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Biomedical subjects

D A Lawlor

Publications and source records attributed to D A Lawlor.

At least 19 recordsLinked to original sources
PubMed2003

Associations of adult measures of childhood growth with breast cancer: findings from the British Women's Heart and Health Study.

Since the two components of adult height - leg length and trunk length - are poorly correlated with each other and appear to be influenced by different early life factors, examining their separate influence on breast cancer may provide additional insights into the mechanisms responsible for the positive association between adult height and breast cancer. In a cross-sectional study of 4286 women aged 60-79 years, in whom there were 170 cases of breast cancer, we found total height, leg length and trunk length were all modestly positively and linearly associated with breast cancer. The magnitudes of the associations of leg and trunk length were similar: fully adjusted odds ratio (95% confidence interval) of breast cancer for a one standard deviation (s.d.) increase in leg length 1.17 (0.98, 1.39) and for a 1 s.d. increase in trunk length 1.19 (0.99, 1.41). Self-reported birth weight (available on 33% of the sample) was positively and linearly associated with breast cancer: fully adjusted odds ratio of breast cancer for a 1 s.d. increase in birth weight 1.30 (0.93, 1.80). These associations were all independent of each other and other potential confounding factors and are likely to reflect different mechanisms by which factors operating prenatally and prepubertally influence breast cancer risk.

Aged↗
PubMed2003

Geographical variation in cardiovascular disease, risk factors, and their control in older women: British Women's Heart and Health Study.

OBJECTIVES: To measure the geographical variation in prevalence of cardiovascular disease, risk factors, and their control in a nationally representative sample of older British women. METHODS: Baseline survey using general practitioner record review, a self completed questionnaire, research nurse interview, and physical examination in a randomly selected sample of women aged 60-79 drawn from 23 towns in England, Scotland, and Wales. RESULTS: Of 7,173 women invited and eligible to participate, information was obtained on 4,286 (60%). One in five women had a doctor diagnosis of any one of myocardial infarction, angina, heart failure, stroke, or peripheral vascular disease. Fifty per cent of women were hypertensive, 12% smoked, and over one quarter were obese. Fifty per cent had a total cholesterol level greater than 6.5 mmol/l, though only 3% had low high density lipoprotein concentrations. Cardiovascular disease prevalence varied by geographical region being highest in Scotland: age adjusted prevalence (95% confidence intervals) 25.0% (21.5% to 28.8%) and lowest in South England: age adjusted prevalence (95% confidence intervals) 15.4% (13.5% to 17.6%). The geographical variations in cardiovascular disease prevalence were attenuated by adjustment for risk factors and socioeconomic position; further adjustment for health service use (as indicated by aspirin or statin use) reduced the differences further. However, variation remained even after full adjustment for these factors: odds ratio (95% confidence intervals) comparing Midlands and Wales to South England 1.15 (0.82 to 1.61) and comparing Scotland to South England 1.53 (1.08 to 2.14). Of women with cardiovascular disease, 12% were current smokers, a third had uncontrolled hypertension, a third were obese, and 90% had a blood cholesterol over 5 mmol/l. Only 41% were taking antiplatelet drugs and 22% were taking a statin. CONCLUSIONS: Older British women have a higher prevalence of cardiovascular disease and risk factors than previously documented. The workload consequences of attempting to control risk factors and ensure optimal secondary prevention for older British women are considerable. Geographical variations in cardiovascular disease prevalence in older women are somewhat, but not fully, explained by variations in major risk factors, socioeconomic position, and health service utilisation.

Aged↗
PubMed2003

Performance of the WHO Rose angina questionnaire in post-menopausal women: are all of the questions necessary?

OBJECTIVE: To assess the performance of a shortened version of the Rose angina questionnaire focusing on exertional chest pain. METHODS: Cross sectional analysis of 3987 women aged 60 to 79 years from 23 British towns. The performances of definite Rose angina (using data from the full Rose angina questionnaire) and exertional chest pain (using data from a subset of three questions from the Rose angina questionnaire) were assessed against a medical record of angina. RESULTS: The sensitivity (the proportion with a medical record of angina who were identified as having angina by the questionnaire) was 29.9% (95% confidence intervals 25.7% to 34.4%) comparing definite Rose angina to any medical record of angina since 1978 and 50.7% (45.9% to 55.5%) comparing exertional chest pain to any medical record diagnosis of angina. The positive predictive values of both questionnaires were similar. When the two questionnaires were compared with a gold standard of a primary care consultation for angina symptoms within the past five years the sensitivity of definite Rose angina was 33.0% (26.9% to 39.6%) and that of exertional chest pain was 51.8% (45.1% to 58.5%). Although the sensitivity of both versions of the questionnaire was greater in those aged 60-69 years compared with those aged 70-79 years, it remained higher in the exertional chest pain version of the questionnaire than for definite Rose angina based on the full version of the questionnaire in both age groups. Performance of either version of the questionnaire was not affected by occupational social class. CONCLUSIONS: With respect to identifying women with a medical diagnosis of angina or those presenting to primary care with anginal symptoms, these results suggest that a shortened version of the Rose angina questionnaire focusing on exertional chest pain performs better than the full version. Other studies suggest that exertional chest pain is the crucial element of the Rose angina questionnaire with respect to predicting future coronary events. It is concluded that using a shortened version of the Rose angina questionnaire is adequate in epidemiological studies.

