Search

Background: Injuries are common and make a significant contribution to sickness absence, but little is known about problems experienced by injured people on return to work (RTW).Aim: To quantify work problems on RTW and explore predictors of such problems.Design& Setting: Multicentre longitudinal study in four UK hospitals.Method: Prospective study of injured participants aged 16-65 years who were employed or self-employed prior to the injury and had RTW at 1 or 4 months post injury.Results: At 1 month, most (59%) had only made a partial RTW. By 4 months, 80% had fully RTW. Those who had partially RTW had problems related to physical tasks (work limited for median of 25% of time at 1 month, 18% at 4 months), time management (10% at 1 month, 20% at 4 months) and output demands (10% at 1 month, 15% at 4 months). Productivity losses were significantly greater among those with partial than full RTW at 1 month (median 3.3% versus 0.9%, P<0.001) and 4 months (median 4.6% versus 1.1% P = 0.03). Moderate/severe injuries (relative risk [RR] 1.93, 95% confidence interval [CI] = 1.35 to 2.77) and sports injuries (RR 1.73, 95% CI = 1.12 to 2.67) were associated with significantly greater productivity losses at 1 month while pre-existing long-term illnesses (RR 2.12, 95% CI = 1.38 to 3.27) and upper limb injuries (RR 1.64, 95% CI = 1.06 to 2.53) were at 4 months.Conclusion: Injuries impact on successful RTW for at least 4 months. Those who have only partially RTW experience the most problems and GPs should pay particular attention to identifying work problems in this group and ways of minimising such problems. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Reilly R, Paranjothy S, Beer H, Brooks C, Fielder H, Lyons R. Birth outcomes following treatment for precancerous changes to the cervix: a population-based record linkage study. BJOG 2012;119:236-244. Objective To examine whether treatments for precancerous changes to the cervix are associated with adverse birth outcomes in subsequent pregnancies. Design Population-based retrospective cohort study using electronic linkage of data from the Welsh cervical screening programme and a national routine child health database. Setting Wales. Population A total of 174 325 women aged 20-39 years who received cervical screening between April 2001 and March 2004. Methods Logistic regression was used to compare the odds of each birth outcome between women who had negative cervical smears and women who received either colposcopy ± punch biopsy only or colposcopy and excisional or ablative treatments, adjusted for confounding factors (e.g. age, social deprivation and smoking). Main outcome measures Preterm birth (before 37, 32 and 28 weeks of gestation), and low birthweight (<2500 g). Results Compared with women who had negative cervical smears, the odds ratio for preterm birth (<37 weeks) was significantly increased in women who had colposcopy only (adjusted odds ratio 1.54, 95% CI 1.32-1.80) and single excisional treatment (adjusted odds ratio 1.77, 95% CI 1.47-2.13). Similar results were observed for preterm birth at <32 weeks of gestation. There was no increased risk of preterm birth or low birthweight for women who had treatment compared with women who had colposcopy only. Conclusion Women who were referred for colposcopy had an increased risk of preterm births regardless of whether or not they received treatment to the cervix. This increased risk could be the result of common risk factors for abnormal smears and preterm birth. [ABSTRACT FROM AUTHOR]

AIM: To determine whether local politicians influence the distribution of traffic calming measures. METHODS: Longitudinal ecological study in two UK cities. Local political constituencies were categorized by representation by members of the cabinet structure as a marker of influence. The density of traffic calming features per political area, adjusted for the historical pattern of road injuries, was compared between cabinet represented and non-represented areas. RESULTS: Traffic calming density was significantly associated with cabinet representation status, adjusted for historical collision risk (risk ratio 2.77, 95% confidence interval 1.37 to 5.61). CONCLUSION: These results support the hypothesis that senior local politicians are effective advocates for enhancing safety in their areas. [ABSTRACT FROM AUTHOR]

This report details the development and use of a population based emergency room surveillance system in the UK. Despite some difficulties in accessing high quality data the system has stimulated a considerable number of research and intervention projects. While surveillance systems with high quality data collection and coding parameters remain the gold standard, imperfect systems, particularly if population based, can play a substantial part in stimulating injury prevention initiatives. [ABSTRACT FROM AUTHOR]

