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1.  The influence of the birth of a malformed child on the mother's further reproduction. 
Births which occurred in Birmingham in 1964-70 were assembled into fraternities by computer linkage. By calculating the frequency with which one birth was followed by another and the interval between births the reproductive behavior of mothers after the birth of a malformed child was compared with that of all mothers, taking account of differences in maternal age, parity, and period of observation. It was found that malformations which resulted in stillbirth or early death were more frequently followed by another birth and that the interval to the following birth was shorter than usual. In this respect malformations did not differ in their effect from other causes of stillbirth and infant death. The birth of children were severe malformations who survived, however, acted as a slight deterrent to further reproduction. The malformation rate among children born after a malformation was double the usual rate; the recurrence rate was particularly high for neural tube defects, 5% of subsequent children being affected. In spite of this parents of children with central nervous system malformations were not deterred from further reproduction unless the affected child survived.
PMCID: PMC478925  PMID: 1220838
2.  Primary schoolboys: image of self and smoker. 
The way primary schoolboys see themselves and also see young smokers, may have implications for health education. In this paper a comparison is made between the self-images of 229 primary schoolboys and their images of a young person who smokes. The two images were very different, both for smokers and non-smokers, although the difference for smokers was smaller. It appears that children of this age who smoke do not see themselves as 'smokers', and may not relate the health education they receive on this subject to themselves.
PMCID: PMC478924  PMID: 1220837
3.  Vaccination of schoolgirls against rubella. Assessment of serological status and a comparative trial of Wistar RA 27/3 and Cendehill strain live attenuated rubella vaccines in 13-year-old schoolgirls in Dudley. 
A total of 1525 schoolgirls aged 13 years from 21 schools in the County Borough of Dudley, were bled for titration of rubella haemagglutinating inhibiting antibody and then were immediately vaccinated with either Wistar RA 27/3 or Cendehill strain live attenuated. Both vaccines were administered subcutaneously by syringe and needle but the Wistar RA 27/3 vaccine was also given by multiple injection apparatus. Significnatly higher conversion rates and geometric mean haemagglutinating inhibiting antibody titres were obtained in girls initially seronegative given the Wister RA 27/3 than in those given the Cendehill vaccine, regardless of the method of vaccination. The RA 27/3 strain was associated with a small but significantly greater incidence of local pain immediately on injection. With this exception, differences in the occurrence of reactions were not found between vaccines, between those initially susceptible and immune or with the level of antibody response.
PMCID: PMC478923  PMID: 766879
4.  Regional variations in the development of illness in Finland. 
The aim of the present study is to investigate the incidence of morbidity leading to incapacity for work in the working age population of Finland, and to examine critically the development of such illness and variations between different population groups. An attempt is made to analyse to what extent regional differences in illness development are connected with the communal structure of an area and the provision and use of medical services. The material is based on data from the sickness insurance and national penisons, and mortality statistics. The variables used as those defined by Kalimo (1967; 1968) to describe the various features of community structure and the supply of medical services, and data from the insurance and hospital service statistics to measure the use of medical services. The results indicate considerable variation in the course of illnesses between population groups, as expressed as the incidence rates for the various phases of illness or as development probabilities. Illness development proved to be more unfavourable in men than in women. Large regional differences were found, with the course of illnesses appearing to be much more unfavourable in the eastern and northern parts of Finland than in the south and south west. This seems to be closely connected with poorer socioeconomic development and lower urbanization in an area. A clear correlation was found between illness development and the supply and use of medical services in ambulatory care. Illness development was particularly unfavourable in areas where the supply and use of ambulatory medical services, especially doctors' services, were poor. No corresponding correlation was found with the supply and use of hospital services. Development of sickness proved to be connected with a neglect of illnesses at an early phase and delay in seeking medical care. The result is confirmed by variations between population groups in the numbers of sickness benefits awarded. It was confirmed that morbidity resulting in incapacity for work is closely associated with local socioeconomic development.
