British journal of preventive & social medicine最新文献

Data relating to the incidence of anencephalus for the 12-year period 1961-72 were abstracted from the Statistical Reviews of the Registrar General for Scotland. It was shown that considerable geographical variation is still apparent with the highlands having, in general, the lower incidences. In comparison with the earlier study of Edwards (1958), there were some changes: the incidence in the areas to the west had increased and that in those to the east decreased. During the 12-year period there was an overall decline in the incidence of the lesion; this was most marked in births to women under 20 years, and to those of social classes III, IV, and V. The decline was least apparent for births to women of high social class and the unmarried. It was shown that there was little seasonal variation in the time of delivery, but that even when the trend had been taken into account the yearly fluctuation was significantly different from that expected, with an excess of cases in 1961 and 1971.

Seventy-seven women discharged from hospital with a diagnosis of myocardial infarction and 207 control patients were investigated. All were under 45 years of age at the time of admission. Heavy cigarette smoking, reported treatment for pre-eclamptic toxaemia, and type II hyperlipoproteinaemia were found to be independent risk factors for myocardial infarction. Reported treatment for hypertension and diabetes are probably also independently associated with subsequent development of the condition, but the associations between myocardial infarction and reported treatment for obesity and psychiatric illness appear to be secondary. Previous publications have suggested that use of oral contraceptives is an independent risk factor. Examination of the effect of several factors combined, suggests that they act synergistically, the presence of three or more factors increasing the risk 128-fold.

The personality scores at 16 years of age of 2753 people, all members of the National Survey of Health and Development, were related, in a follow-up study, to cigarette smoking behaviour in their young adult years. Survey members who recorded high neuroticism scores were found to be more likely to smoke than those with low scores and, among the smokers, deep inhalers formed the most neurotic group. Extraverts were more likely to smoke than introverts, the mean extraversion score being greatest for the male smokers with a high daily consumption of cigarettes. The personality scores were found to have some power in predicting changes in smoking behaviour. Neurotics and extraverts who had not started to smoke by the time of completing the personality inventory at 16 were more likely than the stable and introverted to take up the habit subsequently. Among survey members who were regular smokers at the time of completing the personality inventory the proportion giving up smoking by the time they reached the age of 25 years was related to consumption level recorded at 20 years and the personality scores recorded at 16, stable extraverts among the men being most likely to stop smoking.

A community survey of skin disease was carried out in Lambeth, London. A postal questionnaire asking recipients to give details of the presence of skin disease was sent to a stratified sample of 2180 adults; a subsample of 614 persons were interviewed at home and an inspection was made of the exposed parts of their skin. Altogether 92 conditions were identified. These were graded for clinical severity and classified into 13 groups. The overall prevalence of skin disease thought to justify medical care was 22-5%. The most common important condition was eczema with a prevalence of 6-1%. Age, sex, and social class trends in prevalence were found in certain groups of skin disease. Of those with a skin disease thought to justify medical care, only 21% reported having attended their general practitioner in the past six months for a skin complaint. The reported use of medical care and self medication is discussed in relation to the presence of skin disease and other factors.

The possibility that some of the common childhood infections lead to unrecognized impairments of neurological function was examined in 43 820 Birmingham children whose intelligence was assessed in the 11-plus examination. Mean verbal reasoning scores were lower for children who had had measles or pertussis than for those who had had neither of these diseases. However, since attack rates and measured intelligence are related inversely to social class, the lower scores of children with measles and pertussis may be due to class differences which are not eliminated completely by standardization for maternal age and birth order. Mean scores were a little higher for children who had had rubella than for those who had not, and it is suggested that this difference may be due to more frequent reporting of the disease by the more intelligent mothers.

The twin pairs with spina bifida and or anencephalus collected from the literature by Rogers and Weatherall (1976) form the basis for an argument that the apparent rarity of dizygous twins concordant for these malformations may be due to the breakdown of the interamniotic partition and a subsequent fetus-fetus interaction. It is suggested that this may lead to complete or partial destruction of one twin. When cells survive they may form teratoma or patches of anomalous skin cover. The hypothesis that monozygous twins concordant for these defects may form double monsters is re-stated. The present hypothesis predicts that the incidence of pineal and intraspinal teratoma will vary in time and place with anencephalus and spina bifida, and that the scalp type hairs found over or around spina bifida may prove, in male infants, to have female chromosomes.

The hypothesis proposed by Knox (1970) that an anencephalic fetus arises from a fetus-fetus interaction between two dizygous twins predicts that the twinning rate, the population incidence of anencephalus, and the female proportion of anencephalics in a population should be positively interrelated. These associations were tested using Canadian data during a long period of time and over a large geographical area. The results did not support the hypothesis.

The records of a selected group of 215 subjects who had successfully lost surplus weight were followed-up for periods of one to six years. Mean initial weight was 131% of standard (19.5 kg surplus) and the mean time taken to achieve 'goal weight' was 7.05 months (range two to 20 months) at a mean rate of 2.9 kg per month (range 1.85 to 5 kg). Altogether 121 subjects (56.3%) maintained goal weights within plus or minus 2.3 kg of goal; 79 subjects (36.7%) maintained within plus or minus 4.5 kg. At time of examination of the records, 39 subjects (18.8%) had maintained constant weight for more than four years, 22 subjects (10.6%) for three to four years, 65 subjects (31.4%) for two to three years, 58 subjects (28.5%) for one to two years, and 23 subjects (11.1%) for periods of up to one year.

A comparison of two methods of screening schoolgirls for asymptomatic specimens of urine from 96.3, but that the home self-administered use of dipslides was successful in only 70.2%. The failure to obtain the return of satisfactory dipslides was most frequent in children under seven and over 11 years of age, and in children from the lower social classes; satisfactory dipslides were returned by 84% of children from social classes I, II, and III non-manual workers, but by only 58% of children from social class V and the unemployed. The cost per child screened was pounds 0.77 with the supervised method and pounds 0.26 with the dipslide method. An alternative supervised method which would have successfully screened 85% would have cost pound 0.55 per child screened. Using the home dipslide method, the cost per case of asymptomatic bacteriuria detected would vary from pounds 10.40 to pounds 20.00, depending on the age group screened.

This paper reports the findings of a survey of smoking habits among secondary schoolchildren and medical students in Lagos, Nigeria. Altogether 40% of boys and 8.4% of girls at secondary school, and 72.4% of men and 22.2% of women at medical school were found to smoke. While the smoking habit of the secondary schoolboys was influenced by the smoking habits of their parents and friends, the smoking habit of the secondary schoolgirls and female medical students was mainly influenced by that of their friends. This study provides a baseline against which future studies on smoking habits in developing African countries may be measured, and the results show that health education on cigarette smoking must start in primary and secondary schools.