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D H Stone

Publications and source records attributed to D H Stone.

At least 37 records · Page 2Linked to original sources
PubMed2000

Evaluation of a community-based intervention to increase breastfeeding prevalence.

BACKGROUND: The aim of the study was to determine whether peer counselling in the antenatal and post-natal period would increase the prevalence and duration of breastfeeding among low-income women in Glasgow. METHODS: The study was designed as a quasi-experimental evaluation of a community-based breastfeeding promotion programme. The intervention comprised peer counselling of pregnant women, support of breastfeeding mothers and local awareness-raising activities. The study subjects were all women attending the antenatal booking clinic resident in either the intervention or control area. Data were collected by means of four self-completion questionnaires, two administered antenatally and two post-natally. The proportions intending to breastfeed or breastfeeding in the intervention and control groups were compared at each assessment and over time. RESULTS: Of the 995 women enrolled in the study, data were available for analysis on 919 (92 per cent) to 6 weeks postnatally. At booking, 18 per cent of the intervention group and 21 per cent of the control group stated an intention to breastfeed. At delivery, the proportions initiating breastfeeding were 23 per cent of the intervention subjects and 20 per cent of the controls, and by 6 weeks post-natally, the proportion providing any breast milk had declined to 10 per cent of the intervention group and 8 per cent of the control group. Using multivariate analysis to adjust for factors (such as socio-economic status) known to influence breastfeeding, the breastfeeding prevalence was significantly higher in the intervention group relative to the controls at delivery [odds ratio (OR) 2.0; 95 per cent confidence interval (CI) 1.2-3.1, p = 0.006]. By 6 weeks post-natally the difference between the two groups was not statistically significant (OR 1.8; 95 per cent CI 1.0-3.4, p=0.07). CONCLUSIONS: As the impact of the intervention was not sustained even for the modest duration of 6 weeks postnatally, it would be premature to justify widespread use of peer support programmes to increase the prevalence of breastfeeding in socially disadvantaged communities.

Breast Feeding↗
PubMed2000

Lead levels in domestic water supplies and neural tube defects in Glasgow.

OBJECTIVE: To study the association between "pregnancy" prevalence (affected births and terminations) of neural tube defects in postcode districts of Glasgow and lead concentrations in domestic water. SETTING: Postcode districts of Glasgow supplied by water from the Loch Katrine reservoir. DESIGN: An ecological study. Lead concentrations from 1911 randomly selected domestic water samples were obtained from the Glasgow 93 lead study. Neural tube defects (affected births and terminations) were identified from the Glasgow register of congenital anomalies for the period 1983-95 for each postcode district in the study population. Correlations were sought between lead concentrations and pregnancy prevalence of neural tube defects/1000 live births in postcode districts. RESULTS: No correlation was found between domestic water lead concentrations > 10 microg/litre and pregnancy prevalence of neural tube defects within postcode districts. Areas of Glasgow previously with high domestic water lead concentrations did not have a higher prevalence of neural tube defects. Houses with the lowest domestic water lead concentrations were in Carstairs deprivation categories 1 (least deprived), 6, and 7 (most deprived). The highest pregnancy prevalence of neural tube defects was found in the most deprived areas. CONCLUSION: Deprivation is a risk factor for neural tube defects and might have been a confounding factor in previous studies looking at the association between such defects and domestic water lead concentrations. This study does not support the hypothesis that levels of lead > 10 microg/litre in domestic water supplies are associated with a higher pregnancy prevalence of neural tube defects. The reasons behind the decline in pregnancy prevalence of neural tube defects seen in the past two decades remain unexplained.

Female↗
PubMed2000

Capture-recapture: a useful methodological tool for counting traffic related injuries?

