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Biomedical subjects

E G Jessop

Publications and source records attributed to E G Jessop.

At least 19 recordsLinked to original sources
PubMed2000

Small area variation in hospital admission: random or systematic?

For some conditions hospital admission is mandatory. This should lead to low variability in admission rates and no effect on admission rate of distance from hospital. If admission is discretionary, we would expect high variability in small area admission rates, and a decline in admission rate as travel time to hospital increases. We wanted to see if non-random variability of admission rates, as measured by the systematic coefficient of variation (SCV), and distance decay, as estimated in regression models, were related. We examined variability and travel time dependence of hospital admission for seven conditions in 62 small (mean population 9900) areas of Surrey, England. Age and sex standardized admission ratios (SAR) were calculated, and their dependence on travel time, adjusting for deprivation, were estimated by linear multiple regression adjusted for spatial correlation. Deprivation was measured by Jarman's score, and time by computerized estimates of drive time to the nearest acute hospital. We found an inverse relationship between time to hospital and admission ratio for ischaemic heart disease, bronchopneumonia and chronic bronchitis. Admission ratios for diabetes mellitus and stroke were related to neither deprivation nor time. For these seven conditions there was no simple relationship between SCV and travel time dependence.

Age Distribution↗
PubMed1996

A comparison of measures of disability and health status in people with physical disabilities undergoing vocational rehabilitation.

BACKGROUND: The aim of the study was to test among people undergoing vocational rehabilitation six measures of disability and health status commonly used in medical rehabilitation. METHOD: A cross-sectional survey was carried out on 30 people with disabilities on an occupational programme at a non-medical rehabilitation facility in England. Measures used were the Barthel index, Extended Activity of Daily Living (EADL) scale, the Office of Population Censuses and Surveys (OPCS) disability questionnaire, the Functional Independence Measure (FIM), the Nottingham Health Profile (NHP) and the Medical Outcome Study Short Form 36 (SF36). The main outcome measures were item non-response and time for completion of each measure, profile of disability and health status described by each measure, including pertinent domains detected or missed, and floor and ceiling effects. RESULTS: Item non-response was very low with all the instruments; the Barthel index was on average the quickest to complete (mean time 2.2 minutes) and the SF36 the longest (mean time 9.1 minutes). The study group were characterized as having problems in mobility or locomotion and bladder or bowel control, but some of the instruments were insensitive, detecting no disability in many subjects (e.g. 33 per cent showed no disability on the Barthel index). The SF36 scores were the least affected by floor and ceiling effects; mean SF36 scores on all scales except physical functioning were similar to those for the general population of similar age. Some problems were detected by only one of the instruments (e.g. pain and sleep by the NHP, problems with intellectual functioning by the OPCS scale). CONCLUSION: Disability measures commonly used in medical rehabilitation, such as the Barthel score and FIM, may be less useful in vocational rehabilitation where disabilities are less severe. Other measures show more promise but further testing is needed.

Activities of Daily Living↗
PubMed1996

Deprivation and mortality in non-metropolitan areas of England and Wales.

OBJECTIVE: To test the hypothesis that the relationship between deprivation and mortality is weaker among residents of non-metropolitan areas of England and Wales than among residents of metropolitan areas. DESIGN: This study compared mortality, expressed as standardised mortality ratios (SMRs), in residents of metropolitan and non-metropolitan districts at three levels of deprivation classified by an electoral ward deprivation score and by home and car ownership. SMRs were computed for all causes of death, for bronchitis and asthma (ICD9 codes 490-493), and for accident, violence, and poisoning (ICD9 codes 800-999). SETTING: England and Wales. PARTICIPANTS: Members of the longitudinal study of the Office of Population Censuses and Surveys, a quasi-random 1% sample of the population of England and Wales. MAIN RESULTS: There was an association between deprivation and mortality which was clear for all cause mortality, more noticeable for respiratory disease, and less clear for deaths from accident, violence, and poison. In general, the results showed a remarkable similarity between metropolitan and non-metropolitan areas. CONCLUSIONS: This study does not support the hypothesis that the relationship between mortality and deprivation differs between residents of metropolitan and non-metropolitan areas of England and Wales.

Accidents↗
PubMed1995

Early management of meningococcal disease.

