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Biomedical subjects

C R Victor

Publications and source records attributed to C R Victor.

At least 19 recordsLinked to original sources
PubMed2005

Deaths certified as asthma and use of medical services: a national case-control study.

BACKGROUND: Studies have linked asthma death to either increased or decreased use of medical services. METHODS: A population based case-control study of asthma deaths in 1994-8 was performed in 22 English, six Scottish, and five Welsh health authorities/boards. All 681 subjects who died were under the age of 65 years with asthma in Part I on the death certificates. After exclusions, 532 hospital controls were matched to 532 cases for age, district, and date of asthma admission/death. Data were extracted blind from primary care records. RESULTS: The median age of the subjects who died was 53 years; 60% of cases and 64% of controls were female. There was little difference in outpatient attendance (55% and 55%), hospital admission for asthma (51% and 54%), and median inpatient days (20 days and 15 days) in the previous 5 years. After mutual adjustment and adjustment for sex, using conditional logistic regression, three variables were independently associated with asthma death: fewer general practice contacts (odds ratio 0.82 (95% confidence interval (CI) 0.74 to 0.91) per 5 contacts) in the previous year, more home visits (1.14 (95% CI 1.08 to 1.21) per visit) in the previous year, and fewer peak expiratory flow recordings (0.83 (95% CI 0.74 to 0.92) per occasion) in the previous 3 months. These associations were similar after adjustment for markers of severity, psychosocial factors, systemic steroids, short acting bronchodilators and antibiotics, although the association with peak flow was weakened and just lost significance. CONCLUSION: Asthma death is associated with less use of primary care services. Both practice and patient factors may be involved and a better understanding of these may offer possibilities for reducing asthma death.

Administration, Inhalation↗
PubMed2005

Changes in the emergency workload of the London Ambulance Service between 1989 and 1999.

OBJECTIVES: To examine changes in the emergency workload of the London Ambulance Service (LAS) between 1989 and 1999. METHODS: All emergency responses by the LAS during week 16 in each of 1989, 1996, and 1999 were studied. For each week, 999 call responses were analysed by time and day of call, and age/sex of the patient. Call response rates were calculated using age/sex census population estimates for London. Changes in call rates over time were calculated as rate ratios. RESULTS: Emergency responses increased from 6624 to 13 178 in the index weeks of 1989-1999. The ratio of response rates (1999/1989) was 1.91 (95% CI: 1.85 to 1.96). The proportion of out of hours calls increased significantly, from 68.8% in 1989 to 71.3% in 1999 (p = 0.0003). Response rates rose significantly more steeply for male patients than female patients from 1989 to 1999: rate ratio (95% CI); male patients 2.00 (1.91 to 2.08), female patients 1.69 (1.62 to 1.77), p<0.0001. Response rates varied by age in each of the three years investigated. Rates were consistently highest for patients aged 75 and above, and lowest for those aged 5-14. However, there was no evidence that call rates had increased disproportionately in any particular age group (p = 0.79). CONCLUSIONS: Demand for emergency ambulance services in London has doubled in a decade. This increase is similar for all age groups, with no evidence of a greater rise in demand among older people. Call rates have increased more steeply in men than in women. Demographic changes do not explain the observed increases in demand.

Adolescent↗
PubMed2002

Psychological, social and health behaviour risk factors for deaths certified as asthma: a national case-control study.

BACKGROUND: Uncontrolled studies suggest that psychosocial factors and health behaviour may be important in asthma death. METHODS: A community based case-control study of 533 cases, comprising 78% of all asthma deaths under age 65 years and 533 hospital controls individually matched for age, district and asthma admission date corresponding to date of death was undertaken in seven regions of Britain (1994-98). Data were extracted blind from anonymised copies of primary care records for the previous 5 years and non-blind for the earlier period. RESULTS: 60% of cases and 63% of controls were female. The median age in both groups was 53. Cases had an earlier age of asthma onset, more chronic obstructive lung disease, and were more obese. 48% of cases and 42% of controls had a health behaviour problem; repeated non-attendance/poor inhaler technique was related to increased risk of death. Overall, 85% and 86%, respectively, had a psychosocial problem. Four psychosocial factors were associated with increased risk of death (psychosis, alcohol/drug abuse, financial/employment problems, learning difficulties) and two with reduced risk (anxiety/prescription of antidepressant drugs and sexual problems). While alcohol/drug abuse lost significance after adjustment for psychosis, other associations appeared independent of each other and of indicators of severity and co-morbidity. None of the remaining 13 factors including family problems, domestic abuse, bereavement, and social isolation were significantly related to risk of asthma death. CONCLUSION: There was an apparently high burden of psychosocial problems in both cases and controls. The associations between health behaviour, psychosocial factors, and asthma death are varied and complex with a limited number of factors showing positive relationships.

