It has long been realized that skeletal development is divisible into two components, increase in size and increase in maturity. Although closely integrated in the healthy child, each follows its own individual pattern. Increase in size is relatively easy to assess; skeletal maturation, however, is not only elusive of measurement, but is also difficult to define. It is usually accepted as being the metamorphosis of the cartilaginous and membranous skeleton of the foetus to the fully ossified bones of the adult. It can be studied conveniently by X-ray.

One way of addressing this subject would be, like Freymann (1974), to assume that any 'versus' between prevention and cure stems from a fundamental discordance between curative medicine and public health, and proceed to analyse, as he did in the USA the reasons for such a discordance. Another approach would be to attempt to weigh the advantages brought by high technology clinical medicine against those that would be gained if the same resources were invested in a preventive programme. I am not properly qualified to attempt this even were suitable data available, and I am reluctant simply to dismiss 'high tech' anyway. The only procedure based upon it I have studied at first hand (with colleagues) is cardiac transplantation (Buxton et al. 1985). This operation is only offered to patients who have been considered unsuitable for coronary artery by-pass graft and all other forms of therapy and who are not expected to live for more than six months. Our analysis showed that the expectation of life for 94 per cent of a comparison group of 70 for whom no organ was available, was six months or less as anticipated, but 50 per cent of those receiving a new heart could expect to live for at least five years. Whereas at the time they were put on the waiting list for the operation only 11 per cent were employed, subsequently 57 per cent had jobs and a further 23 per cent were actively seeking them. On the basis of these facts it is reasonable to consider it to be an outstandingly successful operation.

Journal Article Epidemiology in Medical Education: Introduction to the Symposium Get access ROY M. ACHESON ROY M. ACHESON 31 Bedford Square, London WCIB 3EL, England Search for other works by this author on: Oxford Academic PubMed Google Scholar International Journal of Epidemiology, Volume 2, Issue 4, WINTER 1973, Pages 355–357, https://doi.org/10.1093/ije/2.4.355 Published: 01 December 1973

This is the second of a series of reports comparing 604 deaths from stroke among U.S. veterans over 12 months in 1967–1968 in Georgia with 560 stroke deaths in the states of Colorado, Idaho, Montana, Utah and Wyoming; 1210 and 1644 deaths randomly selected from all other deaths in 2 areas, respectively, in the same year are used as controls.

The data were collected during the U. S. National Health Examination Survey between 1960–1962 from 5,545 of the probability sample of 7,710 adults of both sexes; 4,854 respondents were white and 691 black. A stepwise multiple regression analysis was used to examine, on a sex and colour specific basis, the inter-relationships between serum cholesterol on the one hand (which was treated as the dependent variable) and hematocrit, blood glucose, height, weight, body bulk, blood pressure, age, family income, occupation, population density at place of residence and degree of urbanization at place of residence on the other (which were treated as independent variables). It was found that in general the ability of the independent variables to predict serum cholesterol was poor, though it was better in females than in males. R2 values were as follows: white males 0.198; black males 0.169; white females 0.295; black females 0.230. The independent variables which contributed consistently and significantly to the predictions in all four groups were age and body bulk; in whites of both sexes hematocrit also contributed significantly. It is emphasized that inter-relationships of this kind cannot necessarily be taken as cause and effect.

