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Showing papers by "George Davey Smith published in 1990"


Journal ArticleDOI
18 Aug 1990-BMJ
TL;DR: In the 10 years since its publication new information has become available in four areas in particular: the use of alternative measures of socioeconomic position to index mortality risk; the collection of morbidity data; the comparison of inequalities in Britain with those in other industrialised countries; and the understanding of the causes of the differentials.
Abstract: Introduction This month marks the 10th anniversary of the publication of the Black report.' In 1977 the Research Working Group on Inequalities in Health had been convened by David Ennals, then Secretary of State for Social Services, under the chairmanship of Sir Douglas Black, president of the Royal College of Physicians. Its findings were not welcomed by the government when they were published in August 1980,23 but they generated great interest both in the United Kingdom and in other countries. Copies of the \"Black report\" were initially in short supply until Penguin published a paperback version, whose sales have ensured it a wide readership.4 The central finding of the working group -that there were large differentials in mortality and morbidity that favoured the higher social classes and that were not being redressed by health or social services-became widely known. In the 10 years since its publication new information has become available in four areas in particular: the use of alternative measures of socioeconomic position to index mortality risk; the collection of morbidity data; the comparison of inequalities in Britain with those in other industrialised countries; and the understanding of the causes of the differentials. These four areas are reviewed in this paper.

478 citations


Journal ArticleDOI
TL;DR: Intermittent claudication is not a rare condition, and simple questionnaires exist for its detection, and the latter can be usefully incorporated in cardiovascular risk assessment and screening programs.
Abstract: In the Whitehall study, 18,388 subjects aged 40-64 years completed a questionnaire on intermittent claudication. Of these subjects, 0.8% (147) and 1% (175) were deemed to have probable intermittent claudication and possible intermittent claudication, respectively. Within the 17-year follow-up period, 38% and 40% of the probable and possible cases, respectively, died. Compared with subjects without claudication, the probable cases suffered increased mortality rates due to coronary heart disease and cerebrovascular disease, but the mortality rate due to noncardiovascular causes was not increased. Possible cases demonstrated increased mortality rates due to cardiovascular and noncardiovascular causes. This difference in mortality pattern may be due to chance. Possible and probable cases still showed increased cardiovascular and all-cause mortality rates after adjusting for coronary risk factors (cardiac ischemia at baseline, systolic blood pressure, plasma cholesterol concentration, smoking behavior, employment grade, and degree of glucose intolerance). Intermittent claudication is independently related to increased mortality rates. It is not a rare condition, and simple questionnaires exist for its detection. The latter can be usefully incorporated in cardiovascular risk assessment and screening programs.

409 citations


Journal ArticleDOI
TL;DR: The use of social class as an index of socioeconomic position leads to underestimation of the association between social factors and mortality, which may be reflected in public health initiatives and priorities.
Abstract: STUDY OBJECTIVE--The aim was to explore the magnitude and causes of the differences in mortality rates according to socioeconomic position in a cohort of civil servants. DESIGN--This was a prospective observational study of civil servants followed up for 10 years after baseline data collection. SETTING--Civil service offices in London. PARTICIPANTS--11,678 male civil servants were studied, aged 40-64 at baseline screening between 1967 and 1969. Two indices of socioeconomic position were available on these participants--employment grade (categorised into four levels), and ownership of a car. MEASUREMENTS AND MAIN RESULTS--Main outcome measures were all cause and cause specific mortality, with cause of death taken from death certificates coded according to the eighth revision of the ICD. Employment grade and car ownership were independently related to total mortality and to mortality from the major cause groups. Combining the indices further improved definition of mortality risk and the age adjusted relative rate between the highest grade car owners and the lowest grade non-owners of 4.3 is considerably larger than the social class differentials seen in the British population. Factors potentially involved in the production of these mortality differentials were examined. Smoking, plasma cholesterol concentration, blood pressure, and glucose intolerance did not appear to account for them. The pattern of differentials was the same in the group who reported no ill health at baseline as it was in the whole sample, which suggests that health selection associated with frank illness was not a major determinant. The contribution of height, a marker for environmental factors acting in early life, was also investigated. Whereas adjustment for employment grade and car ownership attenuated the association between short stature and mortality, height differences within employment grade and car ownership groups explained little of the differential mortality. CONCLUSION--The use of social class as an index of socioeconomic position leads to underestimation of the association between social factors and mortality, which may be reflected in public health initiatives and priorities. Known risk factors could not be shown to account for the differentials in mortality, although the degree to which this can be explored with single measurements is limited.

