Trends in suicide in Scotland 1974-84: an increasing problem

A detailed investigation of trends in suicide rates in Scotland from 1974 to 1984 showed a complex pattern. Overall rates for men increased by 40% with the greatest increases in those aged 45-64. In contrast, rates for women showed a small decline, which was most noticeable in those aged 15-24. The well recognised decline in poisoning by domestic gas was seen over this period, and suicide by this method virtually stopped. Both sexes showed a decline in suicide by poisoning with drugs, although the decrease was larger among women. The fall in suicide rates among young women was almost all due to the decrease in this method. The rise in rates for men was largely due to increases in hanging and poisoning with vehicle exhaust gases, although all methods except drugs and domestic gas showed some increase. These findings indicate that suicide is an increasing problem with causes that are far from understood, so that prevention may be difficult

Partnerships with health and private voluntary organizations: what are the issues for health authorities and boards?

Background. The number of voluntary organizations active in health care is considerable. There have been recent calls for a new closer working relationship between voluntary bodies and the National Health Service. The relationship between the two healthcare sectors needs to be efficient and harmonious in the interests of patient care; however, little is known about the nature and problems in the current relationship. The present study was undertaken to examine aspects of this relationship from the point of view of health board personnel.Objective. To identify the practices and views of Scottish health board staff concerning the funding, role and responsibility of voluntary organizations in the health sector.Methods. A qualitative study based on in-depth interviews with health board officials in all 15 Scottish health boards.Results. Policies for financial and other relationships with the voluntary sector were often not explicit. The levels and method of funding voluntary health organizations varied across boards, as did the tenure of awards (from 1 to 3 years). Demand for funding far exceeded monies available. Some health boards ensured accountability through audited accounts, annual reports and site visits; however, others thought this inappropriate for small organizations. Health boards recognized the problems of the precariousness of funding and the administrative burden of the monitoring process and the ritual of applying for funding.Conclusion. The uncertainties of long-term funding may impede the contribution of voluntary organizations. There is a tension between the requirements of clinical governance and the ability of small voluntary organizations to provide the necessary documentation. One proposed solution, to reduce the number of organizations, might not appeal to the voluntary sector. Future initiatives could address the problem of tailoring funding and accounting to the resources of voluntary organizations

Asthma and growth--cause for concern? Asthma & growth in Tayside children

This project aimed to investigate the height and weight of children with asthma in the community. The Tayside Childhood Asthma Project examined medical records of 3143 children drawn from 12 general practices, for details of asthma morbidity and management. Concurrently, but independent from it, the Tayside Growth Study measured heights and weights of children aged 3-5, 5, 7, 9, 11 and 14 years. This paper reports on a cross-sectional analysis of 699 children who were known to be receiving some form of asthma medication during the school years 1990-91 and 1991-92 when a growth measurement was recorded. A standard deviation score (SDS) was calculated from height measurements for this cohort of children and from weight and body mass index (BMI = weight/height2) measurements for 559 of these children. The mean and standard deviation of these SDS values were calculated, and the distribution of the scores plotted. The results showed no difference in height, weight or BMI between the general population and the cohort receiving asthma medication. However, further analysis showed the distribution of height for children with severe asthma receiving high doses of inhaled corticosteroids (mean -0.38, SD 0.95) was significantly different from the general population (mean 0, SD 1). This group of children appeared to be shorter, by as much as 2 cm on average for a 5-year-old boy. In general, children receiving treatment for asthma within the community have a similar distribution of height and weight to normal children. Children receiving high-dose inhaled corticosteroids are shorter than their contemporaries, and deserve long-term follow-up

School absence--a valid morbidity marker for asthma?

OBJECTIVE: To determine how often children with asthma are absent from school compared to the 'average' child and to assess the validity of school absence as a marker of morbidity for asthma. DESIGN: Case control study. SETTING: Children registered with 12 general practices, attending 98 primary and secondary schools in the Tayside region. SUBJECTS: 773 children with asthma or related symptoms and 773 controls from school registers. MAIN OUTCOME MEASURES: Episodes of school absence and days absent per term, recorded from school registers. RESULTS: Comparing children taking asthma medication against their controls showed a significant difference for both days absent and episodes of absence. This increase in absence was approximately one school day each term. Severity of asthma was not related to increased school absence. Children receiving no asthma medication, but with asthma related symptoms, were absent no more than their age/sex matched controls. Applying a deprivation index to the cases on asthma medication, gave a significant difference in episodes of absence between Primary children classified as highly deprived and other Primary children. CONCLUSION: The increase in school absence of around one day per term for children with asthma is less than previously reported and could be caused by clinic attendance rather than ill health due to asthma. Recorded absence varied according to deprivation index but not asthma severity. The use of school absence as a marker of morbidity in childhood asthma needs to be reassessed