BMJ NO 7080 Volume 314 Saturday 22 February 1997

This Week in BMJ | Editor's Choice | Press releases | Advertisement details

Editorials

529 Working together to reduce poverty's damage Andrew Haines, Richard Smith

531 The endothelin system in cardiovascular disease David E Newby, David J Webb

532 The medical health emergency card L P Weston, L A Lawson

533 Screening could seriously damage your health Sarah Stewart-Brown, Andrew Farmer

534 Clinical information systems and the year 2000 M F Smith

News

535 Network planned to help asylum seekers * Sri Lankan asylum seekers at risk * Nazi anatomy book to be investigated * Row over UK primary care bill * Poor education linked with teen pregnancy * Guidance on persistent vegetative state broken * Dutch tighten up embryo storage rules * Israeli court overturns IVF regulations * Ethnic groups get poor cancer care in UK * Battle over diagnosis of Palestinian prisoners * Canada proposes tough antitobacco laws * Mobile phones can cause accidents * Medical supplies airlifted to Afghanistan * European food policy analysed

Papers

541 Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register Caroline Morrison, Mark Woodward, Wilma Leslie, Hugh Tunstall-Pedoe

547 Lifetime socioeconomic position and mortality: prospective observational study George Davey Smith, Carole Hart, David Blane, Charles Gillis, Victor Hawthorne

553 Interaction of workplace demands and cardiovascular reactivity in progression of carotid atherosclerosis: population based study Susan A Everson, John W Lynch, Margaret A Chesney, George A Kaplan, Debbie E Goldberg, Starley B Shade, Richard D Cohen, Riitta Salonen, Jukka T Salonen

558 Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study Hans Bosma, Michael G Marmot, Harry Hemingway, Amanda C Nicholson, Eric Brunner, Stephen A Stansfeld

565 Randomised double blind controlled study of recurrence of gastric ulcer after treatment for eradication of Helicobacter pylori infection A T R Axon, C A Ó'Moráin, K D Bardhan, J P Crowe, A D Beattie, R P H Thompson, P M Smith, F D Hollanders, J H Baron, D A F Lynch, M F Dixon, D S Tompkins, H Birrell, K R W Gillon

569 Controlled trial of weight bearing exercise in older women in relation to bone density and falls Marion E T McMurdo, Patricia A Mole, Colin R Paterson

General Practice

570 An economic evaluation of thrombolysis in a remote rural community Luke Vale, Jonathan Silcock, John Rawles

572 Statistics notes: Cronbach's alpha J Martin Bland, Douglas G Altman

Information in practice

573 Smart cards - the key to trustworthy health information systems Roderick Neame

578 Netlines Mark Pallen

Clinical review

579 Recent advances: HIV infection - II Claire Beiser

583 Grand Round - University Hospital of Wales, Cardiff: Pyrexia of unknown origin Richard H Evans

587 ABC of clinical haematology: Polycythaemia, primary (essential) thrombocythaemia and myelofibrosis Maria Messinezy, T C Pearson

Education and debate

591 Socioeconomic determinants of health: Health inequalities: relative or absolute material standards? Richard G Wilkinson

595 Primary care: opportunities and threats: An opportunity to improve primary care Mike Pringle

598 Threat to social justice Iona Heath

Letters

600 Replacement therapy should be offered to adults with severe growth hormone deficiency Stephen Shalet

600 Interferon beta in multiple sclerosis A Burnfield; C Price; J C Napier; J Holmes; G Winyard; P Cardy; J Peltola and T Keranen

602 New antiepileptic drugs M J Brodie; A J A Elferink and B J Van Zwieten-Boot; J J Craig and J I Morrow; I C Wong

604 Report of research assessment exercise should have focused on British medical schools K Peters

604 Newly licensed drugs L Smeeth; J Hippisley-Cox; J A G Paris; R Tiner

605 Peak expiratory flow is a prognostic indicator in elderly people R Tilvis and others

606 Active management of labour P Boylan; R Buist

607 Litigation in obstetrics and gynaecology has increased in Merseyside B Alderman

607 Pilot trial of integrating pharmacy into primary care in rural areas is needed S Ford

607 Those who believe in alternative theories of AIDS have little room for manoeuvre S W G Derbyshire

608 Causality, the menopause, and depression M Petticrew; L Nicol-Smith

608 New guidelines on managing back pain are similar to previous ones J Campbell

608 General practitioners have always been the A-Team A Nimmo

Obituaries

609 E Hare, D McLarty, P E C Manson-Bahr, M O'Sullivan, R W T Mason, D R L Newton, I R Smith, K A Tomlinson, J R Wilkie

Medicopolitical digest

611 Police bill amended * Multiprofessional working * Nurse prescribing * Defence medical services * Review of prescribing

Views & reviews

Personal views

612 Alternative options George Dunea

A retiring sort of chap Ron Mulroy

A transatlantic brush with the law Karen Cranfield

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Medicine and the media

614 Michael Farrell

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Medicine and books

615 Sustainability, the Environment and Urbanization
Ed Cedric Pugh
Paul Garner

Evidence-based health care
J A Muir Gray
Liam J Donaldson

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Minerva

616

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S2 Career Focus (Classified supplement)

Moving into management Dr Jenny Simpson

Editor's choice

Poverty and equity matter

As the cover suggests, the theme of this week's BMJ is poverty; specifically, socieconomic deprivation and its relationship to health. Richard Wilkinson - the main proponent of the hypothesis that in developed countries mortality is affected more by relative than absolute living standards - outlines the arguments on p 591, while in their editorial Andy Haines and Richard Smith urge doctors to play their part by prodding governments and international agencies to take poverty - and equity - seriously (p 529).

Four research papers also address the issue directly or indirectly. Morrison and colleagues show how the number of coronary events in a population of 25-64 year olds in poor area of Glasgow increased with age and increasing social deprivation (p 541). Those from the most socially deprived areas had higher overall case fatality rates and were less likely to reach hospital alive - though once they were there no social class variation in case fatality was apparent.

People in low paid jobs often suffer more stress than those in seemingly more high powered and better paid jobs - because they lack control over their work. On p 553 Susan Everson and colleagues show in a Finnish population how men with high workplace demands and blood pressure reactivity to stress had 10-40% greater progression of carotid atherosclerosis than men who showed less reactivity and had fewer job demands. Similarly, an analysis by Hans Bosma and colleagues of British civil servants (p 558) shows how low job control (itself associated with low job grade) is associated with an increased risk of future coronary heart disease. George Davey Smith and colleagues assessed the influence of socioeconomic position over a lifetime on risk factors for cardiovascular disease, morbidity, and mortality (p 547). Among almost 6000 men in Scotland they found that those born to fathers with manual jobs who started their working life in manual jobs and remained in them had an age adjusted relative death rate 70% higher than those who were born to fathers with non-manual jobs and themselves worked in non-manual jobs.

The issue of equity is also the subject of this week's article in our primary care series, in which Mike Pringle and Iona Health argue about how well primary care can serve deprived communities (p 595). George Dunea meanwhile offers a characteristically different perspective on primary care: American graduates, he points out, emerge with an excellent foundation in biological sciences, to confront patients who also hold science in high regard, "many having consulted books on ... firewalking, poltergeists, and better ways of communciating with angels." They'd better read J A Muir Gray's book on evidence based health care (p 615), which manages to quote both Archie Cochrane and the Hitch Hiker's Guide to the Galaxy