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PubMed1989

Passive smoking and cardiorespiratory health in a general population in the west of Scotland.

UNLABELLED: OBJECTIVE-To assess the risk of cardiorespiratory symptoms and mortality in non-smokers who were passively exposed to environmental smoke. DESIGN: Prospective study of cohort from general population first screened between 1972 and 1976 and followed up for an average of 11.5 years, with linkage of data from participants in the same household. SETTING: Renfrew and Paisely, adjacent burghs in urban west Scotland. SUBJECTS: 15,399 Men and women (80% of all those aged 45-64 resident in Renfrew or Paisley) comprised the original cohort; 7997 attended for multiphasic screening with a cohabitee. Passive smoking and control groups were defined on the basis of a lifelong non-smoking index case and whether the cohabitee had ever smoked or never smoked. MAIN OUTCOME MEASURE: Cardiorespiratory signs and symptoms and mortality. RESULTS: Each of the cardiorespiratory symptoms examined produced relative risks greater than 1.0 (though none were significant) for passive smokers compared with controls. Adjusted forced expiratory volume in one second was significantly lower in passive smokers than controls. All cause mortality was higher in passive smokers than controls (rate ratio 1.27 (95% confidence interval 0.95 to 1.70)), as were all causes of death related to smoking (rate ratio 1.30 (0.91 to 1.85] and mortality from lung cancer (rate ratio 2.41 (0.45 to 12.83)) and ischaemic heart disease (rate ratio 2.01 (1.21 to 3.35)). When passive smokers were divided into high and low exposure groups on the basis of the amount smoked by their cohabitees those highly exposed had higher rates of symptoms and death. CONCLUSION: Exposure to environmental tobacco smoke cannot be regarded as a safe involuntary habit.

Age Factors↗
PubMed1973

Epidemiology and course of gastrointestinal haemorrhage in North-east Scotland.

A prospective study was made of 817 consecutive episodes of major gastrointestinal haemorrhage in patients admitted to hospital during 1967-8 from the defined population of North-East Scotland. The yearly admission rate was 116 per 100,000 population. Comparison of the data for city and country residents showed no appreciable differences. In the duodenal ulcer group there was an undue incidence of bleeding among foremen and skilled workers and among those who were unmarried or widowed.Both the clinical history and the results of any previous barium meal examinations were unreliable guides to the source of the current haemorrhage. Prognosis was worse for patients who did not have a dyspeptic history and was better for those who had bled on a previous occasion. The simultaneous ingestion of alcohol and aspirin had an adverse effect on the occurrence of bleeding. Forty-seven per cent. of the patients had another major coincidental disease.Mortality was 13.7% in the whole series and 8.6% in those with peptic ulcer (duodenal ulcer 7.1%, gastric ulcer 16.9%). In 28% of the patients further haemorrhage occurred after admission to hospital and caused a 28.8% mortality. Seventy-four patients were already in hospital when they first bled and 44% of them died.

Adult↗
PubMed1990

Current practice in transferring critically ill patients among hospitals in the west of Scotland.

OBJECTIVE: To identify the requirements of an interhospital transfer service for critically ill patients. DESIGN: Retrospective survey of the current functions of a specialist interhospital transfer team from data collected at the time of transfer and from records of intensive care unit. SETTING: Mobile intensive care unit based at a tertiary referral centre, which serves the west of Scotland. PATIENTS: All critically ill patients (378) transferred between hospitals by the unit from 1986 to 1988. RESULTS: 365 Patients were transferred by road and 13 by air. There was a wide variation in age (range 6 weeks to 87 years), diagnosis, reason for transfer, support required, and distance travelled. Most patients (232) were transferred for respiratory or cardiovascular support; 100 were trauma cases. 300 Patients (79%) were mechanically ventilated during transfer. No patient died in transit, although the eventual mortality was 28% (105 patients). Mortality was significantly higher in patients transferred from hospitals with intensive care units than from those without (38% (125 patients) v 23% (253); p less than 0.005). IMPLICATIONS: Safe interhospital transfer of critically ill patients is feasible; the high eventual mortality in some patient groups emphasises the need for accurate prediction of outcome if inappropriate transfer is to be avoided. The findings may help in organising secondary transfer services in future.

Adolescent↗
PubMed1991

Total cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol and coronary heart disease in Scotland.

