The relationship between monthly Ischaemic Heart Disease mortality and mean monthly temperature and rainfall is examined using data for England and Wales covering the period 1968 to 1976. The statistical procedure adopted involves a time series analysis of each of the individual series employing an approach which has become increasingly popular in other sciences over the last decade. Results indicate the correlation coefficients quoted in previous studies involving monthly data are spuriously high implying that temperature is not as closely related to Ischaemic Heart Disease deaths as has often been claimed.
100 consecutive patients with Colles' fracture were assessed functionally three months after the injury, and the result correlated with initial shortening of the radius. Three methods were used to measure radial shortening; only the one that measured the distance from distal radial to distal ulnar surfaces correlated with functional outcome. It is concluded that this is the most valid method of measurement and the deficiencies of the other methods are discussed.
SUMMARYThe stress upon the principal relative caregivers of a series of dementia sufferers attending an assessment day hospital was studied. The main variables influencing stress levels were the caregiver's own health self-rating and a measure of behaviour and mood disturbance in the patient. Predictors of the breakdown of community care over a 1-year follow-up period were studied. At 12 months caregiver's 'caseness' on the GHQ was a highly significant predictor. Clinical work with dementia sufferers in the community should include an assessment of the health and psychological status of the caregiver. Future research should focus upon evaluating specifically targeted interventions aimed at reducing stress in caregivers.KEY WORDS-Dementia, stress, elderly mental illness teams, relatives, caregivers.The psychological and health impact upon relatives caring for dementia sufferers in the community has been extensively studied over the past 10 years. Research in the area can be divided into a number of conceptual themes. The first theme has been to define the nature of the burden and stress felt by relatives and to examine factors influencing levels of stress. Such work has been influenced by the separation made by Grad and Sainsbury (1965) of objective and subjective burden. Vitaliano et al. (1991) criticize burden measures that do not separate objective from subjective factors, and argue for the use of instruments which relate the two concepts, so that the sources of subjective burden are explained. Early work found that caring for a relative suffering from dementia is felt to be more stressful upon relatives than caring for a physically ill relative (Eagles et al., 1987;Poulshock and Deimling, 1984). Morris et al. (1988a) review nine studies which have investigated the mental health of relatives; seven have reported raised levels of depression or stress symptoms.Research has focused upon a number of themes relevant to the stress felt by relatives:-The severity of dementia and level of problem behaviour shown by the sufferer -The type of relationship between caregiver and sufferer (eg blood relative, spouse, etc) and the past quality of the relationship -The cognitive styles and coping mechanisms used by the relative -The impact of services and of social supports -The satisfactions derived from the caring roleThe severity of dementia has not been found to be simply related to levels of stress in family members. There is agreement about which behaviours relatives most often report as problems: incontinence, overdemanding behaviour and the need for continual supervision (Morris et al., 1988a). However, such problems are not reliably related to raised stress levels. Other factors clearly mediate
A total of 519 patients presenting with carcinoma of the caecum in the Plymouth Health District between 1975 and 1987 were reviewed. The clinical course was determined in relation to patients with and without a history of previous appendicectomy. There was no difference in the incidence of previous appendicectomy between patients with carcinoma of the caecum and an age and sex matched control group. The presence of synchronous carcinomas and/or adenomas was unrelated to previous appendicectomy. Ten patients presented with appendicitis and 11 with a mucocele of the appendix as the first sign of carcinoma of the caecum. Previous appendicectomy was associated with a higher incidence of local fixity, invasion of the abdominal wall, metastatic spread and poor differentiation. These differences were reflected in a significantly lower resection rate for carcinomas in patients who had previously undergone appendicectomy. The survival of patients who had previously had appendicectomy was significantly reduced. Four independent prognostic factors for survival were identified using multivariate discriminant analysis. These were Dukes' classification, local invasion, tumour differentiation and previous appendicectomy. Local recurrence was more common in patients who had previously had appendicectomy and was often in the old appendicectomy wound itself. Appendicectomy does not increase the risk of carcinogenesis in the caecum. In this study a history of appendicectomy was an independent risk factor for survival and significantly worsened the prognosis for patients who subsequently developed carcinoma of the caecum.
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