General practice on a new housing estate. 1956.

An analysis has been carried out of the records kept for the year 1953 by six doctors practising on a new housing estate near London. The population of the estate is described in terms of age, sex, and social class. 76 per cent. of the registered patients consulted a doctor at some time during the year, the consultation rate per person being 4.1 based on the average registered population; females had more consultations than males; 80 per cent. of all consultations were made by people under the age of 45. One-sixth of the patients accounted for about half of the consultations, and 30 per cent. of the consultations were made by the 7 per cent. of registered patients who consulted twelve or more times in the year. The consultation rates showed a slight, but statistically significant, social gradient, with more consultations among patients in the lower social classes. The illness rate was 26 per person, and was higher among males in infancy and old age, and among females between the ages of 5 and 64. A method of estimating the duration of sickness in terms of the period under medical care was employed. This showed that 70 per cent. of all illnesses were dealt with in single consultations, and that only 3 per cent. of illnesses were under care for more than 90 days. Over half of the practice population were under care for less than 5 days, and only 8 per cent. for more than 90 days. The proportion of patients having more than 30 days sickness generally increased with age, but there was a slight fall among the women aged 65 and over. Certificates were issued at the rate of about one for every five consultations, two-thirds of these being necessitated by the requirements of the National Insurance regulations. Prescriptions were issued at the rate of about one per consultation, the prescription rate being 41 per person. Only 5 per cent. of the practice population consulted the doctor but did not obtain a prescription. About 30 per cent. of the patients who consulted a doctor were referred outside the practices, 80 per cent. of all referrals being to hospitals, either as inpatients or as out-patients. The person-hospital referral rate was 20 per 100, and there were 31 referrals for every 100 registered patients. Males over 65 had the highest rates for consultations, illnesses, prescriptions, and referrals. The reason for this is discussed. The value of record-keeping by general practitioners is stressed, together with the need for a generally accepted method of expressing rates in studies of this kind.

Vigorous exercise in leisure-time: protection against coronary heart disease.

1138 first clinical episodes of coronary heart disease (CHD) in 17 944 middle-aged male office workers in the Civil Service are reported. Men who engaged in vigorous sports, keep-fit, and the like during an initial survey in 1968-70 had an incidence of CHD in the next 8 1/2 years somewhat less than half that of their colleagues who recorded no vigorous exercise. The CHD rates of men who took such vigorous exercise were lower in both fatal and non-fatal clinical manifestations, though more so in fatal; throughout the age-range studied, though more striking in later middle age and early old age; and in all other sub-groups examined, including men with a family history of CHD, the obese, the short of stature, cigarette smokers, and men with severe hypertension and subclinical angina, as well as in those in favourable situations for CHD or neutral. The generality of the advantage suggests that vigorous exercise is a natural defence of the body, with a protective effect on the ageing heart against ischaemia and its consequences.

Vigorous exercise in leisure time and the death rate: a study of male civil servants.

In 1968-70, 17,944 middle-aged male executive grade civil servants in Great Britain provided a record of their leisure-time activities for two sample days and they have been followed until the end of 1977. In a 20% sample (3591 men), 268 have died. Men who had reported "vigorous exercise" (VE) during the two days suffered fewer deaths from coronary heart disease throughout the years 1968-77; there was no significant difference in mortality from other causes. VE men recorded more physical activity in general, and they saw themselves as physically more active than the rest. Total physical activity scores, however, were weakly related to coronary mortality. Men reporting vigorous exercise smoked somewhat less than other men, but the two factors were independently associated with mortality from coronary heart disease.