Environmental Public Health Tracking: a cost-effective system for characterizing the sources, distribution and public health impacts of environmental hazards.

Background: The contemporary environment is a complex of interactions between physical, biological, socio-economic systems with major impacts on public health. However, gaps in our understanding of the causes, extent and distribution of these effects remain. The public health community in Sandwell West Midlands has collaborated to successfully develop, pilot and establish the first Environmental Public Health Tracking (EPHT) programme in Europe to address this 'environmental health gap' through systematically linking data on environmental hazards, exposures and diseases. Methods: Existing networks of environmental, health and regulatory agencies developed a suite of innovative methods to routinely share, integrate and analyse data on hazards, exposures and health outcomes to inform interventions. Results: Effective data sharing and horizon scanning systems have been established, novel statistical methods piloted, plausible associations framed and tested, and targeted interventions informed by local concerns applied. These have influenced changes in public health practice. Conclusion: EPHT is a powerful tool for identifying and addressing the key environmental public health impacts at a local level. Sandwell's experience demonstrates that it can be established and operated at virtually no cost. The transfer of National Health Service epidemiological skills to local authorities in 2013 provides an opportunity to expand the programme to fully exploit its potential.

A prospective mini health impact assessment of the 'Towards 2010' programme in Sandwell and West Birmingham in the West Midlands.

OBJECTIVES: To conduct a health impact assessment (HIA) of the four 'Towards 2010' programme options under consideration. This is an innovative and visionary programme involving a 750 million pound capital investment to deliver modern and flexible healthcare services across Sandwell and West Birmingham in the West Midlands, UK. The HIA aimed to inform the Board which of the four options would be most beneficial for the local population. STUDY DESIGN: A prospective mini HIA. METHODS: The study involved a desktop exercise using a combination of the Merseyside and West Midlands Directors of Public Health guidelines for conducting HIAs. Ten broad determinants of health including employment and economy, education, transport, housing, visual amenity (environment), access to services, crime, lifestyle, pollution, and family and social cohesion were selected. For each determinant potential positive and negative impacts were identified using readily available local information and professional knowledge. RESULTS: Overall over 600 positive and negative impacts were predicted across the four options. These were summarized into 90 positive and 84 negative impacts for each of the ten broad determinants of health. The findings suggest that two out of the four options seem to offer maximum opportunity for improving the health and wellbeing of the local population and for linking into the wider regeneration initiatives within the programme area. DISCUSSION: Besides the obvious benefits that one would expect from brand new modern healthcare facilities, a wide range of other impacts were identified. This raised a level of awareness amongst the decision makers of the range of impacts that would need to be maximized or minimized to improve the health and wellbeing of the local population.

The effect of trauma program registry on reported mortality rates.

BACKGROUND: This study assesses the relationship that the brand of trauma program registry (TPR) has on mortality rate (MR) in the reports prepared by the American College of Surgeons Committee on Trauma (ACSCOT) trauma center (TC) site surveyors. METHODS: Data from 242 ACSCOT adult TC survey reports (88 Level I, 115 Level II, and 39 Level III) were analyzed for annual trauma volume, injury severity score (ISS), MR, and TPR. Six TPR (A through F) were identified; group F was a composite of several infrequently used TPRs. This report focuses on the ISS range 16-24 because of the likelihood that the mean for each TC would be near 20 and MR is high enough so that a difference, if present, could be statistically documented. RESULTS: For the total group, MR showed no correlation with TC volume or TC level for ISS 16-24. MR was significantly different according to which TPR was used by the TCs. The MR is less (4.8%) for 14 high volume TCs (over 1200 admits) using TPR A compared with 33 low volume TCs (below 800 admits) using TPR A (6.34%). CONCLUSION: The MR for ISS 16-24 in ACSCOT-surveyed TCs differs within subgroups based on type of TPR utilized. This may reflect improper use of the software programs. Enhanced skill in the application of software programs designed to generate ISS scores is essential if meaningful studies on the effects of improved trauma care on MR are to be conducted. Hand scored ISS by trained personnel may circumvent this problem.

Mathematical modeling to define optimum operating room staffing needs for trauma centers.

