Thames Regions Accident and Emergency Trainees Association, A Craig Davidson, Jean Emberlin, Adrian D Cook, Katherine M Venables
Abstract
Objective - To investigate the time course of an epidemic of asthma after a thunderstorm, characteristics of patients affected, and the demand on emergency medical resources.
Design - Study of registers and records in accident and emergency departments and questionnaire to staff.
Setting - London area.
Subjects - All patients presenting at 12 accident and emergency departments with
asthma or other airways disease.
Results - The epidemic had a sudden onset on 24 June 1994; 640 patients with
asthma or other airways disease attended during 30 hours from 1800 on 24 June,
nearly 10 times the expected number. Over half (365) the patients were aged 21 to
40 years. A history of hay fever was recorded in 403 patients; for 283 patients
this was the first known attack of asthma; a history of chronic obstructive
airways disease was recorded in 12 patients. In all, 104 patients were admitted
(including five to an intensive care unit). Several departments ran out of
equipment or drugs, called in additional doctors, or both.
Conclusions - This study supports the view that this epidemic was larger than
previously reported epidemics and the hypothesis that "thunderstorm associated
asthma" is related to aeroallergens. Demands on resources were considerable; a
larger proportion of patients needing intensive care would have caused greater
problems.
Thames Regions Accident and Emergency Trainees Association
Daniel N Wallis senior registrar
Julian Webb registrar
Duncan Brooke registrar
Beata Brookes registrar
Ruth Brown senior registrar
Alice Findlay senior registrar
Miriam Harris registrar
Diana Hulbert registrar
George Little registrar
Cindy Nonoo senior house officer
Charles O'Donnell registrar
Gillian Park senior registrar
Akbar Soorma registrar
Newham General Hospital
London
A Craig Davidson consultant physician
Pollen Research Unit
Worcester WR2 6AJ
Jean Emberlin director
Department of Occupational and Environmental Medicine
National Heart and Lung Institute
London SW3 6LR
Adrian D Cook statistician
Katherine M Venables consultant senior lecturer in epidemiology Correspondence to: Dr D Wallis, Accident and Emergency Department, Newham Genera]
Hospital, London E13 8RU.
Thunderstorm associated asthma: a detailed analysis of environmental factors
Antonio Celenza, Jane Fothergill, Emil Kupek, Rory J Shaw
Abstract
Objectives - To seek associations between meteorological factors, concentrations
of air pollutants or pollen, and an asthma epidemic which occurred in London on
24 and 25 June 1994 after a thunderstorm.
Design - Retrospective study of patients' accident and emergency department
records, with bivariate and multivariate analysis of environmental factors and
data collection for the two months surrounding the epidemic.
Setting - The accident and emergency department of St Mary's Hospital in west
central London.
Subjects - 148 patients presenting with asthma between 1 June and 31 July 1994,
of whom 40 presented in the 24 hours after the storm.
Results - The asthma epidemic was significantly associated with a drop in air
temperature six hours previously and a high grass pollen concentration nine hours
previously. Non - epidemic asthma was significantly associated with lightning
strikes, increase in humidity or sulphur dioxide concentration, a drop in
temperature or high rainfall the previous day, and a decrease in maximum air
pressure or changes in grass pollen counts over the previous two days.
Conclusion - New episodes of asthma during the epidemic on 24 and 25 June 1994
were associated with a fall in air temperature and a rise in grass pollen
concentration. Non - epidemic asthma was significantly associated with a greater
number of environmental changes. This may indicate that the patients with
thunderstorm associated asthma were a separate population, sensitive to different
environmental stimuli.
Correspondence to: Dr Fothergill.
Cognitive impairment and mortality in a cohort of elderly people
Catharine R Gale, Christopher N Martyn, Cyrus Cooper
Abstract
Objectives - To investigate the relation between cognitive function and cause
specific mortality in people aged 65 and over.
Design - A 20 year follow up study of a cohort of randomly selected elderly
people living in the community who in 1973 - 4 had taken part in a nutritional
survey funded by the Department of Health and Social Security.
