The Health Status Questionnaire: achieving concordance with published disability criteria

Aim: To compare the Health Status Questionnaire with established methods of assessing disability in preterm and very low birthweight infants. Method: All survivors of gestational age <31 weeks or birth weight <1500 g, born in 1994 to women resident in Wales were identified. Assessments were by a single observer at a median corrected age of 28.3 months and included the Health Status Questionnaire and a Griffiths developmental test. Outcome was also described according to criteria for disability used in three published studies. Results: There were 297 survivors of which 279 (94%) were assessed. Using the Health Status Questionnaire, severe disability was found in 12.9% of cases compared to 8.2%, 2.9%, and 3.6% using the Northern, Victorian, and Mersey outcome criteria respectively. Following the simple modifications of removing the growth criteria from the Health Status Questionnaire and reclassifying the severe disability group in the Victorian and Mersey criteria, comparable severe disability rates ranging from 7.9% to 9.3% were found. Conclusion: The Health Status Questionnaire requires no formal training, is rapid to perform, and with simple modifications provides comparable results to established methods of assessing disability. Its use in the follow up of preterm and very low birthweight infants should be encouraged

Reemergence of canine echinococcus granulosus infection, Wales

As a consequence of large-scale outdoor slaughter of sheep during the 2001 foot and mouth disease (FMD) outbreak in the United Kingdom and the possibility of increased risk for transmission of Echinococcus granulosus between sheep and dogs, a large survey of canine echinococcosis was undertaken in mid-Wales in 2002. An Echinococcus coproantigen-positive rate of 8.1&#37; (94/1,164) was recorded on 22&#37; of farms surveyed, which compares to a rate of 3.4&#37; obtained in the same region in 1993. Positivity rates between FMD-affected properties and unaffected ones did not differ significantly. Significant risk factors for positive results in farm dogs were allowing dogs to roam free and the infrequent dosing (&#62;4-month intervals) of dogs with praziquantel. When these data are compared to those of a previous pilot hydatid control program in the area (1983–1989), an increase in transmission to humans appears probable

A scoring system for bruise patterns: a tool for identifying abuse

Aims: To determine whether abused and non-abused children differ in the extent and pattern of bruising, and whether any differences which exist are sufficiently great to develop a score to assist in the diagnosis of abuse. Methods: Total length of bruising in 12 areas of the body was determined in 133 physically abused and 189 control children aged 1–14 years. Results: Our method of recording bruises by site, maximum dimension, and shape was easy to use. There were clear differences between cases and controls in the total length of bruises. These differences were at their greatest in the head and neck and were less notable in the limbs. A scoring system was developed using logistic regression analysis using total lengths of bruising in five regions of the body. Good discrimination between the two sets of children was achieved using this score; by including a variable that indicates whether a bruise had a recognisable shape the discrimination could be made even better. Given a prior probability of abuse the score can be used to give posterior odds of abuse, given a particular bruising pattern. Conclusions: The scoring system provides a measure that discriminates between abused and non-abused children, which should be straightforward to implement, though the results must be interpreted carefully. We do not see this score as replacing the complex qualitative analysis of the diagnosis of abuse. This clearly includes history as well as examination, but rather as the beginning of the development of an important aid in this process

Differences in risk of mortality under 1 year of age between rural and urban areas: an ecological study

Objective: To investigate differences in risk of categories and causes of death before 1 year of age between rural and urban areas. Methods: Population-based ecological study using Poisson regression analysis of data from all enumeration districts in Wales. Data included all 243 223 registrable births to women resident in Wales, 809 therapeutic and spontaneous abortions, 1302 stillbirths and 1418 infant deaths occurring between 1993 and 1999. Main results: The relative risk of mortality in rural areas compared with urban areas for all deaths before 1 year of age was 0.89 (95% confidence interval 0.82, 0.98, P=0.02). The risk of mortality in rural areas was significantly lower than in urban areas for all categories of deaths occurring after 7 days of life. The relative risk of death due to infection was significantly lower in rural areas compared with urban areas (P=0.04), with similar results for deaths due to sudden infant death syndrome (P=0.03). After adjusting for social deprivation, there were no significant differences in the risk of death between rural and urban areas. Conclusions: While there were significant differences in crude risk between rural and urban enumeration districts for some causes and age groups before 1 year, after adjusting for social deprivation, these differences were not significant. The lack of significant interaction between rurality and deprivation indicated that the relationship between social deprivation and death before 1 year of age was not significantly different in rural areas compared with urban areas. Collaborative public health programmes to tackle deprivation are necessary in both rural and urban areas

Is regional paediatric surveillance useful? Experience in Wales

The Welsh Paediatric Surveillance Unit was established in 1994 to monitor the incidence and prevalence of a number of uncommon disorders of childhood in Wales. Its work complements that of the British Paediatric Surveillance Unit. Information from consultant paediatricians is obtained by means of a monthly card return system; return rate is over 90%.


A case-control study of domestic kitchen microbiology and sporadic Salmonella infection.