Adolescent↗
PubMed2001

Do income questions and seeking consent to link medical records reduce survey response rates? A randomised controlled trial among older people.

Traditional measures of socioeconomic status may not be reliable for older people and income may be a useful measure for research into inequalities in health. At the same time, researchers increasingly wish to link survey findings to individual data taken from medical records. For this, consent must be sought. To examine whether questions on household income and seeking consent for medical record linkage affected response rates, a postal health survey of patients aged 65 to 74 was undertaken in an inner London practice. The overall response rate was 62.8%. In this study, the inclusion of an income question or seeking consent to access medical records did not reduce response rates to a health survey among older people.

Aged↗
PubMed1999

Who calls 999 and why? A survey of the emergency workload of the London Ambulance Service.

BACKGROUND: In 1996-97 there were 623,000 emergency (999) calls made to the London Ambulance Service (LAS) and this represents a 30% increase over the previous five years. The reasons for this increase, which is also observed nationally, remain unknown. It has been suggested that some callers may be using the 999 service "inappropriately" but no data are available from the ambulance service. OBJECTIVE: To describe the workload of the emergency ambulance service in London with specific reference to the nature and characteristics of 999 calls, to determine who dials 999 and why, and to establish the number and types of calls that could most appropriately be dealt with by other agencies. DESIGN: A one week census of all emergency calls responded to by the LAS. SETTING: Sixty eight LAS stations. METHODS: Collation of all routine LAS incident forms (LA4) including the classification of the crews' free text description of the incident. This was supplemented by a detailed workload questionnaire for 25% of calls. RESULTS: There were 10,921 calls responded to from 29 April to 5 May 1996. The census showed that the daily number of calls was highest on Saturday and lowest on Wednesday with about half being made during normal general practitioner (GP) working hours. Half of all calls were for women and one third were for people aged > or = 65. Accidents were the commonest type of incident (24%). The remainder comprised various medical conditions such as respiratory, cardiac, and obstetric problems. In 1.5% of calls there was no illness, injury, or assistance required and 5% were for "general assistance" and mostly concerned people aged > or = 65. The workload survey indicated that two thirds of incidents occurred at home and 70% of callers had not tried to contact a GP before dialing 999. In the professional opinion of the responding crew, 60% of calls required a 999 response, with the remainder thought more appropriately dealt with by other services such as primary care, psychiatric services, and social services. CONCLUSIONS: This study suggests that while the majority of 999 calls were "appropriate", part of the 999 workload could be dealt with by other services. More research is required to clarify why people contact the 999 service for non-emergency incidents and also to establish the views of GPs and other agencies as to the role and function of the IAS.

Emergency Medical Service Communication Systems↗
PubMed1998

Are women who have abortions different from those who do not? A secondary analysis of the 1990 national survey of sexual attitudes and lifestyles.

Studies of women undergoing termination of a pregnancy are often used to make recommendations about family planning and health education policy. However, it is not clear how similar the women in these studies are to the general population of women of childbearing age. Our secondary analysis of the National Sexual Attitudes and Lifestyles Survey allowed us to test the hypothesis that women who have undergone an abortion are the same as those who have not (in terms of socio-demographic characteristics, lifestyles, and attitudes). Our findings show significant differences between these two groups of women, particularly regarding ethnicity, marital status, number of natural children, lifetime number of sexual partners, and attitudes to abortion. We conclude that family planning/reproductive health services and health education policies need to take these differences into account and that further research is required to explain why these differences arise.

Abortion, Legal↗
PubMed1997

Key problems in using health status measures.

This article describes the development of health status measures and the benefits to be gained from their use. The difficulties in conceptualising and quantifying health are described. The authors conclude that a critical approach to the use of health status measures is needed if these instruments are to be of benefit to health care and health research.

Attitude to Health↗
PubMed1995

Services for children with HIV/AIDS: the views of parents.

In this qualitative study, the parents of ten children who attended an inner-London teaching hospital for HIV/AIDS were interviewed to find out their views on the services. Speaking from their own experiences, parents expressed a high level of satisfaction with the specialist paediatric care at the teaching hospital but had little confidence in the expertise of other hospitals or of GPs and health visitors. Few cases had been identified antenatally; the diagnosis of HIV/AIDS was often made only after the child had become ill and been investigated for a variety of diseases before being tested for HIV. The families felt considerable anxiety about the future, especially about what would happen if both child and parent were to become ill at the same time. The increasing number of HIV-infected mothers and children means that in future the caseload and expertise of the specialist centres will need to be shared with the primary health care team.

Attitude to Health↗
PubMed1994

'We just want to be a normal family...'. Paediatric HIV/AIDS services at an inner-London teaching hospital.