OBJECTIVE: To investigate long term changes in total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol concentrations and in measures of other risk factors for coronary heart disease and to assess their importance for the development of coronary heart disease in Scottish men. DESIGN: Longitudinal study entailing follow up in 1988-9 of men investigated during a study in 1976. SETTING: Edinburgh, Scotland. SUBJECTS: 107 men from Edinburgh who had taken part in a comparative study of risk factors for heart disease with Swedish men in 1976 when aged 40. INTERVENTION: The men were invited to attend a follow up clinic in 1988-9 for measurement of cholesterol concentrations and other risk factor measurements. Eighty three attended and 24 refused to or could not attend. MAIN OUTCOME MEASURES: Changes in total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol concentrations, body weight, weight to height index, prevalence of smoking, and alcohol intake; number of coronary artery disease events. RESULTS: Mean serum total cholesterol concentration increased over the 12 years mainly due to an increase in the low density lipoprotein cholesterol fraction (from 3.53 (SD 0.09) to 4.56 (0.11) mmol/l) despite a reduction in high density lipoprotein cholesterol concentration. Body weight and weight to height index increased. Fewer men smoked more than 15 cigarettes/day in 1988-9 than in 1976. Blood pressure remained stable and fasting triglyceride concentrations did not change. The frequency of corneal arcus doubled. Alcohol consumption decreased significantly. Eleven men developed clinical coronary heart disease. High low density lipoprotein and low high density lipoprotein cholesterol concentrations in 1976, but not total cholesterol concentration, significantly predicted coronary heart disease (p = 0.05). Almost all of the men who developed coronary heart disease were smokers (91% v 53%, p less than 0.05). CONCLUSION: Over 12 years the lipid profile deteriorated significantly in this healthy cohort of young men. Smoking, a low high density lipoprotein concentration and a raised low density lipoprotein concentration were all associated with coronary heart disease in middle aged Scottish men, whereas there was no association for total cholesterol concentration. The findings have implications for screening programmes.

Adult↗
PubMed1994

Multicentre criterion based audit of the management of induced abortion in Scotland.

OBJECTIVES: To assess and improve the quality of care provided to women undergoing induced abortion. DESIGN: Two rounds of prospective, criterion based case note review audit. SETTING: Ten NHS gynaecology units throughout Scotland. SUBJECTS: 2004 patient episodes of abortion care identified consecutively during two rounds of audit. The first round comprised 967 cases and the second round 1037. INTERVENTIONS: Dissemination of results from the first round of audit and recommendations for change in the form of a written report and at postgraduate meetings in participating hospitals. MAIN OUTCOME MEASURES: Improvements in quality of care as assessed against 16 previously agreed criteria, both overall across the 10 study hospitals and within individual hospitals. RESULTS: Overall, four significant improvements occurred: increased availability of early medical abortion, decreased utilisation of surgical abortion at very early gestation, increased use of mifepristone priming before second trimester medical abortion, and increased provision of follow up. At the individual hospital level 42 of 150 elements of care studied were "close to optimal" at the time of the first round of audit, rising to 54 at the second round (NS). A total of 31 significant improvements in individual elements of care occurred, but 11 significant deteriorations also occurred (at the P < 0.05 level). CONCLUSIONS: The prospective multicentre audit proved feasible and achieved the aims of any form of audit in terms of identifying deficiencies and variations in care. The audit results prompted objective review of local abortion services in participating hospitals. At least for some elements of care in some hospitals significant improvements were detectable.

Abortion, Induced↗
PubMed1995

Period trends in rate of suicide in first 28 days after discharge from psychiatric hospital in Scotland, 1968-92.

OBJECTIVE: To examine period trends in the rate of suicide in the first 28 days after discharge from psychiatric hospital. DESIGN: Cohort study of patients discharged from psychiatric hospital. SETTING: Scotland. SUBJECTS: All patients aged 15-84 who were discharged from Scottish psychiatric hospitals during 1968 to 1992. OUTCOME MEASURE: The rate of suicide (classified as codes E950-9 and E980-9 according to the International Classification of Diseases, Ninth Revision) within 28 days of discharge per 100,000 person years at risk for five year periods during 1968 to 1992. Crude, within cohort rates and externally standardised rates were calculated. RESULTS: Overall, 196 male patients committed suicide in 20,520 person years at risk, and 171 female patients committed suicide in 24,114 person years at risk. A significant linear trend was seen in period effect on externally standardised mortality ratios in both sexes: a decrease in male patients (P = 0.008) and an increase in female patients (P = 0.0001). The adjusted standardised mortality ratio in 1988-92 compared with 1968-72 was 0.62 (95% confidence interval 0.39 to 0.98) in male patients and 2.73 (1.64 to 4.56) in female patients. CONCLUSION: The increase in the rate of suicide in the 28 days after discharge in female psychiatric patients makes this an increasingly important period to target. The rise has occurred against the background of a reduction of 60% in the number of psychiatric beds for adults.

