Ascertainment of occupational histories in the working population: the occupational history calendar approach.

BACKGROUND: self-reported occupational histories are an important means for collecting historical data in epidemiological studies. An occupational history calendar (OHC) has been developed for use alongside a national occupational hazard surveillance tool. This study presents the systematic development of the OHC and compares work histories collected via this calendar to those collected via a traditional questionnaire. METHODS: the paper describes the systematic development of an OHC for use in the general working population. A comparison of data quality and recall was undertaken in 51 participants where both tools were administered. RESULTS: the OHC enhanced job recall compared with the traditional questionnaire. Good agreement in the data captured by both tools was observed, with the exception of hazard exposures. CONCLUSIONS: a calendar approach is suitable for collecting occupational histories from the general working population. Despite enhancing job recall the OHC approach has some shortcomings outweighing this advantage in large-scale population surveillance.

Investigation of bias after data linkage of hospital admissions data to police road traffic crash reports.

RESEARCH QUESTION: Does a database of hospital admission data linked to police road traffic accident (RTA) reports produce less biased information for the injury prevention policymaker, planner, and practitioner than police RTA reports alone? DESIGN: Data linkage study. STUDY POPULATION: Non-fatal injury victims of road traffic crashes in southern England who were admitted to hospital. DATA SOURCES: Hospital admissions and police RTA reports. MAIN OUTCOME MEASURES: The estimated proportion of road traffic crashes admitted to hospital that were included on the linked database; distributions by age, sex, and road user groups: (A) for all RTA injury admissions and (B) for RTA serious injury admissions defined by length of stay or by nature of injury. RESULTS: An estimated 50% of RTA injury admissions were included on the linked database. When assessing bias, admissions data were regarded as the "gold standard". The distributions of casualties by age, sex, and type of road user showed major differences between the admissions data and the police RTA injury data of comparable severity. The linked data showed smaller differences when compared with admissions data. For RTA serious injury admissions, the distributions by age and sex were approximately the same for the linked data compared with admissions data, and there were small but statistically significant differences between the distributions across road user group for the linked data compared with hospital admissions. CONCLUSION: These results suggest that investigators could be misinformed if they base their analysis solely on police RTA data, and that information derived from the linked database is less biased than that from police RTA data alone. A national linked dataset of road traffic crash data should be produced from hospital admissions and police RTA data for use by policymakers, planners and practitioners.

Clusters within a general adult population of alcohol abstainers.

BACKGROUND: Our previous study found that alcohol abstainers use acute services more and preventative services less than safe level drinkers. The observed relationships between four categories of alcohol consumption and service use were J-shaped for acute services and inverted J-shaped for preventive services. The aim of this paper was to further investigate these relationships. METHODS: The design was a health and lifestyle survey of 41 000 randomly-sampled adults in SE England. The response rate was 60%. Distinctive subgroups within the alcohol abstainer group were investigated using cluster analysis, based on socio-demographic and health status variables. Odds ratios for services use for the abstainer clusters, and three alcohol consumption groups were estimated from a logistic regression model which included age, social class, ethnic group, employment status, household composition, whether the respondent was a carer, smoking habit, use of private health insurance, and health status. RESULTS: Two clusters were formed for both males and females. Cluster 1 comprised, on average, older, frailer, and more disabled people. Cluster 2 comprised younger, healthier people, a greater proportion of whom belonged to ethnic minority groups. Cluster 2 had similar rates of use of Accident & Emergency, GP, optician, and dental services compared with safe level drinkers. Cluster 1's rates differed from those of both Cluster 2 and safe level drinkers in almost all instances. CONCLUSIONS: The J- and inverted J-shaped relationships between alcohol consumption and service use are partly explained by a subgroup of abstainers who are older, of less good health, and who use hospital, clinic, and domiciliary healthcare services much more than safe level drinkers.

Why the government was right to change the 'Our Healthier Nation' accidental injury target.

