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Biomedical subjects

H Inskip

Publications and source records attributed to H Inskip.

52 records · Page 3Linked to original sources
PubMed1990

The pattern of childhood hepatitis B infection in two Gambian villages.

Serologic markers of hepatitis B virus (HBV) infection were measured in children from Manduar and Keneba, two adjacent villages in The Gambia, in 1980 and in 1984. The rate of HBV infection over the 4 years differed markedly: in Manduar 71% of children who were less than 5 years of age in 1980 became infected, whereas in Keneba only 37% became infected. Male children were more frequent carriers of either HBs or e antigen than were female children. Marked clustering of hepatitis B surface antigen (HBsAg) antigenemia within sibling relationships was shown in both villages. The chance of the youngest child in a household being a carrier of HBsAg was strongly related to the number of antigen-positive siblings. Four years later, 53% of children who were initially positive for HBsAg and 33% who were positive for hepatitis B e antigen still carried these antigens. Jaundice was not observed.

Adolescent↗
PubMed1989

Respiratory symptoms as predictors of 27 year mortality in a representative sample of British adults.

OBJECTIVE: To examine associations between reported respiratory symptoms (as elicited by questionnaire) and subsequent mortality. DESIGN: Prospective cohort study. SETTING: 92 General practices in Great Britain. PARTICIPANTS: A nationally representative sample of 1532 British men and women aged between 40 and 64. MAIN OUTCOME MEASURES: Mortality from all causes, cardiovascular disease, lung cancer, and chronic bronchitis. RESULTS: Subjects were interviewed in 1958 regarding various respiratory symptoms (including cough, phlegm, breathlessness, and wheeze) by using a questionnaire which formed the basis of the Medical Research Council's questionnaire on respiratory symptoms. By the end of 1985, 889 deaths had been reported, including 51 in men due to chronic bronchitis. After adjustment for differences in age and smoking habits death rates from chronic bronchitis in men who reported symptoms were greater than those in men who did not for each of the symptoms examined. The adjusted mortality ratios were 3.4 (95% confidence interval 1.8 to 6.5) for morning cough, 3.7 (2.0 to 6.9) for morning phlegm, 6.4 (3.0 to 13.8) for breathlessness when walking on the level, and 10.5 (4.4 to 24.6) for wheeze most days or nights. Mortality ratios were also significantly raised for four episodic symptoms not usually included in more recent respiratory symptom questionnaires--namely, occasional wheeze (mortality ratio 6.0; 95% confidence interval, 2.4 to 15.1), weather affects chest (5.7; 3.1 to 10.3), breathing different in summer (4.9; 2.8 to 8.6), and cold usually goes to chest (3.7; 2.0 to 6.8). The excess mortality associated with these symptoms remained significant after further adjustment for breathlessness or phlegm. Ratios for all cause mortality in men and women were also significantly raised for most respiratory symptoms, death rates being some 20-50% higher in people reporting symptoms after adjustment for age, sex, and smoking. Breathlessness was the only symptom significantly associated with excess mortality from cardiovascular disease (mortality ratio 1.4 (95% confidence interval 1.0 to 1.9) for breathlessness when walking on the level). Ratios were generally around unity and not significant for mortality due to lung cancer. CONCLUSIONS: The results suggest that episodic symptoms, which often do not appear in standard respiratory questionnaires, predict subsequent mortality from chronic obstructive airways disease. This supports the hypothesis that reversible airflow obstruction may be a precursor of progressive and irreversible decline in ventilatory function.

Adult↗
PubMed1987

Further assessment of the effects of occupational radiation exposure in the United Kingdom Atomic Energy Authority mortality study.

The United Kingdom Atomic Energy Authority mortality study was designed to investigate the relation between exposure to ionising radiation and mortality among the authority's employees. The present paper describes some of the problems encountered in assessing occupational exposure to low dose radiation and examines whether the study's conclusions about the relation between exposure and mortality could be affected by the methods used. The study covered the years 1946 to 1979 during which time the frequency with which personal film dosimeters were issued changed from weekly to monthly, and the threshold level below which measurements were not made decreased 20-fold. Exposure from "below threshold" readings made an important contribution to total exposure in the early years. Estimates, based on the remeasurement of a sample of old films, indicated that the average whole body exposure before 1961 may have been about double that which was measured. Furthermore, although records were kept of when dosimeters were lost or damaged, the associated exposures were unknown and could only be estimated. Workers whose dosimeter readings were missing for more than 5% of the time during which they were monitored had higher all cause mortality (p = 0.04) and higher mortality from accidents and violence (p = 0.05) than other radiation workers. The results of analyses of mortality in relation to whole body exposure were compared when the exposures included estimates of the below threshold and missing exposures and when these exposures were assumed to be zero. Some of the findings differed, but none changed sufficiently to alter the general conclusions. Although the trend in mortality from all cancers changed from one in which the increase with exposure was far from statistically significant (p = 0.3) when the below threshold and missing values were assumed to be zero to one that approached significance (p = 0.06) after they were estimated, calculations of the annual excess deaths from cancer per unit dose resulted in broadly similar estimates. Studies of workers exposed to ionising radiation usually focus on mortality in relation to whole body exposure. In the present paper its relation to neutron and surface exposure is also examined. Workers with measured neutron exposures had significantly lower all cause mortality than other workers with a radiation record (p = 0.03). Surface exposure was significantly related to mortality from all cancers (p = 0.02) and prostatic cancer (p less than 0.001). Some data on cancer registration are presented but these cannot be readily interpreted because cancer registration details were available only for ex-employees who may not be typical of the workforce as a whole.

