James Pearson

Randomised placebo-controlled crossover trial on effect of inactivated influenza vaccine on pulmonary function in asthma

BACKGROUND Despite current recommendations, many people with asthma do not receive annual vaccination against influenza, partly because of concern that vaccine may trigger exacerbations. Colds can trigger exacerbations, which may be mistaken for vaccine-related adverse events. We undertook a double-blind placebo-controlled multicentre crossover study to assess the safety of influenza vaccine in patients with asthma, with allowance for the occurrence of colds. METHODS We studied 262 patients, aged 18-75 years, who recorded daily peak expiratory flow (PEF), respiratory symptoms, medication, medical consultations, and hospital admissions for 2 weeks before the first injection and until 2 weeks after the second injection. Order of injection (vaccine and placebo) was assigned randomly. There was an interval of 2 weeks between injections. The main outcome measure was an exacerbation of asthma within 72 h of injection (defined as a fall in PEF of >20%). FINDINGS Among 255 participants with paired data, 11 recorded a fall in PEF of more than 20% after vaccine compared with three after placebo (McNemars test p=0.06); a fall of more than 30% was recorded by eight after vaccine compared with none after placebo (binomial test p=0.008). However, when participants with colds were excluded, there was no significant difference in the numbers with falls of more than 20% between vaccine and placebo (six vs three; binomial test p=0.51), although the difference for PEF decreases of more than 30% approached significance (five vs none; binomial test, p=0.06). This association was confined to first-time vaccinees. INTERPRETATION Our findings indicate that pulmonary-function abnormalities may occur as a complication of influenza vaccination. However, the risk of pulmonary complications is very small and outweighed by the benefits of vaccination.

Excess hospital admissions for pneumonia and influenza in persons > or = 65 years associated with influenza epidemics in three English health districts: 1987-95

OBJECTIVES To study the association between community influenza activity and acute hospital admissions for pneumonia and influenza among elderly persons. DESIGN Multiple regression analysis of acute hospital admissions against community influenza activity, air temperature and seasonal and long-term trends. SETTING Three English health districts: 1987-95. SUBJECTS Persons aged > or = 65 years. OUTCOME MEASURES Acute hospital admissions for pneumonia and influenza (ICD9: 480-487); excess hospital admissions during epidemic periods. RESULTS The final regression model explained 70% of the total variation in hospital admissions for pneumonia and influenza, including 14% due to community influenza activity. However, most variation was explained by long-term and seasonal changes unrelated to influenza. In the large influenza epidemic of 1989/90 a typical health district (500,000 total population) experienced 56 excess admissions for pneumonia and influenza attributable to epidemic influenza among persons aged > or = 65 years, requiring 672 additional bed-days. However the figure varied widely between seasons and over the whole study period, the average winter excess was 17.5 admissions per health district, requiring an additional 210 bed-days. CONCLUSIONS Influenza epidemics exert a variable impact on acute hospital admissions for pneumonia and influenza among elderly persons, which in the past have been poorly quantified. Although the absolute numbers of excess admissions is modest, their impact on bed availability may be considerable because of the duration of hospital stay in elderly persons.

Adverse medical events in British service personnel following anthrax vaccination.

The safety of the UK anthrax vaccine in British service personnel was evaluated by a retrospective cohort study of randomly selected personnel from five Royal Air Force bases by investigating adverse medical events and consultation rates for a period before and after vaccination. Vaccination acceptance rate varied from 27 to 89% (P=0.0001). In the vaccinated cohort 11.1% (n=368) reported side-effects. The number of consultations in the year prior to vaccination (P=0.04) and RAF base (P=0.0085) were associated with side-effects. Only the RAF base remained a statistically significant factor (P=0.007) after adjusting for other factors. The anthrax vaccine resulted in mild side-effects in 11%, and no serious side-effects were observed. Acceptors of vaccine did not have significantly more medical consultations following vaccination than their unvaccinated counterparts.

Do Influenza Epidemics Affect Patterns of Sickness Absence Among British Hospital Staff

Influenza vaccination for healthcare workers is not recommended in Britain, but some hospitals offer vaccine to reduce sickness absence. However, in Nottingham, the influenza epidemics of 1993-94 and 1996-97 made no impact on staff absence. Annual vaccination of healthcare workers against influenza is unlikely to reduce absence most winters, but there may be gains in terms of preventing nosocomial infection.

Risk factors for hospital-acquired urinary tract infection in a large English teaching hospital: a case-control study.

About 10% of patients in hospital develop a hospital-acquired infection (HAI); the most commonly affected site is the urinary tract. Many studies have examined risk factors for HAI but few have adjusted for confounding and interaction. We performed a prospective case-control study on six acute wards of a busy English teaching hospital to assess risk factors for hospital-acquired urinary tract infection (HAUTI). Over a 2-year period, 136 cases were identified (2.8% of all patient episodes) along with 408 controls. Multiple logistic regression revealed that female sex, increased length of stay, elective admission, surgical operation, and transurethral and repeated intermittent catheterization were all significant independent risk factors for HAUTI. However, specialty of admission was also a significant risk factor when added to the model and, under these conditions, only length of stay and catheterization also remained significant. We detected significant interactions suggesting that the risk of HAUTI is maximal among women undergoing elective surgery, especially those who are catheterized; however, the overall risk of HAUTI among patients admitted electively was greater than for patients admitted as emergencies.SummaryAbout 10% of patients in hospital develop a hospital-acquired infection (HAI); the most commonly affected site is the urinary tract. Many studies have examined risk factors for HAI but few have adjusted for confounding and interaction. We performed a prospective case-control study on six acute wards of a busy English teaching hospital to assess risk factors for hospital-acquired urinary tract infection (HAUTI). Over a 2-year period, 136 cases were identified (2.8% of all patient episodes) along with 408 controls. Multiple logistic regression revealed that female sex, increased length of stay, elective admission, surgical operation, and transurethral and repeated intermittent catheterization were all significant independent risk factors for HAUTI. However, specialty of admission was also a significant risk factor when added to the model and, under these conditions, only length of stay and catheterization also remained significant. We detected significant interactions suggesting that the risk of HAUTI is maximal among women undergoing elective surgery, especially those who are catheterized; however, the overall risk of HAUTI among patients admitted electively was greater than for patients admitted as emergencies.

