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To aid discussion on the introduction of an appointment system in an inner city practice with a 'walk-in' (non-appointment) system, we surveyed, firstly, patients' and staff members' attitudes to appointment systems, and secondly, aspects of the functioning of the current system. Of 250 patients in the first survey 73 per cent were against appointment systems while 24 per cent indicated that they would consider registering with another practice if such a system were introduced. Adverse comments about appointment systems greatly outweighed favourable ones. Staff members perceived clear advantages and disadvantages of both methods of consulting e.g. the 'walk-in' system was thought to be stressful due to the unpredictable workload but thought to reduce the demand for housecalls. Appointment systems were seen as giving staff more control over consulting but as less flexible for the patient. In the second survey of 352 patients, 17 per cent estimated a wait of 10 minutes or less for their consultation, 62 per cent estimated it as 10 to 20 minutes and 21 per cent as more than 30 minutes. Further, 68 per cent of patients estimated that their consultation lasted five minutes or less and 27 per cent indicated that the doctor seemed rushed. As a compromise between the wishes of patients and the needs of staff, 'walk-in' morning surgeries and appointment-only evening surgeries are now offered.

Over 10 months 5,000 practice information leaflets were distributed in a practice in Glasgow. The leaflet was principally evaluated by assessing patients' attitudes to and use of leaflets and changes in their knowledge about the practice. Changes in the pattern of consultation with the practice nurse and the timing of incoming telephone calls were also measured. Most patients read, kept and referred to the leaflet and reported it to be useful. Those who had seen the leaflet had significantly greater knowledge (mean knowledge score 7.5) on 15 questions on practice organization than two comparison groups: the base-line study sample (mean knowledge score 5.2) and those in the follow-up sample who had not seen the leaflet (mean knowledge score 5.7). Improvements in knowledge were statistically significant for 10 out of 15 questions. Two changes of behaviour were noted, increased self-referral to nurses (37% of new consultations at follow-up were self-referred compared with 29% at baseline: P = 0.05) and the timing of incoming telephone calls was more in line with practice policy (for example, 23% of calls for repeat prescriptions were made between 12.00 and 16.00 hours at follow-up compared with only 11% at baseline, P less than 0.001). The leaflet was judged to be useful.

Epidemiological studies suggest that Asians living in Britain, particularly children, have poor oral health. This study of the dental health knowledge, beliefs, attitudes and behaviour of a random sample of sixty-nine Asian adults in Glasgow aimed to identify some possible underlying factors. The dental health knowledge of Asians living in Glasgow appeared to be limited, specifically with regard to methods of reducing the incidence of caries. Thirty per cent could not name any foods which were known to be detrimental to dental health and only 30% felt that children under the age of five required access to dental services. The aesthetic value of a healthy mouth was highly appreciated by the majority of respondents and poor oral health was considered to be socially unacceptable. The Asian population examined would seem to be an appropriate target group for dental health education, since low knowledge levels rather than negative attitudes appear to cause Asians to be at high risk from caries.

This survey assessed the maintenance of evaporative cooling towers in Glasgow, following two Legionnaires' disease outbreaks. Information was obtained from 76 of 81 premises and a maintenance score was calculated for each of 174 towers. The quality of maintenance was extremely varied (range of maintenance scores, 8-30; mean, 22 (S.D., 5.0); median, 23; maximum possible, 33) and some towers were neglected. Breaches of maintenance principles were mainly structural and organizational, e.g. inadequate drift control, rather than failure to use chemicals. Low maintenance scores were associated with no log book, no guidelines, no change in procedures in last 5 years, solitary cooling towers, and towers on industrial premises. Despite intense publicity the standard of cooling tower maintenance in Glasgow remained a concern. Information campaigns directed at those responsible for cooling-tower maintenance are necessary.

A comparative study of Asian and non-Asian women's reproductive health was performed. The hospital case notes of 48 Asian and 51 non-Asian women, matched for age, were examined. Asian women had shorter stature, bigger families, booked later for antenatal care, and were less likely to have a cervical smear taken. Of the above, 30 Asian and 24 non-Asian women were interviewed in their homes. Many Asian women had difficulties with the English language and a low literacy rate which gave rise to communication barriers during health care. Their knowledge of procedures and tests such as amniocentesis, self examination of the breast etc. was comparatively low. Fewer Asians attended parent-craft classes or did post-natal exercises. Many disliked, and some refused, vaginal examination by male doctors. Despite equal access, Asian women were less well informed and made lesser use of services. Lack of knowledge and difficulties of communication, rather than negative attitudes, may explain Asian women's lesser use of services and to some extent the poor outcome of pregnancy observed in many studies.

A community-based interview study of Asians and a questionnaire study of health professionals were performed to ascertain the role of traditional medicine in the context of health care within the Asian community. Among Asians, knowledge of herbal remedies, the Asian healer and cultural concepts such as the 'hot/cold' theory was high. They frequently used culinary ingredients to treat common diseases such as abdominal discomfort, earache and toothache. The use of metal-based medications was rare, application of the 'hot/cold' concept was not of nutritional significance and Asian healers were infrequently consulted except during visits to India and Pakistan. Among health professionals awareness of Asian medicine was low. None had encountered morbidity resulting from its remedies while 50% felt that such remedies should be encouraged unless shown to be harmful. Traditional medicine was found to play a modest but not insignificant role within the context of total health care. There was little evidence that is use comprises a significant health threat. Opportunities for further research and a prediction of the future of Asian medicine in Britain is presented.

Consultation patterns in a practice with no appointment system, situated in a socially deprived area, were examined to confirm or refute one doctor's perception that the consultation rate was much higher than average. Seventy five per cent of a sample of patients (n = 394) had consulted in the previous year. The mean annual consultation rate was 3.8 (range 0 to 29) but the median was 3.0 and the mode 0. Among 222 patients consulting over one month the mean annual consultation rate was 10.0 (range 0 to 47) with a median of 9.0 and a mode of 6. The duration of consultation (n = 506) varied from one to 25 minutes (with mean, median and modal values of 5.3, 4.0 and 4 minutes respectively) and 53% of patients received between one and four minutes. The overall consultation rate was not high, particularly in view of the socioeconomic deprivation of the practice population, and the doctor's perception of excessive consultation was explained by the high consultation rate among attenders. The consultation pattern, particularly of males, was not conducive to a preventive approach. The mean was a poor descriptor of the average consultation rate or duration.

Eight studies that examined the relation between snoring and vascular disease were identified. The prevalence of habitual snoring, measured by questionnaire or interview, varied from 3% to 29% of adults and was dependent on age, sex, obesity, and smoking habit. In men, habitual snoring was associated with hypertension and ischaemic heart disease, with adjusted relative risks in the range 1.3-2.0. For women, only one study provided adjusted estimates of relative risk, which were 2.8 for hypertension and 1.2 for angina. Adequately adjusted relative risks for cerebrovascular disease have not been reported, but unadjusted estimates varied from 1.6 to 10.3. These studies had several limitations, including the lack of a standard definition of snoring, the use of unvalidated questionnaires, and failure to account for confounding variables and the possibility of reporting bias. Only one study was prospective. Epidemiological criteria for a causal association between snoring and vascular disease have not been satisfied. The apparent excess risk is probably due to the consequences of sleep apnoea rather than snoring itself.