PMCID: PMC478922  PMID: 1220836
5.  Asthma in schoolchildren. Demographic associations and peak expiratory flow rates compared in children with bronchitis. 
The frequency of asthma in 10 971 school-children between the ages of 5 and 14 years was reported by their parents to be 3-8%. Of these, 20-7% were said to have had bronchitis, 5-9% pneumonia, and 4-7% eczema. Asthma was reported more commonly in boys than girls and was greatest in children of social classes I and II. One-third of the children were reported to have their first attack before the age of 2 years. Few (18%) first attacks started after the age of 5 years. There was no evidence that bronchitis predisposed to the later development of asthma, or vice versa. Within each age-sex group children with a history of asthma had lower peak expiratory flow rates than children who gave no such history. These diffences in PEFR were greater than for children with a history of bronchitis.
PMCID: PMC478920  PMID: 1220834
6.  Priorities in biomedical research. Indices of burden. 
The relative burden of different diseases is a legitimate component in the consideration of priorities for biomedical research. Simple prevalence statistics do not directly reflect the different burdens on services imposed by diseases of comparable prevalence. This paper sets out for each 54 categories of disease five indices of the burden on services, based respectively on inpatient days, outpatient referrals, consultations in family practice, sickness benefit, and loss of expectation of life. There is considerable variation in the rank-order of categories of disease, in their contribution to the five burdens; but for each burden the number of categories accounting for 50% of the total burden is not large, ranging from 3 to 9 out of the possible 54.
PMCID: PMC478919  PMID: 1220833
7.  Epidemiology and family characteristics of severely-abused children. 
Severe child abuse in north-east Wiltshire was studied retrospectively during the period 1965-71, and prospectively for 18 months from January 1972, after a period of consultative activity with those actively involved to increase awareness of the phenomenon. Severe abuse was strictly defined. A rate of 1 per thousand children under four years old was obtained, together with a death rate of 0-1 per thousand. The families of the retrospective series of abused children were studied in detail and identifying characteristics of large family size, youthfulness, low social-class, instability, and gross psychiatric, medical, and social pathology described. The implications of the ascertainment and death rates are discussed in relation to data from some other studies, and the need emphasized for detailed studies of the apparent clustering of disorder in the families, using linked record systems.
PMCID: PMC478918  PMID: 1220832
8.  Acceptability of the cytopipette in screening for cervical cancer. 
A randomized controlled trial was carried out in which the acceptability of screening for cervical carcinoma in situ by a postal 'do-it-yourself' method--the cytopipette--was compared with that of an invitation to attend a clinic or see a general practitioner for the conventional cervical scrape examination. In parallel with this, a sociological study of women who had been invited by both methods was undertaken in which information was obtained from responders and non-responders on attitudes to health care. The results show that, while the pipette was used by a greater proportion of women overall than the scrape examination, its acceptance by women most at risk of the disease is still not high. It is concluded that, taking into account the relative merits of the two methods as screening tests, as well as their acceptability and cost, the postal pipette may be useful in some circumstances, such as areas where clinical resources are limited, and as a second approach to women who have not taken up the offer of a scrape examination.
PMCID: PMC478921  PMID: 1220835
9.  An investigation of space and space-time clustering in a large sample of infants with neural tube defects born in Cardiff. 
Altogether 406 infants with neural tube defects born in Cardiff between 1956-71 were investigated for evidence of space-time clustering and 100 similarly affected infants, together with matched controls born in Cardiff between 1964-66 were investigated for evidence of spatial clustering. No evidence of excessive prevalence in either dimension was observed.
PMCID: PMC478915  PMID: 1104033
10.  Statistical analysis of individually matched case-control studies in epidemiology: factor under study a discrete variable taking multiple values. 
It is now well established in case-control studies with individual matching that the statistical analysis must take the fact of individual matching into account. The problems of so doing have been thoroughly dealt with for the situation of the factor of interest being a two-level factor (all-or-none response) and with one or more matched controls per patient. These results are extended in this paper to the situation where the factor can assume multiple levels in studies where each patient is matched with a single control.
