British journal of preventive & social medicine最新文献

The dangers inherent in comparing measures of health service provision and usage at high levels of aggregation and of ignoring variations at lower levels are illustrated with particular reference to regional and subregional level in the NHS. Analysis of variance indicates that, for a wide range of variables, there is more variation at the subregional level than regional level.

Family factors associated with the incidence of asthma and wheezing during childhood have been studied in a cohort of over 2000 children who, together with their families, were followed-up for five years. Episodes of wheezing not regarded by the parents as asthma had a different pattern of association with family factors to that found for asthma. The outcome of the two conditions in terms of ventilatory function at the age of five years was also different, in that children with a history of asthma had a lower peak expiratory flow rate than did children with a history of non-asthmatic wheezing.

A study of the whole spectrum of drug incidents dealt with in one month by 62 casualty departments in the Greater London area was carried out in the summer of 1975. Apart from demonstrating the large number of such incidents, this preliminary report presents an analysis of the drugs responsible for these episodes, basic demographic characteristics of the drug users, and an estimate of the contribution of drug dependence.

We wanted to assess the relative influence of various personal and family factors upon the development of ventilatory function in young children. The relationship of several such factors to peak expiratory flow rates measured at the age of five years was studied in 454 children. These children were members of a birth cohort born between 1963 and 1965 in Harrow, north-west London, who were examined regularly from birth through the first five years of life. Beside its expected association with height, peak expiratory flow rate at the age of five years was also related to a lesser extent with peak expiratory flow rate in parents. Children with a history of lower respiratory illness had mean peak flow rates which were lower than those of children who escaped these illnesses. The earlier the onset of the illness and the more frequent its recurrence, the more marked its effect on ventilatory function. The group of children with a history of asthma and bronchitis had the lowest mean peak expiratory flow rate, but a history of bronchitis or pneumonia alone (that is, without asthma) was also associated with reduced ventilatory function. Respiratory illness beginning in the first year of life was the most potentially modifiable determinant of peak expiratory flow rate in children in this study.

In a representative sample of 895 schoolchildren, aged between 9 years 10 months and 11 years 2 months, the risk of being overweight or obese was compared between those who had gained weight rapidly during infancy and those whose weight gain had been normal. A substantially increased risk ratio was found only in boys for whom a correlation analysis showed that the total weight gain during the first year of life was associated with the total body mass in relation to height, more or less independently of the degree of fatness at 10 1/2 years of age. In girls, a direct but very weak association was found between weight gain in infancy and the degree of fatness at 10 1/2 years. The implications of these findings with respect to aetiology and the possibilities of prevention are briefly discussed.

The mortality experience of 5971 members of the British Diabetic Association (BDA) was followed-up for between five and eight years to mid-1973. Overall, 1207 deaths occurred compared with 778 expected from the mortality of the population of England and Wales in 1972. This excess of deaths was due almost entirely to diabetes mellitus and ischaemic heart disease. Deaths from cancer (128) were significantly fewer than expected (168), mainly because of a deficit in the number of deaths from cancers related to smoking (cancers of the buccal cavity and pharynx, oesophagus, respiratory system, and bladder). There was also a lower than expected mortality from chronic bronchitis and emphysema. Data on saccharin consumption by BDA members showed that more than half of them used saccharin tablets daily, with an overall daily intake of three to six tablets, depending on age and sex. Information on a small sample of survivors from the mortality study suggested that about 23% of them would have taken saccharin daily for 10 years or more and 10% for 25 years or more by the end of the follow-up. It was concluded that these relatively high levels of saccharin intake had not increased the risk of cancer in general among BDA members.

A randomized controlled trial of the effect of 1 g ascorbic acid per day in the prevention of the common cold was conducted on 688 adult women. There is evidence of a small reduction by vitamin C in the mean number of chest colds, but no evidence of any effect on simple colds. The existence of a subgroup of vulnerable women in the community who benefit from vitamin C was considered but further examination of the data gives no support to this conclusion.

The decline in the stillbirth and death rates from haemolytic disease of the newborn in England and Wales between 1961 and 1973 is examined. The possible causes for this decline are identified and data related to each are assembled. The effects of intrauterine transfusions, changes in the abortion law, and changes in the racial mix as well as changes in the incidence of toxaemia of pregnancy and caesarean section can probably be disregarded for this purpose. Two major factors are the change in the birth rank distribution of births in England and Wales and general improvements in the quality of perinatal and obstetric care. When the above factors are excluded the effects of the specific control programmes upon stillbirths are not easy to measure or even detect. They probably accounted for less than one-fifth of the total decline in stillbirths from haemolytic disease of the newborn, although probably a larger proportion of the decline in neonatal deaths. During the period concerned, the most effective component in reducing losses was probably in the care of affected live-born infants and the primary preventive programme played only a minor part. Nevertheless, its effects are now discernible and it is likely to play a larger part in subsequent years. The quantification and monitoring of the part played by the preventive programme may require more developed information systems than are at present avilable.

51 adults with spina bifida, aged between 18 and 56 years, resident in South Wales, were interviewed in their home. Although only four had obvious hydrocephalus, one-third of them were severely handicapped and a further 40% had moderate handicap. Over half of them had had their secondary education in a normal school, with the remainder having special schooling or home tuition. Seventy per cent of the series was in normal, full-time occupation, including half those severely handicapped. Those in work were largely in managerial/technical, clerical, and light manual occupations. It is concluded that extendance and training, followed by special job placement, would help to integrate them into the community. These patients show that, in the absence of mental retardation, even severe physical handicap is no bar to normal occupation and that paralysis and incontinence alone are probably not valid selection factors for or against 'aggressive' treatment for spina bifida.

The twinning rate was analysed using figures taken from statistics for Japan. During the years 1955 to 1959 there were 58 570 twin deliveries out of a total of 9 088 233, a frequency of 6-44 per 1000. Using Winberg's differential method for zygosity estimation, the monozygotic twinning rate was 4-04 per 1000 and the dizygotic was 2-40. Twinning rates in 46 prefectures were also estimated and their correlations with meteorological parameters as well as with the mortality from cerebrovascular disease were examined. The twinning rates increased from a low level in the south west to a high level in the north east of Japan. The tendency was more obvious for the dizygotic than the monozygotic twinning rate. A negative correlation was observed between incidence rates of dizygotic twins and mean air-temperatures throughout the year, and a positive one between incidences of dizygotic twins and mortality rates for vascular lesions affecting the central nervous system in 46 prefectures. A seasonal variation of twinning rates was also observed in Niigata City for statistics of births during the periods 1948-55 and 1963-70. This took the form of a bimodal curve, with high conception rates for twin births in intermediate mild seasons, the spring and autumn and, low rates in the more stressful hot and cold seasons. These relationships between climate and twin births within a single race-group are discussed.