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All scientists who argue for caution share Sikora and colleagues’ desire for normality.12 Our case against their position has been made in the letter by Greenhalgh and colleagues,3 of which I am a signatory. On the risks of attempting herd immunity, even if we optimistically assume that immunity would persist after infection and that vulnerable people can really be shielded, infecting, say, half of the 35 million younger people (20-59 …

Carter raises concerns about the vulnerability of people living in care homes, including those with dementia.1 Non-memory led dementias account for around 15% of all dementia cases.2 They are relatively more common in younger people (under 65 years) who do not fit with societal perceptions of dementia, making their disability and support needs less noticeable. Dementias such as behavioural variant frontotemporal dementia (bvFTD), posterior cortical atrophy (PCA), and primary progressive aphasia (PPA) have phenotype specific symptoms that increase the challenges of …

Adults under 40 with no underlying health conditions that put them at risk of serious covid-19 illness will be offered an alternative to the Oxford-AstraZeneca vaccine, the UK’s Joint Committee on Vaccination and Immunisation has said, as long as one is available and it does not cause a substantial delay. This decision, which is based on a risk-benefit calculation, was informed by the committee’s review of the latest evidence on the AstraZeneca vaccine and the extremely rare cases of concurrent blood clots and low platelet count, as well as the current infection rates and vaccine supply plans in the UK. Younger people with no underlying conditions are less likely to develop serious covid-19 illness than those with underlying conditions or older people, so their risk-benefit profile is different. Speaking at a televised conference on 7 May, the joint committee’s covid-19 chair, Wei Shen Lim, said, “We offer this advice which places a high priority on safety in the hope that it will further increase vaccine confidence, so that those of us …

Background:in almost half of patients with ankylosing spondylitis (AS) in Russia, damage to the hip joints (HJ) is detected, but the rate of its progression has not been studied.Objectives:to evaluate the radiological progression of coxitis in patients with early axial spondylarthritis (axSpA) for two years.Methods:the study involved the patients of the Moscow cohort CORSAIR (Early Spondyloarthritis Cohort), which was formed in V.A. Nasonova Research Institute of Rheumatology. We analyzed 62 patients with a diagnosis of axSpa (ASAS criteria 2009), observed for at least 2 years and having survey images of the pelvic bones during inclusion in the cohort and 2 years after the start of observation. The average age at the time of inclusion in the cohort was 29.2 ± 6.4 years with an average disease duration of 23.8 ± 16.2 months, 32 men and 30 women, 92% of patients positive for HLA-B27. All patients received standard anti-inflammatory therapy.Results:when including out of 62 patients in the study, only one (2%) patient showed X-ray changes in HJ, Fig. 1 (a; b)). After 2 years of follow-up, the number of patients with radiological changes in HJ increased to 13 (21%), Fig. 1 (a; b).Patients were divided into two groups depending on the presence of radiological progression in HJ.A comparative analysis of the groups revealed that progression is more common in men and in younger people (p ParameterΔBASRI hip=0n=39ΔBASRI hip >0n = 23pSex (m/w), n15/2417/6Duration of the disease months., Me [25; 75 percentile]22 [7;36]24 [18,8;24,8]>0,05Age, years, Me [25; 75 percentile]29 [25,5;32,5]26,5 [23,2;28,7]BASDAI, Me [25; 75 percentile]3,6 [2,1;5,2]3,45 [1,1;5,2]>0,05BASFI, Me [25; 75 percentile]1,5 [0,5;2,8]0,7 [0,3;2,4]>0,05ASDAS (CRP), Me [25; 75 percentile]2,5 [1,6;3,35]2,4 [1,25;3,45]>0,05ESR, mm/h, Me [25; 75 percentile]8 [6;22]10 [5;28,75]>0,05CRP, mg/L, Me [25; 75 percentile]5,3 [1,3;24,5]5,2 [1,1; 23,4]>0,05Peripheral Arthritis, n%12 (32%)5 (22%)>0,05Conclusion:it has been shown that in some patients with axSpA already in the first years of the disease, radiological signs of HJ destruction are detected. The progression of coxitis was not dependent on the activity of the disease and was more often detected in men than in women.Disclosure of Interests:Ekaterina Agafonova: None declared, Tatiana Dubinina Speakers bureau: Novartis, BIOCAD, MSD, Pfaizer, Abbvie, UCB, Shandor Erdes: None declared, Daria Rumiantceva: None declared

