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1.  Incomplete right bundle branch block and vital capacity. 
Right bundle branch block (RBBB) is occasionally encountered in young persons who lack any other evidence of overt cardiac disease (Hiss and Lamb, 1962; Lancaster, Schechter, and Massing, 1972). The block may be complete or incomplete, the latter being more common. Right bundle branch block has been studied in relation to body weight, obesity, serum cholesterol and glucose levels, and blood pressure, but the results have been negative (Ostrander, 1964; Kannel et al., 1962). Data presented here suggest that incomplete RBBB is related to vital capacity.
PMCID: PMC478978  PMID: 1009278
2.  Survival of healthy older people. 
The purpose of this study was to discover any relationships which might exist between measurable variables recorded when a healthy group of men and women, aged 70 years and over, were examined and their subsequent survival time. It was found that height, body weight, systolic and diastolic blood pressures, haemoglobin, hand grip power, cardiothoracic ratio, and pulse rate are of no predictive value in the estimation of survival time. Survival is not influenced by marital status or occupational class. For both sexes the degree of kyphosis and age are useful predictive criteria in respect of survival time. However, much research work requires to be done to explain why many people die at the time they do.
PMCID: PMC478971  PMID: 1009273
3.  Detection and treatment of hypertension in an inner London community. 
A postal survey of a random sample of the population living near St Mary's Hospital, Paddington was taken to determine earlier experience in these people of blood pressure measurement and treatment. Eighty-five per cent of those who could return their questionnaires did so; eighty per cent of the respondents said they had had their blood pressure measured in the past, and 60% reported such a measurement during the previous three years. The respondents aged between 40 and 59 years were invited for a blood pressure screening measurement and 52% responded. Seventy-seven per cent of those found to be hypertensive on screening (systolic greater than or equal to 160 mmHg and/or diastolic greater than or equal to 100 mmHg) said they had had their blood pressure measured during the preceding three years. The reason for the poor control of hypertension in a community, therefore, is more likely to be a failure of doctors to take action on hypertension than a failure to detect it in the first place.
PMCID: PMC478979  PMID: 1009279
4.  Adrenosympathetic overactivity under conditions of work stress. 
Serial measurements of urinary adrenaline, noradrenaline, and 11-hydroxycorticosteroid excretion were performed on 32 healthy men under two conditions of work stress; piecework and work on assembly line. A statistically significant increase in adrenaline, noradrenaline, and 11-hydroxycorticosteroids was observed for piecework and assembly line workers compared with salaried and 'ordinary' workers. The results support the assumption that psychosocial factors of an everyday type have significant effects on the sympathoadrenomedullary and adrenocortical function.
PMCID: PMC478977  PMID: 1009277
5.  Obstetric and neonatal care related to outcome. A comparison of two maternity hospitals. 
Infants of birthweight up to 2500 g born in 1966 in two district hospitals were followed-up until their school medical examination at six years. Neonatal mortality rates differed in the two cohorts despite similar maternal age, parity, and social class distribution; differences in the management of labour and in neonatal care may have been responsible. Numbers were small but the prevalence of mild or more severe handicaps among the survivors did not differ significantly between the cohorts; an improved mortality was not achieved at the expense of an increased overall morbidity, although there was a suggestion of a difference in cerebral palsy prevalence. It is suggested that the neonatal mortality rate in conjunction with the prevalence of handicaps among the survivors of low birthweight infants be used as an indicator of the efficacy of perinatal care.
PMCID: PMC478976  PMID: 137759
6.  Drug problems dealt with by 62 London casualty departments. A preliminary report. 
A study of the whole spectrum of drug incidents dealt with in one month by 62 casualty departments in the Greater London area was carried out in the summer of 1975. Apart from demonstrating the large number of such incidents, this preliminary report presents an analysis of the drugs responsible for these episodes, basic demographic characteristics of the drug users, and an estimate of the contribution of drug dependence.
PMCID: PMC478975  PMID: 1009276
7.  NHS resources: scales of variation. 
The dangers inherent in comparing measures of health service provision and usage at high levels of aggregation and of ignoring variations at lower levels are illustrated with particular reference to regional and subregional level in the NHS. Analysis of variance indicates that, for a wide range of variables, there is more variation at the subregional level than regional level.
PMCID: PMC478974  PMID: 827320
8.  Relationship of weight gain in infancy to subcutaneous fat and relative weight at 10 1/2 years of age. 
In a representative sample of 895 schoolchildren, aged between 9 years 10 months and 11 years 2 months, the risk of being overweight or obese was compared between those who had gained weight rapidly during infancy and those whose weight gain had been normal. A substantially increased risk ratio was found only in boys for whom a correlation analysis showed that the total weight gain during the first year of life was associated with the total body mass in relation to height, more or less independently of the degree of fatness at 10 1/2 years of age. In girls, a direct but very weak association was found between weight gain in infancy and the degree of fatness at 10 1/2 years. The implications of these findings with respect to aetiology and the possibilities of prevention are briefly discussed.
