No abstract

SUMMARYThe relationship between age-specific mortality rates and some indices of health facilities and some environmental and dietary factors has been studied in 18 developed countries. 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.

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.

The increased incidence of adverse events during induction, postoperative nausea and vomiting and postoperative delirium in the sevoflurane group suggests that sevoflurane is not ideal as a sole agent for paediatric day case anaesthesia.

Mite counts and tests for mite antigen were performed on samples of dust taken from the bedding of 53 children with mite-sensitive asthma. The samples from damp houses and the beds of enuretic children had markedly more mites and mite-antigen than those from dry houses. Although the predominant species was usually Dermatophagoides pteronyssinus, some of the beds in the damp houses were heavily infested with another pyroglyphid mite Euroglyphus maynei, so that this was the species found in the greatest numbers. D pteronyssinus antigen was found to be correlated broadly with the total mite count, but more antigen was present for a given number of mites in the mattresses than in the blankets. The children were randomly allocated into two groups, one of which carried out rigorous anti-mite measures. The amounts of dust and mite antigen were reduced, though not the numbers of mites. Peak flow readings were monitored in the two groups for eight weeks and a final assessment made by a paediatrician who was unaware of the allocation of each patient in the trial. No significant differences emerged in the progress of the two groups, both tending to improve. Measures designed to remove mites from bedding do not greatly benefit the majority of children with mite-sensitive asthma.There is a considerable body of evidence which suggests that the house-dust mite Dermatophagoides pteronyssinus is a major allergen in the provocation of allergic asthma.'-3 These mites are especially prolific in blankets and feather pillows and on the surface of mattresses.4-6 Sarsfield et at7 reported that a group of children with mite-sensitive asthma improved considerably when measures were taken to remove mites from their bedding. Their study did not include a control group, however, so it cannot be known whether the improvement was spontaneous or psychosomatic rather than a response to the removal of provoking allergens. A randomised controlled trial was, therefore, undertaken to evaluate the effects of anti-mite procedures on children with mite-sensitive asthma. Subjects and methodsSubjects for the trial were selected from among the children attending a paediatric outpatient clinic. They were all aged 4 years or over, with positive skin tests to D pteronyssinus (weal size