Polysomnographic assessment of DIMS: empirical evaluation of its diagnostic value.

This investigation examined the diagnostic value of polysomnography (PSG) for evaluating disorders of initiating and maintaining sleep (DIMS). The sample consisted of 100 outpatients who presented to the Duke Sleep Disorders Center with a complaint of chronic insomnia. All patients were given comprehensive medical, psychiatric, behavioral, and ambulatory PSG evaluations.

Mortality patterns among workers exposed to acrylamide.

A cohort of 8854 men, 2293 of whom were exposed to acrylamide, was examined from 1925 to 1983 for mortality. This cohort consisted of four plant populations in two countries: the United States and The Netherlands. No statistically significant excess of all-cause or cause-specific mortality was found among acrylamide workers.

What do health visitors contribute to the care of children? A study in the north of England.

All the health visitors in the north of England, and more than half the general practitioners, were sent questionnaires about the primary health care of children. More than 90% of the health visitors responded. Most of them took part in developmental screening and considered it primarily their responsibility; some conducted developmental or well baby clinics with no other professionals present.

Audit of 26 years of obstetrics in general practice.

To assess the feasibility and quality of general practitioner obstetrics an audit of 1223 consecutive obstetric deliveries over 26 years was carried out with standard clinical records. The perinatal mortality of 9.0 per 1000 births was significantly better than the national average of about 19.

Two methods of scoring sleep with the Oxford Medilog 9000: comparison to conventional paper scoring.

This study evaluated two methods of scoring taped polysomnographic data directly on the Medilog 9000 scanner: (a) screen-by-screen scoring, and (b) rapid screen scoring. Sixteen overnight polysomnograms recorded on Medilog 9000 recorders were scored using the above two methods and were also printed on paper for conventional paper scoring. Interscorer agreement was 87.

Rising mortality from motoneuron disease in the USA, 1962-84.

From 1962 to 1984, age-specific mortality for motoneuron disease (MND) in the United States rose in all demographic groups over the age of 40. The increase was seen in both men and women, and both whites and non-whites, and was most pronounced in the elderly (eg, 378% in white women aged 80-84 years). Men were at 50% higher risk than women, and whites had twice the risk of non-whites.

Is paediatrics safe in general practitioners' hands? A study in the north of England.

More than half the general practitioners in the north of England, and all the health visitors, were sent questionnaires about the primary health care of children. Eighty per cent of general practitioners responded. Their qualifications and experience in paediatrics were poor, although this was less true for younger practitioners.

Narrowing the health gap between a deprived and an endowed community.

A 15 month campaign by a primary health care team in Stockton on Tees raised the uptake of preventive care of its patients in a severely deprived area to a level generally exceeding that of a more endowed neighbouring community. This was achieved by opportunistic attention after unrelated consultations, writing twice to each household with a list of its outstanding items necessary for preventive care, using health visitors to encourage attendance, and occasionally undertaking preventive care in patients' homes. Extra clerical staff were needed to implement the new recording and monitoring procedures introduced.

Effects of ECT on Polysomnographic Sleep: A Prospective Investigation.

The authors describe a pilot investigation using ambulatory polysomnography (PSG) to assess rapid eye movement (REM) latency in 11 depressed inpatients before and after a course of electroconvulsive therapy (ECT). Prior to beginning ECT, all subjects had REM latencies of 56 minutes or less (mean 22 min). A course of ECT was associated with clinical improvement in every patient and a statistically significant (p < 0.

Direct methods of obtaining information on cigarette smoking in occupational studies.

Many occupational epidemiology studies require complete and accurate information on tobacco use to control for confounding by smoking and to assess interactions of smoking with workplace exposures. This paper reviews and evaluates the availability, reliability, validity, and efficiency of the various data sources and techniques for obtaining individual smoking data, including existing records, biological markers, and surveys. Emphasis is placed on the highly problematic issue of obtaining retrospective smoking histories.

Some effects of cigarette smoking, arsenic, and SO2 on mortality among US copper smelter workers.

Previous studies of the relationship between arsenic levels and respiratory cancer among copper smelter workers have not directly accounted for possible effects of SO2 exposure and cigarette smoking. This is a report on the 1949-1980 mortality experience of 6,078 white male workers who worked at least 3 years between 1 January 1946 and 31 December 1976 at one or more of eight US copper smelters. The completeness of the cohort was verified statistically, and worker exposures to arsenic, SO2, dust, nickel, cadmium, and lead were estimated from retrospective industrial hygiene surveys reported elsewhere.

Sickle cell disease in North London.

We have examined our experience of sickle cell disease in the London Borough of Haringey over the past 20 years. There are currently (1986) 145 patients on the Haringey Sickle Cell Register and when comparison is made with other centres, admission for painful crises in Hb SS disease is more frequent than in Jamaica, but the acute chest syndrome appears to be less common in the United Kingdom than in Jamaica. Splenomegaly is less frequent in Hb SC patients in this country and there is also a lower incidence of leg ulceration in both Hb SS and Hb SC disease in the United Kingdom than in Jamaica.

A study of telephone advice in managing out-of-hours calls.

Two doctors in a five-partner urban practice recorded details of their out-of-hours telephone calls for a year. No caller was refused a visit, but 474 of the 809 incoming calls (59%) were managed by telephone advice, an unexpectedly high proportion. Although these callers were instructed to telephone again if still worried, only 40 did so during the same duty period, and only 55% of a smaller sample of patients receiving telephone advice only consulted again within a week.

Exposure to arsenic and respiratory cancer. A reanalysis.

This paper is a reanalysis of data on the respiratory cancer mortality experience of 2,802 men who worked one year or more during the period 1940-1964 at a copper smelter in Tacoma, Washington. Exposure estimates presented earlier have been recalculated and perhaps improved. While the previous analysis showed only a weak relation between respiratory cancer and arsenic exposure, use of new data shows a much stronger relation--but one that is concave downward and not ordinarily considered for environmental exposure and cancer.

A strategy for merging and analyzing work history data in industry-wide occupational epidemiological studies.

Study populations examined in epidemiologic investigations of occupational disease risks often are assembled by the pooling of employee data from several workplaces that share common exposure factors. The primary objectives of this approach are to enhance the representativeness of the overall study population and to obtain sufficient employee sample sizes in exposure subgroups of interest. Among the many epidemiologic aspects that must be considered carefully in such industry-wide studies is the inter- and intra-company or plant comparability of employee work history data.