PMCID: PMC478973  PMID: 1009275
9.  Weight gain in infancy and physical development between 7 and 10 1/2 years of age. 
Heights and weights were measured in 963 10-year-old children, whose weight data from the first year of life were available. Rapid weight gain in infancy was arbitrarily defined on the basis of sex-specific percentiles of weight gain at four-month intervals and from birth to 12 months. In girls, no significant association between rapid weight gain in infancy and overweight at 10 1/2 years was found. In boys, the association was significant for severe overweight (greater than 120% of standard weight for height). An estimation of the possible benefit of an intervention programme (food restriction in all male infants with rapid weight gain) showed, however, that at the very best 12% of the boys treated in this way could be expected to gain some benefit. The result of a correlation analysis between weight gain in infancy and change in height and relative weight between 7 and 10 1/2 years suggested that the factors which determined weight gain in infancy were no longer operative at ages between 7 and 10 1/2 years.
PMCID: PMC478972  PMID: 1009274
10.  Low mortality rates in industrial cohort studies due to selection for work and survival in the industry. 
Occupational groups are often described as being relatively healthy because their mortality rates are lower than those of the national average. Although correct this confuses the issue for those who are interested in assessing the effects of exposure to a particular chemical. In a further analysis of data collected in a study of all men ever exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride in Great Britain, three factors have been shown to contribute to the low mortality rates that were observed. The three factors: the selection of a healthy population for employment, the survival in the industry of the healthier men, and the length of time that this population has been pursued, have been quantified. The mortality experience within five years of entering this industry was shown to be as low as 37% of that expected; for circulatory disease and respiratory disease it was as low as 21%. There was a progressive increase in standardized mortality ratio with the length of time since entry so that the effect had almost disappeared 15 years after entry. To avoid confounding the selection effect with the survival effect the latter was measured by separating men who survived 15 years after entering the industry according to whether or not they were still in the industry after this period. Those who had left experienced an overall standardized mortality ratio some 50% higher than those still in the industry. This effect, although consistent in the age groups between 25 and 74 years and for all cause groups studied, was greatest in those aged between 25 and 44 years and for lung cancer and respiratory disease.
PMCID: PMC478970  PMID: 1009272
11.  Influence of personal and family factors on ventilatory function of children. 
We wanted to assess the relative influence of various personal and family factors upon the development of ventilatory function in young children. The relationship of several such factors to peak expiratory flow rates measured at the age of five years was studied in 454 children. These children were members of a birth cohort born between 1963 and 1965 in Harrow, north-west London, who were examined regularly from birth through the first five years of life. Beside its expected association with height, peak expiratory flow rate at the age of five years was also related to a lesser extent with peak expiratory flow rate in parents. Children with a history of lower respiratory illness had mean peak flow rates which were lower than those of children who escaped these illnesses. The earlier the onset of the illness and the more frequent its recurrence, the more marked its effect on ventilatory function. The group of children with a history of asthma and bronchitis had the lowest mean peak expiratory flow rate, but a history of bronchitis or pneumonia alone (that is, without asthma) was also associated with reduced ventilatory function. Respiratory illness beginning in the first year of life was the most potentially modifiable determinant of peak expiratory flow rate in children in this study.
PMCID: PMC478969  PMID: 1009271
12.  Influence of family factors on asthma and wheezing during the first five years of life. 
Family factors associated with the incidence of asthma and wheezing during childhood have been studied in a cohort of over 2000 children who, together with their families, were followed-up for five years. Episodes of wheezing not regarded by the parents as asthma had a different pattern of association with family factors to that found for asthma. The outcome of the two conditions in terms of ventilatory function at the age of five years was also different, in that children with a history of asthma had a lower peak expiratory flow rate than did children with a history of non-asthmatic wheezing.
PMCID: PMC478968  PMID: 1009270
13.  Influence of family factors on the incidence of lower respiratory illness during the first year of life. 
In a study of a cohort of over 2000 children born between 1963 and 1965, the incidence of bronchitis and pneumonia during their first year of life was found to be associated with several family factors. The most important determinant of respiratory illness in these infants was an attack of bronchitis or pneumonia in a sibling. The age of these siblings, and their number, also contributed to this incidence. Parental respiratory symptoms, including persistent cough and phlegm, and asthma or wheezing, as well as parental smoking habits, had lesser but nevertheless important effects. Parental smoking, however, stands out from all other factors as the one most amenable to change in seeking to prevent bronchitis and pneumonia in infants.
