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Biomedical subjects

S Abbott

Publications and source records attributed to S Abbott.

At least 19 recordsLinked to original sources
PubMed2006

What sort of networks are public health networks?

BACKGROUND: Re-organization of the English National Health Service (NHS) has fragmented the public health workforce, relocating teams from about 100 health authorities into over 300 primary care trusts (PCTs). The UK Government announced the setting up of public health networks (PHNs) as a solution to the problems created by fragmentation. METHODS: Fifty-seven semi-structured telephone interviews were held with key players in PHNs in all strategic health authority areas in England in early 2003. RESULTS: PHNs appeared to be primarily networks of public health professionals rather than of organizations. Informants were unsure about PCTs' commitment to public health. Predominantly, members were those NHS personnel with a clear and explicit public health role. Most PHNs intended to include others later (e.g. health visitors, environmental health officers), although a few thought that inclusivity was essential from the start. Continuing professional development for public health personnel dominated the work being undertaken, with some collaborative work across PCTs. PHNs were seen as a compulsory reconfiguration of existing networks, and informants doubted that they were appropriate for the many levels of networking that public health work requires. CONCLUSION: The formation of PHNs does not appear to have been either necessary or sufficient. However, the public health community has a well-established tradition of networking, and therefore has the skills to use PHNs advantageously.

Community Networks↗
PubMed2005

Specialist public health capacity in England: working in the new primary care organizations.

OBJECTIVES: To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. STUDY DESIGN: Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. RESULTS: Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. CONCLUSIONS: Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.

England↗
PubMed2005

Developing a speciality: regearing the specialist public health workforce.

OBJECTIVES: To identify issues surrounding the future training needs of the specialist public health workforce following the most recent restructuring of the National Health Service (NHS) in England. METHODS: All directors of public health (DsPH) based in strategic health authorities and nine senior staff working in public health at the regional level were invited to participate in a semi-structured telephone interview. RESULTS: Twenty-six people were interviewed. Many interviewees expressed concern that because consultants and specialists in public health will be working in much smaller teams than hitherto, they will have to generalize their skills to cover a much wider range of functions (including board-level duties). This may result in a loss of specialist expertise. Successful public health practice in the new structures will require new ways of interorganizational working that will add an administrative burden to specialists in public health. Also, the creation of a board-level post in each primary care trust (PCT) has resulted in more time spent on corporate responsibilities and less on public health for DsPH, who are often the only fully trained specialist in public health in their PCT. Furthermore, interviewees expressed their anxiety about the lack of diversity in the posts available to specialists in public health and particularly to those newly completing their specialist training. Generally, interviewees felt that traditional public health roles and responsibilities were being eclipsed by corporate and managerial ones. Professional development activities were being carried out, but in a rather ad-hoc fashion. Interviewees were hopeful that public health networks would lead professional development initiatives once they were more established. CONCLUSIONS: It is important that excellence in public health is maintained through a set of accreditable standards, whilst corporate skills, essential to successful public health practice in the new UK NHS, are developed among specialists in public health.

Accreditation↗
PubMed2005

A multi-state outbreak of Salmonella serotype Thompson infection from commercially distributed bread contaminated by an ill food handler.

Foodborne transmission is estimated to account for 95% of non-typhoidal Salmonella infections reported in the United States; however, outbreaks of salmonellosis are rarely traced to food handlers. In August 2000, an increase in Salmonella serotype Thompson infection was noted in Southern California; most of the cases reported eating at a restaurant chain (Chain A) before illness onset. A case-control study implicated the consumption of burgers at Chain A restaurants. The earliest onset of illness was in a burger bun packer at Bakery B who had not eaten at Chain A but had worked while ill. Bakery B supplied burger buns to some Chain A restaurants in Southern California and Arizona. This outbreak is notable for implicating a food handler as the source of food contamination and for involving bread, a very unusual outbreak vehicle for Salmonella . Inadequate food-handler training as well as delayed reporting to the health department contributed to this outbreak.

Adolescent↗
PubMed2004

Epidemiological features of a newly described serotype of Shigella boydii.

