An examination was made of the statistical correlations between the main foodstuff and nutrient intakes and the chief causes of mortality in 20 different countries, comprising 17 in Europe, and Canada, USA, and Japan. Subsidiary examinations were made of the effects of including and excluding Japan, and of the effects of various statistical standardisation procedures. Complex food patterns were identified and related both to geographical latitude and to levels of affluence; these, in turn, were related to complex patterns of mortality. Criteria for drawing special attention to specific associations were identified, based partly on statistical significance tests and also on strength-of-association yardsticks supplied by diseases with known causes. Findings suggesting causal interpretations were: (a) alcohol intakes and cirrhosis of the liver, cancer of the mouth, and cancer of the larynx; (b) total fat intakes and multiple sclerosis, cancer of the large intestine, and cancer of the breast; and (c) beer and cancer of the rectum.
Analysis ofthe proportional mortality attributed to ischaemic heart disease, adjusted for age, reminds us that many of the well known geographical, environmental, social, and economic variations within England and Wales are not disease specific.
A retrospective study of behavioural changes in 493 consecutive patients who had survived a first acute myocardial infarction was carried out. The changes in behaviour that were studied related to smoking, physical activity, and weight loss. The personalities of the patients were also studied by means of the Eysenck personality inventory to find out if there was any relationship between the personality factors, extroversion and neuroticism, and the changes in behaviour. Sixty-six per cent of the men and 59% of the women reduced or stopped smoking, 60% of the men and 81% of the women reduced their physical activity, and 67% of the men and 56% of the women lost weight. Some significant associations were found between these changes and the medical advice given, the patients' views of the value of the change in behaviour, and the severity of the illness. Personality factors as assessed were not associated with any of the observed changes, except in the case of physical activity. Those who increased or decreased their physical activity had a significantly higher mean neuroticism score than those who did not change their behaviour in this respect.
The rates at which people smoke cigarettes during different periods of the day were obtained from three occupational groups. Group 1 consisted of those working at the main London production site of a food processing factory, Group 2 consisted of those in the administrative offices of the same company; there are smoking restrictions at both. Group 3 consisted of workers in the offices of a London borough where there are no smoking restrictions. Replies were received from 3174 people, or 88% of those approached. There was a higher proportion on non-smokers (over 70%) among the two groups of office workers than among the food processing workers (about 55%). Smokers in Group 3 recorded somewhat higher average cigarette consumption than those in Groups 1 and 2. During different periods of the day, the maximum hourly rate of cigarette smoking was about three times the minimum rate. For Groups 1 and 2 the maximum rate was consistently during the interval between leaving work and going to bed. In contrast, the maximum rate for Group 3 was consistently during the afternoon, while at work, and the rate between leaving work and going to bed was similar to the rate for the day as a whole. Results will help in deciding the time of day at which blood for carboxyhaemoglobin estimations should be taken.
The statistical evidence for a relationship between pregnancy smoking, birthweight, and perinatal mortality is critically examined. Some apparent discrepancies between and within different studies are resolved.
Names of women eligible to be screened for cervical cancer are taken from the national population registry and the women are invited by a personal letter. The data, from these mass screenings are analysed and stored at the screening registry. To reduced the costs of the system and to increase the yield of preinvasive lesions the idea of selective screening was considered. Tt was decided that if people were selected according to their risk factors, as recorded in the national population registry, the screening would be ineffective as many cases of invasive cancer were found in the low risk groups. High risk factors were determined from anamnestic data on systems and from previous cytological diagnoses. The proportion of women with symptoms of bleeding or the class II-V smears without positive histological results constituted fewer than 10% of the participants, but 20% and 40% respectively of invasive carcinomas were found in these groups during the subsequent follow-up period. Thus it is suggested that selective screening apart from that based on age has a limited application and should be restricted mainly to the interval between the organised screenings, which in Finland is five years.
Certain features of the relationship between 11 measurements of weekly temperature and the number of deaths from ischaemic heart disease (IHD) within age groups in Greater London between 1970 and 1974 are described. Firstly, the correlation coefficients between age-specific deaths from IHD and each of the temperature variables are of a similar order. Secondly, in contrast, the linear regression coefficients between deaths and temperature are more variable and depend upon the particular measurement of temperature chosen. Thirdly, the proportional changes in the number of deaths with the temperature variables are similar within specific age groups; consequently it is suggested that deaths from IHD and temperature may be directly related.
A total of 18 403 men aged between 40 and 64 years took part in a screening examination which included a self-administered version of the London School of Hygiene questionnaire on chest pain and intermittent claudication. The yield of positives for "angina" and "history of possible infarction" was about twice as high as with interviewers, but the positive groups obtained by the two techniques differed little in their association with electrocardiographic findings or in their ability to predict five-year coronary mortality risk. This risk ranged from 0-9% in men negative to questionnaire and electrocardiograms (ECG), to 4-3% for those with positive ECG but no symptoms, 4-5% for those with angina and negative ECG, up to 16% for those with angina and positive ECG. The self-administered version of this questionnaire provides a simple and convenient means of identifying individuals with a high risk of major coronary heart disease.