PMCID: PMC478914  PMID: 1191888
11.  The role of driver demerit points and age in the prediction of motor vehicle collisions. 
The records of drivers, selected from the file of licensed drivers in Ontario, were reviewed to study the relationship between demerit points, other driver characteristics, and the frequency or risk of future collisions and traffic convictions. A stratified sample of 500-600 drivers from each of five levels of demerit points was selected. Low-point drivers differed significantly from high-point drivers in age, sex, and class of licence; estimates of risk of collision or conviction in each demerit point group had to take account of these differences. Discriminant analysis was used to identify drivers likely to be involved in collisions or to be given traffic convictions, and to identify accidents involving injury or fatality. Of the traits considered (demerit points, age, sex, class of licence, history of previous accidents), demerit points represented the only variable of importance in predicting future collision involvement. Since it is the only one of these variables which can be altered by driver behaviour it offers an opportunity to prevent accidents.
PMCID: PMC478913  PMID: 1191887
12.  School meals and the nutrition of schoolchildren. 
The contribution of school meals to the nutrition of 778 primary and secondary schoolchildren attending schools in Kent was assessed using information collected during a survey made in 1968-70 which included a weighed diet record, a socioeconomic questionnaire, and a medical examination. Younger children, those from larger families, those without fathers, and those whose mothers worked were more likely to take school meals. Significantly more children from lower social classes and without fathers received them free. School meals made an important contribution to the nutrition of schoolchildren. Children who took them had higher weekday lunchtime nutrient intake during term-time. Children in lower social classes, larger families, and without fathers who took school meals obtained a higher proportion of their weekday intake of nutrients from lunchtime than other children. This applied in particular to nutrients important for growth. School meals consumed by children in the study broadly met the standard set by the Department of Education and Science. The mean energy and protein content of school meals consumed in the study was slightly lower and the mean fat content higher than the standard set for the meal. The mean sugar content was about one-third higher than the suggested amount of sugar to be included in a school meal. There was no evidence that children who took school meals were taller, heavier, had greater skinfold thickness, or were more likely to be assessed as obese than other children.
PMCID: PMC478912  PMID: 1191886
13.  A study of breast cancer in Irish women. 
In a study of 100 women with breast cancer and 200 unaffected women the epidemiological characteristic of breast cancer most commonly described--namely, an excess of nonparous women among cases when compared with controls, was not observed. It is suggested that two factors, a dearth of first births born to mothers under 20 years of age and an unusually high proportion of first births when aged 30 years or more, are responsible for this finding. No association was found between breast cancer and socioeconomic status, marital status, age at marriage, age at first pregnancy, parity, or age at menarche. Significant associations with breast cancer included age at natural menopause, hysterectomy, and breast trauma. These findings are discussed.
PMCID: PMC478911  PMID: 1191885
14.  Self-poisoning and self-injury in the Oxford area. Epidemiological aspects 1969-73. 
A prospective study of self-poisoning and self-injury in the Oxford area for 1972-73 and a retrospective study for 1969 has shown the following: (a) The number of admissions to a general hospital following self-poisoning and self-injury has increased by approximately 45% in 3 1/2 years. The increase is more marked in women than in men. (b) When compared with a previous study the incidence in Oxford city has quadrupled in ten years. (c) A total of 74% of men and 67% of women, aged 16 years and over, harming themselves in this way are under the age of 35 years. The repetitiveness is increasing and the proportion of those repeating the attempt was 10% within three months, and 15% within six months. (d) The rates are exceptionally high for teenage wives and single, widowed, and divorced women aged between 24-35 years. Single men show exceptionally high rates in the 35-45 year age group. (e) With the exception of married women aged between 25 and 34 years and women over 60, the rates were higher in urban than in rural areas. (f) In men the rates were higher among personal service workers, semi-skilled manual and unskilled manual workers. In women the rates were highest among non-manual, ancillary to professional (especially nurses), and semi-skilled manual workers. Male students had rates much lower than those of their age group, while female students had rates about the same as their age group. The lowest rates were among professional and 'own account' workers.