Screening guidelines may need to be reviewed if the incidence of colorectal cancer continues to increase in adults aged under 50, researchers have warned.1 For now, however, research should focus on what’s causing the increase, they say, as the number of new cases among younger people is still low. Their study, published in Gut , analysed data on age related colorectal cancer incidence and mortality between 1990 and 2016 from European national and regional cancer registries. It found that the incidence of colon cancer in 20-29 year olds rose by 2.7% a year …

No single cause can be found for the slowdown in life expectancy improvement seen in the UK, a report from Public Health England (PHE) has concluded.1 It does not rule out the belt tightening in health and social care that began in 2011 and has coincided with higher mortality and a life expectancy slowdown, but neither does it give this the prominence accorded by some commentators. The report concludes that slowing improvements in heart disease and stroke, high winter mortality from flu in several recent years, the growth of dementia as a recorded cause of death, and more deaths from drug misuse among younger people have all played a part. Similar trends in mortality and life expectancy have been seen throughout Europe and the US over the same period, so a UK specific explanation is unlikely to be correct. But the trends visible everywhere are more pronounced in the UK, which showed the lowest rate of improvement among all large EU countries …

There has been a steady rise in the number of new cases of HIV diagnosed in older age groups in Europe over the past 12 years, a study published in the Lancet HIV has shown, with around one in six (17%) in 2015 diagnosed in people aged over 50.1 People aged 50 or older were more likely than younger people (aged 15 to 49 years) to have acquired HIV through heterosexual sexual contact and to be diagnosed with advanced disease, the results showed. The researchers from the European Centre for Disease Prevention and Control said this highlighted a need to …

Background/introduction Younger people bear the heaviest burden of sexually transmitted infections (STIs). The acceptability and feasibility of conducting a randomised controlled trial of safer sex support delivered by text message are not known. Aim(s)/objectives To develop a safer sex intervention delivered by text messages for people aged 16–24. To assess the acceptability and feasibility of a randomised controlled trial. Methods The intervention was developed based on evidence, behavioural theory, and user views. It was designed to reduce STIs by increasing correct treatment of STI, partner notification, condom use and STI testing. We conducted a pilot, randomised controlled trial with people aged 16–24 diagnosed with chlamydia or reporting unprotected sex with more than one partner in the last year. We conducted qualitative interviews. Results Two hundred participants were randomised. We fully recruited early and achieved 81% follow up for our proposed primary outcome cumulative incidence of chlamydia at 12 months. Ninety-seven percent of messages sent were successfully delivered to participants’ phones. Recipients reported that the tone, language, content, and frequency of messages was appropriate. Messages reportedly increased knowledge and confidence in how to use and negotiate condom use, and reduced stigma enabling participants to tell a partner about a STI. Discussion/conclusion T he intervention is acceptable and a main trial is feasible. The NIHR have funded a randomised controlled trial to establish the effects of the intervention on sexually transmitted infections at 12 months.

In their responses to our article,1 Brusasco and colleagues and Quanjer and colleagues suggest that current NICE guidelines on the management of chronic obstructive pulmonary disease (COPD) may lead to overdiagnosis in older people and underdiagnosis in younger people because of age related changes in lung function.2 3 Although this is possible, …

People aged 65 or over are no more likely to turn down treatment for cancer than younger people, new research by a leading cancer charity has shown. The survey of 1500 British adults commissioned by Macmillan Cancer Support compared the attitudes of older people (aged 65 and over) and younger people (aged 55-64) both with and without cancer.1 It showed that 14% of those aged 65-74 with cancer said that they had opted not to have certain types of treatment, compared with 15% of those aged 55-64 and 12% of those aged 75 or …

Robinson and colleagues refer to non-Alzheimer diagnoses of dementia.1 These less typical diagnoses pose complex problems for those with the disease and for their families, friends, and carers. When these forms of dementia affect younger people the problems can be even more challenging. When asking the question: “What constitutes best practice in early intervention?” we must acknowledge that people …

What can we expect in old age, assuming we are lucky enough to make it that far? We may hope for physical and mental well being, independence, fun, dignity, and a peaceful death, but what are the prospects? Based on current trends, it's hard to say. There will be more of us, with proportionately fewer younger people to finance our longer lives. The expansion of private provision in health care (p 1172) raises fears that the old and chronically ill will be increasingly poorly served. And yet recent reports and initiatives suggest that new targets are improving outcomes and changing attitudes. Jacqueline Morris …

