A matter of life and death: population mortality and football results.

OBJECTIVES: To determine whether football results are associated with mortality from circulatory disease. DESIGN: Retrospective study, comparing mortality on days of football matches between 18 August 1994 and 28 December 1999 with the results of the football matches. SETTING: Newcastle and North Tyneside, Sunderland, Tees, and Leeds Health Authority areas of England. SUBJECTS: All persons resident in Newcastle and North Tyneside, Sunderland, Tees, and Leeds Health Authority areas of England. MAIN OUTCOME MEASURES: Mortality attributable to acute myocardial infarction and stroke. RESULTS: On days when the local professional football team lost at home, mortality attributable to acute myocardial infarction and stroke increased significantly in men (relative risk 1.28, 95% confidence intervals 1.11 to 1.47). No increase was observed in women. CONCLUSIONS: Results achieved by the local professional football team are associated systematically with circulatory disease death rates over a five year period in men, but not women.

Lanterns in the jungle: is the NHS driven by the wrong kind of efficiency?

The performance of the National Health Service is assessed in part by an Efficiency Index (EI) which is applied to the service as a whole as well as to individual health authorities. The EI relates increases in the amount of patient care activity to increases in total expenditure. The index can give a misleading impression of performance, creates perverse incentives and is at odds with the overall strategy of the health service which is to place greater emphasis on the promotion of health and to provide more care in primary and community-based settings. The philosophy, validity and appropriateness of the EI are discussed.

Clinically diagnosed presenile dementia of the Alzheimer type in the Northern Health Region: ascertainment, prevalence, incidence and survival.

Potential cases of presenile dementia of the Alzheimer type (PDAT) in the Northern Health Region (estimated population aged 45-64, 655,800) were ascertained for the years 1979-86 from in-patient ICD-9 codes and other sources. An algorithm was applied to the casenote information to distinguish between Alzheimer-type and other forms of dementia. A search of the NHS central register was made to establish date and place of death. Estimates were made for patients with missing case records. The point prevalence rate for PDAT was estimated as 34.6 per 100,000 with an annual incidence of 7.2 per 100,000 in the 45-64 age range. These rates are compared with those reported in other studies. Five-year survival following diagnosis for incident cases of PDAT was 64% with a longevity quotient (LQ), the percentage of expected time actually survived, of 69%. There was no evidence of a more malignant course in PDAT when compared with survival in older patients with dementia of the Alzheimer type (DAT) in other studies. Sixty-six per cent of deaths occurred in hospital, 19% at home and 15% in residential homes.

Cervical intraepithelial neoplasia and 'wary' atypia: a study of colposcopic, histological and cytological characteristics.

Colposcopic, histological and cytological characteristics of 168 consecutive patients attending a colposcopy clinic were reviewed. A group of patients demonstrated a cluster of histological features previously related to possible human papilloma virus infection of cervical epithelium, including particularly koilocytosis, double nucleation and dyskeratosis. These patients had a significantly greater occurrence of colposcopic 'finger-like' lesion outline and colposcopic impression of warty change, but not of other specific colposcopic features. Over two-thirds of patients with histological warty features did not show these colposcopic changes. Cytological changes previously related to warty lesions did not occur commonly, and appeared to underestimate the histological occurrence of such changes. Histological changes considered to represent CIN were uncommon in patients who said that they had begun sexual activity less than 10 years ago, whereas patients with warty characteristics on histology showed no such bias.

Treatment of cervical intraepithelial neoplasia by colposcopically directed cryosurgery and subsequent pregnancy experience.

Of 420 patients attending a colposcopy clinic 204 were treated with outpatient cryosurgery for cervical intraepithelial neoplasia. It was possible to assess a definite outcome of therapy in 159 patients, and the lesion was successfully eradicated in 87% of them. Treatment failure appeared to be more common in patients of high parity, when the lesion extended into the cervical canal, and in those patients with large lesions. Failure appeared to be unrelated to patient age and to the histological grade of the lesion. In subsequent pregnancies utero-cervical function was preserved.

Colposcopy in the management of the pregnant patient with abnormal cervical cytology.

Thirty patients with abnormal cervical cytology had a colposcopy during pregnancy. Their management during and after pregnancy is described and supports the contention that the introduction of a colposcopy service safely permits a greater selectivity in management without recourse to operative intervention during pregnancy. In one patient a preclinical invasive squamous carcinoma of the cervix was diagnosed by colposcopy, and in another three, in whom colposcopy could not exclude the presence of invasion, a wedge biopsy under anaesthesia and two punch biopsies without anaesthesia had to be performed. In the remaining 26 patients, the possibility of invasion could be excluded by colposcopy and further treatment deferred until after pregnancy.

The accuracy of colposcopically directed biopsy in patients with suspected intraepithelial neoplasia of the cervix.

We compared the histological diagnoses of premalignant/malignant lesions of the cervix obtained by examining colposcopically directed biopsy material from 201 outpatients with those obtained by examining tissues from a subsequent, more extensive operative procedure. In all, 98 per cent of operative diagnoses were never more than one degree in advance of diagnoses made by colposcopic biopsy. In all seven patients with invasive or microinvasive squamous carcinoma, the lesion was suspect at colposcopy and confirmed by directed biopsy.