SUMMARY Data from two community studies on men from South Wales and the west of England suggest that the effects of smoking on the haemostatic system remain for many years after giving up. Long term correlations between several variables, including plasma fibrinogen and white cell count, and the length of time after giving up were seen in ex-smokers. Dose response relations were apparent in current smokers in terms of the white cell count and two haematological variables, the packed and mean cell volumes. These long term correlations probably reflect the toxicity of other agents in tobacco smoke besides nicotine and carbon monoxide, which act only in the short term. Identification of these agents may further our understanding of the mechanism by which cigarette smoking is associated with atherosclerotic disease.Evidence is accumulating that haemostatic factors have a pathogenetic role in ischaemic heart disease' 2 and stroke.3 Smoking habit is known to affect substantially several haemostatic factors4 I and is also a major risk factor for ischaemic heart disease.6 7 This paper examines the activity of several haemostatic factors in non-smokers, smokers, and ex-smokers in two community studies on men from South Wales and the west of England. Material and methods STUDY POPULATIONSAll men aged between 45 and 59 years resident in the town of Caerphilly and five outlying villages (total population 41000) were included in the study. Subjects were selected principally from electoral registers and a private census carried out by letter and houseto-house survey. Age and sex registers and practice records were also used as an additional check on the eligible population. Twenty one general practitioners served the area covered by the survey working in seven independent surgeries. Accepted for publication 13 March 1987 In Bristol computerised age and sex registers of patients were available for all 16 general practitioners who worked from two health centres serving Speedwell, a largely residential district of east Bristol (total population 32 000). All male subjects aged 45 to 59 years of age on September 1 1979 were selected and invited by letter from their general practitioner to participate in the survey. SURVEY METHODSIn Caerphilly a total of 2818 men were included and invited to attend one of seven local clinics for a medical examination. A total of 2512 (89%) subjects were examined. A questionnaire was filled in by all subjects for details of medical history, occupation, and smoking habit, and other data.In the Bristol population 2550 men were included in the study, and 2348 (92%) subjects were seen at the Speedwell clinic. Questionnaires used in this survey were identical in essential respects with those used in Caerphilly. LABORATORY METHODSAll subjects were seen at a morning haematology clinic, and a venous blood sample was obtained with 909 on 11 May 2018 by guest. Protected by copyright.

High-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, viscosity, fibrinogen, and blood pressure were determined in 117 men aged 44 to 60 yr selected from the general population who also completed 7-day weighed dietary records. Associations between these measurements and a number of dietary factors were assessed by multiple regression analysis, allowing where necessary for the effects of age, body mass index, and smoking habit. High-density lipoprotein cholesterol was associated positively with both alcohol and fish consumption and negatively with saturated fat intake. High-density lipoprotein cholesterol expressed as a percentage of total cholesterol was associated negatively with the percentage of energy from fat and positively with fish consumption. Low-density lipoprotein cholesterol was associated positively with the percentage of energy from fat and negatively with fish consumption. Fibrinogen and systolic blood pressure were inversely related to cereal fiber intake.

This paper briefly outlines the history of the medical record and the factors contributing to the adoption of computerized records in primary care in the United Kingdom. It discusses how both paper-based and electronic health records have traditionally been used in the past and goes on to examine how enabling patients to access their own primary care record online is changing the form and function of the patient record. In addition, it looks at the evidence for the benefits of Web-based access and discusses some of the challenges faced in this transition. Finally, some suggestions are made regarding the future of the patient record and research questions that need to be addressed to help deepen our understanding of how they can be used more beneficially by both patients and clinicians.

SUMMARYIn the Speedwell study set up to examine primarily the relation of plasma lipids and ischaemic heart disease in men aged 45 to 64 years drawn randomly from the practices of 16 general practitioners, various haemostatic factors which may contribute both to thrombogenesis and atherogenesis were measured. Fibrinogen measured nephelometrically and plasma viscosity were positively associated with the prevalence of ischaemic heart disease. Antithrombin III was negatively associated with the prevalence of ischaemic heart disease. These associations were statistically significant at the 1% level of probability. Fibrinogen measured by a clotting method and the heparin neutralising activity of platelet poor plasma had negative and positive associations with ischaemic heart disease, respectively, but neither association achieved statistical significance. Because of the interrelation of these variables and also age, a multiple logistic regression analysis was undertaken separately for the two measures of fibrinogen. The negative association of "clottable" fibrinogen and the positive association of plasma viscosity with the prevalence of ischaemic heart disease were confirmed and both were statistically significant at the 5% level of probability. Apart from age the independent association of the other variables with ischaemic heart disease did not achieve statistical significance. Fibrinogen measured by both methods had positive and statistically significant associations with serum total cholesterol, but no associations with serum total triglycerides, smoking, or alcohol consumption. "Clottable" fibrinogen had an inverse and statistically insignificant association with serum high density lipoprotein cholesterol. The observed associations support the concept of the involvement of some haemostatic factors in the aetiology of ischaemic heart disease, and these associations are now being examined more critically in a longitudinal study.

SUMMARY The Westergren erythrocyte sedimentation rate (ESR) and plasma viscosity were compared in 114 patients and their correlations with total and differential plasma protein fractions were analysed.There is a linear correlation between these two screening tests. Higher correlation coefficients were obtained between the plasma viscosity and fibrinogen and alpha and gamma globulins than with the ESR. Albumin affected the two tests in opposite directions. The ESR was falsely increased by a fall in haemoglobin even within two standard deviations from the mean.Both tests gave an appreciable number of incorrect values-the plasma viscosity in 21 cases and the ESR in 33. The cause for these is discussed. It is concluded that the plasma viscosity is the more sensitive and reliable measure of changes in acute phase protein reactants and more useful for monitoring clinical progress.Following tissue injury or inflammation, the commonest alteration in the concentrations of the various plasma proteins is the so-called acute phase plasma protein response. The protein fractions which increase include fibrinogen (its concentration can double within 24 hours), alpha-proteins (alpha-i antitrypsin, alpha-I anti-chymotrypsin, and alpha-I acid glycoprotein), caeruloplasmin, and the second, third, and fourth components of complement. Subsequently, there is an increase in alpha-2 macroglobulin, followed by an increase in the plasma gamma globulins. Unlike these positive acute phase reactants, albumin is a negative acute phase reactant and tends to diminish in concentration. In a more chronic pathological process there may be a predominance of the negative phase response, with normal or slightly increased fibrinogen levels, normal or decreased albumin concentration, and an increase in plasma gamma globulin concentrations following antigenic exposure, beginning about 10-14 days after the initial injury (Alper, 1974).By estimating the erythrocyte sedimentation rate (ESR) and plasma viscosity (PV) in parallel with a 'Present address and requests for reprints: Department of Haematology, Leicester Royal Infirmary Received for publication 1 September 1976 series of total and differential protein fraction estima tions on blood samples obtained from a group of patients, an attempt has been made to determine which of these two tests gave the most direct indication of changes in the plasma proteins. In this way, it was hoped that it might be possible to decide which of these two simple screening tests would be most useful in the assessment of severity and duration of disease known to alter the normal plasma protein pattern. Methods and materialsBlood samples were obtained from 114 unselected patients attending a general medical and rheumatology outpatient clinic. Their clinical diagnoses were not considered during this investigation. The ESR was determined within four hours of collection by the Westergren technique (as described by the International Committee for Standardization in Hematology, 1973), and the normal range was taken as 0-5 mm...