PubMed Health⌕ Search

Biomedical subjects

David Gunnell

Publications and source records attributed to David Gunnell.

88 records · Page 5Linked to original sources
PubMed2003

National suicide rates as an indicator of the effect of suicide on premature mortality.

The health strategies of many nations include targets to reduce suicide rates. In several countries, because suicide rates are rising in young men but falling or unchanging in most other groups, achievement of target reductions might mask rises in potential years of life lost (PYLL). Analysis of routine mortality and census data for England and Wales, UK, shows that although age-standardised suicide rates fell by 18% (95% CI 15-21) between 1981 and 1998, the PYLL before age 65 years increased by 5% (4-6). National suicide reduction targets should focus on PYLL and overall suicide rates.

Adolescent↗
PubMed2003

Patterns of fetal and childhood growth and the development of psychosis in young males: a cohort study.

Factors influencing fetal and childhood growth may affect a person's risk of developing schizophrenia. Associations of size at birth and body size in young adulthood with schizophrenia and other nonaffective psychoses were assessed in a cohort of 334,577 Swedish male conscripts born in 1973-1980 for whom linked birth, census, hospital admission, and adult height and weight data were available. Complete data on all study variables were available for 246,655 subjects. Over a mean 3.4-year follow-up beginning at age 18 years, 80 subjects developed schizophrenia and 124 developed other nonaffective psychoses. A reverse J-shaped association was found between gestation-adjusted birth weight and schizophrenia. The hazard ratios were 7.03 (95% confidence interval: 1.59, 31.10) for males of low birth weight (<2.5 kg) and 3.37 (95% confidence interval: 1.68, 6.74) for those of high birth weight (>4.0 kg). Birth weight was not strongly related to other nonaffective psychoses. Taller males had a reduced risk of psychosis. The lowest risks were seen for low birth weight males who became tall adults. The associations with birth weight indicate that fetal exposures, including possible effects of gestational diabetes, are important in the etiology of psychosis. The role of childhood exposures, as indexed by adult height and body mass index, appears to be less strong.

Adolescent↗
PubMed2003

NHS waiting lists and evidence of national or local failure: analysis of health service data.

OBJECTIVES: To investigate the national distribution of prolonged waiting for elective day case and inpatient surgery, and to examine associations of prolonged waiting with markers of NHS capacity, activity in the independent sector, and need. SETTING: NHS hospital trusts in England. POPULATION: People waiting for elective treatment in the specialties of general surgery; ear, nose and throat surgery; ophthalmic surgery; and trauma and orthopaedic surgery. MAIN OUTCOME MEASURE: Numbers of people waiting six months or longer (prolonged waiting). Characteristics of trusts with large numbers waiting six months or longer were examined by using logistic regression. RESULTS: The distribution of numbers of people waiting for day case or elective surgery in all the specialties examined was highly positively skewed. Between 52% and 83% of patients waiting longer than six months in the specialties studied were found in one quarter of trusts, which in turn contributed 23-45% of the national throughput specific to the specialty. In general, there was little evidence to show that capacity (measured by numbers of operating theatres, dedicated day case theatres, available beds, and bed occupancy rate) or independent sector activity were associated with prolonged waiting, although exceptions were noted for individual specialties. There was consistent evidence showing an increase in prolonged waiting, with increased numbers of anaesthetists across all specialties and with increased bed occupancy rates for ear, nose and throat surgery. Markers of greater need for health care, such as deprivation score and rate of limiting long term illness, were inversely associated with prolonged waiting. CONCLUSION: In most instances, substantial numbers of patients waiting unacceptably long periods for elective surgery were limited to a small number of hospitals. Little and inconsistent support was found for associations of prolonged waiting with markers of capacity, independent sector activity, or need in the surgical specialties examined.

Ambulatory Surgical Procedures↗
PubMed2003

Why are suicide rates rising in young men but falling in the elderly?-- a time-series analysis of trends in England and Wales 1950-1998.

Suicide rates doubled in males aged <45 in England and Wales between 1950 and 1998, in contrast rates declined in older males and females of all ages. Explanations for these divergent trends are largely speculative, but social changes are likely to have played an important role. We undertook a time-series analysis using routinely available age- and sex-specific suicide, social, economic and health data, focussing on the two age groups in which trends have diverged most-25-34 and 60+ year olds. Between 1950 and 1998 there were unfavourable trends in many of the risk factors for suicide: rises in divorce, unemployment and substance misuse and declines in births and marriage. Whilst economic prosperity has increased, so too has income inequality. Trends in suicide risk factors were generally similar in both age-sex groups, although the rises in divorce and markers of substance misuse were most marked in 25-34 year olds and young males experienced the lowest rise in antidepressant prescribing. Statistical modelling indicates that no single factor can be identified as underlying recent trends. The factors most consistently associated with the rises in young male suicide are increases in divorce, declines in marriage and increases in income inequality. These changes have had little effect on suicide in young females. This may be because the drugs commonly used in overdose-their favoured method of suicide-have become less toxic or because they are less affected by the factors underlying the rise in male suicide. In older people declines in suicide were associated with increases in gross domestic product, the size of the female workforce, marriage and the prescribing of antidepressants. Recent population trends in suicide appear to be associated with by a range of social and health related factors. It is possible that some of the patterns observed are due to declining levels of social integration, but such effects do not appear to have adversely influenced patterns in older generations.

