Subject(s)
Public Health/trends , Alcohol Drinking , Anecdotes as Topic , Diet , Disease Outbreaks , Humans , Illicit Drugs , Obesity , State Medicine , United KingdomABSTRACT
The aims of this study were to determine if inter-school variation in smoking prevalence was due to differences in pupil composition or other school-level factors. A cohort of 13-14-year-olds (n = 7147) from 52 schools was followed-up 1 year later. Random effects logistic regression was used to examine school variation in smoking uptake and cessation, with and without adjustment for pupil composition. Inter-school variation in smoking prevalence is not caused by differences in pupil composition but is due to differences in the onset of smoking arising because of unmeasured school contextual or collective factors operating on pupils' decisions.
Subject(s)
Family , Schools , Smoking Cessation/statistics & numerical data , Smoking/epidemiology , Adolescent , Cohort Studies , Female , Humans , Incidence , Male , Smoking/psychology , Smoking Prevention , United Kingdom/epidemiologyABSTRACT
OBJECTIVE: To describe changes in delay to administration of thrombolytic therapy associated with a region-wide audit. DESIGN: Observational study of patients admitted with suspected myocardial infarction (MI) based on continuous audit. SUBJECTS: 18877 patients admitted to 23 hospitals with suspected MI between April 1995 and March 1998. RESULTS: Of 11232 patients with a discharge diagnosis of definite MI, 8802 (46.6%) received thrombolytic therapy during hospitalisation, with 5155 patients eligible for treatment on admission to hospital on the basis of established indications. Call-to-needle time for those eligible for treatment on admission fell from median 105 min in the first year of the project to 85 min in year 3 (P<0.001), and door-to-needle time fell from 45 to 35 min (P<0.001). Forty percent of eligible patients were treated within the then current national standard of 90 min from time of call for help, with nearly 49% in the final year and 20% being treated within the new national standard of 60 min, by the third year. CONCLUSION: The proportion of eligible patients receiving thrombolysis within 1 h of the call for help doubled during the 3-year project but the majority of patients still wait longer than 60-min 'call-to-needle'. New systems to reduce delays to administration of thrombolysis to within 60 min of call for help are required, including consideration of pre-hospital treatment.
Subject(s)
Myocardial Infarction/therapy , Regional Medical Programs/organization & administration , Thrombolytic Therapy/standards , Total Quality Management/organization & administration , Aged , Analysis of Variance , Coronary Care Units , Emergency Medical Services/standards , Emergency Treatment/standards , England , Guideline Adherence/standards , Health Services Research , Humans , Medical Audit , Middle Aged , Outcome and Process Assessment, Health Care/organization & administration , Patient Acceptance of Health Care/statistics & numerical data , Patient Selection , Practice Guidelines as Topic , Program Evaluation , Time Factors , Time and Motion StudiesABSTRACT
BACKGROUND: NHS Direct is a nurse-led telephone help line that covers the whole of England and Wales. NHS Direct derived data are being used for community surveillance, the purpose of which is to detect a local or national increase in symptoms reported by callers. The system has the potential to identify an increase in symptoms reported by callers about people in the prodromal stages of illness caused by the deliberate release of a biological or chemical agent. There are no other community surveillance projects existing on a national scale that utilize electronic daily data. METHODS: We describe the surveillance system and calls to NHS Direct between December 2001 and July 2002. Confidence limits have been constructed for 10 key algorithms at each site and control charts devised for five of these algorithms at sites covering the key urban areas. RESULTS: Daily reporting has been achieved from NHS Direct sites in England and Wales. High levels of activity in specific algorithms at both national and regional levels have been detected. A sustained national increase in calls about fever occurred in January 2002. CONCLUSION: Although the project is still at an early stage, daily analysis of NHS Direct data has the potential to detect symptoms in the community that could be related to deliberate releases of chemical or biological agents or to outbreaks of disease. For this surveillance to act as an 'early warning' of illness resulting from a microbiological or chemical cause, the NHS Direct surveillance needs to be fully integrated into an appropriate public health response (which may require diagnostic samples to be taken from callers).
