Public knowledge and attitudes to AIDS.

Three independent cross-sectional surveys of public knowledge and attitudes about AIDS were conducted on a representative sample of people aged 15-54 resident in Wales. 1,303 were interviewed in their homes in February 1987, 683 in September 1987 and 676 in March 1988. The results show that most people knew that having sexual intercourse or sharing needles with people with AIDS represented a high risk of catching AIDS. However there appeared to be considerable misunderstanding about the nature of HIV infection such that one in three thought that a man and woman with a single heterosexual partner was at high or moderate risk of catching AIDS. The high level of concern coupled with considerable confusion appears to have contributed to both unnecessary anxiety and prejudice. One in four people thought that kissing or being spat on by a person with AIDS represented a high or moderate risk, and one in six thought that coughing, sneezing and sharing towels, soap, drinking utensils or lavatory seats were routes of transmission. More than 50% of men and 40% of women said that it was their own fault if homosexuals and drug addicts got AIDS and did not feel sorry for them. It is concluded that action to date to limit the spread of AIDS has informed but not yet adequately educated the public. If unwanted anxieties and prejudice are to be diminished, initiatives by government, health services and others must now concentrate on developing understanding about the nature of HIV infection and its spread through more personal education.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood pressure and blood lead in surveys in Wales.

The association between blood pressure and blood lead level was examined in two population surveys in Wales. In a survey of 1,721 male and female subjects throughout the principality, there was evidence of a marked relation of blood pressure with age, but when this was removed no residual association with blood lead remained. In a survey of 1,164 older men in Caerphilly, there was no evidence of an association between blood lead and either resting blood pressure or the rise in blood pressure during a cold pressor test.

Human cysticercosis and intestinal parasitism amongst the Ekari people of Irian Jaya.

A random sample of 242 people showed that 42 had palpable cysts of Taenia solium. Faecal examination recovered eggs of T. solium in seven (3%), while Trichuris (83%), Ascaris (83%), hookworms (76%), Strongyloides stercoralis (10%) and Strongyloides sp. (29%), Entamoeba histolytica (14%), Entamoeba coli (22%), Entamoeba hartmanni (7%), Entamoeba polecki (7%), Balantidium coli (9%) and Dientamoeba fragilis (21%) were the most common other intestinal parasites encountered. ELISA tests, using antigens prepared from adults and eggs of T. solium and from cysticerci of T. saginata were not very sensitive, the last diagnosing less than half of known positives while still retaining good specificity.

The use of logit models to investigate social and biological factors in infant mortality. III. Neonatal mortality.

Infant mortality data for England and Wales, cross-classified by mother's age, parity and social class have been published on two occasions, the first giving the relevant data for 1949/50, the second for 1975, some 25 years later. Published analyses of these separate data sets have been based on graphical and tabular analysis. This paper develops the methodology from an earlier paper by Murrells et al. to the analysis of the neonatal data.

The use of logit models to investigate social and biological factors in infant mortality. IV: Post-neonatal mortality.

Infant mortality data for England and Wales, cross-classified by mother's age, parity and social class have been published on two occasions, the first giving the relevant data for 1949/50, the second for 1975, some 25 years later. Published analyses of these separate data sets have been based on graphical and tabular analysis. This paper describes the application of logit models using the methodology presented by Murrells et al. to investigate post-neonatal deaths.

The use of logit models to investigate social and biological factors in infant mortality. II: Stillbirths.

Infant mortality data for England and Wales cross-classified by mother's age, parity and social class have only been published for 1949/50 and 1975. Appropriate statistical methodology for the analysis of such data has been described in Paper I, which used the 1975 stillbirth data for illustration. This paper examines the stillbirth data from both years by formally incorporating the year of data collection into the statistical model, enabling changes in the age, parity and social class effects with time to be investigated. Despite a marked reduction in stillbirth mortality from 21.1 to 10.1 per thousand over the period, the relative contribution of social class has increased. In particular there has been a relative increase in risk for mothers in the lower social classes. By contrast the effects of age and parity, although remaining important, have diminished over the period.

The use of logit models to investigate social and biological factors in infant mortality. I: Methodology.

Infant mortality data for England and Wales, cross classified by mother's age, parity and social class, have been published on two occasions, the first giving the relevant data for 1949/50, the second for 1975, some 25 years later. Published analyses of these separate data sets have been based on graphical and tabular methods. This paper describes the statistical methodology appropriate to the use of logit models to investigate these data sets and shows how such models may be used to supplement the more informal approach. The stillbirth data for 1975 are used for illustration. Paper II, which follows, explores the stillbirth data in greater detail, with emphasis on the changes between 1949/50 and 1975. Subsequent papers describe neonatal and post-neonatal deaths using the same framework. A final paper summarizes the overall changes in infant mortality by means of a multilogit model.

On the state of the public ill health: premature mortality in the United Kingdom and Europe.

