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This paper discusses some of the findings of the Bristol Black and Ethnic Minority Health Survey, especially in relation to local plans to improve opportunities for South Asian women to become more physically active. Low levels of participation in exercise sessions were reported in the survey, particularly among Pakistani women. Many of the South Asian women whom we interviewed have poor self-assessed health and limited knowledge of English; they are also economically disadvantaged. It seems likely that exercise sessions outside the home will not reach many of these women. A project has been funded to discuss the research with local women, to identify exercise facilities and improve opportunities for South Asian women to become more active. In what follows we discuss findings relating to all South Asian women but subsequently with particular regard to Pakistani women, the largest single group. [ABSTRACT FROM AUTHOR]

Suspended fine sediment has a significant impact on freshwater quality variables such as visual clarity (VC). However, freshwater quality is related to the attributes of the catchment sources contributing fine sediment to the stream network. Here, the extent to which an array of sources defined spatially according to erosion process and geological parent material may be discriminated and classified based on sediment-related water quality (SRWQ) attributes that potentially affect VC was examined. Erosion sources were sampled across two New Zealand catchments representing six types of erosion and eight parent materials. Erosion source measurements focused on particle size, organic matter content, and light beam attenuation (which is convertible to VC). The source data were analysed to: 1) evaluate source variability using a combination of Kruskal-Wallis and principal component analysis; 2) reclassify sources using a Random Forest model; and 3) demonstrate how erosion source affects VC for a range of theoretical sediment concentrations (SC) using a simple empirical model. The results indicate that SRWQ attributes show significant variation across erosion sources. The extent to which attributes differed between sources often related to whether there was a strong association between a specific erosion process and parent material. The 19 a priori source classifications were reduced to 5 distinct sources that combined erosion process and parent material (i.e., bank erosion-alluvium; mass movement-ancient volcanics; mass movement-sedimentary; surficial erosion; gully-unconsolidated sandstone). At low SC, the impact of erosion source on VC became most evident ranging from 2.6 to 5.6 m at SC of 5 g m -3 . These findings show how catchment sources of sediment, in addition to sediment concentration, influence VC, and highlight the need to consider quality as well as quantity of material supplied to stream networks when planning erosion control., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Deforestation in New Zealand has led to increased soil erosion and sediment loads in rivers. Increased suspended fine sediment in water reduces visual clarity for humans and aquatic animals and reduces penetration of photosynthetically available radiation to aquatic plants. To mitigate fine-sediment impacts in rivers, catchment-wide approaches to reducing soil erosion are required. Targeting soil conservation for reducing sediment loads in rivers is possible through existing models; however, relationships between sediment loads and sediment-related attributes of water that affect both ecology and human uses of water are poorly understood. We present methods for relating sediment loads to sediment concentration, visual clarity, and euphotic depth. The methods require upwards of twenty concurrent samples of sediment concentration, visual clarity, and euphotic depth at a river site where discharge is measured continuously. The sediment-related attributes are related to sediment concentration through regressions. When sediment loads are reduced by soil conservation action, percentiles of sediment concentration are necessarily reduced, and the corresponding percentiles of visual clarity and euphotic depth are increased. The approach is demonstrated on the Wairua River in the Northland region of New Zealand. For this river we show that visual clarity would increase relatively by approximately 1.4 times the relative reduction of sediment load. Median visual clarity would increase from 0.75m to 1.25m (making the river more often suitable for swimming) after a sediment load reduction of 50% associated with widespread soil conservation on pastoral land. Likewise euphotic depth would increase relatively by approximately 0.7 times the relative reduction of sediment load, and the median euphotic depth would increase from 1.5m to 2.0m with a 50% sediment load reduction., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Few studies have comprehensively measured the effect on water quality of catchment rehabilitation measures in comparison with baseline conditions. Here we have analyzed water clarity and nutrient concentrations and loads for a 13-year period in a headwater catchment within the western Waikato region, New Zealand. For the first 6 years, the entire catchment was used for hill-country cattle and sheep grazing. An integrated catchment management plan was implemented whereby cattle were excluded from riparian areas, the most degraded land was planted in Pinus radiata, channel banks were planted with poplar trees and the beef cattle enterprise was modified. The removal of cattle from riparian areas without additional riparian planting had a positive and rapid effect on stream water clarity. In contrast, the water clarity decreased in those sub-catchments where livestock was excluded but riparian areas were planted with trees and shrubs. We attribute the decrease in water clarity to a reduction in groundcover vegetation that armors stream banks against preparatory erosion processes. Increases in concentrations of forms of P and N were recorded. These increases were attributed to: (i) the reduction of instream nutrient uptake by macrophytes and periphyton due to increased riparian shading; (ii) uncontrolled growth of a nitrogen fixing weed (gorse) in some parts of the catchment, and (iii) the reduction in the nutrient attenuation capacity of seepage wetlands due to the decrease in their areal coverage in response to afforestation. Our findings highlight the complex nature of the water quality response to catchment rehabilitation measures.

