Perspectives in Public Health

Records of 523 consecutive diabetic patients attending a diabetic clinic in Wad Madeni, Central Region, Sudan, were reviewed to determine epidemiologic features and the relation between their diabetes and nutritional state. The male to female ratio was 0.97: 1. The age at diagnosis ranged between 0-61 years with a mean age of 51.7 ± 11.9 years for males and 49.4 ± 11.4 for females. Obesity was a feature, in that 47.4% of females and 30% of males were determined to be in excess of normal body mass index (BMI) standards. A family history of diabetes was present in 67% of cases. Hypertension was present in 38% of cases; it was slightly more common among females than males (52% vs 48%), respectively. Insulin was employed for control of diabetes in 75% of cases, and oral hypoglycaemics in 20%. The re mainder were on diet therapy alone.

Thirty-four percent of the patients are rural dwellers that should be saved from disabling and even fatal compli cations of the disease in combination with malnutrition and infectious diseases that hasten death in rural areas. It is hoped that the interest of those concerned regarding public health implications of the findings in this study will be stimulated.

A self-administered questionnaire was completed by 103 members of a self-help group for irritable bowel syndrome (IBS) and 130 controls, to compare the presence of IBS symptoms. Dietary fibre prescription, compliance and effi cacy were documented in the IBS group. There were significant differences in the frequency of defaecation and number of symptoms present between the two groups. Most of the IBS subjects had been prescribed a high fibre diet but adherence to the diet and symptomatic improve ment were poor. In contrast many IBS sufferers were following a range of diets not prescribed by their doctor. The seriousness of the IBS condition was highlighted by the fact that 8% of the IBS group had retired early due to their condition.

A preliminary case-control study was conducted on Saudi women to detect possible risk factors for spontaneous abortion (SA). Two hundred and twenty six consecutive women hospitalised for SA and 226 women admitted for normal delivery and used as controls, were studied. Women with SA were significantly older at menarche (Relative Risk (RR) = 3.2), more frequently married to blood-related husbands (RR = 2.1) and husbands older than 50 years (RR = 2.4). Number of previous abortions related linearly to the risk of aborting spontaneously in the next pregnancy. Compared to primigravidas, the RR was 3.2 if the outcome of the most recent pregnancy was SA, and 0.8 if it was a livebirth. A family history of SA was more common among cases (RR = 4.6). Spontaneous abortion was also associated with daily consumption of more than 150 mg of caffeine, abdominal trauma, infection and fever during pregnancy. No significant association, however, emerged with mater nal age, social class, education, exposure to video display terminals, parity, use of contraception, diabetes or obesity. The application of these data in clinical practice and future research needs are discussed.

Smoking may influence a women's reproductive ability by having adverse effects on fertility, the early embryo and the fetus. The ability to become pregnant and to maintain the pregnancy long enough for it to be clinically detected is reduced in smokers. Smoking can adversely influence seve ral of the crucial steps within the reproductive process required for achieving a pregnancy.

Despite the increased miscarriage rate in women that smoke there is no evidence to suggest that smoking can cause fetal abnormalities. The chemical composition of cigarette smoke is more closely related to reduction in fetal growth than the number of cigarettes smoked.

In smokers, the placenta appears remarkably normal. The effects of smoking could be due to one or more of the hundreds of different chemical substances in tobacco smoke, but apart from carbon monoxide and nicotine, little is known about the effects of other toxins. Nicotine can adversely affect uterine and placental blood flow by causing constriction of the blood vessels. It can also affect both the maternal and fetal blood pressure and heart rate, but its action on the fetal cardiovascular system does not appear to be dependent on its effect on placental perfusion.

One thousand papers for the Essential Food Hygiene exami nation, chosen consecutively from those being processed in RSH House on 6-7 April 1994, were reviewed.

The purpose of the review was to assess the impact of the redesigned course and the new examination papers which were introduced from 1 January 1994. The pass rate for the sample was 96.7% which was somewhat lower than the pass rate of 99.2% for the whole of 1993 when the previous examination papers were in use.

Out of 1000 papers 33 were failures. Eighteen candi dates had obtained the 70% pass mark yet still failed because one of the two questions on temperature control had been answered incorrectly. The requirement to answer both those questions correctly in order to obtain a certifi cate was introduced with the new examination papers and marked a major change.

The conclusion from this snapshot study was that the majority of Tutors and the candidates from their courses had achieved a high degree of examination success. In particular, Tutors had secured a major objective by ensu ring that trainees had a clear understanding of the concepts of temperature control. Only a minority were having diffi culty. Of the 33 individuals who failed, 18 came from just four of the 108 courses.