Over the past two decades epidemiologists interested in chronic illness have tended to concen trate on conditions which are lethal, and they have generally directed more attention to the elucidation of the causes of such diseases than to their social consequences. Although this work has been of great importance, one result is that we know less than we should about the burden on society of many diseases, especially those with a low case fatality rate such as the arthritides, varicosities, and even diabetes. To date one of the few large-scale sources of information of this kind is in the United States where the National Health Examination Survey (1966a and b, 1968) has shown that the prevalence of arthritic conditions is extremely high, although it has not included data on impairment and disability in objectively ascertained cases. In contrast, the US National Health Interview Survey (1960, 1964, 1969, 1971), which has had to depend on the respon dent's word for ascertainment of diagnosis, has collected data on the extent of limitations of activity. Throughout that country arthritis and rheumatism, which are treated in the National Health Survey as a single category, were by far the most serious cause of limited mobility, and in many areas they are also the most important chronic cause of limited activity (US National Health Survey, 1971). If arthritis and rheumatism are taken in combination with impair ments of the spine, hips, and legs, they have con sistently, between 1961 and 1967, accounted for 29% of all cases of limited activity and in this respect far outstrip in importance any other group of chronic diseases. Over the same seven-year period the next most important conditions have been those of the cardiovascular system, yet 'heart conditions' and 'hypertension without heart involve ment' taken together have accounted for only 22% to 23 % of the cases of chronically limited activity (US National Health Survey, 1968). In 1967 some 3,250,000 civilians who were not in hospitals or other institutions suffered limitation of activity because of these two conditions and in well over half of these there was serious loss of time at work (US National Health Survey, 1971). The communal problem of arthritis and rheumatism is accentuated by the fact that the burden imposed by them is heaviest among the poorest members of the com munity. In Britain the General Household Survey is collecting data which are similar to those from the US Interview Survey (1964, 1969, 1971). This paper presents some information about the interrelationship between impairment and disability and arthritic conditions in a group of adults from the general population of New Haven, Connecticut, and combines objective with interview data.

Background/aims To determine whether the development of non-arteritic anterior ischaemic optic neuropathy (NAION) is increased among patients newly diagnosed with obstructive sleep apnoea (OSA) in a large general population. Methods A 12-year nationwide, population-based, retrospective cohort study including 1 025 340 beneficiaries in the 2002–2013 Korean National Health Insurance Service database was performed. We identified 919 patients newly diagnosed with OSA aged ≥40 years and matched 9190 non-OSA controls using estimated propensity scores in reference to age, sex, demographics, comorbidities and co-medications. We applied Kaplan-Meier curves and Cox proportional hazard models to determine the risk of developing NAION in the OSA group compared with the non-OSA group. Results The 10-year incidence probability of NAION was higher in the OSA group (0.92%; 95% CI 0.88 to 0.97) than the non-OSA group (0.42%; 95% CI 0.41 to 0.44, p=0.002, log-rank test). The OSA group was at increased risk of developing NAION compared with the non-OSA group (HR 3.80; 95% CI 1.46 to 9.90) after adjusting for demographics, comorbidities and co-medications. Conclusions Our results suggest that patients with newly diagnosed OSA have an increased risk of NAION, although the absolute risk of NAION is low.

This is the third of a series of reports which compare 604 deaths from stroke in U.S. veterans between 1 July 1967 and 30 June 1968 in Georgia with 560 stroke deaths over the same period in the states of Colorado, Idaho, Montana, Utah and Wyoming; 1210 and 1644 deaths selected from among all other causes are used for controls.

The "Stroke Belt" describes a region of the southeastern United States with a high incidence of stroke and mortality due to stroke. In an effort to address the problem of stroke in this region, we have formed the Stroke Belt Consortium (SBC). This report describes the formation and functions of the SBC. The SBC is a unique organization with representatives from many areas, including health care, government, nonprofit organizations, the pharmaceutical industry, minority groups, educational groups, and managed care. The goals of the consortium are to advance public and professional education about stroke in the Stroke Belt, with a special emphasis on the populations in that region. The first meeting of the consortium was held in November 1994. Many helpful and innovative ideas and initiatives were generated at the first SBC meeting. These included improved techniques for professional education, the development of a mass media campaign for public education, screening of college students for stroke risk factors, and using fast-food restaurants and sporting events as venues to promote stroke education. This type of organized effort may produce cost-effective programs and initiatives, particularly for largescale educational efforts, that will enhance the prevention and treatment of stroke patients. If successful in the Stroke Belt, similar organizations can be formed in other regions of the nation to address specific issues related to stroke prevention, education, and treatment.

