PubMed Health⌕ Search

Biomedical subjects

H Inskip

Publications and source records attributed to H Inskip.

At least 37 records · Page 2Linked to original sources
PubMed1997

Data management for an efficacy trial of a vaccine in the Gambia.

An individually randomised double-blind trial of PRP-T Hib conjugate vaccine was conducted in the Gambia between 1993 and 1995, in which 42,848 children were randomised into one of 10 groups, five corresponding to vaccine and five to placebo. Basic demographic data were collected on all children, and administration details of all doses of EPI vaccines were recorded. In addition, details on all doses of vaccines were recorded on each child's home-based health card; 2,681 episodes of possible Hib disease were investigated and for each episode detailed clinical data were collected. These investigations yielded 50 cases of confirmed Hib disease, which formed the basis of the final efficacy results. In all 50 cases, the data on the children's health card, describing the doses of study vaccine received exactly, matched the vaccination database which was filled with data returned from the clinics. The data-management procedures are described in detail in this paper.

Child, Preschool↗
PubMed1996

Mortality from scrotal cancer in metal machinists in England and Wales, 1979-80 and 1982-90.

The hazard of scrotal cancer from cutting oils was first recognized in the 1950s, and led to various control measures including the introduction of solvent refined oils, use of splash guards, provision of protective clothing and washing facilities and education of workers to encourage early detection and treatment of tumours. To assess how effective these controls have been, we have analyzed occupational mortality from scrotal cancer in England and Wales during 1979-80 and 1982-90. Over this 11-year period 85 deaths were attributed to the disease in man aged 20-74. This represents a reduction in mortality from the 1960s. Significantly elevated proportional mortality ratios (PMRs) were found in press and machine tool setters (PMR 1,678, five deaths), centre lathe turners (PMR 1,099, three deaths) and machine tool operators (PMR 303, eight deaths), but all of the metal machinists who died of scrotal cancer had been born before 1930, and could have worked with cutting oils before controls were introduced. These findings are reassuring, but continued monitoring of scrotal cancer incidence and mortality is required.

Adult↗
PubMed1996

A survey of the prevalence of biting by the Blandford fly during 1993.

To assess the frequency of bites by the Blandford fly, a postal survey was carried out at the end of the 1993 biting season. Questionnaires were sent to a random sample of 1,500 people, selected from the lists of the two general practices in Blandford Forum, and satisfactory replies were obtained from 1203 (80%). Altogether, 194 (16%) of subjects reported one or more insect bites, during the 2-month season, that had led to skin swelling more than 2.5 cm across. Of these, more than a quarter had suffered associated systemic symptoms, in the form of fever or joint pain. One hundred and forty-nine had used medications for bites, 20 had consulted a doctor, and seven had taken time off work or school. Bites were more common in females (22%) than males (9%). This difference was due largely to a higher frequency of bites on the legs. Risk might be reduced substantially in women by wearing trousers, especially in those who spend a lot of time outdoors.

Adolescent↗
PubMed1996

Mortality of farmers and farmers' wives in England and Wales 1979-80, 1982-90.

OBJECTIVES: To examine the mortality patterns of male and female farmers and farmers' wives in England and Wales. METHODS: Information on all deaths in England and Wales at ages 20-74 during the periods 1979-80 and 1982-90 was obtained from the Office of Population Censuses and Surveys. Proportional mortality ratios (PMRs) and proportional cancer mortality ratios (PCMRs) were used to compare the mortality of farmers with that of the general working population, and of farmers' wives with wives of all working men. RESULTS: Farmers and farmers' wives had high mortality from accidents and suicide and from certain respiratory diseases. Mortality from hernia was also raised. Deaths from cancer were generally below expectations, but the PMR for prostatic cancer was 112 (95%CI 106-118). The PMRs and PCMRs for oesophageal cancer were significantly increased in male farmers from two counties where cider is produced. CONCLUSIONS: The occupational hazards of farming continue to be associated with excess mortality, and most of the risks extend also to farmers' wives. Action is needed to reduce deaths, particularly from accidents and suicide.

Accidents, Occupational↗
PubMed1996

Distribution and determinants of personal exposure to nitrogen dioxide in school children.

