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Biomedical subjects

D R Gorman

Publications and source records attributed to D R Gorman.

At least 19 recordsLinked to original sources
PubMed2006

How has legislation restricting paracetamol pack size affected patterns of deprivation related inequalities in self-harm in Scotland?

OBJECTIVE: To describe how changes in legislation to control sales and thus restrict the general availability of paracetamol have affected deprivation-related inequalities in deliberate self-harm associated with the drug in Scotland. DESIGN AND SETTING: A descriptive analysis of routine death and hospital discharge data for the entire Scottish population between 1995 and 2002. PARTICIPANTS: Patients in Scotland admitted to hospital with a diagnosis of poisoning and deaths in Scotland due to poisoning 1995-2002. OUTCOME MEASURES: Changes in mortality and overdose rates by deprivation quintile, and case fatality rates due to poisoning involving paracetamol. RESULTS: Rates of overdose involving paracetamol, while much higher in disadvantaged quintiles, fell in each deprivation quintile following the 1998 legislation. They then returned to levels similar, or above those in the mid 1990s. All quintiles were affected to a similar extent with the relationship between them remaining constant over time. Case fatality rates were significantly higher in more disadvantaged quintiles. CONCLUSIONS: Marked inequalities exist in paracetamol related harm in Scotland. The most disadvantaged groups (both male and female) have higher overdose and death rates, as well as higher case fatality rates. Following the restrictions all social groups saw similar reductions in paracetamol related harm. This effect has been short-lived and rates have returned to pre-legislation levels. Legislation has not permanently affected overall use of paracetamol in overdose in Scotland or reduced the proportion of patients taking paracetamol as a component of the overdose in the longer term. An important public health policy has failed to achieve its objective and it is not clear why. We need a better understanding of why this measure had only short-term benefits if its full potential is to be achieved.

Acetaminophen↗
PubMed2006

Legislation restricting paracetamol sales and patterns of self-harm and death from paracetamol-containing preparations in Scotland.

AIMS: To describe how changes in legislation to restrict paracetamol sales have affected overdose discharges and death associated with the drug in Scotland. METHODS: A descriptive analysis of routine death and hospital discharge data for the entire Scottish population between 1995 and 2004. Patients in Scotland participated who were discharged from hospital with a diagnosis of poisoning; deaths in Scotland from diagnosis of poisoning 1995-2003 were also analysed. Outcome measures were changes in mortality and overdose due to poisoning involving paracetamol. A comparison was made of in-hospital and out-of-hospital mortality in fatalities involving paracetamol. RESULTS: The majority of paracetamol-associated deaths were due to co-proxamol. Deaths associated with paracetamol alone or with ethanol occurred principally in hospital and were a minority of deaths overall. The proportion of in-hospital deaths attributed to paracetamol increased (post/pre ratio 1.347; 95% confidence interval 1.076, 1.639; P = 0.013). Overall numbers of cases discharged with poisoning fell. The proportion of these involving paracetamol in any form increased significantly in all groups except young men aged 10 to <20 years. CONCLUSIONS: Legislation has not reduced mortality or proportional use of paracetamol in overdose, both of which appear to have increased in Scotland since pack-size limitations. Other approaches are necessary to reduce the death rate from overdoses involving paracetamol.

Acetaminophen↗
PubMed2003

Unintentional home injury in preschool-aged children: looking for the key--an exploration of the inter-relationship and relative importance of potential risk factors.

OBJECTIVE: To investigate the physical, social and psychological environment of families with preschool-age children to identify the most significant risk factors for unintentional injury. DESIGN: A 1-year prospective case-control study, using a health-visitor-administered questionnaire. SETTING: East and Midlothian, Scotland. SUBJECTS: Seventy-nine children under 5 years of age presenting to an accident and emergency (A&E) department during 1998-1999 with an unintentional home injury and 128 matched controls. RESULTS: Of 264 families, 207 responded (78.4% response rate). The main carers of cases had a lower level of educational attainment than controls (P<0.01). This factor explained the case carer leaving fulltime education earlier, being less likely to be married and more often in receipt of government benefits. Cases lived in households with larger numbers of children, were more likely to have a physical illness, were less likely to have had a non-medically attended injury in the previous year (P<0.01) but more likely to have had another A&E injury attendance. Case households had lower electrical socket cover utilization (P<0.01) and fewer thought their child had adequate access to safe play areas. The main carers of cases tended to have a more negative life event experience in the preceding 6 months, but showed no significant differences in physical or mental well-being or social support. Cases seemed to be slightly more deprived members of their community. CONCLUSIONS: The main carer's educational attainment and socket cover utilization were lower in case families. These risk factors could be used to target families for injury-prevention work. Initiatives to raise educational achievement in the general population could lead to reductions in childhood injuries.

Accidents, Home↗
PubMed2001

The association between deprivation levels, attendance rate and triage category of children attending a children's accident and emergency department.

