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Objectives To assess the effectiveness of thermostatic mixing valves (TMVs) in reducing bath hot tap water temperature, assess acceptability of TMVs to families and impact on bath time safety practices. Design Pragmatic parallel arm randomised controlled trial. Setting A social housing organisation in Glasgow, Scotland, UK. Participants 124 families with at least one child under 5 years. Intervention A TMV fitted by a qualified plumber and educational leaflets before and at the time of TMV fitting. Main outcome measures Bath hot tap water temperature at 3-month and 12-month post-intervention or randomisation, acceptability, problems with TMVs and bath time safety practices. Results Intervention arm families had a significantly lower bath hot water temperature at 3-month and 12-month follow-up than families in the control arm (3 months: intervention arm median 45.0°C, control arm median 56.0°C, difference between medians, −11.0, 95% CI −14.3 to −7.7); 12 months: intervention arm median 46.0°C, control arm median 55.0°C, difference between medians −9.0, 95% CI −11.8 to −6.2) They were significantly more likely to be happy or very happy with their bath hot water temperature (RR 1.43, 95% CI 1.05 to 1.93), significantly less likely to report the temperature as being too hot (RR 0.33, 95% CI 0.16 to 0.68) and significantly less likely to report checking the temperature of every bath (RR 0.84, 95% CI 0.73 to 0.97). Seven (15%) intervention arm families reported problems with their TMV. Conclusions TMVs and accompanying educational leaflets are effective at reducing bath hot tap water temperatures in the short and longer term and are acceptable to families. Housing providers should consider fitting TMVs in their properties and legislators should consider mandating their use in refurbishments as well as in new builds.

Objective: To validate self-reported possession and storage of a range of substances within the home. Participants: 30 families with children aged 12–35 months on health visitor caseloads in Nottingham, UK. Methods: Self-reported possession and storage of potentially hazardous substances were validated by observations. Sensitivity, specificity, and predictive values were calculated for possession, storage, and exposure to substances. Results: Self-reported low exposure to substances had high sensitivities (87–100%) and positive predictive values (75–100%) for all substances, except toilet cleaner (positive predictive value 62%) and high negative predictive values for commonly owned household products. Specificity and negative predictive value could not be estimated reliably for medicines and less commonly owned household products, as few families stored these unsafely. Conclusions: A measurement of exposure that combines self-reported possession and storage may be sufficiently accurate to identify families with safer poison prevention practices.

Objective: to evaluate the effectiveness of a school-based injury prevention program. Design: Cluster randomised controlled trial. Setting: 20 primary schools in Nottingham, UK. Participants: 459 children aged 7 to 10 years. Intervention: The “Risk Watch” program delivered by teachers, aimed at improving bike and pedestrian, falls, poisoning and fire and burns safety. Main outcome measures: Safety knowledge, observed safety skills and self-reported safety behaviour. Results: At follow-up, intervention group children correctly answered more fire and burn prevention knowledge questions than control group children (difference between means 7.0% (95% CI 1.5% to12.6%)). Children in intervention group schools were more likely to know the correct actions to take if clothes catch fire and the correct way to wear a cycle helmet (difference between school means 35.3% (95% CI 22.7% to 47.9%) and 6.3% (95% CI 1.4% to 11.1%) respectively). They were also more likely to know the correct actions to take in a house fire and on finding tablets (OR 2.80 (95% CI 1.08 to 7.22) and OR 3.50 (95% CI 1.18 to 10.38) respectively) and correctly demonstrated more safety skills than control group children (difference between means 11.9% (95% CI 1.4% to 22.5%)). There was little evidence to suggest the first year of the program impacted on self-reported safety behaviours. Conclusions: The Risk Watch program delivered by teachers in primary schools increased some aspects of children’s safety knowledge and skills and primary schools should consider delivering this program. Longer term, larger scale evaluations are required to examine retention of knowledge and skills and impact on safety behaviours and child injury rates.

Objective: To determine the relationship between deprivation and hospital admission rates for unintentional poisoning, by poisoning agent in children aged 0–4 years. Design: Cross sectional study of routinely collected hospital admissions data. Setting: East Midlands, UK. Participants: 1469 admissions due to unintentional poisoning over two years. Main outcome measure: Hospital admission rates for unintentional poisoning. Incidence rate ratios (IRRs) comparing hospital admission rates for poisoning in the most and least deprived electoral wards. Results: Children in the most deprived wards had admission rates for medicinal poisoning that were 2–3 times higher than those in the least deprived wards (IRR 2.49, 95% CI 1.87 to 3.30). Admission rates for non-medicinal poisoning were about twice as high in the most compared to the least deprived wards (IRR 1.77, 95% CI 1.19 to 2.64). Deprivation gradients were particularly steep for benzodiazepines (IRR 5.63, 95% CI 1.72 to 18.40), antidepressants (IRR 4.58, 95% CI 1.80 to 11.66), cough and cold remedies (IRR 3.93, 95% CI 1.67 to 9.24), and organic solvents (IRR 3.69, 95% CI 1.83 to 7.44). Conclusions: There are steep deprivation gradients for admissions to hospital for childhood poisoning, with particularly steep gradients for some psychotropic medicines. Interventions to reduce these inequalities should be directed towards areas of greater deprivation.

