Community medicine最新文献

The birth prevalence of neural tube defects (NTD) in the Yorkshire Region was determined for 1985 and 1986 by ascertainment of cases in live-and stillborn babies and of pregnancies terminated for NTD. Sixty-seven cases of anencephaly, 82 of spina bifida and 11 others were identified, a prevalence of 1.54 per 1000 total births. Eighty-eight per cent of pregnancies associated with anencephaly and 48 per cent of those with spina bifida were terminated.

There is much interest in international comparisons of health care expenditures, in particular their relation to national income. They have been widely used to judge countries' performance in cost-containment, and in the United Kingdom have been widely quoted in debates about the funding of the National Health Service. This paper challenges conclusions drawn from simple analyses of this topic, which have used dubious and inappropriate data, questionable methods and assumptions, and simplistic ad-hoc reasoning. It looks particularly at price differences between countries, which have usually been hidden by using exchange rates to standardize national figures. When more appropriate conversion factors called purchasing power parities are used, many of the simple and conventionally-accepted conclusions no longer appear so obvious. The attempt to create apparent scientific facts for policy debates has been based on a misuse of international comparisons.

Published research shows people of Asian origin to be less healthy than the white population. Most of the studies have not taken account of differences in employment between populations of white and Asian origin. Also, little research has been carried out on the patients' perceived health. This study, based on 215 patients from an inner-city general practice in Bradford, looks at the influence of ethnicity and unemployment on the perceived health of the sample. The Nottingham Health Profile was used as the measure of perceived health. In the study population, twice as many Asians as white people were unemployed, and significant differences in perceived health were observed between the employed and the unemployed. After controlling for employment, Asian males had significantly better perceived health than white males in the 16-34 age group. Perceived health of Asian and white females was similar on most morbidity dimensions.

Three pilot studies looked at women who had not attended for cervical screening following a computer-generated invitation to a health authority clinic. From these a typology of reasons for non-attendance for computer-managed screening has been developed, specifying inaccessibility, ineligibility, unsuitability, failure of communications, misclassification and refusal because of practical problems, inappropriate beliefs or attitudinal barriers. Underlying the typology are issues connected with the inaccuracy of the database, service organization and provision, and the characteristics of the women themselves.

In the largest survey of smoking in pregnancy to date in the United Kingdom, 3882 women attending the two antenatal clinics in Nottingham during July and August 1986, were asked about their smoking habits. Thirty-seven per cent of pregnant women were smoking and only one in four of these was successful at stopping at some point during pregnancy. However, 55 per cent of the mothers who smoked at the start of pregnancy claimed to smoke less during pregnancy. No change was reported in the habits of one-quarter of the mothers who smoked during pregnancy and this proportion may represent an 'irreducible minimum'. Mothers were more likely to continue to smoke if younger (14-20 years), single, living with a partner who smoked, who left school at 16 years and were from manual working families. Those who succeeded in giving up smoking during pregnancy were more likely to be from professional and managerial families. Antenatal booklets about the dangers of smoking were the source of information cited most frequently. Half of the smoking mothers claimed not to have received advice from their family practitioners about the hazards of smoking nor information about how to give up the habit. Even fewer received such advice from hospital doctors, or midwives. This represents a major challenge to professional training in health education.

Registrations of leukaemias and lymphomas for 1986 available during October 1987 from three Regional Cancer registries have been cross-checked against a specialist registry of haematopoietic malignancies. The process has increased the specialist registries numbers by 7 per cent. At that time the cancer registries had not registered 50 per cent of identified cases.

People living in 102 rural households on private water supplies, and their matched controls on mains water, were asked about their health in a postal questionnaire. People using private water supplies were more likely to be from farming families (and so in socioeconomic class II) and less likely to be retired than their controls on mains water. Families using contaminated private supplies ('dirty' water) reported lower rates of colds and respiratory illnesses than people using mains water or uncontaminated private supplies ('clean' water). The mains-water users had visited their general practitioners more often in the last three months. There was no difference in the incidence of acute abdominal symptoms recorded in a diary kept by survey participants. Considering children, who are more susceptible to infectious illnesses, the only difference in health was that children in the families with 'dirty' private water took more medication (though reported illness less often) than others. In conclusion, the study indicated that private water is not harmful to health, but the results must be put in the context of evidence from other work.

The Acheson Report highlights confusion about responsibilities and the poor communication in the control of communicable disease. There is evidence that printed sources of information appear high in the list of reported use of information sources by doctors, although health professionals appear to make poor use of them. This interview survey, conducted by telephone, ascertained the views of 83 recipients of the Fife Community Health Report (CHR) -a monthly communicable disease/environmental health newsletter for community and primary care health staff working in Fife. The 83 individuals interviewed were representing their practice or group of health staff so that the consensus of each group was being sought in the interview. The response rate was 100 per cent and 95 per cent of the respondents stated that all the members of their practice or group read the CHR. Ninety per cent thought the CHR was relevant to their work, and 64 per cent filed it for future reference. However, criticisms were made about the quality of printing. As a result of the survey, improvements have been initiated in the CHR, including the proposed use of desk top publishing (DTP) in its production. Furthermore, the survey has initiated proposals for a similar report in the Greater Glasgow Health Board.

The South Birmingham Coronary Prevention Project is described, in which health checks by practice nurses in GPs' surgeries are combined with direct patient access to a secondary referral system. Where appropriate, health check attenders are offered the choice of either (a) counselling by the practice nurse, (b) direct referral to their GP, or (c) direct referral to secondary intervention, including specialist dietary advice for patients with high (greater than 6.5 mmol/l) serum cholesterol, stress management training for mild hypertension (diastolic blood pressure greater than 90 less than 105 mmHg), and smoking cessation groups. Significant reductions in blood pressure (p less than 0.005) and serum cholesterol levels (p less than 0.001) have been achieved. Further, substantial numbers of smokers have ceased since attending smoking cessation groups. This multidisciplinary approach to the identification and modification of risk factors for coronary heart disease may provide a powerful adjunct to wider ranging population interventions.