We report the clinical, microbiological, and epidemiological features of an emerging serotype, Shigella boydii 20. We interviewed patients about symptoms, and history of travel and visitors during the week before illness onset. Seventy-five per cent of the 56 patients were Hispanic. During the week before illness onset, 18 (32%) travelled abroad; 17 (94%) had visited Mexico. Eight (21%) out of 38 who had not travelled had foreign visitors. There were eight closely related patterns by PFGE with XbaI. S. boydii 20 may be related to travel to Mexico and Hispanic ethnicity. Prompt epidemiological investigation of clusters of S. boydii 20 infection may help identify specific vehicles and risk factors for infection.

Adolescent↗
PubMed2003

Alfalfa sprouts and Salmonella Kottbus infection: a multistate outbreak following inadequate seed disinfection with heat and chlorine.

Raw sprouts have been implicated in a number of foodborne disease outbreaks. Because contaminated seeds are usually responsible, many sprout producers attempt to disinfect seeds before germination and detect sprout contamination during production. In March 2001, we detected an increased number of Salmonella serotype Kottbus isolates in California. Overall, we identified 31 cases from three western states. To identify the cause, we conducted a case-control study with the first 10 identified case-patients matched to 20 controls by age, sex, and residential area. Our case-control study found illness to be statistically associated with alfalfa sprout consumption. The traceback investigation implicated a single sprouter, where environmental studies yielded Salmonella Kottbus from ungerminated seeds and floor drains within the production facility. Pulsed-field gel electrophoresis patterns of all patient, seed, and floor drain Salmonella Kottbus isolates were indistinguishable. Most implicated sprouts were from seeds that underwent heat treatment and soaking with a 2,000-ppm sodium hypochlorite solution rather than the Food and Drug Administration (FDA)-recommended 20,000-ppm calcium hypochlorite soak. Other implicated seeds had been soaked in a calcium hypochlorite solution that, when tested, measured only 11,000 ppm. The outbreak might have been averted when screening tests of sprout irrigation water detected Salmonella in January; however, confirmatory testing of these samples was negative (but testing improperly utilized refrigerated irrigation water). Producers should use the enrichment broth of positive screening samples, not refrigerated irrigation water, for confirmatory testing. Until other effective disinfection technologies are developed, producers should adhere to FDA recommendations for sprout seed disinfection.

Adult↗
PubMed2001

Escherichia coli O157 and Salmonella infections associated with sprouts in California, 1996-1998.

BACKGROUND: In California, from 1996 through 1998, more than 50% of multicounty outbreaks with confirmed food vehicles were related to alfalfa or clover sprouts. OBJECTIVE: To summarize investigations of sprout-associated outbreaks. DESIGN: Matched case-control studies. SETTING: California. PATIENTS: Outbreak-associated patients and matched population controls. MEASUREMENTS: Matched odds ratios and 95% CIs; traceback and environmental investigations of sprout and seed growers; and pulsed-field gel electrophoresis of isolates from patients, sprouts, and seeds. RESULTS: Five sprout-associated outbreaks of salmonellosis and one outbreak of infection with nonmotile Shiga toxin-producing Escherichia coli O157 occurred. Six hundred patients had culture-confirmed disease, and two died. It is estimated that these outbreaks caused 22 800 cases of gastrointestinal illness or urinary tract infection. In the case-control studies, odds ratios for the association between illness and alfalfa sprout consumption ranged from 5.0 to infinity (all were statistically significant). Three sprout growers were implicated, and each was associated with two outbreaks. Outbreak strains of Salmonella were isolated from sprouts supplied by two sprout growers and from seeds used by the third sprout grower. CONCLUSIONS: As currently produced, sprouts can be a hazardous food. Seeds can be contaminated before sprouting, and no method can eliminate all pathogens from seeds. Seed and sprout growers should implement measures to decrease contamination. The general public should recognize the risks of eating sprouts, and populations at high risk for complications from salmonellosis or E. coli O157 infection should avoid sprout consumption.

Agriculture↗
PubMed2001

An outbreak of Salmonella serotype Thompson associated with fresh cilantro.

