- Email: [email protected]
Health and poverty
953
of women are likely to become pregnant after unprotected sexual intercourse (the risk varies at different times in the menstrual cycle) and that the emergency pill reduces the risk by 50-90%. The success rate with the less convenient IUCD is about 98%. The only totally reliable postcoital agent is mifepristone,4,5 which is licensed only for termination of first-trimester pregnancy in three countries (France, UK, and Sweden) and as an adjunct to prostaglandin in the termination of second-trimester pregancy in one (France). It is not yet available anywhere in the world for emergency contraception, but Roussel Uclaf, the manufacturer, and the World Health Organization are investigating its use for this indication.
Dorothy Bonn 1. Burton R, Savage W, Reader F. The "morning after pill" is the wrong name for it. Br J Family Plann 1990; 15: 119-21. 2. Burton R, Savage W. Knowledge and use of postcoital contraception: a survey among health professionals in Tower Hamlets. Br J Gen Pract 1990; 40: 326-30. 3. Anonymous. Hormonal emergency contraception. Drug Ther Bull 1993; 31: 27-28. 4. Glasier A, Thong KJ, Dewar M, Mackie M, Baird DT. Mifepristone (RU 486) compared with high-dose estrogen and progestogen for emergency postcoital contraception. N Engl J Med 1992; 327: 1041-42. 5. Webb AMC, Russell J, Elstein M. Comparison of the Yuzpe regimen, danazol and mifepristone (RU 486) in oral postcoital contraception. BMJ 1992; 305: 927-31.
Developments in health surveys
poverty in Bangladesh have increased in a decade from 45 million to 82 million.
Dorothy E. Logie Asthma treatment:
a consensus
Inappropriate treatment—overuse of bronchodilators or underuse of steroids-has long been suspected to be responsible for fluctuations in asthma mortality. A consensus on treatment of adult asthma in Britain, reached in 1990 under the aegis of the British Thoracic Society, has been updated and the treatment of children and infants included.l Coincidentally, the Royal College of General Practitioners has produced its own guidelines. The two sets of guidelines differ mainly in emphasis on particular treatments.2 Both reports stress the importance of closely assessing the response to treatment and swiftly altering it when necessary. The ready availability of peak-flow meters enables patients to monitor their treatment, and to know when to seek urgent advice--which, on its own, may make a substantial contribution to reducing deaths. The Thoracic Society’s schedules and associated advice are tabulated in posters for hospital wards, emergency rooms, and general practitioners. The RCGP guidelines have been circulated to all general practitioners with the aid of a grant from a manufacturer of pharmaceuticals.
Advances in health surveys and some problems were reviewed at a recent conference in London on New Developments in Health Surveys jointly organised by the Society for Social Medicine and the Royal Statistical Society. Speakers from the UK Department of Health’s Central Health Monitoring Unit emphasised the importance of health surveys in monitoring progress towards the Health of the Nation targets, but many active in this field considered their remit to be somewhat broader than this, and the acknowledgment of the need to act on the information obtained was encouraging. By contrast, the potential waste and duplication of expertise produced through a policy of privatisation in health surveys must be viewed with alarm. The continued cumbersome and wasteful need to write to each local ethics committee for approval for national surveys stressed yet again the need for a broadly constituted national ethics committee with the power to approve national studies. Imaginative approaches to population sampling, particularly in inner cities, were described so that those without a postcode, family doctor, or entry on the electoral roll would not be excluded. For instance, in the Sheffield Heart of Our City survey, subjects were recruited by a "snowballing" method, whereby each subject identified by the project was asked to nominate 8 to 10 others. This survey, and the Trent Lifestyle Survey (which fed back results to participating district authorities), highlighted the importance of community involvement in identifying and meeting local needs.