Sex education in schools needs to be improved and the number of clinics for young people increased if the substantial rise in sexually transmitted infection in the United Kingdom is to be tackled properly, the BMA has said. The association's Board of Science and Education is calling for a substantial investment in education services, improved training for healthcare staff, and better prevention and treatment services after reports of a large rise in infections, particularly among teenage women and among men who have sex with men. “We need to get the message across to young people that there is still no …

I agree with Greenhalgh and colleagues that evidence based medicine works best for single diseases and not for patients with complex comorbidity, frailty, and dementia.1 But such patients are now the “core business” of health services. Their exclusion from clinical trials, with research funding mainly allocated to younger people with single diseases, means that much of the …

Background In Italy 45.45% of patients have completly confidence in Rheumatologists and 68.67% undergo a Rheumatological inspection, because Rheumatologist “erase the desease” (26.83%) and “always discuss with me about new theraputic strategies” (31.71%). All players have to know a new approach to desease treatment and an appropriate communication is the most important instrument to overall obstacles and give patients awardness, visibility and empowerment. ANMAR (Italian National Association of Patients with Rheumatic Deseases) in 2013 published a booklet - made for patients and their families, ditributed in all italian Rheumatologic centers and on the ANMAR official website (www.anmar.it) and in websites of all italian associations federated with ANMAR – to introduce Treat to Target approach. Objectives To give information about Rheumatic deseases not only to patients, but to all who are involved and to inform them about the possibility they will be treated according the new therapeutic approach, using languages and expressive forms such simple as all people in all ages can understand them, because “ageing starts wen we born”. Methods Reaching preset goals, we used both the conventional hard copy way – that was wildly distributed and which can become part of your own library and consulted when you need it – and the web, where the booklet was published in PDF and was integrated with short movies, available on linked You Tube sites. To reach an intuitive and easy understanding, messages and informations are not supplied in photos, schemes or diagrams, but in sketches and comic strips, surely pleasing the younger people too. The selected language was not the scientific one and as it was sometimes unaivoidable to use official therms, we prepare a vocabulary to explain them. Results The booklet – 21 pages – was organized to treat all new therapeutic strategy aspects; we gave no unproductive information about epidemiology and ethiology of the rheumatic deseases, but we gave only suggestions about how to avoid that pathologies cause loss of normal every day activities (in work or leasure). Each one of the 10 T2T points was singularly analized and – as it was necessary – warnings or answers to ask to phisicians (to verify they were according to T2T) were insert in. We wrote a glossary to explain all the techinical words we used, with reference to the page in which they were used. Some pages in the end of the booklet were put just to be a diary to verify if goals were reached or not and to use as a personal block notes. 5 short comic strips were performed (average long lasting 2 minutes) about: RA and inadequate treatment; therapy is important; participating medicine; how to take drugs; drugs side effects. Conclusions 100.000 copies have been printed and during 2013 the booklet was sold out: now a new print is commissioned. At the time we are studing how to verify the booklet impact on the T2T adherence. Cartoons were seen by about 500 contacts during 2013, with a great success. It9s now starting a study with the development of a specific questionnaire to evaluate their utility reaching preset goals. References ANMAR internal data. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4031

Background It is time to get of the sofa! We are giving people with rheumatism an alternative way to train. For many people it is not enough just to walk and stay regularly fit. There are many who have rheumatism, but still think they can do just as others do. And we believe they can too. So we are helping them train for the biggest mountain bike race in Norway, Birkebeineren. The project is called !Sykt Aktiv”. Objectives There are 3 objectives. We want to show others that we can do what they can do. Rheumatism does not automatically mean that we have to stop doing all the fun stuff. And we need to show ourselves that we can do this. Even if you have pain in your muscles and joints, we will push extra hard and we shall succeed! Rebranding the Norwegian Rheumatism Association as a organization that takes challenges straight on and say. WE CAN DO IT! Methods Through advertisements and articles we have gathered a group of 28 people who have signed up for the project. Some were members already, some where not. They range from 22 and in fit shape to 50 and unfit. We will have 4 meetings before the race in august. The participants will meet a number of people who will talk to them about empowerment, training, exercise, cycling and nutrition. They will be given individual training schedules which will be renewed every 8 weeks. We are cooperating with several gyms, physiotherapists and others. Results In 2012 we only had two people cycling this race in our name. This year we have 28 who want to do so. We already have gotten a lot of attention on this project and others want to do other, similar activities. Our goal is that we get a lot of small groups around in the country that train a bit harder than the rest of us. This is not meant for everybody, but an alternative to those who feel they need the extra push. They might not need to participate in a bike race, but maybe run a local race, or climb a mountaintop. The sky is the limit, and we want you to try and reach for it. Conclusions We believe this is the right way to go to empower younger people in the organization and reach out to new potential members who want something different. They want to train, but know they have to respect their body. Here they can do so with others who understand their problems. Disclosure of Interest None Declared

