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BACKGROUND: Older women have been observed to have more serious injury particularly fractures after slips, trips or falls at the workplace. It is unclear whether this excess reflects a greater likelihood of falling or a greater proportion presenting with fractures once the fall has occurred. METHODS: Two studies were carried out: Study A, of 130 women who fell at work and matched referents, and Study B, of 120 women who fell at work and sustained a major fracture and 314 matched referents who fell but for whom no fracture was recorded. In Study A, the workplace of the case and referent was observed, questionnaires completed and objective health measures carried out. Study B relied on information obtained from the subject by postal questionnaire. RESULTS: Women who fell were older than referents matched on workplace and occupation, but age did not continue to be a significant factor after allowing for bodyweight and use of spectacles. Fractures were more common in older women who fell, particularly post-menopausal women with low body mass. The risk of fracture increased steadily with age without an obvious discontinuity around the likely age of menopause. CONCLUSIONS: The observed excess of fractures in older women falling at work appeared to be explained by the greater risk of fracture among those who fell.

The medical care of people with epilepsy has often been described as being poor, although objective markers for the quality of epilepsy care are lacking. This paper describes the results of using a simple quality marker, appropriate measuring of serum anticonvulsant levels, in assessing the quality of epilepsy care. The checking of serum phenytoin levels in certain clinical circumstances is advocated, whereas the checking of serum sodium valproate levels is not generally supported. A total of 1254 people with epilepsy in the community had their medical records examined for evidence of checking of anticonvulsant levels and 1204 of these individuals completed questionnaires about their epilepsy and its treatment. Of those on phenytoin, only 26% to 47% had phenytoin levels checked appropriately; 23% of patients on sodium valproate were inappropriately having their serum levels checked. The only clinical or organizational factor that predicted whether checking of serum phenytoin levels was performed was whether or not patients reported three common phenytoin side-effects but this still showed a small effect size (odds ratio 2.4).