Socioeconomic forces as determinants of childhood mortality decline in Rhode Island, 1860-1970: a comparison with England and Wales

The author tests McKeown's hypothesis that socioeconomic improvement was the most important cause of mortality decline in England and Wales. First, McKeown's basic work is replicated using data on childhood mortality in Rhode Island between 1860 and 1970. "Then the effect of socioeconomic change on mortality change is examined in ways that differentiate it from other effects. Next, socioeconomic and public health effects on disease are differentiated by computing case-fatality and incidence rates." The results provide support for McKeown's argument.

Prematurity

Perinatal epidemiologists no longer speak much of "prematurity". Instead the World Health Organization recommends that infants born before 37 completed weeks of gestation should be designated "preterm" and those of birthweight less than 2500 g "low birthweight". Both definitions have obvious drawbacks--the former because menstrual dates are often unknown or unreliable, the latter because it does not separate preterm from small-for-gestational-age infants. Whatever the classification of these small infants there is no dispute about their high mortality and morbidity; in the United Kingdom they account for over two-thirds of first-week deaths.

Research, preparation and not having to turn them away

Thanks to joint funding, a day care abortion clinic has opened at the South London Hospital for Women. Sally Burningham finds that the unit is working very much as the people who proposed it had envisaged and the care given to the women concerned is by no means diminished by the short time spent under supervision.

Abortion counselling by nurse specialists

This paper describes additional training given to nurse specialists in family planning to cover abortion counselling. The primary counselling was carried out by general practitioners or family planning clinic doctors, following this the patient was referred to hospital for counselling by nurse specialists. Of the first 742 patients seen, 3.2% were not pregnant and a further 25 patients (3.4%) decided against termination, 21 after counselling, and 4 because of advanced gestation. The interval between nurse counselling and termination (TOP) was 3 to 9 days, and of 682 TOPs 566 (83%) were in the first trimester. The additional training for nurse specialists prevented the unnecessary wastage of resources as only 42 (5.1%) required a second visit to confirm blood test results, e.g. rubella titres, and only a further 44 (5.3%) required referral to medical social workers.

An analysis of the influences of maternal age, gestational age, contraceptive method, and the mode of primary treatment of patients with hydatidiform moles on the incidence of subsequent chemotherapy

In relation to the total number of births in the United Kingdom there was an excess of hydatidiform moles arising in women over 34 years of age and possibly also under 15. The incidence of trophoblastic tumour requiring chemotherapy after hydatidiform mole was greatest in the 30 to 34 years age group and it was also high in the 20 to 24 years age group. This distribution appears to be influenced by the morphology of the moles, the mode of their removal and the use of oestrogens and progestogens in the post-evacuation period. The need for chemotherapy for trophoblastic tumour after evacuation of a hydatidiform mole was found to be two- to three-fold greater in patients who had undergone a medical induction, hysterectomy or hysterotomy compared with those whose hydatidiform moles had been evacuated by vacuum or surgical curettage, or who had aborted spontaneously. The increased risk of chemotherapy was most marked in the earlier weeks of gestation.

Reversal of vasectomy

Vasovasostomy to reverse a previous vasectomy for sterilization was attempted for 27 men, the procedure being technically impossible in only one case. A testicular biopsy was performed at the time of operation and a number were investigated for cell-mediated immunity to sperm and for the presence of circulating sperm-agglutinating and cytotoxic antibodies. The first 17 cases have been studied and of these there have been 11 pregnancies, ten of which have already come to term with the birth of normal infants, including one set of twins. Of the rest, two are known to have oligozoospermia and four have been lost to follow-up, although two of them were euspermic when last examined. In spite of these encouraging results, it is considered that there are no grounds for alterning the present basis of vasectomy counseling which is that the operation is likely to be irreversible.

Recognition and regulation of midwives

There is an urgent need for internaltion standards for the recognition, training and licensure of midwives. It is important for obstetricians to use their influence constructively to help meet the need.

The need for a chlamydial culture service

In a prospective study of unselected, female patients attending a sexually transmitted disease clinic one in eight patients would have been errouneously declared free of infection in the absence of a chlamydial culture service. Chlamydia trachomatis is now accepted as a causative organism of non-specific urethritis and post-gonococcal urethritis in men and non-specific genital infection in women. Thus, facilities for isolation of C. trachomatis should be an essential aid in the management of women attending STD clinics. Male patients would also benefit if such facilities were readily available.

