Damp housing and adult health: results from a lifestyle study in Worcester, England

STUDY OBJECTIVE

To explore the relationship between damp housing and adult health using two separate measures of ill health and taking into account the confounding effects of health related lifestyles and social factors.

DESIGN AND SETTING

Analysis of responses gathered in a cross sectional, postal questionnaire survey of a randomly selected sample of 5347 residents of Worcester.

PARTICIPANTS

Altogether 2353 people aged 16 to 64 years responded to the survey (adjusted response 52%).

RESULTS

Nine per cent of respondents lived in housing which they reported to be damp. Rates were highest among young women. People who lived in damp housing were more likely to report long standing illness, disability, or infirmity; the increased prevalence could not be attributed to any particular medical condition. Perceived ill health, as measured by the sleep, energy, and social isolation dimensions of the Nottingham Health Profile, was also more common in this group. These associations could not be explained by lifestyle factors; the relationship proved strongest among people in non-manual social classes living in owner occupied housing. The prevalence of ill health increased as the severity of dampness increased.

CONCLUSION

Self reported damp housing and ill health in adults were strongly associated, most noticeably among people in non-manual social classes living in owner occupied housing. The association met many of the epidemiological criteria necessary for suggesting causality: alternative explanations are discussed.

Screening for hearing loss in childhood: a study of national practice

A questionnaire survey of all health districts in England and Wales was carried out at the end of 1984 to document screening programmes for identifying hearing loss in childhood. The response rate was 81.3%. All districts performed distraction testing, all but nine aiming at doing so at 7-9 months of age. All districts tested children's hearing at school, generally before 7 years of age. The number of times that children were screened both before school and at school varied considerably, from one to six times before school and one to six times at school. Few districts collected information that would allow them to make judgments about the efficiency of effectiveness of their screening programmes.

Case definition in childhood accident studies: a vital factor in determining results

Research into possible aetiological factors associated with childhood accidents has failed to produce a consistent picture. In this paper we investigate the extent to which these discrepancies are attributable to different methods of case ascertainment. The approach was to use three different criteria for identifying accidents and to apply a number of commonly used statistical techniques to eight social and environmental factors. The data base consists of a nationally representative sample of 13 135 children (the Child Health and Education Study). In this way, broadly similar profiles were obtained for children reported to have had at least one accident in the first five years and for those who were said to be accident repeaters--the major risk factors in common for these two outcomes were young maternal age and residence in 'average' or 'well-to-do' urban areas. On the other hand, there were major differences in the results when admission to hospital for an accident was taken as the outcome--although young maternal age was still strongly associated, large family size and the loss or replacement of a natural parent were now also dominant risk factors. There was no relationship with area of residence. The conclusion from these example analyses is therefore that variation in case selection can lead to different conclusions about the risk factors associated with childhood accidents.

Preschool wheezing and prognosis at 10

Information was collected at birth and at 5 and 10 years of age on the national cohort of children born in one week of April 1970 (the Child Health and Education Study). For 11 465 children, information on wheezing attacks before 5 years was compared with reports of wheezing occurring in the 12 months before the interview at 10 years. Of 2345 children who had had at least one wheezing attack before their fifth birthday, 80% (1869) were free of wheeze at 10 years; only 8% of children who had just one wheezing attack by 5 years wheezed in their 10th year. The more attacks the child had had by the age of 5 the higher the risk of continuing to wheeze at the age of 10, but there were no major differences in prognosis according to the age of the first attack. Half of the children who had been labelled asthmatic at the age of 5 were wheezing at the age of 10 compared with an eighth of those with wheezing not so labelled. There was little evidence to suggest that the prognosis of wheezing with bronchitis was markedly different from that of children with other episodes of wheezing provided they were not said to be asthmatic. A longer follow up is necessary to ascertain whether remission at the age of 10 is followed by relapse later.