PMCID: PMC478910  PMID: 1191884
15.  Subacute myelo-optic neuropathy and clioquinol. An epidemiological case-history for diagnosis. 
Between about 1955 and 1970, some 100,000 Japanese were diagnosed as having subacute myelooptic neuropathy (SMON), a new disease characterized by abdominal and neurological manifestations, the former nearly always preceding the latter. Circumstantial evidence obtained in 1969-70 suggested that SMON might have been caused by clioquinol (CQL), a gastrointestinal disinfectant, and led to the suspension of further sales of CQL in Japan. However, several inconsistencies for the CQL theory of SMON have now emerged; first, CQL had been widely used in Japan for nearly 20 years before SMON occurred. Secondly, the SMON epidemic began to subside several months before CQL sales were suspended. Thirdly, a large proportion of SMON patients--probably about one-third and possibly more--had not taken CQL within six months of the onset of the disease (the modal interval between first taking CQL and the onset of SMON being about three weeks, and more than 100 days in only 4% of SMON patients); of the remaining two-thirds or so, many had taken CQL as part of the treatment of the first (that is, abdominal) symptoms of SMON itself. Fourthly, there was no dose-response relationship. Finally, SMON rarely, if ever, occurred outside Japan. CQL could, however, have been involved in the causation of SMON as an optional enhancer of some other necessary cause; the history of post-war environmental pollution in Japan is compatible with this hypothesis. Over-readiness to accept postulated toxic effects of medicines and chemicals as proven is likely to do at least as much harm as good to individual and community health.
PMCID: PMC478909  PMID: 127638
16.  Relationship between month of birth and month of death in the elderly. 
A special analysis of mortality data for England and Wales fof 1972 has been used to examine the relationship between month of birth and month of death. For persons 75 and over in eight subgroups (by sex and marital status) there was a consistent trend in deaths with an excess in the birth month and the following three months. This excess was of the order of only 1% of all deaths in the year but statistically significant for each subgroup. The method of analysis was adjusted for the nonsynchronous monthly variation in births and deaths, but a systematic error in recording the month of birth could not be excluded. A wide range of studies on the relationship between stress, morbidity, and mortality are briefly reviewed; it is suggested that in the elderly a birthday may in some subtle way influence the general morale of an individual. Further studies have been planned to test whether 'birthday stress' is a realistic explanation, or if a number of other hypotheses need to be invoked.
PMCID: PMC478908  PMID: 1191883
17.  The contribution of intensive coronary care. 
Coronary care units are expensive consumers of scarce resources, and it is unfortunate that there has been little attempt to evaluate their achievements: even simple data relating outcome to age, duration of stay, and severity are not available. Indirect evidence is presented from the Hospital In-patient Enquiry and the national mortality reports for England and Wales. Over the period in which intensive care facilities have become widespread the hospital admission rates have risen steeply but numbers of hospital deaths have been stable. A part of this decline in case fatality has probably resulted from therapeutic advance, but most is probably due to the admission of larger numbers of milder cases.
PMCID: PMC478907  PMID: 1191882
19.  Recall of women in a cervical cytology screening programme. An estimate of the true rate of response. 
In a sample of 1007 women from a large cervical cytology screening programme in the Manchester region, the apparent response-rate to a letter inviting women to have a second routine smear three years after their first was 47-6%. After taking account of those who had become ineligible on medical grounds, or inaccessible, a conservative estimate of the true rate of response was 65-7%. When women who had had interim smears or examinations elsewhere were included, 72-2% of the original population of women had continued to make use of facilities for cytological screening.