Adolescent↗
PubMed2003

Urban-rural differences in suicide trends in young adults: England and Wales, 1981-1998.

Suicide rates amongst young people, particularly males, have increased in many industrialised countries since the 1960s. There is evidence from some countries that the steepest rises have occurred in rural areas. We have investigated whether similar geographical differences in trends in suicide exist in England and Wales by examining patterns of suicide between 1981 and 1998 in relation to rurality. We used two complementary population-based indices of rurality: (1) population density and (2) population potential (a measure of geographic remoteness from large concentrations of population). We used the electoral ward (n=9264, median population aged 15-44: 1829) as the unit of analysis. To assess whether social and economic factors underlie rural-urban differences in trends we used negative binomial regression models to investigate changes in suicide rates between the years for which detailed national census data were available (1981 and 1991). Over the years studied, the most unfavourable trends in suicide in 15-44-year olds generally occurred in areas remote from the main centres of population; this effect was most marked in 15-24-year-old females. Observed patterns were not explained by changes in age- and sex-specific unemployment, socio-economic deprivation or social fragmentation. The mental health of young adults or other factors influencing suicide risk may have deteriorated more in rural than urban areas in recent years. Explanations for these trends require further investigation.

Adolescent↗
PubMed2003

Exposures in childhood, adolescence and early adulthood and breast cancer risk: a systematic review of the literature.

A growing body of work indicates that exposures over the life course have important roles to play in the aetiology of breast cancer. This review synthesises the literature that has been published in the area of early life events and female breast cancer risk. The review finds some evidence, primarily from cohort studies on the relationship between birthweight and breast cancer, to suggest that in utero events are related to breast cancer risk in adulthood. Strong evidence to support a positive association between height and breast cancer exists. Postulated mechanisms for this relationship include the role of early diet in subsequent disease risk, and the influence of endogenous growth factors mediating the relationship. There is some evidence to suggest that leg length is the component of height which is generating the observed associations between height and breast cancer. There is no consistent pattern of association between relative weight in childhood or adolescence and risk of breast cancer. The evidence to suggest an association between physical activity in early life and breast cancer risk is convincing from case-control studies, but is not fully substantiated by the results of three cohort studies. There are inconsistent results regarding the association between smoking at a young age and breast cancer risk. There is little evidence for an association between passive smoking in early life and breast cancer risk. No clear association between early drinking and breast cancer risk exists. These results are discussed in relation to possible underlying mechanisms and health promotion strategies which could reduce breast cancer risk.

Adolescent↗
PubMed2003

Birth weight, adult height, and testicular cancer: cohort study of 337,249 Swedish young men.

OBJECTIVE: A positive association has been reported between adult height and the incidence of testicular cancer. No previous study has explored whether this relationship is due to the influence of fetal growth on adult height. METHODS: This research question was studied in a Swedish national cohort comprising 337,249 males born 1973-1980 and followed-up for a mean of 4.8 years after army medical conscription examination. Cases of testicular cancer were ascertained from the Swedish National Cancer Register. 144 cases of testicular cancer (120 non-seminomas) diagnosed after conscription were identified. RESULTS: Positive associations were found between height at age 18 years and the incidence of testicular cancer. No associations were observed between gestational age adjusted birthweight and cancer incidence. The positive association between height and cancer incidence was not attenuated in models controlling for birth weight. CONCLUSIONS: Factors influencing post-natal growth such as diet or growth related genes might underlie the association between height and cancer.

Adult↗
PubMed2003

Influence of cohort effects on patterns of suicide in England and Wales, 1950-1999.

BACKGROUND: Age- and gender-specific suicide rates in England and Wales have changed considerably since 1950. AIMS: To assess whether cohort effects underlie some of these changes. METHOD: Graphical displays to assess age-period-cohort effects on suicide for the period 1950-1999. RESULTS: Successive male birth cohorts born after 1940 carried with them, as they aged, a greater risk of suicide than their predecessors although this effect diminished for the 1975 and 1980 birth cohorts. There was less clear evidence of any increased risk of suicide in post-war female birth cohorts. CONCLUSIONS: Succeeding generations of males born in the post-war years have experienced increasing rates of suicide at all ages, an observation in keeping with patterns seen in other countries. If these trends continue into middle- and old-age they will lead to a great increase in overall male suicide rates.

Adolescent↗
PubMed2003

Height, leg length, and cancer: the Caerphilly Study.

