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Biomedical subjects

R K Griffiths

Publications and source records attributed to R K Griffiths.

18 recordsLinked to original sources
PubMed2002

An evaluation of clinical governance in the public health departments of the West Midlands Region.

STUDY OBJECTIVES: (1) To evaluate the development of clinical governance within public health departments. (2) To assess two models for examining clinical governance in public health departments. DESIGN: Semi-structured interviews carried out during the annual visits of the regional director of public health to the health authority public health departments. SETTING: West Midland Region, England. PARTICIPANTS: Directors of public health plus other members of public health departments. MAIN RESULTS: These visits demonstrated that there is already a substantial amount of clinical governance activity taking place in the region's public health departments. There was also a need to reclassify many routinely occurring activities and include them under the clinical governance heading. CONCLUSIONS: The two models both proved useful for examining clinical governance in public health departments, however combining them into a matrix provided the best results. This matrix will still be useful after the reorganisation of the NHS and could be used to assess any public health department in the world. The West Midland public health departments find the visits valuable as they provide a source of external peer review of their activities. The public health departments have ownership of the process.

England↗
PubMed2001

Can calls to NHS Direct be used for syndromic surveillance?

This study assessed whether NHS Direct could be a useful source of surveillance data for communicable diseases, using influenza as a pilot condition. Data on the weekly total number of calls and the number from people reporting influenza-like symptoms to three pilot NHS Direct sites were collected between November 1999 and March 2000. NHS Direct data were compared with routinely available influenza surveillance data. The NHS Direct call rate peaked at 331 per 100,000 population in week 52 of 1999. The percentage of calls for 'influenza-like illness' (one site) peaked at 15% during week 51. Information about weekly call numbers to NHS Direct could be produced in a timely way. It was not clear whether the observed peak in calls reflected a true increase in influenza or whether it was the result of an increase in calls over the Christmas/Millennium holiday period due to more difficulty in accessing other services. The ability to assess the proportion of calls made directly by, or on behalf of, each age group will be of vital importance in interpreting seasonal respiratory disease.

Disease Outbreaks↗
PubMed1998

Variations in hospitalization rates for asthma among black and minority ethnic communities.

In response to the introduction of ethnic monitoring within the U.K. hospital inpatient data set, this study investigates the variations in secondary healthcare utilization by Black and minority ethnic communities whose cause of admission is related to asthma. The study examines all residents of the West Midlands: over 5 million people, of whom 8.5% are from Black and minority ethnic groups. A retrospective study of 15,921 asthma-related hospital admissions, from 1 April 1995 to 31 March 1996, was carried out. Age-standardized admission rates were higher in all Black and minority ethnic groups studied than in the White group. There were elevated rates in Black children aged 5-14 years, and particular differences were observed for Indian and Bangladeshi men and women aged 65 years or over. Emergency admissions to hospital for asthma were strongly associated with patients' socioeconomic background but this was largely observed for Black and minority ethnic groups that also generally experience high levels of deprivation. The findings support previous studies which suggest that hospital utilization rates for asthma among people from Black and minority ethnic groups are high compared with the White group, despite little evidence in measured prevalence. This study suggests that ethnic background is more important in asthma admissions than deprivation, which raises serious concerns on the appropriateness and quality of asthma care for these patient groups within our society. Future studies need to examine pathways to care, that is the health-seeking behaviour of Black and minority ethnic groups, the type of treatment received at the primary care level and referral patterns to secondary care.

Adolescent↗
PubMed1998

Slippage in the NHS breast screening programme: an assessment of whether a three year screening round is being achieved.