OBJECTIVES: To assess the distribution of personal exposures to nitrogen dioxide (NO2) in school children, and to investigate factors that might influence personal exposure. METHODS: NO2 exposures were assessed by use of passive diffusion tubes for 46 children aged 9-11 years, selected from two Southampton schools. The tubes were worn for seven days, and parallel measurements were made with static samplers in the child's kitchen, living room, classroom, and playground. Information about potential exposures was collected by questionnaire. RESULTS: Personal exposures to NO2, averaged over seven days, ranged from 11 to 257 micrograms/m3 (6 to 137 ppb) with a geometric mean of 36 micrograms/m3 (19 ppb). Exposures correlated with concentrations of NO2 recorded in the home, but the relation was far from exact. Factors associated with increased personal exposure included the use of gas appliances in the home, living with one or more smokers, and travel to school by means other than a car. However, together these variables only explained a small part of the variation in personal exposures. CONCLUSIONS: These findings reinforce the need for personal monitoring of exposure in studies investigating potential health effects of NO2 in children.

Child↗
PubMed1996

Work related respiratory symptoms in radiographers.

OBJECTIVE: To determine the prevalence of work related symptoms among radiographers compared with a control group of physiotherapists. METHOD: A postal questionnaire was used to collect information from radiographers and physiotherapists who registered in the United Kingdom during 1985-9. RESULTS: Satisfactory questionnaires were returned by 2354 (65%) of the radiographers and 3048 (69%) of the physiotherapists. There was a clear excess of work related symptoms among the radiographers. In particular, they were more likely to complain of symptoms that were worse at work, mouth soreness, sore, itchy, or runny eyes, persistent blocked nose, persistent itchy nose or sneezing, sore throat, headache, and of lower respiratory tract symptoms, which were also worse on workdays. These symptoms were associated particularly with the use of automatic processing machines. 235 radiographers gave a history of wheeze or chest tightness that had been worse at work or on days when at work. CONCLUSIONS: Work related symptoms suggesting irritation of the eyes and upper airways were more common in radiographers than controls, and may be related to exposure to x ray film processing chemicals. Men and women who reported work related wheeze or chest tightness will be followed up in more detail to assess the prevalence of occupational asthma in the cohort.

Adult↗
PubMed1996

Water fluoridation and osteoporotic fracture.

Osteoporotic fractures constitute a major public health problem. These fractures typically occur at the hip, spine and distal forearm. Their pathogenesis is heterogeneous, with contributions from both bone strength and trauma. Water fluoridation has been widely proposed for its dental health benefits, but concerns have been raised about the balance of skeletal risks and benefits of this measure. Fluoride has potent effects on bone cell function, bone structure and bone strength. These effects are mediated by the incorporation of fluoride ions in bone crystals to form fluoroapatite, and through an increase in osteoblast activity. It is believed that a minimum serum fluoride level of 100 ng/ml must be achieved before osteoblasts will be stimulated. Serum levels associated with drinking water fluoridated to 1 ppm are usually several times lower than this value, but may reach this threshold at concentrations of 4 ppm in the drinking water. Animal studies suggest no effect of low-level (0-3 ppm) fluoride intake on bone strength, but a possible decrease at higher levels. Sodium fluoride has been used to treat established osteoporosis for nearly 30 years. Recent trials of this agent, prescribed at high doses, have suggested that despite a marked increase in bone mineral density, there is no concomitant reduction in vertebral fracture incidence. Furthermore, the increase in bone density at the lumbar spine may be achieved at the expense of bone mineral in the peripheral cortical skeleton. As a consequence, high dose sodium fluoride (80 mg daily) is not currently used to treat osteoporosis. At lower doses, recent trials have suggested a beneficial effect on both bone density and fracture. The majority of epidemiological evidence regarding the effect of fluoridated drinking water on hip fracture incidence is based on ecological comparisons. Although one Finnish study suggested that hip fracture rates in a town with fluoridated water were lower than those in a matching town without fluoride, a later study failed to show differences. Ecological studies from the United States and Great Britain have, if anything, revealed a weak positive association between water fluoride concentration and hip fracture incidence. Two studies examining hip fracture rates before and after fluoridation yielded discordant results, and are complicated by underlying time trends in hip fracture incidence. Only two studies have attempted to examine the relation between water fluoride concentration and fracture risk at an individual level. In one of these, women in a high fluoride community had double the fracture risk of women in a low fluoride community. In the other, there was no relationship between years of fluoride exposure and incidence of spine or non-spine fractures. In conclusion, the epidemiological evidence relating water fluoridation to hip fracture is based upon ecological comparisons and is inconclusive. However, several studies suggest the possibility of a weak adverse effect, which warrants further exploration. Data on the relationship between fluoride intake and hip fracture risk at the individual level, and data relating fluoridation to bone mineral density are required. Until these become available, the burden of evidence suggesting that fluoridation might be a risk factor for hip fracture is weak and not sufficient to retard the progress of the water fluoridation programme.