OBJECTIVE: To determine the relation between deprivation category, triage score and accident and emergency (A&E) attendance for children under the age of 13. DESIGN: Retrospective study of all children attending an A&E department over one year. SETTING: A paediatric teaching hospital in Edinburgh. SUBJECTS: All children attending the A&E department who had a postcode and a triage score documented on attendance. The postcode was used to determine the deprivation category and the triage scored the severity of illness or injury. MAIN OUTCOME MEASURE: The relation between deprivation category, triage score and frequency of attendance. RESULTS: There is a trend towards increased attendance in all triage categories for deprivation categories 6 and 7. CONCLUSIONS: Attendance at A&E is not only related to severity of injury but also to deprivation category. The reason why people from disadvantaged areas attend more frequently needs further evaluation.

Adolescent↗
PubMed2000

The general practice perspective on cancer services in Lothian.

OBJECTIVES: The aim of the present study was to obtain views from general practices about current and potential improvements to services for patients with suspected lung, large bowel, non-melanoma skin and breast cancer. METHOD: A questionnaire study was carried out of 134 general practices within the Lothian Health Board boundary. Information was sought about referral choices, communication, quality of care, liaison between community and hospital, health promotion, treatment outcomes and palliative care. Main outcome measures were determinants of primary care referral behaviour and clinical investigation strategies, and perception of quality in secondary care and health promotion services. RESULTS: Seventy-nine general practices (59%) returned completed questionnaires. One-fifth of practices maintained a cancer register, and 85% provide patient information about cancer prevention. Initial management was disease dependent. Most cases of suspected lung cancer, about half of suspected colorectal cancer cases and very few cases of suspected breast cancer were investigated in primary care before referral to hospital. Hospital referral depended on knowledge of local services. A minority of practices wanted referral guidelines. It was estimated that 92% of lung and breast cancer cases, 68% of colorectal cancers and 35% of skin cancers are seen within 4 weeks. Breast cancer care was rated more highly than that for other cancers. One-third ranked community nursing support as 'excellent' and 10-15% described it as 'fair' or 'poor'; 77% describe palliative care as 'excellent' or 'good'. Fifty-one percent believe that communication with hospital is 'excellent' or 'good'. Practices were sometimes unaware of the hospital's post-diagnosis management plan; communication was often too slow and practices often received 'poor' advice about symptom control. Eighty percent thought that hospital follow-up for breast, colorectal and lung cancer should be routine; 20% thought that it was indicated for non-melanomatous skin cancer. CONCLUSIONS: Communication problems between primary and secondary sectors need to be tackled innovatively and the perceived quality variation in services addressed-perhaps by developing local guidelines. Practices would welcome further education about health promotion resources and cancer epidemiology.

Attitude of Health Personnel↗
PubMed2000

Uptake of the children's traffic club in Lothian.

OBJECTIVE: To calculate the uptake of the Children's Traffic Club in Scotland (CTCS) in Lothian and the road traffic casualty rate of children aged 0-14 living in areas with different deprivation categories. DESIGN: Analysis of road traffic accident hospital admissions, 'STATS 19' (road traffic accident police reports) and CTCS uptake data in affluent, 'intermediate' and disadvantaged households. SETTING: The Lothian Health Board area. RESULTS: Affluent households have both the highest CTCS uptake rates and the lowest rates of road traffic accidents. The most disadvantaged populations have hospital discharge rates over three times that of people living in more affluent parts of Lothian. CONCLUSIONS: Minor changes in how the CTCS is run and fostering a multiagency approach to childhood accident prevention could improve both CTCS uptake and effectiveness of road safety measures.

Accidents, Traffic↗
PubMed1999

Using routine accident and emergency department data to describe local injury epidemiology.

All 17330 Accident and Emergency Department (A and E) attendances following injury (67% of all A and E attendances by residents of the EH54 postcode (the town of Livingston) at St John's Hospital during 1995 and 1996 were examined to study local accident epidemiology. The overall annual injury attendance rate for males (245.7/1000) and females (148.0/1000) and sex and age group analyses show recognised patterns reflecting occupation and domestic circumstances. Higher attendance rates were associated with greater deprivation and living close to the hospital. The unique injury coding system used by the hospital offers the potential to highlight particular injury types occurring within population sub-groups. When linked with primary care and out-of-hours centre data, this could be useful in targeting preventive activities; this will be facilitated in this hospital, which will become part of a 'combined' acute and primary care trust from April 1999.

Accidents↗
PubMed1999

Under representation of morbidity from paediatric bicycle accidents by official statistics--a need for data collection in the accident and emergency department.

OBJECTIVES: To determine the accuracy of currently available data on bicycle related injuries in children. SETTING: A paediatric accident and emergency (A&E) department which annually treats approximately 30000 new patients under the age of 13 years. METHODS: Data on all attendances with bicycle related injuries over a four week period were compared with that currently available from police road traffic accident data (Stats 19) and the International Classification of Diseases, 10th revision, hospital discharge coding. RESULTS: Eighty six children attended the A&E department. Only two bicycle related injuries were identified from Stats 19, and 10 from hospital discharge data. CONCLUSION: Currently available official data do not give an accurate representation of the incidence of bicycle related injuries in children. If health promotion measures are to be assessed properly data collection needs to be improved.

