British journal of preventive & social medicine最新文献

The costs and economic benefits are examined of introducing a programme for the mass-screening of pregnancies for the detection and abortion of fetuses with spina bifida cystica. A benefit-cost index is derived, and the possible effects on it of making different input assumptions are discussed. It is considered that, on economic grounds, screening may be worthwhile only in populations in which the incidence of spina bifida is high.

The health service computer policy is reviewed in this paper particularly the potential contribution of some systems to information gathering. The paper begins with a brief description of the computer applications thought suitable for the medical field in the late 1960s, and two views of the future that were published in 1968. Two reports on computing and information systems in Scotland are then described; the general philosophy and specific proposals on the use of population files are contrasted with the initial Department of Health and Social Services' (DHSS) experimental computer program. The subsequent changes in English policy are revealed in the reports of three reviews published by the DHSS. The present development of a master patient index in Tayside is noted and the potential applications in management and planning of information stemming from such systems are discussed. It is suggested that lack of work in this field is a major gap in the programme of activity in England.

A review of 76 Southampton children with Henoch-Schönlein purpura has confirmed that there is no evidence of a streptococcal aetiology in the majority of cases of this disease. Among these patients the frequency of preceding respiratory infection of all kinds was only 7 percent greater than that in controls. Data on month of admission in four areas of England and Scotland show that the incidence of the disease is lowest in the June-August period. Contrary to previous findings there is no marked peak of incidence in any single month.

The concentrations of 20 trace elements were determined by atomic absorption spectrophotometry on representative samples of tap-water collected from 48 local authority areas in South Wales. The associations between twelve trace elements and central nervous system (CNS) malformation rates for the 48 areas were examined. Significant correlations for four trace elements were observed. Of these, Al was positively correlated while for the remaining three-Ca, Ba, and Cu-negative associations were found. Regression analysis of the data suggested that the relationships between Ba and Cu with CNS malformation rates were improtant than those of Al and Ca.

The Medical Division of the Office of Population Censuses and Surveys (OPCS) organizes and indexes general systems of records for medical research and administration. The main sources of records are the census, registrations of births and of deaths, hospital discharge records, registered cases of cancer and of congenital malformations, surveys by the Social Surveys Division, and samples of records in general practice. Results take the form of regularly published series of statistics and commentaries and of studies in depth, often by scientists in the National Health Service (NHS), and research institutions which are encouraged to use the systems for prospective and retrospective surveys. The surveys are facilitated by the central registry where a note of every death in the country is attached to the relevant record (and the causes of death are available). Recent developments include studies of records of general practitioners; the causes of deaths among immigrants in England and Wales; the fertility, migration, and mortality of a cohort of about 1 percent of the population. The publication policy of OPCS is described.

A survey of 1329 relatives of 139 patients with coeliac disease demonstrated an overall increase of cancer deaths particularly in women, but this did not quite reach 5 percent significance in men. Evidence is insufficient to determine whether this was due to the occurrence of cancer in relatives with undetected coeliac disease or to the operation of independent factors.

In an attempt to corroborate the finding of Roberts and Lloyd (1973) of increased incidence of previous abortions in women living in those areas of South Wales with relatively low incidences of malformations of the central nervous system, we examined the data of the 1958 British Perinatal Mortality Survey. We also found evidence that the history of preceding abortion among all mothers in this survey was slightly more prevalent in areas where the rates of stillbirth and neonatal death from anencephalus or spina bifida were low, but the order of magnitude was much less than in the Welsh study.

The aim of the present study is to investigate the incidence of morbidity leading to incapacity for work in the working age population of Finland, and to examine critically the development of such illness and variations between different population groups. An attempt is made to analyse to what extent regional differences in illness development are connected with the communal structure of an area and the provision and use of medical services. The material is based on data from the sickness insurance and national penisons, and mortality statistics. The variables used as those defined by Kalimo (1967; 1968) to describe the various features of community structure and the supply of medical services, and data from the insurance and hospital service statistics to measure the use of medical services. The results indicate considerable variation in the course of illnesses between population groups, as expressed as the incidence rates for the various phases of illness or as development probabilities. Illness development proved to be more unfavourable in men than in women. Large regional differences were found, with the course of illnesses appearing to be much more unfavourable in the eastern and northern parts of Finland than in the south and south west. This seems to be closely connected with poorer socioeconomic development and lower urbanization in an area. A clear correlation was found between illness development and the supply and use of medical services in ambulatory care. Illness development was particularly unfavourable in areas where the supply and use of ambulatory medical services, especially doctors' services, were poor. No corresponding correlation was found with the supply and use of hospital services. Development of sickness proved to be connected with a neglect of illnesses at an early phase and delay in seeking medical care. The result is confirmed by variations between population groups in the numbers of sickness benefits awarded. It was confirmed that morbidity resulting in incapacity for work is closely associated with local socioeconomic development.

A total of 1525 schoolgirls aged 13 years from 21 schools in the County Borough of Dudley, were bled for titration of rubella haemagglutinating inhibiting antibody and then were immediately vaccinated with either Wistar RA 27/3 or Cendehill strain live attenuated. Both vaccines were administered subcutaneously by syringe and needle but the Wistar RA 27/3 vaccine was also given by multiple injection apparatus. Significnatly higher conversion rates and geometric mean haemagglutinating inhibiting antibody titres were obtained in girls initially seronegative given the Wister RA 27/3 than in those given the Cendehill vaccine, regardless of the method of vaccination. The RA 27/3 strain was associated with a small but significantly greater incidence of local pain immediately on injection. With this exception, differences in the occurrence of reactions were not found between vaccines, between those initially susceptible and immune or with the level of antibody response.

A randomized controlled trial was carried out in which the acceptability of screening for cervical carcinoma in situ by a postal 'do-it-yourself' method--the cytopipette--was compared with that of an invitation to attend a clinic or see a general practitioner for the conventional cervical scrape examination. In parallel with this, a sociological study of women who had been invited by both methods was undertaken in which information was obtained from responders and non-responders on attitudes to health care. The results show that, while the pipette was used by a greater proportion of women overall than the scrape examination, its acceptance by women most at risk of the disease is still not high. It is concluded that, taking into account the relative merits of the two methods as screening tests, as well as their acceptability and cost, the postal pipette may be useful in some circumstances, such as areas where clinical resources are limited, and as a second approach to women who have not taken up the offer of a scrape examination.