Communicating risk—coronary risk scores

Summary. Cardiovascular disease, particularly heart attack and stroke, is the major cause of death in adults in Europe. The underlying atherosclerosis which causes cardiovascular disease is difficult to treat or reverse, and this has led to intense interest in strategies to prevent its development. The major causes of cardiovascular disease—a high fat diet, tobacco smoking and high blood pressure—are now well known. Control of these risk factors has been shown to reduce the risk of heart attack or stroke. It is now possible with simple information (age, sex, blood pressure level, cholesterol level and information on smoking) to predict the risk of heart attack or stroke fairly accurately. The challenge for the future is to make the information available on risk prediction and on how to reduce risk accessible to lay people, so that they may choose, if they wish, to adopt a life style that will reduce their risk. Such a life style involves healthy food choices, avoidance of overweight, the promotion of leisure exercise and complete avoidance of tobacco. Drug treatments can be extremely effective in controlling both blood pressure and cholesterol levels, but they should be seen as an adjunct to life style measures rather than a primary means of achieving prevention. Practical prevention will only be achieved through dynamic partnerships between the medical profession, Government, voluntary bodies, teaching institutions, insurance companies and paramedical bodies. An outline about how cardiac societies can participate in this process is appended.     

Poorer Is Riskier

To examine the relationship between economic well being and health status, two economic concepts were explored: the permanent-income hypothesis and the transitory-income hypothesis. A regression analysis of time-series mortality data for the period of 1950-1988 was conducted. The regression results indicated that the total mortality rate is negatively associated with permanent income and positively associated with the transitory income. Results are also reported for the 8 major causes of death in the United States. The implications for risk analysis are discussed.     

Analysis of an addictions treatment system

A treatment system consisting of an assessment/referral service, a detox, a mission, a hospital recovery unit, and three recovery homes was examined using a retrospective client-tracking approach over 1 year. There were 4,187 admissions to the system accounted for by 1,522 individuals; system users tended to be males, unmarried, unemployed, and in their 30s and 40s. The best predictor of readmission to the system after treatment was prior system use. Use patterns and referral data indicated that perceived gatekeepers (i.e., detoxication and assessment services) were not consistently coordinating the system and that more socially stable clients appeared to be more likely to be involved with non-addiction specific services (i.e., medical, general counselling).     

American sociology’s changing interests as reflected in two leading journals

This study involves an analysis of the major topics published in theAmerican Journal of Sociology andAmerican Sociological Review from the 1890s through the 1970s. The data indicate that the discipline focused initially on its self-definition and major social problems, moving to more theoretical and methodological matters during the 1930s. The war years reflect a major concern with political matters, shifting to economic issues and the problems of minorities in later decades. The limitations of these normative and economic interests are discussed. He has concentrated on sociological theory, the history of sociology and comparative minority relations. He is presently engaged in a world-wide analysis of racial discrimination and conflict.     

General Deterrence of Drunk Driving: Evaluation of Recent American Policies

A testable hypothesis of deterrence theory is that efforts to increase the expected cost of criminal activity by increasing the threat of punishment should, other things being equal, reduce the crime rate. In this paper, we examine whether the incidence of drinking and driving is responsive to escalation of the punitive threat. The recent national campaign against drunk driving provides a natural experiment in which to test the predictions of deterrence theory. Using state level data over the 1975-1986 period, we report no conclusive evidence that any specific form of punitive legislation is having a measurable effect on motor vehicle fatalities. We report suggestive evidence that multiple laws designed to increase the certainty of punishment (e.g., sobriety checkpoints and preliminary breath tests) have a synergistic deterrent effect. The most striking finding is that mandatory seat belt use laws and beer taxes may be more effective at reducing drunk driving fatalities than policies aimed at general deterrence.     

Race,language, and social policy: Comparing the black and Hispanic experience in the U.S.

Recent studies project that most new U.S. workers by the year 2000 will be minorities, and warn that educational deficiencies among blacks and Hispanics may lead to a two-tiered society. Since the 1960s the U.S. government, prodded by a coalition of black and Hispanic rights organizations, has adopted a minority-discrimination model of equal opportunity that requires affirmative-action benefits for both protected groups to compensate for past discrimination. For Hispanics these programs have required separate, Spanish-language instruction in school.Since 1969, the availability of new survey data on ethnicity, family income, and Englishlanguage proficiency from the Census Bureau and the National Assessment for Educational Progress has permitted comparisons of social mobility by racial and ethnic groups. These studies show greater economic success among nonEnglish-speaking groups from Europe and Asia than among white-Anglo-Saxon-Protestant (WASP) groups, and they show similar upward mobility among Hispanics when proficiency in English is taken into account.These optimistic trends are tempered by the demands of the new global economy for high levels of literacy and numeracy in the knowledge-based industries of the future. In this job competition Asian-Americans, despite their language difficulties, have been most successful and blacks least successful. The political and ideological needs of black and Hispanic leaders have tied government policies to the minority-discrimination model and linked Hispanic remedies to Spanish-language programs, but the empirical data associate economic success with the acculturation model and English-language proficiency.     

McMaster Transposed: An Interview with Nathan Epstein

On a recent tour of the United States, Graham Martin spent a privileged, information-packed, two and a half days at Butler Hospital, Providence, Rhode Island, in a programme carefully organised by Dr Duane Bishop. During that visit Dr Epstein agreed to the following interview.     

T Cell Immunity and Aging

The effect of age on the immune system is generally detrimental and results in "immunosenescence," a poorly-defined state inadequately reflected in clinical data and for which few reliable "biomarkers of aging" are available. The multinational consortium "T-Cell Immunity in Ageing," T-CIA, was set up to examine these issues specifically as applied to T lymphocytes. This Perspective discusses some of the outcomes of a recent conference that considered progress toward resolving these questions in humans.     

A survey of substance abuse prevention efforts at Virginia's colleges and universities

The extremes of college student substance use and the negative consequences students face as a result of such use are of great public health concern. Although a multitude of campus-based substance abuse prevention efforts have appeared in literature, a clear picture of the programs and policies currently in use at colleges and universities is not readily available. This research was undertaken to detail both the efforts aimed at general student samples and those targeting at-risk (eg, Greeks, student athletes) and historically underserved (eg, ethnic minorities, students with disabilities) student groups at colleges and universities in the Commonwealth of Virginia. While a variety of efforts were being made, there was a reliance on program orientations with limited scientific support. Four-year institutions used a wider array of outlets for their prevention messages. Targeted programs for at-risk groups were common but were largely unavailable specifically for ethnic minority students and students with disabilities.