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OBJECTIVE To establish the relation between socioeconomic status and the age-sex specific prevalence of type 1 and type 2 diabetes mellitus. The hypothesis was that prevalence of type 2 diabetes would be inversely related to socioeconomic status but there would be no association with the prevalence of type 1 diabetes and socioeconomic status. SETTING Middlesbrough and East Cleveland, United Kingdom, district population 287 157. PATIENTS 4313 persons with diabetes identified from primary care and hospital records. RESULTS The overall age adjusted prevalence was 15.60 per 1000 population. There was a significant trend between the prevalence of type 2 diabetes and quintile of deprivation score in men and women (χ for linear trend, p<0.001). In men the prevalence in the least deprived quintile was 13.4 per 1000 (95% confidence intervals (95% CI) 11.44, 15.36) compared with 17.22 per 1000 (95% CI 15.51, 18.92) in the most deprived. For women the prevalence was 10.84 per 1000 (95% CI 9.00, 12.69) compared with 15.48 per 1000 (95% CI 13.84, 17.11) in the most deprived. The increased prevalence of diabetes in the most deprived areas was accounted for by increased prevalence of type 2 diabetes in the age band 40–69 years. There was no association between the prevalence of type 1 diabetes and socioeconomic status. CONCLUSION These data confirm an inverse association between socioeconomic status and the prevalence of type 2 diabetes in the middle years of life. This finding suggests that exposure to factors that are implicated in the causation of diabetes is more common in deprived areas. [ABSTRACT FROM PUBLISHER]

OBJECTIVE: To compare the prevalence of cardiovascular risk factors and coronary heart disease in Chinese and Europid adults. DESIGN: Population based, cross sectional survey. SETTING: Newcastle upon Tyne, UK, 1991-93. SUBJECTS: Altogether 380 Chinese and 625 Europid adults, aged 25-64 years. MAIN OUTCOME MEASURES: Fasting lipid levels, blood pressure, body mass index (BMI), the proportions who smoked, and the prevalence of coronary heart disease based on the Rose angina questionnaire and major electrocardiographic abnormalities on resting 12 lead electrocardiogram (Minnesota codes 1.1-1.2). All figures were age adjusted to the 1991 England and Wales population. RESULTS: Altogether 183 and 197 Chinese, and 310 and 315 Europid men and women respectively were seen. Compared with Europid men, Chinese men had a lower mean total cholesterol concentration (5.1 versus 5.6 mmol/l, p < 0.001) and LDL cholesterol (3.2 versus 3.6 mmol/l, p < 0.001); lower BMI values (23.8 versus 26.1 kg/m-2, p < 0.001); and smoked less (23% versus 35%, p < 0.01)). Compared with Europid women, Chinese women also had lower mean lipid levels (total cholesterol: 4.9 versus 5.4 mmol/l p < 0.001, LDL cholesterol: 2.8 versus 3.1 mmol/l p < 0.001); BMI values (23.5 versus 26.1 kg/m-2, p < 0.001); and far fewer were smokers (1.4% versus 33%, p < 0.001). Chinese women, however, had higher mean systolic (121 versus 117 mmHg, p > 0.05) and diastolic (75 versus 68 mmHg, p < 0.001) blood pressures. The prevalence of coronary heart disease was significantly lower in Chinese than Europid men (4.9% versus 16.6%, p < 0.001) but not significantly different in women (7.3% versus 11.1%, p = 0.16). CONCLUSION: Strategies for UK Chinese are needed to maintain this favourable risk factor profile and prevent any potential increase in the risk of coronary heart disease associated with increasing acculturation. [ABSTRACT FROM PUBLISHER]