Adolescent↗
PubMed1996

Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland.

OBJECTIVE: To compare survival outcome for patients with breast cancer cared for by specialist and non-specialist surgeons in a geographically defined area. DESIGN: Retrospective study of all female patients aged under 75 years in the area treated between 1980 and June 1988 (before breast screening began). Patients were identified from the cancer registry and from pathology records of all hospitals in the area. Specialist surgeons were identified by one author. All other surgeons caring for patients from the area were considered non-specialists. SETTING: A geographically defined population in urban west of Scotland. SUBJECTS: 3786 patients with histologically verified breast cancer operated on between 1 January 1980 and 30 June 1988 and followed to 31 December 1993. MAIN OUTCOME MEASURES: Five and 10 year survival rates for specialists and non-specialists; relative hazard ratios derived from Cox's proportional hazards model adjusted for prognostic factors--age, socioeconomic status, tumour size, and nodal involvement. RESULTS: The five year survival rate was 9% higher and the 10 year survival 8% higher for patients cared for by specialist surgeons. A reduction in risk of dying of 16% (95% confidence interval 6% to 25%) was found after adjustment for age, tumour size, socioeconomic status, and nodal involvement. The benefit of specialist care was apparent for all age groups, for small and large tumours, and for tumours that did and did not affect the nodes and was consistent across all socioeconomic categories. CONCLUSIONS: Survival differences of the magnitude demonstrated have implications for the provision of services for the treatment of women with breast cancer. There is a need to improve equity in the treatment of breast cancer.

Adult↗
PubMed1996

Teenagers' knowledge of emergency contraception: questionnaire survey in south east Scotland.

OBJECTIVE: To determine the level of knowledge of emergency contraception among 14 and 15 year olds. DESIGN: Confidential questionnaire survey. SETTING: 10 secondary schools in Lothian, south east Scotland. SUBJECTS: 1206 pupils predominantly (98.7%) aged 14 and 15 in the fourth year of secondary school. MAIN OUTCOME MEASURES: Knowledge of the existence of emergency contraception; of its safety, efficacy, and time limits; and of where to obtain it. RESULTS: 1121 (93.0%) fourth year pupils aged 14-16 had heard of emergency contraception. 194 girls (32.7%) and 168 boys (27.5%) had experienced sexual intercourse. Of girls who had experienced sexual intercourse, 61 (31.4%) had used emergency contraception. Knowledge of correct time limits was poor, sexually active girls being the most knowledgeable. Pupils attending schools ranked lower than the national average for academic attainment were less likely to have heard of emergency contraception and more likely to have been sexually active. 861 (76.8%) pupils knew they could obtain emergency contraception from their doctor. 925 (82.5%) pupils believed emergency contraception to be effective but 398 (35.5%) thought it more dangerous than the oral contraceptive pill. CONCLUSIONS: One third of sexually active girls aged under 16 in Lothian have used emergency contraception. This may help explain the fairly constant teenage pregnancy rates despite increasing sexual activity. Scottish teenagers are well informed about the existence of emergency contraception. However, many do not know when and how to access it properly. Health education initiatives should target teenagers from less academic schools as they are more likely to be sexually active at a young age and are less well informed about emergency contraception.

Adolescent↗
PubMed1997

Case-control study of sudden infant death syndrome in Scotland, 1992-5.

OBJECTIVE: To investigate the relation between routine infant care practices and the sudden infant death syndrome in Scotland. METHODS: National study of 201 infants dying of the sudden infant death syndrome (cases) and 276 controls by means of home interviews comparing methods of infant care and socioeconomic factors. RESULTS: Sleeping prone (odds ratio 6.96 (95% confidence interval 1.51 to 31.97) and drug treatment in the previous week (odds ratio 2.33 (1.10 to 4.94)) were more common in the cases than controls on multivariate analysis. Smoking was confirmed as a significant risk factor (odds ratio for mother and father both smoking 5.19 (2.26 to 11.91)). The risk increased with the number of parents smoking (P < 0.0001), with the number of cigarettes smoked by mother or father (P = 0.0001), and with bed sharing (P < 0.005). A new finding was an increased risk of dying of the syndrome for infants who slept at night on a mattress previously used by another infant or adult (odds ratio 2.51 (1.39 to 4.52)). However, this increased risk was not established for mattresses totally covered by polyvinyl chloride. CONCLUSIONS: Sleeping prone and parental smoking are confirmed as modifiable risk factors for the sudden infant death syndrome. Sleeping on an old mattress may be important but needs confirmation before recommendations can be made.

