Journal of public health medicine最新文献

Health inequalities research has a long history in the United Kingdom, and the development of government policies that are intended to explicitly address the existing health inequalities has been gathering pace since the Labour Party returned to power in 1997. In this paper, using the influential Acheson Report as a reference point, one of us (D.N.) describes how health inequalities policies have been developed, and the other (A.O.) assesses how, ideally, such policies ought to be developed. Although progress in the development of health inequalities policies has been made, the policies, and the evidence that has informed them, have been less than ideal.

Background: The objective of the study was to investigate the implications for equity of geographical access for population subgroups arising from hypothetical scenarios of change in configuration of National Health Service tertiary hospital service provision located in Wales.

Methods: For each of three scenarios, the status quo and centralization of services to one of two locations, we used a travel time road length matrix in geographical information software to calculate the proportion of the population living within 30, 60, 90 and 120 min travel of each hospital site and the associated mean, median and 90th percentile travel times. We analysed data for the total resident population of Wales, for residents aged 75 or more years, for residents of the most deprived 10 per cent of enumeration districts, and for residents of rural areas.

Results: Centralization of services reduces geographical access for all population subgroups. Access varies between population subgroups, both between and within different scenarios of service configuration. A change in service configuration may improve access for one subgroup but reduce access for another. The interpretation may also vary according to whether the defined cut point for comparing access is based on short or long travel times. Measurements of absolute and relative access are sensitive to the assumed travel speeds.

Conclusion: Access for the total population does not imply equity of access for subgroups of the population. Comparisons of access between scenarios are dependent on which measure of access is the indicator of choice. Results are sensitive to the road network travel speeds and further local validation may be necessary. This method can provide explicit information to health service planners on the effects on equity of access from a change in service configuration.

Background: NHS Direct is a nurse-led telephone help line that covers the whole of England and Wales. NHS Direct derived data are being used for community surveillance, the purpose of which is to detect a local or national increase in symptoms reported by callers. The system has the potential to identify an increase in symptoms reported by callers about people in the prodromal stages of illness caused by the deliberate release of a biological or chemical agent. There are no other community surveillance projects existing on a national scale that utilize electronic daily data.

Methods: We describe the surveillance system and calls to NHS Direct between December 2001 and July 2002. Confidence limits have been constructed for 10 key algorithms at each site and control charts devised for five of these algorithms at sites covering the key urban areas.

Results: Daily reporting has been achieved from NHS Direct sites in England and Wales. High levels of activity in specific algorithms at both national and regional levels have been detected. A sustained national increase in calls about fever occurred in January 2002.

Conclusion: Although the project is still at an early stage, daily analysis of NHS Direct data has the potential to detect symptoms in the community that could be related to deliberate releases of chemical or biological agents or to outbreaks of disease. For this surveillance to act as an 'early warning' of illness resulting from a microbiological or chemical cause, the NHS Direct surveillance needs to be fully integrated into an appropriate public health response (which may require diagnostic samples to be taken from callers).

Background: We investigated claims by a campaigning group of a cancer cluster associated with a local cement works.

Methods: To investigate cancer rates in the town we defined the study area as the Census wards matching the geographical area code supplied to the campaigning group. Standard methods were applied to registered cases of cancer for the area for the years 1974-1989 to derive observed and expected numbers. The significance of the relative risk was assessed using the Poisson distribution. By selecting a different denominator population we attempted to reproduce the results of the campaign group. Cancer rates around the cement works were investigated for four cancer types plausibly associated with emissions, using cancer registrations for the years 1985-1994. Cases were mapped to 1981 Census ward boundaries, and the same statistical methods were used, but expected counts were also adjusted for deprivation. Rates were calculated for an inner 2 km zone and outer zone 2-5 km from the works. Relative risk was calculated and the ratio of risks was examined for evidence of increased risk closer to the works.

Results: Relative risks were not significantly elevated either in the town or around the cement works itself. We were able to reproduce the likely errors that resulted in the elevated relative risks for five cancer groups claimed by the campaigning group.

Conclusions: We found no evidence of increased incidence of cancer around the cement works. Incorrect handling of cancer registration data can result in spurious cancer clusters and unnecessary public alarm.

Background: The aim of the study was to establish the prevalence and patterns of aspirin use in people with vascular problems.

Methods: A cross-sectional population survey was carried out on a stratified random sample of 10,000 adults aged 35 and over in North Staffordshire.

Results: A total of 6322 adults replied to the questionnaire (adjusted response 67 percent). The prevalence of vascular problems was 12.9 percent, and 67.6 per cent of respondents were using aspirin. The main association with aspirin use was previous advice about aspirin: adults who recalled being given advice were more likely to be using aspirin. Increasing age, disease severity and level of deprivation were also associated with increased aspirin use. Of adults without vascular problems, 7.1 percent also reported using aspirin regularly.

Conclusions: There is still potential to increase aspirin use in those with vascular problems. The extent and quality of health care professionals' advice may be an important area to target. The reasons why some people without vascular problems take regular aspirin is an area for further investigation.