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Biomedical subjects

W W Holland

Publications and source records attributed to W W Holland.

At least 19 recordsLinked to original sources
PubMed1992

Equity and medical practice variation: relationships between standardised discharge ratios in total and for selected conditions in English districts.

STUDY OBJECTIVE: The aim was to investigate relationships for residents of English district health authorities between rates of discharges from acute hospitals for all conditions and variations in discharge rates for eight common conditions (five surgical, three medical). DESIGN: Hospital Inpatient Enquiry data on discharges for 1984 were analysed. Standardised discharge ratios (ratios of actual to expected numbers of discharges x 100) were derived for selected conditions and all conditions; and correlation coefficients for these statistics were calculated. Districts were grouped into quintiles according to the value of the standardised discharge ratio, and systematic variation within each quintile was calculated for the selected conditions. SETTING: The study involved all 192 English district health authorities, but 57 were excluded because the proportion of unspecified diagnoses exceeded 5%. PATIENTS: The analyses were based on 336,799 cases from 135 districts. MEASUREMENTS AND MAIN RESULTS: Discharge ratios for the medical conditions and one surgical condition were significantly correlated with the levels of total discharge rates (p less than 0.01). The medical conditions showed greater systematic variation in discharge ratios than the surgical conditions. There was no consistent pattern in the values of systematic variation for the selected conditions across the different levels of discharge ratios for all conditions. CONCLUSIONS: It is argued that the changes in the NHS introduced in April 1991 are intended to introduce greater equity in the standardised discharge ratios and increase the total numbers of discharges. The results of this analysis suggest that, even if these objectives were achieved, they may not result in increased levels of elective care, nor result in greater equity in terms of rates of discharge for individual conditions.

Acute Disease↗
PubMed1992

Respiratory effects of lowering tar and nicotine levels of cigarettes smoked by young male middle tar smokers. I. Design of a randomised controlled trial.

STUDY OBJECTIVE: The aim was to investigate the effect on respiratory health of male middle tar smokers changing the tar and nicotine levels of the cigarettes they smoke for a six month period. DESIGN: This was a randomised controlled trial. Middle tar smokers were randomly allocated to smoke one of three different types of cigarette (low tar, middle nicotine; middle tar, middle nicotine; and low tar, low nicotine) in place of their usual cigarette for a six month period. Main outcome measures were assessment of respiratory health by documenting respiratory symptoms and peak expiratory flow rates, and of nicotine inhalation by measuring the urinary excretion of nicotine metabolites. SETTING: 21 local authority districts of England. SUBJECTS: Participants were male middle tar smokers aged 18-44 years. MAIN RESULTS: Postal questionnaires were sent to 265,016 individuals selected from the electoral registers of 21 local authority districts of England; 64% of questionnaires were returned revealing 7736 men aged 18-44 years who smoked only middle tar cigarettes. Of these, 7029 (90%) were sent a health warning and 707 (10%) were not; the latter acted as a control group to assess the effect of the health warning. Of the 7029 men who had received a health warning and were visited at the recruitment stage, 2666 agreed and were eligible to participate in the trial although only 1541 (58% of those who agreed and were eligible) actually started smoking the study cigarettes; 643 men (24% of those willing to participate at the beginning of the trial and 42% of those who actually started smoking the study cigarettes) completed the trial smoking the study cigarettes. Of these, 213 were in the low tar middle nicotine group, 220 were in the middle tar middle nicotine group, and 210 were in the low tar low nicotine group. CONCLUSIONS: This study shows the feasibility of identifying and recruiting sufficient numbers of male middle tar smokers, with adequate numbers completing the trial, to detect any changes in respiratory health over a six month period.

Adolescent↗
PubMed1992

Respiratory effects of lowering tar and nicotine levels of cigarettes smoked by young male middle tar smokers. II. Results of a randomised controlled trial.