Aged↗
PubMed2002

The association between components of adult height and Type II diabetes and insulin resistance: British Women's Heart and Health Study.

AIMS/HYPOTHESIS: The aim of this study was to investigate the associations between components of adult height (leg length, trunk length, ratio of leg to trunk length) and Type II (non-insulin-dependent) diabetes mellitus and insulin resistance. METHODS: A cross sectional study was carried out on 4286 women of age 60 to 79 years from 23 towns across England, Scotland and Wales. RESULTS: Total height was weakly and inversely associated with diabetes but this masked differences in the association with leg and trunk length. Leg length was inversely associated with Type II diabetes [age adjusted odds ratio (95% CI) for diabetes for each standard deviation (4.3 cm) increase in leg length: 0.81 (0.73, 0.90)] whereas trunk length was not associated with diabetes [age adjusted odds ratio (95% CI) for diabetes for each standard deviation (3.6 cm) increase in trunk length: 1.05 (0.94, 1.18)]. Adjustment for potential confounding factors attenuated but did not remove the inverse association between leg length and the prevalence of diabetes: fully adjusted odds ratio (95% CI) per standard deviation increase in leg length was 0.87 (0.77, 0.98) and that per standard deviation increase in the ratio of leg to trunk length was 0.88 (0.78, 0.99). In non-diabetic women leg length was inversely associated with insulin resistance, whereas trunk length was positively associated with insulin resistance. CONCLUSION/INTERPRETATION: Leg length is an indicator of early childhood environmental circumstances, in particular of infant nutrition. These results suggest that poor infant nutrition is an important causal factor in the development of Type II diabetes and insulin resistance in later life.

Aged↗
PubMed2002

Caring for the health of the public: cross sectional study of the activities of UK public health departments.

The relative time spent in different areas of work in public health departments in the UK was assessed by means of a postal questionnaire. Departments spend one third of their time on population health work, this being similar to the amount of time spent on planning health services. Having a planning department in the health authority did not affect the amount of time spent in any area of work. Having a greater number of consultants in the department was associated with a tendency to spend more time on population health and being involved in training was associated with spending less time on planning. Public health departments in the UK are the only part of the health service with responsibility for the broader aspects of public health. Whilst the tensions between medical care and the wider influences upon population health may represent a false dichotomy, public health professionals must maintain a central focus of their work on the wider influences upon population health if balance is to be maintained within the National Health Service.

Communicable Disease Control↗
PubMed2002

Is housework good for health? Levels of physical activity and factors associated with activity in elderly women. Results from the British Women's Heart and Health Study.

OBJECTIVE: To determine the prevalence of achieving new recommended levels of physical activity, the types of activity involved, and their determinants among elderly British women. DESIGN: National cross sectional survey. PARTICIPANTS: 2341 women aged 60 to 79 from 15 British towns. MAIN OUTCOME MEASURES: Prevalence of subjects achieving recommended levels of physical activity. RESULTS: Over two thirds of the participants were active at new recommended levels. This was mainly achieved through participation in heavy housework. If domestic activities were excluded only 21% were regularly active. Women who participated in brisk walking for at least 2.5 hours per week had reduced odds of being overweight: odds ratio (95% confidence intervals) 0.5 (0.3 to 0.6) after adjustment for other forms of activity, health status, smoking, and socioeconomic position. Participating in at least 2.5 hours of heavy housework was not associated with reduced odds of being overweight 1.1 (0.8 to 1.4). Age, self reported poor health status, coronary heart disease, and respiratory disease were independently associated with reduced odds of participating in all types of activity. In addition participation in brisk walking and physical exercise were less likely in current smokers, those from the lowest socioeconomic class, and those living in the north of the country. Participation in heavy housework was less likely in women reporting depression but was not associated with smoking, socioeconomic class, or area of residence. CONCLUSIONS: If new physical activity recommendations, which include domestic activities, are used to assess population levels of physical activity then it seems that the majority of elderly women are sufficiently active. Heavy housework is not associated with reduced levels of being overweight and prospective studies are necessary to demonstrate an independent health benefit of participating in domestic activities.

Aged↗
PubMed2001

Sex matters: secular and geographical trends in sex differences in coronary heart disease mortality.

