Meningococcal infections in Scotland 1972-82.

Strains of Neisseria meningitidis isolated from patients with meningitis or septicaemia without meningitis in Scotland during the years 1972-82 have been reviewed together with details of the age, sex, disease and outcome of the patients from whom they were isolated. A total of 1185 strains were isolated, of which 927 were examined at the Meningococcal Reference Laboratory (Scotland): 19.3% were of serogroup A, 63% of group B, 9.6% of group C, 6% of W135 and 1.6% of other groups. Non-groupable strains were rare. Disease was most common in the first years of life but there was a difference in the age distribution of disease due to the different serogroups, the proportion of disease due to group B being smaller in adults than that due to other serogroups. The overall mortality in meningitis was 7.5% and in septicaemia was 20.6%, although there were differences between the rates for the various serogroups. The serogroup distribution differed in disease as opposed to meningococci isolated from carriers although group B strains were predominant in both series. Overall, approximately 15% of strains were resistant to sulphadiazine, the proportion of resistant group A strains being higher than that of other serogroups.     

Proteus bacteraemia in a general hospital 1972-1982

During 1972-1982, 318 isolates of Proteus spp. were recovered from blood cultures, accounting for 14.4% of the aerobic, Gram-negative isolates from blood in a large general hospital. Bacteraemia was most common among male patients on the internal medicine service. A high level of resistance to antibiotic agents was found. Since 1976, 49 proteus isolates were sensitive to either gentamicin or tobramycin, but not to both.     

Carcinoma of the vulva. A ten year retrospective study in the West of Scotland (1972-1982)

Vulval carcinoma is a rare and often fatal disease. Little is known about its incidence and distribution in the West of Scotland. This paper records the current distribution and methods of treatment employed in the area and suggests that the results might be improved by a regionally based service.     

Social class inequalities in perinatal outcomes: Scotland 1980-2000

OBJECTIVE: To examine social class inequalities in adverse perinatal events in Scotland between 1980 and 2000 and how these were influenced by other maternal risk factors. DESIGN: Population based study using routine maternity discharge data. SETTING: Scotland. PARTICIPANTS: All women who gave birth to a live singleton baby in Scottish hospitals between 1980 and 2000 (n=1,282,172). MAIN OUTCOME MEASURES: Low birth weight (LBW), preterm birth, and small for gestational age (SGA). RESULTS: The distribution of social class changed over time, with the proportion of mothers with undetermined social class increasing from 3.9% in 1980-84 to 14.8% in 1995-2000. The relative index of inequality (RII) decreased during the 1980s for all outcomes. The RII then increased between the early and late 1990s (LBW from 2.09 (95%CI 1.97, 2.22) to 2.43 (2.29, 2.58), preterm from 1.52 (1.44, 1.61) to 1.75 (1.65, 1.86), and SGA from 2.28 (2.14, 2.42) to 2.49 (2.34, 2.66) respectively). Inequalities were greatest in married mothers, mothers aged over 35, mothers taller than 164 cm, and mothers with a parity of one or more. Inequalities were also greater by the end of the 1990s than at the start of the 1980s for women of parity one or more and for mothers who were not married. CONCLUSION: Despite decreasing during the 1980s, inequalities in adverse perinatal outcomes increased during the 1990s in all strata defined by maternal characteristics.     

Perinatal mortality in Scotland: 1970-9.

An examination of the recent decline in perinatal mortality in Scotland during the 1970s showed that despite substantial changes in fertility and the demographic pattern of births, differences in the age, parity, and social class composition of the obstetric population in this decade accounted for just 7% of the overall improvement in perinatal mortality between 1970 and 1979. The general pattern of relative risks associated with maternal age, parity, and social class remained largely unchanged. Marginal changes in the birthweight distribution, however, were sufficient to account for 13% of the reduction in perinatal mortality. The low birthweight infant, especially those weighing under 1500 g, assumed increasing importance as a factor in perinatal mortality owing to a progressive worsening in the relative risk of perinatal mortality associated with low birth weight. Although regional differences in perinatal mortality persisted over this period, there occurred some lessening of the traditional inequality between western and eastern parts of the country. Finally, registered causes of perinatal mortality are reviewed. In the absence of other explanations the results of this analysis, collectively, suggest that much of the recent decline in perinatal mortality was perhaps due to changes in obstetric practice and in the clinical management of neonatal morbidity.     

Dietary changes in the North Karelia Project (1972-1982)

The North Karelia Project is a community-based program to reduce the high cardiovascular disease rates in the province of North Karelia in eastern Finland. Dietary changes aimed at reducing serum cholesterol levels were among the main objectives. The evaluation of the program was based on examinations of independent cross-sectional population samples in 1972, 1977, and 1982 in North Karelia and in a matched reference area. A questionnaire was used to measure changes in dietary habits during the program. A major shift from whole to low-fat milk took place in both areas as well as a reduction in the amount of butter used on bread. The net reduction in North Karelia (difference in change compared with the reference area) in the intake of saturated fatty acids from milk and fat spreads used on bread was 20% in men and 14% in women. This reduction was similar in different age, education, and occupational groups suggesting that the dietary intervention had reached the whole community. The validity of the reported dietary changes was confirmed by parallel changes in serum cholesterol levels.     

