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Biomedical subjects

D J Gunnell

Publications and source records attributed to D J Gunnell.

31 records · Page 2Linked to original sources
PubMed1998

Childhood leg length and adult mortality: follow up of the Carnegie (Boyd Orr) Survey of Diet and Health in Pre-war Britain.

OBJECTIVE: To investigate the relation between childhood height, its components--leg length and trunk length--and mortality in adulthood. DESIGN: Cohort study based on the Carnegie (Boyd Orr) Survey of diet and health in pre-war Britain, 1937-9. SETTING: The 14 centres in England and Scotland that participated in the Carnegie Survey and where children were examined. Scottish centres: Aberdeen, Dundee, West Wemyss, Coaltown of Wemyss, Hopeman, Methlick, Tarves, Barthol Chapel. English Centres: Liverpool, York-shire, Barrow in Furness, Wisbech, Fulham, and Bethnal Green. SUBJECTS: 2990 boys and girls aged between 2 years and 14 years 9 months when they were examined in 1937-9. These children were drawn from 1134 families who underwent a one week assessment of family diet and home circumstances. Of these, 2547 (85%) have been traced and flagged using the NHS Central Register. MAIN OUTCOME MEASURES: Age adjusted overall, coronary heart disease, and cancer mortality in men and women in relation to age and sex specific z scores for height, leg length, and trunk length. All analyses were adjusted for the possible confounding effects of childhood and adult socioeconomic circumstances and childhood diet. RESULTS: Leg length was the component of childhood height most strongly associated with socioeconomic and dietary exposures. There was no significant relation between childhood height and overall mortality. Height-mortality relations were observed in relation to both coronary heart disease (CHD) and cancer. Leg length was the component of height most strongly related to cause specific mortality. In men and women CHD mortality increased with decreasing childhood leg length. Men in the lowest leg length quintile had a relative risk (RR) of 2.5 (95% CI 1.0 to 6.2) compared to those with the longest legs (linear trend p = 0.14). Similarly, women in the lowest leg length quintile had a RR of 3.9 (95% CI 0.8 to 19.0; linear trend p < 0.01). Adjustment for childhood and adult socioeconomic circumstances had little effect on these trends. In men, but not women, those who as children had long legs experienced increased cancer mortality. The significant relations between anthropometry and both CHD and cancer mortality were restricted to those aged < 8 years when measured. CONCLUSIONS: These findings suggest that adverse diet and living conditions in childhood, for which leg length seems to be a particularly sensitive indicator, are associated with increased risk of CHD in adulthood and possibly reduced cancer risk. It is likely that these influences operate after birth, during the first few years of life.

Adolescent↗
PubMed1996

Variation in purchasing for the invasive management of coronary heart disease.

This paper reports the results of a postal questionnaire survey of Directors of Public Health in all health authorities in the United Kingdom (as at March 1994). Our aim was to examine variations in the purchasing of coronary artery bypass grafting, percutaneous transluminal coronary angioplasty and coronary angiography. Information on planned service developments in cardiology was also sought. The response rate was 62%. The mean rate of CABG was 374 per million total population (range 162-710); PTCA 183 (range: 18-648); and coronary angiography 1,010 (range 581-2,334). The mean ratio of invasive treatment to angiography was 1:2 Variations in provision were not related to mortality from coronary heart disease or the availability of a local provider. Those districts purchasing higher levels of CABG tended to purchase higher levels of PTCA (Spearman's r = 0.52). Observed variations in purchasing of invasive treatments and investigation for coronary heart disease do not relate to population "need' as defined by mortality rates from CHD. The greatest variations are seen in the purchasing of PTCA, an intervention whose place in the management of CHD is as yet not fully defined. Consensus guidelines on the appropriate use of these interventions and on population needs are required.

Angioplasty, Balloon, Coronary↗
PubMed1996

Lifecourse exposure and later disease: a follow-up study based on a survey of family diet and health in pre-war Britain (1937-1939).

There is an increasing interest in the origins of adult disease in early life. The elucidation of such explanations of current morbidity and mortality must depend upon the follow-up of previously established cohorts. This paper describes the design of and background to such a follow-up of one of the richest data sources for this type of research: Sir John Boyd Orr's survey of diet and health in pre-war Britain. 1,352 families from 16 centres in England and Scotland were surveyed; 3,762 children aged up to 19 years from these families were examined. Socio-economic information and detailed one week dietary diary records are available for all families. Detailed medical examinations (including anthropometry) were undertaken on children in 14 of the centres. Most of the information is cross-sectional although 1,322 children were examined on two or more occasions one year apart to assess the effects of dietary supplementation. Dietary records were retrieved for 1,343 (99.3%) of the families. Medical examination records were found for 3,560 (94.6%) of the children who were examined in the survey and attempts have been made to trace 4,973 children who were either examined or whose family participated in the dietary survey. The data demonstrate relationships between family food expenditure and height in childhood and housing conditions. Eighty-five per cent (4211/4973) of the children have been traced and flagged on the National Health Service Central Register, Southport. The characteristics of those traced do not differ significantly from those we have been unable to trace although untraced females were slightly heavier. To date 696 (16.5%) of the cohort have died. The cohort will be used to investigate the relationship between diet, nutritional status (height, weight, cristal height), health and social circumstances in childhood, and mortality and morbidity in adulthood.

