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Comparing Health Inequality In Men And
Women: Prospective Study Of Mortality 1986-96
- To study prospectively the differences in health inequality in men and women from
1986-96 using the Office for National Statistics' longitudinal study and new socioeconomic
- To assess the relative importance of social class (based on employment
characteristics) and social position according to the general social advantage of the household to
mortality risk in men and women.
Design: Prospective study.
Setting: England and Wales.
Subjects: Men and women of working age at the time of the 1981 census, with a recorded
Main outcome measures: Mortality. Results: In men, social class based on
employment relations, measured according to the Office for National Statistics' socioeconomic
classification, was the most important influence on mortality. In women, social class based on
individual employment relations and conditions showed only a weak gradient. Large differences in
risk of mortality in women were found, however, when social position was measured according to
the general social advantage in the household.
Conclusions: Comparisons of the extent of health
inequality in men and women are affected by the measures of social inequality used. For women,
even those in paid work, classifications based on characteristics of the employment situation may
give a considerable underestimate. The Office for National Statistics' new measure of
socioeconomic position is useful for assessing health inequality in men, but in women a more
important predictor of mortality is inequality in general social advantage of the household.
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Size And Quality Of Randomised Controlled Trials In Head Injury: Review Of
Cochrane Injuries Group, Child Health Monitoring Unit, Department of Epidemiology and Public
Health, Institute of Child Health, London WC1N 1EH.
Objective: To assess whether trials in head injury are large enough to avoid moderate random errors and designed to avoid moderate biases.
Design: All randomised controlled trials on the treatment and rehabilitation of patients with head injury published before December 1998 were surveyed. Trials were identified from electronic databases, by hand searching journals and conference proceedings, and by contacting researchers. Data were extracted on the number of participants, quality of concealment of allocation, use of blinding, loss to follow up, and types of participants, interventions, and outcome measures.
Results: 279 reports were identified, containing information on 208 separate trials. The average number of participants per trial was 82, with no evidence of increasing size over time. The total number of randomised participants in the 203 trials in which size was reported was 16 613. No trials were large enough to detect reliably a 5% absolute reduction in the risk of death or disability, and only 4% were large enough to detect an absolute reduction of 10%. Concealment of allocation was adequate in 22 and inadequate or unclear in 25 of the 47 (23%) in which it was reported. Of 126 trials assessing disability, 111 reported the number of patients followed up, and average loss to follow up was 19%. Of trials measuring disability, 26 (21%) reported that outcome assessors were blinded.
Conclusions: Randomised trials in head injury are too small and poorly designed to detect or refute reliably moderate but clinically important benefits or hazards of treatment. Limited funding for injury research and unfamiliarity with issues of consent may have been important obstacles.
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Randomised, Double Blind, Placebo Controlled Study Of Fluticasone
Propionate In Patients With Moderate To Severe Chronic Obstructive
Pulmonary Disease: The Isolde Trial
Objectives: To determine the effect of long term inhaled corticosteroids on lung function,
exacerbations, and health status in patients with moderate to severe chronic obstructive
Design: Double blind, placebo controlled study.
Setting: Eighteen UK
Participants: 751 men and women aged between 40 and 75 years with mean forced
expiratory volume in one second (FEV1) 50% of predicted normal.
fluticasone propionate 500 mug twice daily from a metered dose inhaler or identical placebo.
Main outcome measures: Efficacy measures: rate of decline in FEV1 after the bronchodilator
and in health status, frequency of exacerbations, respiratory withdrawals.
morning serum cortisol concentration, incidence of adverse events.
Results: There was no
significant difference in the annual rate of decline in FEV1(P=0.16). Mean FEV1 after
bronchodilator remained significantly higher throughout the study with fluticasone propionate
compared with placebo (P<0.001). Median exacerbation rate was reduced by 25% from 1.32 a
year on placebo to 0.99 a year on with fluticasone propionate (P=0.026). Health status
deteriorated by 3.2 units a year on placebo and 2.0 units a year on fluticasone propionate
(P=0.0043). Withdrawals because of respiratory disease not related to malignancy were higher in
the placebo group (25% v 19%, P=0.034).
Conclusions: Fluticasone propionate 500 mug twice
daily did not affect the rate of decline in FEV1 but did produce a small increase in FEV1.
Patients on fluticasone propionate had fewer exacerbations and a slower decline in health status.
These improvements in clinical outcomes support the use of this treatment in patients with
moderate to severe chronic obstructive pulmonary disease.
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