Biomedical subjects
Publications and source records attributed to B F Walker.
Current nutrition theory holds that maximization of human growth and stature is a desired anthropometric outcome. However, some evidence demonstrates that lower energy intakes may actually confer a degree of future protection against degenerative processes, particularly atherosclerosis and cancer.
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An analysis has been made of causes of admission of black patients in 1991 to Murchison Hospital, Port Shepstone, Natal. Of 6675 total admissions, 6329 (95%) were classifiable. Of the latter, 1462 (23%) were aged 12 years and-younger, namely, 763 boys and 699 girls. Their chief causes of admission were pneumonia, gastroenteritis, trauma, acute glomerular nephritis, and malnutritional diseases. Of 4867 adults (73%), 1536 were males and 3331 females. Among men, chief causes were tuberculosis, congestive cardiac failure, hypertension and cerebral vascular accidents. Among women, apart from pregnancy, chief causes of admission were disorders of pregnancy, tuberculosis, congestive cardiac failure, pneumonia, diabetes, and hypertension. Of western diseases, 3.9% of adults were admitted for diabetes, and 2.8% for asthma. The general pattern of admissions is similar to that in other rural hospitals. The causes of admissions are discussed, regarding (1) public health improvements occurring, and (2) means of promoting further improvements by (a) community self-help, and (b) help from State health and other services.
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Cancer incidence rates and patterns in three African populations in the Gambia, Mali and South Africa, have been compared with corresponding data on the Black population in Connecticut, USA. In the African populations, total rates for cancer are much lower than that of US Blacks, even allowing for under-reporting. Chief cancers are those of the oesophagus, liver and cervix. In Mali, stomach cancer is very common. As to trends, among South African Blacks, a population in transition, rates are rising, albeit slowly, of cancers of prosperity--prostate, lung, breast and colon-rectum. Salient questions are: can the number of cancers of underprivilege be lessened, and can cancers linked with rising socioeconomic states be restrained? Discussions of common risk factors, including diet, reproduction, smoking and drinking practices, indicate that for Africans as a whole, continuing poverty will prevent major changes in cancer pattern and rises in occurrence of the disease. However, should prosperity increase for Africans in big cities, rates are ultimately likely to attain those prevailing in the US Black population. Significant avoiding action seems almost impossible.
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The far-reaching effects of the ageing of populations is being increasingly appreciated. Lengthening longevity, associated with decreasing family size, evokes rising charges, socioeconomically, and on health services. Information on these and other parameters is presented for developed and developing populations. Examples are given, with lessons to be learned, of long-living segments of populations, past and present. The roles of diet, physical activity, and smoking and alcohol consumption also of attitudes, are discussed. It is concluded that if the middle-aged and elderly could be persuaded to follow long-term practices associated with good public health, then morbidity could be compressed, and disability-free years extended. However, this goal could only be achieved with a high level of motivation.
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Management of melanoma of the external ear is controversial. Thirty-one patients treated for this disease were identified at our institution between January 1, 1974 and December 31, 1989. Follow-up was an average of 7.12 years (range 1-15). Local therapy performed included 16 wedge resections, 3 split thickness skin grafts after excision to the perichondrium, 10 partial and 2 total amputations. There were two local recurrences, four metachronous cervical metastases, and four distant metastases. Three elective and five therapeutic neck dissections were performed. Survivors at 1, 5, and 10 years were 93, 77, and 47%, respectively. There was no relationship between DNA ploidy, local surgical therapy, and eventual recurrence. Clinical stage and tumor thickness demonstrated a statistically significant correlation with likelihood of recurrence (P = .02 and .05). There is no evidence that melanoma of the ear has a poorer prognosis or different prognostic factors than melanoma at other cutaneous sites. In selected cases, local disease can be controlled by excision and skin graft rather than the more aggressive current procedures.
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