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Most studies evaluating the impact of electronic prescribing on prescribing safety have used comparatively weak study designs such as uncontrolled before-and-after studies. This study aimed to apply a more robust naturalistic stepped wedge study design to compare the prevalence and types of prescribing errors for electronic prescribing and paper prescribing. Data were collected weekly during a phased electronic prescribing implementation across 20 wards in a large English hospital. We identified 511 (7.8%) erroneous orders in 6523 paper medication orders, and 312 (6.0%) in 5237 electronic prescribing orders. Logistic regression suggested no statistically significant effect of electronic prescribing use or of study week; patient and ward had significant effects. Errors involving incorrect doses and illegible or incomplete orders were less common with electronic prescribing; those involving duplication, omission, incorrect drug and incorrect formulation were more common. Actions are needed to mitigate these error types; future studies should give more consideration to the effects of patient and ward. [ABSTRACT FROM AUTHOR]

This paper examines determinants of ethnic disparities in workplace risks of COVID-19 among health and social care workers (HCWs) in the UK. This was undertaken to inform public health policy in the management of COVID-19 relating to health and social care provision. A cross-sectional survey was administered in July–August 2020 (n = 456) to elicit HCWs' experiences of COVID-19 management in the workplace and their perceptions of exposure, personal protection against infection, involvement in local clinical management, and other workplace hazards. Findings suggest minority ethnic HCWs were twice as likely as White HCWs to be in a patient-facing role (OR = 2.14, 95% CI:1.21; 3.78, P < 0.01) and twice as likely (63% vs 39%) to be caring for COVID-19 positive patients (OR = 2.68, 95% CI: 1.77; 4.06, P < 0.01). Those in nursing, were three times as likely to be redeployed to a COVID-19 care setting (OR = 3.33, 95%CI: 1.23; 9.02, P= 0.02). Minority ethnic HCWs within lower- and mid-level roles carried a higher burden of frontline clinical management of COVID-19 positive patients than their White counterparts. This study found evidence of ethnic disparities across several workplace hazards, with increased exposure to and less protection against infection, more responsibility for the clinical management of infection, and evidence of systemic racial bias in the disproportionate redeployment of minority ethnic nursing staff to COVID-19 areas. An NHS-wide review is required to assess procedural fairness, ensure safe practices now, and to avert future crises. [ABSTRACT FROM AUTHOR]

Background: Rugby Union has one of the highest reported incidences of match injuries amongst all professional team sports. The majority of research within this field has focused on elite male cohorts; in this study we present the first meta-analytic review of these data. Objective: The aim of this study was to summarise the incidence and severity of injuries in senior men's professional Rugby Union, and determine the overall effects of level of play, new versus recurrent injuries, playing position, type of injuries, location of injuries, severity of injuries, period of match, and injury incident. Methods: Electronic databases were searched using keywords 'Rugby Union' and 'inj*'. Fifteen papers addressing injuries in senior men's professional Rugby Union (from 1995 through September 2012) were included in the review. A maximum of ten of these papers provided incidence data that could be modelled via a Poisson mixed-effects generalised linear model, while up to nine studies provided severity data that could be modelled via a general linear mixed model. Magnitude based inferences were used to assess differences between factors. A descriptive analysis was provided for studies that could not be included in the pooled analysis due to incongruent injury definitions. Results: The overall incidence of injuries in senior men's professional Rugby Union matches was 81 per 1,000 player hours (95 % CI 63-105), and 3 per 1,000 player hours (95 % CI 2-4) during training. Estimated mean severity for match injuries was 20 days (95 % CI 14-27), and 22 days (95 % CI 19-24) for training injuries. A higher level of play was associated with a greater incidence of injuries in matches, with no clear difference in severity. New injuries occurred substantially more often than recurrent injuries, while the severity of recurrent injuries was, on average, 10 days (95 % CI 4-17) greater than new injuries. Trivial differences were found in injury incidence and severity between forwards and backs. Muscle/tendon and joint (non-bone)/ligament injuries were the two most prevalent injury groups, whereas fractures and bone stress injuries had the highest average severity. The lower limb was the body region with the highest injury incidence, while upper limb injuries were most severe. The third quarter (40-60 min) of matches had the highest injury rate, and injuries most commonly occurred as a result of being tackled. Conclusions: This meta-analysis confirms match injury incidence rates in professional Rugby Union can be considered high in comparison with other team sports, but similar to other collision sports. In order to markedly reduce overall injury burden, efforts should target lower-limb injury prevention strategies and technique during contact, as these may render the largest effect. [ABSTRACT FROM AUTHOR]

