J.N. Morris

VIGOROUS EXERCISE IN LEISURE-TIME: PROTECTION AGAINST CORONARY HEART DISEASE

1138 first clinical episodes of coronary heart disease (CHD) in 17 944 middle-aged male office workers in the Civil Service are reported. Men who engaged in vigorous sports, keep-fit, and the like during an initial survey in 1968-70 had an incidence of CHD in the next 8 1/2 years somewhat less than half that of their colleagues who recorded no vigorous exercise. The CHD rates of men who took such vigorous exercise were lower in both fatal and non-fatal clinical manifestations, though more so in fatal; throughout the age-range studied, though more striking in later middle age and early old age; and in all other sub-groups examined, including men with a family history of CHD, the obese, the short of stature, cigarette smokers, and men with severe hypertension and subclinical angina, as well as in those in favourable situations for CHD or neutral. The generality of the advantage suggests that vigorous exercise is a natural defence of the body, with a protective effect on the ageing heart against ischaemia and its consequences.

Diet and heart: a postscript.

During 1956-66, 337 healthy middle-aged men in London and south-east England participated in a seven-day individual weighed dietary survey. By the end of 1976, 45 of them had developed clinical coronary heart disease (CHD) which showed two main relationships with diet. Men with a high energy intake had a lower rate of disease than the rest, and, independently of this, so did men with a high intake of dietary fibre from cereals. Energy intake reflects physical activity, but the advantage of a diet high in cereal fibre cannot be explained; there was no evidence that the disease was associated with consumption of refined carbohydrates. Fewer cases of CHD developed among men with a relatively high ratio of polyunsaturated to saturated fatty acids in their diet, but the difference was not statistically significant.

CORONARY HEART-ATTACKS IN EAST LONDON

All cases of cardiac infarction, acute coronary insufficiency and sudden death occurring in residents of the London Borough of Tower Hamlets below age 65 were registered over nearly three years, and survivors were followed up for one year. The attack-rate in men aged 45-64 years was 1 per 100 per annum but the recurrence-rate in survivors was 1 per 100 per month. Immigrants from Asia had more than the average, and those from the Carribean one tenth of the average attack-rate. Although it was unusual for general practitioners to manage cases at home by choice, nonetheless two-thirds of the deaths happened outside hospital and half of these were not witnessed. Half of those suffering coronary heart-attacks had a previous history of coronary disease and a sizable minority were already unfit for work. Approximately half of those attacked were alive at one year.

CLINICAL AND BIOCHEMICAL INDICATORS OF CARDIOVASCULAR DISEASE AMONG MEN LIVING IN HARD AND SOFT WATER AREAS

Abstract Clinical and biochemical measurements are compared in middle-aged male Civil Servants, 244 living in six hard-water and 245 in six soft-water towns. Mean values for blood-pressure, plasma-cholesterol, and heart-rate were higher in the soft-water group. The increase of blood-pressure over the age-groups was greater in the soft-water towns. The diastolic blood-pressure and heart-rate findings showed considerable consistency within the two contrasting groups of towns. The observed differences in blood-pressure, plasmacholesterol, and heart-rate levels could be important in explaining a substantial part of the difference in cardiovascular mortality between these hard and soft water towns.

CHANGES IN WATER HARDNESS AND LOCAL DEATH-RATES

Abstract Changes in the death-rates of eleven county boroughs of England and Wales where the hardness of the water supply has been substantially changed (for a variety of reasons) during the previous thirty or so years have been studied. In general, cardiovascular death-rates showed a favourable effect in the towns where water had become harder and an unfavourable effect in the towns where water had become softer; this was not so for non-cardiovascular rates.

CASE-FATALITY OF HYPERPLASIA OF THE PROSTATE IN TWO TEACHING AND THREE REGIONAL-BOARD HOSPITALS

Mortality of hyperplasia of the prostate, as in many common conditions, is higher in the regional board than the teaching hospitals of England and Wales. 932 men with simple hyperplasia of the prostate consecutively admitted to two teaching and three regional-board hospitals have been studied. There were 5 deaths among 556 men admitted from the waiting-list, and negligible variation between hospitals. Among the 376 unplanned emergency admissions were 35 deaths, 26 of them in 71 men who did not have prostatectomy. Unplanned admissions, especially those not operated on, were older than the rest and mostly in acute retention, and many also had cardiovascular and other disease. 78% of the admissions to two of the regional-board hospitals were unplanned; the operation-rate on these men was generally low and case-fatality among them was 14%. In contrast, only 22% of the admissions to the two teaching hospitals were unplanned, nearly every case was operated on, and the case-fatality was 4.3%. These two regional-board hospitals with relatively small resources were carrying more than their share of the most difficult cases. A national survey to assess the treatment of hyperplasia of the prostate is now indicated, but it is time the National Health Service gathered this kind of information routinely.

EXERCISE AND THE HEART

In this age of modern era, the use of internet must be maximized. Yeah, internet will help us very much not only for important thing but also for daily activities. Many people now, from any level can use internet. The sources of internet connection can also be enjoyed in many places. As one of the benefits is to get the on-line exercise and the heart book, as the world window, as many people suggest.

PLANNING MEDICAL INFORMATION SYSTEMS IN A UNIFIED HEALTH SERVICE

Abstract An integrated health service for England and Wales, aware of and adaptable to local and general needs, will depend upon its information systems. An information service must be able to meet both the intelligence needs of administrators and information engineering requirements in the field. The constraints of N.H.S. administrative structure, costs, and manpower enforce a choice between technical services based on areas but dependent on local-authority facilities, and medically dedicated services established in all regions and in some districts: the second is preferred. Medical staff requirements are identified as a national pool of 100-150 highly trained experts, half in and half outside the N.H.S. at any one time, and about 100 general medical administrators with supplementary training, depending for their training upon the first group. The provision of the first group, from an existing pool of about 30, depends upon prompt provision for their education.