suMMARY A prospective study of acute cerebrovascular disease in a community of about 105,000 people is reported. The study protocol combined rapid clinical assessment of patients with accurate diagnosis of the pathological type of stroke by CT or necropsy, whether or not they were admitted to hospital. The study population was defined as those people who were registered with one of 50 collaborating general practitioners (GPs). Referrals to the study were primarily from the GPs though, to ensure complete case ascertainment, hospital casualty and admission registers, death certificates and special data from the Oxford Record Linkage Study were also scrutinised. Six hundred and seventy five cases of clinically definite first-ever in a lifetime stroke were registered in four years yielding a crude annual incidence of 1 60/1,000 or 2-00/1,000 when adjusted to the 1981 population of England and Wales. The age and sex specific incidence rates for first stroke showed a steep rise with age for both sexes. The odds of a male sustaining a first stroke were 26% greater than those of a female. Ninety one per cent ofpatients were examined in a median time offour days after the event by a study neurologist and 88% had cerebral CT or necropsy.Over the last 25 years there have been many studies of stroke incidence throughout the world. The methods used in community-based studies have varied from detailed retrospective case note reviews (for example Rochester, USA'2), through cohort studies (such as Framingham, USA3 and Hisayama, Japan4) to prospective stroke registers in defined populations (for example, Tilburg, Holland5 and Shibata, Japan6) and despite the methodological difficulties of measuring stroke incidence accurately,7 the magnitude of the clinical, social and economic problems associated with stroke has been well established. Studies ofCaucasians
Study objective-To estimate the number of deaths attributable to current alcohol consumption levels in England and Wales by age and sex. Design-Epidemiological approach using published relative risks and population data. Setting-England and Wales. Main outcome measures-Numbers of deaths by age and sex and years of life lost for alcohol related conditions. Results-Because of the cardioprotective properties of alcohol, it is estimated that there are approximately 2% fewer deaths annually in England and Wales than would be expected in a non-drinking population. This proportion varies greatly by age and sex and only among men aged over 55 years and women aged over 65 years is there likely to be found a net favourable mortality balance. It is also estimated that there were approximately 75 000 premature years of life lost in England and Wales in 1996 attributable to alcohol consumption. The main causes of alcohol attributable mortality among the young include road traYc fatalities, suicide and alcoholic liver disease.
Conclusions-At a population level, current alcohol consumption in England andWales may marginally reduce mortality. However, the benefit is disproportionately found among the elderly. Estimating alcohol attributable mortality by age and sex may be a useful indicator for developing alcohol strategies. More research into the possible eVect modifications of pattern of consumption, beverage type, age and gender will enable these estimates to be improved.
Possible explanations for the variation in alcohol-attributable deaths between countries include different underlying heart disease rates, different patterns of alcohol consumption and beverage preferences, and different use of mortality classification. Differences in the reported alcohol consumption levels explain little of the variation in alcohol-attributable deaths. Estimating alcohol-attributable mortality by age and sex across countries may be a useful indicator for developing alcohol strategies and exploring ways of preventing premature mortality.
The incidence of serious psychiatric illness, as measured by first referral to hospital for specialist advice and treatment, has been investigated among 16,746 women taking part in the Oxford Family Planning Association contraceptive study. Of these women, 9,504 were recruited while using oral contraceptives, 4,144 while using a diaphragm and 3,098 while using an intrauterine device. The results are reassuring with respect to oral contraceptive use. First referral rates per 1000 woman-years of observation in the oral contraceptive, diaphragm, and intrauterine device entry groups were 3.0, 2.6, and 2.8 respectively for non-psychotic psychiatric disorders and 0.46, 0.43 and 0.53 respectively for psychotic disorders. Attempted suicide occurred only 40% as often amongst diaphragm users as amongst users of oral contraceptives or intrauterine devices; this finding presumably reflects the characteristics of women who choose the diaphragm as their birth control method.
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