A working model of the WHO definition of health was developed which involved dialogue with health workers and members of the community. The method developed was applied to the investigation of the health and health care of a mining community in West Fife. In general, health care facilities were found to be less than adequate to cope with presend demand and co-operation between certain services was poor. A cohort of 427 men who had all worked at one coalmine in West Fife in 1955 was traced in 1977. By combining information from standard NHS sources with that supplied by survivors still living in Fife, it was possible to ascertain the vital status of all the cohort, and to confirm this in 97%. Cohort mortality was investigated using actuarial methods and in general did not differ from that of other men in Britain of the same age. Some differences were found in cause-specific mortality and difficulties in interpreting these data are discussed. A stratified simple random sample of men still resident in West Fife was investigated by interview and, where appropriate, by examination of their hospital records and discussion with their GPs. The response rate to the questionnaire was 100%. The men were found to have high levels of ill-health. Difficulties they encountered with the local health services are discussed. All teenage recruits into the cohort in the early 1950s who were still living in Fife were similarly interviewed and the replies supplemented by information from GPs and hospital records. The response rate to the questionnaires was 100%. All these men had been face-workers at some time although less than half were still employed in the coalmining industry at the time of interview. The men were found to have very high levels of acute and chronic ill-health and 14% were confirmed to have severe disability as a direct consequence of their work in the mines. The prevalence of ill-health was much higher than among other men in Scotland and this difference could not be explained on the basis of selective migration of healthy men away from the area.

A descriptive account is presented of a community psychiatric nursing service based at a psychiatric teaching hospital in Edinburgh. The object of the study was to contribute to the identification and analysis of the role and functions of community psychiatry nurses. The study was focused mainly on nurse-patient contact and on the process and content of nurse—patient interaction. The fieldwork for the study was carried out in 1972-73- The main instruments used were self-administered record schedules reporting nurses' contacts with patients and their families and interviews to obtain background information on factors which influenced the nurses' activities. It was found that the service was functioning mainly as an after-care agency. A high proportion of the work of the service took place in a hospital context; the case-load had close connections with hospital care, and the nurses mainly called on hospital resources and staff in support of their work. It was concluded that the staff were acting primarily as intermediaries between the patient and the hospital, and that their direct care functions were secondary to this. Factors which influenced the activities of the nurses included role concepts, role—relationships (which presented some problems) and the needs of the patient and his family. A combination of clinical-psychiatric and psycho-social needs were observed and it was inferred from the evidence that the former were better catered for than the latter. Particular problems in family relationships were recognised. It was concluded that the situation demanded enhanced skills which could be developed through supervised practice. It was also suggested that the functions and case-loads of community psychiatric nursing services were profoundly influenced by their location and organisation, and that these should, therefore, be decided in the light of an explicit formulation of desired objectives.

The major aims of this project were, first, to study a cohort of low birth weight infants and their carefully matched controls in order to determine the effects of perinatal disease and social circumstances on subsequent long term performance; and, second, to improve the current definitions of intrauterine growth retardation. The potential contribution to knowledge of this work lies in its prospective design using a clearly defined catchment area and carefully matched individual controls. As a consequence it has been possible to demonstrate significant differences between the maternal backgrounds of low birth weight and control infants and to conclude that low birth weight infants are in the main derived from biological backgrounds inferior to those of their matched controls. My major interest during the study was to improve the definition of intrauterine growth retardation. Analysis of eight different methods presented in Chapter V highlights the difficulties of achieving such an objective. The difficulties arise because of the multiplicity and variety of biological factors which influence fetal growth; these are discussed in the chapters dealing with maternal contribution to fetal growth, outcome of sibling of LBW infant, congenital abnormalities and the corroboration of the last menstrual period by the total 'maturity' score. As a background to the study, the relevant literature is reviewed, and a detailed discussion is presented of the methodological problems encountered in the setting up of a low birth weight study. One section describes several new clinical features related to gestation or fetal growth. Further details are given in a chapter describing a number of neonatal measurements, such as the Apgar score and biochemical data. Lastly, there is a section describing the morbidity pattern in the cohort during infancy and early childhood.

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A mobile coronary care unit readied about 20% of the population at risk with ischaemic heart disease. It was limited in its ability to reach patients within an hour of the onset of their symptoms, particularly patients with sudden cardiac death. It was much more successful at reaching these patients than the pre-existing intensive care facilities. Beyond the first hour after the onset of symptoms the mobile coronary care unit made a significant impact upon the mortality from ischaemic heart disease, measured in relation to the population at risk. It did this by resuscitating patients with cardiac arrest in the vicinity. There was no evidence of the prevention of deaths by any other method, either the prevention of serious arrhythmias by prophylactic treatment or the reduction of the incidence of cardiogenic shock. The mobile unit was useful in providing information about why some patients delayed in calling for help after the onset of their symptom. The delay was, in general, a rational response to mild symptoms - unfortunately such symptoms were often misleading for many such patients with mild symptoms had a cardiac arrest later. Data collected in the unhurried atmosphere of the mobile coronary care unit gave sate information about factors which influenced most strongly the final outcome for patients in terns of their final diagnosis and their likelihood of having serious complications later in their hospital treatment. The initial electrocardiogram was particularly useful in this regard. No patient group was defined which was completely safe from all complications but a small group could be defined which was unlikely to have a cardiac arrest and a grading of severity could be easily achieved, so that for example scarce intensive care facilities could be best utilised by patients with the worst prognostic score, i.e. those most likely to have complications. The mobile coronary care unit was an effective addition to the hospital services for patients with ischaemic heart disease as far as resuscitation from cardiac arrest was concerned. It did not significantly increase the incidence of cardiac arrhythmias while the patients were in the unit and did not increase patient anxiety more than admission to a hospital general medical ward.