Recently published data on mortality in the European Economic Community and Scandinavia convincingly showed that mortality among men and women aged 45-64 was considerably higher in the United Kingdom than elsewhere. This applied to deaths due to circulatory and respiratory disease, cancer, and all causes. For example, in 1980 in Scotland twice as many, or more, women aged 55-64 per 100 000 died of heart disease than in Belgium, Denmark, France, Greece, West Germany, the Netherlands, Norway, and Sweden. Reductions in mortality from all causes during 1950-80 in the United Kingdom did not match those in other countries, such as Finland and France. Whether the public in the United Kingdom knows about its relatively poor mortality state is doubtful. To secure improved funding of appropriate preventive and treatment services directed at reducing premature mortality, public awareness should be raised urgently so that politicians and political parties will respond quickly in a way that the problem demands.

Confidential paediatric inquiry into neonatal deaths in Wessex, 1981 and 1982.

From 1 January 1981 to 31 December 1982, 66 256 births and 386 neonatal deaths were recorded in the Wessex Regional Health Authority, giving a neonatal mortality of 5.8/1000 live births. An experienced consultant paediatrician undertook a confidential inquiry into each death shortly after it had been reported. One hundred and forty four deaths (37%) were found to be due to lethal or severe malformations, an incidence of 2.2/1000 births. Of the 242 normally formed infants, 111 (46%) died within 24 hours of birth. Seventy seven (32%) weighed over 2500 g at birth. Factors operating before delivery accounted for 104 (43%) of the deaths of normally formed infants. The commonest factors were short gestation and low birth weight, and intrauterine hypoxia and birth injury. Factors after delivery accounted for 81 deaths (33%), the commonest being infections and sudden infant deaths. In the remaining 57 deaths (24%) it seemed that a combination of factors before and after birth had led to the death. Factors before birth thus played a part in two thirds of all deaths. Possible adverse factors in medical care were sought in 154 potentially viable babies and were identified in 38--that is, 10% of all neonatal deaths. Better provision and training of district staff in immediate care at birth would achieve more in lowering neonatal mortality in Wessex than the setting up of a regional unit specializing in advanced neonatal intensive care. Moreover, the greatest scope for improving the outcome of childbirth in Wessex would be offered if there were further advances in obstetric rather than neonatal care.

Prevention in practice: what Wessex general practitioners are doing.

A random sample of 214 general practitioners in the Wessex region was invited to complete a postal questionnaire about the practice of preventive medicine and 90% replied. This inquired into their attitude and behaviour towards smoking and accident prevention, promoting exercise, and controlling obesity and hypertension. The results were generally encouraging. Most recognised their key role in health promotion and health education and their shared responsibility with other professionals. Many had made progress in smoking prevention and control of obesity and hypertension. Promoting exercise and accident prevention left room for improvement. The availability of information in patients' records to identify and monitor problem areas was particularly lacking. We conclude that further progress might be achieved by better training of general practitioners, and developing information systems orientated towards promoting health. The team approach in primary care needs to be strengthened. In particular extending the role of the health visitor and practice nurse may provide the support so vital for the successful outcome of preventive initiatives. Community unit management teams need to consider carefully how they may encourage advances in health promotion in primary care.

Smoking in hospitals.

Restricting smoking in public places is an important part of a smoking prevention strategy. To find out the extent to which smoking is restricted in health service premises a survey of 190 hospitals and health centres in the Wessex Region was done. It showed that the levels of smoking restriction were high, and that patients, visitors, and staff complied well with the restrictions. For ambulant patients the situation clearly favoured the smoker-for example, only 18% of acute hospitals could offer "smoke-free" day rooms to every patient who requested it, yet 92% could offer day-room accommodation to all smokers. Cigarettes were sold in a quarter of acute and maternity hospitals. Doctors played a small role in promoting non-smoking. Goals, based on percentage of floor space designated as non-smoking areas, should be set and their achievement monitored. Cigarettes should not be sold in hospitals, except perhaps long-stay hospitals.

Congenital hip dislocation: an increasing and still uncontrolled disability?

A study of 178 cases of congenital dislocation of the hip in babies born between 1965 and 1978 in Southampton health district showed that the incidence had virtually doubled over this period. Established cases (persisting beyond the first birthday) had risen to around two cases per 1000 per live births. One-third of these were first diagnosed after the age of 1 year and one-fifth after 18 months. The findings are particularly disappointing as there were opportunities after the neonatal period for earlier diagnosis. Thus, neonatal screening appears to have failed to make a substantial impact on the morbidity of the disease, probably because of a combination of inherent difficulties in the neonatal screening test as well as failure in its proper application. Much greater vigilance is needed during the first year of life if congenital dislocation of the hip is to be detected and treated as early as possible. Perhaps this could be achieved if all health professionals were more aware of the problem and were encouraged to examine hips at every opportunity and health authorities periodically audited their results.