Objective. To determine the relationship between hospital admissions for falls and hip fracture in elderly people and area characteristics such as socio-economic deprivation. Study design. Ecological study of routinely collected hospital admissions data for falls and hip fracture in people aged 75 years or over for 1992-1997, linked at electoral ward level with characteristics from census data. Methods. In total, 42,293 and 17,390 admissions were identified for falls and hip fracture, respectively, from 858 electoral wards in Trent. Rate ratios (RRs) for hospital admissions for falls and hip fracture were calculated by the electoral wards' Townsend score divided by quintiles. RRs were estimated by negative binomial regression and adjusted for the ward characteristics of age, gender, ethnicity, rurality, proportion of elderly people living alone and distance from hospital. Results. There was a small but statistically significant association at electoral ward level between hospital admissions for falls and the Townsend score, with the most deprived wards having a 10% higher admission rate for falls compared with the most affluent wards (adjusted RR 1.10, 95% CI 1.01-1.19). No association was found between hospital admission for hip fracture and deprivation (adjusted RR 1.05, 95% CI 0.95-1.16). Conclusion. There is some evidence of an association at electoral ward level between hospital admissions for falls and socio-economic deprivation, with higher rates in deprived areas. No such association was found for hip fracture. Further work is required to assess the impact of interventions on reducing inequalities in hospital admission rates for falls in elderly people.

This study aimed to explore the accident prevention activities of primary care organizations (PCOs) and the views of their board members regarding accident prevention. Qualitative study using semi-structured telephone interviews of 17 board members of PCOs (primary care groups and primary care trusts) in the National Health Service (NHS) Trent Region was undertaken. Accident prevention activity varied substantially between PCOs. The reduction of home hazards was a frequent focus of the PCOs’ accident prevention initiatives. Board members did not see accident prevention as their biggest priority in health improvement, although they had positive attitudes towards it. Local morbidity and NHS guidance were seen to be key determinants of PCOs’ priorities in health promotion. There was little reference to any strategic planning for accident prevention. Information to support accident prevention could be more timely and relevant to PCOs’ needs. The degree of involvement with outside agencies in accident prevention work varied substantially. Collaboration between agencies may be held back by mutual lack of knowledge and differences in culture and priorities. It was concluded that accident prevention appears to be receiving less attention in PCOs than other national health priorities. They may need more support for developing strategies for accident prevention and better provision of information so that they can identify local problems which can be addressed by preventative activities. The accident prevention plans contained in health improvement programmes should be monitored. © 2004, Arnold. All rights reserved.

Our objective was to assess accidental injury prevention activity within Primary Care Groups/Trusts (PCG/Ts), and current knowledge and attitudes towards accidental injuries and their prevention amongst PCG/T board members. We used a cross-sectional postal questionnaire survey design. Participants were board members of 51 PCG/Ts in Trent. The main outcome measures were prioritization of accidental injury prevention and factors influencing prioritization, perceptions of the accidental injury rates in the population served by the PCG/T, accidental injury prevention activity undertaken by the PCG/T, attitudes towards accidental injury prevention and towards the PCG/Ts involvement in accidental injury prevention, knowledge of accidental injury mortality, and beliefs in the effectiveness of interventions. Many (66%) PCG/T board members see accident prevention as the least important of the priority areas in the Government's health strategy for England. Half the PCG/Ts (49%) had formally discussed accidents at a PCG/T meeting, 34% had taken action and 29% had written an accident prevention strategy. The median number of agencies PCG/Ts were working with on accident prevention was 2. GPs held less positive attitudes about accident prevention than other board members (Z = -10.01, P0.001), but had a greater knowledge about injury mortality (Z = -3.92, P0.001). Health promotion leads had more positive attitudes towards accident prevention than other board members (Z = -3.70, P0.001). There were misconceptions amongst health promotion leads about the effectiveness of some accident prevention interventions. We conclude that there is little evidence of prioritization of accidents as an area for health improvement. Although some PCG/Ts are undertaking accidental injury prevention, a minority have demonstrated strategic planning with respect to accident prevention or collaboration with a wide range of agencies. Accident prevention and the PCG/Ts role within this are not viewed positively by all board members. Gaps in knowledge about accidents and their prevention are apparent. PCG/Ts will need help and support to fully develop their potential in preventing accidental injuries.