Fine sediment continues to be a major diffuse pollution concern with its multiple effects on aquatic ecosystems. Mass concentrations (and loads) of fine sediment are usually measured and modelled, apparently with the assumption that environmental effects of sediment are predictable from mass concentrations. However, some severe impacts of fine sediment may not correlate well with mass concentration, notably those related to light attenuation by suspended particles. Light attenuation per unit mass concentration of suspended particulate matter in waters varies widely with particle size, shape and composition. Data for suspended sediment concentration, turbidity and visual clarity (which is inversely proportional to light beam attenuation) from 77 diverse New Zealand rivers provide valuable insights into the mutual relationships of these quantities. Our analysis of these relationships, both across multiple rivers and within individual rivers, supports the proposition that light attenuation by fine sediment is a more generally meaningful basis for environmental management than sediment mass. Furthermore, optical measurements are considerably more practical, being much cheaper (by about four-fold) to measure than mass concentrations, and amenable to continuous measurement. Mass concentration can be estimated with sufficient precision for many purposes from optical surrogates locally calibrated for particular rivers.

Fallout (137)Cs has been widely used to determine floodplain sedimentation rates in temperate environments, particularly in the northern hemisphere. Its application in low fallout, tropical environments in the southern hemisphere has been limited. In this study we assess the utility of (137)Cs for determining rates of floodplain sedimentation in a dry-tropical catchment in central Queensland, Australia. Floodplain and reference site cores were analysed in two centimetre increments, depth profiles were produced and total (137)Cs inventories calculated from the detailed profile data. Information on the rates of (137)Cs migration through local soils was obtained from the reference site soil cores. This data was used in an advection-diffusion model to account of (137)Cs mobility in floodplain sediment cores. This allowed sedimentation rates to be determined without the first year of detection for (137)Cs being known and without having to assume that (137)Cs remains immobile following deposition. Caesium-137 depth profiles in this environment are demonstrated to be an effective way of determining floodplain sedimentation rates. The total (137)Cs inventory approach was found to be less successful, with only one of the three sites analysed being in unequivocal agreement with the depth profile results. The input of sediment from catchment sources that have little, or no, (137)Cs attached results in true depositional sites having total inventories that are not significantly different from those of undisturbed reference sites.

Clearing of native vegetation and replacement with cropping and grazing systems has increased nutrient exports to the Great Barrier Reef (GBR) to a level many times the natural rate. We present a technique for modelling nutrient transport, based on material budgets of river systems, and use it to identify the patterns and sources of nutrients exported. The outputs of the model can then be used to help prioritise catchment areas and land uses for management and assess various management options. Hillslope erosion is the largest source of particulate nutrients because of its dominance as a sediment source and the higher nutrient concentrations on surface soils. Dissolved nutrient fractions contribute 30% of total nitrogen and 15% of total phosphorus inputs. Spatial patterns show the elevated dissolved inorganic nitrogen export in the wetter catchments, and the dominance of particulate N and P from soil erosion in coastal areas. This study has identified catchments with high levels of contribution to exports and targeting these should be a priority.

To reduce sediment exports discharging to the Great Barrier Reef (GBR), it is essential to identify the sources of exported sediment. We used modelling of spatial sediment budgets (the SedNet model) to identify sources and deposition of sediment as it is transported through river networks. Catchments with high levels of land clearing, cattle grazing and cropping show the largest increases in sediment export compared with natural conditions. Hillslope erosion supplies 63% of sediment to the rivers. Gully erosion and riverbank erosion are lower sources of sediment at the GBR catchment scale, but they are important in some catchments. Overall, 70% of sediment exported from rivers comes from just 20% of the total catchment area, showing that much of the problem can be addressed in a relatively small area. This is a much more manageable problem than trying to reduce erosion across the entire GBR catchment. Areas of high contribution are all relatively close to the coast because of the high erosion and high sediment delivery potential.

Activities of daily living scales can be a useful tool in assessing change in people with dementia, either as the disease progresses or in response to treatment. However, little data exist as to the sensitivity to change of instruments used. The Bristol Activities of Daily Living Scale was developed with assistance from the carers of community dwelling people with dementia to be completed by such people and has been shown to have internal consistency as well as face and construct validity. This study aimed to analyse the sensitivity to change of the Bristol Activities of Daily Living Scale in people with Alzheimer's disease receiving anticholinesterase medication. Using the Clinician's Global Rating of Change as a gold standard for change, differences between Bristol Activities of Daily Living Scale scores before and after medication were compared with change in Mini-Mental State Examination, Alzheimer's Disease Assessment Scale - Cognitive and the Nurses Observation Scale for Geriatric Patients, in 61 older adults receiving anticholinesterase medication for Alzheimer's disease. Both the Bristol Activities of Daily Living Scale and the Nurses Observation Scale for Geriatric Patients are sensitive and specific in predicting improvement or stability as measured by the clinician's global rating of change. However, unlike the Nurses Observation Scale for Geriatric Patients, change over time in the Bristol Activities of Daily Living Scale significantly correlates with change in the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale - Cognitive. The Bristol Activities of Daily Living Scale is sensitive to change in activities of daily living and shows the expected and desirable relationship with measures of cognition., (Copyright 2000 John Wiley & Sons, Ltd.)