The immune response to vasectomy and its relation to the HLA system

We examined 188 men who had undergone vasectomy up to 6 years previously and, for comparative purposes, 100 men who were about to undergo the operation. Blood specimens were available from a total of 283 men. Sperm antibody assays using immunofluorescence, microagglutination, and microimmobilization confirmed that the prevalance of several types of antibody is higher after vasectomy. Immobilizing and agglutinating antibodies appeared to be the most important. Trends in antibody prevalence according to the time after the operation were analyzed. Screening against lymphocytes and lymphoid lines showed that the anti-sperm activity of era was not related to anti-HLA or anti-Ia activity. Associations were examined between different types of sperm antibody, and between these antibodies and autoantibodies to other antigens. When antibody prevalence was studied in relation to HLA types, the HLA antigen A28 was found to be strongly associated with production of head agglutinating antibody (and immobilizing and immunofluorescent equatorial antibodies) after vasectomy. This is one of the first clear-cut examples of antibody production associated with the HLA system.

The effect of laparoscopic sterilisation by diathermy or silastic bands on post-operative pain, menstrual symptoms and sexuality

A total of 530 patients was reviewed six months after laparoscopic sterilisation by diathermy (235 patients) or silastic bands (295 patients). In the immediate postoperative period severe lower abdominal pain was more common in the patients who had silastic bands. There was no differences in the nature or incidence of menstrual problems when the two methods were compared. In all, 40 per cent of patients reported an increase in menstrual blood loss ad 26 per cent of patients an increase in menstrual pain, and this could not be attributed entirely to stopping oral contraception; 42 per cent of patients reported improvement in their sex lives after sterilisation, while 6.6 per cent reported deterioration mainly due to lack of libido. There was some regret about the operation in 5.1 per cent of patients.

Evidence of whooping-cough-vaccine efficacy from the 1978 whooping-cough epidemic in Hertfordshire

The question of the efficacy of whooping-cough immunisation was central to the controversy that started in 1974. Definitive answers were not possible at the time because of the very low levels of whooping-cough in the preceding years and the absence of up-to-date information. The widespread abandonment of whooping-cough immunisation and the subsequent epidemic of whooping-cough have provided a natural epidemiological experiment. Figures from Hertfordshire in 1978 show that for children aged 4 years and under whooping-cough immunisation conferred 92% protection.

New method for measuring milk intakes in breast-fed babies

A method for the measurement of milk intake in young breast-fed babies is described in which heavy water (2H2O) enrichment in saliva is measured on only two occasions after a single oral dose of 2H2O. Values obtained by this method are compared with those obtained by test-weighing. This new method is ideal for routine surveys since it does not interfere with feeding habits and maternal life style, and no technical expertise is required of the mother.

Hormonal profiles in lactating and non-lactating women immediately after delivery and their relationship to breast engorgement

Prolactin, human placental lactogen (HPL), oestrone, oestradiol and progesterone levels in plasma were measured before and during the first seven days after delivery in women who did not breast feed. The results confirmed the rapid clearance of placental steroids from the circulation after delivery. Plasma prolactin levels remained elevated during the early puerperium and the range of values were the same in non breast-feeding women and a group of breast feeding women. Of the 25 women studied, six developed breast engorgement. No difference in hormonal profiles were found leading to the conclusion that there is no endocrine basis for breast engorgement in non-breast feeding women.

Female sterilization using an elasticated silicone ring

This paper presents the experience, in a District General Hospital, of using an elasticated silicone ring applied to the Fallopian tubes by the laparoscope. It is concluded that this is a safe and effective method of female sterilization, with good patient acceptance.

Vesicovaginal fistulae

The aetiology, methods of repair and results are described in 616 patients with vesicovaginal fistulae (26 also had rectovaginal fistulae). The cure rate was 81%.

Paradoxical embolism associated with oral contraceptives: an underdiagnosed lesion?

A case of cerebral embolism is described in which paradoxical features have been proved clinically, and which may explain some hitherto unaccountable reported cases, and suggests the value of prospective studies. A successful outcome of such a proved case, associated with oral contraceptives, does not appear to have been reported previously.

Mortality and age differences in marriage

That married people have lower death rates than either the unmarried or the widowed has been recognized since the mid-19th century. Marital condition involves diverse and complex selection processes and is associated with differences in life style, factors which may contribute to differences in mortality. Mortality statistics of married people are presented here by age of surviving partner in an attempt to assess the influence of age difference between spouses.

