Sophie Hyndman

Rates of admission to hospital for asthma.

Abstract Objective: To describe trends in hospital admission rates for asthma in England and Wales (1976-85), the East Anglian region (from 1976 to 1991- 2), and Wales (1980-90). Design: Descriptive study. Setting: Hospitals in England and Wales; hospitals in the East Anglian Regional Health Authority; hospitals in Wales. Main outcome measures: Hospital admissions for asthma as principal diagnosis in England and Wales (Hospital In-patient Enquiry, 1976-85), for the East Anglian region (Hospital In-patient Enquiry, 1976-7; Hospital Activity Analysis, 1978-86; Regional Information System, 1987-8 to 1991-2), and for Wales (Hospital Activity Analysis, 1980-90). Results - Rates for England and Wales as a whole showed a steady upward trend throughout the period examined. Rates in East Anglia, though they were similar to the national trends in the early years, showed a peak in 1985 (for males and females) with some indication of a decline in rates thereafter. Rates for Wales showed an upward trend until 1988 (for both males and females) after which they showed a decline. Conclusions: Interpretation of the East Anglian trends is made more difficult by the change in England in 1987 of the system for the collection of hospital admission data. The fact that the rates for the East Anglian region seem to decline before this change and other considerations suggest that the observed trends, although partly reflecting the disruption of the coding during the changeover in systems, may not be entirely artefactual. The possible roles of diagnostic transfer and changes in the delivery of care, asthma treatment, admission and readmission policies, and the severity and prevalence of asthma in changing admission rates are considered. The changing trends in admission rates for East Anglia and Wales reflect recently published trends for mortality from asthma in England.

A randomized trial of dehumidification in the control of house dust mite

House dust mites (HDM) are sensitive to humidity. Few studies have adequately examined the potential of dehumidification in reducing HDM numbers.

Sex differences in the use of asthma drugs: cross sectional study

Objectives: To assess the use of asthma drugs by men and women with asthma and to identify sex specific predictors for the use of oral steroids. Design: Cross sectional study. Setting: Six general practicesin East Anglia. Subjects: 103 men and 134 women aged 20-54 with asthma. Main outcome measures: Self reported use of β agonists, inhaled steroids, and oral steroids. Results: No sex difference was found in use of β agonists or inhaled steroids. However a strong association existed between sex and oral steroid use. 40 (30%) women reported using oral steroids compared with nine (9%) men. Women were more than five times (odds ratio=5.5, 95% confidence interval 2.2 to 13.7) more likely to report use of oral steroids than men after asthma symptoms, age, visits to the general practitioner in previous six months, and time since diagnosis of asthma were controlled for. Women who had visited the general practitioner for asthma one or more times in the previous six months were four times (3.9, 1.6 to 9.5) as likely to report use of oral steroids. In addition, more frequent visits to the general practitioner for asthma were related in a dose-response manner to a greater likelihood of using oral steroids among women after asthma symptoms, age, and time since diagnosis were controlled for. This relation was not observed among men. Conclusion: Women used oral steroids more than men. The more frequent consultations with a doctor by women may result in more requests for oral steroids or doctors may preferentially prescribe oral steroids to women.

Criteria formulation and application: an evaluative framework

This paper critically examines how criteria are formulated and applied in quality assurance or quality improvement systems. It begins by drawing attention to the division that exists between criteria derived by so-called expert groups and those developed more locally by practitioners. In seeking to analyse the strengths and weaknesses of these two contrasting approaches, it explores the more fundamental questions of how criteria are formulated in general and how they can best be applied. An evaluative framework is offered as a working checklist for practitioners involved in criteria formulation. The framework identifies three main areas: actual construction of criteria; procedures for formulation and issues related to application. An example of each area is offered from results of the ODySSSy Project. The paper concludes by recommending more systematic studies in this highly complex area.