In the reorganized British National Health Service (NHS), purchasers are supposed to assess the health care requirements of their resident populations and contract for an appropriate volume of services. In the case of elective surgical procedures this can be problematic when there is no reliable information on health needs and no consensus on appropriate rates of use. An examination of hysterectomy rates in 8 districts in 1 Regional Health Authority found a nearly 2-fold variation in population-based rates, a difference which had persisted for at least 12 years. A detailed comparison of a high- and a low-rate district was conducted to assess the extent to which the variations in the rates were related to indices of data quality, resource availability, use of alternative surgical procedures, use of private hospitals, differences in gynaecologists' admission thresholds and differences in demand. The difference was not accounted for by supply factors, but there were significant differences between the 2 districts in levels of demand for specialist gynaecology services and differences in gynaecologists' admission thresholds. It seems likely that the low-rate district contained a greater number of general practitioners who were willing to treat patients themselves rather than refer them to specialists. Because of the sparsity of scientific evidence on which to base judgements about appropriateness and the lack of consensus about need, it will be impossible to specify a target figure for an optimal hysterectomy rate.
Correspondence to : Professor Hamadeh. Abstract Objective To determine (a) the preva lence of smoking and its distribution by demographic characteristics in the gen eral population of Bahrain; (6) the types and pattern of smoking ; and (c) smoking trends. Design Analysis of smoking and demo graphic questions from a 4 5 % sample of households. The survey was conducted between September 1981 and February 1983. A two stage sampling design was used, the block being the first stage unit and the household the second stage unit. Setting A national morbidity survey in Bahrain, Arabian Gulf. Subjects A total of 9282 adults aged 15 and over. Results The prevalence of smoking was 331% among men and 9-2% among women. Non-Bahraini men had the highest prevalence of smoking (40 4%) followed by Bahraini men (30*6 %), Bah raini women (9 5%), and non-Bahraini women (7-9%). Cigarette smoking was the most popular type of smoking fol lowed by the waterpipe. The latter was more prevalent among Bahraini women than men, but has begun to decrease in both sexes. Conclusion The prevalence of smoking among men and women in Bahrain was lower than in most of the developed and developing countries. However, a secular trend of increasing cigarette smoking was seen.
The effect of cervical suture on pregnancy outcome was studied in 194 women with a high risk (approximately 30%) of having a late abortion or a preterm delivery. The women were randomly allocated either to have a cervical suture inserted (n = 96) or to be managed without a suture (n = 98). There was no evidence that cervical cerclage either prolonged gestation or improved survival. Patients allocated to receive cerclage spent significantly longer in hospital, even when the period of admission for insertion was excluded. The patients in the cerclage group were more likely to receive tocolytic drugs, and more of them experienced puerperal pyrexia, although these differences between the groups were not statistically significant.
A random sample of 6000 people from eight general practices in and around Oxford was studied to ascertain their surgical histories and method of care received. The proportion of operations that were performed privately had increased with time and had a steep gradient according to social class. Different procedures had different likelihoods of being performed privately, but the age and sex of the patient had a non-significant association with private surgery. Adjustment for possible confounding variables using logistic analysis indicated that in the 1980s elective surgery is five times more likely to be performed privately than it was at the institution of the National Health Service.
AIM--To re-examine the contentious relation between diet and plasma lipids within a population. DESIGN--Cross sectional sample from a large prospective cohort study of people eating different diets in Britain. Blood samples and diet records collected from subjects. SUBJECTS--Volunteers eating one of four distinct diets--namely, vegans, vegetarians, fish eaters who do not eat meat, and meat eaters. 52 Subjects selected from each group. METHODS--Examination of the relation between nutritional intake recorded in a four day dietary record and plasma lipid concentrations of subjects measured in blood samples collected previously. RESULTS--After controlling for age, sex, and body mass index, the correlation between plasma total cholesterol and the Keys score (which includes dietary cholesterol and saturated and polyunsaturated fat) was 0.37 (p less than 0.001). The mean saturated fat intake in all groups was low (6-14% of energy), but polyunsaturated fat intake was high, so mean total fat intake was generally above that recommended. A high dietary fibre intake was not associated with high carbohydrate intake. Plasma high density lipoprotein values were not associated with any measure of fat intake, but there was a significant correlation of 0.24 between high density lipoprotein values and alcohol intake. CONCLUSIONS--The nature rather than quantity of dietary fat is an important determinant of cholesterol concentrations. Health conscious individuals select a fat modified, rather than a low fat--high carbohydrate diet. National cholesterol lowering dietary advice should be reconsidered.
Background Cardiovascular disease (CVD) mortality in Russia is 2-3 times higher than in the rest of the developed world and accounts for 57% of all deaths. It has been observed that in recent years mortality from stroke is declining, whereas that from myocardial infarction is increasing. Modifiable risk factors: excessive alcohol and tobacco consumption, diet and sedentary lifestyles, have a negative effect on life expectancy resulting in high mortality rates. Russia, similar to most developed countries has observed a steady increase in body mass index (BMI) leading to a high burden of coronary heart disease (CHD), stroke and hypertension and associated costs. This paper looks at obesity related CVDs and costs for the Russian healthcare system. Methods A Markov-type simulation has been utilised to estimate the future burden of the weight changes and costs up to 2050. Incidence, mortality and healthcare costs were collected for CHD, stroke and hypertension. The results have been simulated for 3 hypothetical scenarios to project a potential impact of policy interventions: a) assuming no reduction in BMI; b) 1% reduction in BMI across the population; c) 5% reduction in BMI across the population. Results The disease prevalence rates will triple for diseases by 2050. Prevalence of CHD and stroke is projected to increase from 4,455 in 2010 to 12,723 cases only in 2050 (per 100,000 population). Hypertension prevalence is estimated to increase from 18,833 to 36,438 between 2010 and 2050. For the year 2050 in isolation, it is projected that nearly 280 incidence cases of CHD and stroke and 820 incidence cases of hypertension can be avoided with a 1% decrease in BMI across the population (per 100,000). A 5% reduction in BMI would, for 2050, cause a fall of nearly 7,600 incidence cases of CHD and stroke and 15,250 incidence cases of hypertension (per 100,000). Costs savings are substantial; 3-9 million Euros can be saved each year due to reduction in the BMI by 1% and 5% respectively. Conclusion Disease and economic burden attributed to the projected obesity rates are severe and have alarming adverse effects on the Russian healthcare. Despite the recent decreasing trend in rate of stroke, it is projected to increase along with CHD and hypertension due to increased obesity prevalence. The risk factors, however, are modifiable and Russia should act immediately to establish a strong policy to prevent the future increases in rates of morbidity and economic consequences of CVDs.
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