John
Bignall
ed. Guidelines on the management of asthma. Thorax 1991; 48 (suppl): S1-S24. 2. Guidelines for the care of patients with asthma. London: Royal College of General Practitioners. 1993. Pp 9. 1. Woodward M,
Asthma and premature labour Asthmatic
women are at
increased risk of premature labour,
prospective studyl that compared pregnancy outcomes in women with and without a history of respiratory illness. By assessing the relation between maternal respiratory illness and labour or delivery before 37 weeks’ gestation in 3891 women, a maternal history of asthma in the 12 months before conception was associated with a relative risk of premature labour of 2-33 (95% CI 1-03-5-26). Although the number of premature labours was small, these results support the hypothesis proposed in 19852 that one mechanism underlies the hyperreactivity of the bronchial airways and the myometrium. Indirect support has been available for some time in that &bgr;2-receptor agonists can relieve bronchospasm and stop premature labour, and prostaglandin F2(X
according
to
a
induce both bronchoconstriction and labour. Asthmatic particularly those in whom asthma is acute around conception, are an identifiable risk group for premature labour, suggest the authors. can
women,
Astrid James
Carol Dezateux 1. Doucette
Health and poverty The once forgotten diseases of poverty are returning to the UK. The incidence of TB and scabies is rising and cases of dysentery have increased six-fold in the past 2 years, said David Blunkett, Shadow Secretary of State for Health at a Catholic Institute for International Relations study day (1April) on health inequalities. It can be no coincidence, he added, that the number of water supply disconnections trebled in 1991-92 and has already outstripped the 1991 figure in the first 5 months of 1992-93. There is mounting scientific evidence to show that the more advantaged people are, the healthier they are, and that the narrower the economic gap between rich and poor, the better the health of the whole population. Sadly this wealth gap is widening, said Prof Peter Townsend, professor of social policy, Bristol. In the past decade, the wealthiest 20% of UK households have increased their disposable income by an average 5500 per person per year, whereas the poorest 20% (representing over 11 million people) have each lost an annual 150. This polarisation trend is especially striking in the USA, but in the poorest countries of the world too there is a growing divide between rich and poor, resulting in a "predatory existence" for substantial sections of society. The numbers living in extreme
JT, Bracken MB. Possible role of asthma in the risk of preterm labor and delivery. Epidemiology 1993; 4: 143-50. 2. Bertrand JM, Riley SP, Popkin J, Coates AL. The long-term pulmonary sequelae of prematurity: the role of familial airway hyperreactivity and the respiratory distress syndrome. N Engl J Med 1985; 312: 742-45.
OPCS stillbirth and
perinatal mortality statistics
The UK Stillbirth (Definition) Act 1992 extends the definition of stillbirth to include losses at 24-27 weeks’ gestation. All published data since Oct 1, 1992, will thus include stillbirths of 24-27 weeks’ gestation. This change will mean approximately 800 more registered stillbirths in England and Wales annually. To ensure that the effect of the new definition will be reflected in the routine statistics and also that trends can continue to be monitored and analysed despite the change, future publications from the Office of Population Censuses and Surveys over the next few years will contain data on trends with and without stillbirths in the 24-27 week period as from Oct 1, 1992. The OPCS has also completed a comprehensive review of how best it can maintain the confidentiality and security of the personal data that it holds. Its statement of the minimum standards that it will apply can be obtained from the OPCS Information Branch, St Catherine’s House, 10 Kingsway, London WC2B 6JP.
of women are likely to become pregnant after unprotected sexual intercourse (the risk varies at different times in the menstrual cycle) and that the emergency pill reduces the risk by 50-90%. The success rate with the less convenient IUCD is about 98%. The only totally reliable postcoital agent is mifepristone,4,5 which is licensed only for termination of first-trimester pregnancy in three countries (France, UK, and Sweden) and as an adjunct to prostaglandin in the termination of second-trimester pregancy in one (France). It is not yet available anywhere in the world for emergency contraception, but Roussel Uclaf, the manufacturer, and the World Health Organization are investigating its use for this indication.
Dorothy Bonn 1. Burton R, Savage W, Reader F. The "morning after pill" is the wrong name for it. Br J Family Plann 1990; 15: 119-21. 2. Burton R, Savage W. Knowledge and use of postcoital contraception: a survey among health professionals in Tower Hamlets. Br J Gen Pract 1990; 40: 326-30. 3. Anonymous. Hormonal emergency contraception. Drug Ther Bull 1993; 31: 27-28. 4. Glasier A, Thong KJ, Dewar M, Mackie M, Baird DT. Mifepristone (RU 486) compared with high-dose estrogen and progestogen for emergency postcoital contraception. N Engl J Med 1992; 327: 1041-42. 5. Webb AMC, Russell J, Elstein M. Comparison of the Yuzpe regimen, danazol and mifepristone (RU 486) in oral postcoital contraception. BMJ 1992; 305: 927-31.
Developments in health surveys
poverty in Bangladesh have increased in a decade from 45 million to 82 million.
Dorothy E. Logie Asthma treatment:
a consensus
Inappropriate treatment—overuse of bronchodilators or underuse of steroids-has long been suspected to be responsible for fluctuations in asthma mortality. A consensus on treatment of adult asthma in Britain, reached in 1990 under the aegis of the British Thoracic Society, has been updated and the treatment of children and infants included.l Coincidentally, the Royal College of General Practitioners has produced its own guidelines. The two sets of guidelines differ mainly in emphasis on particular treatments.2 Both reports stress the importance of closely assessing the response to treatment and swiftly altering it when necessary. The ready availability of peak-flow meters enables patients to monitor their treatment, and to know when to seek urgent advice--which, on its own, may make a substantial contribution to reducing deaths. The Thoracic Society’s schedules and associated advice are tabulated in posters for hospital wards, emergency rooms, and general practitioners. The RCGP guidelines have been circulated to all general practitioners with the aid of a grant from a manufacturer of pharmaceuticals.