Objective: To evaluate the effectiveness of arm traction for cervical spine imaging in trauma patients and devise a scheme to predict the probability of visualising the C7/T1 level in trauma patients., Methods: 98 trauma patients were studied. Each vertebral body was divided into three equal horizontal zones, the disc space between vertebral bodies being equivalent to one zone. The fifth cervical vertebra was used as the starting level (zone 1). Zones obtained pre and post arm traction on the lateral cervical spine radiographs were recorded. Results were analysed to show the probability of imaging the lower cervical spine, including the cervico-thoracic junction., Results: If the initial film showed less than zone 10 (mid-C7 vertebra), the probability of showing zone 13 (upper body of T1) with arm traction was only 7.7%, that is, one success in every 13 pulls; or conversely, 12 failures in every 13 pulls., Conclusions: Unless an initial cervical spine radiograph includes the upper one third of the body of the C7 vertebra, the probability of attaining the C7/T1 level with arm traction is < 15%. It is suggested that all initial radiographs of the lateral cervical spine in major trauma patients be done with arm traction, and where the upper one third of the body of C7 vertebra is not seen, then computerised tomography, swimmer's, or oblique views be considered.

Objective: To determine strictly comparable rates per embryo of implantation and birth of a baby related to the woman's age, which would be representative of natural fertility at least in relative terms., Design: Comparative study of IVF-ET results controlling for confounding variables including cause and duration of infertility, history of previous pregnancy, hormonal treatment, rank cycle of treatment, and numbers of embryos transferred and available., Setting: University comprehensive fertility service., Patients: All couples (n = 561) in their first cycle of treatment reaching oocyte collection, women with normal uterus and ovulatory cycles, and men with normal sperm., Interventions: Standardized methods of pituitary desensitization, ovarian stimulation, and IVF-ET, and maximum of three embryos transferred., Main Outcome Measures: Oocytes, pregnancies, and live births per cycle; fertilization and cleavage rates; embryo implantation and live baby rates., Results: The numbers of oocytes and consequent embryos declined with age but fertilization and cleavage rates rose slightly. Embryo implantation rates were reduced when no more than three embryos were available (9.3 percent), especially in women aged 35 to 39 years (6.2 percent) or older compared with four or more embryos (17.1 percent) but were equally low in all women over 40 years even with more embryos (6.1 percent). In the age bands 25 to 29, 30 to 34, 35 to 39, and 40 to 44 years, the rates per embryo of implantation were 18.2 percent, 16.1 percent, 15.3 percent, and 6.1 percent, respectively, and of a live baby were 15.7 percent, 12.1 percent, 12.0 percent, and 3.5 percent., Conclusions: Embryo implanting ability and survival decline gradually after 30 years of age, but by more than two thirds after 40 years and in younger women with reduced ovarian capacity.

Background: The objective of the study was to describe the design and sampling methods used to carry out face-to-face interviews with a sample of the black and ethnic minority population of the area. This study was conducted in the city of Bristol, England (part of Bristol and District Health Authority)., Methods: The sample was based on up to 1000 interviews with black Caribbean/African, South Asian and Far-East Asian residents. The design of the study focuses on the problems of definition of the appropriate group to sample and the various sampling techniques that were necessary to procure the interviews., Results: A total of 574 interviews were carried out by bilingual interviewers matched for sex and ethnicity of the respondent, thereby allowing analysis that would be beneficial to the Health Authority in its planning and decision-making., Conclusions: The use of name spotting and 'snowball' sampling proved the most productive. The Electoral Register was preferred to the Family Health Services Authority lists. Interviewers must be carefully selected and adequately trained to work in this difficult area. The questionnaire must be culturally and linguistically acceptable across all the ethnic groups.

Objective: To compare the effect of oxytocin and Syntometrine when used as part of active management of third stage of labour on postpartum haemorrhage, hypertension, nausea/vomiting and retained placenta., Study Design: A randomised double blind trial was conducted in the Obstetric Unit of Corniche Hospital, Abu Dhabi in the United Arab Emirates. Between 1 January 1991 and 30 June 1991, 2040 women were randomly allocated either to the oxytocin (n = 1017) or the Syntometrine (n = 1023) group. Twelve patients had to be excluded from the trial (oxytocin, 5; Syntometrine, 7) after randomisation because they no longer fulfilled the inclusion criteria. All women in the trial received either oxytocin 10 units or Syntometrine 1 ml (oxytocin 5 units+ergometrine (ergonovine) 0.5 mg) by intramuscular injection with delivery of the anterior shoulder of the baby. Relative risk with 95% confidence intervals was calculated for each variable., Results: Oxytocin (10 units) alone was as effective as Syntometrine (1 ml) in preventing post-partum haemorrhage without an increase in the incidence of retained placenta. Median blood loss was similar in both groups. The incidences of nausea, vomiting and headache were significantly lower in the oxytocin group, as was the occurrence of a mean rise in diastolic and systolic blood pressures of 20 and 30 mmHg or more, respectively., Conclusion: Prophylactic administration of oxytocin 10 U in the third stage of labour, as part of active management, reduces the incidence of maternal nausea, vomiting, headache and rise in blood pressure than does Syntometrine 1 ml without adversely affecting the rate of post partum haemorrhage.

