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Debbie A Lawlor

Publications and source records attributed to Debbie A Lawlor.

At least 91 records · Page 5Linked to original sources
PubMed2004

Exercise interventions for cancer patients: systematic review of controlled trials.

OBJECTIVE: To systematically review controlled trials investigating the effects of exercise interventions in cancer patients. METHODS: Studies were located through searching seven electronic databases (Medline, Embase, Cochrane Library, CancerLit, PsycInfo, Cinahl, SportDiscus), scanning reference lists of relevant articles, contacting experts (n = 20), and checking the contents lists of journals available through ZETOC (Electronic Table of Contents). To be included, trials had to be prospective, controlled, involve participants diagnosed with cancer and test an exercise intervention. Types of outcome were not restricted. Two reviewers independently applied the selection criteria. RESULTS: Thirty-three controlled trials (including 25 randomized trials) were included in the review. There was some evidence that physical function was increased among those who exercised. Furthermore, symptoms of fatigue did not appear to be increased and there were few adverse effects reported. There was insufficient evidence to determine effects on other outcomes, such as quality of life, with results hampered by the heterogeneity between studies as well as poor methodological quality. Data were also lacking on the long term effects of exercise relating to cancer recurrence or survival. CONCLUSIONS: There is preliminary evidence that exercise interventions for cancer patients can lead to moderate increases in physical function and are not associated with increased symptoms of fatigue. However, it is impossible from current evidence to determine whether exercise has long term beneficial effects on survival or quality of life.

Controlled Clinical Trials as Topic↗
PubMed2004

Hyperinsulinaemia and increased risk of breast cancer: findings from the British Women's Heart and Health Study.

OBJECTIVE: To assess the association between fasting insulin levels and breast cancer. DESIGN: Cross sectional study. PARTICIPANTS: 3868 women aged 60-79 years. MAIN OUTCOME MEASURE: Prevalent breast cancer (151 cases). RESULTS: Insulin levels were positively associated with breast cancer. The age adjusted odds ratio (95% confidence interval) for a one unit increase in log(e) insulin levels among women without diabetes was 1.34 (1.02, 1.77). This association was not substantively altered by adjustment for potential confounding factors (age of menopause, hysterectomy/oophorectomy, hormone replacement use, oral contraceptive use, parity, adult social class and smoking) or potential mediating factors (body mass index, waist to hip ratio, leg length, age at menarche and childhood social class). Women with both long legs and higher insulin levels were at particularly increased risk, with breast cancer prevalence being 5.7% among women in the highest thirds of both insulin levels and leg-length compared to 1.8% among those in the lowest thirds of both. Positive associations between insulin levels and breast cancer were found for both pre- and post-menopausal breast cancers. Fasting glucose levels, HOMA score, diabetes and a history of gestational glycosuria or diabetes were also positively associated with breast cancer CONCLUSIONS: Hyperinsulinaemia is positively associated with breast cancer in this cohort of older women. This effect may be mediated via a number of hormonal pathways acting at different stages of the life course.

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PubMed2004

Chronic diseases, locomotor activity limitation and social participation in older women: cross sectional survey of British Women's Heart and Health Study.

OBJECTIVES: To examine the association of chronic degenerative diseases with locomotor activity limitation and social participation among older British women. METHODS: Cross-sectional survey of 4,286 women aged 60-79 years from 23 towns in England, Scotland and Wales. RESULTS: The prevalence of locomotor activity limitation was 37.2% and 33.5% of women had difficulty with some aspect of social participation. This prevalence of locomotor activity limitation and difficulties with social participation increased with increasing age and with increasing number of chronic diseases. All chronic diseases assessed were independently (of each other and confounding factors) associated with locomotor activity limitation. Associations were particularly strong for stroke (OR 5.44, 95% CI 3.38-8.75), arthritis (OR 3.95, 95% CI 3.25-4.81) and coronary heart disease (OR 2.26, 95% CI 1.77-2.88). The population attributable fraction for locomotor activity limitation was greatest for arthritis: 37.8% (95% CI 32.0-43.1) and coronary heart disease: 6.7% (95% CI 4.8-8.8). Locomotor activity limitation was strongly associated with social participation. Most chronic diseases of ageing were independently (of locomotor activity limitation, other chronic diseases and confounding factors) associated with reduced social participation. CONCLUSIONS: Locomotor activity limitation and difficulties in social participation are common. Arthritis and coronary heart disease contribute importantly to locomotor activity limitation and difficulties with social participation. Effective strategies to prevent or limit the disabling impact of these conditions are essential to improving the quality of life of older women.

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PubMed2004

The challenge of secondary prevention for coronary heart disease in older patients: findings from the British Women's Heart and Health Study and the British Regional Heart Study.