Long-range temporal choices are built into contemporary policy-making, with policy decisions having consequences that play out across generations. Decisions are made on behalf of the public who are assumed to give much greater weight to their welfare than to the welfare of future generations. The paper investigates this assumption. It briefly discusses evidence from sociological and economic studies before reporting the findings of a British survey of people's intergenerational time preferences based on a representative sample of nearly 10,000 respondents. Questions focused on two sets of policies: (i) health policies to save lives and (ii) environmental policies to protect against floods that would severely damage homes, businesses and other infrastructure. For both sets of policies, participants were offered a choice of three policy options, each bringing greater or lesser benefits to their, their children's and their grandchildren's generations. For both saving lives and protecting against floods, only a minority selected the policy that most benefited their generation; the majority selected policies bringing equal or greater benefits to future generations. Our study raises questions about a core assumption of standard economic evaluation, pointing instead to concern for future generations as a value that many people hold in common. [ABSTRACT FROM AUTHOR]

Objective The main aim of this study was to explore any association between colorectal cancer (CRC) and rotating shift work in nurses and midwives. The secondary aim of this study was to identify risk factors for CRC in nurses and midwives who are rotating shift workers. Design Cross-sectional study. Setting Electronic survey of participants from Australia, New Zealand and the United Kingdom. Subjects A sample of 8,199 male and female nurses and midwives from Australia, New Zealand and the United Kingdom invited through their registration papers or newsletter advertisement. Main outcome measure Prevalence of CRC in participants who have worked rotating shifts for 1-14 years or ≥15 years compared to participants who have never worked rotating shifts. In addition, risk factors for CRC in the rotating shift work population were analysed in a multivariate logistic regression model in order to obtain odds ratio of CRC. Results No statistically significant difference was found in the prevalence of CRC between those who have never worked rotating shift work, worked 1-14 years and worked 15 or more years. Among rotating shift workers, diabetes was associated with a 123-fold (95% CI 39-392; p<0.001) increased odds of CRC, while Inflammatory Bowel Disease (IBD) was associated with a 190-fold (95%CI 68-526; p<0.001) increased odds of CRC. Screening colonoscopy or sigmoidoscopy for CRC was associated with a 10-fold (95% CI 3-35; p<0.001) increased odds of being diagnosed with CRC. Conclusion No significant association was found between rotating shift work and colorectal cancer in nurses and midwives. In nurses and midwives who are rotating shift workers, diabetes, IBD and CRC screening significantly increased the odds of CRC. [ABSTRACT FROM AUTHOR]

Background: Eating self-regulatory capacity can help individuals to cope with the obesogenic environment and achieve, as well as maintain, a healthy weight and diet. At present, there is no comprehensive, reliable and valid questionnaire for assessing this capacity and measuring change in response to self-regulation interventions in adults. This paper reports the development of the Self-regulation of Eating Behaviour Questionnaire (SREBQ) for use in UK adults, and presents evidence for its reliability and construct validity. The development of the SREBQ involved generation of an item pool, followed by two pilot studies (Samples 1 and 2) and a test of the questionnaire's underlying factor structure (Sample 3). The final version of the SREBQ was then assessed for reliability and construct validity (Sample 4). Results: Development of the SREBQ resulted in a 5-item questionnaire. The face validity was satisfactory, as assessed by the pilot studies. The factor structure analysis (Sample 3) suggested that it has a single underlying factor, which was confirmed in a second sample (Sample 4). The SREBQ had strong construct validity, showing a positive correlation with general measures of self-regulation. It was also positively correlated with motivation and behavioural automaticity, and negatively correlated with food responsiveness and emotional over-eating (p < 0.001). It showed good discriminant validity, as it was only weakly associated with satiety responsiveness, food fussiness and slowness in eating. Conclusions: The SREBQ is a reliable and valid measure for assessment of eating self-regulatory capacity in the general UK adult population. [ABSTRACT FROM AUTHOR]