Bedding and Linens↗
PubMed1997

The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetes register. DARTS/MEMO Collaboration.

OBJECTIVES: To identify all patients with diabetes in a community using electronic record linkage of multiple data sources and to compare this method of case ascertainment with registers of diabetic patients derived from primary care. DESIGN: Electronic capture-recapture linkage of records included data on all patients attending hospital diabetes clinics, all encashed prescriptions for diabetes related drugs and monitoring equipment, all patients discharged from hospital, patients attending a mobile unit for eye screening, and results for glycated haemoglobin and plasma glucose concentrations from the regional biochemistry database. Diabetes registers from primary care were from a random sample of eight Tayside general practices. A detailed manual study of relevant records for the 35,144 patients registered with these eight general practices allowed for validation of the case ascertainment. SETTING: Tayside region of Scotland, population 391,274 on 1 January 1996. MAIN OUTCOME MEASURES: Prevalence of diabetes; population of patients identified by different data sources; sensitivity and positive predictive value of ascertainment methods. RESULTS: Electronic record linkage identified 7596 diabetic patients, giving a prevalence of known diabetes of 1.94% (0.21% insulin dependent diabetes, 1.73% non-insulin dependent): 63% of patients had attended hospital diabetes clinics, 68% had encashed diabetes related prescriptions, 72% had attended the mobile eye screening unit, and 48% had biochemical results diagnostic of diabetes. A further 701 patients had isolated hyperglycaemia (plasma glucose > 11.1 mmol/l) but were not considered diabetic by general practitioners. Validation against the eight general practices (636 diabetic patients) showed electronic linkage to have a sensitivity of 0.96 and a positive predictive value of 0.95 for ascertainment of known diabetes. General practice lists had a sensitivity of 0.91 and a positive predictive value of 0.98. CONCLUSIONS: Electronic record linkage was more sensitive than general practice registers in identifying diabetic subjects and identified an additional 0.18% of the population with a history of hyperglycaemia who might warrant screening for undiagnosed diabetes.

Diabetes Mellitus↗
PubMed1998

Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland.

OBJECTIVE: To investigate whether asthma or its treatment impairs children's growth, after allowing for socioeconomic group. DESIGN: 4 year follow up of a cohort of children aged 1-15. SETTING: 12 general practices in the Tayside region of Scotland. SUBJECTS: 3347 children with asthma or features suggestive of asthma registered with the general practices. MAIN OUTCOME MEASURES: Height and weight standard deviation scores. RESULTS: Children who lived in areas of social deprivation (assessed by postcode) had lower height and weight than their contemporaries (mean standard deviation score -0.26 (SD 1.02) and -0.18 (1.15) respectively, P < 0.001 for both). Children who were receiving > or = 400 micrograms daily of inhaled steroids and who were attending both hospital and general practice for asthma care had lower height and weight than average, independent of the effect of deprivation (mean standard deviation score -0.62 (1.01), P = 0.002, for height and -0.58 (0.94), P = 0.005, for weight). Children receiving high doses of inhaled corticosteroids also showed lower growth rates (mean change in standard deviation score -0.19 (0.51), P = 0.003). However, no other children with asthma showed growth impairment. CONCLUSION: Most children with asthma were of normal height and weight and had normal growth rates. However, children receiving high doses of inhaled steroids and requiring both general practice and hospital services had a significant reduction in their stature. This effect was independent from but smaller than the effect of socioeconomic group on stature.

Adolescent↗
PubMed1998

Evaluation of total purchasing pilots in England and Scotland and implications for primary care groups in England: personal interviews and analysis of routine data. The Total Purchasing National Evaluation Team.