The nature of the HIV epidemic in the UK is changing with the increasing number of infected women and children. This recent onset means that there are few data about the specific problems of HIV in families. This study examines current issues in service provision to HIV infected children and their families at an inner-London teaching hospital. A sample of ten families were interviewed, from a caseload of approximately 100 HIV-positive children. Of the ten children, seven were under the age of 5 years. All the children were vertical transmissions and six of the mothers were from Sub-Saharan Africa. Only three of the ten children were identified antenatally. In terms of service provision, families were very satisfied with the care provided by the study hospital's paediatric HIV team but felt that the hospital's paediatric and adult HIV services were poorly co-ordinated and impractically located over different sites. Families did not have confidence in GP and community services, preferring to use hospital services which they felt to have more expertise in paediatric HIV. Future policy developments will have to confront the hospital-centred nature of paediatric HIV services and develop primary and community care services.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Is hospital the right place? A survey of 'inappropriate' admissions to an inner London NHS trust.

BACKGROUND: Acute hospital beds form an important health care resource. However, it is accepted that some beds may be used 'inappropriately' by patients who, although no longer requiring the facilities of an acute bed, cannot be discharged because of difficulties in organizing care at home or elsewhere. METHODS: Using the Oxford Bed Study Instrument, all admissions to an inner London NHS trust over a one-week period were classified as either appropriate or inappropriate. RESULTS: During the study week there were 689 in-patient admissions of which five were classed as inappropriate. Of the five inappropriate patients two were children and three were aged 65+. For one child the admission was for clear social reasons. However, the remaining four patients all presented a clear need for either respite or hospice care. Lack of provision of such facilities meant that they had to be admitted to an acute hospital bed. CONCLUSION: Overall our study highlighted the comparative rarity of inappropriate admissions, but did indicate that such patients may have long lengths of stay or repeated admissions which, as well as the amount of resources involved, prevent the bed from being used by other patients.

Aged↗
PubMed1993

Whose responsibility is it anyway? Hospital admission and discharge of older people in an inner-London District Health Authority.

The division of responsibilities that exists between primary and secondary health care services and health and social care services may create problems in the provision of care to patients whose needs mean that a number of different agencies are involved in their care. The objective of all the agencies involved is the smooth transfer of clients between different sectors of care provision. One client group thought to be particularly vulnerable to dislocations in the continuous pattern of care provision is older people. Problems over the division of responsibility between professional groups are particularly evident on admission to and discharge from hospital. It is the latter rather than the former aspect that has been the focus of research. An extensive multi-methods study of the admission and discharge of older people from hospital in an inter-city District Health Authority was undertaken. This paper examines the transfer of older people between different elements of the health and social care systems. Our study illustrates that on neither admission nor on discharge was there a clearly defined mechanism for affecting liaison between hospital and community. Clearly, the responsibility for this task must be delegated to a specific group. However, such responsibility must be given within a properly resourced and managed system, otherwise the current position of blurred responsibilities will remain. It is unclear as to how the reform of the National Health Service and the introduction of the internal market and the purchaser/provider division will aid the improved co-ordination which this study has identified as being required.

Aged↗
PubMed1992

Health status of the temporarily homeless population and residents of North West Thames region.

OBJECTIVES: To survey the health status of the temporarily homeless population of North West Thames region and make comparisons with regional residents. DESIGN: Direct interview with standardised questionnaires. SETTING: Temporarily homeless people resident in hotels in the London boroughs in the North West Thames region and a random sample of regional residents. SUBJECTS: 137 hotels thought to be providing accommodation to homeless people selected at random from a list of 295. 113 (82%) participated in the study, and 319 (61%) of 522 homeless people approached participated. The study was restricted to adults aged 16 and over selected at random. RESULTS: The homeless population was predominantly female (195/319; 61%), young (229 (72%) aged 16-34), and poor, 54% (172/319) receiving income support. 207 subjects (65%) had dependent children aged 16 and under. Rates of acute illness among homeless people (32 cases; 10%) were similar to those reported by regional residents. The prevalence of longstanding limiting illness (108 cases; 34%) was similar to that for regional residents, but the prevalence of mental morbidity was twice that for the region as a whole (145 cases (45%) v 1485 (18%)). Utilisation of general practitioner services, accident and emergency departments, and inpatient admission was much higher by the homeless population than by regional residents. General practitioner registration rates were above 90% for the homeless sample. CONCLUSIONS: Survey data provide empirical evidence about the nature and characteristics of the temporarily homeless population. The high service utilisation recorded may, in part, have resulted from the higher morbidity in this sample of homeless people. The concentration of homeless people into specific locations may suggest that additional funding should be provided to the district which provides care to this group. However, such funding should not necessarily be used for additional acute care but should be used to purchase appropriate services which meet the health needs of this very young, poor and vulnerable group.

Adolescent↗