The additional cost of obesity to the health service and the potential for resource savings from effective interventions

Background: Obesity affects 15% of men and 16.5% of women inthe UK (1995). UK prevalence of obesity has doubled in 10 yearsand continues to rise: it is projected to reach 18 and 24% respectivelyby 2000. Obesity is a complex condition influenced by both geneticand environmental factors and is associated with reduced longevityand increased risk of serious co-morbidities including diabetes,coronary heart disease, stroke and hypertension. Methods: Datafrom a large population survey in north-west England allowedestimation of the additional direct costs to the NHS of majorco-morbidities associated with obesity. The change in costsexpected from a lower prevalence of obesity were projected.Results: Initial estimates suggest annual reductions in healthcare spending in England of up to £131 million per annum(1996 prices) may be possible with effective Interventions forbeing overweight and obesity. This is equivalent to 11% (males)or 13% (females) of spending on the main co-morbidities andapproximately 1% of overall expenditure. Conclusions: The numberof grossly obese patients in the UK remains very small and theburden they place on the health service is not very serious.Most of the additional cost is for those moderately overweight(WHO grade 1) and research should concentrate on evaluatinginterventions that reduce the numbers in this group. Obesityoften develops at an early age, but the more expensive co-morbiditiesappear 10–20 years later. Thus, interventions targetedat younger age groups are more likely to provide significantcost savings, but must be evaluated over a lifetime to includethe full impact of chronic co-morbidities.     

The impact of mass media anti-smoking publicity

The rapidly rising cost of health care has brought increasingattention to the potential of preventive measures as distinctfrom curative ones. Cigarette smoking is the leading preventablecause of morbidity and mortality in the UK. It is of considerableimportance therefore that the effectiveness of the differentpolicies which seek to reduce smoking be evaluated, This paperfocuses on how effective mass-media anti-smoking publicity isin reducing smoking. The approach adopted here is to reviewthe econometric literature of the past fifteen years which bearson this question. Thirteen articles are critically assessed.Both British and American work is included, as well as a relevantarticle from Switzerland. The conclusion reached is that mass-mediaanti-smoking publicity has proved effective in reducing smoking,both initially and in the longer term.     

Performance of a 3.2-mm to 6-mm Adaptor

A study was undertaken to evaluate the performance of a 366–08 adaptor that adapts an in-line bipolar 3.2-mm connector to a 6-mm pulse generator connector. A total of 14 adaptors were implanted in individual patients. Eight of the 14 adaptors failed, an additional failure is probable. Tbe average follow-up time was 32.1 months. The most likely cause of failure was the spring-loaded mechanism of the adaptor, which fatigues with time. All eight of the documented failures presented with loss of capture and were accompanied by increased measured lead impedances. In addition, some failed systems demonstrated loss of sensing. As a result, prophylactic replacement of ventricular lead systems incorporating this adaptor would be advisable. Otherwise, more frequent monitoring with lead impedance measurements may suffice.     

The number of pregnancies prior to the birth of twins

Data from the birth certificates of twins born in New York City showed that the number of previous pregnancies differs significantly when mothers of like-sex twins are compared to mothers of unlike-sex twins. Also the number of previous pregnancies of mothers of male-male twins differed significantly from that of mothers of female-female twin pairs. The average number of previous pregnancies was adjusted so that the average maternal age was the same for each comparison. This adjustment produced no substantial differences in the original observations.     

Fatal squamous cell carcinoma following whole body electron beam therapy and photochemotherapy for mycosis fungoides

The development of fatal metastatic squamous cell carcinoma in a patient with poikiloderma atrophicans vasculare, following treatment with whole body electron beam therapy and photochemotherapy is described. The place of electron beam therapy and photochemotherapy in the treatment of mycosis fungoides is discussed, and the conclusion drawn that the two should be used together only with caution.     

A Guide to Ocular Photography with the Nikon Photo Slitlamp

Photography of the eye is becoming an increasingly more routine procedure in private ophthalmic practice. Considerable instrumentation exists for observing and photographically recording most areas of the internal and external eyeball. In this respect, the slit-lamp biomicroscope is one of the most versatile clinical instruments. This report outlines the essential procedures for photographing the anterior segment using the photo slit-lamp, with particular reference to the Nikon instrument. A detailed guide for photographing certain ocular features is provided in order to familiarise the user with the capabilities of the photo slit-lamp. Numerous illustrations are included and the various methods of slit-lamp illumination of the eye are demonstrated.