Adolescent↗
PubMed1996

Epidemiology and patterns of hospital use after parasuicide in the south west of England.

OBJECTIVE: To describe the epidemiology, management, and outcome of parasuicide in the south west of England. DESIGN: Descriptive analysis using routine information systems. SETTING: The former South Western Regional Health Authority, population aged 10 and over: 2.9 million. SUBJECTS: These comprised 5080 residents of the South Western Health Region, admitted on 5770 occasions for parasuicide between April 1992 and March 1993 to hospitals in the south west. MAIN OUTCOME MEASURES: Person based age and sex standardised admission ratios for parasuicide; readmission for parasuicide in the subsequent 12 months; admission to psychiatric hospital after parasuicide; in-hospital mortality for those admitted after attempted suicide. RESULTS: The overall rate of parasuicide admission was 174 per 100,000 per year. Rates were highest in males aged 20-24 (381 per 100,000) and in females aged 15-19 (625 per 100,000). Parasuicide is the third most frequent cause of acute medical admission in the south west. A total of 10.0% of admissions received psychiatric inpatient care as a direct result of their parasuicide admission and 10.1% were readmitted in the following 12 months with a repeat episode of parasuicide. Significant variations in standardised admission ratios for parasuicide were observed between the districts. Some of this variation is related to socioeconomic differences between districts, the rest is probably due to differences in practice between districts. There is no clear evidence that these variations result in differences in readmission rates. Districts where psychiatric inpatient facilities were located on the same site as the general hospital tended to admit a greater percentage of parasuicide patients for psychiatric inpatient care. A quarter of all suicide deaths from overdose occurred in hospital. It is estimated that there are 87,000 parasuicide admissions in England and Wales annually. CONCLUSIONS: Parasuicide is a common cause of acute hospital admission and there is evidence that hospital admission practices for parasuicide vary across the south west. Randomised controlled trials are needed to evaluate the most appropriate form of management for those patients who do not require admission on medical grounds.

Adolescent↗
PubMed1995

Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation.

OBJECTIVE: To examine the relations between parasuicide, suicide, psychiatric inpatient admissions, and socioeconomic deprivation. DESIGN: Ecological analysis with data from routine information systems and the 1991 census. SETTING: 24 localities in the area covered by the Bristol and District Health Authority (population 817,000), consisting of aggregations of neighbouring wards, with an average population of 34,000. SUBJECTS: 6089 subjects aged over 10 years admitted to hospital after parasuicide between April 1990 and March 1994; 997 suicides occurring 1982-91; 4763 subjects aged 10-64 years admitted with acute psychiatric illness between April 1990 and March 1994. RESULTS: Localities varied significantly in standardised admission ratios for parasuicide and standardised mortality ratios for suicide (P < 0.001). Spearman's rank correlation coefficient between the standardised mortality ratio for suicide and standardised admission ratio for parasuicide was 0.73 (95% confidence interval 0.46 to 0.88). Correlation between parasuicide and Townsend score was 0.86 (0.70 to 0.94) and between suicide and Townsend score 0.73 (0.46 to 0.88). The partial correlation coefficient between suicide and parasuicide after the Townsend score was adjusted for was 0.29 (-0.13 to 0.62). The correlation between standardised admission ratio for parasuicide and standardised admission ratio for psychiatric illness was 0.76 (0.51 to 0.89) and between standardised mortality ratio for suicide and standardised admission ratio for psychiatric illness was 0.72 (0.45 to 0.87). CONCLUSION: A strong ecological association exists between suicide and parasuicide, with socioeconomic deprivation accounting for much of this relation. This strong association provides supporting evidence for the importance of social policy measures in attaining Health of the Nation targets on mental health.

Adolescent↗
PubMed1995

Antibiotic prophylaxis for bacterial meningitis: overuse and uncertain efficacy.

BACKGROUND: There is little evidence supporting the efficacy of prophylactic antibiotics in preventing secondary cases of bacterial meningitis, and recent guidance extended the use of prophylactic antibiotics amongst children who attend pre-school groups. METHODS: We examined the volume of rifampicin prescribed, and that recommended to contacts of cases of meningococcal and Hib meningitis in Somerset over a three-year period using case note records of the Consultant for Communicable Disease Control (CCDC) and PACT data. RESULTS: There was evidence of excessive prescribing over and above that recommended by the CCDC. CONCLUSIONS: Excessive prescribing increases the chance of serious drug side effects and the development of antibiotic resistance. It is suggested that both meningitis contacts and information about early symptoms of meningitis, as well as an explanation of the rationale behind the prescribing of antibiotic prophylaxis to contacts. This may reduce the likelihood of unnecessary prescribing and subsequent complications.

