BMJ No. 7050 Volume 313 Saturday 20 July 1996
Abstract
Objective - To re-examine the prevailing hypothesis that women fare worse than men after acute myocardial infarction. Design - 10 year follow up of all patients with confirmed acute myocardial infarction registered in the database of the Danish verapamil infarction trial in 1979-81.
Setting - 16 coronary care units, covering a fifth of the total Danish population.
Patients - 3073 consecutive patients with acute myocardial infarction, 738 (24%) women and 2335 (76%) men.
Main outcome measures - Early mortality (before day 15). For patients alive on day 15: mortality, cause of death, admission with recurrent infarction, and mortality after reinfarction.
Results - Early mortality increased significantly with age (P\h0.0001) but was not significantly related to sex, with a 15 day mortality of 17% in women and 16% in men. Adjustment for age and sex simultaneously revealed a significant interaction (P=0.02) between these variables, with a greater increase with age in early mortality for men than for women (early mortality was equal for the two sexes at age 64 years). Ten year mortality in patients alive on day 15 was 58.8%. The overall age adjusted hazard ratio (95% confidence interval) for women versus men was 0.90 (0.80 to 1.01); 0.90 (0.78 to 1.04) for 10 year reinfarction (48.8%); and 0.98 (0.82 to 1.16) for 10 year mortality after reinfarction (82.3%). No difference in cause of death was found between the sexes. With a follow up of up to 10 years for patients alive on day 15 mortality, rate of reinfarction, and mortality after reinfarction increased with increasing age (P\h0.0001).
Conclusion - Sex by itself is not a risk factor after acute myocardial infarction.
Department of Cardiology B,
National University Hospital,
Rigshospitalet,
Blegdamsvej 9,
DK-2100
Copenhagen,
Denmark
S Galatius-Jensen, registrar
J Launbjerg, senior registrar
Danish Computing Centre for Research and Education,
Aarhus,
Denmark
L Spange Mortensen, statistician
Department of Cardiology,
University Hospital,
Hvidovre,
Denmark
J Fischer Hansen, head of department of cardiology
Correspondence and requests for reprints to: Dr Galatius-Jensen.
Abstract
Objective - To assess the efficacy of a single dose of oral dexamethasone 0.15 mg/kg in children with mild croup not admitted to hospital.
Design - Double blind, randomised, placebo controlled clinical trial.
Setting - The emergency department of a tertiary paediatric hospital.
Subjects - 100 children aged 4-122 months presenting with mild croup.
Intervention - A single oral dose of dexamethasone 0.15 mg/kg or placebo.
Main outcome measure - Return to medical care with ongoing croup.
Results - Baseline characteristics of the two treatment groups were similar. Eight children (all from the placebo group) returned to medical care with ongoing croup, one being admitted. There was no reported difference in duration of croup symptoms, duration of viral symptoms, or rate of return to medical care for other reasons.
Conclusion - Oral dexamethasone in a dose of 0.15 mg/kg is effective in reducing return to medical care with ongoing croup in children with mild croup.
Emergency Department,
Princess Margaret Hospital for Children,
Box D184,
GPO, Perth,
WA 6001,
Australia
G C Geelhoed, department director
J Turner, registrar
W B G Macdonald, consultant
Correspondence to:Dr Geelhoed.
Abstract
Objectives - To evaluate the nature, prevalence, and severity of chronic memory deficit in patients resuscitated after cardiac arrest outside hospital and to determine whether such deficits are related to duration of cardiac arrest.
Design - Case-control study.
Subjects - 35 survivors of cardiac arrest outside hospital and 35 controls matched for age and sex who had had acute myocardial infarction without cardiac arrest.
Main outcome measures - Subjects assessed at least two months after index event for affective state (hospital anxiety and depression scale), premorbid intelligence (national adult reading test), short term recall (digit recall test), and episodic long term memory (Rivermead behavioural memory test).
Results - Cases and controls showed no difference in short term recall. Cases scored lower on Rivermead test than controls (mean (SD) score out of 24 points: 17.4 (5.4) v
Conclusions - Clinically important impairment of memory was common after cardiac arrest outside hospital. Improvement in response times of emergency services could reduce the severity of such deficits. With an increasing numbers of people expected to survive cardiac arrest outside hospital, rehabilitation of those with memory deficit merits specific attention.
Cardiovascular Research Unit,
Neil R Grubb, lecturer in cardiology
MRC Brain Metabolism Unit,
Ronan E O'Carroll,
senior scientist
Department of Medical Cardiology,
Stuart M Cobbe, Walton professor of cardiology
Correspondence to: Dr N R Grubb,
Department of Cardiology,
Abstract
Objective - To examine the extent to which the prescription of drugs for asthma adhered to recommended guidelines in 1990-1 and to assess the influence of ethnic group on prescription.
Design - Cross sectional.
Setting - Primary schools in England and Scotland in 1990-1.
Subjects - Children aged mainly 5-11 years. The representative samples included 10,628 children. The inner city sample included 7,049 children, 4,866 (69%) from ethnic minority groups. For the prevalence estimation 14,490 children were included in the analysis (82% of the eligible children). For the treatment analysis a subgroup of 5,494 children with respiratory symptoms was selected.
Main outcome measures - Prevalence of respiratory symptoms and drugs commonly prescribed for asthma, method of administration, inappropriate treatment, and odds ratios to assess the effect of ethnic group on rate of prescription and method of administration.
Results - Children with respiratory symptoms in the inner city sample were less likely to be diagnosed as having asthma. Of children with reported asthma attacks, those in inner city areas had a higher risk of not having been prescribed any drug for asthma (odds ratio 1.87 (95% confidence interval 1.26 to 2.77). Overall, 773 (75%) of these children had received a Beta-2 agonist, 259 (25%) had received steroids, 148 (14%) had received sodium cromoglycate, and 194 (19%) had received no drug treatment in the previous year. When prescribed, Beta-2 agonists were inhaled in 534 (69%) of cases, and this percentage was even lower in ethnic minority groups. Children of Afro-Caribbean and Indian subcontinent origin who had asthma were less likely to receive Beta-2 agonists, and those from the Indian subcontinent were less likely to receive anti-inflammatory drugs. Antibiotics were less prescribed and antitussives more prescribed in children from ethnic minority groups than in white children.
Conclusion - In 1990-1 the risk of underdiagnosis and undertreatment of asthma was higher in children from ethnic minority groups. The implementation of indicators and targets to monitor inequalities in the treatment of asthma in ethnic groups could improve equity and effectiveness in the NHS.
Department of Public Health Medicine,
Enric Duran-Tauleria, lecturer in public health medicine
University of Edinburgh,
Edinburgh
Keith A A Fox, Duke of Edinburgh professor of cardiology
Royal Edinburgh Hospital,
Edinburgh
Glasgow Royal Infirmary,
Glasgow
Jane Sirel, research assistant
Royal Infirmary of Edinburgh,
Edinburgh EH3 9YW.
Influence of ethnic group on asthma treatment in children in 1990-1: national cross sectional study
Enric Duran-Tauleria, Roberto J Rona, Susan Chinn, Peter Burney
United Medical and Dental Schools of Guy's and St Thomas's Hospitals,
St Thomas's Hospital,
London SE1 7EH
Roberto J Rena, reader in public health medicine
Susan Chinn, reader in medical statistics
Peter Burney, professor of public health medicine
Correspondence to:
Dr Duran-Tauleria.