Sixty-eight cases of meningococcal disease were ascertained at a district hospital in Wessex region over a four year period. Forty-seven of the 68 patients were reported to have a haemorrhagic rash on admission to hospital, three of whom died. Twelve of the 47 had received parenteral antibiotic treatment before admission, and none of these died. The overall case fatality was 4% (3/68). Sixty-three patients were referred by general practitioners. In 19 of the 63 a haemorrhagic rash was described at referral, and a haemorrhagic rash was described in 42 on hospital admission. Thirteen of the 63 received parenteral antibiotic treatment before admission. Such treatment was significantly more likely when the referral letter described a haemorrhagic rash and appeared to be less likely in child cases and when patients had received earlier oral antibiotics.

Adolescent↗
PubMed1995

Deprivation and hospital use in a non-metropolitan region of England.

OBJECTIVE: To investigate influences on hospital use in a non-metropolitan region of England (Wessex). DESIGN: Least-squares regression analysis was used to identify area predictors, at local authority level, of number of consultant episodes and (separately) of bed use. Variables were assigned for deprivation, strength of primary care, private sector provision, and local levels of ill health. Short-stay (less than 30 days) episodes and bed use were examined separately from long stays. RESULTS: There were substantial differences between the regression models for number of episodes and bed use, and between those for short stays and long stays. Significant predictors of the number of short-stay episodes were: number of general practitioners, standardised mortality ratio and proportion of residents with limiting long-term illness; these variables did not predict bed use in short-stay episodes. None of the variables was significantly associated with long-stay episodes or bed use. CONCLUSIONS: Analysis of geographic variation in hospital use should distinguish between short-stay and long-stay use, and should defend the choice of number of admissions versus bed use as the dependent variable. Deprivation was not shown to be a factor influencing bed use in Wessex. This finding argues against the use of a single funding formula across the whole of the country.

Bed Occupancy↗
PubMed1993

Severity of sickness at admission to hospital in Colchester 1985 and 1990.

In 1991 concern was expressed by hospital physicians and general practitioners about hospital services in Colchester, Essex, following a period of declining real resources. One focus of complaints was that over a period of about five years it had become increasingly difficult to admit acutely ill medical patients. We wished to obtain some objective data to corroborate or refute this anecdotal evidence. We therefore studied the severity of illness at admission in a random sample of emergency admissions for acute chest problems in 1985 and 1990. The main finding was that APACHEII scores were significantly higher (P = 0.002) in the 1990 sample than in the 1985 sample. These objective data contributed to a decision to allocate pounds 100,000 extra funding to the acute medical service in 1991-92.

Aged↗
PubMed1992

Individual morbidity and neighbourhood deprivation in a non-metropolitan area.

STUDY OBJECTIVE: The aim was to replicate, in a non-metropolitan area, a study by Curtis based on data from different parts of London which found a significant relationship between individual morbidity and neighbourhood deprivation. DESIGN: This study used the same design as the previous study. Information on individual morbidity was obtained, using the Nottingham health profile. Deprivation scores were assigned to respondents according the Jarman (and also Townsend) scores of the enumeration district in which they lived. Logistic regression models were built, using the enumeration district as the unit of analysis, to see if, after allowance for age and sex, the Jarman (or Townsend) score significantly improved the prediction of the enumeration district being above or below the sample median to any of the six dimensions of the profile. SETTING: The survey involved households in 10 electoral wards in Colchester and Clacton, Essex, United Kingdom, in 1988. PARTICIPANTS: A systematic sample of 200 persons was drawn from the electoral register in each of 10 wards yielding 2000 names. MAIN RESULTS: Nottingham health profiles were obtained from 1555 respondents out of an initial sample of 2000 names from the electoral register; the response rate among those alive and resident at a valid address was 93%. Jarman and Townsend scores were assigned to 1496 of the respondents, and the 162 enumeration districts were used as a unit of analysis. Contrary to Curtis's finding, Jarman score did not add significantly in a multiple logistic regression model to the prediction of response to any of the six dimensions of the Nottingham health profile, nor did the Townsend score. CONCLUSIONS: Apart from chance variation, there are two possible explanations for this finding. The measures of deprivation may be valid in London but not elsewhere; or there may be a true difference between cities and towns in the effect that deprivation has on subjective health.

Adolescent↗