This week in the BMJ

Effect of lifetime socioeconomic position on mortality varies with cause of death

Numerous studies have shown that mortality varies with socioeconomic circumstances. The specific influences of socioeconomic factors in early life, however, have been little investigated. On p 1631 Davey Smith et al show that adverse socioeconomic conditions in childhood are strongly related to the risk of mortality from stroke and stomach cancer in later adulthood. Socioeconomic factors in childhood also contribute to mortality from coronary heart disease and respiratory disease in adulthood. Mortality from lung cancer, other cancer, and accidents and violence is predominantly influenced by risk factors that are related to social circumstances in adulthood. The authors also suggest that the increasing child poverty seen in Britain and elsewhere over the past 20 years may herald unfavourable future trends in adult health.   

Socioeconomic inequalities for specific diseases show north-south gradient in Europe

Socioeconomic inequalities in mortality are common to all countries of western Europe. Most studies seeking to determine whether these inequalities are larger in some countries than in others have focused on total mortality, but on p 1636 Kunst et al present data for specific causes of death. They found a north-south gradient that showed large inequalities in mortality from ischaemic heart disease in England and Wales, Ireland, and Nordic countries, and large inequalities in cancers other than lung cancer and in gastrointestinal diseases in France, Switzerland, and Mediterranean countries. These variations indicate differences between countries in the contribution that risk factors for specific diseases, like smoking and alcohol consumption, make to inequalities in total mortality.   

Untreated visual impairment is common in elderly people

Data on the prevalence of eye disease in Britain are scarce, but on p 1643 Reidy et al report results of a study of over 1500 people aged 65 years or more in north London. Bilateral cataracts impaired vision in nearly a third of those examined yet was not listed for treatment. In many people, impaired vision in both eyes could be treated with correct spectacles.

Outpatients like being followed up by telephone

Patients attending rheumatology outpatient clinics have said that they would be willing to be followed up by telephone. To test this in practice Pal identified 173 suitable patients from a rheumatology clinic. All but three agreed to telephone follow up at their next review (p 1647). During the telephone call their progress was discussed, along with any changes in the condition or treatment, any results, and advice on management. Calls averaged 3.5 minutes (range 1-15). Decisions made at the telephone follow up were not revised later except in two cases. Twenty patients could not be contacted at the arranged time; they were phoned later or sent an appointment. Patients were positive about the service (90% satisfied or very satisfied).

Cost effectiveness should count in choosing a strategy for eradicating Helicobacter pylori

The value of eradicating Helicobacter pylori in duodenal ulcer disease is well established. On p 1648 Duggan et al used decision analysis to investigate how small differences in efficacy and cost of antibiotic regimens can affect the overall cost effectiveness of strategies for eradicating H pylori. For uncomplicated duodenal ulcer disease the most cost effective strategy of omeprazole, clarithromycin, and metronidazole was neither the least expensive nor the most effective strategy tested.

Clinical information system based on the individual patient

The UK Audit Commission has urged that healthcare computing should be based on systems centred on individual patients. Simpson and Gordon (p 1655) describe such a system in use at Glasgow Royal Infirmary. It is based on an underlying flexible software package which has been designed so that it can be adapted for any clinical department. In the department of nephrology it has superseded paper records and has been successfully expanded to deal with administration. The system was developed over several years, avoiding the well known hazards of a rigid initial specification. The use of a generic approach could form the basis of a comprehensive, integrated electronic patient record.