The number of old people living in UK nursing homes has increased substantially over the past 15 y. There is evidence that such patients generate larger workloads for primary carers than do those of similar age and sex living in their own homes. Clearly, any extra workload involved in providing primary care services to nursing home patients, needs to be reflected in the resources afforded general practitioners (GPs) who are tasked with its provision. By the same token variations in workloads between patients need to be examined and explained for any insights these might provide on funding issues. To examine and explain variations in GP workload associated with nursing home patients and determine the implications of these for GP funding, a 12 month case control study of all nursing home residents over 65 y old registered with nine general practices was undertaken. A multivariate regression analysis was used to examine variations in GP workload associated with 270 nursing home patients. Multivariate regression models explaining the variation in workload cost per month in terms of the GP practice delivering care and patients age and sex had little explanatory power ( R 2 = 0.07 ). A fuller method including the patient's Barthel score and initial diagnosis as additional explanatory variables added little to the explanatory power of the model ( R 2 = 0.12 ). The ability of the multivariate models used here to explain the variation in GP workload was poor. GPs may require an allowance to compensate for differences in workload associated with nursing home patients but adjusting these payments for differences in age, sex, initial diagnosis or the other variables included in this analysis would not appear to be supported. Public Health (2000) 114, 446–450.

This paper reports the results of a study of GP costs associated with a group of nursing home patients who died at various stages during a 12-month period. The relationship between costs per month of care, patient age and proximity to death, where sex and diagnosis are controlled for are reported. A comparison of care costs for patients in their last year of life and those who survived the course of the study is also made. The study found that those in their last year of life were significantly more expensive to care for than those who survived the duration of the study, but that there was no statistically significant difference in age. In multivariate regression analyses, it was also found that among those who died during the study care costs were unrelated to age, but significantly related to proximity to death. The study supports the contention of others (Zweifel P, Felder S, Meiers M. Ageing of population and health care expenditure: a red herring? Health Econ 1999; 8: 485-496) that health care costs are more directly related to proximity to death than age.

SUMMARY Objectives: To examine and explain variations in prescribing costs associated with nursing home patients and patients matched by age and sex living in the community. Design: A 12-month case control study. Subjects: All nursing home residents over 65-years-old registered with nine general practices and patients matched with them for age and sex living in the community. Method: Multivariate regression analysis of variations in monthly GP prescribing costs. Results: Multivariate regression models explaining cost variations in terms of the GP practice delivering care and patients’ age and sex had little explanatory power (R(2)=0·07 for nursing home patients, R(2)=0·03 for matched pairs). A fuller model for nursing home patients only, incorporating the patient's Barthel score and initial diagnosis as additional explanatory variables, added little to the explanatory power of the model (R(2)=0·16). Conclusion: The ability of the multivariate models used here to explain variations in prescribing costs among a group of elderly patients is poor. Adjusting weighted capitation formulae with respect to older patients to take account of such information or referring to it in negotiations on prescribing budgets would not appear to be warranted.

SUMMARY Objectives: To compare the costs of prescribing for older people in nursing homes with older people living at home and to compare patterns of prescribing between these two groups. Design: Retrospective case-control study. Setting: Nine general practices in Nottinghamshire. Subjects: Two hundred and seventy patients aged 65 years and over living in nursing homes matched for age, sex and general practice, with 270 patients living in their own homes. Main outcome measures: A comparison of the costs of prescriptions, the number of items on prescription and the types of drugs prescribed between the cases and controls. Results: The mean cost of prescriptions per patient month was almost three times higher for nursing home patients than controls (£45·27 compared to £16·46). The mean number of items prescribed per patient month was also higher in nursing home patients (5·60 compared to 2·55). Total costs of prescriptions for nursing home patients were higher than for controls (P < 0·0001), as were total numbers of prescription items (P < 0·001). There were differences in the types of medication prescribed between the two groups, including considerably higher costs for central nervous system drugs, ulcer healing drugs, laxatives and enteral nutrition in nursing home residents. Conclusions: When calculating general practice prescribing budgets, nursing home patients should have a greater weighting than other patients of similar age and sex.

