P Patel, M A Mendall, D Carrington, D P Strachan, E Leatham, N Molineaux, J Levy, C Blakeston, C A Seymour, A J Camm, T C Northfield
Abstract
Objective - To investigate the relation between seropositivity to chronic infections with Helicobacter pylori and Chlamydia pneumoniae and both coronary heart disease and cardiovascular risk factors.
Design - Cross sectional study of a population based random sample of men. Coronary heart disease was assessed by electrocardiography, Rose angina questionnaire, and a history of myocardial infarction; serum antibody levels to H pylori and C pneumoniae were measured, risk factor levels determined, and a questionnaire administered.
Setting - General practices in Merton, Sutton, and Wandsworth, south London.
Subjects - 388 white south London men aged 50-69.
Main outcome measures - Evidence of coronary risk factors and infection with H pylori or C pneumoniae.
Results - 47 men (12.1%) had electrocardiographic evidence of ischaemia or infarction. 36 (76.6%) and 18 (38.3%) were seropositive for H pylori and C pneumoniae, respectively, compared with 155 (45.5%) and 62 (18.2%) men with normal electrocardiograms. Odds ratios for abnormal electrocardiograms were 3.82 (95% confidence interval 1.60 to 9.10) and 3.06 (1.33 to 7.01) in men seropositive for H pylori and C pneumoniae, respectively, after adjustment for a range of socioeconomic indicators and risk factors for coronary heart disease. Cardiovascular risk factors that were independently associated with seropositivity to H pylori included fibrinogen concentration and total leucocyte count. Seropositivity to C pneumoniae was independently associated with raised fibrinogen and malondialdehyde concentrations.
Conclusions - Both H pylori and C pneumoniae infections are associated with coronary heart disease. These relations are not explained by a wide range of confounding factors. Possible mechanisms include an increase in risk factor levels due to a low grade chronic inflammatory response.
St George's Hospital Medical School Tooting London SW17 0RE P Patel research fellow in gastroenterology M A Mendall lecturer in gastroenterology D Carrington senior lecturer in virology D P Strachan senior lecturer in public health sciences E Leatham research fellow in cardiology N Molineaux research nurse J Levy research assistant C Blakeston research assistant C A Seymour professor of clinical biochemistry and metabolism A J Camm professor in cardiology T C Northfield professor in gastroenterology
Correspondence to: Dr Mendall, division of biochemical medicine.
Leiv Sandvik, Gunnar Erikssen, Erik Thaulow
Abstract
Objective - To study association between s king habits and long term decline in physical fitness and lung function in middle aged men who remained healthy.
Design - Baseline and follow up measurements performed during 1972-5 and 1980-2 respectively.
Setting - National University Hospital of Oslo, Norway.
Subjects - 1393 men aged 40-59 at baseline who were all healthy at baseline and at follow up.
Main outcome measures - Forced expiratory volume in one second and physical fitness (defined as total work done during a symptom limited bicycle ergometer test divided by body weight.
Results - Initial fitness was substantially lower among 347 persistent smokers than among 791 persistent non-smokers (1349 J/kg v 1618 J/kg), as was initial forced expiratory volume (3341 ml v 3638 ml). Mean (95% confidence interval) decline in fitness over 7.2 years was 217 (185 to 249) J/kg among smokers compared with 86 (59 to 113) J/kg among non-smokers (P less than 0.001). Corresponding declines in forced expiratory volume were 271 (226 to 316) ml in smokers and 116 (85 to 147) ml in non-smokers (P less than 0.001). Differences between smokers and non-smokers remained practically unchanged after adjustment for age and level of physical activity. Changes in fitness and forced expiratory volume among 199 men who had stopped smoking mimicked the findings for persistent non-smokers, and 56 men who started smoking presented findings close to those of persistent smokers.
Conclusion - Decline in physical fitness and lung function among healthy middle aged men was considerably greater among smokers than among non-smokers and could not be explained by differences in age and physical activity.
Department of Medicine Central Hospital of Akershus N-1474 Nordbyhagen Norway Leiv Sandvik senior statistician Gunnar Erikssen senior registrar Erik Thaulow consultant
Correspondence to: Dr Erikssen.
Geoff Cohen, John Forbes, Michael Garraway
Abstract
Objective - To examine the association between self reported limiting long term illness and other dimensions of self reported health.
Design - Stratified random sample of general population.
Setting - Lothian region, Scotland, in 1993.
Subjects - 6212 men and women aged 16 and over.
Main outcome measures - Limiting long term illness was assessed by the same question as used in the 1991 United Kingdom census. The short form 36 health survey was used to assess other dimensions of health.
Results - Rates of limiting long term illness were much higher than reported in the census. Scores on general and physical health scales had strong associations with limiting long term illness, but after adjustment for these associations psychosocial health measures had little influence on limiting long term illness. Being at the lower rather than the upper quartile on the physical functioning scale more than doubled the odds of having limiting long term illness. Reported prevalence of many common illnesses was between two and three times higher among those with limiting long term illness.
Conclusions - A positive response to the question used by the census to define limiting long term illness was strongly associated with physical limitations on activity and less strongly influenced by scores on scales of mental and social wellbeing. Socio-economic effects on limiting long term illness seem largely mediated through measures of general health and physical limitations on health.
Department of Public Health Sciences Medical School University of Edinburgh Edinburgh EH8 9AG Geoff Cohen lecturer in medical statistics John Forbes senior lecturer in health economics Michael Garraway professor of public health
Correspondence to: Mr Cohen.
Jennifer Dixon, Howard Glennerster
A tract
The general practice fundholding scheme was introduced four years ago. So far its impact has not been formally evaluated nationally, but review of published research shows some trends. Fundholding has curbed prescribing costs and given general practitioners greater power to lever improvements in hospital services - for example, reducing waiting times for hospital treatment - but fundholding practices may have received more money than non fundholding practices. The impact of fundholding on transactions costs, equity, and quality of care (particularly for patients of non-fundholding general practitioners) is unknown. Research into costly reforms such as fundholding needs to be coordinated.
Health Services Research Unit London School of Hygiene and Tropical Medicine London WC1E 7HT Jennifer Dixon senior registrar in public healthSuntory and Toyota International Centres for Economics and Related Disciplines London School of Economics and Political Science London WC2A 2AE Howar Glennerster professor of social administration
Correspondence to: Dr J Dixon, King's Fund Policy Institute, London W1M 0AN.