PMCID: PMC478902  PMID: 1182355
20.  Family social characteristics related to physical growth of young children. 
Altogether 164 poor families who had children of normal and subnormal weight and height were studied in Bogota, Colombia. Physical growth was found to be positively associated with expenditure on food, sanitary conditions in the home, mother's age, birth interval between surviving children, level of parental newspaper reading, aspirations for children, and socioeconomic status. Physical growth was negatively associated with crowded living conditions and family size. Only mother's age, family size, spacing of births, and sanitary conditions were related to weight and height, independent of socioeconomic status. Food expenditure, crowding, parental newspaper reading, and aspirations for children all reflected the influence of socioeconomic status upon physical growth. The findings emphasized the importance of within-class social differences as they affect the physical growth of young children.
PMCID: PMC478901  PMID: 1182354
21.  Influence of some social and environmental factors on the nutrient intake and nutritional status of schoolchildren. 
Only children had significantly higher intakes of many nutrients and nutrients/1000 kcal than other children. A higher proportion of only children was found to be obese. There were no significant differences according to birthrank in intakes by children. There were more obese children among the fatherless than those with fathers, in particular among those whose mothers were widowed. However, this was not accounted for by the present dietary findings, since fatherless children had lower intakes of carbohydrate and added sugar. There were no differences in nutrient intake or intake/1000 kcal by mother's country of origin or her level of education, or by disposable income.
PMCID: PMC478900  PMID: 1182353
22.  Potato avoidance during pregnancy in women with a previous infant with either anencephaly and/or spina bifida. 
This investigation is a direct attempt to test Renwick's (1972) hypothesis that 95% of anencephaly and spina bifida (ASB) is preventable by the avoidance of potatoes during pregnancy. Although the numbers involved in the study are small, the investigation fails to support the concept that short-term avoidance of potatoes before conception and throughout pregnancy in women who have had a previous ASB infant reduces the recurrence risk. In the potato-free group, of 23 pregnancies which went to term two infants had ASB (8-7%); whereas in the non-potato-free group, of 56 which went to term two infants had ASB (3-6%). The recurrence risk in both groups was about 5%. The incidence of ASB in the groups shows no significant difference (P = 0-58) and in the potato-free group was not reduced by 95% as postulated by Renwick.
PMCID: PMC478899  PMID: 1102005
23.  Epidemiology of cleft lip and palate. An attempt to rule out chance correlations. 
The findings of a previous epidemiological study on oral clefts (599 children) were tested in an independent sample of 194 children, using the same source as for the previous study (Finnish Register of Congenital Malformations). Several of the earlier results--such as seasonal variation and associations between clefts and parental age, social factors, and emotional stress--were not reproduced. It is concluded that chance correlations introduce a marked problem to epidemiological studies. The findings of both studies show that there is an exceptionally high incidence of cleft palate in Finland. Significant geographical variations and associations between clefts and prematurity, threatened abortion during the first and second trimesters, maternal drug consumption during the first trimester, and influenza and fever during the first trimester were found. The possible role of these findings in the aetiology of oral clefts is discussed, and particular attention is paid to the possible teratogenicity of salicylates.
PMCID: PMC478898  PMID: 241446
24.  Ischaemic heart disease and the water factor. A variable relationship. 
A comparison is made between mortality from ischaemic heart disease and the quality of drinking water in the cities of Brisbane and Melbourne. Mortality from ischaemic heart disease is found to be higher in Brisbane where drinking water is harder, than in Melbourne. Moreover, mortality from all causes is higher in Brisbane than in Melbourne.
PMCID: PMC478897  PMID: 1182359
25.  Incidence of ischaemic heart disease in two cohorts of Belgian clerks. 
A study during a five-year period has been conducted on the incidence of ischaemic heart disease (IHD) among two cohorts of Belgian employees who were free of IHD at entry. As regards the final outcome these incidences differ significantly. The chief difference between the two cohorts is their systolic blood pressure. These pressure differences may be attributed to differences in the level of work pressure. The increased work pressure in Cohort I might account, through stress, for the greater incidence of sudden death or myocardial infarction.
PMCID: PMC478896  PMID: 1182358

Results 1-25 (37)