OBJECTIVES: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department. DESIGN: Six month longitudinal study. SETTING: Six general practices and the sole accident and emergency department in Nottingham. SUBJECTS: 4745 out of hours contacts generated by 45,182 patients from 23 electoral wards registered with six practices. MAIN OUTCOME MEASURES: Rates of out of hours contacts for general practice and accident and emergency services calculated by electoral ward; Jarman and Townsend deprivation scores and distance from accident and emergency department of electoral wards. RESULTS: Distances of wards from accident and emergency department ranged from 0.8 to 9 km, and Jarman deprivation scores ranged from -23.4 to 51.8. Out of hours contacts varied by ward from 110 to 350 events/1000 patients/year, and 58% of this variation was explained by the Jarman score. General practice and accident and emergency rates were positively correlated (Pearson coefficient 0.50, P = 0.015). Proximity to accident and emergency department was not significantly associated with increased activity when deprivation was included in regression analysis. One practice had substantially higher out of hours activity (B coefficient 124 (95% confidence interval 67 to 181)) even when deprivation was included in regression analysis. CONCLUSIONS: A disproportionate amount of out of hours workload fell on deprived inner city practices. High general practice and high accident and emergency activity occurred in the same areas rather than one service substituting for the other.

Poisoning in children is a significant cause of morbidity. In 1999, an estimated 31 186 children aged 0 – 14 years attended Accident and Emergency (A&E) Departments in the UK following a poisoning ...

IN a study involving seven practices, the records of 292 men found to be at high risk of a heart attack were analysed twelve months after identification, to determine how far a protocol for follow up of patients was followed and the extent to which targets for risk reduction were achieved. It was found that 248 (84.9 per cent) had a further recording of one or more risk factors after identification at the screening examin ation. Follow up was most thorough for those with a raised blood pressure, and least complete for those with raised cholesterol. Of the 205 men with an in itially raised blood pressure, 153 achieved the target of 100 mm Hg or less at follow up, representing 75 per cent of the original group and 94 per cent of those followed up. Approximately 20 per cent of smokers and heavy drinkers identified at the screening exam ination reported achieving the target of cessation and safe drinking respectively at their last follow up. Rates of change for the overweight and those with raised cholesterol were no better than might be ex pected by chance. Overall these results compare favourably with previous studies. The use of proto cols, facilitator support and the motivational effect of knowledge of risk status may all have contributed. However, even with this level of support a significant number of patients was lost to follow up. Practices should give priority to achieving optimal rates of follow up for smoking and hypertension.

Objective: To describe poison prevention practices for a range of substances and explore the relationship between prevention practices and perceptions of toxicity. Design: Cross-sectional study using a validated postal questionnaire. Participants: Parents with children aged 12–35 months on 23 health visitors’ caseloads. Setting: Areas of various levels of deprivation in Nottingham, UK. Main outcome measures: Possession and storage of substances, putting substances away immediately after use, and perceptions of toxicity. Results: Dishwasher tablets (68%), toilet cleaner (71%), bleach (74%), oven cleaner (78%), oral contraceptives (80%), and essential oils (81%) were least likely to be stored safely. Children’s painkillers (69%), cough medicine (72%), and essential oils (77%) were least likely to be put away immediately after use. More than 50% of parents perceived antibiotics and oral contraceptives as harmful in small quantities and cough medicines as harmful only in large quantities. Six substances perceived by parents to be more harmful were more likely to be put away immediately after use. Parents perceiving dishwasher tablets (OR 1.96, 95% CI 1.05 to 3.66), essential oils (OR 2.80, 95% CI 1.35 to 5.81), turpentine (OR 14.54, 95% CI 2.75 to 76.95), and rat/ant killer (OR 15.33, 95% CI 2.01 to 116.82) as more harmful were more likely to store these substances safely. Conclusions: Parents’ perceptions of toxicity of substances were sometimes inaccurate. Perceived toxicity was associated with putting substances away immediately after use for six substances and with safe storage for four substances. The effect of addressing perceptions of toxicity on poison prevention practices requires evaluation.

Emergency departments have the potential to maximize recruitment efficiency and minimize recruiting costs For many studies, especially those requiring incident injury cases, emergency departments are the most suitable location for recruiting participants.1 Although the total number of injury attendances is greater in outpatient or primary care settings than in emergency departments,2 geographical spread and the mixture of incident and prevalent cases make recruiting participants from these sites less feasible, more time consuming and more costly. Emergency departments, on the other hand, will see the largest number and spectrum of injury cases, usually presenting very shortly after injury in a single healthcare setting. This has the potential to maximize recruitment efficiency and minimize recruiting costs. Recruiting in emergency departments also provides opportunities to study the aetiology and epidemiology of injuries before recall of events diminishes with time and to enroll participants for studying short- and long-term consequences of injury. They are the only setting in which complete ascertainment of incident cases of specific injuries may be possible—for example, virtually all patients with long bone fractures will attend an emergency department, fewer will attend primary care and a proportion will be admitted to hospital, but this will vary between hospitals depending on a range of factors including clinician preference for management options, bed availability, social circumstances.3,4 Recruiting cases from emergency departments therefore, has the potential to minimize the selection bias inherent in recruiting such cases from other sites. Inspite of the potential for recruiting injured patients to studies within emergency departments, there are characteristics of the clinical setting and of injured patients which may make recruitment difficult. Emergency departments are often busy and crowded places, and the demand for emergency care continues to increase.5 Many emergency departments experience shortfalls in medical staffing and difficulties in recruiting and …