It has been suggested that seasonal variation in endometrial receptivity may occur in women, which could affect the likely success of in-vitro fertilization (IVF) treatment. We therefore studied implantation rates (fetal sacs as a proportion of embryos transferred) as an indirect index of receptivity in a narrowly defined population of women under 40 years old with normal ovulatory cycles and normal uterus and men with normal sperm function. A total of 577 cycles of IVF treatment were undertaken using a standard protocol of pituitary desensitization and ovarian stimulation during the 3 years 1990-1992. Results were compared between calendar months and 3-month seasons. The overall implantation rate was 14.9% of embryos, and the clinical pregnancy rate was 30.3% of cycles reaching egg collection. There were no significant differences in the monthly rates of eggs collected, fertilization and cleavage, or embryos transferred. Implantation rates varied to a greater extent but analysis of variance showed no seasonal variation. These findings do not support a seasonal variation in ovarian responsiveness or endometrial receptivity when stimulated for IVF treatment, but larger studies are needed for firm conclusions to be drawn.

Objective: To assess changes, if any, in the numbers of referrals and outcome of glaucoma referrals to the hospital eye service since the introduction of the sight test fee on 1 April 1989., Design: Review of referral records and clinical notes., Setting: Referrals to the Bristol Eye Hospital., Subjects: 51,919 patients referred to the Bristol Eye Hospital between 1984 and 1992. 9438 case notes of patients referred between 1987 and 1991 were examined in detail., Main Outcome Measures: Numbers of referrals; rate of adult true positive glaucoma referrals., Results: Referrals to the Bristol Eye Hospital were between 13.7% and 19.0% fewer than expected after the introduction of the sight test fee. True positive glaucoma referrals were reduced by the same proportion., Conclusions: The numbers of patients being identified as requiring treatment or follow up for potentially blinding glaucoma have declined by nearly one fifth since the introduction of the sight test fee. An increased prevalence of preventable blindness may result.

This case control study investigated environmental factors in 74 confirmed cases of meningococcal disease (MD). In children aged under 5, passive smoking in the home (30 or more cigarettes daily) was associated with an odds ratio (OR) of 7.5 (95% confidence interval (CI) 1.46-38.66). ORs increased both with the numbers of cigarettes smoked and with the number of smokers in the household, suggesting a dose-response relationship. MD in this age group was also significantly associated with household overcrowding (more than 1.5 persons per room) (OR 6.0, 95% CI 1.10-32.8), with kisses on the mouth with 4 or more contacts in the previous 2 weeks (OR 2.46, 95% CI 1.09-5.56), with exposure to dust from plaster, brick or stone in the previous 2 weeks (OR 2.24, 95% CI 1.07-4.65); and with changes in residence (OR 3.0, 95% CI 1.0-8.99), marital arguments (OR 3.0, 95% CI 1.26-7.17) and legal disputes in the previous 6 months (OR 3.10, 95% CI 1.24-7.78). These associations were independent of social class. Public health measures to lower the prevalence of cigarette smoking by parents of young children may reduce the incidence of MD. The influence of building dust and stressful life events merits further investigation.

The family history of patients identified during incidence studies in Leicestershire were investigated and the prevalence and comparative risks calculated; 1254 patients aged 15 to 80 years were sent a questionnaire about their family history. All cases with a positive family history were reviewed and confirmed cases included in the study. In Europeans the standardised prevalence of Crohn's disease was 75.8/10(5) and that of ulcerative colitis 90.8/10(5). The prevalence of Crohn's disease among South Asians was 33.2/10(5) and that of ulcerative colitis 135/10(5). The prevalence of Crohn's disease in Europeans was significantly greater than that in Hindus (chi 2 = 16, p < 0.001), while the prevalence of ulcerative colitis was significantly lower in Europeans than Hindus (chi 2 = 27, p < 0.001) and Sikhs (chi 2 = 4.4, p < 0.05). The comparative risk of developing ulcerative colitis in first degree relatives of Europeans patients with ulcerative colitis was increased by approximately 15, but the risk of Crohn's disease was not increased. The comparative risk of developing Crohn's disease among first degree relatives of patients with Crohn's disease was increased by up to 35, the comparative risk of ulcerative colitis was approximately 3. The risk among relatives of South Asian patients with Crohn's disease was not increased, but the risk of ulcerative colitis to relatives of patients with ulcerative colitis was. This study supports the view that Crohn's disease and ulcerative colitis arise in people with a genetic predisposition and exposed to some, as yet unknown, environmental factor.