Background: weak grip strength is a key component of sarcopenia and is associated with subsequent disability and mortality. We have recently established life course normative data for grip strength in Great Britain, but it is unclear whether the cut points we derived for weak grip strength are suitable for use in other settings. Our objective was to investigate differences in grip strength by world region using our data as a reference standard. Methods: we searched MEDLINE and EMBASE for reporting age- and gender-stratified normative data for grip strength. We extracted each item of normative data and converted it on to a Z-score scale relative to our British centiles. We performed meta-regression to pool the Z-scores and compare them by world region. Findings: our search returned 806 abstracts. Sixty papers met inclusion criteria and reported on 63 different samples. Seven UN regions were represented, although most samples (n = 44) were based in developed regions. We extracted 726 normative data items relating to 96,537 grip strength observations. Normative data from developed regions were broadly similar to our British centiles, with a pooled Z-score 0.12 SDs (95% CI: 0.07, 0.17) above the corresponding British centiles. By comparison, normative data from developing regions were clearly lower, with a pooled Z-score of -0.85 SDs (95% CI: -0.94, -0.76). Interpretation: our findings support the use of our British grip strength centiles and their associated cut points in consensus definitions for sarcopenia and frailty across developed regions, but highlight the need for different cut points in developing regions. [ABSTRACT FROM AUTHOR]

This paper focusses on coping strategies employed by children and adolescents with diagnosed short stature, assesses the impact of socio-demographic and clinical characteristics on coping, examines the relationship between coping and health related quality of life (QoL) and investigates the role of coping strategies in mediating the relationship between height and QoL. Coping with a disease (CODI) and quality of life in short stature youth (QoLISSY-QoL) questionnaires were completed by 137 short-statured children and adolescents between 8 and 18 years, participating in the crosssectional European QoLISSY study. Clinical and socio-demographic data were collected to examine differences in coping via variance and regression analyses, associations between CODI and QoLISSY were inspected using correlation and mediation analyses. Most frequently employed coping strategies in the CODI were 'Acceptance' and 'Wishful Thinking', with 'Emotional Reaction' used least. Significant effects of age, diagnosis and treatment status on coping strategies were detected. CODI scales 'Acceptance' and 'Distance' were associated with higher QoLISSY-QoL scores, 'Emotional Reaction' and 'Wishful Thinking' with lower scores. Coping strategies predicted 60 % of the QoLISSY-QoL variance. Relationships between height deviation and QoLISSY-QoL were mediated by the coping strategies of 'Wishful Thinking' and 'Distance'. Findings suggest that coping efforts vary with socio-demographic and clinical characteristics, that protective coping strategies in terms of QoL can be identified and that coping mediates the relationship between short stature and QoL. Future longitudinal research should focus on the adaptive function of coping in relation to QoL over time. [ABSTRACT FROM AUTHOR]