Background Globally and nationally large numbers of people are injured each year, yet there is little information on the impact of these injuries on people's lives, on society and on health and social care services. Measurement of the burden of injuries is needed at a global, national and regional level to be able to inform injured people of the likely duration of impairment; to guide policy makers in investing in preventative measures; to facilitate the evaluation and cost effectiveness of interventions and to contribute to international efforts to more accurately assess the global burden of injuries. Methods/Design A prospective, longitudinal multi-centre study of 1333 injured individuals, atttending Emergency Departments or admitted to hospital in four UK areas: Swansea, Surrey, Bristol and Nottingham. Specified quotas of patients with defined injuries covering the whole spectrum will be recruited. Participants (or a proxy) will complete a baseline questionnaire regarding their injury and pre-injury quality of life. Follow up occurs at 1, 4, and 12 months post injury or until return to normal function within 12 months, with measures of health service utilisation, impairment, disability, and health related quality of life. National estimates of the burden of injuries will be calculated by extrapolation from the sample population to national and regional computerised hospital in-patient, emergency department and mortality data. Discussion This study will provide more detailed data on the national burden of injuries than has previously been available in any country and will contribute to international collaborative efforts to more accurately assess the global burden of injuries. The results will be used to advise policy makers on prioritisation of preventive measures, support the evaluation of interventions, and provide guidance on the likely impact and degree of impairment and disability following specific injuries.

Primary Care Groups and Trusts (PCG/Ts) are responsible for improving the health of local populations, but there is little evidence of their strategic involvement in accident prevention.To determine the effect of providing information on local accidental injuries to PCG/Ts on the development of accident prevention strategies.The study is a randomized controlled trial in PCG/Ts in the former Trent Region. Intervention PCG/Ts were sent profiles containing PCG/T specific information on hospital admissions for accidental injury and their costs and on accident prevention interventions. Health promotion leads were surveyed at baseline and three and fifteen months. The primary outcome was whether the PCG/T had a written accident prevention strategy. Secondary outcome measures included other accident prevention activities, prioritization of accident prevention, and knowledge and attitudes towards accident prevention.At three months 38% of PCG/Ts in the intervention arm had a written accident prevention strategy, compared with 42% in the control arm [difference -4%, 95% confidence interval (CI) -31% to 25%]. At fifteen months these values were 55% in the intervention arm and 50% in the control arm (difference 5%, CI -24% to 33%). There were no statistically significant differences between the groups for any outcome measures.Providing profiles containing information on accidental injuries to PCG/Ts did not significantly increase the development of accident prevention strategies, however this study only had sufficient power to detect substantial changes. Larger national studies would be required to detect moderate effects of tailored packages in changing PCG/T behaviour.

Objectives: These were to find: the importance of various research skills in departments of general practice; the most useful methods of developing them; the support departments give researchers in developing skills; and what initiatives departments have made in research skills training.Methods: A postal questionnaire was sent to all members of the United Kingdom-based Association of University Departments of General Practice (AUDGP) in May 1993.Results: The response rate was 62%. Forty-five per cent were professors or senior lecturers, 32% were junior lecturers, and 23% held other posts; 77% held clinical posts. More than three quarters of responders rated eight research skills as ‘important’ or ‘very important’. Five skills were rated by more than a third of these responders as having been covered ‘not very well’ or ‘not at all’ in their training or experience. Most responders found self-directed learning and hands-on experience helpful in developing their skills, but less than half said that discussion...