Trends in infant mortality in Scotland, 1970-1987

Infant mortality rates in Scotland have fallen by 56.6 per cent from 19.6 per 1000 live births in 1970 to 8.5 per 1000 in 1987. The reduction has been more marked in the early neonatal period than at later ages. The causes of death, based on generally high post-mortem rates, have been examined in functional groups and the changes over time are described. Ninety per cent of neonatal deaths throughout the period reviewed were due to congenital anomalies, asphyxia or immaturity-associated conditions. Eighty per cent of post-neonatal deaths are now due to congenital anomaly or sudden infant death syndrome (SIDS). The principal shifts in cause of death groups from infections and external causes in the 1970s to SIDS in the 1980s are described in detail and are probably related to improved recognition of the syndrome of sudden infant death, rather than to true changes.     

The proprietary hospital industry: a financial analysis 1972-1982

This paper evaluates the performance of both specific firms within the American for-profit hospital industry and the industry as a whole. First, traditional financial analysis is used to evaluate individual publicly traded for-profit chains. Then, industry performance from 1973 to 1982 is evaluated using a set of measures based on Modern Portfolio Theory. The traditional financial analysis indicates that the industry seems increasingly profitable as well as increasingly healthy from the perspective of utilizing its assets and reducing its collection period. However, the industry's rapid growth rate has strained its ability to use additional debt funding and has created a potentially dangerous liquidity position. Measures based on Modern Portfolio Theory indicate that the average return of the industry has improved over the past 5 years. However, its risk has also increased. Nevertheless, the increase in risk is more than offset by the increased average return. In addition, recent legislation designed 'to reward the efficient' has introduced a significant degree of uncertainty into the industry's performance for the coming years. Thus, hospitals' ability to maintain the substantial profitability and rate of growth they have experienced over the past decade will depend on how well they will adapt to the changing environment.     

Surveillance of hepatitis B virus infection in Scotland, 1973-1982

Since 1973 epidemiological surveillance of laboratory-confirmed hepatitis B virus infection has been undertaken in Scotland. During the ten-year period, 1973-82, 2893 persons with laboratory evidence of infection were reported and the number increased by almost threefold between the beginning and the end of this time. Males accounted for 66% of the patients and intravenous drug abuse was the most commonly encountered risk factor. The low risk to laboratory staff is confirmed, but among National Health Service hospital staff nurses accounted for 54% of those reported.     

Antenatal and perinatal care in Jamaica: do they reduce perinatal death rates?

Summary. Information concerning 9919 singleton pregnancies delivered in Jamaica in the 2-month period of September and October 1986 and surviving the early neonatal period were compared with 1847 singleton perinatal deaths occurring in the 12-month period from 1 September 1986 to 31 August 1987, classified according to the Wigglesworth schema.
Logistic regression was used to assess features of antenatal and intrapartum care that were associated with the different groups of perinatal death after taking account of environmental, maternal and medical factors.
In Jamaica, 67% of all mothers took iron during pregnancy. These mothers appeared to have a lower risk of perinatal death. This does not appear to be an artefact related to the gestation at which the mother delivers, and was particularly associated with antepartum fetal deaths.
Commencement of antenatal care in the first trimester appeared to reduce the risk of all perinatal deaths, and for intrapartum asphyxia in particular. It is speculated that the mechanism may involve early detection and treatment of anaemia and syphilis.
Quality of perinatal care available in the area of residence, as measured by the presence of consultant obstetricians and a paediatric consultant unit, is shown to be significantly related to a reduction in deaths from intrapartum asphyxia, but it appeared not to be related to antepartum fetal deaths.     

Evaluation of mortality in hospitalized mental patients 1968-1982

Yearly, between 1968 and 1976, and every two years from 1976 to 1982, diagnostic data based on a national classification of mental disorders were homogeneously collected in French public psychiatric hospitals. The hospitalized population was estimated by the person-year method, using data on length of stay. The number of observed deaths was compared with the number of deaths expected (Standardized mortality ratio). The standardized mortality ratio (SMR) for psychiatric inpatients were found irregularly and slightly decreasing, except among women under 45: this SMR was higher in 1982 (9.6) than in 1968 (7.4). The SMR for neuroses, in the under 55 years age group, showed a regular increase especially among women. The SMR for psychoses and mental retardation was decreasing among men. For people aged more than 55 years the SMR was decreasing for all groups of diagnosis.