Police crime statistics and crime survey data are known to be poor indicators of levels of violence in society. Longitudinal investigations of assault injury have not been carried out in accident and emergency departments hitherto, but may provide an accurate perspective of trends in violence. The attendance of assault patients at a city centre accident and emergency department was compared with 'wounding against the person' recorded by the police between 1973 and 1990. Woundings recorded by the police increased consistently throughout the study period whereas the number of assault patients did not increase between 1977 and 1987. From 1975 to 1990, police statistics showed a 9-fold and accident and emergency data a 6-fold increase. Both data sets showed substantial overall increases in violence after 1987, and a decrease in 1979. Further epidemiological studies of violence are necessary.

Because the prevalence of the irritable bowel syndrome (IBS) in the general population is unknown, a questionnaire of intestinal symptoms was administered to a stratified random sample of 1058 women and 838 men. Subjects were asked if they had consulted a physician about such symptoms. One or more symptoms occurred frequently in 47% of women and 27% of men. Diagnosable IBS, defined as three or more symptoms, was present in 13% of women and 5% of men. Abdominal pain was the most common symptom, and recurrent intestinal pain was reported by 20% of women and 10% of men. All symptoms were more common in women except runny or watery stools. Most symptoms including pain were unrelated to age. Only half the people with diagnosable IBS had consulted a physician about it. The likelihood of consulting a physician was directly proportional to the number of symptoms and was similar in men and women after controlling for the number of symptoms. Of individual symptoms, the one most strongly associated with consulting was abdominal pain, especially in men. It is concluded that IBS is prevalent at all ages, especially in women, that it is nearly always painful, and that people with multiple symptoms are more likely to consult a physician.

Because the range of bowel habits and stool types in the community is unknown we questioned 838 men and 1059 women, comprising 72.2% of a random stratified sample of the East Bristol population. Most of them kept records of three consecutive defecations, including stool form on a validated six point scale ranging from hard, round lumps to mushy. Questionnaire responses agreed moderately well with recorded data. Although the most common bowel habit was once daily this was a minority practice in both sexes; a regular 24 hour cycle was apparent in only 40% of men and 33% of women. Another 7% of men and 4% of women seemed to have a regular twice or thrice daily bowel habit. Thus most people had irregular bowels. A third of women defecated less often than daily and 1% once a week or less. Stools at the constipated end of the scale were passed more often by women than men. In women of child bearing age bowel habit and the spectrum of stool types were shifted towards constipation and irregularity compared with older women and three cases of severe slow transit constipation were discovered in young women. Otherwise age had little effect on bowel habit or stool type. Normal stool types, defined as those least likely to evoke symptoms, accounted for only 56% of all stools in women and 61% in men. Most defecations occurred in the early morning and earlier in men than in women. We conclude that conventionally normal bowel function is enjoyed by less than half the population and that, in this aspect of human physiology, younger women are especially disadvantaged.

Objective: To follow up and assess the significance of borderline change in cervical smears., Design: Retrospective study of women undergoing routine cervical cytological screening in 1981., Setting: Avon Cervical Screening Programme, covering 250,000 women in Bristol and Weston super Mare., Subjects: 437 women showing borderline cervical changes in 1981 and 437 age matched controls with normal results in 1981., Main Outcome Measures: Cytological progression to high grade dyskaryosis (cervical intraepithelial neoplasia grade III or invasive carcinoma)., Results: During follow up ranging from 13 to 106 months 98 of the 437 women (22.4%) with borderline cytological changes on routine cervical cytology screening had a subsequent smear test showing high grade dyskaryosis compared with three of the 437 women (0.9%) in the control group. The risk of progression was greater in women aged 20 to 39 than in those aged 40 and over. Human papillomavirus infection had initially been diagnosed cytologically in 101 of the 437 (23%) women with borderline results. Significantly fewer of these women developed high grade dyskaryosis (13/98 (13%) v 88/339 (26%), p less than 0.05)., Conclusions: Women with borderline smear test results are at increased risk of developing high grade dyskaryosis, particularly if the borderline changes occur without cytological features of human papillomavirus infection. Progression occurs within three years in 50% of cases, although a linearly increasing risk was sustained over the nine years of follow up and was greatest in women aged 20 to 39. Careful follow up of these women is indicated.

A survey was made of simple statistical errors in the precirculated booklets of abstracts to the Anaesthetic Research Society. In the five booklets June 1988-November 1989, only four of 19 figures included clearly labelled error bars when necessary; in four figures there was no indication of variability. In a more detailed survey of the 115 abstracts presented in 1990, errors were placed in categories: the presentation of method or choice of statistical test; variability; probability. There was a total of 115 errors in 61 abstracts, which was 65% of the 94 abstracts presenting numerical information. The most common errors were: failure to identify tests of inferential statistics (n = 29 abstracts); failure to present data to allow interpretation of P values (n = 21); misuse of SEM (n = 13). Confidence limits were given in seven abstracts. Type II (beta) error was not searched for formally, but no abstract that reported a negative result included the power of the study. With this level of elementary errors, there is considerable room for improvement in the use of straightforward guidelines to the presentation of statistical information. The problem is not confined to British anaesthesia: in more than 30% (25 of 71) of the figures contained in abstracts of the International Anesthesia Research Society in 1990, plots of variables against time showed only mean values.