375 citations


Journal ArticleDOI
TL;DR: This paper explored the relationship between local temperature and precipitation and large-scale climate using regression analysis using monthly-mean data from Oregon, with separate analyses for each month, with independent verification, spatial-mean explained variances range from 58 to 87% for temperature and from 39 to 76% for precipitation.
Abstract: The relationships between local temperature and precipitation and large-scale climate are explored using regression analysis. The motivation for this study is the need of the impact analyst for small-scale information given only coarser resolution General Circulation Model output. The predictor variables employed are area averages (over ∼2.5 × 106 km2) of temperature and precipitation and propinquitous grid point values of mean sea level pressure and 700 mbar height, together with the zonal and meridional gradients of these two variables. Regression analyses are performed using monthly-mean data from Oregon, with separate analyses for each month. In independent verification, spatial-mean explained variances range from 58 to 87% for temperature and from 39 to 76% for precipitation. Most of the variance explained arises from the area average of the variable which is the predictand: in other words, if the temperature, say, at point x is to be estimated, the best predictor is generally the area average temperature. There are large spatial differences in the amount of local climate variance that can be explained by large-scale data. Examples are given which show how site-specific changes can differ markedly from those at the grid point scale.

279 citations


Journal ArticleDOI
01 Sep 1990-BMJ
TL;DR: Examination of the change in class differences between 1971 and 1981 for all causes of death combined and for the three categories of death which during these ages make a major contribution to total years of potential life lost shows complex changes.
Abstract: British social class differences in mortality are examined in terms of years of potential life lost, a measure that gives more weight to deaths that take place at younger ages It shows wider class differences during the years of working life than those found when mortality is expressed in terms of standardised mortality ratios Examination of the change in class differences between 1971 and 1981 for all causes of death combined and for the three categories of death which during these ages make a major contribution to total years of potential life lost shows complex changes Inequalities in years of potential life lost have increased between 1971 and 1981, during which all the principal causes of death have shown stationary or rising rates among the manual classes The use of years of potential life lost as a measure of population health trends focuses attention on the major contribution of violent death, which occurs mainly in younger men, to widening class differences in mortality

101 citations


Journal ArticleDOI
TL;DR: In this paper, the behavior of substitutional alloying elements during and after the growth of upper bainite in Fe-Mn-Si-C and Fe-mn- Si-C-Mo alloy steels has been examined using an atomic resolution microanalysis technique.
Abstract: The behavior of substitutional alloying elements during and after the growth of upper bainite in Fe-Mn-Si-C and Fe-Mn-Si-C-Mo alloy steels has been examined using an atomic resolution microanalysis technique. From the results obtained, and judging from published data, it is concluded that manganese, nickel, silicon, chromium, and molybdenum do not redistribute during the growth of bainitic ferrite. Their concentrations are found to be uniform both at and in the vicinity of the transformation interface, with no indications of any segregation to the transformation interface during growth. However, prolonged annealing at the isothermal transformation temperature, after the formation of bainite has stopped, eventually stimulates the partitioning of substitutional alloying elements as the system tends toward equilibrium. The results demonstrate the existence of an atomic correspondence between the parent and product phases during transformation, the effect of substitutional alloying additions being manifestedvia a modification of the driving force for transformation.

57 citations


Journal ArticleDOI
TL;DR: It is concluded that the present classification of bladder carcinomata is reliable and that pathologists can determine stage with a high degree of reproducibility and grade with a fair degree of reproducecibility.
Abstract: Sections from 90 urinary bladder biopsy specimens were examined by 11 consultant histopathologists with varying experience to determine the appropriateness of existing pathology terminology. Analysis with kappa statistics showed fair to good agreement in the grading and staging of transitional cell carcinoma. There was also reasonable agreement in the diagnosis of high grade dysplasia in random biopsy specimens from the urothelium adjacent to the neoplasm, but very poor agreement for lesser degrees of dysplasia. It is concluded that the present classification of bladder carcinomata is reliable and that pathologists can determine stage with a high degree of reproducibility and grade with a fair degree of reproducibility.

53 citations


Journal ArticleDOI
TL;DR: In this article, a comparison is made between the fit of experimental data from the atom-probe to a sinusoidal distribution and also to the amplitude of the composition variations expected from non-linear theories of the spinodal decomposition.

