Methodology
A mixture of quantitative and qualitative techniques were used to look at a
sample of men and women of South Asian origin using a checklist/questionnaire by an
interviewer who had ethnic minority language skills or by health staff with access to an
interpreter where necessary. This was done by accessing existing groups and those in
attendance at the local TB screening clinic.
Results
54 questionnaires were completed and returned. 22 from New Immigrants
interviewed at the TB clinic in Preston and 32, which we distributed at the Preston Muslim
Forum - a local voluntary organisation. The results showed considerable lack of knowledge
and understanding of tuberculosis. Also that there was considerable reluctance to divulge
a diagnosis of tuberculosis to workplace managers or to educational staff due to concern
about stigma. This also held for religious places and other social establishments attended
by people.
Conclusions
Educational programmes need to be undertaken within ethnic minority communities
especially targeting employers and educational establishments emphasising that
tuberculosis is treatable, not highly infectious and addressing issues of stigma and
ignorance.
Title : The
health and social impact of a major chemical contamination incident on a
close working class
community in Runcorn
Authors: Geoffrey Barnes
Organisation: Wirral
Health Authority (North Cheshire Health Authority at time of
research)
Background
The presentation describes research exploring the health and social impact of a
major chemical contamination incident on a close long-standing working class community.
In January 2000 toxic chemical contamination was found to be affecting a number of
houses in the village of Weston, Cheshire close to Runcorn. The toxin was leaking from
sealed waste quarries owned by ICI. The company rapidly agreed to compensation packages
which enabled almost everyone in the village to sell their houses above market value. Over
the next year half the households decided to move away. It was later concluded that the
contamination was localised to a very small part of Weston.
Method
Six months after the incident semi-structured interviews were conducted with 23
residents still living in houses which had been found not to have been
affected by the chemical.
Results
The interviews revealed that many in the community were afflicted with high
levels of stress and depression. This was caused not so much by worries of chemical
contamination but by grief at the demise of a community that many were very attached to.
Significantly many of the supportive relationships which had existed in the community and
beyond had broken down. Many blamed ICI for introducing high levels of compensation which
they felt induced people to move away.
Conclusions
This research highlights the importance of attention to community and
interpersonal health in the face of scientific and epidemiological uncertainty.
Title : Predicting
the likelihood of older people have emergency admissions
Authors: i)Hannah Chellaswamy, ii)David Lyon
Organisation:
| i)North Cheshire Health Authority &
Halton Primary Care Groups |
| ii)General Practitioner at Castlefields
Health Centre, Runcorn |
Background
Older people are disproportionately in those admitted to hospitals as an
emergency. If it were possible to predict the likelihood of admissions and then be able to
prevent or delay an acute admission based on this knowledge, it would be of enormous
benefit to older people generally and the NHS.
Aim
To predict the likelihood of older people having an emergency admission to hospital
by using routinely collected data.
Design of study
Longitudinal cohort study.
Setting
One multi-handed general practice in the North West of England.
Method
The computerised database of a general practice was interrogated for
socio-demographic and morbidity (Read coded) data items on people aged above 75 years
between April 1996 and March 1997. Emergency admissions within the following twelve months
were noted for the same cohort. Step-wise multiple logistic regression analysis was
undertaken on all likely predictive variables and factors independently predictive of an
emergency admission were identified.
Results
Of the 486 people in the same population, 93 had at least one emergency
admission. Nine variables were independently predictive of an emergency admission. These
were: history of falls, ischaemic heart disease, living alone, leg ulcer, cancer,
respiratory disease, atrial fibrillation, mobility problems and male gender.
Conclusions
It possible to identify factors predictive of emergency admissions in older
people. If validated, these factors can be used to develop a tool to provide thresholds to
target interventions at people who are at high risk of having an emergency admission.
Keywords
older people; emergency admissions
Title : Combining
patient and public health data sets to determine the epidemiology
of, and potential
lifestyle risk factors for miscarriage
Author: R A Harrison
Organisation:
Wigan and Bolton Health Authority
Background
Miscarriage describes fetal loss before 20 weeks of pregnancy and often caused
by genetic abnormality and the prevalence may be as high as 30%. Lifestyle factors
including diet and physical activity might also increase the risk although less
information is available.
A service payment is given to general practitioners for women who miscarriage
before referring to secondary care. This information could be used with hospital data to
derive robust incidence estimate for miscarriage at a local level. Moreover, multi-level
logistic regression can combine local area information, including that from local health
needs assessments, to examine potential lifestyle risk factors for miscarriage (and other
conditions).
Methods
Primary care service payment data and routinely collected hospital statistics
were used to determine the annual incidence of at least one miscarriage, in women living
in wards in Wigan and Bolton for a three-year period (crude and age-adjusted). This was
combined with lifestyle information from a local health survey (15,000 residents) and with
census data using multi-level logistic regression to control for potential confounding and
to determine associations of miscarriage with area-based lifestyle and demographic
factors.
Results
Over the three years 1998-2001, 2,135 (12.3%) from a total of 17,313 maternity
payments were reported in primary care and ranged from 6.5% to 19.9% at the ward level.
Crude and adjusted rates incorporating hospital-recorded miscarriages will be presented,
and associations with area-based lifestyle factors.
Conclusions
Absolute rates of miscarriage vary widely by ward and influenced by age and
possibly certain lifestyle factors. Multi-level modelling enables potential associations
to be examined between individual patient-measured variables and area-based variables and
enables extensive use of data from public health needs assessments.