UNLABELLED: The objective was to determine the relationship between the risk of assisted delivery in women aged under 20 years and place of treatment, deprivation and age. DESIGN: Cross sectional survey utilising routinely collected hospitals admissions data. POPULATION: Teenagers (women aged under 20 years) whose delivery resulted in a hospital admission in the period April 1st 1994 to March 31st 1997 in the Trent Health Region of England. METHODS: The cases were identified using Office of Population Census and Surveys procedural codes, and International Classification of Diseases diagnostic codes associated with delivery. Variables collected included type of delivery, age at delivery and place of treatment. The data were analysed using the chi-square test for categorical data and the independent samples t-test for continuous data. Logistic regression analysis was used to calculate adjusted odds ratios for the variables of type of assisted delivery and place of treatment. MAIN OUTCOME MEASURES: Factors associated with increased risk of assisted delivery. RESULTS: There was variation in rates of instrumental delivery between hospitals, with two having a significantly increased risk of assisted delivery, suggesting that place of treatment may be a factor in the risk of teenage patients experiencing an assisted delivery. There was also a large amount of variation in terms of the risk of experiencing a forceps or vacuum extraction compared to caesarean section. Age (under 16 years and 16-19 years of age) had no effect on the risk of a teenage patient experiencing an assisted delivery (X2 = 2.59 df = 1 P = 0.11 OR 1.27 (95% CI 0.94 to 1.72)). Similarly, teenagers who experience an assisted delivery were not more likely to come from a more deprived area than teenagers who did not have an assisted delivery (P = 0.189). CONCLUSIONS: The risk of assisted delivery varied between hospitals, suggesting that this factor is important in terms of a young women's risk of an assisted delivery. The young women in this study who had experienced an assisted delivery were not significantly different to young women who had a normal delivery. They were not more likely to be aged under 16 years of age, and were not more likely to be from a more deprived area.

Unintentional injury is the leading cause of death in children aged 1 to 15, and two thirds of fatal injuries in schoolchildren result from road traffic crashes.1 More than 75% of children fatally or seriously injured in road traffic crashes are pedestrians or cyclists. Socioeconomic gradients exist in children admitted with pedestrian and pedal cycle injuries,2 but little is known about trends in these gradients over time. We examined trends in admission rates and socioeconomic gradients for traffic injuries in children between 1992 and 1997. We considered children aged 0-14 years who were admitted to hospital for pedal cycle, pedestrian, or other transport injuries in the 862 electoral wards in the old Trent NHS Executive Region, United Kingdom, between 1 April 1992 and 31 March 1997.2 …

Objectives The UKBOI study was designed to quantify important components of the population burden of injury in the UK. Methods A mixed methods study incorporating a multi-centred prospective cohort of injured individuals; extrapolation of patient reported outcomes to population metrics using routine data from emergency departments (ED), hospital discharge registers and mortality data; calculation of Disability Adjusted Life Years (DALYs) using Global Burden of Diseases methodology and estimated indirect costs; and the calculation of direct medical costs. Results The study recruited 1517 injured individuals. Estimated numbers (and rates per 100 000) for UK population extrapolations were 750 999 (1240) for hospital admissions, 7 982 947 (13 339) for emergency department attendances, and 22 185 (36.8) for injury related deaths, in the financial year 2005/6. An estimated 1 574 000 DALYs were lost from injuries occurring in that year, with 80% due to Years Lived with Disability (YLDs) and 20% from Years of Life Lost (YLLs). Some 10% of DALYs lost were due to YLDs occurring within 12 months post injury and 70% due to lifelong injuries. Direct medical costs were estimated at 482 million for ED visits and 2.15 billion for inpatient stays, with indirect costs of up to 31.5 billion. The qualitative study with 90 participants revealed many additional negative consequences for individuals, family and society. Implications The high population burden and costs associated with injuries in the UK demonstrates the need for sustained policies and interventions in support of prevention.

OBJECTIVE--To investigate annual health checks for patients of 75 years and over required by the 1990 contract for general practitioners. DESIGN--Visits to practices to collect information on how assessments were organised and carried out; completion of questionnaires for every patient who had been assessed in a sample month, using information provided by the practice records. SETTING--20 general practices in one family health services authority. SUBJECTS--Patients of 75 years and over in 20 general practices. RESULTS--Three practices (15%) had not performed checks. Thirteen practices sent a letter to invite patients to undergo a check. Of these practices, seven followed up non-responders. Two practices visited patients' homes unannounced, and two did checks on an opportunistic basis only. Sixteen practices used a checklist. Sixteen practices involved their practice nurses; at eight of these, doctors also performed checks; in six practices the nurses undertaking the checks had no training in assessing old people. Ten practices assessed more than 75% of their old people in the first year of the new contract. Practices that did not follow up patients who had not responded to the invitation for assessment completed significantly fewer checks. During the sample month, 331 patients were assessed in the 17 practices. 204 new problems were discovered in 143 patients. Significantly more problems per patient were found in inner city areas. CONCLUSIONS--The way health checks were performed varied greatly, both in their organisation and the practices' attitudes. Many old people did not respond to letters asking if they wanted an assessment but very few refused one if followed up. Forty three per cent of those assessed had some unmet need. The number of new problems found per patient may reduce over the next few years if the assessments are successful. The need for annual assessment should be kept under review and adequate resources made available for the needs uncovered. Improved training for practice nurses in assessment is needed. Effectiveness of the checks must be monitored. If most unmet need falls in particular high risk groups it would seem sensible to modify the annual check to target these groups.