BACKGROUND: The NHS breast screening programme (NHSBSP) was established in 1987 to screen women aged 50-64 every three years to achieve a significant reduction in breast cancer mortality. Ensuring that women are re-invited every three years (that is, a three year screening round is in operation) is becoming increasingly difficult as pressure on the service rises. Coverage measures the proportion of eligible women receiving a screen in the previous three years and is currently used as an NHS performance indicator, while uptake measures the proportion of invited women who attend for screening. Data for 1996/1997 for the West Midlands NHSBSP show that, although uptake among 50-64 year olds was in excess of the 70% target at 78%, coverage was 10% below this at 68%. The discrepancy between coverage and uptake is likely to in part reflect "round slippage" in which women are re-invited at three years or more from their previous screen. To investigate the extent to which slippage is occurring in the region a technique for assessing round length independently of coverage was developed. METHODS: Records for women receiving routine recall (incident) screens between 1994 and 1997 in the West Midlands NHSBSP were examined and the time between the most recent screen and the previous screen measured in months. FINDINGS: Of 73,785 women screened in 1996/1997, 46.3% had a round length of under three years, although 74.9% had been re-screened within 38 months of the previous screen. Overall the regional programme was estimated to have a round slippage of approximately two months. CONCLUSIONS: The West Midlands NHSBSP operates to high standards in terms of uptake and cancer detection, but round slippage must be reduced. The lack of quantitative data with which to assess round length has hindered assessment in the past. The simple technique developed in this study will allow assessment of round length to be used routinely as the key quality assurance measure for the programme.

Breast Neoplasms↗
PubMed1994

Temporal association between hospital admissions for asthma in Birmingham and ambient levels of sulphur dioxide and smoke.

BACKGROUND: A study was performed to determine whether daily and weekly variations in the levels of smoke and sulphur dioxide (SO2) in Birmingham are related to hospital admissions for asthma and acute respiratory diseases. METHODS: Daily numbers of hospital admissions for asthma (ICD code 493) and acute respiratory conditions (ICD 466, 480-486, 490-496) for residents of Birmingham between 1988 and 1990 were obtained from West Midlands RHA Körner inpatient data. Average daily levels of sulphur dioxide and smoke were obtained from Birmingham City Council for the same period, together with daily meteorological summaries from the Department of Geography, University of Birmingham. With the exception of one day, all air pollution measurements remained within current EC guide levels. Data were divided into seasons and the relation between hospital admissions and pollutant levels were explored by stepwise least squares regression models. Meteorological variables (temperature, pressure, humidity) were entered into the model if they showed significant association with hospital admissions during the season in question. Analysis was undertaken for daily (same day and lagged by two days) and weekly pollutant levels. Admissions were lagged behind pollution levels to allow for delayed effects of pollutants. RESULTS: The mean daily level of smoke was 12.7 micrograms/m3 and of SO2 was 39.1 micrograms/m3, with maxima of 188.3 micrograms/m3 and 126.3 micrograms/m3, respectively. Significant associations were found between hospital admissions for respiratory disease lagged by two days, and smoke and SO2 levels during winter. Associations between admissions for asthma and smoke and SO2 levels were significant at the 5% level. These were independent of temperature, pressure, and humidity. Stepwise regression including both pollutants showed that smoke, but not SO2, was a significant independent predictor of hospital admissions for both asthma and all respiratory conditions. During winter a rise of 100 micrograms/m3 smoke might result in five (95% CI 0.6 to 9) more asthma admissions and 21.5 (95% CI 10 to 33) more acute respiratory admissions each day in Birmingham. A 100 micrograms/m3 rise in SO2 might result in four (0 to 7) more asthma admissions and 15.5 (6 to 25) more respiratory admissions each day. Independent associations were also found between weekly mean smoke and SO2 levels and all respiratory admissions during autumn and winter. During summer, daily mean smoke and SO2 levels were significantly associated with non-lagged daily admissions for all respiratory diseases (p < 0.02). There was no association between air pollution and hospital admissions during spring. CONCLUSIONS: Daily variations in smoke and SO2 levels are significantly associated with hospital admissions for asthma and respiratory disease during winter in Birmingham at levels of air pollutants within the EC guide levels. This association was independent of potential confounding effects of weather (temperature, pressure, humidity) and suggests that current levels of air pollution can still produce significant health effects.