A randomized double-blind trial of two low dose combined oral contraceptives

Fifty-five women using Loestrin-20 (20 microgram ethinyl oestradiol and 1 mg norethisterone acetate) as an oral contraceptive have been compared with a like number using Microgynon-30 (30 microgram ethinyl oestradiol and 150 microgram levonorgestrel) in a randomized, double-blind trial. Despite the small sample size, the main finding in the trial is clear-cut; Loestrin-20 provides poor cycle control and is thus less acceptable as an oral contraceptive than Microgynon-30. Although there is also a suggestion that Loestrin-20 may be less effective than Microgynon-30, the difference in the accidental pregnancy rates is not statistically significant.

Psychiatric aspects of urology

Psychiatric investigation of 342 patients attending a urological clinic during one year showed a wide spectrum of problems. Patients with lower urinary tract complaints scored higher on the Hamilton Scale than those with upper tract complaints.

Down syndrome: prevalence at birth, mortality and survival. A 17-year study

Analysis of comprehensive records over a period of 15 yr permits calculation of the total prevalence of Down Syndrome in an industrial city. The prevalence at birth is shown to have fallen from 1.70 per 1000 births in the period 1961--65 to 0.84 per 1000 births in 1971--75. The fall in prevalence can be shown to be largely due to a change in distribution of maternal age. An earlier increase in the number of Down Syndrome children is shown to reflect a greatly improved survival in the first 5 yr of life to a continuing level of 81%. The number of Down Syndrome children is unlikely to increase much even with increase of birth rate unless older mothers have further pregnancies. For these reasons the policies of amniocentesis of older women and termination of affected pregnancies will have progressively less effect on the number of affected children if this demographic trend continues. A further effect is that special schools will have a proportionately greater burden as the younger children being admitted have less prospect of development and may be more demanding of staff than Down Syndrome children.

The mortality of men in the Rhondda Fach, 1950--1970

A more detailed analysis of material from the 20-year follow-up of men in the Rhondda Fach confirms the similarity between the Standardised Mortality Ratios (SMRs) of miners and exminers with radiological categories 0, 1, 2, 3 and A (120.3, 116.5, 119.0, 115.7, and 120.1 respectively) as well as the difference between these SMRs and that of the non-moners (98.7). The specific death rates show a raised SMR for bronchitis and other respiratory diseases excluding pneumoconiosis for all categories including category 0, but little difference between those for category 0 and those for simple pneumoconiosis. The SMRs for ischaemic heart disease and other circulatory diseases for categories A, B and C combined are lower than those for simple pneumoconiosis and category 0 (84.2 and 85.0, compared with 109.8 and 121.8 for simple pneumoconiosis, and 117.5 and 114.6 for category 0). Fortunately the SMR for leukaemia is low. A comparison between the survival rates of men aged 55-64 in Leigh, Lancashire and those in the Rhondda Fach suggests that nonminers in the two areas have similar survival rates while the survival rates for category 0 and simple pneumoconiosis are lower in the Rhondda Fach.

Nutritional anemia: its understanding and control with special reference to the work of the World Health Organization

Since 1949, the World Health Organization, recognizing the public health importance of nutritional anemia, has sponsored efforts directed towards its understanding and control. During this period, often as a result of the work of the Organization, advances have been made in many areas. Basic understanding of iron, folate and vitamin B12 nutrition, and the various factors which may influence the availability and requirements of these factors, has greatly increased. Surveys in a number of countries have highlighted the widespread prevalence of nutritional anemia, particularly in developing countries. The major factor responsible is a deficiency of iron, whith folate deficiency also playing a role in some population groups, especially in preganant women. There is increasing evidence that anemia adversely affects the health of individuals and may have profound socioeconomic consequences. Control of nutritional anemia is possible by providing the deficient nutrient(s) either as therapeutic supplements or by fortification of commonly used foodstuffs. Some control programs are reviewed and suggestions for further action outlined. The Organization still has an important role to play in this field, encouraging the development of control programs and providing advice and technical assistance ot member countries.

[The demographic profile of the Late Iron Age/early Roman-age population of Cannington, Great Britain]

The author reports on a 1962-1963, excavation of a Late Iron Age and early Roman-age cemetery in Cannington, England. The population was reconstructed using Drenhaus's method and data on 510 individuals. "Probability of dying by years of age, survival and life expectancy at birth were estimated." (SUMMARY IN ENG)