Background Some drugs can cause Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Tolvaptan is a new drug to treat SIADH. There is a lack of studies about the prevalence of SIADH as an Adverse Drug Reaction (ADR). Purpose To classify by the Naranjo Algorithm (NA) and to determinate the prevalence of SIADH in hospitalised patients caused by ADR and treated with tolvaptan. Materials and Methods Two-year descriptive, retrospective, longitudinal, historical cohort study of 33 patients (15 men, 18 women). We sought patients and their clinical characteristics (age, sex, pre-treatment in the week prior to tolvaptan with drugs that could cause SIADH as ADR) using pharmacotherapy management software SINFHOS, Silicon, IANUS and BOT Plus. To determine the probability of ADR, we used the NA. Probability levels based on total score are: definite (>9), probable (5–8), possible (1–4), doubtful (0). Results 12 of the 33 (6 men, 6 women) patients were treated in the week prior to tolvaptan with drugs that could cause SIADH as ADR. 16 treatments with 10 drugs that could cause SIADH as ADR (1.3 drugs per patient) were found in the week prior to tolvaptan. The 16 treatments detected were classified as possible (12 times), probable (once) and doubtful (three times); average score was 2.6. SIADH could have been caused by a drug in 10 patients and was classified as possible (4 men, 5 women, 7 older than 65, 2 younger), and probable (1 man over 65). Prevalence was 30%, 40% in men and 34% in women, 28% in people older than 65 and 40% in younger people. Conclusions Our results suggest that some drugs may contribute to the development of SIADH, and there seems to be a greater risk in male patients under 65. Further research is required to evaluate the prevalence and the relative risk of suffering from SIADH as ADR. No conflict of interest.

Commentary on: Gagliardi AM, Gomes Silva BN, Torloni MR, et al. Vaccines for preventing herpes zoster in older adults. Cochrane Database Syst Rev 2012; 10 :CD008858. The problem addressed by this study is that older individuals, for example, those over 60 years of age, are more likely to develop herpes zoster (HZ) than younger people. Older adults are far more likely to develop severe complications of HZ, especially postherpetic neuralgia (PHN). Gagliardi and colleagues reviewed eight randomised controlled trials (RCTs) involving 52 269 participants. By focusing on RCTs and assessing the risk of bias in these studies, the authors concluded that vaccination against HZ is safe and effective. The risk of HZ was less compared to placebo: risk ratio (RR) 0.49 (95% CI 0.43 to 0.56), with a …

One of the main aims of the London 2012 Olympic and Paralympic Games is to encourage more people to participate in sport in the future rather than to boost public health, a minister has told peers. Hugh Robertson, minister for sports and the Olympics, said he hoped improving public health will be a positive consequence of the games, when he gave evidence to the House of Lords science and technology committee on 26 June. Boosting participation in sport, particular among younger people, was a “key policy objective,” Robertson told the peers as part of the committee’s inquiry into sports and exercise science medicine, which is looking at how the legacy of the 2012 Games can be used to …

Inequalities set to rise as criteria for funding change in the UK Multimorbidity, usually defined as the coexistence of two or more long term conditions within an individual, is rapidly becoming the norm among people with chronic disease. Although often seen as a problem of elderly people, it affects large numbers of younger people too. Multimorbidity is not simply a problem of chronological ageing, but neither is it randomly distributed.1 In a recent Scottish study of almost 1.8 million people, more people with multimorbidity were aged below 65 years than above,2 and similar findings have been reported outside the United Kingdom.3 The level of deprivation influences not just the amount but also the type of multimorbidity that people experience. Multimorbidity is more common and occurs 10-15 years earlier in the most deprived areas than in the most affluent ones.2 4 A greater mix of mental and physical problems …

