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Abstractobjectives To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children's school absenteeism.methods We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm).results Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (À25%, 95% confidence intervals [CI] = À37%, À2%), ARIs (À15%, 95% CI = À30%, À8%), school absences due to illnesses (À27%, 95% CI = À41%, À18%) and eye infections (À46%, 95% CI = À58%, À31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for 'whole families' (À31%, 95% CI = À37%, À5%; and À14%, 95% CI = À23%, À6%, respectively), 6-to 15-year-olds (À30%, 95% CI = À39%, À7%; and À15%, 95% CI = À24%, À6%) and under 5 s (À32%, 95% CI = À41%, À4%; and À20%, 95% CI = À29%, À8%).conclusions Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public-private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.keywords hand washing with soap, diarrhoea, acute respiratory infection, hygiene, school absence

Objective: To determine the cost effectiveness of a magnetic resonance imaging scan (MRI) within 5 days of injury compared with the usual management of occult scaphoid fracture. Methods: All patients with suspected scaphoid fractures in five hospitals were invited to participate in a randomised controlled trial of usual treatment with or without an MRI scan. Healthcare costs were compared, and a cost effectiveness analysis of the use of MRI in this scenario was performed. Results: Twenty eight of the 37 patients identified were randomised: 17 in the control group, 11 in the MRI group. The groups were similar at baseline and follow up in terms of number of scaphoid fractures, other injuries, pain, and function. Of the patients without fracture, the MRI group had significantly fewer days immobilised: a median of 3.0 (interquartile range 3.0-3.0) v 10.0 (7-12) in the control group (p = 0.006). The MRI group used fewer healthcare units (median 3.0, interquartile range 2.0-4.25) than the control group (5.0, 3.0-6.5) (p = 0.03 for the difference). However, the median cost of health care in the MRI group ($594.35 AUD, $551.35-667.23) was slightly higher than in the control group ($428.15, $124.40-702.65) (p = 0.19 for the difference). The mean incremental cost effectiveness ratio derived from this simulation was that MRI costs $44.37 per day saved from unnecessary immobilisation (95% confidence interval $4.29 to $101.02). An illustrative willingness to pay was calculated using a combination of the trials measure of the subjects' individual productivity losses and the average daily earnings. Conclusions: Use of MRI in the management of occult scaphoid fracture reduces the number of days of unnecessary immobilisation and use of healthcare units. Healthcare costs increased non-significantly in relation to the use of MRI in this setting. However, when productivity losses are considered, MRI may be considered cost effective, depending on the individual case.

Objective: To describe complaints by patients and compare rates of complaint in demographic subgroups of patients and hospital departments. Design and setting: Retrospective analysis of complaints made by patients attending 67 hospitals (metropolitan, 25; rural, 42) in Victoria, and lodged with the Victorian Health Complaint Information Program (January 1997 – December 2001). Main outcome measures: Demographic characteristics of patients lodging complaints and the hospital department involved; nature and outcome of complaints. Results: From a total of over 13 million patients presenting to hospital during the study period, 19 156 patients or their representatives (mostly their parents, children or spouses) lodged 26 785 “issues” of complaint (overall complaint rate, 1.42 complaints/1000 patients). Significantly more complaints (P < 0.001) were lodged by (or on behalf of) female patients (complaint rate ratio, 1.3; 95% CI, 1.2–1.3), public patients (rate ratio, 2.1; 95% CI, 2.0–2.2) and Australian‐born patients (rate ratio, 8.9; 95% CI, 8.3–9.6). The complaint rate for general wards was 6.2/1000 patients (95% CI, 6.1–6.3). Intensive care units had a similar rate of 5.9/1000 (95% CI, 5.4–6.5), but aged‐care departments had a significantly higher rate of 45.2/1000 (95% CI, 39.5–51.7), while emergency departments (1.9/1000; 95% CI, 1.8–2.0), operating theatres (1.0/1000; 95% CI, 1.0–1.1), day‐procedure units (0.5/1000; 95% CI, 0.5–0.6) and outpatient departments (0.4/1000; 95% CI, 0.4–0.4) had significantly lower rates. Complaints relating to communication (poor attention, discourtesy, rudeness), access to healthcare (no/inadequate service, treatment delays) and treatment (inadequate treatment and nursing care) accounted for 29.2%, 28.5% and 22.5% of complaints, respectively. Most (84.5%) complaints were resolved. Apologies or explanations resolved 27.8% and 27.5% of complaints, respectively. Conclusion: Interventions to decrease the number of complaints in the areas of communication and access to healthcare need to be implemented. The active use of complaint data for quality‐improvement activities is recommended.

Missing data on the TWEAK, lower internal consistency for the TWEAK and CAGE, and the better ability of the AUDIT to differentiate problem drinkers from non-problem drinkers, suggest that the AUDIT performs best in screening for problematic alcohol use among under-aged drinkers treated in emergency departments.