone do rely on someone else entirely to do their shopping for them. The study identified a number of aspects of ill health in elderly people. There was a substantial proportion with urinary incontinence and, amongst those aged 75 and over living with others, a significant proportion with a degree of faecal incontinence. There was also a high proportion of people unable to cut their own toenails.(ABSTRACT TRUNCATED AT 250 WORDS)

A census of waiting lists in five surgical specialties within the Northern Region has been carried out. In addition to enumerating those patients waiting for inpatient treatment and outpatient consultation, the census characterized lists in terms of the age and sex structure of those waiting; the length of time people had waited; their district of residence and (for inpatients only) the numbers waiting for certain specified operations or procedures. Patients waiting for inpatient treatment were older, overall, than the general population and, within specialties, ophthalmology lists contained a higher proportion of the very elderly whilst ear, nose and throat surgery lists had a younger age-structure. Three-quarters of ophthalmology inpatient lists were made up of patients waiting for cataract surgery, 14 per cent of patients awaiting orthopaedic inpatient treatment were waiting for hip joint replacement and 32 per cent of gynaecology lists comprised women needing sterilization. These data on age-structure and case composition are broadly similar to recent work carried out by Yates's group who restricted their study to longer waiting lists in the West Midlands Region and Wales. When data in the present study were related to the population from which the cases arose, it was found that the prevalence of outpatient waiting was greater than inpatient waiting except for general surgery (where a higher proportion of the population was awaiting inpatient treatment) and in gynaecology (where outpatient and inpatient waiting was equally common).2+ Standardized waiting list ratios (SWLRs) have been calculated to allow comparisons between districts and specialties, free of distortions produced by differing age-structure of populations.(ABSTRACT TRUNCATED AT 250 WORDS)