Setting - Eight areas in Britain (five in England, two in Scotland, and one in
Wales).
Subjects - 921 men and women whose cognitive function was assessed by a
geriatrician in 1973 - 4 and for whom data on health, socioeconomic
circumstances, and diet had been recorded.
Results - Cognitive impairment was associated with increased mortality, in
particular death from ischaemic stroke. Those who scored 7 or less on the
Hodkinson mental test had a relative risk of dying from stroke of 2.8 (95%
confidence interval 1.4 to 5.5), compared with those who gained the maximum score
(10), after adjustment for age, sex, blood pressure, serum cholesterol
concentration, and vitamin C intake. These associations were independent of
illness or social class. At the time of the nutritional survey, cognitive
function was poorest in those with the lowest vitamin C status, whether measured
by dietary intake or plasma ascorbic acid concentration. The relation between
vitamin C status and cognitive function was independent of age, illness, social
class, or other dietary variables.
Conclusion - The relation between cognitive function and risk of death from
stroke suggests that cerebrovascular disease is an important cause of declining
cognitive function. Vitamin C status may be a determinant of cognitive function
in elderly people through its effect on atherogenesis. A high vitamin C intake
may protect against both cognitive impairment and cerebrovascular disease.
Correspondence to: Dr Martyn.
J Atri, M Falshaw, A Livingstone, I Robson for Healthy Eastenders Project
Abstract
Objective - To describe the association of ethnic and socioeconomic status with
recording of preventive care information by selected general practitioners.
Design - Random selection of people aged 20 - 64 registered with 43 general
practitioners. Ethnic and social characteristics of stratified samples were
determined at interview in the subject's home. Recording of preventive
information was ascertained from general practitioners' medical records.
Setting - Inner London borough of Tower Hamlets.
Subjects - 505 out of 739 people confirmed as resident at their home address (190
white, 86 black, 112 Bangladeshi, 105 Chinese or Vietnamese, 12 other).
Main outcome measures - Socioeconomic characteristics, consultation with general
practitioner, and recorded preventive activities for ethnic groups.
Results - Minority ethnic groups were considerably more disadvantaged than white
people and five times more likely to be overcrowded (31% v 6%), three times less
likely to own their own home (11% v 37%), twice as likely to be in social classes
IV and V (54% v 28%) and less likely to be employed (34% v 63%). There were no
significant differences between white, black, Bangladeshi, and Chinese or
Vietnamese subjects in recording of smoking, blood pressure, alcohol consumption,
weight, and height in the general practitioners' medical records. White women
were more likely to have a record of mammography (46% v 20%; P equal to 0.03) and
of cervical smears than women in minority ethnic groups.
Conclusion - Despite major socioeconomic inequity, equitable recording of
preventive activity for the major causes of death for white, black and
Bangladeshi populations is possible. Chinese and Vietnamese people had lower
levels of recording and consultation. Mammography and, to a lesser extent,
cervical cytology are inequitably recorded and require additional support at
practice level.
Health Eastenders Project
Department of General Practice and Primary Care
Medical Colleges of St Bartholomew's and the London Hospitals
Queen Mary and Westfield College
London El 4NS
J Atri researcher
M Falshaw researcher
A Livingstone general practitioner
J Robson project manager
Department of Medical Statistics
London Hospital Medical College at Queen Mary
and Westfield College
London El 4NS
F Pereira statistician Correspondence to: Dr Robson.
Members of the steering group: M Ahmed, J Atri, G Chappell, M Falshaw, J Gray, J
Law, A Livingstone, S Nair, I Richardson, J Robson, B Selli, S Shanmugadasan.
St Mary's Hospital
London W2 1NY
Antonio Celenza registrar in accident and emergency medicine
Jane Fothergill consultant in accident and emergency medicine
Emil Kupek research assistant in statistics
Rory J Shaw consultant respiratory physician
MRC Environmental Epidemiology Unit
University of Southampton
Southampton General Hospital
Southampton SO16 6YD
Catharine R Gale research student
Christopher N Martyn clinical scientist
Cyrus Cooper clinical scientist