An evaluation of a new teenage clinic and its impact on teenage conceptions in Nottingham from 1986 to 1992

A new contraceptive clinic for teenagers was developed in the centre of Nottingham from 1987 to 1992 and provided care for over 1500 young people in its first three years. Twenty-five percent of clients were aged 16 years and 32% aged 15 or younger. Sixty-seven percent were in full-time education and young unemployed people were under-represented. The majority were young women, who came for routine contraception, usually the oral contraceptive or condom. Seventeen percent came for emergency contraception and 8% for abortion counselling and referral. Over the period 1986 to 1992, data on conceptions for teenage women and women aged over 20 years, who were resident in Nottingham Health district, were compared and when corrected for the estimated population showed that there had been no reduction in teenage conception rates; reasons for this are discussed. The value of conception rates as a measure of quality of sexual health care for teenagers is questioned and other more qualitative methods suggested.

The management and organisation of health promotion: a survey of school policies in Nottinghamshire

A postal survey of health education and related policy issues was conducted in Nottinghamshire state-maintained primary and secondary schools, in 1995. A response rate of 82 per cent was achieved. Fifty-eight per cent of schools possessed a written policy in health education or were in the process of drafting one. Teaching staff were involved in the consultation process, in the main, with a minority of schools involving non-teaching staff, parents and pupils. Primary schools, and in particular small primaries, had less well-developed policies than secondaries. They were also less likely to have a designated person in charge of health education and to reward them financially for undertaking the responsibility. The schools reported difficulty in prioritising the development of health education. Nevertheless, they were developing a wide range of policies, written guidelines and procedures which reflect the broad concept of the health promoting school. The health promotion specialist services have, in partnership with the education authorities, a good basis on which to build further improvements in the health promoting status of schools in the county.

Effectiveness of ambulance paramedics versus ambulance technicians in managing out of hospital cardiac arrest.

OBJECTIVE: To determine the effectiveness of extended trained ambulance personnel (paramedics) for the management of out of hospital cardiac arrest. METHODS: A retrospective cohort study of patients who suffered a cardiac arrest between 1 January 1992 and 31 July 1994, and who were transported to their local accident and emergency (A&E) department. Data were collected on basic demography, operational time intervals, and ambulance crew status. Further clinical data were collected, and outcome measures included status on arrival at A&E, status on leaving A&E (hospital admission), and status on leaving hospital. The data were analysed using univariate and multivariate techniques. RESULTS: Univariate analysis showed the likelihood of arriving in A&E with a return of spontaneous circulation was more than doubled among patients attended by a paramedic crew compared with those attended by technicians (relative risk = 2.48, 95% confidence interval 1.34 to 4.60). The likelihood of successful hospital admission was also significantly increased (RR = 1.92, 95% CI 1.13 to 3.27); however, beyond this point, further survival benefits appeared to be much smaller. Similar findings were revealed using multivariate analysis. Second level modelling revealed further possible differences between paramedic and technician crews according to type of incident. Patients successfully admitted to hospital who died before discharge remained severely disabled between admission and death. CONCLUSIONS: There are marked short term survival advantages after cardiac arrest associated with paramedic care, but these probably diminish rapidly over time.

A Survey of HIV- and AIDS-Related Knowledge, Beliefs and Attitudes among 14-year-olds in Nottinghamshire.

Summary A survey of the knowledge, beliefs and attitudes related to HIV/AIDS was carried out, using a self‐completion questionnaire, on 803 14‐year‐old pupils in 13 schools in Nottinghamshire. Knowledge levels of the main transmission routes for HIV were found to be high but with some confusion surrounding the safety of kissing, receiving a blood transfusion in the UK and the donation of blood. The great majority (95 per cent) knew that the use of condoms during sexual intercourse reduced the risk of HIV infection, expressed positive attitudes towards condom use and felt that they knew how to use them. Most did not want to see children with HIV excluded from school, but a sizeable minority (29 per cent) thought that everyone in school had a right to know who these children are. Recommendations are drawn from the findings of the survey for the planning of HIV and AIDS education programmes under the new legal framework for sex education in schools in England.

Adolescents' desires and beliefs about motorcycling: implications for education

A QUESTIONNAIRE survey undertaken in October 1984 involving 480 adolescents aged between 15 and 16 years investigated the desirability of taking up motorcycling whilst still a teenager in relation to various demographic and road safety factors. This desire was strongest in males from rural areas who had poor prospects for further education. This group also had the least inclination to take rider training and other road safety precautions. Since the majority of pupils were well aware of the casualty levels, deliberate risk-taking may be involved. There are a number of implications for health education about road safety.