BACKGROUND: Secondary prevention of coronary heart disease (CHD) among older individuals is associated with considerable benefit. METHODS: In this study, we have examined the extent of secondary prevention among British women and men aged 60-79 years who were surveyed and examined between 1998 and 2001. RESULTS: Among 483 women (12.1% of the whole sample) and 831 men (19.5%) with CHD, >90% of both sexes had at least one modifiable risk factor, with over two-fifths having high blood pressure and over three-quarters high cholesterol. For total cholesterol and body mass index, mean values in both male and female subjects were above recommended levels, and a large shift in the population distributions would be required for targets to be met. Less than one-quarter of subjects of either sex were on a statin, and whilst the majority of men were taking an antiplatelet medication, only 40% of women were. CONCLUSIONS: Most older women and men in Britain were failing to meet National Service Framework standards for secondary prevention in the period immediately before its implementation. Large shifts in the population distributions of some risk factors would be required in this group to meet these standards.

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PubMed2004

Sex differences in body fat distribution and carotid intima media thickness: cross sectional survey using data from the British regional heart study.

OBJECTIVE: To determine the role of central adiposity in explaining sex differences in carotid intima media thickness (IMT). DESIGN: Cross sectional survey. SETTING: Two British towns. PARTICIPANTS: 800 men and women aged 56-75 years. MAIN OUTCOME MEASURES: Carotid IMT. RESULTS: There was a continuous linear association between waist-hip ratio and IMT in both men and women. The magnitude of the association between waist to hip ratio and IMT was identical in both sexes. In age adjusted analyses IMT was 14% greater in men compared with women (age adjusted male to female ratio of geometric means 1.14; 95% confidence interval 1.07 to 1.21) with adjustment for waist to hip ratio this attenuated to no difference (1.00; 0.92 to 1.09). Adjustment for body mass index and for lifestyle risk factors had very little effect on the sex difference in mean intima media thickness. CONCLUSIONS: Sex differences in body fat distribution may explain sex differences in arterial atherosclerosis.

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PubMed2004

Socioeconomic position and hormone replacement therapy use: explaining the discrepancy in evidence from observational and randomized controlled trials.

OBJECTIVES: We assessed the association between life-course socioeconomic status or position (SEP) and hormone replacement therapy (HRT). METHODS: We conducted a cross-sectional analysis of 4286 women aged 60 to 79 years. RESULTS: Women experiencing adverse socioeconomic circumstances across the life course were less likely to have used HRT. The associations of childhood socioeconomic measures with HRT use were independent of adult SEP, behavioral risk factors, and physiological risk factors for heart disease. CONCLUSIONS: SEP from across the life course is associated with HRT use. Because the association between early life SEP and HRT is not fully explained by adult risk factors, residual confounding (which is not captured by adjustment for adult variables only) may explain some of the disparity between observational studies and randomized controlled trials in this area.

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PubMed2004

Association between childhood socioeconomic status and coronary heart disease risk among postmenopausal women: findings from the British Women's Heart and Health Study.

OBJECTIVES: We assessed the association between childhood socioeconomic status (SES) and coronary heart disease among postmenopausal women. METHODS: We conducted a cross-sectional analysis of 3444 women aged 60 to 79 years. RESULTS: There was an independent linear association between childhood and adult SES and coronary heart disease. The association between childhood SES and coronary heart disease was attenuated when we adjusted for insulin resistance syndrome, adult smoking, physical activity, biomarkers of childhood nutrition, and passive smoking. CONCLUSIONS: The association between adverse childhood SES and coronary heart disease is in part mediated through insulin resistance, which may be influenced by poor childhood nutrition, and in part through the association between childhood SES and adult behavioral risk factors.

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PubMed2004

Missed appointments in primary care: questionnaire and focus group study of health professionals.

BACKGROUND: The issue of missed appointments in primary care is important for patients and staff. Little is known about how missed appointments, and the people who miss them, are managed in primary care, or about effective strategies for managing missed appointments. AIMS: To understand the perceptions of primary care staff as to why patients miss appointments, to determine how these perceptions influence their management, and to explore the merit of different management strategies. DESIGN OF STUDY: A postal questionnaire survey and focus group interviews. SETTING: General practices in Yorkshire. RESULTS: Missed appointments were regarded as an important problem. Patient factors rather than practice factors were perceived as most important in causing missed appointments. Intervention strategies appeared to be driven by perceptions of why patients miss appointments. Negative attitudes, embodied in terms such as "offenders" to refer to those who missed appointments were prevalent, and favoured intervention strategies included punishing the patient in some way. Receptionists believed that general practitioners should address the issue of the missed appointment with the patient. General practitioners felt guarded about addressing missed appointments with their patients in case it affected the doctor-patient relationship. CONCLUSION: People who miss appointments were viewed negatively by primary care staff, and most of the reasons for missed appointments were focused on patients. These beliefs underpinned intervention strategies aimed mainly at punishment. Since there is no evidence base concerning interventions that are effective in reducing missed appointments, these negative attitudes may not be beneficial to staff or their patients.

Appointments and Schedules↗
PubMed2004

What's in a name?

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Biomedical Research↗
PubMed2003

Association between falls in elderly women and chronic diseases and drug use: cross sectional study.

