The cost of saving a life through cervical cytology screening: implications for health policy.

Through a review of the published literature on routine cervical cytology screening, this paper seeks to establish a likely range for the cost of saving a life through this screening programme as presently organised in England and Wales. The current performance of the programme may be expressed in several ways: a cost of 270,000 pounds to 285,000 pounds per life saved, 40,000 smears and 200 excision biopsies per death averted, or 1000 to 1500 avoidable deaths annually in England and Wales alone. The policy problems are thus of two kinds.

Sodium fluoride in delayed measurement of umbilical blood gases.

In blood samples stored at 5 degrees C with 20 mM sodium fluoride, only small changes in blood gas measurements were observed over 24 h. Most of the changes occurred within the first 2 h after collection. In samples stored at 5 degrees C without fluoride, blood gas measurements showed continuous changes over the 24-h period.

Regulation by calcium of parathyroid hormone mRNA in cultured parathyroid tissue.

We have examined the effect of changes in the concentration of extracellular calcium on parathyroid hormone mRNA in both short-term (hours) and long-term (days) cultures of bovine parathyroid tissue. Using a 32P-labeled PreProPTH cDNA probe, PTH mRNA was measured by gel blot hybridization of total RNA from tissue slices incubated for 4 h in low (0.5 mM) or high (5 mM) calcium concentrations and also by dot blot hybridization of cytoplasmic RNA extracted from aggregates of partially dispersed cells cultured up to 72 h in low (0.

Membrane-associated pyruvate kinase in developing guinea-pig liver.

During analysis of pyruvate kinase distribution in developing guinea-pig liver it was observed that a substantial proportion of the activity remained associated with the microsomal membrane fraction ('microsomes'). Although some of this could be removed by washing with sucrose, the majority required detergent treatment for liberation, and even then at least one-half remained attached to the microsomes. Estimates of the contribution of this fraction to total cell pyruvate kinase activity indicated that it was more than 50% of the total, and this is likely to be an underestimate because of the continued latency of the enzyme even in the presence of detergent.

Risk targetting: an approach to cost-containment.

The need for rationing in an insurance-based system of health care is inescapable. The best way to tackle the mismatch between demand and supply is, however, not clear. Of the four general strategies described, increasing the risk of disease in a population is shown to be the most effective way of reducing the outcome cost of a service.

Monitoring performance in the NHS. The district neural tube defect screening service.

A small medical school team has developed a six item system (SIS) for monitoring the neural tube defect (NTD) screening service. SIS is discussed in relation to possible alternative monitoring systems and the advantages which led to its implementation are described. In July 1982 the system was introduced in three districts in South Wales and the first year's results are presented.

Epidemiology for medical students: a controlled trial of three teaching methods.

Medical students taking a course in epidemiology for clinical practice were taught by either lectures, small group seminars or self-learning packages. Examination performances were no different for the three groups, but self-perceived mastery of learning objectives, and satisfaction with the course were higher for students who received self-learning packages. Sixty per cent of self instruction students found the teaching method was successful compared with 37% of the seminar students and only 19% who received lectures.

Epidemiology for medical students: a course relevant to clinical practice.

A new course was designed to make epidemiology clinically relevant to medical undergraduates. The objectives were that students should (1) know the epidemiology of common diseases, (2) understand epidemiological concepts useful in diagnosis and treatment, and (3) be able to critically assess published medical evidence. Results of a written examination showed that objectives 1 and 2 had been 'easily' achieved by 80% and 68% of students respectively.

Epidemiology in anaesthesia: a method for predicting hospital mortality.

Data on 13 043 operations were abstracted from 108 878 anaesthetic records in the Cardiff Anaesthetic Record System. Nine groups of surgical operations with high mortality in hospital were identified. These records were analysed using a logistic regression model to determine the probability of death in hospital.

Epidemiology in anaesthesia. III: Mortality risk in patients with coexisting physical disease.

The Cardiff Anaesthetic Record System has been used to examine the hospital mortality rates and relative risks for patients having anaesthesia who have certain preoperative conditions coexisting with their disease requiring surgery. Each preoperative condition was associated with a higher mortality rate than occurred in patients with no preoperative condition (for example ischaemic heart disease 7%, diabetes 5.7%, no preoperative condition 0.

A fast interval processor (FIP) for cervical prescreening.

A cervical prescreening device (FIP: fast interval processor) designed to scan and classify a slide-mounted specimen within two minutes is described. The image analysis techniques are based directly on the MRC Cerviscan equipment with the minimal conversion needed to adapt these techniques for interval processing. A high scanning rate is achieved by scanning with a charge-coupled diode linear image sensor along one axis and by stepping the microscope stage continuously along the other axis.

An empirical definition of "primary care".

An operational definition of "primary care", useful to a wide variety of professionals, has eluded researchers since the term first gained popularity. This paper presents an activity-based definition of primary care derived from ratings of 59 representative health care activities by a group of state health administrators, a group of local health department directors, and a random sample of primary care physicians practicing in North Carolina. Thirty-one activities received ratings indicating they were considered core primary care services.

Thermal injury and the sodium, potassium and water exchanges of skin.

A number of changes in tissue content of Na, K and water are known to occur after injury. In order to elucidate the exact sequence of these changes, experiments were made on explants of guinea-pig flank skin maintained in vitro. This work explores some techniques using explants subjected to graded thermal injury (37 degrees-50 degrees).

Distribution of water and electrolytes in normal and thermally damaged skin.

The alterations in contents of Na, K and water in thermally injuried explants of guinea-pig flank skin involve changes in both the cells and the interstitial material of the tissue. A full interpretation of the distribution of such changes can only be obtained if the volumes of cellular and extracellular fluid are known. This work examines the techniques of measuring extracellular fluid volume using 14C-inulin and 51Cr EDTA.