Adult↗
PubMed1994

Epidemiology of meningococcal disease and a community outbreak in Somerset.

We describe the epidemiology of meningococcal disease in Somerset and a community outbreak in one district. Fifty-seven cases of meningococcal disease occurred in residents of Somerset between 1 May 1990 and 30 April 1993 (incidence 4.7/100,000/year), of whom six died. Thirteen of the cases occurred in one local authority area in a six month period from 1 November 1992 to 30 April 1993; an incidence of 26.6/100,000/year. Twenty-seven patients were given benzyl-penicillin before admission to hospital. General practitioners were significantly more likely to give benzylpenicillin to patients with rashes. The proportion that received prophylaxis tended to increase after a press release was issued and general practitioners were advised. The number of cases was too small to demonstrate the protective effect of early administration of benzylpenicillin. In five cases the consultant in communicable disease control was not informed for over 12 hours. Thirty-seven of the 48 index cases for whom information was available received rifampicin prophylaxis before discharge from hospital.

Adolescent↗
PubMed1994

Risk factors for giardiasis: a case-control study in Avon and Somerset.

Giardia lamblia is a common and increasing cause of gastrointestinal illness in the UK. We report a case-control study that examined risk factors for giardiasis. Patients with giardiasis were identified from reports to the Consultants in Communicable Disease in Avon and Somerset, and age-sex matched controls were obtained from their general practitioners' lists. Details of travel history, water consumption and recreational water use were collected by postal questionnaire. Over the period July 1992 to May 1993, 74 cases and 108 matched controls were obtained. The data were analysed using conditional logistic regression. Swimming appeared to be an independent risk factor for giardiasis (odds ratio 2.4, 95% CI 1.0 to 6.1, P = 0.050). Travel (P = 0.001), particularly to developing countries, and type of travel (P = 0.004)--that is, camping, caravanning or staying in holiday chalets--were also observed to be significant risk factors. Other recreational water use and drinking potentially contaminated water were found to be not statistically significant after adjustment for other factors.

Adolescent↗
PubMed1994

Infertility prevalence, needs assessment and purchasing.

A postal questionnaire was used to assess the prevalence of primary and secondary infertility in Somerset. Three age groups of women were surveyed: those aged 36-40 (n = 965), 41-45 (n = 1115) and 46-50 years (n = 1061). Using these three age groups, most of whom had completed their reproductive lifespan, time trends both in the prevalence of infertility and service use were obtained. A 75.7 per cent response rate was achieved. No trends towards increasing prevalence of infertility were seen, but greater use was made of services in the younger age group. The overall prevalence of primary infertility was 16.1 per cent (95 per cent confidence interval (Cl) 14.6-17.6) if failure to conceive after one year is used as the definition of infertility. Similarly, the prevalence of secondary infertility was 15.8 per cent. It was found that 26.4 per cent (95 per cent Cl 24.6-28.2) of women were likely to suffer from infertility at some time and only 3.0 per cent of women were involuntarily childless. Twenty-five women (1.1 per cent) suffered recurrent miscarriages. There was no change in the likelihood of conception in the three age groups of women suffering infertility. Those in lower socio-economic groups were less likely to consult their general practitioners (GPs) when difficulties in conceiving were experienced. Examinations of a sample of responders' and non-responders' medical records suggested that the use of postal questionnaires in assessing the prevalence of infertility may, to some extent, be prone to bias.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1993

The public health physician's role in chemical incidents.

Chemical incidents such as the methylisocyanate release at Bhopal and the aluminium sulphate incident in Lowermoor, Cornwall, are uncommon. However, five chemical incidents occurred in Somerset in 12 months between 1990 and 1991, and District Health Authorities are required to have plans to deal with such events. A survey of the plans held by the Consultants in Communicable Disease Control in South Western and Wessex Regional Health Authorities is discussed and the roles of public health physicians and emergency organizations are outlined.

Accidents, Traffic↗
PubMed1993

Suicide rates.

Explore the source record for details and available documents.

Adult↗
PubMed1992

Mysterious slapped face rash at holiday centre.

OBJECTIVE: To discover the cause of an outbreak of facial rash in a holiday centre. DESIGN: Questionnaire survey of those with rash; analysis of samples of linen. SETTING: Holiday centre in south west England. PATIENTS: 98 holiday-makers presenting to the first aid post with a facial rash. INTERVENTION: Replacement of bed linen with new linen in selected parts of the site. RESULTS: The attack rate was 7.0-14.2/1000 for most accommodation areas in the centre, but in one accommodation area the rate was zero. The pH of rinse water from sheets varied from 7.4 to 9.0. Those parts of the accommodation provided with new linen had zero attack rates. CONCLUSION: The facial rash resulted from irritation from washing powder retained owing to insufficient rinsing during laundering. Modifications to the rinsing process led to a gradual disappearance of the rash.

Adolescent↗