STUDY OBJECTIVE: The aim was to investigate the effect on respiratory health of male middle tar smokers changing the tar and nicotine levels of the cigarettes they smoke for a six month period. DESIGN: This was a randomised controlled trial. Middle tar smokers were randomly allocated to smoke one of three different types of cigarette (low tar, middle nicotine; middle tar, middle nicotine; and low tar, low nicotine) in place of their usual cigarette for a six month period. Main outcome measures were assessment of respiratory health by documenting respiratory symptoms and peak expiratory flow rates, and of nicotine inhalation by measuring the urinary excretion of nicotine metabolites. SETTING: 21 local authority districts of England. SUBJECTS: Participants were male middle tar smokers aged 18-44 years. MAIN RESULTS: Changes in the measures of respiratory health showed little difference over the trial period between the three cigarette groups. Analyses of the urinary nicotine metabolites showed that smokers allocated to each of the three study cigarettes adjusted their smoking so that throughout the trial their nicotine inhalation differed little from their pretrial intakes when they were smoking their own cigarettes. As a result of the altered patterns of smoking to compensate for the reduced nicotine yields of the three study cigarettes, the tar intake of those allocated to smoke the middle tar, middle nicotine cigarettes remained essentially unchanged, while those allocated to smoke the low tar, low nicotine and low tar, middle nicotine cigarettes had calculated reductions in tar intakes of about 14% and 18%, respectively. CONCLUSIONS: Due to the phenomenon of compensation, tar intake can only be reduced substantially by using a cigarette with a markedly lower tar/nicotine ratio. Nevertheless reductions of up to about 18% in tar intake failed to result in any detectable effect on respiratory symptoms or peak expiratory flow rates over a six month period.

Adolescent↗
PubMed1978

Prevention--everybody's responsibility.

The importance of individual responsibility in many aspects of preventive medicine is emphasised in the introduction. A section on infectious disease as applied to Western society today follows with special mention of particular conditions such as turberculosis, influenza, rubella, gastro-intestinal diseases and Legionaire's Disease. The section on non-communicable disease is subdivided into coronary heart disease, malignant neoplasms and chronic bronchitis. It includes some discussion of screening. Short sections on prevention in the elderly, pregnancy and early life, dental health, accidents, alcoholism and drug misuse follow. In the conclusions the difficulty of determining priorities for different societies and the importance of establishing cost effectiveness of preventive measures are covered. The relative importance of societal, governmental and individual preventive measures are described and the authors emphasise that any expensive screening programme must adhere to established criteria.

Accident Prevention↗
PubMed1978

Long-term consequences of respiratory disease in infancy.

In a study of Kent schoolchildren it has been shown that those who had a history of bronchitis under the age of five were more likely to have reported respiratory symptoms as the age of 11 (Bland et al., 1974). After this finding, it was necessary to test whether these differences would continue or diminish as the children grew older. One thousand three hundred schoolchildren in four areas of Kent were studied by physical examination and parental questionnaire at the ages of 5, 11, and 14. The relative risk of having reported respiratory symptoms for children with a history of early bronchitis, asthma, or pneumonia, compared with other children, was the same at the age of 14 as it was at the age of 11. These relationships could not be explained by social class effects, and were probably not due to parental bias in reporting.

Adolescent↗
PubMed1977

Change in respiratory symptom prevalence in adults who alter their smoking habits.

The prevalence of chronic cough and phlegm production has been studied in 3916 young married adults, with recent new births and young children in their families, on six consecutive annual occasions. Among those who were smokers, in all years of the study more men than women reported respiratory symptoms. Respiratory symptoms were also reported more commonly among men than among women who did not smoke at all, whereas no sex difference in symptom prevalence was apparent among men and women who changed their smoking habits during the study. Equal numbers of men stopped or started smoking on their own initiative during the second three years of the study, whereas twice as many women started smoking as stopped in the same period. Men who had been smokers in the first three years and who spontaneously stopped smoking during the second three years showed a progressive decline in respiratory symptoms to a level similar to that of nonsmokers.

Adult↗
PubMed1977

Respiratory symptom prevalence in adults: the comparative importance of smoking and family factors.

In a study of the prevalence of chronic cough and phlegm production in a group of nearly 4000 young adults, those adults who had several children had a higher prevalvalence of these symptoms than those with few children, especially if the children suffered from bronchitis or pneumonia. Nevertheless, cigarette smoking was the factor most strongly associated with chronic cough and phlegm production in young adults in this study.

Adult↗
PubMed1976

Influence of family factors on the incidence of lower respiratory illness during the first year of life.

In a study of a cohort of over 2000 children born between 1963 and 1965, the incidence of bronchitis and pneumonia during their first year of life was found to be associated with several family factors. The most important determinant of respiratory illness in these infants was an attack of bronchitis or pneumonia in a sibling. The age of these siblings, and their number, also contributed to this incidence. Parental respiratory symptoms, including persistent cough and phlegm, and asthma or wheezing, as well as parental smoking habits, had lesser but nevertheless important effects. Parental smoking, however, stands out from all other factors as the one most amenable to change in seeking to prevent bronchitis and pneumonia in infants.

Age Factors↗