BMJ No. 7062 Volume 313 Saturday 12 October 1996
Design - Retrospective analysis using data from the Office of Population Censuses and Surveys (recoded to differentiate exomphalos and gastroschisis) and the National Congenital Malformation Notification Scheme.
Setting - England and Wales, 1987 to 1993.
Results - 1,043 congenital anterior abdominal wall defects were notified within the seven year study period. Of these, 539 were classified as gastroschisis, 448 as exomphalos, 19 as "prunebelly syndrome," and 37 as "unclassified." Gastroschisis doubled in incidence from 0.65 in 1987 to 1.35 per 10,000 total births in 1991, with little further change; the incidence of exomphalos decreased from 1.13 to 0.77 per 10,000 births. The overall incidence of notified congenital abdominal wall defects was 2.15 per 10,000 total births. Gastroschisis was associated with a lower overall maternal age thanexomphalos and with a significantly lower proportion of additional reported congenital malformations (5.0%) than in the cohort with exomphalos (27.4%) (odds ratio 0.14, 95% confidence interval 0.09 to 0.22; P<0.001). The sex ratio of the two cohorts was the same. The incidence of gastroschisis and exomphalos was higher in the northern regions of England than in the south east of the country.
Conclusions - The national congenital malformation notification system showed an increasing trend in the incidence of fetuses born with gastroschisis and a progressive decreasing incidence of exomphalos in England and Wales between 1987 and 1993. Although the reasons for this are likely to be multifactorial, a true differential change seems likely. The observed increase in incidence of gastroschisis relative to exomphalos and the differentiation in maternal age have implications for resource management within the NHS and warrant further epidemiological monitoring. Regional differences may be due to a dietary or environmental factor, which requires further study.
Division of Fetal Medicine,
Academic Department of Obstetrics,
University of Birmingham,
Birmingham B15 2TG
Kelvin H Tan, research registrar
Mark D Kilby, senior lecturer
Martin J Whittle, professor
Department of Fetal Medicine,
University of Wales Heath Park,
Cardiff CF 4 4XN
Bryan R Beattie, consultant
Institute of Child Health,
University of Birmingham
Ian W Booth, professor
Office for National Statistics,
London WC2B 6JP
Beverley J Botting, medical statistician
Correspondence to: Dr Kilby.
Design - Non-comparative prospective trial.
Setting - Urban Manila, the Philippines.
Subjects - 485 lower income, educated women with extensive experience of breast feeding.
Intervention - Women were offered all available contraceptives for use after birth. Those who chose the lactational amenorrhoea method were taught the method, screened for the study, and followed for 12 months to determine the risk of pregnancy when the method was used. Main outcome measures - Life table pregnancy rates during correct and incorrect use of the method, censored monthly in the event of sexual abstinence or the use of another contraceptive method.
Results - The lactational amenorrhoea method was 99% effective when used correctly (that is, during lactational amenorrhoea and full or nearly full breast feeding for up to six months). At 12 months the effectiveness during amenorrhoea dropped to 97%.
Conclusions - The lactational amenorrhoea method provided as much protection from pregnancy as non-breast feeding women experience with non-medicated intrauterine devices and barrier methods.The contraceptive effect of lactation cannot be attributed to lactational or postpartum abstinence.
Comprehensive Family Planning Center,
Jose Fabella Memorial Hospital,
Manila,
Philippines
Rebecca Ramos, director
Family Health International,
Research Triangle Park,
NC 27709,
USA
Kathy Irene Kennedy, principal research scientist
Cynthia M Visness, senior research analyst
Correspondence to: Dr K I Kennedy,
2201
South Fillmore Street,
Denver,
CO 80210,
USA
Design - Descriptive cohort study applying an innovative testing procedure to a nationwide systematic sample. The test sample received an unsolicited home visit and without warning were required to perform cardiopulmonary resuscitation on a manikin while being videoed. The videos were then analysed for effectiveness and safety using the new test.
Setting - Nine cities and surrounding areas in the United Kingdom.
Subjects - 280 people aged between 11 and 72.
Results - Thirty three (12%) trainees were able to perform effective cardiopulmonary resuscitation, but of these 14 (5%)performed one or more elements in a way that was deemed to be potentially injurious. Thus only 19 (7%) trainees were able at six months to provide safe cardiopulmonary resuscitation. In addition,large numbers of subjects failed to shout for help, effectively assess the status of the patient, or alert an ambulance. Significantly better performances were recorded by those under 45 years old (31 (14%) versus 2 (4%) gave effective performances respectively, P<0.05),those who had attended a subsequent cardiopulmonary resuscitation course (8 (40%) versus 25 (10%) gave effective performances respectively, P<0.0001), and those confident in their initial ability (26 (20%) versus 7 (6%) gave effective performances respectively, P<0.005). Females were significantly less likely than males to perform procedures in a harmful way (117 (62%) versus 10 (12%) performed safely respectively, P<0.005).
Conclusion - Television is an effective means of generating large training cohorts. Volunteers will cooperate with unsolicited testing in their home, such testing being a realistic simulation of the stress and lack of forewarning that would surround areal event. Under such conditions the performance of cardiopulmonary resuscitation was disappointing. However, retraining greatly improves performance.
Centre for Applied Public Health Medicine,
University of Wales College of Medicine,
Cardiff F1 8UL
C Ll Morgan, research officer
P D Donnelly, senior lecturer
C A Lester, research officer
D H Assar, project manager
Correspondence to: Dr Donnelly.
Design - Postal questionnaire survey using the psoriasis disability index and SF-36.
Setting - Five general practices in Cleveland.
Subjects - Of 767 patients identified, 546 completed the questionnaire and 435 were eligible and gave informed consent.
Main outcome measures - Scores on SF-36 and psoriasis disability index.
Results - The psoriasis disability index score was highly negatively correlated with all eight of the SF-36 health measures (P<0.0001 for each), and the manual social classes scored higher than the non-manual social classes (P<0.0001). The manual social class group scored significantly lower scores than the controls on all the SF-36 scales, and the non-manual group scored significantly lower for physical and mental role limitation (P<0.0004 and P = 0.026), mental health (P<0.0001), energy and vitality (P<0.0004), and health perception (P<0.0001). Also, the manual group had poorer health perception on five of the SF-36 variables when compared with the non-manual group.
Conclusions - Patients with psoriasis have an overall lower perception of their quality of life than healthy controls, and those in the lower social classes suffer a greater degree of disability from their disease than the higher social classes.
Norton Medical Centre,
Norton,
Stockton on Tees
TS2O 1AN
Patrick O'Neill, general practitioner
Centre for Health and
Medical Research,
University of Teeside,
Middlesbrough TS1 3BA
Peter Kelly, director
Correspondence to: Dr O'Neill.