The incidence of several cancers increases with height. Some studies report that leg length, a marker of prepubertal growth, is the component of height underlying these associations, but few prospective studies have investigated this issue. We examined height-cancer associations in a 21-yr follow-up of a cohort based on 2,512 men aged 45-59 living in the town of Caerphilly, South Wales, U.K., between 1979 and 1983. The men underwent a detailed examination, and 2,393 (95.3%) had measures of height and sitting height (from which leg length and trunk length were derived) recorded and were cancer-free at baseline. Cox proportional hazards models were used to investigate associations of height, leg length, and trunk length with overall and site-specific cancer incidence; 328 men developed cancer over the follow-up period. Associations with height were weak and did not reach conventional levels of statistical significance. In models controlling for age, socioeconomic position, smoking, and body mass index, cancer incidence was weakly positively associated with increases in height; hazard ratio (HR, 95% confidence interval) per standard deviation (6 cm) increase in height was 1.09 (0.97, 1.21; P = 0.14). Associations were somewhat stronger in relation to leg length (HR 1.09; (0.97-1.22) than trunk length (HR 1.05; 0.94-1.18). Height-cancer associations were strongest for lung cancer (HR 1.21; 0.96-1.51). This analysis provides limited support for the suggestion that leg length is the component of height underlying height-cancer associations

Body Height↗
PubMed2002

General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial.

OBJECTIVES: To evaluate the impact of an intervention based in general practice on the incidence of repeat episodes of deliberate self harm. DESIGN: Cluster randomised controlled trial in which 98 general practices were assigned in equal numbers to an intervention or a control group. The intervention comprised a letter from the general practitioner inviting the patient to consult, and guidelines on assessment and management of deliberate self harm for the general practitioner to use in consultations. Control patients received usual general practitioner care. SETTING: General practices within Avon, Wiltshire, and Somerset Health Authorities, whose patients lived within the catchment area of four general hospitals in Bristol and Bath. PARTICIPANTS: 1932 patients registered with the study practices who had attended accident and emergency departments at one of the four hospitals after an episode of deliberate self harm. MAIN OUTCOME MEASURES: Primary outcome was occurrence of a repeat episode of deliberate self harm in the 12 months after the index episode. Secondary outcomes were number of repeat episodes and time to first repeat. RESULTS: The incidence of repeat episodes of deliberate self harm was not significantly different for patients in the intervention group compared with the control group (odds ratio 1.2, 95% confidence interval 0.9 to 1.5). Similar findings were obtained for the number of repeat episodes and time to first repeat. Subgroup analyses indicated that there was no differential effect of the intervention according to patient's sex (P=0.51) or method used to cause deliberate self harm (P=0.64). The treatment seemed to be beneficial for people with a history of deliberate self harm, but it was associated with an adverse effect in people for whom the index episode was their first episode (interaction P=0.017). CONCLUSIONS: An invitation to consult, sent by the general practitioner of patients who have deliberately harmed themselves, and the use of management guidelines during any subsequent consultation did not reduce the incidence of repeat self harm. A subgroup analysis that indicated that patients who had previously harmed themselves benefited from the intervention was inconsistent with previous evidence and should be treated with caution. More research is needed on how to manage patients who deliberately harm themselves, to reduce the incidence of repeat episodes.

Adolescent↗
PubMed2002

Childhood growth and adult cancer.

Associations between different patterns of childhood growth and later adult health have recently received much attention. Most studies have found higher mortality in shorter people, explained by their higher incidence of cardiorespiratory disease. In this chapter, associations of cancer with markers of growth at different developmental phases - infancy, childhood and puberty - and with final adult height are reviewed. The relationship between birthweight and cancer is generally positive, with the greatest risk among high-birthweight babies. Childhood and adult tallness are related to higher cancer risk. This is particularly evident for cancers of the breast, prostate, colo-rectum, haematopoietic system and endometrium. Leg length may be more strongly associated than trunk length with cancer risk. Possible explanations for these findings are discussed in relation to nutritional intake and hormonal levels.

Adolescent↗
PubMed2002

Associations between premorbid intellectual performance, early-life exposures and early-onset schizophrenia. Cohort study.

BACKGROUND: Impaired intellectual performance is associated with an increased risk of schizophrenia. AIMS: To investigate whether this association is due to the influence of prenatal and early childhood exposures on both intellectual development and the risk of schizophrenia. METHOD: Cohort of 197 613 Swedish male conscripts with linked birth, census and hospital admission data together with five measures of verbal and non-verbal intellectual performance recorded at conscription. RESULTS: 109 643 subjects had complete data; over a mean 5-year follow-up, 60 developed schizophrenia and 92 developed other non-affective psychoses. Poor scores for each of the five tests were associated with 3- to 14-fold increased risk of psychosis, particularly schizophrenia. Controlling for birth-related exposures, including birth weight, and parental education did not attenuate these associations. CONCLUSIONS: Poor intellectual performance at 18 years of age is associated with early-onset psychotic disorder. Associations do not appear to be confounded by prenatal adversity or childhood circumstances, as indexed by parental education.

Adolescent↗