We congratulate the current UK Government on their inclusion of accidental injury as one of the national targets in the White Paper: Saving Lives-Our Healthier Nation (OHN). We had concerns about the particular target that was proposed in the Green Paper: 'ellipsisto reduce the rate of accidents-here being defined as those which involve a hospital visit or consultation with a family doctor-by at least a fifthellipsis'. The limitations of this target were: firstly, it would focus attention on minor injury and so not reflect the main burden of injury; and secondly, that ascertainment of cases would be influenced by social factors as well as provision of service and access factors. The new target stated in Saving Lives also has its limitations since it will be influenced by service factors. This target is to reduce by 10% the rate of serious injury, defined as injury resulting in four or more days in hospital. We have proposed the use of an alternative indicator of unintentional injury occurrence, based on serious long bone fracture admitted to the hospital. This alternative indicator is based on the occurrence of serious rather than minor injury. It is likely that a high proportion of cases of these injuries can be identified from existing data sources. Ascertainment of cases is likely to be independent of social, service or access factors. Finally, these injuries are associated with significant long term outcomes including disablement, reduced functional capacity and reduced quality of life. It does have the limitation that it does not measure all serious injury. Such a measure is much more difficult to achieve. Further improvements to our proposed indicator could be made in a number of ways, through investigating an extended definition of the indicator to include a range of other serious injuries, improving the quality of existing data, making other data sources available, including outpatient data, and making serious injury a notifiable disease.

The use of acute and preventative medical services by a general population: relationship to alcohol consumption.

AIMS: To investigate the hypothesis that increasing alcohol consumption is accompanied by increasing use of acute, but decreasing use of preventative, medical services among the general population. DESIGN AND PARTICIPANTS: Health and life-style survey of 41,000 randomly-sampled adults in SE England who self-completed a validated questionnaire covering socio-demographics, alcohol and tobacco usage and use of acute (A&E department and general practitioner) and preventative (dental, optician, mammography and cervical cytology) services: the response rate was 60%. MEASUREMENTS: Comparative use of acute and preventative health care services by patients with varying consumption of alcoholic beverages. This was estimated by the odds ratio for service use, after correcting for the following confounding variables; age, social class, ethnic group, employment status, whether lives with children or with other adults, whether is a career, limiting long-term illness, depression status, smoking habit and use of private health insurance. FINDINGS: There was increased use of accident and emergency services by the harmful and intermediate drinking groups compared with the safe drinking group. Male abstainers attended their A&E departments more frequently than 'safe limit' drinkers. With respect to preventative services, both male and female abstainers and harmful drinkers used dental services less than safe limit drinkers. For females, mammography and cervical cytology services were less frequently used by abstainers and by harmful drinkers. CONCLUSIONS: This study supports the generally held view that heavy alcohol consumers are disproportionate users of acute medical services but they are relative under-users of preventative medical care services. Alcohol abstainers are also over-users of acute services, but under-users of preventative services. These latter observations are relevant to the claims that moderate alcohol consumers have lower apparent morbidity and mortality rates compared to abstainers.

Rates of, and the factors affecting, cycle helmet use among secondary schoolchildren in East Sussex and Kent.

OBJECTIVES: To assess the level of cycle helmet wearing among young people in two counties in the South East of England in 1994, and to identify the factors associated with helmet wearing. DESIGN: Cross sectional survey in a convenience sample. SETTING: Secondary schools in East Sussex and Kent. SUBJECTS: Students in year 7 (aged 10-12 years) and year 11 (aged 14-16 years). Main outcome measures--Self reported "always wears a helmet". RESULTS: Among those who ride a bicycle, 32% of boys and 29% of girls aged 10-12 years, and 14% of boys and 10% of girls aged 14-16, reported that they always wear helmets. The variables that were most consistently associated with helmet wearing (that is significantly associated with helmet wearing in at least five of the six age, sex, and county subgroups) were: "parental encouragement to wear a helmet" "closest friend wears a helmet", "belief that laws that make children wear helmets are good", and "sometimes rides off-road". CONCLUSIONS: The self reported rates of always wearing a cycle helmet in East Sussex and Kent are consistent with overseas findings for populations who had not been exposed to intensive helmet promotion. The evidence suggests that parental encouragement has a favourable effect on rates of cycle helmet use among secondary schoolchildren, which is separate from and additional to peer influences. When designing a helmet promotion programme, therefore, it will have added impact if both parents and children are addressed.