To compare the prevalence of glucose intolerance (impaired glucose tolerance and diabetes), and its relationship to body mass index (BMI) and waist-hip ratio in Chinese and Europid adults. This was a cross sectional study. Newcastle upon Tyne. These comprised Chinese and Europid men and women, aged 25-64 years, and resident in Newcastle upon Tyne, UK. Two hour post load plasma glucose concentration, BMI, waist circumference, and waist-hip ratio. Population based samples of Chinese and European adults were recruited. Each subject had a standard WHO oral glucose tolerance test. Complete data were available for 375 Chinese and 610 Europid subjects. The age adjusted prevalences of glucose intolerance in Chinese and Europid men were 13.0% (p = 0.04). Mean BMIs were lower in Chinese men (23.8 v 26.1) and women (23.5 v 26.1) than in the Europids (p values < 0.001), as were waist circumferences (men, 83.3 cm v 90.8, p < 0.001; women, 77.3 cm v 79.2, p < 0.05). Mean waist-hip ratios were lower in Chinese men (0.90 v 0.91, p = 0.02) but higher in Chinese women (0.84 v 0.78, p < 0.001) compared with Europids. In both Chinese and Europid adults, higher BMI, waist circumference, and waist-hip ratio were associated with glucose intolerance. The prevalence of glucose intolerance in Chinese men and women, despite lower BMIs, is similar to or higher than that in local Europid men and women and intermediate between levels found in China and those in Mauritius. It is suggested that an increase in mean BMI to the levels in the Europid population will be associated with a substantial increase in glucose intolerance in Chinese people. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE: To assess agreement between two Takeda UA-731 automatic blood pressure measuring devices (referred to as machines A and B) and two manual mercury sphygmomanometers. DESIGN: A 'Y' connector attached each Takeda UA-731 to a manual mercury sphygmomanometer. Simultaneous measurements were made on adult subjects. SETTING: A population based cardiovascular disease survey in Newcastle upon Tyne, UK. PARTICIPANTS: Measurements on machine A were compared in 71 individuals (all women), and on machine B in 75 individuals (9 men, 66 women). The age range of subjects was 28 to 76 years and median ages were 59 years for machine A and 50 years for machine B. MAIN RESULTS: Blood pressure (mmHg) ranged from 72 to 212 systolic and 44 to 102 diastolic. Both Takedas gave significantly lower readings than the manual devices for systolic and diastolic pressures: differences were mean (SD: 95% CI) 3.7 mmHg (6.5: 2.2, 5.2) for machine A systolic, 2.3 mmHg (4.5: 1.3, 3.4) machine A diastolic; 1.8 mmHg (6.2: 0.4, 3.3) machine B systolic, and 1.8 (4.4: 0.8, 2.8) machine B diastolic. On the British Hypertension Society criteria, machine A was graded C on systolic measurements and B on diastolic; machine B was graded B on both systolic and diastolic measurements. CONCLUSIONS: The performance of these machines compares favourably with the Dinamap 8100, recently adopted for survey work by the Department of Health. The Takeda UA-731 looks promising for epidemiological survey work but before it can be fully recommended further evaluations are needed. [ABSTRACT FROM PUBLISHER]

Background Historically, policy initiatives have made variable contributions to improvements in public health. Today there is a growing interest in translating evidence from health research into healthy public policy. Although research evidence may be a component of policy development, it is rarely enough, because policy makers are subject to a wide range of influences. Furthermore, researchers and policy makers usually work within different time frames and rules of evidence. There is a growing, albeit limited, literature on how researchers can most effectively engage with policy makers. Evidence suggests that more active and effective dialogue between researchers and policy makers is needed, in the formulation of research questions, presentation of evidence, and drafting and choice of policy options. Aim To develop, implement, and evaluate an interactive approach to informing policy for the prevention and management of cardiovascular disease (CVD) and diabetes. Setting This work is being undertaken in four eastern Mediterranean territories, known to have high burdens of CVD and diabetes: Palestine, Tunisia, Turkey and Syria. Methods and results Available epidemiological data are being identified, appraised and used to populate the IMPACT CHD Policy Model in order to examine CHD trends. Two corresponding epidemiological models have been developed to examine trends in type 2 diabetes and ischaemic stroke. An intensive review of the literature and consultation assists in the identification of efficacious policy interventions. A situation analysis is being undertaken within each country using mixed methods, which include: key informant and in depth interviews, document reviews, and participant observation. Its aim is to review current policy (stated and implemented), perceived facilitators and barriers to policy change, including health beliefs, and aspects of the health system. Policy makers are explicitly involved as key informants, participants, advisors and “lobbyists”. The epidemiological modelling, evidence based reviews, and situation analyses are together being used to generate diverse policy options. The cost-effectiveness of each chosen option will then be assessed. Conclusions We have developed a provisional framework for developing policy options, initially for the prevention of CVD and diabetes. This is based on local epidemiological data, an assessment of the socio-political-cultural context and cost effectiveness. Policy makers are involved throughout, and will be presented with costed policy options along with their potential consequences. Implemented options will then be evaluated. The framework represents a “policy effectiveness-feasibility loop”, analogous to Tugwell's clinical effectiveness loop. The impact of this approach, and its potential generalisability, will be rigorously evaluated. [ABSTRACT FROM AUTHOR]