INTRODUCTION: Although the capture-recapture technique is increasingly employed in studies of human populations to correct for under-ascertainment in traditional epidemiological surveillance, it has rarely been used in injury research. OBJECTIVES: To estimate the completeness of official data sources on traffic related injuries (TRIs) by using the capture-recapture technique and to calculate an ascertainment corrected number of fatal and serious TRIs among Scottish young people aged 15-24 years. The appropriateness of the approach in this context is also assessed. METHOD: A two sample capture-recapture technique was applied to two official sources of TRI data. Data on TRIs were obtained from the Scottish Health Service and the STATS19 dataset at the University of Essex Data Archive for 1995. Four standards (A-D) of matching were applied to fatalities and serious TRIs to allow plausible relaxation of matching standards within the context of the data collection setting. The completeness of each data source was assessed, and an ascertainment corrected number of fatalities and serious TRIs calculated. RESULTS: The ascertainment corrected number of TRI fatalities among 15-24 year olds using standard D was 104. This represents only a small increase in the number of fatalities using capture-recapture than when using each individual dataset. The completeness of the Scottish Health Service database for TRI fatalities was 93%. The STATS19 database was 95% complete. The ascertainment corrected number of TRI hospital admissions was 1969. The STATS19 and the Scottish Health Service databases were approximately two thirds and three quarters complete respectively for non-fatal TRIs requiring hospitalisation. CONCLUSIONS: Injury researchers have advocated the linkage of major datasets to supplement and improve the quality of injury data. Using capture-recapture we found that routine databases enumerate TRI fatalities accurately, in contrast to injury morbidity databases that do not. Capture-recapture is a potentially useful method of evaluating the completeness of data sources and identifying biases within datasets. However, ascertainment corrected rates should be viewed with caution. A number of requirements of the capture-recapture technique are unachieved in this study of injury in the human population.

Accidents, Traffic↗
PubMed1999

Injury surveillance in an accident and emergency department: a year in the life of CHIRPP.

BACKGROUND: The design of childhood injury prevention programmes is hindered by a dearth of valid and reliable information on injury frequency, cause, and outcome. A number of local injury surveillance systems have been developed to address this issue. One example is CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program), which has been imported into the accident and emergency department at the Royal Hospital for Sick Children, Glasgow. This paper examines a year of CHIRPP data. METHODS: A CHIRPP questionnaire was completed for 7940 children presenting in 1996 to the accident and emergency department with an injury or poisoning. The first part of the questionnaire was completed by the parent or accompanying adult, the second part by the clinician. These data were computerised and analysed using SPSSPC for Windows. RESULTS: Injuries commonly occurred in the child's own home, particularly in children aged 0-4 years. These children commonly presented with bruising, ingestions, and foreign bodies. With increasing age, higher proportions of children presented with injuries occurring outside the home. These were most commonly fractures, sprains, strains, and inflammation/oedema. Seasonal variations were evident, with presentations peaking in the summer. CONCLUSIONS: There are several limitations to the current CHIRPP system in Glasgow: it is not population based, only injuries presented to the accident and emergency department are included, and injury severity is not recorded. Nevertheless, CHIRPP is a valuable source of information on patterns of childhood injury. It offers local professionals a comprehensive dataset that may be used to develop, implement, and evaluate child injury prevention activities.

Adolescent↗
PubMed1999

Unintentional childhood injury mortality in Europe 1984-93: a report from the EURORISC Working Group.

OBJECTIVE: To examine recent trends in unintentional childhood injury mortality in Europe, and to identify the contribution of specific causes. SETTING: The 15 current member countries of the European Union. METHODS: Analysis of mortality data (1984-93) obtained from the World Health Organisation and national government agencies. RESULTS: Injuries continue to be the leading cause of childhood death in all study countries, with more than 4500 fatalities annually, accounting for over 30% of all child mortality. The major causes of death in all countries were injuries due to motor vehicle traffic accidents, drownings, fire and flames, and falls. Portugal experienced mortality rates double those of most other countries, with the differentials particularly stark early in the study period. Although a decrease in age standardised mortality rates was observed in all countries over the decade, the extent of the decrease varied widely, from -47% in the UK to -11% in Finland. CONCLUSION: The pattern of childhood injury in Europe is similar to that observed elsewhere in the world. None the less, differences in rates of childhood injury mortality persist between countries. Identifying the reasons for these variations between countries may hold the key to the reduction injury rates in Europe as a whole.

Adolescent↗
PubMed1999

Similarities in the epidemiology of neural tube defects and coronary heart disease: is homocysteine the missing link?

It is hypothesised that a single aetiological pathway could explain both the strong ecological association between the birth prevalence of neural tube defects (NTD) and coronary heart disease (CHD) mortality and the potential efficacy of dietary measures, especially increased folic acid intake, in their prevention. The epidemiological similarities between NTD and CHD are strong and consistent suggesting that the relation is real rather than artefactual. It is suggested that this epidemiological association reflects a shared aetiology arising from the role of disturbed homocysteine metabolism in the pathogenesis of both conditions. Current public health measures designed to increase the intake of periconceptional folic acid in women, reinforced by a broadening of this policy to target both sexes throughout life, will (if successful) result in a reduction in both the birth prevalence of NTD and the incidence of CHD, although not necessarily contemporaneously. If disordered homocysteine metabolism is the cause of both NTD and CHD, this has implications for future research and preventive strategies for these serious and often lethal diseases.