Descriptive epidemiology of injury in the south east: identifying priorities for action.

OBJECTIVE: To demonstrate the significance of injury in relation to other health problems, to describe the pattern of injury in one region of England, and to identify priorities for further epidemiological and prevention work. DESIGN: Cases were identified retrospectively from secondary data sources, namely using routinely collected data on deaths (OPCS anonymized death registrations for the period 1988-1991) and hospital in-patients (South Thames (East) RHA files of in-patient episodes). Denominator data for rates were obtained from the 1991 mid-year population estimates from the OPCS. SETTING: The cohort was defined as those resident in South Thames (East) during the study period, namely Kent, East Sussex, and South East London. The study period was 1988-1991 calendar years inclusive for the fatalities: and was the financial year from 1 April 1991-31 March 1992 for injury resulting in hospital admission. MAIN RESULTS: Injuries were found to be the fifth leading cause of death, the third leading cause of potential years of life lost (PYLL), and the third most common cause of hospital bed utilisation. Injury rates varied dramatically with age, and sex. The highest injury death and hospitalization rates were amongst elderly people. The leading causes of injury death were motor vehicle traffic crashes (25%), and suicide (23%), and falls (15%); for injury hospitalizations they were falls (60% of bed-days), and motor-vehicle traffic crashes (13% of bed-days). The most common places identified for the occurrence of injury death were road, home and residential institutions. Those injuries that accounted for most admissions to hospital were fractures (59% of bed-days). CONCLUSIONS: A number of areas have been identified as regional priorities. These are motor vehicle traffic crashes involving pedestrians (especially children under 15 and those aged 65 and over), car occupants and motor cyclists (especially young adult males); falls (especially those aged 65 and over); those occurring in residential institutions (especially for elderly people); fire and flames (affecting children under 15); suicide/self harm (all ages 15 and above); and homicide/assault (in males aged 15-34).

The epidemiology of forestry work-related injuries in New Zealand, 1975-88: fatalities and hospitalisations.

AIM: This paper presents a detailed investigation of the injury experience of New Zealand forestry workers, including loggers and silviculture workers. METHODS: Record linkage of multiple data sources. RESULTS: During the period 1975-88, there were 81 work-related fatalities among loggers and 10 fatalities among silviculture workers, yielding fatality rates of 2.03 and 0.15 per 1000 workers/year, respectively. These figures were substantially higher than the fatal injury rate among the overall New Zealand workforce of 0.07 deaths per 1000 workers/year. In addition there were 1068 work-related injuries resulting in hospitalisation among loggers, and 478 among silviculture workers, yielding hospitalisation rates of 38.93 and 9.58 per 1000 workers/year, respectively. The types of injury contact involved in each incident were analysed. Contact with falling trees was the leading cause of death in forestry, accounting for over half of the fatal injuries among loggers and a third among silviculture workers. For loggers, the three commonest types of contact resulting in hospitalisation were: chainsaw injuries (n = 351; 33%), falling trees (n = 269; 25%), and rolling logs (n = 82; 8%). Among silviculture workers, the three commonest types of contact resulting in hospitalisation were: chainsaw injuries (n = 108; 23%), falling trees (n = 96; 20%), and falls/slips and trips (n = 94; 20%) CONCLUSION: There is clear need for continued efforts to improve the overall safety of forestry work in New Zealand.

Work related injury in New Zealand commercial fishermen.