Complex wounds (superficial-, partial-, or full-thickness skin loss wounds healing by secondary intention) are common; however, there is a lack of high-quality, contemporary epidemiological data. This paper presents point prevalence estimates for complex wounds overall as well as for individual types. A multiservice, cross-sectional survey was undertaken across a United Kingdom city ( Leeds, population 751,485) during 2 weeks in spring of 2011. The mean age of people with complex wounds was approximately 70 years, standard deviation 19.41. The point prevalence of complex wounds was 1.47 per 1,000 of the population, 95% confidence interval 1.38 to 1.56. While pressure ulcers and leg ulcers were the most frequent, one in five people in the sample population had a less common wound type. Surveys confined to people with specific types of wound would underestimate the overall impact of complex wounds on the population and health care resources. [ABSTRACT FROM AUTHOR]

Background The study examines the relationship between transitions to residential and sheltered housing and mortality. Past research has focused on housing moves over extended time periods and subsequent mortality. In this paper, annual housing transitions allow the identification of the patterning of housing moves, the duration of stay in each sector and the assessment of the relationship of preceding moves to a heightened risk of dying. Methods The study uses longitudinal data constructed from pooled observations from the British Household Panel Survey (waves 1993-2008). Records were pooled for all cases where the survey member is 65 years or over and living in private housing at baseline and observed at three consecutive time points, including baseline (N=23 727). Binary logistic regression (death as outcome three waves after baseline) explored the relative strength of different housing transitions, controlling for sociodemographic predictors. Results (1) Transition to residential housing within the previous 12 months was associated with the highest mortality risk. (2) Results support existing findings showing an interaction between marital status and mortality, whereby unmarried persons were more likely to die. (3) Higher male mortality was observed across all housing transitions. Conclusions An older person's move to residential housing is associated with a higher risk of mortality within 12 months of the move. Survivors living in residential housing for more than a year, show a similar probability of dying to those living in sheltered housing. Results highlight that it is the type of accommodation that affects an older person's mortality risk, and the length of time they spend there. [ABSTRACT FROM AUTHOR]

Background Evidence is conflicting regarding the relationship between low maternal alcohol consumption and birth outcomes. This paper aimed to investigate the association between alcohol intake before and during pregnancy with birth weight and gestational age and to examine the effect of timing of exposure. Methods A prospective cohort in Leeds, UK, of 1303 pregnant women aged 18-45 years. Questionnaires assessed alcohol consumption before pregnancy and for the three trimesters separately. Categories of alcohol consumption were divided into ≤2 units/week and ≥2 units/week with a nondrinking category as referent. This was related to size at birth and preterm delivery, adjusting for confounders including salivary cotinine as a biomarker of smoking status. Results Nearly two-thirds of women before pregnancy and over half in the first trimester reported alcohol intakes above the Department of Health (UK) guidelines of ≤2 units/week. Associations with birth outcomes were strongest for intakes ≥2 units/week before pregnancy and in trimesters 1 and 2 compared to non-drinkers. Even women adhering to the guidelines in the first trimester were at significantly higher risk of having babies with lower birth weight, lower birth centile and preterm birth compared to non-drinkers, after adjusting for confounders (p<0.05). Conclusions We found the first trimester to be the period most sensitive to the effect of alcohol on the developing fetus. Women adhering to guidelines in this period were still at increased risk of adverse birth outcomes. Our findings suggest that women should be advised to abstain from alcohol when planning to conceive and throughout pregnancy. [ABSTRACT FROM AUTHOR]

Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure - the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [ SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs ( AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care ( N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department ( OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [ OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up ( AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. [ABSTRACT FROM AUTHOR]