PMCID: PMC478967  PMID: 1009269
14.  Degree of physical handicap, education, and occupation of 51 adults with spina bifida. 
51 adults with spina bifida, aged between 18 and 56 years, resident in South Wales, were interviewed in their home. Although only four had obvious hydrocephalus, one-third of them were severely handicapped and a further 40% had moderate handicap. Over half of them had had their secondary education in a normal school, with the remainder having special schooling or home tuition. Seventy per cent of the series was in normal, full-time occupation, including half those severely handicapped. Those in work were largely in managerial/technical, clerical, and light manual occupations. It is concluded that extendance and training, followed by special job placement, would help to integrate them into the community. These patients show that, in the absence of mental retardation, even severe physical handicap is no bar to normal occupation and that paralysis and incontinence alone are probably not valid selection factors for or against 'aggressive' treatment for spina bifida.
PMCID: PMC478964  PMID: 788821
15.  A randomized controlled trial of vitamin C in the prevention and amelioration of the common cold. 
A randomized controlled trial of the effect of 1 g ascorbic acid per day in the prevention of the common cold was conducted on 688 adult women. There is evidence of a small reduction by vitamin C in the mean number of chest colds, but no evidence of any effect on simple colds. The existence of a subgroup of vulnerable women in the community who benefit from vitamin C was considered but further examination of the data gives no support to this conclusion.
PMCID: PMC478963  PMID: 788820
16.  Accuracy of cancer registration. 
In South Wales cancer registration is done principally by means of the Hospital Activity Analysis. Altogether 1460 hospital records of cancer patients (19% of the 1972 registrations received by May 1973) were studied and the principal items of information required for cancer registrations by the Office of Population Censuses and Surveys were copied and subsequently compared with the corresponding registrations at the Welsh Hospital Board's cancer bureau. Differences between these 're-registrations' and the original registrations were analysed item by item. There were 234 registrations with errors in the diagnostic summary (although 110 of these would cause misclassification only under the fourth digit of the ICD code), 164 with errors in date of birth (36 of which would cause classification in the wrong WHO age group) and 198 with errors in the date of registration (112 of which were wrongly ascribed to the year 1972). Error and omission rates were particularly high for NHS number, occupation, place of birth, and histology.
PMCID: PMC478962  PMID: 974439
17.  A study of the validity of the Hospital Activity Analysis information. 
For a number of years the medical profession and its administrators have been using statistical tabulations from the Hospital Activity Analysis returns. The quality of this information has often been criticized and no attempt has been made to quantify the levels of 'errors' in England and Wales. This paper reports the findings of such a study in Nottingham, and concludes that the Hospital Activity Analysis system in that area is almost as good as the clinical notes from which it is derived.
PMCID: PMC478961  PMID: 974438
18.  Epidemiology of twin births from a climatic point of view. 
The twinning rate was analysed using figures taken from statistics for Japan. During the years 1955 to 1959 there were 58 570 twin deliveries out of a total of 9 088 233, a frequency of 6-44 per 1000. Using Winberg's differential method for zygosity estimation, the monozygotic twinning rate was 4-04 per 1000 and the dizygotic was 2-40. Twinning rates in 46 prefectures were also estimated and their correlations with meteorological parameters as well as with the mortality from cerebrovascular disease were examined. The twinning rates increased from a low level in the south west to a high level in the north east of Japan. The tendency was more obvious for the dizygotic than the monozygotic twinning rate. A negative correlation was observed between incidence rates of dizygotic twins and mean air-temperatures throughout the year, and a positive one between incidences of dizygotic twins and mortality rates for vascular lesions affecting the central nervous system in 46 prefectures. A seasonal variation of twinning rates was also observed in Niigata City for statistics of births during the periods 1948-55 and 1963-70. This took the form of a bimodal curve, with high conception rates for twin births in intermediate mild seasons, the spring and autumn and, low rates in the more stressful hot and cold seasons. These relationships between climate and twin births within a single race-group are discussed.
PMCID: PMC478960  PMID: 974437
19.  Mental capability of children exposed to lead pollution. 
'Eleven-plus' school examination scores were obtained for 851 Birmingham children residing since birth in a lead-polluted area and 1642 children residing in two similar but unpolluted areas. It was found that the children in the lead-polluted area actually scored higher on the average than children in the control areas. Within the area of lead contamination, children living closest to the source of pollution did not have significantly lower scores than children living further away. The results indicate that lead pollution of the magnitude reported in this investigation did not have a demonstrable effect on the mental capabilities of children in the affected community.
