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The authors are indebted to the collaborators in the participating centres and all parents, children, teachers and other school staff who participated in the surveys. There are many field workers and funding agencies who supported data collection and national, regional and international meetings, including the meetings of the ISAAC Steering Committee. Unfortunately, these are too numerous to mention (they are acknowledged elsewhere) but the authors particularly wish to thank the funders who supported the ISAAC International Data Centre including the Health Research Council of New Zealand, the Asthma and Respiratory Foundation of New Zealand, the National Child Health Research Foundation, the Hawke’s Bay Medical Research Foundation, the Waikato Medical Research Foundation, Glaxo Wellcome New Zealand and Astra New Zealand, as well as Glaxo Wellcome International Medical Affairs for finding the regional coordinating centres. The International Data Centre is now supported by a grant from the BUPA Foundation., The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here. In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution. Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence. The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit., peer-reviewed

An audit of the handling of medical negligence complaints recorded by the Lothian Health during 1991 and 1992 was undertaken, to ascertain whether the process was providing an adequate response, or whether improvements could result in fewer potential claims proceeding. A complaints database was set up using d-Base IV and a personal computer, as there was not an adequate system of data recording in existence at the time. Analysis of data collected within the Department of Public Health Medicine revealed that there was potential for reducing the number of medical negligence complaints proceeding to litigation by the prompt handling of the complaints as recommended by the Wilson Report. The relative risk of a medical negligence claim for hospital doctors was greatest for the specialties of Accident and Emergency and Obstetrics and Gynaecology, and these specialties had the greatest difficulty in returning medical case notes or consultant reports quickly. The potential for both improved patient satisfaction and financial savings are identified in the handling of complaints, and the requirement for a complaints database to allow monitoring and audit of the complaints process, and implementation of the recommendations of the Wilson Report, are noted.

The single homeless are a heterogeneous population with health care needs greater than those of the general population. The Edinburgh primary health care scheme for single homeless hostel dwellers is an attempt to provide an easily accessible service for this population. Having continued for eight years it is one of the longest established of such schemes. The original aim was for house doctors to take services to the residents in the hostels but the scheme has developed to include a primary health care team operating from a central clinic.The scheme was evaluated by a study of the use of the service and by interviews with recipients of the service, hostel managers and others. The study confirmed the high health care burden from chronic handicapping conditions for this population. It was also found that the nature and level of primary health care provided by the scheme was acceptable to the hostel residents and the majority of hostel managements and to accident and emergency department staff. The female hostel dwellers expressed a need for a female practitioner in the scheme. Alternatives for primary health care provision for the single homeless are discussed in the light of the findings, and recommendations are made for the future of the scheme.