Humans↗
PubMed1985

Collection and validation of data in the United Kingdom Atomic Energy Authority mortality study.

The United Kingdom Atomic Energy Authority mortality study investigated the relation between mortality and recorded exposure to ionising radiation among employees working at the authority's seven establishments between 1946 and 1979. This report examines the design of the study and methods of data collection and validation. The completeness of the study population was deemed to be unsatisfactory at two establishments, where records of employment before 1965 had been destroyed. Assessment of the magnitude of the deficit led to the conclusion that the data from these establishments were too incomplete for inclusion in the mortality analysis. At the other establishments validation showed that the data collected were accurate and unbiased. Certain characteristics of the 39 546 employees included in the mortality analysis were identified which were relevant in interpreting the findings.

Data Collection↗
PubMed1985

Mortality of employees of the United Kingdom Atomic Energy Authority, 1946-1979.

An analysis was conducted of 3373 deaths among 39 546 people employed by the United Kingdom Atomic Energy Authority between 1946 and 1979, the population having been followed up for an average of 16 years. Overall the death rates were below those prevailing in England and Wales but consistent with those expected in a normal workforce. At ages 15-74 years the standardised mortality ratios (SMRs) were 74 for deaths from all causes and 79 for deaths from all cancers. Mortality from only four causes was above the national average--namely, testicular cancer (SMR 153; 10 deaths), leukaemia (SMR 123; 35 deaths), thyroid cancer (SMR 122; three deaths), non-Hodgkin's lymphoma (SMR 107; 20 deaths)--but in none was the increase significant at the 5% level. Half of the authority's employees were recorded as having been monitored for exposure to radiation, their collective recorded exposure being 660 Sv (65 954 rem). Among these prostatic cancer was the only condition with a clearly increased mortality in relation to exposure. Of the 19 men who had a radiation record and died from prostatic cancer at ages 15-74 years, nine had been monitored for several different sources of exposure to radiation. The standardised mortality ratios were 889 (six deaths) in employees monitored for contamination by tritium, 254 (nine deaths) in those monitored for contamination by other radionuclides, and 385 (nine deaths) in those with dosimeter readings totalling more than 50 mSv (5 rem); but the same nine subjects tended to account for each of these significantly raised ratios. Because multiple exposures were common and other relevant information was not available the reason for the increased mortality from prostatic cancer in this population could not be determined and requires further investigation. Excess mortality rates of 2.2 and 12.5 deaths per million person years per 10 mSv (1 rem) were estimated for leukaemia and all cancers, respectively. The confidence limits around these estimates were wide, included zero, and made it unlikely that the International Commission on Radiological Protection's cancer risk coefficients were underestimated by more than 15-fold. Thus despite this being the largest British workforce whose mortality has been reported in relation to low level ionising radiation exposure, even larger populations will need to be followed up over longer periods before narrower ranges of risk estimates can be derived.

Adolescent↗
PubMed1985

Occupational mortality among women in England and Wales.

Occupational mortality in women who died in England and Wales from 1970 to 1972 was analysed. Many of the associations found were consistent with those that have been described for men, with high mortality ratios for cirrhosis in barmaids and publicans, for suicide in the medical and allied professions, and for respiratory disease in textile workers. Parity is a determinant of patterns of disease in working women, and the relative excess of cancer of the breast, ovary, and uterine body in professional and clerical workers probably reflected the high proportion of nulliparous women in these groups. Other associations may have reflected true occupational hazards; one observation requiring further attention was the high proportional mortality ratio for anaemia in textile and clothing workers. The description of the occupational mortality among women in England and Wales is hampered by the incomplete recording of information about women's occupations at registration of death. As women now constitute 40% of the workforce, often have their own specific occupations, and possibly also have their own diseases related to specific occupations it is time for the registrar's guidelines on the recording of women's occupation--last reviewed at the beginning of this century--to be revised.

Adolescent↗
PubMed1985

Epidemiological studies related to enhanced natural radiation: possibilities and problems.