PMCID: PMC478959  PMID: 974436
20.  Control of haemolytic disease of the newborn. 
The decline in the stillbirth and death rates from haemolytic disease of the newborn in England and Wales between 1961 and 1973 is examined. The possible causes for this decline are identified and data related to each are assembled. The effects of intrauterine transfusions, changes in the abortion law, and changes in the racial mix as well as changes in the incidence of toxaemia of pregnancy and caesarean section can probably be disregarded for this purpose. Two major factors are the change in the birth rank distribution of births in England and Wales and general improvements in the quality of perinatal and obstetric care. When the above factors are excluded the effects of the specific control programmes upon stillbirths are not easy to measure or even detect. They probably accounted for less than one-fifth of the total decline in stillbirths from haemolytic disease of the newborn, although probably a larger proportion of the decline in neonatal deaths. During the period concerned, the most effective component in reducing losses was probably in the care of affected live-born infants and the primary preventive programme played only a minor part. Nevertheless, its effects are now discernible and it is likely to play a larger part in subsequent years. The quantification and monitoring of the part played by the preventive programme may require more developed information systems than are at present avilable.
PMCID: PMC478958  PMID: 824003
21.  The relationship between blood pressure and biochemical risk factors in a general population. 
The relationship between blood pressure, ponderal index, sex, blood glucose, haemoglobin, serum uric acid, calcium cholesterol and creatinine, and albumin has been examined in 698 subjects aged between 44 and 49 years from the register of a group general practice. Sixty per cent of the variation in systolic pressure could be explained by statistically significant associations with diastolic pressure, sex, blood glucose, serum calcium, and cholesterol. The diastolic blood pressure (not corrected for systolic pressure) was significantly related only to ponderal index, haemoglobin in men, and cholesterol in women. Pulse pressure was also positively related to the risk factors blood glucose, serum cholesterol, and calcium. The possibility is discussed that one or more of these variables reduce aortic compliance and that the serum calcium contributes to this end. Diastolic, but not systolic pressure, had a prime association with relative weight, obesity being only basically associated with an increase in diastolic pressure.
PMCID: PMC478957  PMID: 974435
22.  Cancer mortality and saccharin consumption in diabetics. 
The mortality experience of 5971 members of the British Diabetic Association (BDA) was followed-up for between five and eight years to mid-1973. Overall, 1207 deaths occurred compared with 778 expected from the mortality of the population of England and Wales in 1972. This excess of deaths was due almost entirely to diabetes mellitus and ischaemic heart disease. Deaths from cancer (128) were significantly fewer than expected (168), mainly because of a deficit in the number of deaths from cancers related to smoking (cancers of the buccal cavity and pharynx, oesophagus, respiratory system, and bladder). There was also a lower than expected mortality from chronic bronchitis and emphysema. Data on saccharin consumption by BDA members showed that more than half of them used saccharin tablets daily, with an overall daily intake of three to six tablets, depending on age and sex. Information on a small sample of survivors from the mortality study suggested that about 23% of them would have taken saccharin daily for 10 years or more and 10% for 25 years or more by the end of the follow-up. It was concluded that these relatively high levels of saccharin intake had not increased the risk of cancer in general among BDA members.
PMCID: PMC478956  PMID: 974434
23.  Study of disease associations from linked records. 
Comparisons are made between the principal diagnosis on discharge from hospital in successive periods of inpatient care for persons in the Oxford Record Linkage Study area admitted over a period of years. The observed numbers of pairs of diagnoses are compared with expected numbers computed to take account of the discharge rates in the population by age and sex and the number of man years of exposure. Three topics have been selected to display some of the types of analysis possible with the very extensive material: mental disorder and diseases of the central nervous system, hospital discharges preceding those for neoplasm, and discharges following those for tuberculosis. The details of the method of calculation of the observed and expected numbers and the assumptions and approximations involved are given in an Appendix.
PMCID: PMC478955  PMID: 974433
24.  Cancer in the offspring of fathers in hydrocarbon-related occupations. 
A case-control study has been conducted to see whether a hydrocarbon-related occupation of the father at the time of conception constitutes a risk factor for malignant disease in the offspring. The series comprised 852 cancer cases from the Finnish Cancer Registry and 852 controls matched for date of birth and domicile. The father's occupation for both the cases and controls was ascertained from the records of antenatal clinics. No significant associations were found between the commonest types of childhood cancer and hydrocarbon-related occupations--that is, motor-vehicle mechanics, machinists, miners, painters, and motor-vehicle drivers. Risk ratio 2 was excluded from most of the 95% confidence intervals for children under 15 years of age. The results do not support the hypothesis that there is an excess risk of cancer in the children of fathers in hydrocarbon-related occupations.
PMCID: PMC478952  PMID: 953378
25.  Anencephalus in Scotland 1961-72. 
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.
PMCID: PMC478951  PMID: 953377

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