Health trends最新文献

Recent guidelines recommend that children with a family or personal history of convulsions should receive all vaccinations. To determine vaccination status and adverse events following vaccination, questionnaires were sent to the general practitioners of 83 children referred for specialist advice between January 1988 and June 1991 in Redbridge Health Authority. Details of consultations within seven days of vaccination, and of any subsequent neurological or developmental problems were collected. Follow-up data were obtained for 77 of the 83 children (93%); 66 of whom had a family history, and 11 a personal history, of convulsions. Of the 66 children with a family history of convulsions, 57 received pertussis-containing vaccines, of whom one child was reviewed for a possible neurological event. Of the nine remaining children who received diphtheria-tetanus (DT) only vaccine, two children were reviewed for possible neurological events. Of the 11 children with a personal history of convulsions, nine received pertussis-containing vaccines and two received DT vaccines; none had any further neurological event. At late follow-up, none of the 77 children vaccinated had developed recurrent convulsions or any other neurological or developmental problems. Children with a family or personal history of convulsions who are given pertussis-containing vaccines seem unlikely to suffer adverse events or long-term neurological sequelae, and should be considered for all routine vaccinations in line with current recommendations.

An audit of facilities recommended to be available in consultant obstetric units (COUs) in the United Kingdom (UK) received responses from 248 (95%) of all 260 COUs. Of the respondents, 86% were on the site of an acute general hospital, 76% had an intensive therapy unit on site, and 87% had a blood bank on site. Eighty-two per cent had a protocol for management of massive haemorrhage, and 91% had a local protocol for the management of severe pre-eclampsia/eclampsia. The development of Regional protocols and advisory centres for the management of hypertensive disorders is at present fragmentary. Purchasers and providers should give urgent attention to correcting remaining deficiencies, and the availability of recommended facilities and protocols should be taken into account when units are assessed for recognition for training.

The first six years work of the Secretary of State for Health's Inspectorate for regulation 4 of the Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 is described. The regulations are colloquially known by the acronym POPUMET, and implement European Directive 84/466 EURATOM in Great Britain. This laid down basic measures for the protection of persons undergoing medical examination or treatment involving ionising radiation. The POPUMET regulations are applicable to all health care settings, public or private sector, but exclude research. Regulation 4 is intended to prevent unnecessary or excessive medical exposure to radiation. Of 68 reported incidents, 54 (79%) were relevant to regulation 4, comprising 20 (37%) incidents in radiotherapy, 21 (39%) in radiology, 11 (20%) in nuclear medicine and 2 (4%) in dental radiology. Allowing for the denominator number of NHS departments in England, the greatest frequency of incidents were reported from radiotherapy departments, followed by nuclear medicine and then radiology departments. Of the 54 incidents investigated, 42 (78%) required a site visit; 39 (72%) resulted in advice from the Inspectorate; 13 (24%) required no action following investigation and 2 (4%) were still under investigation as at 31 May 1994. No enforcement notices were issued and there were no prosecutions.

Previous studies of day-case laparoscopy have indicated considerable post-operative morbidity, with high incidences of nausea, vomiting and pain, often resulting in overnight admission. These studies also indicate that 30% of patients would have preferred an overnight stay. Changes in day surgery anaesthetic practice since then have included the wider use of non-steroidal analgesics and the specific use of propofol, a new short acting anaesthetic drug, with improved recovery and anti-emetic properties. We audited 74 patients who had day-case laparoscopy for diagnosis or sterilisation, and found that the incidence of nausea and vomiting was lower than any previously recorded, and mean pain scores were minimal. No patient was admitted for recovery problems, despite the inclusion of afternoon procedures; two patients only were admitted for surgical complications. Despite considerable morbidity after their return home, only 8% of patients said they would have preferred an overnight stay. Changes in anaesthetic practice would seem to make day-case laparoscopy a more acceptable procedure than previously reported.

Medical students from 13 medical schools in England, Scotland and Wales were asked about their use of tobacco, alcohol and other drugs. Data from 1,278 students (68% response rate) are presented here. 10% of the respondents were current smokers, 10% ex-smokers. In a typical week 17% of the respondents exceeded the recommended limits for sensible drinking. Other drugs besides tobacco or alcohol had been used by 37% of the respondents. Most of the students who had used drugs had done so on no more than 10 occasions. 9% were current users. Although the majority of medical students neither smoke nor drink heavily nor take drugs, a significant minority either persist in or develop potentially harmful substance use behaviour during their studies. The scope for preventive efforts is considerable.

The legal documentation and hospital case-notes of all patients detained during 1989 in Nottingham and Lincoln under Section 5(2) of the Mental Health Act 1983 (empowering the emergency detention of a voluntary inpatient who wishes to leave), were audited to establish if there were any predictors of conversion to longer-term restraint under that Act. Of the 146 Section 5(2) orders, 80 were converted to a Section 2 or 3; the conversion rate in people detained outside normal working hours and those detained within 12 hours of admission was significantly lower; and the conversion rate was significantly higher in people with a mental illness, compared with those with personality disorders, substance abuse and stress reactions. No differences existed in the overall conversion rates of people managed by senior or junior doctors, but junior doctors who did not seek the advice of a senior doctor had a significantly lower rate of conversion than those who did. These results indicate that Section 5(2) may have been inappropriately used in up to 45% of cases, and underline the need for appropriate consultation.

This article provides a brief update on current national policies affecting medical education and training, and information on the present medical and dental workforce. Although of general interest, senior medical students and doctors in the training grades may find it particularly helpful when considering choices of future career. As there may be marked local variations in career prospects for any one specialty, further information and advice is available from Regional Postgraduate Medical and Dental Deans, specialty advisors (through Royal College and specialty associations) and clinical tutors. The information in this article relates to the present situation only and a review of previous articles in this series may be useful to observe certain trends.

The Health Advisory Group on Chemical Contamination Incidents (HAGCCI) (pronounced 'Hag-C'), is an independent advisory group which was established to advise Directors of Public Health throughout the United Kingdom (UK) and the Chief Medical Officers of the UK Health Departments on the medical aspects of major chemical contamination incidents involving air, soil or water. Separate arrangements exist for the provision of advice on chemical contamination of food. HAGCCI comprises a core group of three individuals, supported by a multidisciplinary panel of experts, and a secretariat provided by the Department of Health. We describe the role of HAGCCI within the overall framework of preparedness for the public health aspects of chemical emergencies.

Following concern over a suggested link between the implantation of silicone gel and connective tissue disease, the Medical Devices Directorate (MDD) of the Department of Health reviewed all available data for submission to a specially convened Expert Advisory Group. Animal studies indicated that silicones are unlikely to stimulate a specific antibody response or cell-mediated immunity, that they have no adverse effect on resistance to infection, and produce minimal effects in the presence of potent adjuvants but can act as adjuvants themselves. The connective tissue disease most commonly claimed to be associated with breast implants is scleroderma. Although one series of patients showed a significantly higher prevalence of this disease than expected, there is no clear indication that the incidence of scleroderma in women with breast implants is any higher than in the general population.