British journal of preventive & social medicine最新文献

The relationship between blood pressure, ponderal index, sex, blood glucose, haemoglobin, serum uric acid, calcium cholesterol and creatinine, and albumin has been examined in 698 subjects aged between 44 and 49 years from the register of a group general practice. Sixty per cent of the variation in systolic pressure could be explained by statistically significant associations with diastolic pressure, sex, blood glucose, serum calcium, and cholesterol. The diastolic blood pressure (not corrected for systolic pressure) was significantly related only to ponderal index, haemoglobin in men, and cholesterol in women. Pulse pressure was also positively related to the risk factors blood glucose, serum cholesterol, and calcium. The possibility is discussed that one or more of these variables reduce aortic compliance and that the serum calcium contributes to this end. Diastolic, but not systolic pressure, had a prime association with relative weight, obesity being only basically associated with an increase in diastolic pressure.

In South Wales cancer registration is done principally by means of the Hospital Activity Analysis. Altogether 1460 hospital records of cancer patients (19% of the 1972 registrations received by May 1973) were studied and the principal items of information required for cancer registrations by the Office of Population Censuses and Surveys were copied and subsequently compared with the corresponding registrations at the Welsh Hospital Board's cancer bureau. Differences between these 're-registrations' and the original registrations were analysed item by item. There were 234 registrations with errors in the diagnostic summary (although 110 of these would cause misclassification only under the fourth digit of the ICD code), 164 with errors in date of birth (36 of which would cause classification in the wrong WHO age group) and 198 with errors in the date of registration (112 of which were wrongly ascribed to the year 1972). Error and omission rates were particularly high for NHS number, occupation, place of birth, and histology.

Comparisons are made between the principal diagnosis on discharge from hospital in successive periods of inpatient care for persons in the Oxford Record Linkage Study area admitted over a period of years. The observed numbers of pairs of diagnoses are compared with expected numbers computed to take account of the discharge rates in the population by age and sex and the number of man years of exposure. Three topics have been selected to display some of the types of analysis possible with the very extensive material: mental disorder and diseases of the central nervous system, hospital discharges preceding those for neoplasm, and discharges following those for tuberculosis. The details of the method of calculation of the observed and expected numbers and the assumptions and approximations involved are given in an Appendix.

'Eleven-plus' school examination scores were obtained for 851 Birmingham children residing since birth in a lead-polluted area and 1642 children residing in two similar but unpolluted areas. It was found that the children in the lead-polluted area actually scored higher on the average than children in the control areas. Within the area of lead contamination, children living closest to the source of pollution did not have significantly lower scores than children living further away. The results indicate that lead pollution of the magnitude reported in this investigation did not have a demonstrable effect on the mental capabilities of children in the affected community.

For a number of years the medical profession and its administrators have been using statistical tabulations from the Hospital Activity Analysis returns. The quality of this information has often been criticized and no attempt has been made to quantify the levels of 'errors' in England and Wales. This paper reports the findings of such a study in Nottingham, and concludes that the Hospital Activity Analysis system in that area is almost as good as the clinical notes from which it is derived.

Estimates of the population prevalence of peptic and duodenal ulceration in men aged between 25 and 64 years were made in the London borough of Lambeth. The sampling frame for these estimates was a 20% private census. The lifetime prevalence rate of proved peptic ulcer (haematemesis, gastric and duodenal ulcers as validated by operation or barium meal), adjusted for age and social class, was estimated to be 6-7%, while the similarly adjusted lifetime prevalence for duodenal ulcer was 4-4%. The lifetime prevalences increased with age but not significantly so. A social class gradient was demonstrated with the highest prevalence in social class I and II. Previously described associations with blood group, secretor status, and serum pepsinogen were confirmed. Reported use of medical services increased with increasing severity of symptoms. A large number of respondents, however, who reported symptoms reported no medical care. It seemed unlikely that those men who reported symptoms and no medical care had demonstrable peptic ulcers.

A case-control study has been conducted to see whether a hydrocarbon-related occupation of the father at the time of conception constitutes a risk factor for malignant disease in the offspring. The series comprised 852 cancer cases from the Finnish Cancer Registry and 852 controls matched for date of birth and domicile. The father's occupation for both the cases and controls was ascertained from the records of antenatal clinics. No significant associations were found between the commonest types of childhood cancer and hydrocarbon-related occupations--that is, motor-vehicle mechanics, machinists, miners, painters, and motor-vehicle drivers. Risk ratio 2 was excluded from most of the 95% confidence intervals for children under 15 years of age. The results do not support the hypothesis that there is an excess risk of cancer in the children of fathers in hydrocarbon-related occupations.

Current methods of ranking or scoring disability tend to be arbitrary. A new method is put forward on the hypothesis that disability progresses in regular, cumulative patterns. A model of disability is defined and tested with the use of Guttman scale analysis. Its validity is indicated on data from a survey in the community and from postsurgical patients, and some factors involved in scale variation are identified. The model provides a simple measurement technique and has implications for the assessment of individual disadvantage, for the prediction of progress in recovery or deterioration, and for evaluation of the outcome of treatment regimes.

A survey was conducted on 1035 persons constituting a semi-random age-structured sample of the populations of three areas in the west of Scotland. The object was to attempt to estimate the needs of this population for domiciliary services. A method was developed of classifying the subjects into 12 'care groups' based on two characteristics, those of 'potential need' and 'solitude'. 'Potential need' was a measure of disability and its severity was graded according to the intervals that elapsed between necessary periods of help. 'Solitude' was a measure of the time during each day when potential sources of help were spontaneously available. 'Potential need' was found to be related linearly to age but to be independent of the other variables studied. 'Solitude' was commonest in the 75-84-year age group and varied in the three areas studied, but no relationship with any other variable was detected. An estimate was made of the domiciliary services which would be required to ensure a satisfactory standard of care for the subjects in the sample. Assuming present or slightly better levels of hospital provision and slightly lower provision of residential homes there is still a need for a very great increase in domiciliary services if satisfactory standards of community care are to be attained.