Background This study was designed to address some current issues concerning the use of general practice and accident and emergency (A & E) services outside normal surgery hours. Method Six general practices in Nottingham (with a combined population of 46 698 patients) were recruited to take part in the study. Over a six month period, data were collected on patient contacts with general practice services and the local A & E department outside normal surgery hours. Results General practice services dealt with 63 per cent of first contacts over the course of the study. There were 3181 (136 per 1000 patients per year) contacts with general practitioners and deputizing service doctors (of which 1009 (31.7 per cent) were dealt with by telephone alone) and 1876 (80 per 1000 patients per year) attendances at the A & E department. There were marked differences in the distribution of problems that patients presented to the two types of service. The proportion of presentations dealt with by telephone alone by general practice services varied with the type of presentation. However, the use of the telephone was not particularly high, even for problems such as a sore throat. Conclusions Given the differences in presentations to both general practice and A & E services there may be limited scope for altering patients’ consulting patterns without making significant changes to service provision. However, there may be scope for increasing the proportion of general practice contacts dealt with by telephone alone.

Objectives The UKBOI study was designed to quantify important components of the population burden of injury in the UK. Methods A mixed methods study, incorporating a multi-centred prospective cohort of injured individuals; extrapolation of patient reported outcomes to population metrics using routine data from emergency departments (ED), hospital discharge registers and mortality data; calculation of Disability Adjusted Life Years (DALYs) using Global Burden of Diseases methodology and estimated indirect costs; and the calculation of direct medical costs. Results The study recruited 1517 injured individuals. Estimated numbers (and rates per 100 000) for UK population extrapolations were 750 999 (1240) for hospital admissions, 7 982 947 (13 339) for emergency department attendances and 22,185 (36.8) for injury related deaths, in the financial year 2005/6. An estimated 1 771 486 DALYs were lost from injuries occurring in that year, with 82% due to Years Lived with Disability (YLDs) and 18% from Years of Life Lost (YLLs). Some 20% of DALYs lost were due to YLDs occurring within 12 months post injury and 62% due to lifelong injuries. Direct medical costs were estimated at 482 million for ED visits and 2.15 billion for inpatient stays, with indirect costs of up to 35.5 billion. The qualitative study with 90 participants revealed many additional negative consequences for individuals, family and society. Implications The high population burden and costs associated with injuries in the UK demonstrates the need for sustained policies and interventions in support of prevention.

Safety 2010 World Injury Conference, London, Abstract: Objectives To determine whether an advocacy package aimed at elected councillors resulted in improved pedestrian safety in deprived areas. Methods Cluster randomised controlled trial involving 617 councillors from 239 wards in England and Wales, from deprived areas with high pedestrian injury rates. The intervention group were provided with information and maps on casualty sites, numbers and effective interventions. Outcomes were measured at 3, 18 and 27 months. Results The intervention improved short-term outcomes such as increasing councillors interest in child accident prevention (RR 1.09, 95% CI 1.03 to 1.16), increasing belief they could take action to help prevent child accidents (RR 1.36, 95% CI 1.16 to 1.61), and particularly on pedestrian safety (RR 1.55, 95% CI 1.19 to 2.03). By 18 months 63% of intervention councillors reported involvement in supporting new pedestrian road safety schemes. However, pedestrian safety measure changes were statistically non-significant: difference in road length traffic calmed (0.07 km, 95% CI: −0.07 to 0.20); proportion of schools with 20 mph zones (RR 1.47, 95% CI: 0.93 to 2.32), Safe Routes to School (RR 1.34, 95% CI: 0.83 to 2.17; or proportion providing practical pedestrian training (RR 1.23, 95% CI: 0.95 to 1.61). Implications The AIAS intervention succeeded in raising councillors awareness of and interest in pedestrian safety but failed to improve engineering or educational measures of pedestrian safety. Longer term supported advocacy may be needed for change. KW: SR2S

To investigate the state of health and needs of over-75-year-olds discharged from hospital and not referred to the District Nurse Service, patients in this age group who were discharged from hospital, who returned to their own or a relative's home and were not referred to the District Nurse Service were interviewed by Health Visitors during their normal post-discharge visit. Assessment was by a questionnaire on details of discharge, statutory, voluntary and informal support, physical status, disability level, ability to self-care and mental status. It was found that there was wide variation in timing of Health Visitors' post-discharge visits, and most patients had had some contact with their GP before this visit. Almost half the patients were discharged from General Surgery or surgical specialties. Most patients were fairly healthy but a minority had severe disabilities. Physical status, disability level and ability to self-care were related to age and sex of the patient, with older patients and women having poorer health status. Women had poorer mental status than men. It is concluded that the wide variety in health status and needs of this group of patients suggest that they should be taken into account in the planning of new discharge procedures. Closer links between the hospital, community teams and general practice are suggested.

