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BMJ No 7102 Volume 315 Papers - Abstracts Saturday 26 July 1997
Contribution of deaths related to alcohol use to socioeconomic
variation in mortality: register based follow up study
Contribution of deaths related to alcohol use to socioeconomic variation in mortality: register based follow up studyPia Mäkelä, Tapani Valkonen, Tuija Martelin AbstractObjective: To estimate the contribution of excessive alcohol use to socioeconomic variation in mortality among men and women in Finland.Design: Register based follow up study. Subjects: The population covered by the 1985 and 1990 censuses, aged 20 and over in the follow up period 1987-93. Main outcome measures: Total mortality and alcohol related mortality from all causes, from diseases, and from accidents and violence according to socioeconomic position. The excess mortality among other classes compared with upper non-manual employees and differences in life expectancy between the classes were used to measure mortality differentials. Results: Alcohol related mortality constituted 11% of all mortality among men aged 20 and over and 2% among women and was higher among manual workers than among other classes. It accounted for 14% of the excess all cause mortality among manual workers over upper non-manual employees among men and 4% among women and for 24% and 9% of the differences in life expectancy, respectively. Half of the excess mortality from accidents and violence among male manual workers and 38% among female manual workers was accounted for by alcohol related deaths, whereas in diseases the role of alcohol was modest. The contribution of alcohol related deaths to relative mortality differentials weakened with age. Conclusions: Class differentials in alcohol related mortality are an important factor in the socioeconomic mortality differentials in Finland, especially among men, among younger age groups, and in mortality from accidents and violence. Population Research Unit, Correspondence to: Ms Mäkelä
Effect of cleansing the birth canal with antiseptic solution on maternal and newborn morbidity and mortality in Malawi: clinical trialTaha E Taha, Robert J Biggar, Robin L Broadhead, Laban A R Mtimavalye, Aafke B Justesen, George N Liomba, John D Chiphangwi, Paolo G Miotti AbstractObjective: To determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnatally.Design: Clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention. Setting: Queen Elizabeth Central Hospital (tertiary care urban hospital), Blantyre, Malawi. Subjects: A total of 6,965 women giving birth in a six month period and their 71,60 babies. Intervention: Manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery. Babies born during the intervention were also wiped with chlorhexidine. Main outcome measures: Effects of the intervention on neonatal and maternal morbidity and mortality. Results: 3,635 women giving birth to 3,743 babies were enrolled in the intervention phase and 3,330 women giving birth to 3,417 babies were enrolled in the non-intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. Among infants born in the intervention phase, overall neonatal admissions were reduced (634/3,743 (16.9%) v 661/3,417 (19.3%), P<0.01), as were admissions for neonatal sepsis (7.8 v 17.9 per 1,000 live births, P<0.0002), overall neonatal mortality (28.6 v 36.9 per 1,000 live births, P<0.06), and mortality due to infectious causes (2.4 v 7.3 per 1,000 live births, P<0.005). Among mothers receiving the intervention, admissions related to delivery were reduced (29.4 v 40.2 per 1,000 deliveries, P<0.02), as were admissions due to postpartum infections (1.7 v 5.1 per 1,000 deliveries, P=0.02) and duration of hospitalisation (Wilcoxon P=0.008). Conclusions: Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems. The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortality. Infectious Diseases Programme, Viral Epidemiology Branch, College of
Medicine, Correspondence to: Dr Taha.
Bone density and risk of hip fracture in men and women: cross sectional analysisChris E D H De Laet, Ben A van Hout, Huibert Burger, Albert Hofman, Huibert A P Pols AbstractObjective: To determine the relative contribution of decline in bone density to the increase in risk of hip fracture with age in men and women.Design: Incidence data of hip fracture from the general population were combined with the bone density distribution in a sample from the same population and with a risk estimate of low bone density known from literature. Setting: The Netherlands.
Main outcome measure: One year cumulative risk of hip fracture by age, sex, and bone density measured at the femoral neck. Results: A quarter of all hip fractures occurred in men. Men reached the same incidence as women at five years older. Controlled for age, the risk of hip fracture by bone density was similar in men and women. The risk of hip fracture increased 13-fold from age 60 to 80; decrease in bone density associated with age contributed 1.9 (95% confidence interval 1.5 to 2.4) in women and 1.6 (1.3 to 1.8) in men. Conclusions: The risk of hip fracture by age and bone density is similar in men and women. The decrease in bone density associated with age makes a limited contribution to the exponential increase of the risk of hip fracture with age. Department of Epidemiology and Biostatistics, Institute for Medical Technology Assessment, Department
of Internal Medicine III, Correspondence to: Dr Pols.
Comparison of two methods of screening for genital chlamydial infection in women attending in general practice: cross sectional surveyLucia Grun, Julia Tassano-Smith, Caroline Carder, Anne M Johnson, Angela Robinson, Elizabeth Murray, Judith Stephenson, Andrew Haines, Andrew Copas, Geoffrey Ridgway AbstractObjectives: To estimate the prevalence of Chlamydia trachomatis in asymptomatic women attending general practice; to assess the potential of the ligase chain reaction as a screening tool; and to evaluate selective screening criteria.Design: Cross sectional survey. Setting: Four general practices in northeast London. Subjects: 890 women aged 18-35 years attending general practice for a cervical smear or a "young well woman" check between October 1994 and January 1996. The women were tested for C trachomatis with confirmed enzyme immunoassay (endocervical specimens) and ligase chain reaction assay on urine specimens. Main outcome measures: Prevalence of C trachomatis infection in women aged 18-35 on the basis of each test; sensitivity and specificity of both tests in this population. Results: Prevalence of confirmed infection was 2.6% (95% confidence interval 1.6% to 3.6%) in all women. Prevalence on the basis of enzyme immunoassay was 1.6% (0.8% to 2.7%), with a sensitivity of 60% and a specificity of 100%. Prevalence on the basis of ligase chain reaction was 2.5% (1.5% to 3.9%), with 90% sensitivity and 99.8% specificity. Screening all women aged 25 and under and all women who had had two or more partners in the past year would have detected 87% (20/23) of infections. Conclusion: Ligase chain reaction on urine samples performs at least as well as enzyme immunoassay on cervical specimens in this low prevalence population. It offers potential as a non-invasive screening tool. A simple selective screening strategy might be appropriate and would be able to detect most cases of infection. However, a rigorous economic evaluation of possible screening strategies is needed first.
Department of Sexually Transmitted Diseases, Joint Department of Primary
Care and Population Sciences, Department of
Microbiology, Correspondence to: Dr Grun.
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