Bicycling↗
PubMed1997

A survey of infertility practices in primary care in Scotland.

An 83% response rate was obtained to a postal questionnaire survey of general practitioners (GPs) carried out as part of a national infertility audit in Scotland. This provided information about how GPs are managing infertility and their opinions on 12 suggested criteria for good practice in a primary care setting.

Family Practice↗
PubMed1996

Auditing out-of-hours primary medical care.

As a preliminary to evaluating the introduction of a primary care emergency centre in Midlothian, information was recorded about 2,236 out-of-hours contacts made with eight general practices in the ten weeks before the centre opened. The overall rate of calls was estimated at 265 cells per 1,000 patients per year, with 63% of calls resulting in a home visit, 8% in the patient being seen at the surgery and 29% in telephone advice only; 18% of the out-of-hours calls generated a night visit fee. Eighty-five per cent of patients who requested a home visit were seen by a doctor and 15% of patients contacting their general practitioner out of hours were referred to hospital, either for admission or for treatment in an accident and emergency department. Doctors classified 61% of the calls as necessary, 29% as unnecessary and were unsure about the need for 9% of calls.

Adolescent↗
PubMed1992

Junior medical posts in the NHSSB: what the doctors think.

This survey of house officers in the Northern Health and Social Services Board in Northern Ireland demonstrated that they have complaints not just about the number of hours they work. Thirty-nine per cent noted poor standards of food and/or accommodation. Many complained about doing routine "non-medical" work and thought that their working conditions would be improved by nurses having more responsibility for managing intravenous medication and the employment of phlebotomists. Doctors expressed concerns about a lack of career counselling and availability of training in research methods in their posts.

Job Satisfaction↗
PubMed1991

The health of Travellers' children in Northern Ireland.

A study was carried out to examine aspects of the health status of children from a group of 'travelling people' in Northern Ireland. A total of 350 children, aged under 16 years, were included in the study. Data were gathered by community health doctors and health visitors using a standardised questionnaire. The study revealed that this community has a high degree of consanguinity and points to higher levels of congenital abnormalities than in the settled community. Uptake of immunisation was less than the settled community and hospital admissions in the younger age group were particularly due to infectious diseases. The authors conclude that provision of health services for travelling people in Northern Ireland should be urgently reviewed with consideration of the needs and lifestyle of this group. The provision of suitable sites for travelling people with adequate water and sewage facilities to reduce potential risks to health is also advocated.

Child↗
PubMed1988

Assessment of a screening method for heart disease.

This study examined the effects of a cardiovascular screening programme on a group of 79 patients in an Edinburgh general practice. Serum cholesterol levels were measured two to four months after the original screening interview and risk scores recalculated to see if the collection of data was reliable; a control group was used. Patient attitudes to this screening were assessed by questionnaire and the repeatability of the risk score calculation investigated. The programme was popular with patients and was successful in changing their reported behaviour. However, it may have been counter-productive in some patients by sanctioning personal habits detrimental to health. This effect was particularly marked in patients at lower risk levels who it is shown may have raised serum cholesterol levels. It is suggested that the risk score calculation could be improved, in particular by improving the accuracy of the serum cholesterol measurement. It is concluded that more research is needed into the behavioural aspects of cardiovascular screening.

Adult↗
PubMed1988

Relationship between self-control and alcohol consumption patterns and problems of college students.

The relationship between self-control strategies, alcohol-related problems and the quantity and frequency of alcohol use was examined. Analyses of data from 410 university students who completed the Student Alcohol Questionnaire and the Self-Control Questionnaire indicated that both internal and external self-control strategies were significantly correlated with alcohol-related problems and alcohol consumption variables. Self-control strategies were also found to be applied differentially across drinking patterns and problem status. It was concluded that college students naturally attempt to control their alcohol consumption or the unwanted consequences related to drinking. Further research is needed to detail the self-change attempts of college-aged drinkers.

Alcohol Drinking↗
PubMed1987

Effects of the bogus-pipeline on enhancing validity of self-reported adolescent drug use measures.

This study examined effects of a bogus objective measure (bogus-pipeline) on self-reports of experimentation, frequency, intentions, beliefs, and attitudes related to alcohol, tobacco, and other drug use. One hundred ninety-one adolescents (means age = 11.74 years) were assigned randomly to one of three conditions: a bogus-pipeline with saliva collection, a bogus-pipeline only, or a questionnaire only control. A significantly greater percentage of participants in the questionnaire only condition (28%) reported having experimented with alcohol, compared to those in the bogus-pipeline only condition (22%), and the bogus-pipeline with saliva condition (21%). No differences were found across conditions for subject experimentation with other drugs, frequency of drug use, intentions to use drugs, and beliefs and attitudes related to drug use (p greater than .05). The discrepancy among studies suggesting a validity enhancing effect due to bogus-pipeline procedures and those indicating no effect may be accounted for by variables including age, experimental setting, population under study, and drug types. The broad, unquestioned application of the bogus-pipeline in tobacco, alcohol, and other drug use prevention programs, or epidemiological studies of drug use, cannot be recommended at present.

Adolescent↗