All new patients attending a Dublin Hospital's Accident and Emergency (A&E) Department were surveyed to document their reasons for attending and to make comparisons between self-referred and GP referred groups. Of the 557 responders 395 (70.9%) were self-referred. Four-fifths of this group said they had a GP but only 6.6 per cent attempted to contact the GP before attending. Compared with GP referred patients the self-referred group were more likely to be under 45 (74.6 per cent v 59.8 per cent, P< 0.01) and have soft tissue injuries (57 per cent v 32.9 per cent, P < 0.01). They were less likely to require laboratory investigation or to be admitted to hospital (11 per cent v 31.2 per cent, P < 0.01). It is likely many of the self-referred patients could have been managed by a GP. However, A & E departments remain popular sources of treatment for patients with a wide variety of conditions. Current methods of delivering health care to patients with minor conditions require assessment so that patient demands for both a responsive minor injury and emergency service can be met. Almost 70 per cent of all hospital admissions originated from the A&E department. This makes rational planning and management of booked admissions difficult. GPs who refer patients for admission should have an alternative route to hospital beds besides the A&E department.

Objectives-To identify the rate of baby walker use, parental attitudes, and associated injuries. Design-Parents of babies attending clinics for developmental assessment were surveyed by self administered questionnaire about their use, attitudes, and history of injuries associated with walkers. Setting-Dublin, Ireland. Subjects-Parents of 158 babies. Results-Fifty five per cent of the sample used a walker. The main reasons for doing so included babies' enjoyment of them and the fact that the walker was used for an older sibling. Although none of the users listed safety concerns as a reason to stop using the walker, non-users (45%) did so; 12-5% of the users had at least one walker related injury. Conclusions-Parents ofbabies who use a walker perceive them as beneficial. However these babies are placed at unnecessary risk. It behoves all health professionals and child carers to alert parents to these dangers and the sale of walkers should be reviewed.

Neither mortality data nor admissions data alone give an adequate guide to the impact of injuries, but together the two provide a reasonable basis on which to establish policy.

Ireland, in common with many countries, has a mixed private and public health care system. Concern has been expressed that this system may lead to inequity in access to medical treatment. To investigate this concern, all contacts and first admissions to the national liver transplant unit were identified between

SUMMARYFollowing an episode of water contamination with sewage in a rural Irish town, a community-wide survey of gastrointestinal-associated illness and health service utilization was conducted. Random sampling of households yielded residents who were surveyed using a self-administered questionnaire. Of 560 respondents from 167 (84%) households, equal proportions lived in areas known to have been exposed and unexposed to the contaminated water, although 65% of subjects reported using contaminated water. Sixty-one percent of subjects met the case definition. The most common symptoms among cases were abdominal cramps (80%), diarhoea (75%), appetite loss (69%), nausea (68%) and tiredness (66%).Mean duration of illness was 7-4 days. Only 22 % of cases attended their general practitioner. Drinking unboiled water from the exposed area was strongly associated with being a case. A substantial degree of community illness associated with exposure to contaminated water was observed. The episode ranks as one of the largest reported water-borne outbreaks causing gastrointestinal illness in recent times.