Michael Ryan

Alcoholism and rising mortality in the Russian Federation.

In the Russian Federation today the high incidence of alcoholism and drunkenness helps to account for rising death rates, more particularly among the male population. During the mid-1980s a significant reduction in deaths from alcohol related diseases was achieved by state action in curtailing the supply of alcohol. However, official data disclose a pattern of sharply increased consumption per head since 1987, with high proof drinks--especially vodka--now forming a larger share in the total. In current economic conditions the effects of a traditional macho drinking culture are exacerbated by a reduction of state control over the quality of alcohol available for purchase. A substantial increase has occurred in deaths from most principal causes, with a disproportionate increase in deaths from non-natural causes, including deaths caused predominantly by alcohol. Average expectation of life at birth has fallen especially sharply for men; by 1993 it had slumped to 59.0 years--that is, to below the age at which a pension starts to be paid.

NHS Direct versus general practice based triage for same day appointments in primary care: cluster randomised controlled trial

Abstract Objective To assess the relative effects on consultation workload and costs of off-site triage by NHS Direct for patients requesting same day appointments compared with usual on-site nurse telephone triage in general practice. Design Cluster randomised controlled trial. Setting Three primary care sites in York, England. Participants 4703 patients: 2452 with practice based triage, 2251 with NHS Direct triage. All consecutive patients making requests for same day appointments during study weeks were eligible for the trial. Main outcome measures Type of consultation after request for same day appointment (telephone, appointment, or visit); time taken for consultation; service use during the month after same day contact; costs of same day, follow up, and emergency care. Results Patients in the NHS Direct group were less likely to have their call resolved by a nurse and were more likely to have an appointment with a general practitioner. Mean total time per patient in the NHS Direct group was 7.62 minutes longer than in the practice based group. Costs were greater in the NHS Direct group—£2.88 (£0.88 to £4.87) per patient triaged—as a result of the difference between the groups in proportions of patients at each final point contact after triage. Conclusions External management of requests for same day appointments by nurse telephone triage through NHS Direct is possible but comes at a higher cost than practice nurse delivered triage in primary care. If NHS Direct could achieve the same proportions of consultation types as practice based triage, costs would be comparable.

Serum cholesterol concentrations in parasuicide. Scottish study does not replicate findings.

EDITOR,--Massimo Gallerani and colleagues found lower cholesterol concentrations in subjects after parasuicide than in control subjects matched for age, sex, diabetes, hypertension, heterozygote β thalassaemia, drug misuse, and alcoholism.1 These results suggest an association between low cholesterol concentrations and suicide. The control population--331 non-suicidal …

Monitoring effects of deprivation on health.

EDITOR,—Recent reports have restated the link between socioeconomic deprivation and experience of poor health.1 2 Children are sensitive indicators of deprivation, and their health experience reflects the health inequalities in the wider adult population.3 In our district we have been looking at ways of monitoring the effects of deprivation on the community through the experiences of children, using data from the routine contract minimum dataset. There …

Aspects of male mortality.

The author reviews recent trends in male mortality in the USSR using official Soviet statistics and data from articles by BTs Urlanis published in 1968 and 1978. Some causes of male mortality are discussed. (ANNOTATION)

Patterns of Child-bearing

The rate at which the Soviet population is being renewed has clear implications for the future size of the workforce and for the Soviet Union’s geopolitical role as a superpower. In the recent past, concern over the birth rate has led the Party and government to implement a wide range of measures whose general purpose was spelt out in Guidelines for the economic and social development of the USSR for 1981–1985. Among the objectives specified in that document are the following: ‘Pursue an effective demographic policy, promote consolidation of the family as the principal nucleus of socialist society and ensure the provision of better conditions for women to combine motherhood with active participation in labour and social activities’.1

The Family and Marriage

The main sources of quantitative data about the characteristics of Soviet families in the post-war period are the population censuses of 1959, 1970 and 1979. Before examining the picture which emerges from them, however, it is necessary to define what is meant in this context by the term ‘family’. According to the definition used for the censuses, it denotes a group of people who have a common residence, are linked by marriage or kinship and have shared finances. It excludes people who are not connected to other members of the family by ties of kinship, despite the fact that they may have the same residence.

Standards in Soviet medical institutes.

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USSR Letter: Aspects of Soviet surgery

In recent months the Western media has given prominence to the multiple and deep rooted shortcomings of the Soviet economy, as identified with great incisiveness by the new general secretary of the CPSU, Mikhail Gorbachev. Informative as the reporting has been, however, it is open to objection on the ground that its narrow focus tends to reinforce a fairly widespread disposition to underestimate the actual and potential achievements of the Soviet Union. For those who take for granted the backwardness of that countrys industry and technology it is salutary to recall at least two dates on which,

Urgent admissions to a large general hospital.

In the Soviet Union, as in many other countries, the treatment of inpatients claims the lions share of health service expenditure. However, analysis of the activity of Soviet hospitals remains at a rudimentary level in certain major respects, one explanation for which is likely to be the comparatively low figures for cost per case and cost per bed-day. Given that little attention is devoted to seeking information and to critical scrutiny in this area, special interest attaches to the findings of a survey recently carried out at one of the Unions largest general hospitals.1