Humans can be studied from a variety of academic perspectives. In some biological disciplines the focus may be on parts of individuals, perhaps even molecular parts, while in others humans are considered zoologically as an entire species, Homo sapiens, in the order Primatii. Some biologists are concerned with the physiologically functioning body of an individual, while others are interested in world-wide human diversity, distribution and population groupings. Among the social sciences, the focus is also frequently on the group, but here the emphasis tends to be upon the social and cultural factors which underpin the way such phenomena as societies, communities and ethnic groups are constructed, delimited and defined. There are also the behavioural sciences, which utilise both biological and social information in relation to the study of the group, the individual or elements in the behaviour of the individual. Recognition of the number of perspectives on these population variables emphasises the need to study material across the boundaries of traditional academic disciplines and several of these perspectives are introduced in this volume.

The twentieth century began with observers of the human condition integrating, in what we now recognise to be a confused way, their ideas on the biological and social nature of humans. During the century the fragmentation of all disciplines grew, something exemplified most particularly in the divergence between biological and social pursuits of knowledge.

It is clear that there are many perspectives on human populations and that these are studied within different disciplines, whose terminology and literature are becoming increasingly specialised. Furthermore, the features and conditions of the populations are always changing and the processes of this are viewed and reported upon from different angles. What is required, therefore, for a complete understanding of the complex dynamics of human populations is an appreciation of the work of specialists in different disciplines, something which this volume provides. It is anticipated that the book will be useful to all who consider human populations in their research or their studies, and particularly those who are undertaking degree courses in human sciences, anthropology, demography, human geography, ecology and human biology. The book will also have a wider appeal for the more general reader who wishes to advance their understanding of human population dynamics by adopting a wide-ranging disciplinary focus.

This volume arises from the fifteenth workshop of the Biosocial Society, which was held at the Pauling Human Sciences Centre, Oxford, in 2000. The Society thanks Ros Odling-Smee and the Centre for accommodating the conference. The help with arrangements for and at the workshop by the team of postgraduates from Oxford Brookes {University} is gratefully acknowledged, and the Society is thanked for providing finances for the workshop. The Editors also wish to thank Chris McDonaugh for reading the book and making helpful suggestions, Jennifer Jay for work on the glossary, index and referencing, and finally Geoff Harrison for writing the Foreword.

Introduction

Biochemical testing is the ‘Gold standard’ for the diagnosis of acute myocardial infarction (AMI). Although the electrocardiogram (ECG) is the first test used for the differential diagnosis of patients who present with suspected acute coronary syndromes (ACS), the diagnostic accuracy of the ECG is only 55–75%. ST segment elevation has excellent specificity for AMI and identifies patients who will respond to thrombolytic therapy [1]. Biochemical tests form part of the World Health Organization criteria for AMI and have a diagnostic sensitivity of 95–100%.

The breakdown of diagnoses in patients with chest pain presenting to a typical district general hospital is shown in Figure 31.1. Only 10% have ST segment elevation AMI and the majority of patients have either low-risk ischaemic heart disease (IHD) or no IHD. Admission of these patient groups represents a significant waste of scarce healthcare resources. As only 10% of the patients present with characteristic ECG changes, biochemical diagnosis to confirm or exclude a diagnosis of AMI is required for 90% of the patients who present with suspected ACS. The role of the ECG is, therefore, to select patients for thrombolysis, not as the definitive diagnostic test for AMI. Creatinine kinase (CK)-MB is the best of the current enzymes and CK-MB mass the best test for the diagnosis of AMI according to current criteria [2]. Diagnosis can be achieved reliably within 12 hours from admission by serial measurement of myoglobin, CK or CK-MB.