The increased trend of GGLE in Japan could be partly explained by increased disease-specific mortality ratios (male/female), especially those involving chronic bronchitis and emphysema, diseases of the liver, suicide and cancer. The recent decline of GGLE might imply that Japanese women have been catching up with the lifestyle of men, resulting in similar mortality patterns. This calls for gender-sensitive approaches to developing policies and programs that will help sustain healthy lifestyles to combat smoking and alcohol intake, and social support to prevent suicide.
supplementary oxygen who are monitored by routine oximetry and given conventional sedation. Until this information is available, routine use of a ,B blocker for patients undergoing endoscopic cholangiopancreatography seems premature because the risk of hypotension induced by I blockade may be an additional hazard. JOHN Danish data confirm low prevalence of HRT among women prescribed oral corticosteroids ED1TOR,-L J Walsh and colleagues report the use of oral corticosteroids in a population of 65 786 in Nottinghamshire.' They had found few epidemiological data on the use of corticosteroids in community populations, which is surprising, since the potential side effects of corticosteroids-for example, osteoporosis, hypertension, and diabetes-are important. We report here supplementary data on the use of oral corticosteroids and hormone replacement therapy obtained from a population based prescription registry for the county ofNorthJutland in Denmark. The region has 330 general practitioners and 487 000 inhabitants. For each prescription for drugs for which the costs are reimbursed the pharmacies collect the name and amount of the drug, the defined daily dose, the personal registration number ofthe patient, the date that the drug is dispensed, and several other variables.The population consisted of 242 614 men and 244 379 women. In the database we identified 3023 men (1.2%) and 4133 women (1.7%) who had received at least one prescription for oral corticosteroids in 1993. Walsh and colleagues found that 0.5% of their population had been "continuously" treated with oral corticosteroids. The difference is probably due to the different inclusion criteria, as Walsh and colleagues included only patients treated with oral corticosteroids for at least three months. Among the 4133 women who had received corticosteroids in North Jutland we identified 567 (13.7%) who had received hormone replacement therapy. In their study Walsh and Investigation is needed into why some patients are not offered cardiac rehabilitation EDrroR,-Jill Pell and colleagues report the influence of social deprivation on the uptake of cardiac rehabilitation.' Through their study the authors have identified an important area of research that could eventually lead to improvements in rehabilitation for deprived patients. In 1995 we reported that economically disadvantaged patients showed poorer survival than others after myocardial infarction,2 and Pell and colleagues' study suggests a possible mechanism for this: that fewer deprived patients take up and complete rehabilitation programmes. We note that the type of consultant and the hospital attended were also associated with uptake of rehabilitation. Just as striking is that the invitation to take up rehabilitation also depended on the consultant and hospital attended. In addition to carrying out research into why deprived patients are less likely to complete rehabilitation we clearly need to ask ourselves why some patients are not invited in the first place. The sizes of the effects suggest that the ...
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