Coronary Disease↗
PubMed1999

An audit of paediatric audit in Scotland.

We undertook a retrospective review of the Scottish Clinical Audit Project Register (SCAPR). This generated information on audit activities in Scotland relating to children aged 0-15 years over the period 1992 to 1997. All healthcare specialties (including dentistry) in both acute and community sectors were included. Of the 7,073 registered entries, 613 (9%) relating to children were identified. Greater Glasgow contributed a third of entries despite having only 18% of the child population. Over half the projects were conducted in secondary care settings and only 5% in primary care. Medicine and nursing appeared the most audit active professional groups. Our findings suggest that children (who comprise 19% of the Scottish population) are an under-audited group in Scotland. Secondary care (especially surgery) seemed over-represented and primary care under-represented as audit settings. We were unable to use the SCAPR to identify specific service deficiencies or improvements that may have been stimulated in the course of "closing the audit loop." Future refinements to the way data are collected and recorded on the SCAPR will clearly require to address this shortcoming.

Adolescent↗
PubMed1999

Childhood injury mortality in Scotland, 1981-95.

OBJECTIVE: To examine the trends in childhood injury mortality in Scotland between 1981 and 1995. DESIGN: Analysis of mortality data from the Registrar General for Scotland. SETTING: Scotland, UK. SUBJECTS: Children aged 0-14 years. MAIN RESULTS: A total of 1,728 children died in Scotland as a result of an injury between 1981-1995. While a significant decrease in the rates of unintentional injury mortality was observed for both sexes, all ages and most causes over the study period, the proportion of total child deaths due to injury decreased only slightly. Road traffic accidents were the major cause of injury mortality in this age group, representing over 40% of all injury deaths both at the beginning and the end of the study period. Males and young children of both sexes had consistently higher injury mortality rates. Similar reductions in injury mortality rates were observed for males and females. CONCLUSIONS: Childhood injury mortality rates have declined in Scotland, affecting all injury causes. The analysis of injury mortality rates in the population is helpful in highlighting potential environmental hazards that result in injury and in monitoring progress towards the achievement of national and local targets.

Accidents, Traffic↗
PubMed1998

The clinical epidemiology ward round: can we teach public health medicine at the bedside?

BACKGROUND: The clinical epidemiology ward round (CEWR) is an educational tool for integrating the teaching of epidemiology with clinical paediatrics. It aims to facilitate the acquisition of the knowledge, skills and attitudes that promote the effective application of epidemiological insights into routine clinical practice. This paper describes experience of the CEWR in a UK medical school and initial student responses to it. METHODS: Since 1995, the CEWR has formed an integral part of the clinical teaching given to all final phase medical students during their eight-week child health course at the University of Glasgow. It took place in a general paediatric ward of the Royal Hospital for Sick Children, Glasgow. Groups of up to seven students were taught by a clinical epidemiologist with a strong research interest, as well as clinical experience, in child health. Each round lasted approximately 90 minutes and the teaching style was informal and interactive. At the end of the child health course, students were asked a series of questions relating to the CEWR's educational objectives. RESULTS: The evaluation indicated that the CEWR had been well received by students, 85 per cent of whom said it was an excellent or good idea in principle, and 71 per cent of whom said it worked well in practice. Most students seemed unconvinced about its role in reinforcing epidemiological knowledge or in clinical skill development. CONCLUSION: The CEWR requires further development but offers a potentially inexpensive, effective and enjoyable vehicle for integrating the teaching of two previously separate components of the curriculum.

Adult↗
PubMed1998

Injury surveillance in accident and emergency departments: to sample or not to sample?

OBJECTIVES: To establish whether injury surveillance based on sampling strategies is as valid as total patient surveillance. METHODS: Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) data for 1996 were retrospectively analysed using five sampling frames. Proportions for key variables were calculated for each sample, then compared with the proportions for the total population of patients. RESULTS: Two of the five sampling frames produced statistically significant differences from the total population, which can be explained by seasonal variations. However, no significant differences were observed between the remaining three samples and the total population. CONCLUSIONS: A well planned and executed sampling strategy can generate as valid data as total patient surveillance, obviating the need for data collection on every patient presenting with an injury or poisoning. In practice, however, systematic sampling can be difficult to implement and sustain, counterbalancing the economic advantages.

Adolescent↗