Child behavior and accidental injury in 11,966 preschool children

Social and behavioral characteristics of 11,966 British children, aged 5 years, and mothers' reports of accidental injuries between birth and age 5 years were analyzed. Aggressive behavior was associated with all accidental injuries after controlling psychosocial variables including social class; crowding; mother's psychological distress, age, and marital status; and child's sex. Overactivity was associated only with injuries not resulting in hospitalization after control of the covariates. The relative risk of injuries resulting in hospitalization was 1.9 among children with both high activity and high aggression scores compared with children with low scores on both behavioral scales. The findings support the inference that aggression and overactivity are independently associated with accidents. The associations between child behavior and injuries were stronger than the associations between injuries and the social factors including social class and crowding. This finding suggests that interventions aimed at high-risk groups may be effective supplements to environmental interventions.

Spectacle prescribing among 10-year-old children

Between 10 and 12% of the 10-year-old children in the 1970 national birth cohort were prescribed a pair of spectacles. One-fifth of these children had no impairment of visual acuity and a further 15-20% had only minimal visual defects. Only two-thirds of children with spectacles could produce them when asked to do so at the survey school medical examination; this was particularly common among those in the lower social classes and among children who had no detectable impairment. The information presented in this paper combined with that from earlier national birth cohort studies suggests that overprescribing of spectacles to school children is very common. The financial implications of this overprescribing are discussed.

Educational attainment of 10-year-old children with treated and untreated visual defects

Children with visual defects who took part in a 10-year survey were compared with their peers on measures of intelligence, reading, mathematics and sporting ability. Results are consistent with earlier findings of increased intelligence among children with myopia and slightly reduced intelligence among children with amblyopia. Those with other visual defects had normal intelligence scores. Once intelligence had been taken into account, only children with mild hypermetropia were under-achieving at reading. Those with severe myopia were reading better than expected. None of the children could be shown to be over- or under-achieving at maths, any variation being due to intelligence. The mothers of children with visual defects perceived them to be less able at sport. Comparison of the performances of children with minor visual defects who had and had not been prescribed spectacles did not suggest any disadvantage for those without spectacles, with the possible exception of children with mild hypermetropia. It is concluded that the majority of visual defects do not affect children's learning, and that current indications for prescribing spectacles need to be validated.

Visual acuity in a national sample of 10 year old children

The prevalence of defects of visual acuity among the 10 year old children in the 1970 birth cohort was 22.1%, but only in one third of these children was the defect more severe than 6/9. Defects were more common among girls. The relation of defects to social class was complex. Comparison with data collected on the children of the 1958 cohort when they were 11 years old suggests that although the prevalence of 6/9 visual acuity has remained constant over the last decade, the prevalence of more severe defects has declined from 12.9% to 7.3%. These findings have a number of implications for the provision of screening programmes and of ophthalmic services for children.

Covering stoma for elective anterior resection of the rectum: an outmoded operation?

A prospective multicenter study of the management of large bowel cancer recorded the results in 4,500 patients in whom 2,056 have had an elective colorectal anastomoses. Of these patients, 15.8 percent had a synchronous covering stoma to protect the anastomoses. Although the anastomotic leak rate was high in patients with a stoma, no overall differences were observed in mortality between those patients who had a covering stoma and those patients who did not (7 percent and 6.1 percent, respectively). However, when surgical policies were analyzed, clinically large and statistically significant differences were found. Some surgeons frequently used a covering stoma for low anterior resection whereas others only rarely did so. The differences in anastomotic leak and mortality were 20 percent and 7.8 percent, and 8.4 percent and 3.6 percent, respectively. We conclude that all surgeons should know their own clinical and radiologic anastomotic leak rate. If and when this figure becomes low (less than 5 percent), the covering stomas will become necessary except for the very rare and difficult case.

Preoperative urography in large bowel cancer: a useless investigation?

The utility of intravenous urography (IVU) in the preoperative assessment of patients with adenocarcinoma of the large bowel has been investigated in 4226 patients derived from a prospective multicentre study entitled the Large Bowel Cancer Project. An IVU was carried out in 956 of these patients (22.6 per cent), subsequent surgery revealed unsuspected direct urinary tract involvement in 75. However, 42 (56 per cent) had shown no IVU abnormality. Twenty patients having a clinical colovesical fistula had had a preoperative IVU. Only half showed an abnormality. In the entire study group, 10 nephrectomies and 40 other concomitant urinary tract resections were performed. Four of these nephrectomies were associated with right-sided tumours. A significantly higher number of patients with a rectal primary had a preoperative IVU. The value of routine preoperative urography before large bowel cancer surgery is questioned, and other methods of determining function in the other kidney before nephrectomy should be sought.