Aged↗
PubMed1995

Differences in occupational mortality from pleural cancer, peritoneal cancer, and asbestosis.

OBJECTIVE: To assess whether the increased risk of disease related to asbestos in occupations from the construction and engineering industries applies equally to pleural cancer, peritoneal cancer, and asbestosis. METHODS: Analysis was based on deaths among men aged 20-74 in England and Wales during 1979-80 and 1982-90. (n = 1,656,096). Information about cause of death and the last full time occupation of decedents was derived from death certificates. Proportional mortality ratios (PMRs) by occupation were calculated for each of pleural cancer, peritoneal cancer, and asbestosis. RESULTS: Altogether, 2848 deaths were attributed to cancer of the pleura, 362 to cancer of the peritoneum, and 281 to asbestosis. When occupations were ranked according to PMRs from these diseases, striking differences were found. The category of construction workers which included laggers had the highest mortality from peritoneal cancer (PMR 990, 64 deaths), but a PMR of only 160 (77 deaths) for pleural cancer. In contrast, several occupations with much higher mortality from pleural tumours had no excess of peritoneal cancer. PMRs for asbestosis related more closely to those for peritoneal than pleural cancer. CONCLUSIONS: These findings suggest that the exposure-response relations for diseases related to asbestos are not all linear, and that risks of pleural mesothelioma may be underestimated by simple extrapolation from observations in cohorts with heavy exposure.

Adult↗
PubMed1995

Contrasting geographical distribution of mortality from pneumoconiosis and chronic bronchitis and emphysema in British coal miners.

To explore whether the characteristics of coal mine dust that predispose to chronic airways obstruction are the same as those associated with pneumoconiosis, mortality from the two disease was compared in coal miners in 22 counties of England and Wales during 1979-80 and 1982-90. The proportional mortality ratios (PMRs) for coal workers' pneumoconiosis varied from 135 (95% confidence interval (95% CI) 16-488) in Leicestershire to 3825 (95% CI 1538-7881) in South Glamorgan. The PMRs for chronic bronchitis and emphysema were consistently higher than those in other occupations, but showed much less geographical variation and did not correlate geographically with those for pneumoconiosis. These findings indicate that the pathogenetic mechanisms by which coal mine dust causes chronic bronchitis and emphysema depend on different features of the dust from those producing pneumoconiosis. Also, they suggest that current social security regulations in Britain, which require evidence of pneumoconiosis as a condition of compensation for chronic bronchitis and emphysema in coal miners, may discriminate unfairly against claimants from some regions.

Adult↗
PubMed1994

Lobar pneumonia: an occupational disease in welders.

We have used data from three analyses of occupational mortality for England and Wales to investigate a suspected hazard of pneumonia in welders. Mortality from the disease was consistently raised in welders aged 15-64, with standardised mortality ratios of 184 (95% CI 150-224) in 1959-63 and 157 (121-200) in 1970-72. Analysis of data for 1979-80 and 1982-90 showed that the increased risk is attributable mainly to an excess of pneumococcal and unspecified lobar pneumonia (proportional mortality ratio 255, 95% CI 192-332). No excess occurred in men above retirement age (65). A possible explanation of these findings is that welding fume reversibly increases the susceptibility of the lung to pneumonic infection. The observation of a similar mortality pattern in moulders and coremakers points to the metallic component of the fume as a possible culprit, but ozone or oxides of nitrogen could also be implicated. There are grounds for lobar pneumonia to be considered an occupational disease in welders.

Adolescent↗
PubMed1994

Is there an epidemic of cancer?

Trends in cancer mortality in England and Wales are dominated by a slowly evolving epidemic of lung cancer attributable to smoking. When the substantial effects of tobacco are discounted there is no evidence that the overall incidence of cancer is rising, but striking trends are apparent for several specific tumours. These may offer important clues to aetiology.

