Relationship of blood lead in women and children to domestic water lead.
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Biomedical subjects
Publications and source records attributed to A S St Leger.
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Deaths from ischaemic heart-disease in 18 developed countries are not strongly associated with health-service factors such as doctor and nurse density. There is a negative association with gross national product per capita and a positive but inconsistent association with saturated and monounsaturated fat intake. The principal finding is a strong and specific negative association between ischaemic heart-disease deaths and alcohol consumption. This is shown to be wholly attributable to wine consumption.
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A study to determine the prevalence of urinary incontinence in a random sample of a total elderly community is described. The prevalence of incontinence in women aged 65 years or more was found to be 17% and in men 11%. The findings show that the prevalence of incontinence is particularly high among residents of old people's homes and geriatric hospitals, but that the majority of cases occur within the general community. The prevalence increases with age in both sexes; associations with a history of cerebrovascular disease, certain surgical procedures, multiple hospital admissions and drug usage are described. The findings of a follow-up study suggest that, although the disorder is long-standing and severe in a proportion of subjects, it is transient in approximately a third of all elderly subjects with the condition.
Plasma vitamin C, total and high density lipoprotein (HDL) cholesterol and cortisol levels were measured in a random sample of 337 elderly subjects living at home in S. Wales; measurements of relative body weight and information about fruit intake, smoking habits and symptoms of cardiovascular disease were also collected. There was a sex difference, over all age groups, in plasma vitamin C and in total HDL cholesterol levels. Plasma vitamin C was strongly correlated with fruit intake in both sexes. Both HDL cholesterol and low and very density lipoprotein (LDL + VLDL) cholesterol levels tended to increase with increasing plasma vitamin C but this reached significance only for the LDL + VLDL fraction. In addition, HDL cholesterol was negatively correlated with Quetelet's index in the women. Symptoms and medication for heart disease did not correlate significantly with plasma vitamin C or with HDL cholesterol levels, but reported angina showed a weak positive association with total cholesterol in the men, and there was some evidence of increased cortisol levels in subjects with heart disease.
If an environmental agent is strongly associated with only one disease then that is greater evidence in favour of a casual relationship than if that agent were also strongly associated with other unrelated diseases. Standard regression and correlation analysis are shown to be incapable of answering questions about disease specificity. A simple index, based upon regression, is proposed. The standardised regression coefficients in a regression equation based on the logistic transformation of a death rate are shown to have a particularly simple interpretation in terms of our index. The work is illustrated on an example drawn from the controversy concerning the association between area differences in ischaemic heart disease mortality and water hardness.
Two hundred and fourteen children aged 7-11 years had tests of lung function performed. Mothers were asked about their past and current smoking habits and whether their children had ever had pneumonia or severe bronchitis. The findings suggest a relationship between early childhood bronchitis or pneumonia and impairment of lung function in later childhood and also suggest that maternal smoking habit may contribute directly to impairment of lung function in children.
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The relationship between age-specific mortality rates and some indices of health facilities and some environmental and dietary factors has been studied in 18 developed couuntries. The indices of health care are not negatively associated with mortality, and there is a marked positive association between the prevalence of doctors and mortality in the younger age groups. No explanation of this doctor anomaly has so far been found. Gross national product per head is the principal variable which shows a consistently strong negative association with mortality.
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To explain the associations of water hardness and air temperature with area differences in ischaemic heart disease mortality, samples of tap water were obtained from homes in 61 county boroughs in England and Wales, and the concentration of calcium and 12 other elements was estimated. Multiple regressions were calculated with the death rates from various causes as dependent variables and with the concentration of the elements in the tap water, mean annual temperature, mean annual rainfall, and a socioeconomic index as independent variables. The well known negative association between water hardness and ischaemic heart disease was shown to be due to calcium, and none of 12 other elements examined appeared to contribute significantly to the association. Area differences in other causes of death also showed an association with calcium. There was little association between temperature and ischaemic heart disease.
The hypothesis was tested that respiratory illness in children occurs more commonly in old housing than in housing built to modern standards. Three areas of housing were chosen in a South Wales valley: a recently constructed council estate with district central heating; a modern council estate heated with open coal fires; and an area of much older, traditional valley housing. Mothers reported the greatest proportion of children free of colds and sore throats during the previous 12 months in the area of traditional valley housing; mothers of children in the centrally heated estate reported the least proportion of children free of colds. Children's lung function was best in the area of traditional valley housing and worst in the centrally heated council estate. Data on demographic indices and respiratory morbidity suggest that the inhabitants of the two council estates have comparable characteristics. Another hypothesis which may explain the findings is proposed.
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A cross-over controlled trial has been conducted among 32 adult patients with mite-sensitive asthma. The bedclothes and pillows of each subject were laundered and vacuum-cleaned and a plastic cover applied to the mattress for six weeks in an attempt to reduce exposure to mites. No improvement in daily peak-flow reading or drug usage was found in comparison with a control period.
A randomized controlled trial of the effect of 1 g ascorbic acid per day in the prevention of the common cold was conducted on 688 adult women. There is evidence of a small reduction by vitamin C in the mean number of chest colds, but no evidence of any effect on simple colds. The existence of a subgroup of vulnerable women in the community who benefit from vitamin C was considered but further examination of the data gives no support to this conclusion.