The fatal and non-fatal injuries related to work in commercial fishermen operating out of New Zealand ports is described. Three data sources were used to provide information on the nature of the injuries sustained, as well as their circumstances. High rates of fatal and non-fatal injury were found, with most deaths attributed to drowning, and concerning a vessel operating in rough seas or poor weather. A higher fatal injury rate was found for the west coast of New Zealand when compared with the rest of the country. This is likely to be due to a combination of factors, including rougher sea conditions, a lower density of fishing vessels operating in the area, and the siting of many west coast fishing ports at dangerous river and harbour bars. Injuries to hands and fingers related to the use of winches, machinery and knives were common, as were back strains associated with lifting, and a variety of injuries resulting from falls. There is need for a comprehensive injury information source, such as an industry based register specific for fishing, so that effective preventative strategies and their evaluation can be developed.

Are national hospital data adequate for coding injury severity?

The purpose of this study was to determine whether accurate severity scores, using the abbreviated injury scale (AIS), could be produced from hospital discharge data held on the National Health Statistics Centre (NHSC) computer files. The data from two New Zealand trauma studies, in which AIS scores had been assigned to patient injuries, were linked to the patient data on NHSC computer files and AIS scores assigned for those injuries that were present. Sixty-five percent of the injuries for which a link was made were scorable and of these, there was 54% agreement between the AIS scores generated from NHSC data and the scores from the trauma studies. Percent agreement varied with body area, whether the injury was from a single or multiple injury victim, and with the severity of injury. Recommendations include a revision of data collection and NHSC data coding to incorporate AIS scores, and to educate medical personnel regarding AIS in order that they collect appropriate information so that AIS may be coded on the patient's discharge form.

A review of work-related fatal injuries in New Zealand 1975-84--numbers, rates and trends.

Deaths resulting from work-related injuries during 1975 to 1984 in New Zealand were identified and reviewed. Nine hundred and eighty-six members of the workforce (workers) were killed at work during this period. This excluded deaths resulting from traffic-related injuries on public roads which occurred during a person's work activity and injuries which occurred whilst travelling to or from work. The estimated average work-related fatal injury rate for New Zealand was 7.2/100,000 workers/year. Variations in fatal injury rate by year of injury, age, sex and race were observed. Occupation and industry fatality rates were also estimated and gross variations by occupation were found. Those occupations with the highest estimated rates included helicopter and agricultural pilots, demolition labourers, deer cullers and commercial deer shooters. These rates are likely to be biased to some degree. Occupations with the largest number of workers killed during this 10 year period were farmers (109), fishermen (79) and forestry workers (68).

Analysis of the components of a linear trend in proportions.

The standard epidemiologic methods for evaluating trends in the prevalence or incidence of disease are reviewed, and a method is presented for assessing the contribution of a specific disease subgroup to the overall trend, based on the slope obtained by a grouped weighted linear regression of the proportions of persons experiencing the outcome of interest in each exposure level. The slopes for specific disease subgroups contribute to the overall slope in an additive manner, and measures based on the individual slopes can be used to assess the relative strengths of the trends for specific disease subgroups as well as their relative contributions to the overall trend. This approach is illustrated with data on social class patterns of mortality in New Zealand males aged 15-64 years during 1974-1978; it is shown that the strongest mortality gradients were for mental disorders, infectious diseases, respiratory diseases, and accidents. The latter two categories together accounted for approximately two thirds of the overall social class mortality gradient.

A single-blind comparative study of once daily dothiepin ("Prothiaden") and divided daily doses of amitriptyline.

Forty-eight patients took part in a single-blind clinical trial comparing a once daily dose of dothiepin (75 mg) and 25 mg 3-times a day of amitriptyline. The results showed that dothiepin caused a greater improvement than amitriptyline after 4 weeks of treatment as judged by depression scores, total scores and global assessments. The incidence of side-effects was less with dothiepin and in those patients who actually reported side-effects the severity was much less with dothiepin than with amitriptyline.