BACKGROUND: Level II trauma centers may be verified (1999, American College of Surgeons Committee on Trauma) with an on-call operating room team if the performance-improvement program shows no adverse outcomes. Using queuing and simulation methodology, this study attempted to add a volume guideline. STUDY DESIGN: Data from 72 previously verified trauma centers identified multiple demographic factors, including specific information about the first trauma-related operation that was done between 11:00 PM and 7:00 AM each month for 12 consecutive months. RESULTS: The annual admissions averaged 1,477 for 37 Level I trauma centers, 802 for 28 Level II trauma centers, 481 for 4 Level III trauma centers, and 731 for 3 pediatric trauma centers. The annual admissions correlated with the number of operations done between 11:00 PM and 7:00 AM (p < 0.001). These 946 operations were performed by general surgery (39%), neurosurgery (8%), orthopaedic surgery (33%), another specialty (9%), or multiple services (10%). Admission to operation time was within 30 minutes for 12.1% of patients (2.6% for blunt and 24.1% for penetrating injuries). The probability of operation within 30 minutes of arrival varied with the number of admissions and with the percentage of penetrating versus blunt injuries. The likely number of operations from 11:00 PM to 7:00 AM would be 19 for 500 annual admissions, 26 for 750 annual admissions, and 34 for 1,000 annual admissions, with 5.83, 7.98, and 10.13 patients, respectively, going to operation within 30 min. The probability that two rooms would be occupied simultaneously was 0.14 and 0.24 for centers admitting 500 and 1,000 patients, respectively. CONCLUSIONS: Trauma centers performing fewer than six operations between 11:00 PM and 7:00 AM per year could conserve resources by using an immediately available on-call team, with responses monitored by the performance-improvement program.

Simulation program for optimal orthopedic call: a modeling system for orthopedic surgical trauma call.

This report uses a mathematical modeling system to define optimal orthopedic coverage for trauma centers. Data from 2,325 patients treated with emergency orthopedic operations within 24 hours of admission at 78 randomly sampled and at four totally sampled verified centers were used to create a profile of (1) admission by month, day, and hour; (2) operation times; and (3) operation duration. The reason for operation included (1) open fracture or crush (809 patients); (2) irreducible dislocations (164 patients); (3) fracture with vascular injury (seven patients); (4) dislocation with vascular injury (17 patients); (5) compartment syndrome (11 patients); (6) femoral neck fracture in young patients (36 patients); (7) combination of categories 1 to 6 (70 patients); (8) fracture with multiple injuries (171 patients); and (9) urgent not emergent (1,040 patients). The program defined the frequency that an injured patient needing an orthopedic consult would wait beyond 30 minutes because the orthopedic surgeon was doing a trauma related operation at a center with one or two orthopedic surgeons on call. The probability that a patient cannot be seen promptly by one orthopedic surgeon in a center doing 25, 50, 75, 100, 200, and 300 emergency procedures per year is 0.17, 0.74, 1.6, 3.1, 12.5, and 28 patients per year. When two are on call, 1.3 patients, yearly, will wait more than 30 minutes in a center doing 300 emergency procedures. Thus, mandatory orthopedic backup call for a trauma center performing fewer than 100 emergent trauma procedures within 24 hours is unwarranted.

Health promotion is peace promotion.

This paper discusses the effects of the arms race on health, in the absence of nuclear war. High levels of military expenditure are inextricably linked to unemployment, poverty, starvation and ill health. Alternatives to the escalation of military expenditure are possible; health promotion can be involved in wider public health initiatives towards economic and industrial conversion to peaceful, socially useful production. The interests of the health and scientific communities have traditionally transcended narrow chauvinism and nationalism. World Health Organization activities such as work towards primary health care and the Expanded Programme on Immunization actively involve international co-operation, demystify potential enemies and promote health and peace.

An outbreak of hepatitis A on a hospital ward.

An outbreak of hepatitis A has been recognised on a medical ward of a district general hospital. Eleven nurses and one patient were reported to have hepatitis over a period of 18 days in October, 1984. Specific tests for hepatitis A IgM were positive in all cases. Following extensive investigations, the outbreak was traced to a female patient who had recently returned from India and who was incontinent. Her serum, when tested subsequently, showed evidence of recent hepatitis A infection. The implications of this outbreak are discussed.

Determination of sun protection factors in the hairless mouse.

Synopsis A laboratory method for determining sun protection factors (SPF) in the hairless mouse has been developed. The ability of the method to predict the SPF in man has been investigated using sunscreen ingredients and finished products with known activities in man. The results indicate that the hairless mouse can be used to assess sunscreen products although the SPF found appeared slightly higher than that determined in man.

Normal use levels of respirable cosmetic talc: preliminary study.

Synopsis This preliminary study was undertaken to provide data from which a more comprehensive investigation to establish the safety in-use of cosmetic talcs could be designed. Methods for collecting and analysing respirable talc generated during the use of loose face powder and adult and baby dusting powders were established. Respirable particles in the air were separated from larger size particles by means of a cyclone and were collected on membrane filters. The collected dust was dissolved in acid and the solution was analysed for magnesium by atomic absorption spectroscopy. From the results the concentrations of talc in the air samples were calculated. The method was used to monitor the in-use levels of a range of cosmetic talcs. Mean concentrations in air sampled for 5 min from the start of use of Chinese grades and Italian 00000 grades of talc formulated for use as loose face powder, adult dusting powder and baby dusting powder were 0.48, 1.13 and 0.21 mg m(-3), respectively. Higher levels were found with micronised adult dusting powder (mean concentration 1.9 mg m(-3)). There was no evidence that the presence of perfume in the talc or the ambient relative humidity in the range 54-74% during use affected the levels of respirable talc, but high relative humidity <90% reduced the amount of respirable talc.