Objective: To examine the relation between alcohol consumption and risk factors for coronary heart disease in women., Design: Cross sectional study of a stratified random sample of the population grouped into five categories of habitual alcohol consumption., Setting: People registered with general practitioners at two large health centres in east Bristol, England., Subjects: 1048 women aged 25-69 years., Main Outcome Measures: Fasting plasma concentrations of insulin, total cholesterol, total triglycerides, and high density lipoprotein cholesterol, including its subfractions HDL2 and HDL3, and body mass index., Results: Compared with non-drinkers women consuming a moderate amount of alcohol (1-20 g/day) had lower plasma concentrations of triglycerides, by 0.19 mmol/l (95% confidence interval 0.07 to 0.35); cholesterol, by 0.4 mmol/l (0.19 to 0.61); and insulin, by 1.4 mU/l (0.43 to 1.97) and a lower body mass index, by 1.2 kg/m2 (0.43 to 1.97). They also had higher concentrations of high density lipoprotein cholesterol, by 0.09 mmol/l (0.03 to 0.15); HDL2 cholesterol by 0.05 mmol/l (-0.02 to 0.10) and HDL3 cholesterol, by 0.06 mmol/l (0.06 to 0.11). All these were independent of body mass index, smoking habits, and taking oral contraceptives., Conclusions: Moderate alcohol consumption is associated with lower levels of cardiovascular risk factors in women. Insulin may have a central role.

The prevalence of gall stone disease in a stratified random sample of 1896 British adults (72.2% of those approached) was established using real time ultrasound. The prevalence rose with age, except in women of 40-49 years, so that at 60-69 years, 22.4% of women and 11.5% of men had gall stones or had undergone cholecystectomy. The cholecystectomy rate of people with gall stone disease was higher in women than in men (43.5% v 24%, p less than 0.05). Very few subjects with gall stones had convincing biliary symptoms. In women, 10.4% had symptoms according to a questionnaire definition of biliary pain and 6.3% according to conventional history taking, while no men at all admitted to biliary pain. Nevertheless, cholecystectomy in men had nearly always been preceded by convincing biliary symptoms. The age at cholecystectomy was, on average, nine years less than the age at detection of silent gall stones in both sexes. It is concluded that either gall stones are especially prone to cause symptoms in younger people or that there are two kinds of cholelithiasis - symptomatic and silent. The lack of symptomatic gall stones in cross sectional surveys is probably due to their rapid diagnosis and treatment.

Seventy four asthmatic children aged 7 to 11 years were examined along with controls matched by age and sex. Clinical and laboratory investigations preceded a 28-day follow-up where data about morning and evening peak expiratory flow rate (PEF), symptoms and treatment were recorded. The coefficient of variation of PEF was found to be an objective measurement of asthma severity that has statistically significant correlation with both symptoms (rs = .36) and treatment (rs = .60). Moreover, it separates mild and severe asthmatics, as confirmed by statistically significant differences (p = .008 or less) in symptoms, treatment, skin allergy and airways response to exercise. Skin allergy and airways responsiveness to exercise were found to be predictors of both disease and severity. By means of logistic regression analysis it was possible to establish the probabilities for both asthma and severe asthma when children presenting and not presenting these characteristics are compared. One single positive skin test represent a probability of 88% for the development of asthma and a probability of 70% for severe disease. A PEF reduction of 10% after an exercise test implies a probability of 73% for disease and a probability of 64% for severe disease. Increases in these variables imply geometrically increased risks and their presence together have a multiplicative effect in the final risk.

Up to 15% of abdominal aortic aneurysms are designated as inflammatory. They are characterized by marked fibrous thickening of the aneurysmal wall, with the fibrosis extending into the adjacent retroperitoneum. Thirty-five abdominal aortic aneurysms were studied, 15 inflammatory and 20 atherosclerotic. Of the inflammatory group, 10 were symptomatic and five asymptomatic. For each resection specimen, 59 microscopic features (variables) were scored semi-quantitatively. Discriminant function analysis showed that endarteritis obliterans, fibrosis around nerves or ganglia at the outer margin of mural fibrosis, and the thickness of the combined fibrotic media and adventitia gave a satisfactory high discrimination between atherosclerotic and inflammatory aneurysms. When these three variables are used together, a histological diagnosis of inflammatory aneurysm can be made with an expected accuracy in excess of 80%.