This study was undertaken to determine whether exposure to various indoor pollutants is associated with a higher prevalence of respiratory symptoms, a diagnosis of asthma, or more variable peak flow rates. Four hundred and twenty-six children aged 8-11 years in four junior schools at three locations recorded respiratory symptoms and diagnosis of asthma using the ISAAC questionnaire. Daily peak flow measurements were taken during two six-week periods (winter and summer). Symptoms in children with and without asthma were not related to gas fires, cookers, smokers, or pets in the home. However, the variability of lung function, expressed as the coefficient of variation, in all children was increased with a household smoker. Environmental tobacco smoke increases airways variability in children with and without asthma. Its effects were not apparent from a questionnaire completed by parents, and the coefficient of variation of serially measured peak flows was a more sensitive indicator of lung function. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To measure the incidence of childhood fractures in a defined population. SETTING: Accident and emergency (A&E) departments covering the Swansea and Neath Port Talbot areas of South Wales in 1996. METHODS: Linkage of data from A&E departments with population data to produce fracture incidence rates by anatomical site and cause in children aged 0-14 years. RESULTS: During 1996, 2463 new fractures occurred in 2399 residents yielding a fracture rate of 36.1/1000 children. Fractures were more common in boys than girls and increased with age in both groups. Sports and leisure activities accounted for 36% of fractures, assaults for 3.5%, and road traffic accidents 1.4%. Fractures of the radius/ulna were most frequent (36%). CONCLUSIONS: The fracture rate in South Wales children is twice the rate reported in previous studies. Further research is required to elucidate the reasons behind this high rate. Many fractures could be prevented by the use of safer surfaces in school playgrounds, and wrist protection in in-line skaters and possibly in soccer players. [ABSTRACT FROM AUTHOR]

The role of physicians in public health practice has been widely debated. To help identify the distinctive contribution of public health medicine, we reviewed recommended competencies in the UK and USA and debated these with members of the Welsh Affairs Committee of the UK Faculty of Public Health Medicine. We concluded that none of the lists of competencies published to date adequately defined a distinct medical specialty. We have distinguished public health medicine expertise from related public health competencies and other general competencies needed for the effective practice of public health medicine. We discuss the implications of this proposed scheme for training and recruitment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the usefulness of a centralised injury database in monitoring progress towards nationally set health targets for the reduction of childhood injuries. SETTING: West Glamorgan County, Wales. METHODS: Analysis was undertaken of data held in the West Glamorgan injury database which amalgamates population data with data from the three hospital units covering a population of 370,000. All first attendances due to a new injury in children aged 0-14 occurring in 1993 were analysed, with subgroup analysis for injuries occurring in the home and injuries resulting in fractures. Standardised injury ratios were compared with the distance travelled, car ownership, and Townsend index of deprivation at the ward level, using multiple linear regression. RESULTS: A total of 10,117 first time visits due to injuries were recorded, representing a rate of 182 injuries/1000 children aged 0-14 in West Glamorgan County. Distance from home to the accident and emergency departments was inversely correlated with total injury attendances, and injuries occurring at home, but not with injuries resulting in fractures. Visit rates for any type of injury were not associated with local car ownership rates or deprivation indices. CONCLUSIONS: Proximity to accident and emergency departments is a strong determinant of the use of the service by children with overall injuries, and injuries occurring at home. The lack of a significant association between travel distance and injuries resulting in fractures suggests that it is more meaningful to use a centralised database of accident and emergency department attendances to monitor the more severe spectrum of childhood injuries in assessing progress towards national targets for their reduction. The absence of an association between severe injuries and local socioeconomic factors suggests that national targets for the reduction of socioeconomic differentials in childhood injuries may need to be reassessed. These databases are also useful in generating information to direct preventive strategies and to target resources to areas of greatest need. [ABSTRACT FROM AUTHOR]