Title : Cervical
screening for women with learning difficulties
Author: H J Lewis-Parmar
Organisation:
Wigan and Bolton Health Authority
Background
The healthcare needs of people with learning difficulties are less well met
than the rest of the population. People with a learning disability are more likely to
experience health problems and this is compounded by poverty together with barriers in
accessing health services. Studies have shown that cervical screening coverage in women
with learning difficulties is much lower than that within the general population. For some
women this is an informed choice based upon a balance of risk and benefit. For many of
these women cervical screening is not discussed and the decision not to have a cervical
smear is taken for them either by carers or health professionals. This is often
based upon the unfounded assumption that women with learning difficulties are not sexually
active and are therefore at low risk of developing cervical cancer. The time and skills
needed to explore these issues are often not available in primary care and women with
learning difficulties are excluded from attending cervical screening.
Objectives
This project aims to determine the uptake of cervical screening with women
known to have learning difficulties in Wigan and Bolton and to use this information to
develop services. The ethical issues concerning consent will be discussed together with a
description of how communication and other barriers to accessing cervical screening
are going to be addressed locally within primary care.
Setting and participants
Women known to have learning difficulties identified by the Learning Disability
Teams and Social Services in Wigan and Bolton.
Results
Cervical screening uptake for 800 women with learning difficulties resident in
Wigan and Bolton.
Conclusions
A discussion of the issues raised by the low uptake of cervical screening for
women with learning difficulties together with recommendations of how the project will be
taken forwards to improve screening services to meet the needs of this vulnerable group.
Title : Management
of blood-borne viruses in Cheshire drug users
Authors:
i)Alex Macherianakis, ii)Daniel Seddon
Organisation:
|
i)Sefton Health Authority |
|
ii)South Cheshire Health Authority |
What we know
Blood-borne viral infections are preventable. Injecting drug users who share
needles or other injecting paraphernalia (e.g spoons, water and filters) are at high risk
of infection. Drug users should be encouraged to avoid these harmful behaviours to disrupt
viral transmission. If giving up completely is not possible, then a harm reduction
strategy should be sought. Counselling, blood testing and immunisation are the main
components of this strategy and Community Drug Teams are in good position to deliver them
to those in contact with their service.
National Policy in England and Wales recommended hepatitis
B immunisation for injecting drug users. National surveys have shown that this policy has
been unsuccessful so far, in achieving even moderate immunisation uptake.
What we did
In this paper, we describe the review commissioned by the Cheshire Drug Action
Teams of the current management of blood-borne viruses in clients of the local Community
Drug Teams. We present the results of a linked audit of blood-borne viruses testing and
hepatitis B immunisation. Finally we make recommendations for improvement.
What we found
The initial audit for 1999 showed great variation in testing policies between
the four Community Drug Teams and hepatitis B immunisation uptake being unsatisfactory.
Even more, completion of immunisation courses was erratic. As a result, the Cheshire Drug
Action Team committed itself to a blood-borne viral infection prevention programme in drug
users. This programme was supported with special funding.
The second audit for 2000 showed considerable progress in testing and hepatitis B
immunisation uptake. However, there is still scope for further improvement, as only few
full immunisation courses have been completed
What we should do
The most important recommendations are:
a) To raise the programme profile
b) To involve in its delivery more Community Drug Team staff and
GPS
c) To expand the programme target groups
d) To increase the programme time flexibility
e) To give first dose on first visit, without waiting for the
blood results
f) To consider contact tracing
g) To refer positive clients directly for assessment and
treatment is considered
appropriate.
Title : Enhanced
respiratory surveillance in a district; evolution and possible future
direction
Authors:
i)John Reid, ii)Valerie Upton
Organisation: Sefton
Health Authority
Background
Sefton experienced severe winter excess deaths in 1992/93 and 1993/94. Extra
Hospitals admissions for respiratory illness placed major pressures on local health
services. The subsequent PHAR recommended that sentinel surveillance be developed to alert
about future peaks.
A second local concern since the early 1990s was about the perceived high levels of
asthma in south Sefton believed to be associated with fugitive coal dust emissions from
the coal landing and handling processes on the adjacent Liverpool docks. Sefton
Environmental Protection Dept, Sefton Public Health dept and academic colleagues upgraded
local health and pollution data. Sefton Council invested in comprehensive dust and air
pollution monitoring. Sefton Public Health dept with investigators at Liverpool School of
Tropical Medical sponsored investigations of respiratory health of local school children.
Objectives
To develop a sentinel surveillance system for influenza/respiratory monitoring.
To develop systems for air quality monitoring and dissemination.
Results
Weekly respiratory sentinel surveillance was developed with 6 GP practices in
Sefton covering 14% of local population, the first multi-practice district project of
sentinel surveillance in the Mersey sub-region. The system also monitors a range of
respiratory conditions all year round.
A 'Breathing Space' initiative was launched in 1997 in response to local concerns
and given the enhanced availability of local air pollution data and we launched the first
Air Quality alert system in the North-West to inform local agencies about air quality
conditions. We launched one of the first multi-agency web-sites for pollution and
respiratory indicators, in June 2001.
Examples of local information will be presented.
Conclusions
We have retained wider respiratory surveillance pending further debate on how
to proceed. Should such work be seen as specific to concerns in local areas/PCTs or part
of a wider regional population approach to respiratory surveillance?
MANCHESTER
MEDICAL SOCIETY