The number of adults starting treatment for using heroin or crack cocaine in 2010-11 was about 10 000 fewer than in 2008-9, falling from 62 963 to 52 933, the government’s agency for drug treatment in England has announced. The fall was particularly large among younger people: the number of users aged 18-24 who started treatment for these drugs has more than halved since 2005-6, from 12 320 to 6108, with a fall almost as steep among 25-29 year olds. The National Treatment Agency for Substance Misuse, a special health authority of the NHS, released annual statistics on 6 October 2011. These also show that 27 969 adults left treatment services “free from dependence,” which the agency defines …

Objectives To examine the trends in hospitalisation rates for coronary heart disease from 2007 to 2009 in Beijing. Methods The authors determined hospitalisation rates for coronary heart disease using data from Beijing Hospital Discharge Database and Beijing Municipal Bureau of Statistics from 2007 to 2009. A total of 182 791 patients aged 25 years or more, hospitalised with the primary discharge diagnosis of coronary heart disease, were examined. Results The overall coronary heart disease age-standardised hospitalisation rate in Beijing increased by 13.3% in two years, from 444.2 per 100 000 in 2007 to 503.5 per 100 000 in 2009. The greatest increase was 49.7%, which was observed for patients diagnosed with unstable angina. The rate of hospitalisation increased by 20.1% for acute myocardial infarction, but decreased by 10.2% for other coronary heart diseases. Although the trends in coronary heart disease were similar between men and women, men had significantly higher rate for acute myocardial infarction than women (21.3% vs 16.6%). There was a greater increase of hospitalisation rate among younger people than the older (aged 65 years or more), 35.8% vs 15.2% for acute myocardial infarction, 75.8% vs 42.0% for unstable angina, respectively. The hospitalisation rates of coronary heart disease increased annually over 2 years among the three areas in Beijing (urban, suburbs and outer-suburbs), and the greatest increase (29.4%) was found in outer-suburbs. Conclusion There was an increase in hospitalisation rate for coronary heart disease in Beijing, especially for those younger people (aged 25–64 years) and those living in outer-suburbs area who need more medical resources. Awareness of these trends may help to evaluate the burden of cardiovascular disease accurately and adjust the distribution and utilisation of healthcare resources for policy makers.

The highest age of participants in the current National Surveys of Sexual Attitudes and Lifestyles (NATSAL III) is 74 years; the rise from 44 year in NATSAL II is both timely and apposite. Analysis of UK surveillance data shows that while younger people still account for the majority of sexually transmitted infections (STIs), the fastest growing increases are in people over 45 years.1 For example, between 1999 and 2008, there was a 102% increase in reported cases of Chlamydia among 16–19 year old women …

Tackling inequalities in cancer care will help to even out outcomes, a new government report says. The report, by the Department of Health’s National Cancer Equality Initiative, calls on clinicians to promote equality in cancer care “throughout the patient pathway.” The report highlights the nature and extent of inequalities in cancer outcomes. It found that cancer incidence and mortality are generally higher in deprived groups than in affluent groups, higher in older than in younger people, and higher in men than in women. Conversely, however, the incidence of breast …

The US Food and Drug Administration has launched an initiative to reduce unnecessary radiation exposure from medical imaging. The initiative will promote the safe use of medical imaging, support doctors’ decision making about medical imaging, increase patients’ awareness, and encourage patients to record their history of imaging. Concern about radiation exposure was raised by a paper late last year in the Archives of Internal Medicine (2009;169:2078-86, doi:10.1001/archinternmed.2009.427) that reported a 13-fold variation between the highest and lowest dose in computed tomography in four hospitals in the San Francisco area. The risk of cancer related to medical imaging is higher for younger people, …

Increased risk is probably restricted to younger people and varies greatly between individual medicines

Its incidence is rising, as more and younger people dye their hair For more than 100 years para-phenylenediamine (PPD) and other related members of the aromatic amine family have been the main agents used in permanent hair dyes, and more than two thirds of hair dyes currently contain PPD. This compound is an effective hair dye owing to its low molecular weight, its ability to penetrate the hair shaft and follicle, its strong protein binding capacity, and its rapid polymerisation in the presence of a coupler (a kind of catalyst) and an oxidising agent. However these properties also make PPD an ideal contact allergen and, indeed, it is among the most potent.1 During the 20th century allergic reactions to PPD became such a serious problem that it was banned from hair dyes in Germany, France, and Sweden.2 Current European Union legislation allows PPD to comprise up to 6% of the constituents of hair dyes on the consumer market (3% when added to the oxidising solution required to develop the colour). …

