Biomedical subjects
J N Morris
Publications and source records attributed to J N Morris.
Social inequalities and health.
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Social inequalities in child health.
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[Primary prevention of ischemic heart disease using clofibrate. Cooperative epidemiological study].
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Social inequalities undiminished.
Traditional differences in death-rates by social class continue in Britain in the 1970s, mostly at lower levels of mortality. The professions do well, unskilled workers and their families particularly badly. Data on health services are scanty, but they suggest that lower-class families, with greater needs, do not make proportionate demands on some services and receive less of others. Continuing socioeconomic inequalities, disparities in child health and education, and current smoking and exercise habits indicate that inequalities in health will persist. Some ways of levelling up are suggested, starting with children: by creating more equal opportunities for the under-5s through education and day care, expanding child benefit and family endowment, concentrating health services on the socially disadvantaged, and setting an upgraded "health education" to the task--with mothers and children and the whole population.
Evidence for the benefits of exercise from epidemiological studies.
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Vigorous exercise in leisure time and the death rate: a study of male civil servants.
In 1968-70, 17,944 middle-aged male executive grade civil servants in Great Britain provided a record of their leisure-time activities for two sample days and they have been followed until the end of 1977. In a 20% sample (3591 men), 268 have died. Men who had reported "vigorous exercise" (VE) during the two days suffered fewer deaths from coronary heart disease throughout the years 1968-77; there was no significant difference in mortality from other causes. VE men recorded more physical activity in general, and they saw themselves as physically more active than the rest. Total physical activity scores, however, were weakly related to coronary mortality. Men reporting vigorous exercise smoked somewhat less than other men, but the two factors were independently associated with mortality from coronary heart disease.
Diet and heart: a postscript.
During 1956-66, 337 healthy middle-aged men in London and south-east England participated in a seven-day individual weighed dietary survey. By the end of 1976, 45 of them had developed clinical coronary heart disease (CHD) which showed two main relationships with diet. Men with a high energy intake had a lower rate of disease than the rest, and, independently of this, so did men with a high intake of dietary fibre from cereals. Energy intake reflects physical activity, but the advantage of a diet high in cereal fibre cannot be explained; there was no evidence that the disease was associated with consumption of refined carbohydrates. Fewer cases of CHD developed among men with a relatively high ratio of polyunsaturated to saturated fatty acids in their diet, but the difference was not statistically significant.
131I Rose Bengal scanning and clearance ratios in the investigation of jaundiced patients.
It may be difficult to distinguish between obstructive and non-obstructive jaundice despite the use of clinical, biochemical and radiographic tests. Endoscopic cannulation tests promise to be the most accurate means of separating the two groups, but they are not yet widely available, and are not entirely safe. In contrast, the 131I-Rose Bengal test is simple, safe and comparatively widely available. Its accuracy in 70 jaundiced patients is reviewed to determine whether it still has a place in the investigation of jaundiced patients. Blood clearance traces, intestinal radioactivity traces and serial abdominal scans were done during a period of 3 h. The blood clearance ratios were not helpful discriminators, and the most helpful information was the timing of intestinal radioactivity. Its rapid appearance excluded mechanical obstruction. A delay of up to 3 h in its appearance was characteristic of cholestasis. A delay of more than 3 h was found in all cases of mechanical obstruction, but also in ten cases of severe cholestasis which could not be distinguished from those with mechanical obstruction. A follow-up examination within another ten days was of diagnostic value in two of these cases and the overall accuracy of the test was 86%. The potential value of prolonging the test to 24 h is discussed. It is concluded that the 131I-Rose Bengal test is a helpful diagnostic discriminator in the great majority of patients with jaundice. It is offered as a screening procedure for specialised techniques.
Vigorous exercise in leisure time, coronary risk-factors, and resting electrocardiogram in middle-aged male civil servants.