OBJECTIVE: To assess the associations between having had a fall and chronic diseases and drug use in elderly women. DESIGN: Cross sectional survey, using data from the British women's heart and health study. SETTING: General practices in 23 towns in Great Britain. PARTICIPANTS: 4050 women aged 60-79 years. MAIN OUTCOME MEASURE: Whether women had had falls in the previous 12 months. RESULTS: The prevalence of falling increased with increasing numbers of simultaneously occurring chronic diseases. However, no such relation with falling was found in the fully adjusted data for the number of drugs used. Circulatory disease, chronic obstructive pulmonary disease, depression, and arthritis were all associated with an increased odds of falling. The fully adjusted, population attributable risk of falling associated with having at least one chronic disease was 32.2% (95% confidence interval 19.6% to 42.8%). Only two classes of drugs (hypnotics and anxiolytics, and antidepressants) were independently associated with an increased odds of falling. Each class was associated with an increase of about 50% in the odds of falling, and each had a population attributable risk of < 5%. CONCLUSION: Chronic diseases and multiple pathology are more important predictors of falling than polypharmacy.

Accidental Falls↗
PubMed2003

Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing? Findings from the British Women's Heart and Health Study and the British Regional Heart Study.

BACKGROUND: Parity is associated with coronary heart disease (CHD) risk. In the present study, we assessed the associations between number of children and CHD in both women and men. METHODS AND RESULTS: A total of 4286 women and 4252 men aged 60 to 79 years from 24 British towns were studied. Number of children was positively associated with body mass index and waist-hip ratio in both sexes. In women but not in men, number of children was inversely associated with high-density lipoprotein cholesterol and was positively associated with triglycerides and diabetes. For both sexes, similar "J" shaped associations between number of children and CHD were observed, with the prevalence lowest among those with 2 children and increasing linearly with each additional child beyond 2. For those with at least 2 children, each additional child increased the age-adjusted odds of CHD by 30% (odds ratio, 1.30; 95% confidence interval, 1.17 to 1.44) for women and by 12% for men (odds ratio, 1.12; 95% confidence interval, 1.02 to 1.22). Adjustment for obesity and metabolic risk factors attenuated the associations between greater number of children and CHD in both sexes, although in women some association remained. CONCLUSIONS: Lifestyle risk factors associated with child-rearing lead to obesity and result in increased CHD in both sexes; biological responses of pregnancy may have additional adverse effects in women.

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PubMed2003

Systematic review of the epidemiologic and trial evidence of an association between antidepressant medication and breast cancer.

Biologic studies have suggested that antidepressant use may increase breast cancer risk. We conducted a systematic review of trials and controlled epidemiologic studies to assess this association. Pooled data from 31 primary efficacy drug company trials of fluoxetine suggested no increased risk but the short duration of these trials may have been insufficient to detect an association. In one prospective cohort study antidepressant use was associated with breast cancer, but this study was conducted among women attending for breast screening, and only limited data on antidepressant use were available. In a second large prospective drugs screening study no association was found between either amitriptyline or imipramine and breast cancer. In a large well-conducted retrospective cohort study there was no association between antidepressant use and breast cancer. A second retrospective cohort study was flawed, with exposure in those who developed breast cancer being measured over a shorter time period than in those who remained disease free. Two of four case-control studies found no association between antidepressant use and breast cancer after control for a number of potential confounding factors. We conclude that epidemiologic evidence does not support an association between antidepressant use and breast cancer.

Antidepressive Agents↗
PubMed2003

Association between leg length and offspring birthweight: partial explanation for the trans-generational association between birthweight and cardiovascular disease: findings from the British Women's Heart and Health Study.

Low birthweight individuals not only have increased risk of cardiovascular disease themselves, but cardiovascular disease risk is also increased in their parents. The mechanisms underlying these trans-generational associations are not fully understood. We hypothesise that, in part, they reflect the trans-generational effects of poor maternal environmental circumstances in early childhood. Adverse environmental factors acting early in the mother's life will not only influence her own predisposition to cardiovascular disease but will also result in adverse consequences - low birthweight and increased cardiovascular disease risk in later life - for her offspring. Adult leg length is a valid indicator of early life environmental circumstances, in particular of infant nutrition. If our hypothesis is correct, then adult leg length should be positively associated with offspring birthweight. In this study of 4286 randomly selected women aged 60-79 years from 23 towns across England, Scotland and Wales, the magnitude of the association between leg length and offspring birthweight was greater than the association between trunk length and offspring birthweight. After control for potential confounding factors, offspring birthweight increased by 89.8 g [95% confidence interval 66.1, 113.5 g] for each standard deviation increase in maternal leg length, and by 55.2 g [32.2, 78.1 g] for each standard deviation increase in maternal trunk length. The association between leg length and offspring birthweight was unaffected by adjustment for maternal birthweight, but the association between trunk length and offspring birthweight was attenuated to 38.0 g [1.0, 74.9 g]. These findings support the hypothesis that adverse early childhood environmental circumstances affect not only the vitality and health of the woman in later life but also the birthweight of her offspring, and suggest that the trans-generational association between birthweight and cardiovascular disease is in part explained by early childhood maternal environmental circumstances.

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