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BMJ No 7099 Volume 315 Papers - Abstracts Saturday 5 July 1997
Dietary pattern and 20 year mortality in elderly men in Finland,
Italy, and the Netherlands: longitudinal cohort study
Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort studyPatricia Huijbregts, Edith Feskens, Leena Räsänen,
Flaminio Fidanza, Aulikki Nissinen, Design: Cohort study with 20 years' follow up of
mortality.
Setting: Five cohorts in Finland, the Netherlands,
and Italy.
Subjects: Population based random sample of 3045 men
aged 50-70 years in 1970.
Main outcome measures: Food intake was estimated
using a cross check dietary history. In this dietary survey method, the
usual food consumption pattern in the 6-12 months is estimated. A
healthy diet indicator was calculated for the dietary pattern, using
the World Health Organisation's guidelines for the prevention of
chronic diseases. Vital status was verified after 20 years of follow
up, and death rates were calculated.
Results: Dietary intake varied greatly in 1970
between the three countries. In Finland and the Netherlands the intake
of saturated fatty acids and cholesterol was high and the intake of
alcohol was low; in Italy the opposite was observed. In total 1796 men
(59%) died during 20 years of follow up. The healthy diet indicator
was inversely associated with mortality (P for trend <0.05). After
adjustment for age, smoking, and alcohol consumption, the relative risk
in the group with the healthiest diet indicator compared with the group
with the least healthy was 0.87 (95% confidence interval 0.77 to
0.98). Estimated relative risks were essentially similar within each
country.
Conclusions: Dietary intake of men aged 50-70 is
associated with a 20 year, all cause mortality in different cultures.
The healthy diet indicator is useful in evaluating the relation of
mortality to dietary patterns.
Department of Chronic Diseases and
Environmental Epidemiology, Division of Nutrition, Institute of Food Sciences
and Nutrition, Department of Community Health and General Practice, Division of Epidemiology,
Correspondence to: Ms
Huijbregts.
Geert J M G van der Heijden, Daniëlle A W M
van der Windt, Andrea F de
Winter
Design: A systematic computerised
literature search of Medline and Embase, supplemented with citation
tracking, for relevant trials with random allocation published before
1996.
Subjects: Patients treated with
physiotherapy for disorders of soft tissue of the shoulder.
Main outcome measures: Success
rates, mobility, pain, functional status.
Results: Six of the 20 assessed
trials satisfied at least five of eight validity criteria. Assessment
of methods was often hampered by insufficient information on various
validity criteria, and trials were often flawed by lack of blinding,
high proportions of withdrawals from treatment, and high proportions of
missing values. Trial sizes were small: only six trials included
intervention groups of more than 25 patients. Ultrasound therapy,
evaluated in six trials, was not shown to be effective. Four other
trials favoured physiotherapy (laser therapy or manipulation), but the
validity of their methods was unsatisfactory.
Conclusions: There is evidence that
ultrasound therapy is ineffective in the treatment of soft tissue
shoulder disorders. Due to small trial sizes and unsatisfactory
methods, evidence for the effectiveness of other methods of
physiotherapy is inconclusive. For all methods of treatment, trials
were too heterogeneous with respect to included patients, index and
reference treatments, and follow up to merit valid statistical pooling.
Future studies should show whether physiotherapy is superior to
treatment with drugs, steroid injections, or a wait and see
policy.
Institute for Rehabilitation
Research, Institute for Research in Extramural
Medicine,
Correspondence to: Dr van der
Heijden.
Christopher Everett
Design: Two year prospective community study.
Setting: Women registered with four semirural
practices at one health centre.
Subjects: 626 pregnant women from a population
21,448, 5,140 of whom were women aged 15-44 years.
Main outcome measures: Vaginal bleeding and outcome
of pregnancy.
Results: 76 of the 89 women with an unwanted
pregnancy requested a termination. In the 550 ongoing pregnancies
bleeding occurred before the 20th week in 117 (21%), and 67 (12%)
ended in miscarriage. The risk of miscarriage was not significantly
increased after a miscarriage in the previous pregnancy (11 (15%)
women had miscarriage v 55 (12%) women who had not had
miscarriage) who had previously had a live birth). Of the 117 women
with bleeding, 64 were not admitted to hospital by the general
practitioner; 42 of these women had an ultrasound examination at the
health centre and 19 subsequently miscarried at home. In hospital 41 of
46 women who miscarried had evacuation of the uterus.
Conclusions: Bleeding occurred in one fifth of
recognised pregnancies before the 20th week and over half of these
miscarried. Treatment of women with miscarriage at home means current
statistics on miscarriage in Britain are missing many cases.
Alton Health Centre,
Correspondence to: Church Cottage,
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