Norwegian counties show considerable variations in their rates of mortality from arteriosclerotic heart disease.These variations cannot be explained by present-day differences in standard of living.Such differences did exist in the past as was shown by large variations in infant mortality.A significant positive correlation has been found between the county age-adjusted mortality from arteriosclerotic heart disease in people aged between 40 and 69 years and county infant mortality relating to the early years in the same cohorts.The findings suggest that great poverty in childhood and adolescence followed by prosperity, is a risk factor for arteriosclerotic heart disease.
This study was designed to investigate personal and social factors associated with demand for care by women aged between 20 and 44 years, a group unlikely to suffer from chronic illness. A random sample of women was drawn from the age-sex register of a south London group practice, and information was obtained concerning their daily symptom perception, anxiety level, social and health characteristics, and their consultations for one year. Social class, family involvement, number of children in household, satisfaction with the housing, and use of other health and social services were not associated with demand for general practitioner care. Absence of basic housing amenities, difficulties in running the household, brevity of stay in the house or neighbourhood, and lack of attachment of the neighbourhood were related to a high patient-initiated consultation rate. Some of the possible interpretations of these results are discussed together with their implications for social policy planning.
Suicide mortality in the area now administered by the Greater London Council was assessed for three five-year periods 1949-1953, 1959-63, and 1969-73. For each of the periods the standard mortality ratio (SMR) for suicide in various boroughs was calculated for men and women separately. The boroughs with high SMRs for men were constant. There was a pronounced change in the geographical distribution of high mortality among women. These findings support the hypothesis that the determinants of suicide differ between the sexes.
The method of linear analogue self-assessment (LASA) was used to quantify the views concerning day care which were held by patients attending a geriatric day hospital. The results suggest that day hospitals are an acceptable form of care for the elderly.
There is an acknowledged need for better information to guide resource allocation and service planning in the health services. Despite the recognition of the important role of socioeconomic factors, difficulties with the appropriate presentation of daya have so far proved insuperable. Social area analysis (SAA), which is a generic name for a number of methods employing census and other data to classify small areas into similar socioeconomic groups, is an approach which quantifies data in a useful fashion and has important applications in medical, epidemiological and health services research. Most previous British exercises in SAA have been in the field of town planning. The potentialities of the approach for community medicine are evaluated, by the use of information from two existing studies. This is shown to discriminate more effectively than does existing health information between hypotheses concerning geographical variations in mortality, and it provides adequate explanations for urban area differentials in infant mortality, the uptake of vaccination, and the incidence of infectious disease. Specific applications of SAA in health planning and research are discussed.
An examination was made of the statistical correlations between the main foodstuff and nutrient intakes and the chief causes of mortality in 20 different countries, comprising 17 in Europe, and Canada, USA, and Japan. Subsidiary examinations were made of the effects of including and excluding Japan, and of the effects of various statistical standardisation procedures. Complex food patterns were identified and related both to geographical latitude and to levels of affluence; these, in turn, were related to complex patterns of mortality. Criteria for drawing special attention to specific associations were identified, based partly on statistical significance tests and also on strength-of-association yardsticks supplied by diseases with known causes. Findings suggesting causal interpretations were: (a) alcohol intakes and cirrhosis of the liver, cancer of the mouth, and cancer of the larynx; (b) total fat intakes and multiple sclerosis, cancer of the large intestine, and cancer of the breast; and (c) beer and cancer of the rectum.
Epidemiological and clinical evidence is presented on an association between the quantity of milk consumed and the incidence of ischaemic heart disease. It is suggested that the daily intake of liquid milk for adults should be at most one-third of a pint (less than 0-21).
The statistical evidence for a relationship between pregnancy smoking, birthweight, and perinatal mortality is critically examined. Some apparent discrepancies between and within different studies are resolved.
Two ad hoc surveys on drugs prescribed in Reykjavik during November 1972 and November 1974 were made. After the first survey a publicity campaign was launched and doctors were encouraged to change their prescribing habits; only minor changes in docotors' prescribing habits were noticed, although it is realised that this type of programme will require a longer period to prove its effectiveness. The surveys showed that benzodiazepines are more widely prescribed than chlorodiazepoxide. Doctors have been warned of the probable addictive effect of benzodiazepines (Grimsson et al., 1974). Drug addicts who used to go from one surgery to another have now been identified and they can only receive drugs on prescription from their own family doctor or his deputy.
A census was taken of outpatient bookings at all hospitals and health centres in Oxfordshire for the main medical and surgical specialities. Nine per cent of all bookings were to peripheral clinics (that is, those outsie the two main medical centres at Oxford and Banbury). About half of all bookings in the area were made to clinics within three of four miles of the patients' homes. The work load at peripheral clinics was mainly local: 75% of all patients at these clinics lived in the town or parishes adjacent to the town where the clinic was held. Peripheral clinics were associated with a lower work load at central clinics, but a higher overall work load from the town in which they were sited.
Coronary risk factors (CRF) have been recorded for nearly 15 000 men aged between 40 and 49 living in Oslo in 1972. These data are matched with the 1970 census data for Norway so as to analyse CRF within various occupational groups. A fairly good agreement between mortality statistics for Norway and CRF was found in many occupations. For instance, persons in pedagogical work have low total mortality rates consistent with their low coronary risk factors. Taxi and busdrivers, on the other hand, have been reported to have mortality rates from lung cancer and coronary heart disease consistent with their high smoking prevalence, serum triglycerides, and cholesterol levels.
