Community medicine最新文献

Studies carried out in 1978 and 1981 found postneonatal mortality to be associated with poor environmental conditions. Since then, many changes have occurred to the environment. This study was designed to discover which factors are now associated with a higher risk of postneonatal death. A retrospective case-control study was carried out using 107 cases and 422 controls matched only for date of birth, to look at the effect of area of residence, social class, mother's age, and sex, birthweight, legitimacy and number of siblings. Fifty-eight per cent of the deaths were due to the sudden infant death syndrome, making this the leading cause of death. Causes previously absent from the death certificates are now appearing, particularly prematurity related deaths which now account for almost 6 per cent. The deaths were found to occur more frequently at home, in the winter, and at a peak age of 2 to 4 months. As shown previously in Nottingham, the deaths were more likely to have been male (relative risk 2.03), illegitimate (2.91), and of low birthweight (28.8). Total mortality was significantly higher in babies of mothers aged 19 or less and in babies of manual workers. Surprisingly, babies born to unemployed parents were found to have a very low relative risk of death (0.26). Mortality is still higher in the city than the suburbs and in areas of deprivation. Although still a risk factor for SIDS, high parity of the mother was found to be non-significant for postneonatal mortality in total.(ABSTRACT TRUNCATED AT 250 WORDS)

The problems of using cost-effectiveness analysis in health promotion are set out in order to argue against the simplistic application of QALY-type analysis between the preventive and curative sectors. The difficulties of conceptualizing and measuring 'effectiveness', and the obstacle of achieving predictive validity in cost-effectiveness analysis are discussed.

The Government White Paper on the NHS, 'Working for Patients', abolished the Resource Allocation Working Party (RAWP) formula in name, but retained its general approach of ensuring geographical equity through funding health authorities by a system of weighted capitation. As a result, the longstanding debate about the appropriate need indicators to include in RAWP, which was tackled afresh in the recent NHS Management Board review of RAWP, will remain highly pertinent to NHS resource allocation in the 1990s. Yet, the research carried out for the RAWP review, on which its principal proposals for change to the need indicators were based, is inadequate for developing a new method of resource allocation after RAWP. The paper describes the research and sets out its main conceptual limitations and problems of method.

Mortality rates for males aged 20 to 64 in Scotland (1980-1982) display an increasing gradient both by social class (from class 1 to 5) and by the deprivation category of the area (from affluent to deprived) in which the event occurred. Social classes also exhibit gradients in mortality across deprivation categories, the corresponding rates in the most deprived category being around twice those in the most affluent areas. The gradients by deprivation category remain after standardizing for differences in social class composition. Within health boards in Scotland populations show only minor variability in terms of social class, while their composition on the dimension of deprivation is markedly diverse, and the classification of populations by the deprivation category of their area of residence appears to offer a superior basis for the explanation of differences in mortality between health boards than does social class. This evidence of area effects supports a proposal for area socioeconomic characteristics to be adopted as key variables in epidemiological analysis, and for an area classification to be designed and incorporated in the 1991 census output for use on a consistent basis.

Blood samples and self-reported heights and weights have been collected from 114 vegans, 1550 vegetarians, 415 fish eaters who did not eat meat, and 1198 meat eaters. We have previously reported that mean total and LDL cholesterol were lower in the vegetarians and fish eaters than in the meat eaters, while the mean levels in vegans were lower still. We have examined the possibility that this relationship could be explained by differences in the mean body mass index of the four groups. While there was a small positive relationship between body mass index and plasma lipid levels this did not explain the previously reported difference between diet groups. After adjusting for the effect of body mass index there remained a small negative association between height and plasma lipid levels, which has not previously been reported. Height is known to be influenced by childhood ill health and has also been shown to be related to social class, and it may be that the relationship between plasma lipid levels and height can be explained by these factors.