Background Current projections of diabetes prevalence are mostly based on demographic change. Explicitly including trends in obesity and other risk factors could improve the accuracy of the projections and assist in evaluating policy options for prevention. Methods The model integrates population, obesity and smoking trends to estimate future diabetes prevalence. From three starting states (healthy, obese and smokers) the number of people with diabetes and deaths by diabetes status are estimated using a Markov approach. The transition probabilities and RR associated with risk factors were obtained from the literature, except for diabetes incidence that was estimated using DISMOD. For validation purposes, we developed a model for the England and Wales population (1993–2006), and compared model outputs with diabetes prevalence reported by the Health Survey for England (HSE) and the English Longitudinal Study of Ageing (ELSA). Results The prevalence of diabetes mellitus in England and Wales in 1993 was 3% in men and 2% in women (HSE; adjusted for self reporting, 3.9% and 2.6% respectively) and increased to 6% and 4% (7.3% and 5.5%, adjusted) by 2006. Obesity prevalence almost doubled and smoking trends showed a more complex pattern. Comparisons with the HSE showed almost parallel trends, over a period of 13 years. Prevalence as estimated from the model was 7.3% for men and 5.7% for women for 2006 and 8.9% and 7.2% for 2012. The model tends to slightly overestimate prevalence but accuracy improved in later years. The estimated prevalence compared well with that reported in ELSA (Men: model: 9.9%, ELSA: 11.6%; women: 8.3% and 6.8%). Conclusions The model provide a reasonably close estimate of diabetes prevalence for England over the 1993–2006 period, compared with contemporary independent prevalence surveys in the same population. Although the model seems to slightly overestimate prevalence, the observed and modelled trends are almost parallel. Further testing and validation in a range of populations would be desirable but the model appears to provide reasonably accurate estimates of diabetes prevalence that could be used by policymakers. [ABSTRACT FROM PUBLISHER]

Background and Purpose: To establish post-stroke case fatality rates within a community based incident stroke population in rural Tanzania., Methods: Incident stroke cases were identified by the Tanzanian Stroke Incidence Project and followed-up over the next 3-6 years. In order to provide a more complete picture, verbal autopsy (VA) was also used to identify all stroke deaths occurring within the same community and time period, and a date of stroke was identified by interview with a relative or friend., Results: Over 3 years, the Tanzanian Stroke Incidence Project identified 130 cases of incident stroke, of which 31 (23.8%, 95% CI 16.5 to 31.2) died within 28 days and 78 (60.0%, 95% CI 51.6 to 68.4) within 3 years of incident stroke. Over the same time period, an additional 223 deaths from stroke were identified by VA; 64 (28.7%, 95% CI 20.9 to 36.5) had died within 28 days of stroke and 188 (84.3%, 95% CI 78.1 to 90.6) within 3 years., Conclusions: This is the first published study of post-stroke mortality in sub-Saharan Africa from an incident stroke population. The 28 day case fatality rate is at the lower end of rates reported for other low and middle income countries, even when including those identified by VA, although CIs were wide. Three year case fatality rates are notably higher than seen in most developed world studies. Improving post-stroke care may help to reduce stroke case fatality in sub-Saharan Africa.

The issue of mandatory cycle helmets is highly contentious. The aim of this paper is not to argue for or against legislation but to suggest criteria on which the debate should focus. This is done by attempting to answer the question: 'What criteria must be met before cycle helmet wearing is enforced?' Consideration is given to principles, precedents and consequences and four criteria are suggested. The criteria are to do with effectiveness, personal liberty, public acceptability and the promotion of the public health benefits of cycling.