Background Little is known about the links between the time that young children go to bed and their cognitive development. In this paper we seek to examine whether bedtimes in early childhood are related to cognitive test scores in 7-year-olds. Methods We examined data on bedtimes and cognitive test (z-scores) for reading, maths and spatial abilities for 11 178 7-year-old children from the UK Millennium Cohort Study. Results At age 7, not having a regular bedtime was related to lower cognitive test scores in girls: reading (β: −0.22), maths (β: −0.26) and spatial (β: −0.15), but not for boys. Non-regular bedtimes at age 3 were independently associated, in girls and boys, with lower reading (β: −0.10, −0.20), maths (β: −0.16, −0.11) and spatial (β: −0.13, −0.16) scores. Cumulative relationships were apparent. Girls who never had regular bedtimes at ages 3, 5 and 7 had significantly lower reading (β: −0.36), maths (β: −0.51) and spatial (β: −0.40) scores, while for boys this was the case for those having non-regular bedtimes at any two ages (3, 5 or 7 years): reading (β: −0.28), maths (β: −0.22) and spatial (β: −0.26) scores. In boys having non-regular bedtimes at all three ages (3, 5 and 7 years) were non-significantly related to lower reading, maths and spatial scores. Conclusions The consistent nature of bedtimes during early childhood is related to cognitive performance. Given the importance of early child development, there may be knock on effects for health throughout life. [ABSTRACT FROM AUTHOR]

Background: There is a need for a generic, short, and easy‐to‐use assessment measure for common presentations of psychological distress in UK primary care mental health settings. This paper sets out the development of the CORE‐10 in response to this need. Method: Items were drawn from the CORE‐OM and 10 items were selected according to a combination of usefulness, coverage of item clusters, and statistical procedures. Three CORE‐OM datasets were employed in the development phase: (1) a primary care sample, (2) a sample from an MRC platform trial of enhanced collaborative care of depression in primary care, and (3) a general population sample derived from the Office of National Statistics Psychiatric Morbidity Follow‐up survey. A fourth dataset comprising a sample from an occupational health setting was used to evaluate the CORE‐10 in its standalone format. Results: The internal reliability (alpha) of the CORE‐10 was.90 and the score for the CORE‐10 correlated with the CORE‐OM at.94 in a clinical sample and.92 in a non‐clinical sample. The clinical cut‐off score for general psychological distress was 11.0 with a reliable change index (90% CI) of 6. For depression, the cut‐off score for the CORE‐10 was 13 and yielded sensitivity and specificity values of.92 (CI=.83–1.0) and 0.72 (CI=.60–.83) respectively. Conclusion: The CORE‐10 is an acceptable and feasible instrument that has good psychometric properties and is practical to use with people presenting with common mental health problems in primary care settings. [ABSTRACT FROM AUTHOR]

Background: Although free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people. A recent review identified this unmet need as a priority for further investigation, highlighting the need to understand public perceptions of eye services and barriers to service access and utilisation. This paper aims to identify risk factors for (1) having poor vision and (2) not having had an eyesight check among community-dwelling older people without an established ophthalmological diagnosis. Methods: Secondary analysis of self-reported data from the ProAge trial. 1792 people without a known ophthalmological diagnosis were recruited from three group practices in London. Results: Almost two in ten people in this population of older individuals without known ophthalmological diagnoses had self-reported vision loss, and more than a third of them had not had an eye test in the previous twelve months. In this sample, those with limited education, depressed mood, need for help with instrumental and basic activities of daily living (IADLs and BADLs), and subjective memory complaints were at increased risk of fair or poor self-reported vision. Individuals with basic education only were at increased risk for not having had an eye test in the previous 12 months (OR 1.52, 95% CI 1.17-1.98 p=0.002), as were those with no, or only one chronic condition (OR 1.850, 95% CI 1.382-2.477, p<0.001). Conclusions: Self-reported poor vision in older people without ophthalmological diagnoses is associated with other functional losses, with no or only one chronic condition, and with depression. This pattern of disorders may be the basis for case finding in general practice. Low educational attainment is an independent determinant of not having had eye tests, as well as a factor associated with undiagnosed vision loss. There are other factors, not identified in this study, which determine uptake of eye testing in those with self-reported vision loss. Further exploration is needed to identify these factors and lead towards effective case finding. [ABSTRACT FROM AUTHOR]

