Quality of life in treated hypertension: a case-control community based study.

The aim of this case-control community study was to determine whether there was a difference in quality of life between hypertensive subjects and matched normotensive controls. Cases aged 40-79 years were randomly selected from a hypertensive register and matched with controls for age, sex, ethnicity and health centre. Cases had phase V diastolic blood pressure (DBP) > or = 100 mm Hg or systolic blood pressure (SBP) > or = 180 mm Hg, or were on anti-hypertensive medication. Controls had DBP < or = 90 mm Hg and no record of raised BP or anti-hypertensive treatment within the past year. Quality of life was measured by self-administered questionnaire. Data from 90 matched pairs, average age 62 years, with 47% men, were analysed; 80 hypertensive subjects were on anti-hypertensive medication. Hypertensive subjects showed an impairment in well-being compared with controls. They had a lower Health Status Index, had more sickness absence from work, greater symptomatic complaint and impaired psychological well-being. Relatives also reported a poorer quality of life in the hypertensive subjects. This impairment could be a result of the disease, adverse effects of drug treatment or to the effects of labelling.

Factors influencing the career choices of general practitioner trainees in North West Thames Regional Health Authority.

The aim of this study was to identify those factors influencing general practitioner trainees when choosing their future place of work, with particular reference to those issues that might be relevant to a choice of practice in inner London. A questionnaire was sent to the 90 trainees undertaking the final component of general practice training within North West Thames Regional Health Authority in May 1991. Seventy five doctors responded to the questionnaire, of whom 47 (63%) were women. Forty five per cent of women indicated that they wished to work part time, compared with 6% of the men. Only 21 trainees (28%) said that they would consider working in inner London, 36 (48%) stating that they would definitely not work in this location, with only nine (12%) indicating a willingness to work in a single handed practice and 21 (28%) in a two doctor practice. Specific factors identified as important when choosing a practice included a good working relationship with partners and staff, the presence of a practice nurse and practice manager, attached health authority staff, opportunities for postgraduate education, and good relationships with hospitals. Of the 800 practices in the north west Thames region, 62% are either one or two doctor practices, these being more prevalent in inner London areas where training practices are less common. Given the preferences expressed by trainees, future recruitment in inner London is likely to be more difficult than elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)

Cognitive function in hypertension: a community based study.

Cognitive function was investigated in a random sample of subjects on the general practitioners' registry of hypertensive patients in an inner city area and matched with normotensive controls. The response rate was 66% giving 90 matched pairs, average age 63 yrs, with 47% men. There was no difference in educational background or measures of reading ability between the two groups. Cognitive function tests showed a consistent trend of poorer performance in hypertensives, with significant differences in Verbal Learning (immediate recall and retention). Age was inversely related to cognitive function, but no additional deterioration with increasing age was shown in hypertensives.

Training experience of doctors certificated for general practice in 1985-90.

The computerized records held by the Joint Committee on Postgraduate Training for General Practice have been reviewed to determine the post-registration experience offered by doctors who were issued with a joint committee certificate during the years 1985-90, inclusive. The percentage of certificates issued on the basis of experience prescribed in the vocational training regulations rose from 74.4% in 1985 to 89.7% in 1990. Since 1985 obstetrics/gynaecology has been the specialty in which the greatest number of successful applicants have offered experience, increasing from 86.4% in 1985 to 93.8% in 1990. The next most popular specialty was accident and emergency/general surgery (offered by 65.5% of successful applicants in 1985 and 73.6% in 1990) followed by paediatrics (56.7% in 1985 and 62.2% in 1990). The percentage of certificates issued on the basis of experience in geriatric medicine rose slowly from 35.6% in 1985 to 41.7% in 1990, for psychiatry the figures were similar (36.4% in 1985 and 40.7% in 1990), and for general medicine there was a slight decrease (46.2% in 1985 and 44.7% in 1990). There is a need for more doctors to acquire experience in general medicine, geriatric medicine and psychiatry. Since 1985, the trend has been for applicants to offer a more broadly based range of experience. In 1985, 48.5% of successful applicants offered experience in four hospital specialties and this rose to 63.6% in 1990. Although the vocational training regulations offer a degree of flexibility only a small number of successful applicants have taken advantage of this.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of the hospital experience completed by general practitioner trainees in 1984-87.

This report gives details of the hospital experience undertaken by doctors who have completed vocational training for general practice and is based on the information presented by applicants for the certificate of the Joint Committee on Postgraduate Training for General Practice.

Diminished hepatic growth hormone receptor binding in sex-linked dwarf broiler and leghorn chickens.

Hepatic growth hormone (GH) receptor binding was compared in normal and sex-linked dwarfs (SLD) from both Hubbard and Cornell strain chickens. At 6, 8, and 20 weeks of age, hepatic GH receptor binding in the Hubbard SLD chickens was significantly lower than that of normal fast-growing birds. At 20 weeks of age, only 2 of 22 SLD chickens in the Hubbard broiler strain showed positive binding at a high enough level to allow for Scatchard analysis. The affinity constants and binding capacities of these two SLD chickens were numerically (but not significantly) lower than those of the normal fast-growing birds. We further examined hepatic GH receptor binding in two closely related White Leghorn strains of chickens that have been maintained as closed breeding populations for many years. We observed no detectable hepatic GH binding in the Cornell SLD chickens (N = 20), as compared to the normal-growing control strain (K strain). In both SLD strains, pretreatment with 4 M MgCl2 did not enhance GH binding, suggesting that there was no endogenous GH binding to the receptor. Based on these data, we suggest that the lack, or greatly reduced number, of GH receptors may be a major contributing factor to the dwarfism observed in these strains.

North Hammersmith stroke prevention project.

The North Hammersmith stroke prevention project was designed to reduce the number of deaths from stroke in this health district by improving the detection of hypertensive patients and thereafter reducing the default rate from treatment. Starting in May 1979 general practitioners in the district were asked to register hypertensive patients over the age of 40 so that the proportion of such patients in each practice was known and could be compared with the average for all practices. This confidential information was fed back every year to the individual general practitioners so that they could assess their performance. Forty of 44 eligible general practitioners agreed to participate and 29 proceeded to register patients. Over a three year period 1006 patients were registered, representing 4.3% of the project population over the age of 40. Individual practice registration rates ranged from 1.1% to 9.1%. Sixty five per cent of the registered patients were women, 34% of all registrations were in the age group 60-69, 31% in the group 50-59, 12% in the group 40-49, and 23% in the group over 70. The average blood pressure before treatment was 190/111 mm Hg. After one and two years the patients were contacted or their notes examined to ensure that they still receiving treatment. Persistant default from treatment occurred in under 12% over the three year period.