No description available.

The construction of the Aswan High Dam resulted in flooding and submerging the land behind it, By 1964 a large and deep lake was formed and about 150 kilometres of it was inside the northern borders of the Sudan. It covered the Wadi Haifa district where 60,000 Sudanese Nubians had been living and the Republic of the Sudan had obligations, as stated in the 1959 Nile Waters agreement, to resettle these people. Over 50,000 of these Nubians were transferred and resettled in Khashm el Girba, 600 miles away in Eastern Sudan. They had been deeply rooted in their homes for thousands of years and had there been part of an ancient civilisation as evidenced by relics in Bohen and Abu Simbil. This mass resettlement was completed in about 3 years. The magnitude of the problem surpassed any past experience of the kind in Sudan and was perhaps unique in the world. The Nubians in the new area faced completely different social, ecological and environmental conditions from what they had known. This it was thought would expose them to new diseases, a situation which needs to be studied with as objectives first the information of the public health authorities about the health problems detected and thus helping in establishing control measures and secondly the determination of principles for preservation of health that ought to be applicable to other situations. The present study included clinical examinations and investigations . in both areas in an attempt to find the evidence of acquisition of disease resulting from the uprooting and resettlement of the Nubians in the new area. This study had shown that the Nubians are acquiring Schistosoma i mansoni infection for the first time and that this infection is gaining predominance over S. haematobium infection. This study also provides evidence that the reaction of the Nubians to the leishmanin test is changing. This may suggest that the new settlers are being exposed to leishmaniasis. The Nubians came from a malaria free district and are now also faced with the problem of malaria in Khashm el Girba. The results of the malaria survey are therefore reported. The pattern of other diseases in the two districts, as well as G-6-P D deficiency and abnormal haemoglobins in the Nubians are also reported. An ecological study of the resettlement area was made and a survey for the vectors of disease and for snails was performed. Thus the medical problems of immediate importance to the new settlers were found to be'schistosomiasis and malaria and the findings of this study suggest that leishmaniasis and onchocerciasis are possible future problems. Careful surveillance of these medical problems is needed and the possible control measures for these diseases are discussed in this study, Similar surveys are needed in resettlement areas9 and newly established agricultural schemes as this will enable the health authorities to take the necessary control measures. It is suggested that this study ought to be applicable in the proposed Rahad scheme in the Sudan where it is planned to resettle Nomadic tribes. It might also be applicable to similar schemes elsewhere.

Background: Nutrition education programmes are frequently implemented in developing countries with the aim of improving dietary practices. Few studies have, to date, examined the various steps in such an education process in a developing country setting. This study, uses McGuire's "Communication/Persuasion" model to assess the impact among poor rural women in Mozambique of two nutrition education delivery methods: group classes only versus group classes plus individual classes. Methods: Study participants were randomly selected from the total population of RCT taking place in rural Mozambique: the Towards Sustainable Nutrition Improvement project. Participants were female, had a child under 5 years of age and had been randomised to receive the nutrition education program. McGuire's output steps (exposure, attention, understanding, memorisation/recall, skills acquisition, and attitude change) were assessed for both nutrition education delivery methods using a range of tools developed by the investigator, ranging from direct observations to questionnaires. The sample size varied for each output step depending on pre-defined criteria. Results: The methods devised in the current study for the assessment of McGuire's output steps were able to detect a good degree of variability in response. Mothers receiving both the group and individual classes (intervention II) scored higher in most output steps than those receiving only the group classes (intervention I), even after adjusting for possible confounding influences. For example, those mothers in intervention II had significantly higher skills acquisition scores than those mothers in intervention I (difference of means 1.03, independent t-test, p<0.001). Within the sample of intervention II mothers, the scores from measurements taken in individual classes were significantly higher than those taken in the group classes. For example, while there was no difference in observed attention scores between intervention II and intervention I mothers when assessed at group classes, observed attention scores at individual classes were Significantly higher (for intervention II mothers) than those of intervention I mothers at group classes (Independent t-test, p=0.031). Further analysis appeared to suggest that this advantage was due to the added benefit of receiving individual classes in addition to group classes; although this cannot be confirmed in the current study given the lack of a study 'arm providing only individual classes. 2 Conclusions: This study has for the first time used McGuire's model to systematically investigate and compare the communication process in two nutrition education delivery methods in a developing country and attempted to develop tools to measure McGuire's output steps in such a setting. McGuire's model emerged as a good conceptual framework to use for this purpose as it is practical, and. allowed for the breakdown of the process into _, discrete steps that permitted comparisons to be made between two delivery methods. The analysis suggested that there was an advantage in providing individual classes in addition to group classes, although this clearly has important resource implications.