OBJECTIVE: To examine secular trends and geographical variations in sex differences in mortality from coronary heart disease and investigate how these relate to distributions in risk factors. DESIGN: National and international data were used to examine secular trends and geographical variations in sex differences in mortality from coronary heart disease and risk factors. SETTING: England and Wales, 1921-98; Australia, France, Japan, Sweden, and the United States, 1947-97; 50 countries, 1992-6. DATA SOURCES: Office for National Statistics, World Health Organization, and Food and Agriculture Organization of the United Nations. RESULTS: The 20th century epidemic of coronary heart disease affected only men in most industrialised countries and had a very rapid onset in England and Wales, which has been examined in detail. If this male only epidemic had not occurred there would have been 1.2 million fewer deaths from coronary heart disease in men in England and Wales over the past 50 years. Secular trends in mean per capita fat consumption show a similar pattern to secular trends in coronary heart disease mortality in men. Fat consumption is positively correlated with coronary heart disease mortality in men (r(s)=0.79; 95% confidence interval 0.70 to 0.86) and inversely associated with coronary heart disease mortality in women (-0.30; -0.49 to -0.08) over this time. Although sex ratios for mortality from coronary heart disease show a clear period effect, those for lung cancer show a cohort effect. Sex ratios for stroke mortality were constant and close to unity for the entire period. Geographical variations in the sex ratio for coronary heart disease were associated with mean per capita fat consumption (0.64; 0.44 to 0.78) but were not associated with the sex ratio for smoking. CONCLUSION: Sex differences are largely the result of environmental factors and hence not inevitable. Understanding the factors that determine sex differences has important implications for public health, particularly for countries and parts of countries where the death rates for coronary heart disease are currently increasing.

Adult↗
PubMed2001

The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials.

OBJECTIVE: To determine the effectiveness of exercise as an intervention in the management of depression. DESIGN: Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with experts in the field, bibliographic searches, and hand searches of recent copies of relevant journals. MAIN OUTCOME MEASURES: Standardised mean difference in effect size and weighted mean difference in Beck depression inventory score between exercise and no treatment and between exercise and cognitive therapy. RESULTS: All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size -1.1 (95% confidence interval -1.5 to -0.6); weighted mean difference in Beck depression inventory -7.3 (-10.0 to -4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference -0.3 (95% confidence interval -0.7 to 0.1)). CONCLUSIONS: The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up.

Data Collection↗
PubMed2001

The effect of physical activity advice given in routine primary care consultations: a systematic review.

BACKGROUND: Recent evidence and recommendations suggest that physical activity health promotion should be aimed at persuading the whole population to adopt an active lifestyle. Intensive medical programmes aimed at promoting physical activity amongst those at risk are not effective at achieving this aim. Brief advice from primary care professionals to quit smoking has a small but, at a population level, important effect. Brief advice in primary care to adopt a more active lifestyle may be similarly effective. The aim of this review is to determine the effect of advice given in routine primary care consultations on levels of physical activity. METHODS: A systematic review was carried out of trials assessing the effectiveness of advice given in routine primary care consultations. Data sources were four electronic databases (MEDLINE, EMBASE, Sport discus, Cochrane Library), and bibliographies of retrieved papers were searched. Experts were contacted. RESULTS: Eight trials, with a total of 4747 participants, were identified; the majority were from the United States. Outcome measures varied considerably between trials, including continuous measures (e.g. duration of exercise) and dichotomous measures (e.g. being active), therefore statistical pooling was inappropriate. Two of the trials were cluster randomized controlled trials, the remainder were quasi-experimental. None of the trials fulfilled all of the predetermined quality criteria and selection bias in the nonrandomized studies may have exaggerated results. Four of the six trials that presented short-term (up to 8 weeks) results found advice to be effective; only one of the four trials with long-term follow-up (4-12 months) found a sustained effect. The two randomized controlled trials had negative short- and long-term results. CONCLUSIONS: From the available evidence it appears that advice in routine primary care consultations is not an effective means of producing sustained increases in physical activity. However, these results may not be applicable to the United Kingdom, where the structure of primary care is unique. Quality research in UK primary care would be valuable.

Clinical Trials as Topic↗
PubMed2001

Missed appointments in general practice: retrospective data analysis from four practices.

Little is known about which patients miss appointments or why they do so. Using routinely collected data from four practices, we aimed to determine whether patients who missed appointments differed in terms of their age, sex, and deprivation scores from those who did not, and to examine differences between the practices with respect to missed appointments. The likelihood of someone missing at least one appointment was independently associated with being female, living in a deprived area, and being a young adult. Living in a deprived area was associated with a threefold increase in the likelihood of missing an appointment, and the extent of this association was the same across all four practices. Interventions aimed at reducing missed appointments need to be based upon these findings.

Adolescent↗