Measles immunisation rates and the good practice allowance.

The recent discussion document on primary health care proposes that a good practice allowance is paid to general practitioners based in part on the uptake of immunisation by patients. The variation between and the validity of practice immunisation rates for measles as determined by one district health authority''s child health computer are assessed. In areas of low population mobility district health authority rates may be sufficiently accurate to base a good practice allowance on but should not be used until the social environment of each practice can also be characterised. In areas of high mobility intermittent surveys may be a preferable method of auditing performance.     

Attendance of general practitioners at child protection case conferences.

OBJECTIVE--To investigate general practitioners'' attendance at and views on child protection conferences and their confidence in dealing with sexual abuse in children. DESIGN--Anonymous postal questionnaire sent to all general practitioners in Tower Hamlets and review of consecutive case conferences held by social services for three months in 1989. SETTING--Tower Hamlets health district. SUBJECTS--91 general practitioners, 56 of whom (62%) responded. MAIN OUTCOME MEASURES--Number of conferences attended, reasons for non-attendance, and reported confidence in dealing with sexual abuse. RESULTS--General practitioners estimated that 202 child protection conferences had been held in 1989 on their patients and that they had attended 85 of these. Information from social services for three months suggested that general practitioners had attended only nine of the 114 conferences reviewed. Timing of the conference was the most important reason for non-attendance. All respondents wanted access to the minutes of these conferences irrespective of their own attendance. Most general practitioners were very or moderately confident of their ability to detect child sexual abuse and non-accidental injury and to communicate with the family. CONCLUSION--More effort should be made to ensure that general practitioners are notified of case conferences and that the timing and location of conferences is compatible with their other commitments.     

膳食营养素推荐供给量的进展

目录一、背景二、膳食营养素的需要量三、膳食营养素的推荐供给量　 (一 )供给的照顾面问题　 (二 )供给量转换成为日常食物四、膳食营养素供给量的解释与普及五、膳食营养素推荐供给量的进展———膳食参考摄入量膳食营养素推荐供给量 (ｒｅｃｏｍｍｅｎｄｅｄｄｉｅｔａｒｙａｌｌｏｗａｎｃｅｓ,ＲＤＡｓ) ,是依据营养科学的知识和实践 ,为居民集团指定的为使机体处于最佳状态的各种已知营养素摄入量。这一量值考虑到居民集团中不同年龄、性别及生理状况的差别 ,以便指导人们的饮食实践 ,并不断改善人们的健康与生活质量 ;同时也为全民的…     

Attendance at a breast screening clinic: a problem of administration or attitudes.

In a study of why a sample of women, aged 45-64 and registered with a group practice in Edinburgh, attended or did not attend the Edinburgh Breast Screening Clinic demographic, aetiological, social, and perceptual characteristics of attenders and non-attenders were compared. Similar proportions of attenders and non-attenders knew the chance of a breast lump being cancer and were aware of the benefits of early diagnosis and treatment. The study, however, suggests that non-attenders saw the screening clinic as a place of risk while the attenders saw screening in a positive light: 79% of non-attenders as compared with 36% of attenders said that they were afraid of cancer being found, and most women attended either to reassure themselves that they had not got breast cancer or to receive early treatment if they had. Furthermore, 72% of non-attenders as compared with 13% of attenders were anxious that their lives would be disrupted if cancer were found at the screening clinic. There may well be an important irreducible element to non-attendance due to attitudinal factors; the ethical implications of attempting to eliminate this require careful consideration.