During 1968 to 1970, approximately 17 000 middle-aged male executive grade civil service officers, all of them engaged in sedentary or very light work, recorded on a Monday morning their leisure time activities over the previous Friday and Saturday. In 1971 a sample of 509 of these men completed further questionnaires for medical, social, and smoking history; these men had a resting electrocardiogram, and height, weight, skinfold thickness, blood pressure, and plasma total cholesterol were measured. Vigorous exercise in leisure time had previously been reported by 125 (25%) of the men, and these as a group had significantly fewer electrocardiographic abnormalities (changes compatible with myocardial ischaemia, ectopic beats, and sinus tachycardia) than the men not reporting vigorous exercise (P less than 0-02). This difference remained when all men with any history suggestive of cardiovascular disease were excluded from the analysis. Blood pressure, plasma total cholesterol, and smoking habits were examined with respect both to vigorous exercise and to the electrocardiogram, but the only relation found was that electrocardiographic abnormality increased with increasing blood pressure. Even among men with higher pressures, however, those reporting vigorous exercise had fewer electrographic abnormalities than the others. The results provide further support for the association of habitual physical activity with coronary health.
Coronary heart-attacks in East London.
All cases of cardiac infarction, acute coronary insufficiency and sudden death occurring in residents of the London Borough of Tower Hamlets below age 65 were registered over nearly three years, and survivors were followed up for one year. The attack-rate in men aged 45-64 years was 1 per 100 per annum but the recurrence-rate in survivors was 1 per 100 per month. Immigrants from Asia had more than the average, and those from the Carribean one tenth of the average attack-rate. Although it was unusual for general practitioners to manage cases at home by choice, nonetheless two-thirds of the deaths happened outside hospital and half of these were not witnessed. Half of those suffering coronary heart-attacks had a previous history of coronary disease and a sizable minority were already unfit for work. Approximately half of those attacked were alive at one year.
A retesting and modification of the Philadelphia Geriatric Center Morale Scale.
The inter-item structuring of the questions in the Philadelphia Geriatric Center Morale Scale was analyzed for sample members of two studies being conducted by the Dept. of Social Gerontological Research of The Hebrew Rehabilitation Center for Aged (Boston) in an attempt to understand better the several components of the PGC battery first reported by Lawton. PGC items were subjected to principal component and Varimax factor analyses for both the original 22 items and also a reduced 17-item battery. In addition, using more recent findings of Lawton, further structural tests were performed in order to obtain the best possible configuration of items for the several reliable scale components found. The results of these cross SAMPLE ANALYSES INDICATE AN OVER-ALL LEVEL OF RELIABILITY FOR THREE OF THE ORIGINAL PGC components; and at the same time, indices of greater length and reliability resulted when these three PGC components were slightly restructured.
Common themes among morale and depression scales.
This paper reports on the intra- and interbattery scaling of three morale and depression batteries comprised of self-reported items: PGC, G-H, and ZUNG. Responses to the three scales were sought from a sample of long-term residents of a state mental hospital. First, the batteries were factor analyzed separately to identify the intrabattery scales; then the resultant scales were compared using canonical correlation and super matrix factor analysis to identify the interbattery themes. These analyses resulted in the identification of a Clinical Depression domain across all three batteries and single independent themes in both the Zung and PGC batteries.
Developing a system for assigning individuals into an appropriate residential setting.
With the goal of maximizing the most suitable placement of elderly persons into different types of residential settings, a mathematical system is being developed, using discriminant function analysis, for replicating interdisciplinary clinical team judgments concerning case specific appropriateness for (1) an institutional setting; (2) an apartment in sheltered housing (providing at least the major meal of the day plus housekeeping services); and (3) an apartment in more traditional housing for the elderly. Two discriminant function systems are being developed--the first for separating elderly persons into those needing institutionalization and those requiring a less supervised setting and the second for separting persons judged not to be in need of institutionalization into those requiring either sheltered housing or some other more independent residency situation. While the first function is considered more fully developed at this time, the second is nevertheless useful in that is suggests forces (variables) predictive of such judgments.
Changes in morale experienced by elderly institutional applicants along the institutional path.
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Primary prevention of heart attack.
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