488 The failure to detect M.S. in the dog may be due to the long incubation period and the similarity between symptoms of M.S. and signs of old age in the dog. Thus it might be worthwhile to undertake a search for a possible correlation between M.S. and dog ownership during the childhood of the patient. Department of Biochemistry, McMaster University Medical Centre, 1200 Main Street W., Hamilton, WILLIAM W.-C. CHAN Ontario, Canada L8S 4J9
The risk
SiR,—The subject of Britain’s medical manpower needs is of great importance to everyone in the National Health Service, and I was interested to read (Jan. 29, p. 267) that Sir
Cyril Clarke questions the Government’s present policy of increasing the output of our medical schools. Your report refers to the need to increase the efficiency of consultants and general
practitioners in order to compensate for the standstill in their numbers, and specifically to the greater use of "ancillary workers such as nurses, chemists, and health visitors". Since when have nurses and health visitors been classified as ancil-
lary workers? (The chemists will no doubt make their own comment.) The paragraph concludes: "But Sir Cyril notes how tactfully this approach must be pursued, since the doctors are already much concerned at the erosion of their responsibilities". A little more tact might be a good thing all round.
score
STATUS
SIR,-The article by Holme
et
al.
of great interest
was
to
Over
approximately the same period (September, 1972, to May, 1974) comparable data were collected in the Belgian heart-disease prevention project. As a part of this study, all men aged 40-59 years employed by fifteen Belgian factories were invited to attend a cardiovascular screening. The participation-rate was 87%. Educational level and occupational class were found highly correlated. Coronary risk factors by occupational class are presented in the table.
in the
Belgian study
includes age,
smoking
habits, cholesterol, blood-pressure, and job activity; the important difference in serum-cholesterol between occupational classes contributes largely to the positive relation between risk score and professional class. These opposite results with regard to risk prediction will be of interest when data on coronary-heart-disease incidence in both studies are available. Department of Cardiology, University Hospital, Ghent, Belgium
G. DE BECKER M. KORNITZER C. THILLY
Ecole de Santé Publique, University of Brussels
CHOLESTYRAMINE IN HYPERCHOLESTEROLÆMIA
A. P. LITTLE
CORONARY RISK FACTORS AND SOCIOECONOMIC
us.
between class and serum-cholesterol; however, the cholesterol levels are significantly lower in all Belgian classes than in Norwegians. These differences cannot be accounted for by differences in methods. Since Holme et al. probably recruited their men from the city of Oslo while the Belgian prevention project involves factories in rural areas as well as in cities, this difference could eventually lead to a difference in results. However, the positive correlation between cholesterol and professional class was found both in Brussels and in the rural areas of Bel-
gium.
NURSES NOT ANCILLARY
Northumberland Avenue, London E12
regard to cholesterol, the two sets of results are completely opposite. We have found an important positive relation With
SIR,-Like Dr Farah and his colleagues (Jan. 8, p. 59) we have studied the response of serum-cholesterol to varying doses of cholestyramine given twice daily to children with familial hypercholesterolaemia, but our results differ in several respects. The finding of Farah et al. that the total dose required to achieve a therapeutic effect is independent of body-weight was not apparent in our data, which show a positive correlation
CORONARY RISK FACTORS AND PROFESSIONAL CLASS
,
z
02
04L, Dose of
06
z
088
10
;2
Chotestyramine (g/ kg/day)
Effect of cholestyramine dose
on serum
cholesterol in 22 children
with familial hypereholesterolfemia.
s
a
I
’Age-adjusted. Between our data and those of the Oslo study there are both resemblances and differences. The trends with regard to cigarette smoking were similar in both studies: percentage of cigarette smokers decreased and of ex-smokers increased with occupational class; and the percentage of never-smokers also increased with occupational ciass. However, cigarette smoking in general is more prevalent in all Belgian social classes compared with the Norwegians.
between reduction in serum-cholesterol and the dose of cholestyramine expressed on a body-weight basis (figure). We have also found that reduction in cholesterol concentration for a given dose of cholestyramine is independent of whether or not the patient was on a low saturated-fat diet, at least in the dosage range for which we have most data, from 0.3 to 1-Og/kg. At lower cholestyramine dosage dietary modification (as used by Farah et al.) may have a synergistic effect; however, in our experience long-term compliance with dietary treatment is poor, and we have found that cholestyramine treatment without dietary restriction is much more acceptable.1 In our initial study2 mean pre-treatment serum-cholesterol concentration in the 19 children treated was 377 mg/dl, and thus they were more severely affected than the patients of 1. West, R.
1.
Holme, I., Helgeland, A., Hjermann, I., Lund-Larsen, P. G., Leren, P. Lancet, 1976, ii, 1396.