Aim: To determine whether narrative information in emergency department surveillance systems can be systematically interrogated to improve our understanding of the causes of injury. METHODS: Screening algorithms for location, intent, and activity were developed from structured analysis of narrative data from 98999 records. The algorithms were then tested on a 50000 record database containing entries in both of the two narrative fields. A proxy gold standard was defined as the total extract using both code and narrative. Sensitivity and specificity of the emergency department coding and narrative algorithms was calculated. RESULTS: The proportion of records carrying an informative emergency department code was higher in records containing narrative-the percentage of causes coded 'not know' dropped by 28.3%. The sensitivity of coded data varied from 42% to 98 % and from 33% to 99% for narrative data. Narrative analysis increased the percentage of home injuries identified by 19%, assaults by 26%, and rugby injuries by 137%. CONCLUSIONS: Using a small amount of narrative is a practical and effective means of developing more informative injury causation data in an emergency department based surveillance system. It allows for internal validation of the codes and for the identification of emerging hazards without adding more 'tick boxes' or further burdening data entry clerks. [ABSTRACT FROM AUTHOR]

Background: Current methods of measuring the population burden of injuries rely on many assumptions and limited data available to the global burden of diseases (GBD) studies. The aim of this study was to compare the population burden of injuries using different approaches from the UK Burden of Injury (UKBOI) and GBD studies.Methods and Findings: The UKBOI was a prospective cohort of 1,517 injured individuals that collected patient-reported outcomes. Extrapolated outcome data were combined with multiple sources of morbidity and mortality data to derive population metrics of the burden of injury in the UK. Participants were injured patients recruited from hospitals in four UK cities and towns: Swansea, Nottingham, Bristol, and Guildford, between September 2005 and April 2007. Patient-reported changes in quality of life using the EQ-5D at baseline, 1, 4, and 12 months after injury provided disability weights used to calculate the years lived with disability (YLDs) component of disability adjusted life years (DALYs). DALYs were calculated for the UK and extrapolated to global estimates using both UKBOI and GBD disability weights. Estimated numbers (and rates per 100,000) for UK population extrapolations were 750,999 (1,240) for hospital admissions, 7,982,947 (13,339) for emergency department (ED) attendances, and 22,185 (36.8) for injury-related deaths in 2005. Nonadmitted ED-treated injuries accounted for 67% of YLDs. Estimates for UK DALYs amounted to 1,771,486 (82% due to YLDs), compared with 669,822 (52% due to YLDs) using the GBD approach. Extrapolating patient-derived disability weights to GBD estimates would increase injury-related DALYs 2.6-fold.Conclusions: The use of disability weights derived from patient experiences combined with additional morbidity data on ED-treated patients and inpatients suggests that the absolute burden of injury is higher than previously estimated. These findings have substantial implications for improving measurement of the national and global burden of injury. [ABSTRACT FROM AUTHOR]

Background: Vast quantities of electronic data are collected about patients and service users as they pass through health service and other public sector organisations, and these data present enormous potential for research and policy evaluation. The Health Information Research Unit (HIRU) aims to realise the potential of electronically-held, person-based, routinely-collected data to conduct and support health-related studies. However, there are considerable challenges that must be addressed before such data can be used for these purposes, to ensure compliance with the legislation and guidelines generally known as Information Governance.Methods: A set of objectives was identified to address the challenges and establish the Secure Anonymised Information Linkage (SAIL) system in accordance with Information Governance. These were to: 1) ensure data transportation is secure; 2) operate a reliable record matching technique to enable accurate record linkage across datasets; 3) anonymise and encrypt the data to prevent re-identification of individuals; 4) apply measures to address disclosure risk in data views created for researchers; 5) ensure data access is controlled and authorised; 6) establish methods for scrutinising proposals for data utilisation and approving output; and 7) gain external verification of compliance with Information Governance.Results: The SAIL databank has been established and it operates on a DB2 platform (Data Warehouse Edition on AIX) running on an IBM 'P' series Supercomputer: Blue-C. The findings of an independent internal audit were favourable and concluded that the systems in place provide adequate assurance of compliance with Information Governance. This expanding databank already holds over 500 million anonymised and encrypted individual-level records from a range of sources relevant to health and well-being. This includes national datasets covering the whole of Wales (approximately 3 million population) and local provider-level datasets, with further growth in progress. The utility of the databank is demonstrated by increasing engagement in high quality research studies.Conclusion: Through the pragmatic approach that has been adopted, we have been able to address the key challenges in establishing a national databank of anonymised person-based records, so that the data are available for research and evaluation whilst meeting the requirements of Information Governance. [ABSTRACT FROM AUTHOR]