OBJECTIVES: To evaluate the reported achievements of the 52 first wave total purchasing pilot schemes in 1996-7 and the factors associated with these; and to consider the implications of these findings for the development of the proposed primary care groups. DESIGN: Face to face interviews with lead general practitioners, project managers, and health authority representatives responsible for each pilot; and analysis of hospital episode statistics. SETTING: England and Scotland for evaluation of pilots; England only for consideration of implications for primary care groups. MAIN OUTCOME MEASURES: The ability of total purchasers to achieve their own objectives and their ability specifically to achieve objectives in the service areas beyond fundholding included in total purchasing. RESULTS: The level of achievement between pilots varied widely. Achievement was more likely to be reported in primary than in secondary care. Reported achievements in reducing length of stay and emergency admissions were corroborated by analysis of hospital episode statistics. Single practice and small multipractice pilots were more likely than large multipractice projects to report achieving their objectives. Achievements were also associated with higher direct management costs per head and the ability to undertake independent contracting. Large multipractice pilots required considerable organisational development before progress could be made. CONCLUSION: The ability to create effective commissioning organisations the size of the proposed primary care groups should not be underestimated. To be effective commissioners, these care groups will need to invest heavily in their organisational development and in the short term are likely to need an additional development budget rather than the reduction in spending on NHS management that is planned by the government.

Budgets↗
PubMed1998

Call to needle times after acute myocardial infarction in urban and rural areas in northeast Scotland: prospective observational study.

OBJECTIVE: To determine call to needle times and consider how best to provide timely thrombolytic treatment for patients with acute myocardial infarction. DESIGN: Prospective observational study. SETTING: City, suburban, and country practices referring patients to a single district general hospital in northeast Scotland. SUBJECTS: 1046 patients with suspected acute myocardial infarction given thrombolytic treatment. MAIN OUTCOME MEASURES: Time from patients' calls for medical help until receipt of opiate or thrombolytic treatment, measured against a call to needle time of 90 minutes or less, as proposed by the British Heart Foundation. RESULTS: General practitioners were the first medical contact in 97% (528/544) of calls by country patients and 68% (340/502) of city and suburban patients. When opiate was given by general practitioners, median call to opiate time was about 30 minutes (95% within 90 minutes) in city, suburbs, and country; call to opiate delay was about 60 minutes in city and suburban patients calling "999" for an ambulance. One third of country patients received thrombolytic treatment from their general practitioners with a median call to thrombolysis time of 45 minutes (93% within 90 minutes); this compares with 150 minutes (5% within 90 minutes) when this treatment was deferred until after hospital admission. In the city and suburbs, no thrombolytic treatment was given outside hospital, and only a minority of patients received it within 90 minutes of calling; median call to thrombolysis time was 95 (46% within 90 minutes) minutes. CONCLUSIONS: The first medical contact after acute myocardial infarction is most commonly with a general practitioner. This contact provides the optimum opportunity to give thrombolytic treatment within the British Heart Foundation's guideline.

Acute Disease↗
PubMed2002

Used infant mattresses and sudden infant death syndrome in Scotland: case-control study.

OBJECTIVE: To examine the proposition that a used infant mattress is associated with an increased risk of sudden infant death syndrome. DESIGN: Case-control study. SETTING: Scotland (population 5.1 million, with about 53 000 births a year). PARTICIPANTS: 131 infants who died of sudden infant death syndrome between 1 January 1996 and 31 May 2000 and 278 age, season, and obstetric unit matched control infants. MAIN OUTCOME MEASURES: Routine use of an infant mattress previously used by another child and place of last sleep. RESULTS: Routine use of an infant mattress previously used by another child was significantly associated with an increased risk of sudden infant death syndrome (multivariate odds ratio 3.07, 95% confidence interval 1.51 to 6.22). Use of a used infant mattress for last sleep was also associated with increased risk (6.10, 2.31 to 16.12). The association was significantly stronger if the mattress was from another home (4.78, 2.08 to 11.0) than if it was from the same home (1.64, 0.64 to 4.2). CONCLUSION: A valid significant association exists between use of a used infant mattress and an increased risk of sudden infant death syndrome, particularly if the mattress is from another home. Insufficient evidence is available to judge whether this relation is cause and effect.

Bedding and Linens↗
PubMed2003

Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland.