Air Pollution↗
PubMed1992

General practitioners and public health.

Family Health Service Authorities (FHSAs), since 1st April 1991, have been both 'managed', by the Regional Health Authority, and 'managing', their contractor services. Both situations are relatively new to them, their Region and the contractors. We examine the opportunities and potential problems of this major strategic change. These relate to: (1) the establishment of effective coordination between providers of primary care services; (2) the establishment of minimum basic standards of care and administration for GPs (based on those set for training practices by the Regional Advisors in General Practice); (3) the development and validation of a data collection system from General Practice which could be used to establish a morbidity database from general practice as a means of health needs assessment as well as for performance review.

Family Practice↗
PubMed1989

Prevention of AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1988

The changing pattern of calls to an AIDS advice line.

An analysis of the number of and type of calls received by an AIDS advice line over a seven month period is presented. Variations in the number of calls received and differences in the types of questions asked by different sections of the population are examined. The results indicate that the number of calls received is strongly related to television publicity, and that different age and sex groups ask different questions about AIDS. There are also differences in the types of questions asked by homosexual and heterosexual callers. The results of the analysis have important implications for health education about AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Texture, stress and age in the human femur.

The way in which remodelling of human bone is determined by the mechanics of life is explored in a neutron diffraction study of the femur. The hydroxyapatite crystals provide ability to resist vertical stress by a preferred alignment which is low at birth, increases to a maximum at an age of about three years and then falls away steadily in later life. This vertical alignment is greater at the front of the femur than at the back.

Adolescent↗
PubMed1984

A neutron diffraction study of the bones of the foot.

The preferential orientation of the apatite crystals in the lower tibia, talus and calcaneus, as determined by neutron diffraction, serves as an indicator of the lines of stress in the foot. The main stress flows down from the tibia to the heel and the ball of the foot and there is noteworthy orientation along the line of the plantar aponeurosis which acts as a tie. Orientation is particularly marked above the point of attachment of the Achilles tendon, where the edge of the calcaneus functions as a beam. The centre of the talus serves as a junctional region for forces and is relatively unoriented.

Calcaneus↗
PubMed1979

Stress distribution in the scapula studied by neutron diffraction.

High intensity neutron beams provide a method of measuring the preferred orientation of apatite crystals in bulk samples of bone. Measurements at seven different sites on the scapula show that the c axes of the crystals lie preferentially along the directions of pull of the attached muscles. The highest orientation is found at positions under the influence of only a single group of muscles, such as M. teres major or M. infraspinatus. In intermediate regions a multiple distribution of crystals is found, able to withstand stresses in more than one direction. The technique provides a method of assessing the distribution of stress in bones.

Animals↗
PubMed1979

Neutron diffraction studies of lumbar vertebrae.

Neutron diffraction measurements of the orientation of the apatite crystals show a significant preference of their c-axes for the vertical direction. This preference increases from bottom to top of each vertebral body and is substantially greater for the second than for the fifth lumbar vertebrae. This is in line with the predominantly vertical forces which the former withstands.

Apatites↗
PubMedDate not supplied

Hospital admissions for asthma in preschool children: relationship to major roads in Birmingham, United Kingdom.

This study examined the relationship between residence near major roads, traffic flow, and risk of hospital admission for asthma in children younger than 5 y of age living in Birmingham, United Kingdom. Area of residence and traffic flow patterns were compared for children admitted to the hospital for asthma, children admitted for nonrespiratory reasons, and a random sample of children from the community. Children admitted with an asthma diagnosis were significantly more likely to live in an area with high traffic flow (> 24,000 vehicles/24 h) located along the nearest segment of main road than were children admitted for nonrespiratory reasons (p < .02) or children from the community (p < .002). A significant linear trend was observed for traffic flow (p < .006) for children living less than 500 m from a main road but not for those living farther away. Children admitted for nonrespiratory reasons were more likely to be admitted than children in the community sample if they lived within 200 m of a main road (p < .02), irrespective of traffic flow.

Asthma↗