J., Fosbrooke, A. S., Lloyd, J. K. Postgrad. med. J. 1975, 51, suppl. 8, p. 82. 2. West, R. J., Lloyd, J. K. Archs Dis. Childh. 1973, 48, 370.
The risk
SiR,—The subject of Britain’s medical manpower needs is of great importance to everyone in the National Health Service, and I was interested to read (Jan. 29, p. 267) that Sir
Cyril Clarke questions the Government’s present policy of increasing the output of our medical schools. Your report refers to the need to increase the efficiency of consultants and general
practitioners in order to compensate for the standstill in their numbers, and specifically to the greater use of "ancillary workers such as nurses, chemists, and health visitors". Since when have nurses and health visitors been classified as ancil-
lary workers? (The chemists will no doubt make their own comment.) The paragraph concludes: "But Sir Cyril notes how tactfully this approach must be pursued, since the doctors are already much concerned at the erosion of their responsibilities". A little more tact might be a good thing all round.
score
STATUS
SIR,-The article by Holme
et
al.
of great interest
was
to
Over
approximately the same period (September, 1972, to May, 1974) comparable data were collected in the Belgian heart-disease prevention project. As a part of this study, all men aged 40-59 years employed by fifteen Belgian factories were invited to attend a cardiovascular screening. The participation-rate was 87%. Educational level and occupational class were found highly correlated. Coronary risk factors by occupational class are presented in the table.
in the
Belgian study
includes age,
smoking
habits, cholesterol, blood-pressure, and job activity; the important difference in serum-cholesterol between occupational classes contributes largely to the positive relation between risk score and professional class. These opposite results with regard to risk prediction will be of interest when data on coronary-heart-disease incidence in both studies are available. Department of Cardiology, University Hospital, Ghent, Belgium
G. DE BECKER M. KORNITZER C. THILLY
Ecole de Santé Publique, University of Brussels
CHOLESTYRAMINE IN HYPERCHOLESTEROLÆMIA
A. P. LITTLE
CORONARY RISK FACTORS AND SOCIOECONOMIC
us.
between class and serum-cholesterol; however, the cholesterol levels are significantly lower in all Belgian classes than in Norwegians. These differences cannot be accounted for by differences in methods. Since Holme et al. probably recruited their men from the city of Oslo while the Belgian prevention project involves factories in rural areas as well as in cities, this difference could eventually lead to a difference in results. However, the positive correlation between cholesterol and professional class was found both in Brussels and in the rural areas of Bel-
gium.
NURSES NOT ANCILLARY
Northumberland Avenue, London E12
regard to cholesterol, the two sets of results are completely opposite. We have found an important positive relation With
SIR,-Like Dr Farah and his colleagues (Jan. 8, p. 59) we have studied the response of serum-cholesterol to varying doses of cholestyramine given twice daily to children with familial hypercholesterolaemia, but our results differ in several respects. The finding of Farah et al. that the total dose required to achieve a therapeutic effect is independent of body-weight was not apparent in our data, which show a positive correlation
CORONARY RISK FACTORS AND PROFESSIONAL CLASS
,
z
02
04L, Dose of
06
z
088
10
;2
Chotestyramine (g/ kg/day)
Effect of cholestyramine dose
on serum
cholesterol in 22 children
with familial hypereholesterolfemia.
s
a
I
’Age-adjusted. Between our data and those of the Oslo study there are both resemblances and differences. The trends with regard to cigarette smoking were similar in both studies: percentage of cigarette smokers decreased and of ex-smokers increased with occupational class; and the percentage of never-smokers also increased with occupational ciass. However, cigarette smoking in general is more prevalent in all Belgian social classes compared with the Norwegians.
between reduction in serum-cholesterol and the dose of cholestyramine expressed on a body-weight basis (figure). We have also found that reduction in cholesterol concentration for a given dose of cholestyramine is independent of whether or not the patient was on a low saturated-fat diet, at least in the dosage range for which we have most data, from 0.3 to 1-Og/kg. At lower cholestyramine dosage dietary modification (as used by Farah et al.) may have a synergistic effect; however, in our experience long-term compliance with dietary treatment is poor, and we have found that cholestyramine treatment without dietary restriction is much more acceptable.1 In our initial study2 mean pre-treatment serum-cholesterol concentration in the 19 children treated was 377 mg/dl, and thus they were more severely affected than the patients of 1. West, R.
1.
Holme, I., Helgeland, A., Hjermann, I., Lund-Larsen, P. G., Leren, P. Lancet, 1976, ii, 1396.
J., Fosbrooke, A. S., Lloyd, J. K. Postgrad. med. J. 1975, 51, suppl. 8, p. 82. 2. West, R. J., Lloyd, J. K. Archs Dis. Childh. 1973, 48, 370.