Clinical records relating to the last year of life of 2072 U.S. Veterans, who died in Georgia or in five western states during 1 yr, were reviewed to determine the occurrence of cerebrovascular disease as a cause of death.

We have conducted a study to examine some possible explanations for the apparent differences among various sections of the United States in mortality from cerebrovascular disease. Copies of death certificates were obtained for all male veterans who died during the 12 months from July 1967 to June 1968 in 5 western states, Colorado, Idaho, Montana, Utah and Wyoming, or in the state of Georgia. All death certificates showing an entry of nontraumatic cerebrovascular disease were included for study, and a sample of other deaths was selected for comparison.

The systolic and diastolic blood pressure was measured in a nationwide probability sample of persons of both sexes and the two largest racial groups in the United States. Respondents were aged 18–79 years and useable blood pressure data were available for 6,546 of 7,710 (85%) of the total sample. The data are presented in percentiles for Caucasians and Negroes separately by age and sex; age and sex specific means and standard deviations are also presented by racial group. Systolic and diastolic pressure show in general the expected increase with age, and the distribution is skewed. Attention is drawn to the fact that while for systolic pressure there is an increase with age of the lower percentiles in women of both racial groups, there is no such age trend in these percentiles in man of either racial group. Patterns for diastolic pressure are similar, though less clear-cut.

Acheson, R. M. (Director, Extension Training Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London WCi E 7HT, England), von Stein, C. B., and Kelsey, J. L. New Haven survey of joint diseases. XV: size of the finger joints in the general population with and without osteoarthrosis. Int. J. Epid. 1972, 1 : 225–233. This report concerns 1,074 persons (478 men and 596 women) aged 21 and over from the general population of New Haven, Connecticut. Measurements were made of the circumference of the lunulae, and of the distal and proximal interphalangeal joints of the 3rd and 5th fingers of the left hand with jewelers' rings. Independently X-rays of the hands of these people were graded, joint-by-joint, on a 0–4 scale for osteoarthrosis and rheumatoid arthritis. The two cases of the latter disease were discarded from the present analysis. Symptoms of morning stiffness, joint swelling and nocturnal joint pain were recorded. A discriminant function analysis, which took into account circumference of lunula. weight/height;and age was undertaken on a sex and age specific basis for the proximal and distal interphalangeal joints of the 3rd and 5th fingers of the left hand to compare those with osteoarthrosis grades 2–4 with those grades 0–1. Results were similar for all four joints and are presented for the 3rd DIP (middle finger). These show that joint size plays an important role in discriminating between those persons who do and do not have osteoarthrosis. However, over 50 per cent of all the people who had osteoarthrosis of grade 2 or more, and have on an age and sex specific basis joint enlargement detected with jewelers' rings did not themselves report joint swelling nor did they report stiffness or pain. Symptoms were much more frequently associated with joint enlargement, with or without osteoarthrosis, in women than in men.

Analysis of heights and weights of children with slipped capital femoral epiphysis in Connecticut and in the Southwestern United States indicated that about half of the patients in both areas had weights at or above the 95th percentile for their age and about half had weights at or above the 97th percentile for their height. In Connecticut there was an excess of abnormally tall girls and of tall and short boys; in the Southwest there was an excess of short boys. There was no evidence that tall,thinchildren are at high risk for slipped epiphysis. The suggestion is made that children who combine overweight with slower than average maturation may be at particularly high risk for slipped epiphysis.

Data collected by record linkage are used as a basis for an analysis of the burden of cerebrovascular diseases in a population of 340,000 in central England. Comparison with studies which use other methods in the United States and England indicate that for all Cerebrovascular diseases together, and for subarachnoid hemorrhage, the assumptions underlying the analysis may have reflected the overall incidence of and survival from serious disease in Oxford reasonably accurately, but this may not be true for two individual rubrics, cerebral hemorrhage and infarction. Criticisms made of this conclusion in the recent literature are discussed. The system in its present state does not permit the study of transient ischemic attacks. Data shown here and elsewhere indicate that subarachnoid hemorrhage is the most reliable of the stroke diagnoses, and the Oxford data show reasonable consistency with others gathered elsewhere using other methods. It would appear that there are considerable age-specific and sex-specific differences for subarachnoid hemorrhage in terms of incidence and survival. Attention is drawn to the extent to which cerebrovascular disease occurs in people under age 65 years.