A randomized trial was carried out in patients with occlusions of the femoro-popliteal artery to compare the passage of metal-tipped optical fibres with guide wires and catheters through the occlusions, prior to balloon angioplasty. The study was in a provincial English teaching hospital providing a vascular service for the area. Fifty patients were entered; 25 into the "laser" group and 25 into the "control" group. End points were (a) the success in passage through the occlusion and (b) the outcome 1 month after passage. Comparison of the groups showed no appreciable difference between the two methods with regard to age, sex, symptoms, incidence of diabetes, or previous myocardial infarctions. Successful passage through the occlusion followed by dilatation was achieved in 18 (72%) patients in the laser group and 20 (80%) in the control group. After 1 month, 13 (52%) arteries in the laser group were patent compared to 13 (57%) in the control group. Confidence limits for the difference in success of passage are -15% to +31%, and -24% to +33% for patency after 1 month. Since these limits include zero, it is unlikely that a longer trial would alter the difference between the two methods. The results suggest that the laser system currently in use is no better than conventional methods.

Seventy five children with asthma (42 boys and 33 girls; age range 4 years 2 months to 15 years) and 75 of their siblings (37 boys and 38 girls; age range 4 years 3 months to 17 years 8 months) were studied to elucidate the mechanisms involved in the increased prevalence of asthma in boys, a prevalence that tends to disappear after puberty. Immediate cutaneous hypersensitivity to five allergens and maximum fall in peak expiratory flow rate after six minutes of treadmill running (bronchial lability) were determined in patients and siblings. There was no significant difference between boys and girls in skin test reactivity to single or multiple allergens in the sibling group. The percentage fall in peak expiratory flow rate after exercise was significantly greater in male than in female siblings and when a positive test was defined as a fall after exercise of either 10% or 15% of the rate before exercise the number of positive tests was significantly greater in boys. The results suggest that more boys than girls in this age group have asthma because their bronchial lability is greater, and not because more boys are atopic.

Clinical trials of slow-release theophylline and ketotifen as prophylaxis against asthma in 18 young children suggested that both drugs had some efficacy. The theophylline was more effective and produced reduction in salbutamol usage as well as an increase in peak expiratory flow rates. Transient nausea and vomiting was commoner during theophylline treatment but did not usually necessitate discontinuing therapy.

The characteristics of normal labour in 1306 white, Asian and black parturients have been established following a prospective study of 3217 consecutive labours. Asian patients were found to be of significantly shorter stature than white or black women (p less than 0-001) and their infants significantly lighter than those of white (p less than 0-001) and of black (p less than 0-05) women, and a low positive correlation was found between maternal height and infant birth weight. The mean duration of the first stage of labour, taken from the time of admission to the labour ward, was 5-6 hours in primiparae and 3-7 hours in multiparae. The mean durations of the second stage of labour were 41-5 and 17-4 minutes respectively. The correlations between the duration of the first and second stages of labour were too low to be of value in patient management. Similar low correlations were found between the duration of the second stage of labour and both infant birth weight and the Apgar score at one minute. Cervical dilatation-time curves, constructed with reference to the cervical dilatation found on admission to the labour ward, revealed no significant differences in the progress of normal labour in the different racial groups.

This study investigated the experience of recent stressful life events in 85 TMJ dysfunction patients and 85 control patients in the 6 months prior to onset by use of a semistructured interview. The effect of age was studied (under or over age 40 yr). TMJ patients experienced twice as many stressful life events in the 6 months before onset as did control patients. Events concerned problems of work, money, health, problems of loss and of interpersonal relationships. These had a greater negative impact on older patients who seemed less able to cope with them. Almost 50% of TMJ dysfunction onsets were attributable to life events which played a formative role in onset. This was calculated mathematically by use of "brought forward times".

Twenty-four hour urinary oestrogen results obtained in 20 amenorrhoeic patients undergoing human menopausal gonadotrophin (hMG) therapy have been analysed in detail in an attempt to improve their value in predicting multiple conception. Of 96 treatment cycles 88 were acceptably stimulated including 76 presumed ovulatory (midluteal serum progesterone concentration greater than or equal to 30 nmol/l). Conception occurred in 27 (26% of all, 33% of ovulatory cycles), of which 10 were multiple (37%). The chance of conception or multiple conception could not be related to luteal progesterone or preovulatory peak urinary oestrogen levels (at least within the clinically imposed limits of the oestrogen values). Discriminant analysis applied to all oestrogen results in individual cycles failed to predict conception, but in the conception cycles was 86% successful in predicting a single or multiple conception. Multiple conceptions were associated with an earlier but slower rise in oestrogen excretion during the last 5 days of hMG therapy, although the starting and final oestrogen levels were approximately the same. Unfortunately, the differences were small and as conception cycles were in the minority and could not be distinguished from non-conception cycles the oestrogen results could not be used reliably in practice to predict multiple pregnancy.

All cases of Crohn's disease in the Nottingham area were ascertained and the date and place of domicile and work at the time of onset of symptoms noted. Applying the Knox and Pike and Smith tests for clustering of patients in time and space, no significant results were observed. Further analysis of differences in time-space clustering between a group of patients and matched controls is in hand.