Evidence for increasing prevalence of diabetes mellitus in childhood

The prevalence of diabetes mellitus among the cohort of children in the Child Health and Education Study studied at age 10 was 1.3/1000. Comparison with prevalences found in the two previous British birth cohort studies suggested that the prevalence of diabetes is doubling roughly every decade. The data suggested that childhood diabetics are a socially advantaged group. These findings have important implications and should be taken into account by health service planners if the needs of these children are to be met in the future.

Recent Findings from the 1970 Child Health and Education Study: Preliminary Communication

The progress is described of the longitudinal cohort study based on all children born in England, Scotland and Wales in one week of April 1970. The children and their mothers have been surveyed at birth, at five, and recently, at ten. Analyses of the data presented include the finding of improved intellectual outcome in children who had been immunized against pertussis, compared with poor intellectual outcome in children who had had hospital admissions for the disease itself. Preliminary data collected at 10 show that routine hearing and vision testing during the child's school life fell short of recommended standards. The major aim of the 10-year-old contact, however, is to establish details of the national prevalence and pathogenesis of disability. The identification of disability uses a life skills questionnaire, medical history and examination.

Histopathology reporting in large bowel cancer

A review of histopathology reports on 2046 patients in the large bowel cancer project showed considerable observer variation in histological grading. Dukes staging, and lymph node harvest. These parameters have a well-established relationship to prognosis, but, if they are to be applied for both clinical and research purposes, they must be assessed consistently. A minimal level of information which should be recorded from a resection specimen is suggested, with a description of the methods by which this information can be obtained.

Anastomotic integrity after operations for large-bowel cancer: a multicentre study

Clinically evident anastomotic dehiscence was studied in 1466 patients who had undergone resection of a large-bowel adenocarcinoma. The overall incidence of anastomotic leakage was 13%, but the incidence varied between surgeons (range 0.5% to over 30%). Morbidity and mortality were significantly higher in those patients in whom the anastomosis failed to heal primarily. If these results are extrapolated to the national level, it should be possible by achieving results closer to those in patients without leakage to reduce overall post-operative mortality after resection of large-bowel cancer by 2% and to achieve an appreciable reduction in morbidity. Both factors are clinically important and, taken together, could result in appreciable saving of revenue.

Large-bowel obstruction caused by cancer: a prospective study

Patients with obstructing large-bowel cancer may be treated by primary tumour resection or the conventional staged tumour resection, and a prospective study comparing these two treatments was carried out. The post-operative outcome in 174 patients (of whom 90 underwent primary and 47 staged tumour resection) showed that the overall mortality was similar in both groups but that the duration of hospital stay in patients who underwent primary tumour resection was half that of those who underwent staged tumour resection. The mortality for primary tumour resection, however, was unexpectedly high for lesions proximal to the splenic flexure and unexpectedly low for lesions distal to this point. Of patients with distal tumours in whom a staged resection was planned, 35% died after a loop colostomy. The most striking result was that the ratio of postoperative death for trainee surgeons compared with fully trained surgeons was 3:1. It is concluded that patients with large-bowel cancer who present with intestinal obstruction should be treated by a fully trained surgeon and that immediate resection of the tumour should be considered for every patient.

Surgeon-related variables and the clinical trial

CT was used to examine six patients with clinically evident atlantoaxial rotary fixation, two patients with torticollis, and six normal subjects who had turned their heads to the side as far as voluntarily possible. The CT appearances of the atlantoaxial complex were identical in all three groups. To differentiate these groups, we propose a functional scan through C1–C2 in which patients are scanned initially as they present, with their heads fixed in lateral rotation. Subsequent scans are obtained with their heads turned to the maximum contralateral rotation. CT scans in patients with atlantoaxial rotary fixation demonstrate no motion at C1–C2 during this maneuver, while those in patients with transient torticollis show a reduction or reversal of the rotation of C1 on C2.