An outbreak of Salmonella serotype Thompson in California was identified through laboratory-based surveillance and investigated with case-control, traceback, and laboratory studies. There were 35 "sporadic" cases and a restaurant-associated outbreak of 41 cases with onset between 6 March and 31 March 1999. Three case patients were hospitalized. A case-control study found a significant association between illness and eating cilantro at a restaurant (63% of case patients vs. 34% of control subjects; odds ratio, 3.5; 95% confidence interval, 1.1-11.4). Although common distributors of cilantro were identified, inadequate records prohibited the identification of a single farm supplying cilantro. At room temperature, Salmonella Thompson grew more rapidly and to a higher concentration on chopped cilantro, compared with whole-leaf cilantro. Freshly made salsa (pH 3.4) supported growth of Salmonella Thompson. Cilantro should be served promptly after chopping. Accurate records of the distribution of produce should be available, and bacterial contamination of produce should be prevented in retail and wholesale establishments, in packing sheds, and on farms.

Adolescent↗
PubMed2001

Participation in arranging continuing health care packages: experiences and aspirations of service users.

AIMS: This paper examines patients' and carers' experiences of receiving community health services, and considers the degree of patients' participation in the management of their continuing care. BACKGROUND: Care management, advocated for many years as a way of ensuring appropriate and coordinated care, emphasizes the involvement of patients and carers in care planning. Evidence suggests that such involvement is unusual. METHODS: Semi-structured interviews were carried out with 99 continuing health care patients and/or their carers. FINDINGS: A few informants had willingly chosen to be active in arranging and coordinating their care, and a few others, who did not take an active role, were very satisfied with the services which they received. The majority, however, were not satisfied, feeling unclear about how their needs had been assessed and how services had been arranged. They were mostly disappointed by the absence of information and by the lack of regular contact with NHS and/or Social Services personnel. Some had felt compelled to become proactive in order to ensure that the care provided was adequate. CONCLUSIONS: Community nurses are valued by patients, and are well placed to be care managers. However, less qualified staff are also able to offer the regular support and information which patients want and value.

Adult↗
PubMed2000

HImPs (health improvement programmes). Trusting to luck.

An analysis of 36 health authorities' health improvement programmes found they reflected national priorities well. The average number of priorities was 13, with coronary heart disease/stroke, mental health and cancer being the most common. One plan set no priorities. Most programmes included some consultation with the public. Only seven HImPs included measurable targets. Many plans were written in a way which would make them difficult for the public to understand. Only 13 provided a glossary.

Community Health Planning↗
PubMed2000

Welfare benefits advice in primary care: evidence of improvements in health.

It is not uncommon for welfare benefits advice organisations to offer services in primary care settings. Given the link between deprivation and poor health, the maximising of individual income in this way may also be expected to improve health. However, such improvement has hitherto not been successfully measured. This paper reports on a small study of such a service, provided by the local Citizens Advice Bureau. Statistically significant increases in SF-36 scores were measured for those whose income increased as a result of receiving advice, despite the prevalence in the group (average age 56 y) of chronic disabling conditions such as arthritis and sensory impairment. These findings suggest that 'prescribing advice' is a health intervention which is appropriately situated in primary care.

Adolescent↗
PubMed1999

Long-term care. Wait 'til your dad gets home.

Patients and carers were unaware of eligibility criteria for long-term care. Many patients interviewed in a qualitative study were not aware they had been assessed for services. Delays in providing rehabilitation services and mobility restrict independence.

Aged↗
PubMed1999

An outbreak of Salmonella serogroup Saphra due to cantaloupes from Mexico.

An outbreak of Salmonella serogroup Saphra (S. saphra) infections was studied by laboratory-based surveillance, case-control and trace-back studies, and a survey of cantaloupe preparation practices. Twenty-four patients with S. saphra infections had illness onsets between 23 February and 15 May 1997; 75% were </=6 years old; 23% were hospitalized. Case patients were more likely than controls to have consumed cantaloupe (88% vs. 45%; matched odds ratio [MOR], 15. 5; 95% confidence interval [CI], 1.7-139) and precut cantaloupe (59% vs. 19%; MOR, 14.5; 95% CI, 1.6-128). The trace-back study identified 1 growing region in Mexico as the source of cantaloupes for 95% of the patients who ate cantaloupes. Only 17% of case patients washed cantaloupes before cutting them. This outbreak is another example of gastrointestinal disease in the United States associated with imported contaminated produce. Consumers and retailers should wash cantaloupes before cutting them; there should be international efforts to ensure food safety.

Adult↗