Twenty-one asthmatic and twenty-two non-asthmatic children and nine asthmatic adults from two different rural areas of Tanzania, and eight asthmatic children from Dar-es-Salaam were surveyed by questionnaires, skin testing and the measurement of serum IgE. Asthma was significantly commoner in female rural children (four males, fifteen females). The rural asthmatic children apparently had less skin reactivity (in seven of nine tests) and lower specific (in two of four tests) and total serum IgE than age-, sex- and village-matched controls. This pattern of asthma in rural children in the tropics represents a different type of asthma from that found in temperate zones. In contrast, the adult rural asthmatics and the urban children seemed to have the pattern of increased skin reactivity and serum IgE found in asthmatic patients from temperate climates.

Histologic evidence of venous invasion was demonstrated in 52 percent of 703 cases of rectal carcinoma. Quantitation of venous invasion and follow-up study showed that invasion of extramural veins was associated with a low 5 year survival rate (33 percent), whereas invasion limited to intramural veins was not. Spread into thick-walled extramural veins carries a very poor prognosis (15 of 91 patients survived 5 years). The corrected 5 year survival rate for stage C patients with invasion of thick-walled extramural veins was only 8 percent. Host reactions in and around the walls of invaded veins increase the survival rate; inflammatory damage to the vein walls and endarteritis obliterans are particularly important in this respect.

There are certain health risks associated with recreational exposure to bacteriologically polluted water. In this study, 27% (21/77) of swimmers who took part in a snorkel swimming event, experienced gastrointestinal symptoms within 48 hours of entering the untreated water. The incidence of these symptoms was statistically significantly greater than the incidence of such symptoms reported by two control populations (p less than 0.001), but not significantly different to 25% of people who had experienced gastrointestinal symptoms in a previous snorkel event in the same water environment. As the water quality came within the confidence intervals of the EEC standards for bathing water the adequacy of these standards needs further appraisal.

Two schools in rural Tanzania were surveyed regarding the pupils' nutrition (weight and height), serum immunoglobulins (IgA, IgG, IgM, and IgE), autoantibodies, malaria antibodies, hepatitis B antigenemia, and fecal and urinary parasites. The survey attempted to quantify the relative importance of undernutrition and parasitic infestation in determining the serological abnormalities found. Of all the children surveyed 69% were undernourished (less than 80% of expected weight for age); 63% had fecal parasites and 38% had urinary schistosomiasis. Serum IgG and IgM concentrations were raised and the serum IgE concentration was strikingly raised (mean 4990IU/ml). Elevated serum IgE was associated with ascariasis. Autoantibodies were common but no autoimmune disease was detected. Notably there was a 35% prevalence of reticulin antibody. This reticulin antibody positivity correlated with increased malaria antibody concentrations. Reduced malaria antibody concentration was significantly associated with hepatitis B antigenemia. The study illustrates that parasites, notably malaria, are important determinants of the serum antibodies of children in the tropics and suggests that mild undernutrition has little effect.

The distribution of distinguishable disorders in 102 patients with post-pill amenorrhea has been compared with that in 166 other patients with secondary amenorrhea, including 123 patients who had never used oral conception. In the post-pill group there was a 13% to 21% excess of patients who had a functional disorder without any weight loss or psychological disturbance to account for it and who typically were estrogenized and demonstrated intact feedback systems by their ovulatory response to clomiphene (the so-called cycle initiation defect). This excess might be explained by biased selection of oral contraception, but it seems wiser to assume a causal relationship, which amounts to a true risk of post-pill amenorrhea in less than 1 per 1000 users. No risk was revealed of primary ovarian failure, hyperprolactinemia, or pituitary tumor.

The fibrinolytic effects of six different anaesthetic agents were studied in 36 patients undergoing abdominal hysterectomy. Fibrinolytic activity was measured by dilute whole blood and euglobulin clot lysis times. Concentrations of plasminogen, fibrinogen and fibrin degradation products were also determined. Significant enhancement of fibrinolytic activity, measured as a decrease in clot lysis time, was seen during anaesthesia and surgery with all agents studied. Halothane produced the least effect and the greatest increase in fibrinolytic activity was seen during trichloroethylene anaesthesia. Lumbar extradural anaesthesia also consistently produced enhancement of fibrinolysis. The reasons for these results and their clinical implications are discussed.

Residents of Shipham Village, Somerset, England, are exposed to high soil levels of cadmium. Their health was assessed with respect to cadmium exposure, using routinely available morbidity data. Hospital Activity Analysis data were used to calculate standardized admission ratios for diagnostic groups of morbidity associated with cadmium exposure. A small but statistically significant risk for carcinoma of the ovary was demonstrated. Scrutiny of case records confirmed this finding but emphasized that the risk is unlikely to be explained by exposure to cadmium. Further reassurance about this possible risk was obtained from a review of 25 years of Central Cancer Registry data. The value of HAA data could be improved by address coding of data with postcodes to enable rapid identification of small geographical populations, and by record linkage to permit estimates of duration of exposure.