Background Whether the quality of life (QOL) impacts longevity is an interesting research question that has been investigated only in the context of disease and health-related QOL. This paper aims to examine prospectively whether Control, Autonomy, Selfrealisation, and Pleasure (CASP) scores, a measure of generic QOL, can predict mortality in the British Household Panel Survey sample during 2001-2006. Methods The authors used data from the British Household Panel Survey wave 11 (2001-2002) when CASP was first presented to the participants in the survey. The authors selected all those who were interviewed directly and face to face and who were 40 years or older (N=10 291). The authors followed them for the next five waves (waves 12-16) and in this study primary outcome was all-cause mortality. Other covariates used were age, sex, socioeconomic position, household income, self-rated health, limiting longstanding illness and medical conditions. Results Compared with a mortality of 12/1000 personyears in those having average QOL (CASP score 29.4-45.8), those with below-average QOL had more than twice (27/1000 person-years) and those above average had a third less (8/1000 person-years) mortality. This gradient was retained for the most part when age and sex strata were examined separately. Regression models adjusted for covariates confirmed the protective effect of QOL on mortality. Domain-specific analysis showed that only control and self-realisation had this effect. Conclusion CASP predicted 5-year all-cause mortality significantly. Improvement in the QOL reduced the probability of death. [ABSTRACT FROM AUTHOR]

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

Unicompartmental knee arthroplasty (UKA) is widely performed in the United Kingdom for the management of patients with symptomatic osteoarthritis of the medial compartment of the tibiofemoral joint. A limited number of papers have presented the findings of mid-term clinical and survival data with sufficiently large patient numbers following mobile-bearing UKA. The purpose of this study was to present the 6- to 8-year follow-up data on a series of 230 minimally invasive medial Oxford Phase 3 mobile-bearing UKAs in our institution. Data on surgical procedure, postoperative rehabilitation requirement, complications, revision procedures and Oxford Knee Score (OKS), Short Form-12 (SF-12) and visual analogue scale (VAS) pain scores were analysed. The results indicated that the majority of patient's recoveries were uneventful, with 96% experiencing no postoperative complications. The mean OKS, VAS pain and SF-12 scores indicated good functional outcomes and acceptable perceived general health for this age group. Twenty-one patients underwent revision surgery, indicating a survival rate of 85% (95% CI: 0.76-0.91) during the 6- to 8-year follow-up period. The most frequently cited indication for revision was due to progression of osteoarthritis to the lateral component. To conclude, this series indicated that the mobile-bearing Oxford UKA provides good clinical outcomes at 6- to 8-year follow-up, with minimal requirement for postoperative rehabilitation, few complications and an acceptable survivorship in the mid-term. [ABSTRACT FROM AUTHOR]

Background More than 700 UK residents were tested for possible contamination with polonium-210 (210Po) following the alleged poisoning of Mr Alexander Litvinenko in London in November 2006. This paper describes the epidemiology of internal contamination with the radionuclide in this group. Methods 11 locations in London had been identified as sufficiently environmentally contaminated with 210Po to present a health risk to people associated with them. Public health consultant teams identified individuals at risk and offered 24-h urine testing for 210Po excretion. Prevalence of internal contamination was estimated, and a retrospective cohort analysis was completed for each location. Results Overall 139 individuals (prevalence 0.19 (95% CI 0.13 to 0.27)) showed evidence of internal contamination with 210Po, although none with uptakes likely to cause adverse health effects. Substantial prevalence was seen among specific hotel service staff, customers, staff and other users of a hotel bar, office and hospital staff, staff of one restaurant and residents of and visitors to the family home. Increased risks of contamination were seen for a hotel bar in association with occupational, behavioural and temporal factors. Occupational and guest exposure to contaminated areas of hotels were also associated with increased contamination risk. Nurses were more likely to become contaminated than other staff involved in direct patient care. Conclusions Uptake of trace amounts of radionuclide in this incident was frequent. Occupational, behavioural and temporal gradients in contamination risk were mostly consistent with a priori site risk assessments. Utility of the investigation methods and findings for future accidental or deliberate environmental contamination incidents are discussed. [ABSTRACT FROM AUTHOR]