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BMJ No 7107 Volume 315 Papers - Abstracts Saturday 30 August 1997
Acute upper gastrointestinal haemorrhage in west of Scotland:
case ascertainment study
Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment studyOliver Blatchford, Lindsay A Davidson, William R Murray, Mary Blatchford, Jill Pell
AbstractObjectives: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors.Design: Case ascertainment study. Setting: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland. Subjects: 1,882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period. Main outcome measures: Incidence of acute upper gastrointestinal haemorrhage per 100,000 population per year, and case fatality. Results: The annual incidence was 172 per 100,000 people aged 15 and over. The annual population mortality was 14.0 per 100,000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors. Conclusions: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality. Royal College of Physicians and Surgeons of
Glasgow, Glasgow Royal Infirmary NHS Trust, Easterhouse Health Centre, Department of Public Health,
Correspondence to: Dr
O Blatchford
Water fluoridation, tooth decay in 5 year olds, and social deprivation measured by the Jarman score: analysis of data from British dental surveysC M Jones, G O Taylor, J G Whittle, D Evans, D P Trotter AbstractObjective: To examine the effect of water fluoridation, both artificial and natural, on dental decay, after socioeconomic deprivation was controlled for.Design: Ecological study based on results from the NHS dental surveys in 5 year olds in 1991-2 and 1993-4 and Jarman underprivileged area scores from the 1991 census. Setting: Electoral wards in three areas: Hartlepool (naturally fluoridated), Newcastle and North Tyneside (fluoridated), and Salford and Trafford (non-fluoridated). Subjects: 5 year old children (n=10 004). Intervention: Water fluoridation (artificial and occurring naturally). Main outcome measure: Ward tooth decay score (score on the "decayed, missing, and filled tooth index" for each electoral ward). Results: Multiple linear regression showed a significant interaction between Jarman score for ward, mean number of teeth affected by decay, and both types of water fluoridation. This confirms that the more deprived an area, the greater benefit derived from fluoridation, whether natural or artificial (R2=0.84, P<0.001). At a Jarman score of zero (national mean score) there was a predicted 44% reduction in decay in fluoridated areas, increasing to a 54% reduction in wards with a Jarman score of 40 (very deprived). The area with natural fluoridation (at a level of 1.2 parts per million - higher than levels in artificially fluoridated areas) had a 66% reduction in decay, with a 74% reduction in wards with a Jarman score of 40. Conclusion: Tooth decay is confirmed as a disease associated with social deprivation, and the more socially deprived areas benefit more from fluoridation. Widespread water fluoridation is urgently needed to reduce the "dental health divide" by improving the dental health of the poorer people in Britain. North West Dental Public Health
Resource Centre, Newcastle and North
Tyneside Health Authority, Shropshire Health
Authority,
Correspondence to: Dr C M Jones
Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations - a questionnaire studyJill Cockburn, Sabrina Pit AbstractObjectives: To examine the effect of patients' expectations for medication and doctors' perceptions of patients' expectations on prescribing when patients present with new conditions.Design: Questionnaire study of practitioners and patients. Setting: General practice in Newcastle, Australia. Subjects: 22 non-randomly selected general practitioners and 336 of their patients with a newly diagnosed medical condition. Main outcome measures: Prescription of medication and expectation of it. Results: Medication was prescribed for 169 (50%) patients. After controlling for the presenting condition, patients who expected medication were nearly three times more likely to receive medication (odds ratio=2.9, 95% confidence interval 1.3 to 6.3). When the general practitioner thought the patient expected medication the patient was 10 times more likely to receive it (odds ratio=10.1, 5.3 to 19.6). A significant association existed between patients' expectation and doctors' perception of patients' expectation (chi2=52.0, df=4, P=0.001). For all categories of patient expectation, however, patients were more likely to receive medication when the practitioner judged the patient to want medication than when the practitioner ascribed no expectation to the patient. Conclusions: Although patients brought expectations to the consultation regarding medication, the doctors' opinions about their expectations were the strongest determinants of prescribing. Discipline of Behavioural Science in Relation to
Medicine, Correspondence to: Dr Cockburn. jillc@wallsend.newcastle.edu.au
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