OBJECTIVES: To explore how general practitioners operate the sickness certification system, their views on the system, and suggestions for change. DESIGN: Qualitative focus group study consisting of 11 focus groups with 67 participants. SETTING: General practitioners in practices in Glasgow, Tayside, and Highland regions, Scotland. SAMPLE: Purposive sample of general practitioners, with further theoretical sampling of key informant general practitioners to examine emerging themes. RESULTS: General practitioners believed that the sickness certification system failed to address complex, chronic, or doubtful cases. They seemed to develop various operational strategies for its implementation. There appeared to be important deliberate misuse of the system by general practitioners, possibly related to conflicts about roles and incongruities in the system. The doctor-patient relationship was perceived to conflict with the current role of general practitioners in sickness certification. When making decisions about certification, the general practitioners considered a wide variety of factors. They experienced contradictory demands from other system stakeholders and felt blamed for failing to make impossible reconciliations. They clearly identified the difficulties of operating the system when there was no continuity of patient care. Many wished either to relinquish their gatekeeper role or to continue only with major changes. CONCLUSIONS: Policy makers need to recognise and accommodate the range and complexity of factors that influence the behaviour of general practitioners operating as gatekeepers to the sickness certification system, before making changes. Such changes are otherwise unlikely to result in improvement. Models other than the primary care gatekeeper model should be considered.

Attitude of Health Personnel↗
PubMed2006

Does IQ explain socioeconomic inequalities in health? Evidence from a population based cohort study in the west of Scotland.

OBJECTIVE: To test the hypothesis that IQ is a fundamental cause of socioeconomic inequalities in health. DESIGN: Cross sectional and prospective cohort study, in which indicators of IQ were assessed by written test and socioeconomic position by self report. SETTING: West of Scotland. PARTICIPANTS: 1347 people (739 women) aged 56 in 1987. MAIN OUTCOME MEASURES: Total mortality and coronary heart disease mortality (ascertained between 1987 and 2004); respiratory function, self reported minor psychiatric morbidity, long term illness, and self perceived health (all assessed in 1988). RESULTS: In sex adjusted analyses, indices of socioeconomic position (childhood and current social class, education, income, and area deprivation) were significantly associated with each health outcome. Thus the greatest risk of ill health and mortality was evident in the most socioeconomically disadvantaged groups, as expected. After adjustment for IQ, a marked attenuation in risk occurred for poor mental health (range of attenuation in risk ratio across the five socioeconomic indicators: 15-58%), long term illness (25-53%), poor self perceived health (41-56%), respiratory function (44-66%), coronary heart disease mortality (31-111%), and total mortality (45-131%). Despite the clear reduction in the magnitude of these effects after controlling for IQ, in half of the associations examined the risk of ill health in socioeconomically disadvantaged people was still at least twice that of advantaged people. Statistical significance was lost for only 5/25 separate socioeconomic health gradients that showed significant relations in sex adjusted analyses. CONCLUSIONS: Scores from the IQ test used here did not completely explain the socioeconomic gradients in health. However, controlling for IQ did lead to a marked reduction in the magnitude of these gradients. Further exploration of the currently scant information about IQ, socioeconomic position, and health is needed.

Coronary Disease↗
PubMed2004

Difference in injury pattern between drivers and front seat passengers involved in road traffic accidents in Scotland.

OBJECTIVES: To investigate the frequency and pattern of injury in front seat passengers as compared with drivers, in Scotland. METHODS: Using the Scottish Trauma Audit Group (STAG) database from 1994 to 2000, a search for injuries to eight anatomical body regions was performed. Injuries were identified and selected by their abbreviated injury score code. A comparison of injury frequency between drivers and front seat passengers was then made. RESULTS: There were 4189 drivers and 954 front seat passengers included in the study. Mortality was higher in the "front seat passengers" group (6.6% compared with 5.3% p = 0.13). Seven of the eight body regions selected showed higher rates of injury in front seat passengers. There were significantly more injuries to cervical spine (6.0% compared with 3.3% p<or=0.001), chest (41.4% compared with 29.0% p<or=0.001), and lumber spine (7.4% compared with 5.2% p<or=0.001) in front seat passengers. CONCLUSIONS: Front seat passengers are at increased risk of injury relative to drivers in actual road traffic accidents as recorded in the STAG database. This contradicts crash test data, which suggest drivers are less well protected than front seat passengers in laboratory conditions.

Accidents, Traffic↗
PubMed2005

Aeromedical retrieval to a university hospital emergency department in Scotland.

Rural and island areas of Scotland benefit from the availability of the Scottish Ambulance Service paramedic staffed helicopter for transfers and primary scene responses. There are a small number of patients who require advanced airway management, invasive procedures, or critical care interventions to stabilise them before transport to definitive care. At present these additional skills are provided on an ad hoc basis by senior medical staff drawn from intensive care and emergency medicine at the receiving hospitals. Given the potential difficulties of training paramedics to use these infrequently used skills it may be preferable to establish a formalised system to access suitably trained medical staff. This case series illustrates the clinical challenges and potential benefits of such a service and discusses the practicalities involved.

Air Ambulances↗