Community medicine最新文献

Minimizing the need for hospital admissions for hyperglycaemic coma, hypoglycaemic coma and amputation of the lower limbs in patients with diabetes can be regarded as some of the legitimate objectives of a local diabetes service. Routinely collected data are available to calculate rates for such admissions for health service districts and for regions or their equivalents. East Anglian regional rates for admissions mentioning hyperglycaemic coma fell between 1981 and 1986 while rates for those mentioning hypoglycaemic coma rose. Amputation rates remained steady. Between-district variation for all rates was considerable and certain districts showed consistently high rates from year to year for hyperglycaemic coma with others having consistently high rates for amputations. Lack of standardization of case definition and uncertainty about the validity of routinely collected hospital admission data are the most important drawbacks of this approach. With careful interpretation, however, these data provide a possible source for the measurement of the effectiveness of local diabetes services.

Sera obtained from 511 travellers overseas from the West of Scotland were tested for antibody to hepatitis A; 64 per cent were seropositive. The seropositivity rate varied with age, ranging from 30 per cent in those aged under 20 years to 89 per cent in those over 60. These findings indicate that the beneficial effect of giving immunoglobulin to prevent hepatitis A is likely to be high in younger travellers but becomes increasingly less necessary in older persons.

A parallel rise in hip fracture incidence and the rate of prescription of drugs affecting postural stability have been investigated by a case-control study. Other risk factors were also considered. One hundred and seventy-three cases and 134 hospital emergency surgical controls were interviewed and briefly examined, and drug data were corroborated by letter to general practitioners. The analysis revealed no significant difference between consumption of benzodiazepines in cases and controls, major tranquillizers, diuretics or other anti-hypertensives. However, they differed significantly in their average body weight and incidence of stroke. It is suggested that hip fractures on the whole occur in a particularly frail group of elderly people and that the increased fracture incidence over the last 20 years results from the survival of a more frail or less active group than hitherto.

Research shows consistently wide variations in all aspects of general medical practice. Extreme variations in rates of referral to hospital have recently been highlighted, but remain largely unexplained. New information systems now make it possible to identify GPs with very high or very low rates of referral so that their behaviour can be reviewed. Before using this information politicians, managers and doctors should give careful thought to what it means and its limitations. The rate of referral provides no indication of the appropriateness of referrals. Any intervention designed to improve the referral mechanism should aim to increase the proportion of people who are appropriately referred to hospital and to reduce the proportion who are inappropriately referred. This is unlikely to be achieved by focusing attention on GPs with high or low rates regardless of how they are made up.