Biomedical subjects
Publications and source records attributed to G Hems.
Patients of all ages attending hospital for day-case surgery should undergo some form of routine screening by the anaesthetist before the induction of anaesthesia. A questionnaire is presented which can be recommended as an aid to identifying the patient with a more than normal risk, ensuring smoother anaesthesia with speedy and uneventful recovery and avoiding postponement of surgery in most cases.
Changes of breast-cancer (BC) mortality for all women in England and Wales between 1911 and 1975, and for the social-class gradient during the 1950s, were not related to changes in child-bearing. The changes in BC mortality for all women were associated with changes in consumption of fat, sugar and animal protein 1-2 decades earlier. A decline in mortality around 1935 was not obviously related to changes in fat or sugar, but dietary data were sparse. The social-class gradient of BC mortality almost disappeared during the 1950s; rates declined for the upper classes but increased for the lower. These opposite changes could have resulted from the opposite changes in diets of the upper and lower classes which occurred in the early 1940s. In contrast, the geographical variation of BC mortality within the United Kingdom, by region or by urban-rural aggregate area, was closely correlated with child-bearing but poorly correlated with diet. The poor correlation with diet might be a consequence of the small range of variation of diet between regions of the United Kingdom. The regional gradient of BC mortality was low in 1961, a decade after the period of food rationing when regional variation in diet would have been reduced. This suggested that diet did contribute to the regional variation of BC mortality within the United Kingdom, perhaps jointly with contributions from child-bearing.
The records have been studied of 77 cases of acute intussusception in children which occurred in Aberdeen City, Aberdeenshire, and Banffshire during the 10 years 1967--76. There has been a decrease in age-specific incidence of about a third since a previous study in the same region was carried out between 1950 and 1959. The decline in rates is greater for rural areas than for Aberdeen City and it is more marked for girls than for boys.
Neutralization tests for poliovirus antibodies were carried out on 74 patients in an adult mental deficiency hospital: 37 patients with Down's syndrome and 37 non-Down's mental defectives. The distribution of antibody titres to poliovirus types 1, 2 and 3 did not differ significantly between the two groups. Most patients had antibody to at least one poliovirus type but less than a third had antibodies at a titre of 1/8 or greater to all three types. The low level of poliovirus immunity in this population may be of epidemiological importance.
Mean, age-standardized breast-cancer mortality rates for women of 41 countries, during 1970-71, were closely correlated with diet for 1964-66. Partial correlation analysis indicated that breast-cancer rates were positively correlated with total fat, animal protein and animal calories, independently of other components of diet. These 3 components were correlated with one another so closely that it was not possible, with available data, to say whether any one was associated with breast cancer independently of the other 2. In addition to, and independently of, these correlations, breast cancer was associated with consumption of refined sugar.Breast-cancer mortality rates at 50-54 years during 1964-67 for 26 countries were closely correlated with childbearing, expressed as mean family size for women aged 45-49 years in 1960-61. However, this correlation was not independent of the correlations with diet, and it was concluded that variation of breast-cancer rates between countries arose predominantly from differences in diet. The variation of breast-cancer risk with childbearing, observed in clinial studies, seemed best regarded as a second gradient of risk, seen more readily as variation of breast-cancer rates within a population, where differences in diet would be relatively small.The physiological basis for the association between breast cancer and diet was not clear. The dietary associations did not correlate in an obvious way with height, obesity and oestrogen levels, factors observed in clinical studies to influence risk of breast cancer. That the observed statistical associations were real was supported by published findings on effects of diet on mammary cancer in experimental animals, as well as the lower rates of breast cancer amongst vegetarians.
The well known associations of breast cancer with fertility patterns and diet are interdependent and it is difficult to estimate the extent to which breast cancer is related to diet. This was attempted by analysing breast cancer rates in populations of single (never married) women for which the contribution of childbearing would be small. Age specific breast cancer rates for single women showed the same variation by country, social class, urban-rural area and with time, as did the corresponding rates for married women, suggesting that common or related factors determined breast cancer rates in single and married women. Also, dietary correlations of breast cancer rates at 55-64 years, around 1960, were not sifnificantly different for single women and the general female population. This supported the view that the dietary associations with breast cancer, observed in larger studies of general female populations, did not arise indirectly from an association with childbearing rates. It was pointed our that the positive association of breast cancer with sugar, observed for single and for all women, was accopanied by a negative association with starch. These opposite associations with two forms of varbohydrate seemed inconsistent on general nutritional grounds and could be explained as arising indirectly to the association of breast cancer with affluence. Otherwise, it would seem necessary to establish a nutritional difference between starch and sugar, which could reasonably influence breast cancer rates, before the association was accepted as indicating cause.
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The well-known peak of bone cancer during the second decade was found to be closely associated with changes in growth velocity at the adolescent growth spurt, for males and females in England and Wales. Distinct accumulations in the second and third decades could be recognized for cancers of ovary, testis, prostate and thyroid. It was suggested that these accumulations and also the bone cancer peak might be a consequence of the growth and development which occur at puberty.
International rates of breast cancer for females aged 40-44 years (the "early" rate) and for females aged 65-69 years (the "late" rate) were positively correlated with sugar and fat intakes. The correlation explained three-quarters of the variation in the late rate, for 22 countries, but only half of the variation in the early rate. The late rate was, further, positively correlated with estimates of the percentage of nulliparous women (9 populations) and, together with terms for sugar and fat intakes, the multiple regression explained 90% of the variation. Early registration rates (13 populations) were positively correlated with blood group A which appeared, from the multiple regression equation, to contribute more than twice the amount to the early rate than did sugar and fat intakes. The contribution of blood group A to the late rate appeared to be only one-third of that for sugar and fat intakes.
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