Pattern of injury mortality by age-group in children aged 0-14 years in Scotland, 2002-2006, and its implications for prevention.

BACKGROUND: Knowledge of the epidemiology of injuries in children is essential for the planning, implementation and evaluation of preventive measures but recent epidemiological information on injuries in children both in general and by age-group in Scotland is scarce. This study examines the recent pattern of childhood mortality from injury by age-group in Scotland and considers its implications for prevention. METHODS: Routine mortality data for the period 2002-2006 were obtained from the General Register Office for Scotland and were analysed in terms of number of deaths, mean annual mortality rates per 100,000 population, leading causes of death, and causes of injury death. Mid-year population estimates were used as the denominator. Chi-square tests were used to determine statistical significance. RESULTS: 186 children aged 0-14 died from an injury in Scotland during 2002-06 (MR 4.3 per 100,000). Injuries were the leading cause of death in 1-14, 5-9 and 10-14 year-olds (causing 25%, 29% and 32% of all deaths respectively). The leading individual causes of injury death (0-14 years) were pedestrian and non-pedestrian road-traffic injuries and assault/homicide but there was variation by age-group. Assault/homicide, fire and suffocation caused most injury deaths in young children; road-traffic injuries in older ones. Collectively, intentional injuries were a bigger threat to the lives of under-15s than any single cause of unintentional injury. The mortality rate from assault/homicide was highest in infants (<1 year) and decreased with increasing age. Children aged 5-9 were significantly less likely to die from an injury than 0-4 or 10-14 year-olds (p < 0.05). Suicide was an important cause of injury mortality in 10-14 year-olds. CONCLUSION: Injuries continue to be a leading cause of death in childhood in Scotland. Variation in causes of injury death by age-group is important when targeting preventive efforts. In particular, the threats of assault/homicide in infants, fire in 1-4 year-olds, pedestrian injury in 5-14 year-olds, and suicide in 10-14 year-olds need urgent consideration for preventive action.

How should we evaluate patient access to their own records? An example with cancer patients in Scotland.

Government policy in many European countries now assumes that patients should have access to their own medical records. Increasingly such access can be used as one method of tailoring a wide range of information to the patient. Process evaluation, to ensure that human computer interfaces of such systems are appropriate, is needed during their design and implementation. However, studies to assess the impact on health outcomes are relatively expensive and time consuming so are they worth doing? We are carrying out a randomised trial of different types of computer-produced booklet including one based on information from the medical record. Four hundred cancer patients in Glasgow Scotland have been randomised on three binary variables: (a) whether patients chose the information themselves or if it was chosen for them; (b) whether it included personal information from their own medical record or not; (c) whether it included advice on the management of anxiety. We are investigating two 'levels' of outcome: (i) whether booklets are used to help engage and so improve patients' social support, and (ii) whether booklets and the level of social support affect patients' anxiety. We are also assessing anxiety in the patient's 'significant other'. To assess the views of both professionals and patients about the utility of our study, we developed a website which described our project and asked for users' predictions of our outcomes and their assessment of our method. There was no consistent prediction for the results of our stud, suggesting that it will be worthwhile to complete the study to inform discussion. The results will influence the way we give patients access to their medical records and could influence perceptions of its importance compared with other health service activities. Even though health service policy is to give patients access to their records we still need to assess outcomes in terms of health, and wellbeing both for patients and their families.

Does writing a list help cancer patients ask relevant questions?

We examined the use of written lists to give patients an opportunity to have their questions answered. Patients undergoing radical radiotherapy for cancer were given a sheet of paper with the simple prompt to write questions and give to the hospital doctor at their appointment 3 weeks later. At 3 months, patients were asked about their use and opinions of the written list. About half of the 478 patients attended with a written list. Fewer patients living in deprived areas used the list compared to more affluent areas. Doctors thought that 34% of patients would not otherwise have asked those questions and 91% of prompted discussions were a worthwhile use of time.