Objectives To determine the effect of the critical care outreach team on patient survival to discharge from hospital after discharge from critical care and readmission to critical care.

No abstract

Crucial confounding factor was overlooked Editor-Sparén et al retrospectively analysed outcomes, in terms of cardiovascular mortality, in siege survivors and have selected as controls men of similar age who did not experience the siege. 1 The data show that survivors have a higher risk of cardiovascular disease. The authors conclude that the process of starvation has adversely affected the physiology of the men who experienced food shortages at a critical stage of their development. This conclusion could be drawn if the mortality of the starvation process itself could be shown to have been applicable to all physiological types equally. People with greater fat reserves seem likely to outlive people with less in periods of famine, and that ability to withstand protracted famine is probably related to an efficient metabolism, which is substantially genetically inherited. This cohort of siege survivors may owe its survival to the possibility that its members, if not overweight themselves at the start of the siege, nevertheless might have been the children of overweight parents. These parents, with better fat reserves themselves, would have been in a better position to survive the siege than their thinner peers and hence in a better position to ensure the survival of their children. This would have been true whether or not these children had inherited their parents' metabolic type, but especially true if they had. The bread ration for a family would have been distributed in the household as the parents saw fit, and parents with greater fat reserves in the winter of 1941-2 would have been able to hand over a greater proportion of the bread ration to their children. This might imply that siege survivors in Leningrad represent a selected survival group with the metabolic characteristic of obesity, favourable in a time of famine. It would therefore be surprising if this group, when followed up into old age, did not show the increased risk of cardiovascular disease that we all know they should have. Michael D Croft salaried general practitioner Gateways Surgery,