44 citations


Journal ArticleDOI
TL;DR: In this article, the amplitude and wavelength of the spinodal were determined in a low carbon, low molybdenum steel (ASME SA351 CF3) in the temperature range 300-400°C for aging times of up to 20 000 h.
Abstract: Fe–Cr alloys and the ferritic phase of duplex stainless steels may undergo embrittlement during aging in the temperature range 300–500°C, owing to a spinodal reaction process. The atom probe at the University of Oxford. has been used to investigate the microstructural changes accompanying the spinodal in a low carbon, low molybdenum steel (ASME SA351 CF3) in the temperature range 300–400°C for aging times of up to 20 000 h. The amplitude and wavelength of the spinodal were determined. In addition, some other steels, which in previous studies by Trautwein and Gysel had exhibited an extremely low value of activation energy for embrittlement, were examined using both the atom probe and the position sensitive atom probe. Some of this material was re-heat treated to attempt to explain its anomalous behaviour. Steel from the primary cooling circuit of the Shippingport reactor was also examined and carbon and phosphorus were found to have segregated to a phase boundary.MST/1202

36 citations



Journal ArticleDOI
TL;DR: Haemodynamic changes and plasma catecholamine concentrations were measured in 12 patients aged 24 to 87 years after performance of a field block for elective repair of inguinal or femoral hernia, thought to be related to the peak plasma concentrations of adrenaline produced.
Abstract: Summary Haemodynamic changes and plasma catecholamine concentrations were measured in 12 patients aged 24 to 87 years after performance of a field block for elective repair of inguinal or femoral hernia. The local anaesthetic used comprised a mixture of lignocaine 0.5% with adrenaline 1:200000; the dose of lignocaine administered varied from 3.8 mg/kg to 4.9 mg/kg. Plasma adrenaline increased by 326% and plasma noradrenaline by 75% at 10 minutes after completion of the block. Mean heart rate increased from 75 to 94 beats/minute after 20 minutes, whilst there were no obvious changes in systolic and diastolic arterial pressures. Potentially serious arrhythmias developed in two patients, thought to be related to the peak plasma concentrations of adrenaline produced. It is recommended that the dose of adrenaline used as described for this block should be reduced.

Journal ArticleDOI
TL;DR: Gas exchange was optimal in the frequency range between the minimal and maximal responses, suggesting that gas transport was mainly convective in this range.
Abstract: SUMMARY We have studied the relationship between gas exchange and mechanical frequency response during high frequency jet ventilation (HFJV) at 0.5–5.0 Hz in anaesthetized pigs. The mechanical gain curve showed a minimal“anti-resonant” response at 0.8 Hz (f1) and a maximal “resonant” response at 5.0 Hz (f2). This finding may be explained by modelling the thorax and abdomen as a system of coupled masses and compliances which undergo two different modes of forced oscillation in the frequency range studied. Gas exchange was optimal in the frequency range between the minimal and maximal responses. The tidal volumes produced were greater than anatomical deadspace, suggesting that gas transport was mainly convective in this range.

Journal ArticleDOI
TL;DR: The position-sensitive atom probe technique is described in this paper, together with some examples of its application in the study of precipitation in maraging steels, aluminium alloys, and the iron-copper system.


Journal ArticleDOI
TL;DR: It is concluded that it is not possible to entrain predictable concentrations of volatile agents from the low pressure bias flow during HFJV.
Abstract: We have measured tidal (VT), entrained (Ve) and "blowback" (Vbb) volumes during high frequency jet ventilation (HFJV) through a Mallinckrodt Hi-Lo Jet tracheal tube in anaesthetized patients. The above volumes were calculated by digital integration of the appropriate regions of flow curves derived from a pneumotachograph placed between the bias flow tubing and the tracheal tube. At a driving pressure of 1 bar, lung minute ventilation increased with increasing ventilatory frequency, whilst tidal volumes decreased. The contribution of entrainment to tidal volume (Ve/VT) remained constant, although the volumes entrained were relatively small and varied widely from subject to subject. Blowback volumes were considerable, especially at ventilatory frequencies used clinically (1-2 Hz). We conclude that it is not possible to entrain predictable concentrations of volatile agents from the low pressure bias flow during HFJV.

Journal ArticleDOI
TL;DR: The measurement of precipitate size in the field-ion microscope atom probe has been studied by considering the Fe7Mo6 μ-phase precipitate in a Co-bearing C-300 maraging steel as discussed by the authors.

Journal ArticleDOI
TL;DR: a radiolabelled probe (corresponding to the amplified DNA), however, the desired amplication product could be seen in reactions containing as little as 0-5 pg toxoplasma DNA, which corresponds to about two organisms.
Abstract: a radiolabelled probe (corresponding to the amplified DNA), however, the desired amplication product could be seen in reactions containing as little as 0-5 pg toxoplasma DNA, which corresponds to about two organisms. Furthermore, as shown in fig la, this was detectable both in the presence and in the absence of any human DNA. Essentially similar results were obtained with dot blots or slot blots instead of Southern blots and with non-radioactive probes. Because the PCR/hybridisation assay requires at least two days we developed an