The results of a survey of institutions and community-based services in the New Haven area which provided care for arthritics resident in New Haven between the end of 1963 and March 1967 are presented.

Journal Article NEW HAVEN SURVEY OF JOINT DISEASES. XI: OBSERVER VARIABILITY IN THE ASSESSMENT OF X-RAYS FOR OSTEOARTHROSIS OF THE HANDS Get access ELIZABETH C. WRIGHT, ELIZABETH C. WRIGHT Search for other works by this author on: Oxford Academic PubMed Google Scholar ROY M. ACHESON ROY M. ACHESON Search for other works by this author on: Oxford Academic PubMed Google Scholar American Journal of Epidemiology, Volume 91, Issue 4, April 1970, Pages 378–392, https://doi.org/10.1093/oxfordjournals.aje.a121148 Published: 01 April 1970 Article history Received: 04 November 1969 Published: 01 April 1970

A short interview questionnaire relating to self diagnosis and symptoms of joint diseases was applied to a defined study population in New Haven, Connecticut. Of the 2388 people approached, 2199 (92.1 per cent) co-operated. In most body sites the prevalence of morning stiffness, nocturnal joint pain and swelling was higher in women than men. Moreover all three symptoms were more likely to be experienced in several body sites in women compared to men. People who said they had arthritis were most often those who also complained of morning stiffness; self diagnosis of rheumatism was in general most frequently associated with nocturnal joint pain. Gout is associated with pain and swelling of the feet. At all ages and in both sexes arthritis and rheumatism were self diagnosed more frequently in New Haven than in the National Health Survey. It is assumed that this is because in New Haven, but not in the National Health Survey, a symptom review was included early in the questionnaire.

Acheson, R. M., and Collart, A. B. (1975). Annals of the Rheumatic Diseases, 34, 379387. New Haven survey of joint diseases. XVII. Relationship between some systemic characteristics and osteoarthrosis in a general population. In a survey of the general population the presence or absence ofosteoarthrosis of the hand was determined radiologically in 685 adults (300 males and 385 females). Of these, 261 (124 males and 137 females), chosen randomly, were given a complete clinical examination of the musculoskeletal system which included x-ray ofjoints elsewhere in the body. Osteoarthrosis (OA) scores for the hand and for all body sites were computed for each subject by summing the number of affected joints. For all subjects social class, height, weight, total serum protein, serum uric acid, haemoglobin, antistreptolysin 0, (ASO), C-reactive protein (CRP), and rheumatoid factor were also measured. Analyses were carried out by simple comparison of means and by calculating multiple regressions and correlations. The results showed the following. (a) The factor most closely associated with OA score is age. (b) Multiple coefficients of correlation between all the factors and OA were consistently higher in women than in men. For instance, for the hand R2 was 0-32 in men and 0 49 in women. All the factors significantly associated with OA contributed to this sex difference. (c) In the hands and in all body sites OA scores were significantly higher in males than females under the age of 34 years, the opposite being true for those over 35, but the differences were not significant. (d) Other factors significantly associated with OA score both in weight-bearing and in nonweight-bearing joints in both sexes were CRP, weight/height ratio, serum uric acid, and ASO. In females such an association was also found with rheumatoid factor. With the possible exception of ASO, relationships between all these factors and OA have been found in at least one other epidemiological study. It is concluded that systemic factors underly the development of degenerative joint disease, and that this systemic component is more important in women than in men. It is also suggested that transient episodes of inflammatory arthritis earlier in life may predispose to osteoarthrosis. Further studies may help to identify those persons at risk for the traumatic or wear and tear component in the causation of the disease.