Age Factors↗
PubMed1994

Cancer and the environment.

The evidence that problems in the environment are causing cancer is reviewed. Although there is concern that our environment is deteriorating, there is little evidence that this is leading to an increased cancer burden as, although rates in the elderly have been increasing, rates in younger people are declining. It is estimated that only about 5% of cancers are due to environmental factors and more than half of these are due to the geophysical properties of the environment, rather than man-made pollutants. Hazards to which people are exposed at work do contribute to increased cancer rates. Once such a hazard is identified then legislation is used to limit, or eliminate, exposure to it, both at work and in the environment. This paper describes certain specific hazards, but concludes that the largest contribution to cancer prevention would be a reduction in smoking rather than any environmental measure.

Carcinogens↗
PubMed1993

Housing in early life and later mortality.

STUDY OBJECTIVES: The aim was to examine the influence of domestic crowding and household amenities in early life on later mortality from all causes and specifically from stomach cancer, chronic obstructive pulmonary disease, and rheumatic heart disease. DESIGN: This was a retrospective cohort study of people whose houses had been surveyed in 1936 and whose household size was known from the 1939 census. Subjects were followed through the National Health Service Central Register from 1951 to 1989. SETTING: The housing survey had been carried out in the midland town of Chesterfield. SUBJECTS: Subjects comprised 8138 men and women born after 1900. RESULTS: A total of 2929 deaths were observed during the follow up period. All causes mortality in the full cohort was not consistently related to any of the housing variables examined, but among subjects who were still children at the time of the housing survey, death rates were higher in those whose houses were crowded or lacked a hot water tap. No associations could be shown between stomach cancer and domestic crowding or food storage facilities; chronic obstructive pulmonary disease and domestic crowding or use of gas for cooking; or rheumatic heart disease and domestic crowding. There were few deaths from these causes, however, in subjects who were children at the time of housing survey. CONCLUSIONS: The findings suggest that the housing of young adults in Chesterfield during the 1930s had little effect on their later mortality. Further follow up of the cohort is needed before firm conclusions can be drawn about the influence of housing at younger ages.

Age Factors↗
PubMed1991

Vaccination against hepatitis B and protection against chronic viral carriage in The Gambia.

358 children in the Gambian villages of Keneba and Manduar, where hepatitis B virus (HBV) infection is endemic, were vaccinated with plasma-derived vaccine against HBV according to one of four regimens and followed for up to 4 years. Two regimens by which vaccine was injected intradermally into children between 0 and 4 years old led to peak geometric mean (95% CI) concentrations of antibody against HBV surface antigen of 270 (202-358) and 555 (418-748) mlU/ml. The third regimen--intramuscular vaccination of children aged between 0 and 4 years--gave geometric mean peak antibody concentrations of 926 (765-1122) mlU/ml. A fourth regimen was intramuscular vaccination of children between 1 and 9 months old, which gave geometric mean antibody concentrations of 5431 (3903-75,456) mlU/ml. Despite these widely divergent responses and a 89% decay in antibody over the first 2 years, vaccination against HBV was 97% effective in preventing chronic infection. Vaccination was less effective in preventing uncomplicated infection: 5.3% of 264 vaccinees in Keneba and 19.1% of 94 vaccinees in Manduar tested positive for antibody to HBV core antigen. These "breakthrough infections" did not differ in frequency between regimens, and were associated with low initial antibody responses and chronic maternal carriage of HBV.

Adolescent↗
PubMed1991

Antibody response to pneumococcal capsular polysaccharide vaccine in African children.

Antibody titers to six pneumococcal polysaccharides were measured by enzyme-linked immunosorbent assay in Gambian children before and 1 month after vaccination with a 23-valent pneumococcal capsular polysaccharide vaccine at the ages of 2, 4, 6 or 9 months or at 5 to 10 years of age. IgG responses to type 1, 3 and 5 polysaccharides were seen in children in all age groups. Responses to type 19F and 23F polysaccharides were seen only in the oldest children. Few children of any age responded to immunization with type 6A pneumococcal polysaccharide. The immune response of Gambian infants to immunization with six components of a polyvalent pneumococcal polysaccharide vaccine was comparable with that described previously in Finnish infants and would be unlikely to provide substantial protection against invasive pneumococcal disease.

Antibodies, Bacterial↗