The objective of this study was to evaluate a programme of timetabled visiting by Health Visitor Assistants (HVAs) to patients over 75 years old who were recently discharged from hospital. An outcome evaluation examined whether patients benefited in measured health status and use of services over the year of the programme. A randomly selected group of patients (the intervention group) who were allocated to the programme of visiting were compared with an equal-sized randomly selected group of patients (the control group) who had no timetabled visiting. A process evaluation examined the actions taken by HVAs during their visits and related the actions taken to patients' measured health status and other characteristics. No overall benefit from the programme of visiting was found in the outcome evaluation. There was wide variation in the numbers of actions recorded for different patients. Numbers of HVAs' actions were related to patient's health status and sex, with more actions being initiated for those in poorer health and women. Neither age nor whether the patient lived alone were found to be related to numbers of HVAs' actions. It was concluded that the lack of demonstrated overall benefit and the wide variation in actions taken on patients' behalf suggest that this type of service cannot be recommended for all discharged patients over 75 years. Poor health at the time of discharge is recommended as a first choice of measure for need of support. Exchange of information between general practice and hospital about previous dependency may aid the identification of patients who need post-discharge support.

To evaluate an occupational therapy intervention to improve outdoor mobility after stroke.Randomised controlled trial.General practice registers, social services departments, a primary care rehabilitation service, and a geriatric day hospital.168 community dwelling people with a clinical diagnosis of stroke in previous 36 months: 86 were allocated to the intervention group and 82 to the control group.Leaflets describing local transport services for disabled people (control group) and leaflets with assessment and up to seven intervention sessions by an occupational therapist (intervention group).Responses to postal questionnaires at four and 10 months: primary outcome measure was response to whether participant got out of the house as much as he or she would like, and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale, Nottingham leisure questionnaire, and general health questionnaire.Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months (relative risk 1.72, 95% confidence interval 1.25 to 2.37) and 10 months (1.74, 1.24 to 2.44). The treatment group reported more journeys outdoors in the month before assessment at both four months (median 37 in intervention group, 14 in control group: P0.01) and 10 months (median 42 in intervention group, 14 in control group: P0.01). At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group, but there were no significant differences in the other secondary outcomes. No significant differences were observed in these measures at 10 months.A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke.

Objective: To determine the relation between morbidity from injury and deprivation for different levels of injury severity and for different injury mechanisms for children aged 0-14 years. Design: Cross sectional survey of routinely collected hospital admission data for injury 1992-7. Setting: 862 electoral wards in Trent Region. Subjects: 21 587 injury related hospital admissions for children aged 0-4 years and 35 042 admissions for children aged 5-14. Main outcome measures: Rate ratios for hospital admission for all injuries, all injuries involving long bone fracture, and all injuries involving long bone fracture requiring an operation; rate ratios for hospital admission for six types of injury mechanism divided by quintiles of the electoral wards9 Townsend scores for deprivation. Rate ratios calculated by Poisson regression, with adjustment for distance from nearest hospital admitting patients with injuries, rurality, ethnicity, and percentage of males in each electoral ward. Results: Both total number of admissions for injury and admissions for injuries of higher severity increased with increasing socioeconomic deprivation. These gradients were more marked for 0-4 year old children than 5-14 year olds. In terms of injury mechanisms, the steepest socioeconomic gradients (where the rate for the fifth of electoral wards with the highest deprivation scores was ≥3 times that of the fifth with the lowest scores) were for pedestrian injuries (adjusted rate ratio 3.65 (95% confidence interval 2.94 to 4.54)), burns and scalds (adjusted rate ratio 3.49 (2.81 to 4.34)), and poisoning (adjusted rate ratio 2.98 (2.65 to 3.34)). Conclusion: There are steep socioeconomic gradients for injury morbidity including the most common mechanisms of injury. This has implications for targeting injury prevention interventions and resources. What is already known on this topic? There is a steep socioeconomic gradient for injury related mortality There is conflicting evidence regarding the socioeconomic gradient for injury morbidity, particularly with respect to different injury severity and injury mechanisms What this study adds A socioeconomic gradient for injury morbidity exists in children aged The socioeconomic gradient for injury mechanisms is steepest for pedestrian injuries, burns and scalds, and poisoning, which has implications for targeting injury prevention strategies