Peter McCartney

SMOKING AND OTHER RISK FACTORS FOR CORONARY HEART-DISEASE IN BRITISH CIVIL SERVANTS

A five-year follow-up of 18 403 male British civil servants between the age of 40 and 64, who had been the subject of an earlier clinical survey found 277 deaths from coronary heart-disease (C.H.D.). After adjusting for age, current cigarette smoking, systolic and diastolic blood-pressure, and blood-cholesterol were shown to be related to both the prevalence of one or more indices of cardiac ischaemia and to the risk of cardiac death. Neither blood-glucose two hours after a 50 g load nor weight/height showed any such simple linear association with mortality. Multivariate analysis confirmed that the main risk factors were independently related to cardiac morbidity and mortality. Irrespective of blood-pressure or plasma-cholesterol, current cigarette smokers thus had a higher risk of C.H.D. death than those not smoking cigarettes.

Hyperglycaemia and coronary heart disease: the Whitehall study.

Abstract In a 5-yr follow-up of 18,403 male London civil servants, aged 40–64 yr, coronary heart disease mortality has been examined in relation to baseline levels of blood glucose concentration measured 2 hr after a 50 g oral glucose load. When deciles of the blood sugar distribution were considered, no trend of age-adjusted 5-yr CHD mortality rates was apparent. There was also no significant trend in the prevalence of Minnesota-Coded ECG abnormalities with deciles of blood sugar. However, for individuals with blood sugars above the 98th centile (106 mg/dl for ages 40–59 yr; 110 mg/dl for ages 40–64 yr) there was approximately a doubling of CHD mortality, this increase being independent of age and blood pressure. The prevalence of ECG abnormalities (Whitehall Criteria) was also increased above the 90th centile of blood sugar.

HEALTH PROMOTION IN PRIMARY CARE

In his continuing drive to appease disillusioned and overworked general practitioners, Britains secretary of state for health has made major concessions over the data on health promotion that general practitioners are required to record.1 The more than 120 items of data that were previously required have now been reduced to eight. The move will please those general practitioners who have objected to the “ritualistic collection of risk factors when the public health benefits are marginal,”2 but the reductions seem to have been driven more by the pressure to reduce paperwork than by a desire for effective disease prevention. In the absence of either a strategic or an evidence based approach to health promotion in primary care, many important items have been lost while others have been inappropriately retained. Under the new scheme, general practitioners are being asked to record the number of patients in …

Feedback in primary care can improve the prescribing of hormone replacement therapy in women with a history of hysterectomy

Aims to show that audit and feedback could improve the prescribing of hormone replacement therapy (HRT) to women with a history of hysterectomy. Describes a randomised controlled trial involving 28 practices and covering a total of 3,169 women with a baseline coded history of hysterectomy. In addition to data extraction and feedback, intervention practices were given educational material and audit support. A rise in prescribing was evident in both younger and older women. There was also evidence of significant improvement in the appropriate prescribing of HRT. Concludes that prescribing feedback linked with educational material and audit can improve the prescribing of HRT in primary care in women with a history of hysterectomy and that this technique has wider application in the new era of clinical governance.

A note on the calculation of multivariate risk functions.

Abstract In the multivariate analysis of rates, the relationship between the discriminant risk function and the maximum likelihood logistic function is discussed with reference to a recently published analysis by Goldbourt et al . [3] which found the former to be inferior. The calculation of the discriminant risk function is shown to be in error and the performance assessment method (goodness of fit) is questioned. What appeared to be one more nail in the coffin of calculation of multivariate risk functions by non-iterative techniques is at least partially withdrawn. An additional measure of the performance of a risk function, which is often used to rate diagnostic tests, is suggested.

An evaluation of the amount, quality and use of health promotion information from general practice

AbstractThe objective of the study was to evaluate health risk factor information recorded by six general practices, in the light of the GP health promotion contract. A comparison of computer and manual notes was undertaken, for a sample of 709 patients aged 15–74; reports on health promotion activity were generated from practice computers; and interviews were conducted with GPs and practice staff asking about the use of information in the practice. All the practices were in inner London, and were using the computer for Band 3 health promotion, prescribing and disease registers. Blood pressure, smoking, alcohol, weight and height were recorded for over 50% of patients aged 15–74, and computerised for 79% (291/370) for height but only 56% (274/488) for blood pressure. Risk factor information was recorded for a higher proportion of women than men, and for older men but younger women. High risk patients (smokers, heavy drinkers and patients with raised blood pressure) were less likely to have this informatio...

Assessing health needs in primary care. Interventions must be effective to be needed.

EDITOR,—John Shanks and colleagues suggest that conventional methods for assessing needs require adaptation for use in primary care.1 They are right that several methods should be used, although this applies in all areas of needs assessment. An important element of needs assessment that they …