Advances in health surveys and some problems were reviewed at a recent conference in London on New Developments in Health Surveys jointly organised by the Society for Social Medicine and the Royal Statistical Society. Speakers from the UK Department of Health’s Central Health Monitoring Unit emphasised the importance of health surveys in monitoring progress towards the Health of the Nation targets, but many active in this field considered their remit to be somewhat broader than this, and the acknowledgment of the need to act on the information obtained was encouraging. By contrast, the potential waste and duplication of expertise produced through a policy of privatisation in health surveys must be viewed with alarm. The continued cumbersome and wasteful need to write to each local ethics committee for approval for national surveys stressed yet again the need for a broadly constituted national ethics committee with the power to approve national studies. Imaginative approaches to population sampling, particularly in inner cities, were described so that those without a postcode, family doctor, or entry on the electoral roll would not be excluded. For instance, in the Sheffield Heart of Our City survey, subjects were recruited by a "snowballing" method, whereby each subject identified by the project was asked to nominate 8 to 10 others. This survey, and the Trent Lifestyle Survey (which fed back results to participating district authorities), highlighted the importance of community involvement in identifying and meeting local needs.
John
Bignall
ed. Guidelines on the management of asthma. Thorax 1991; 48 (suppl): S1-S24. 2. Guidelines for the care of patients with asthma. London: Royal College of General Practitioners. 1993. Pp 9. 1. Woodward M,
Asthma and premature labour Asthmatic
women are at
increased risk of premature labour,
prospective studyl that compared pregnancy outcomes in women with and without a history of respiratory illness. By assessing the relation between maternal respiratory illness and labour or delivery before 37 weeks’ gestation in 3891 women, a maternal history of asthma in the 12 months before conception was associated with a relative risk of premature labour of 2-33 (95% CI 1-03-5-26). Although the number of premature labours was small, these results support the hypothesis proposed in 19852 that one mechanism underlies the hyperreactivity of the bronchial airways and the myometrium. Indirect support has been available for some time in that &bgr;2-receptor agonists can relieve bronchospasm and stop premature labour, and prostaglandin F2(X
according
to
a
induce both bronchoconstriction and labour. Asthmatic particularly those in whom asthma is acute around conception, are an identifiable risk group for premature labour, suggest the authors. can
women,
Astrid James
Carol Dezateux 1. Doucette
Health and poverty The once forgotten diseases of poverty are returning to the UK. The incidence of TB and scabies is rising and cases of dysentery have increased six-fold in the past 2 years, said David Blunkett, Shadow Secretary of State for Health at a Catholic Institute for International Relations study day (1April) on health inequalities. It can be no coincidence, he added, that the number of water supply disconnections trebled in 1991-92 and has already outstripped the 1991 figure in the first 5 months of 1992-93. There is mounting scientific evidence to show that the more advantaged people are, the healthier they are, and that the narrower the economic gap between rich and poor, the better the health of the whole population. Sadly this wealth gap is widening, said Prof Peter Townsend, professor of social policy, Bristol. In the past decade, the wealthiest 20% of UK households have increased their disposable income by an average 5500 per person per year, whereas the poorest 20% (representing over 11 million people) have each lost an annual 150. This polarisation trend is especially striking in the USA, but in the poorest countries of the world too there is a growing divide between rich and poor, resulting in a "predatory existence" for substantial sections of society. The numbers living in extreme
JT, Bracken MB. Possible role of asthma in the risk of preterm labor and delivery. Epidemiology 1993; 4: 143-50. 2. Bertrand JM, Riley SP, Popkin J, Coates AL. The long-term pulmonary sequelae of prematurity: the role of familial airway hyperreactivity and the respiratory distress syndrome. N Engl J Med 1985; 312: 742-45.
OPCS stillbirth and
perinatal mortality statistics
The UK Stillbirth (Definition) Act 1992 extends the definition of stillbirth to include losses at 24-27 weeks’ gestation. All published data since Oct 1, 1992, will thus include stillbirths of 24-27 weeks’ gestation. This change will mean approximately 800 more registered stillbirths in England and Wales annually. To ensure that the effect of the new definition will be reflected in the routine statistics and also that trends can continue to be monitored and analysed despite the change, future publications from the Office of Population Censuses and Surveys over the next few years will contain data on trends with and without stillbirths in the 24-27 week period as from Oct 1, 1992. The OPCS has also completed a comprehensive review of how best it can maintain the confidentiality and security of the personal data that it holds. Its statement of the minimum standards that it will apply can be obtained from the OPCS Information Branch, St Catherine’s House, 10 Kingsway, London WC2B 6JP.