The microbiology of domestic kitchens in the homes of subjects who had suffered sporadic Salmonella infection (cases) was compared with control domestic kitchens. Case and control dishcloths and refrigerator swabs were examined for the presence of Salmonella spp., total Enterobacteriaceae counts and total aerobic colony counts. Salmonella spp. were isolated from both case and control dishcloths and refrigerators but there were no significant differences between the two groups. Colony counts were similar in case and control dishcloths and refrigerator swabs. There was no relationship between the total counts and presence of Salmonella . There was no evidence that cases of Salmonella infection were more likely to have kitchens which were contaminated with these bacteria or have higher bacterial counts than controls. Total bacterial counts were poor indicators of Salmonella contamination of the domestic kitchen environment. Further factors which could not be identified by a study of this design may increase risk of Salmonella food poisoning. These factors may include individual susceptibility of the patient. Alternatively, sporadic cases of Salmonella food poisoning may arise from food prepared outside the home

A scoring system for bruise patterns: A tool of identifying abuse. Arch Dis Child 2002;86:330–333

Aims: To determine whether abused and non-abused children differ in the extent and pattern of bruising, and whether any differences which exist are sufficiently great to develop a score to assist in the diagnosis of abuse. Methods: Total length of bruising in 12 areas of the body was determined in 133 physically abused and 189 control children aged 1-14 years. Results: Our method of recording bruises by site, maximum dimension, and shape was easy to use. There were clear differences between cases and controls in the total length of bruises. These differences were at their greatest in the head and neck and were less notable in the limbs. A scoring system was developed using logistic regression analysis using total lengths of bruising in five regions of the body. Good discrimination between the two sets of children was achieved using this score; by including a variable that indicates whether a bruise had a recognisable shape the discrimination could be made even better. Given a prior probability of abuse the score can be used to give posterior odds of abuse, given a particular bruising pattern. Conclusions: The scoring system provides a measure that discriminates between abused and non-abused children, which should be straightforward to implement, though the results must be interpreted carefully. We do not see this score as replacing the complex qualitative analysis of the diagnosis of abuse. This clearly includes history as well as examination, but rather as the beginning of the development of an important aid in this process. P aediatricians are often asked for an opinion on whether a particular pattern of bruising is caused by abuse. This might arise in a variety of settings-clinical, child protection, or in legal proceedings. Although some studies have looked at the age of children and bruising, 1 2 and others have looked at the age of individual bruises, 3-5 the evidence base 6 7 for coming to a conclusion on an individual pattern of bruising is very limited. One reason for this is that child protection is a multidisciplinary activity, led by social workers whose research base is largely qualitative. Another is the difficulty of obtaining data on bruises on non-abused children. There is also the problem of recording information on bruises in a way that is not invasive and yet is in sufficient detail for the results to be analysed statistically. There are two related but separate issues to be investigated. Is the extent and pattern of bruising different in abused and non-abused children? Are any differences sufficiently great to develop a score to assist in the diagnosis of abuse? In a preliminary study METHODS The subjects studied were children aged 1-13 years attending the Llandough Children&apos;s Centre, which serves the Vale of Glamorgan and the West of Cardiff. In the centre we see child outpatients, children with special needs, and referrals under child protection procedures but there is no accident and emergency department. We decided to study children under 1 separately as they are not mobile, so bruising in any area has greater significance than in older children. The abused cases were identified from our child protection database. They were children who had attended the centre between 1992 and 1996, whose notes were obtainable, and who were classified as having been physically abused following a case conference or other multidisciplinary meeting. The bruising patterns of control children were obtained from those attending the centre for ambulatory outpatient consultation for reasons other than abuse between 1998 and 1999, during a clinical examination that would have been undertaken anyway. When this study was initially planned the controls were to be children attending the accident department, but this proved impractical because of the extra undressing of children that would be required. The timescale of collection of cases and controls was therefore different, but we do not believe that this invalidates our results. Bruises were measured using paper tape measures. Parental consent was obtained; no parent declined to take part. Cases and controls were examined by consultants or specialist registrars (residents) in community child health. The sex ratios in abused and controls were nearly identical, with 66% boys and 34% girls. The mean age of cases was 7.7 years and of controls 6.4 years. Details of bruises were recorded in each of 12 regions of the body: anterior chest and abdomen, back, buttocks, left and right arms, left and right legs, left and right face, left and right ears, and other head and neck. In each region, the number of bruises was recorded, together with the maximum dimension of each bruise, and whether or not each bruise had a specific shape, such as being linear or shaped like a hand. In order to establish a scoring system we divided regions as follows

Social deprivation and the causes of stillbirth and infant mortality

AIMS To investigate the relation between social deprivation and causes of stillbirth and infant mortality. METHODS Stillbirths and infant deaths in 6347 enumeration districts in Wales were linked with the Townsend score of social deprivation. In 1993–98 there were 211 072 live births, 1147 stillbirths, and 1223 infant deaths. Poisson regression analysis was used to estimate the magnitude of effect for associations between the Townsend score and categories of death by age and the causes of death. The relative risk of death between most and least deprived enumeration districts was derived. RESULTS Relative risk of combined stillbirth and infant death was 1.53 (95% CI 1.35 to 1.74) in the most deprived compared with the least deprived enumeration districts. The early neonatal mortality rate was not significantly associated with deprivation. Sudden infant death syndrome showed a 307% (95% CI 197% to 456%) increase in mortality across the range of deprivation. Deaths caused by specific conditions and infection were also associated with deprivation, but there was no evidence of a significant association with deaths caused by placental abruption, intrapartum asphyxia, and prematurity. CONCLUSIONS Collaborative public health action at national and local level to target resources in deprived communities and reduce these inequalities in child health is required. Early neonatal mortality rates and deaths from intrapartum asphyxia and prematurity are not significantly associated with deprivation and may be more appropriate quality of clinical care indicators than stillbirth, perinatal, and neonatal mortality rates