Background-Evidence for an association between road traYc pollution and asthma is inconclusive. We report a case-control study of hospital admissions for asthma and respiratory illness among children aged 5-14 in relation to proxy markers of traYc related pollution. Methods-The study was based on routine hospital admissions data in 1992/3 and 1993/4 for North Thames (West) health region within the M25 motorway. Cases were defined as emergency admissions for asthma (n = 1380) or all respiratory illness including asthma (n = 2131), and controls (n = 5703) were other emergency admissions excluding accidents. Cases and controls were compared with respect to distance of residence from nearest main road or roads with peak hour traYc >1000 vehicles and traYc volume within 150 m of residence, obtained by Geographical Information System techniques. Statistical analysis included adjustment for age, sex, admitting hospital, and a deprivation score for the census enumeration district of residence. Results-Adjusted odds ratios of hospital admission for asthma and respiratory illness for children living within 150 m of a main road compared with those living further away were, respectively, 0.93 (95% CI 0.82 to 1.06) and 1.02 (95% CI 0.92 to 1.14). Conclusions-This study showed no association between risk of hospital admission for asthma or respiratory illness among children aged 5-14 and proxy markers of road traYc pollution.
We describe a matched case-control study investigating the association between respiratory illness and proximity of residence to main roads. The study was carried out in response to previously inconsistent reports on this question [1][2][3] ; the null hypothesis was of no association of traYc related air pollution to respiratory illness, hospital admissions for asthma and chronic obstructive airways disease. The study focused on Tower Hamlets, East London where hospital admissions for asthma are 80% above national rates. MethodsThe cases were extracted from the medical summaries of sequential emergency medical admissions through the casualty departments at The Royal London Hospitals in 1991-1992. Patient records with a diagnosis of asthma or chronic obstructive airways disease, and resident in Tower Hamlets, were identified. Individually matched controls (also obtained from emergency medical admissions through the casualty departments) with a non-chest related illness were selected based on sex, year of admission and consultant team. The selection method of these controls precludes surgical, orthopaedic or trauma cases. Overall, 82% of the pairs were matched to within five years, the remainder to within 10 years. For each case and control, address, ethnic group, whether there had been treatment in intensive therapy, and whether there had been any re-admission during that year, were extracted. Smoking data were too incomplete to be used.Using the Address-point software the addresses of cases and controls were expressed as a grid reference for all but eight participants. This software allows each postal address to be located to the "front door" at ground level (accurate to 0.1 m). Truncated grid references were obtained for six of the eight missing people; for one, the grid reference of a neighbouring house, and for the remainder, a diVerent flat number within the same block of flats was used. The Carstairs deprivation index was used to classify each case and control using the census enumeration district/postcode link. Eleven case-control pairs were removed from the analysis because the Carstairs index was unavailable for either the case or the control. This removed one suspect address, and left 125 asthma and 124 chronic obstructive airways disease pairs.Bartholomew's road directory and a Geographic Information System were used to calculate the distance of each address to the nearest "main" road (motorway, primary, A or B road).Distance from road was considered as both a discrete two level factor (<150 m, >150 m) and as a continuous variable. For the continuous analysis a model with a smooth monotonic relation between risk and distance was assumed, and was compared with the null model of no relation. 4 For both models, because of the matched design, a conditional likelihood approach was taken, with adjustment made for age and deprivation, the former to account for the non-exact nature of the matching. ResultsSix asthma cases (11 chronic obstructive airways disease cases) required intensive therapy, and nine asth...
ObjectivesThis study aimed to use a theoretical approach to understand the determinants of behaviour in patients not home self-administering intravenous antibiotics.SettingOutpatient care: included patients were attending an outpatient clinic for intravenous antibiotic administration in the northeast of Scotland.ParticipantsPatients were included if they had received more than 7 days of intravenous antibiotics and were aged 16 years and over. Twenty potential participants were approached, and all agreed to be interviewed. 13 were male with a mean age of 54 years (SD +17.6).OutcomesKey behavioural determinants that influenced patients’ behaviours relating to self-administration of intravenous antibiotics.DesignQualitative, semistructured in-depth interviews were undertaken with a purposive sample of patients. An interview schedule, underpinned by the Theoretical Domains Framework (TDF), was developed, reviewed for credibility and piloted. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically using the TDF as the coding framework.ResultsThe key behavioural determinants emerging as encouraging patients to self-administer intravenous antibiotics were the perceptions of being sufficiently knowledgeable, skilful and competent and that self-administration afforded the potential to work while administering treatment. The key determinants that impacted their decision not to self-administer were lack of knowledge of available options, a perception that hospital staff are better trained and anxieties of potential complications.ConclusionThough patients are appreciative of the skills and knowledge of hospital staff, there is also a willingness among patients to home self-administer antibiotics. However, the main barrier emerges to be a perceived lack of knowledge of ways of doing this at home. To overcome this, a number of interventions are suggested based on evidence-based behavioural change techniques.
Computed tomography in childhood epilepsy Sir, Children attending the school at the David Lewis Centre for Epilepsy are a selected group, as with few exceptions they are residential pupils from various parts of the United Kingdom and therefore are likely to have severe and often multiple handicaps. It seemed probable that a group of such children might show a high incidence of significant abnormalities on computed tomography. The children attending the school at the David Lewis Centre and examined by computed tomography over several years numbered 222; there were 154 boys and 68 girls, aged 7 to 19 years. The results showed that 152 were normal. There were 28 with evidence of some degree of generalised atrophy and 30 with focal atrophy. Nine showed calcification and in three the findings were compatible with a cerebral tumour. Abnormalities in a third of the children is in agreement with the findings of Bachman et a1' and Yang et al.2 Bachman et al studied 98
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