EDITOR—In principle it is correct to consider whether advice to younger people is appropriate to older people. With regard to obesity, the evidence on intentional weight loss is scanty and mainly based on self reports. Our study of intentional (at least intended) and measured weight loss among older patients with type 2 diabetes (mean age 64) followed up as a cohort until death, showed a strong positive association with …

Americans hear four good health rules: don't smoke, maintain a normal weight, eat fruit and vegetables, and get some exercise. But almost nobody follows them. A study of national data has shown that only 3% of Americans followed all four of the recommended rules. Women, older people, white people, better educated people, people in good health, and wealthier people did a little bit better in following the rules. Younger people were slightly better at maintaining a body mass index of 25 or less ( Archives …

EDITOR—The paper by Wilkinson et al, on people aged over 75, makes a useful addition to the evidence that winter mortality in Britain is now not caused primarily by deprivation and failure to heat homes.1 In addition to other evidence they quote, a recent study on younger people provides positive indications that cold exposure outside the home causes winter mortality regardless …

Cardiovascular disease is a far greater public health problem in developing countries than previously realised, particularly in younger people, says a report published this week. ![][1] Tobacco consumption has to be tackled to reduce heart disease in developing countries Credit: P VIROT/WHO The report combined population estimates for five lower to middle income countries—Brazil, South Africa, the Russian republic of Tatarstan, India, and China—with current death rates and workforce data to calculate the effects of cardiovascular disease on society and … [1]: /embed/graphic-1.gif

Early onset dementia destroys the mind, often at the peak of its powers. Families are devastated, and children feel cheated by an affected parent's loss of identity. In the face of what appears to be–paradoxically–good bodily health, a lifetime's accumulated experiences, knowledge, and sensible judgment are no longer accessible. Family and friends can see that expert assessment is essential but occasionally lacking. In the United Kingdom about 20 000 middle aged people with this disorder need investigation and support. Their needs are not always met. Families sometimes say that a healthcare system …

A combination pill containing six different drugs could reduce mortality from strokes and myocardial infarctions by 88%, according to a recent study in the BMJ (2003;326:1419-22). Dubbed the “polypill,” it would be intended as a preventive measure and be taken once daily by everyone over 55 years of age and younger people with a clinical history of cardiovascular disease. The researchers, Nicholas Wald and Malcolm Law, from Queen Mary's School of Medicine and Dentistry, London, performed a series of meta-analyses of existing data on the …

The boardroom grew silent as one of our staff made his promised announcement after morning rounds. Everyone seemed to sense that we were about to be dealt some sort of grave news. He told us how our hospital had received word from Scarborough Grace Hospital of a strange respiratory illness that has killed two members of the same family and infected some others. He explained that we would shortly be accepting a patient from that facility here at Sunnybrook. We were surprised to hear that no one was sure exactly what this was and that it appear to severely affect even younger people. This was my first experience of sudden acute respiratory syndome (SARS), though at the time none of us knew it by that name. I am a medical student at the University of Toronto and my base hospital is Sunnybrook and Womens College Health Sciences Centre. This hospital has been near the centre of the action during Canadas outbreak of SARS. For a while, SARS was quite a mysterious illness. I remember one eerie night early in the outbreak, while medical students were still permitted to work in Torontos hospitals. It was the end of my shift on call for general …

More than a third of elderly people in Britain might be willing give up their place on a heart surgery waiting list for a younger patient, says a new report published in Age and Ageing (2002;31:187-92). Two groups of people aged 65 and over were asked to imagine that they had a heart condition that required surgery and were on an NHS waiting list and expecting an operation in a month's …

The relation between blood pressure and subsequent stroke was examined in a four-year follow-up study of a geographically defined population sample of 2704 people aged 65 and over resident in South Tyneside in 1975. In men there was a significant relation between stroke and a history of diagnosed high blood pressure and the taking of antihypertensive medication. Stroke was not associated with either of these factors in women. Stroke incidence increased with blood pressure in men, more consistently with systolic than with diastolic pressure, but neither systolic nor diastolic pressure was related to stroke in women. In the population studied there seems little scope for the primary prevention of stroke in elderly women by detection and treatment of hypertension. Screening for the top quartile of blood pressure in men would have a sensitivity of 30% and a predictive value of 5% for stroke in the next four years. However, the extrapolation of epidemiological findings from one region or period to another may be expected to be less appropriate for the elderly than for younger people.