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BMJ No 7116 Volume 315

Papers - Abstracts Saturday 1 November 1997


Effect of nutrition improvement project on morbidity from infectious diseases in preschool children in Vietnam: comparison with control commune
Inequalities in income and long term disability in Spain: analysis of recent hypotheses using cross sectional study based on individual data
Patients' views on their discharge from follow up in outpatient clinics: qualitative study

Effect of nutrition improvement project on morbidity from infectious diseases in preschool children in Vietnam: comparison with control commune

R M English, J C Badcock, Tu Giay, Tu Ngu, A-M Waters, S A Bennett

Abstract

Objective: To evaluate the effect of a nutrition improvement project based on home garden production and nutrition education on morbidity from acute respiratory infection and diarrhoeal disease in preschool children.

Design: The morbidity survey comprised five data collections undertaken by trained interviewers to ascertain the incidence and severity of respiratory infections and the incidence of diarrhoeal disease in children in two communes.

Setting: A project commune and a control commune in Vietnam.

Subjects: Preschool children to 6 years of age living in the project commune Khai Xuan (average 469 children) and the control commune Ching Cong (average 251 children).

Main outcome measures: Differences between the two communes over time in the incidence and severity of respiratory infections and the incidence of diarrhoeal disease.

Results: In Khai Xuan there was a significant reduction (P<0.0001) in the incidence of respiratory infections (from 49.5% to 11.2%) and diarrhoeal infections (18.3% to 5.1%); the incidence of pneumonia and severe pneumonia was also significantly reduced (P<0.0001). In Ching Cong there was no significant change in the incidence and severity of respiratory disease nor in the incidence of diarrhoeal disease.

Conclusions: These findings emphasise the successful health outcome of a nutrition project based on household food production and nutrition education and the value of evaluating nutrition projects by reference to measurable health outcomes.

University of Queensland,
Department of Social and Preventive Medicine,
Medical School,
Herston,
Queensland 4006,
Australia
R M English,
honorary research consultant in public
health nutrition

Unicef,
Fiji Development Bank Building,
Suva,
Fiji
J C Badcock,
subregional administrator

National Institute of Nutrition,
Hanoi,
Socialist Republic Vietnam
Tu Giay,
chairman of the National Steering Committee for project
Tu Ngu,
head of monitoring and surveillance department

Australian Institute of Health and Welfare,
Bruce,
Australian Capital Territory 2617,
Australia
A-M Waters, data analyst
S A Bennett, senior research fellow,
statistics

Correspondence to: Dr English renglish@ozemail.com.au

Inequalities in income and long term disability in Spain: analysis of recent hypotheses using cross sectional study based on individual data

Enrique Regidor, Pedro Navarro, Vicente Dominguez, Carmen Rodriguez

Abstract

Objective: To compare the relation between inequalities in long term disability and income in the 17 regions of Spain.

Design: Data were taken from the survey on impairments, disabilities, and handicaps that was carried out in Spain in 1986. For each region the inequality in long term disability associated with income was calculated as the odds ratio associated with reducing monthly household income by 10 000 pesetas (about £50) (estimate of effect of inequality of income) and the odds ratio for the inequality in long term disability between those at the bottom and those at the top of the income hierarchy (relative index of inequality).

Main outcome measure: Prevalence of long term disability.

Results: Five of the eight regions where lowering income had a greater effect on long term disability were among those with the lowest income per head, while six of the remaining nine regions where the effect was smaller were among those with the highest income per head. Three regions with the highest estimate of relative index of inequality had the highest estimate of effect, and another three regions with the lowest estimate of relative index of inequality had the lowest estimate of effect. In contrast, the relative position of the remaining 11 regions varied from one measure to another.

Conclusions: These results support the theory that additional increments in material wellbeing have a negligible effect on health in countries with high socioeconomic development. However, inequality in income distribution did not determine inequality in health between those at the bottom and those at the top of the income hierarchy in many Spanish regions.

Department of Preventive Medicine and Public Health,
Complutense University of Madrid,
Faculty of Medicine,
Ciudad Universitaria,
28040 Madrid,
Spain
Enrique Regidor,
honorary professor
Pedro Navarro,
professor
Vicente Dominguez,
head of department

Department of Epidemiology,
Ministry of Health,
Madrid,
Paseo del Prado 18-20,
28071 Madrid
Carmen Rodriguez,
senior epidemiologist

Correspondence to: Dr Regidor

Patients' views on their discharge from follow up in outpatient clinics: qualitative study

Yvonne Burkey, Mary Black, Hugh Reeve

Abstract

Objectives: To discover the views of patients about their discharge from outpatient clinics, to detect any change in these perceptions over time, and explore how the discharge process might be improved for the patient.

Design: A qualitative study comprising in-depth or semistructured interviews with patients 2 weeks and 3 months after discharge from an outpatient clinic.
Subjects: 45 patients who had attended outpatient clinics on three or more occasions.

Setting: Five general medical outpatient clinics from a Manchester provider trust.
Main outcome measures: Aspects of the discharge consultation valued by patients included confidence that the doctor knew and understood their case; clarity of the discharge process; an explanation of the reasons for discharge; information about treatment, future care, and the mechanism for re-referral; and being seen by doctors who sought their views and allowed time for questions and reflection.

Conclusions: Patients' views about their discharge changed over time and varied in relation to several factors, which included patients' perceptions of the discharge process, patients' expectations, the way in which the outpatient clinics were organised, and patients' relationships with, and confidence in, their general practitioners.

National Primary Care Research and Development Centre,
University of Manchester,
Manchester M13 9PL
Yvonne Burkey,
research associate

Public Health Research and Resource Centre,
University of Salford,
Salford M5 4QA
Mary Black,
research fellow

Department of General Practice,
University of Manchester,
Rusholme Health Centre,
Manchester M14 5NP
Hugh Reeve,
honorary lecturer in general practice

Correspondence to: Ms Y Burkey,
Medical Audit Advisory Group,
Stockport Health Authority,
Stockport SK7 5BY
StockportMaag@btinternet.com


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