Ultimately epidemiological studies alone provide the means to determine whether or not persons exposed to specified levels of enhanced natural radiation are at increased risk of developing cancers or other diseases. Various types of epidemiological study can be used to examine this issue, but each type has problems and limitations. In order to be viable any study must satisfy certain basic criteria concerning sample size, timespan, data quality, and allowance for confounding factors.

England↗
PubMed1984

Epidemiological monitoring: methods for analysing routinely-collected data.

Morbidity and mortality statistics are routinely collected in many countries. These data may be arranged in a number of ways, for example, classified by area of residence, or occupation of the person concerned, or by the time-period during which the relevant event occurred. Judicious use of such data enables disease to be monitored and may draw attention to the adverse effects of harmful agents in the environment. This paper describes the different methods of analysing data for such purposes, giving examples of their application and discussing their relative merits. Particular reference is made to the data-collecting systems in England and Wales and to the statistical aspects of monitoring disease.

Communicable Diseases↗
PubMed1984

A survey of dietary nitrate in well-water users.

The hypothesis that high nitrate ingestion may increase the risk of stomach cancer has led to concern over rising levels of nitrate in drinking water, but with little consideration as to whether nitrate from water makes a major contribution to total nitrate intake. In order to investigate the relative importance of water and food as sources of nitrate, 404 adult well-water users completed a diet diary over a 48-hour period and provided a 24-hour urine specimen and a sample of their drinking water. Where the waterborne nitrate level is less than 50 mg/I, as recommended by the World Health Organization (WHO), 30% of ingested nitrate is from water. As the well-water nitrate concentration rises the contribution of water to daily intake increases; at levels between 50 and 100 mg/I, on average, nearly 70% of daily intake is from water, and above 100 mg/I over 80% of daily intake is waterborne. Thus it is only at levels above those currently recommended by the WHO that waterborne nitrate appears to be the major contributor to total nitrate intake.

Adult↗
PubMed1984

Alcohol consumption and outcome of pregnancy.

In a prospective study 1256 pregnant women at their first antenatal visit were asked if they drank alcohol every day, occasionally, or not at all, both at that time and before the diagnosis of pregnancy. There were no significant differences, among the three alcohol groups, in the proportions having miscarriages, perinatal deaths, congenital anomalies, or premature births. Women who reported drinking every day before pregnancy was diagnosed had heavier babies than those who did not drink at all, but there were no differences in mean birth weight according to alcohol use at the first antenatal visit. There were statistically significant differences among the three groups in important background characteristics, such as social class, age, smoking, and marital status. When adjustment was made for these factors, both occasional and daily consumption of alcohol before pregnancy appeared to have significantly positive effects on birth weight. These results illustrate the difficulty of evaluating the effects of alcohol in observational studies, and imply a need for caution in attributing either negative or positive effects of alcohol on the outcome of pregnancy.

Abortion, Spontaneous↗
PubMed1982

Mortality of Shipham residents: 40-year follow-up.

The 1939 populations of Shipham, a village in Somerset with high soil-cadmium levels, and a nearby control village have been followed for 40 years. Death certificates were obtained for those who had died, and the mortality rates were compared with those for England and Wales. Small excesses of hypertensive, cerebrovascular, and genitourinary disease were noted in Shipman but not in the control village. These conditions have been associated wih cadmium toxicity, and so it is possible that cadmium had some influence on the disease pattern in Shipham; but if so, the effect was slight. By contrast, fewer deaths than expected from respiratory disease and cancers were observed in both villages. This gave rise to all-cause mortality rates in Shipham and the control village which were similar and well below the national average.

Cadmium Poisoning↗
PubMed1981

Multicentre trial of physiotherapy in the management of sciatic symptoms.

Four treatments for sciatic symptoms--traction, exercises, manipulation, and corset--were assessed in a randomised controlled trial in 322 outpatients. The design was factorial. There were thus sixteen treatment groups, enabling a comparison of combinations of methods as well as of individual methods. Treatment lasted for four weeks. Patients were reviewed at the end of this period and at four and sixteen months after entry to the trial. Progress was measured by the patient's account of symptomatic improvement or deterioration and by return to work or normal activities. At four weeks each of the treatments was associated with a small degree of benefit over and above the high rate of spontaneous improvement. For manipulation, the benefit was statistically significant on one of the scales used to measure progress. There was a significant increase in symptomatic improvement with increasing numbers of treatments used in combination. This was complemented by a clear tendency for those who had received fewer types of treatment during the trial to have further treatment in the ensuing three months. There were no beneficial effects of treatment detectable at four or sixteen months. In the short-term, active physiotherapy with several treatments appears to be of value in the outpatient management of patients with sciatic symptoms, but it does not seem to confer any longer-term benefit.

Adult↗
PubMedDate not supplied

Methods for age-adjustment of rates.

Different age structures in two populations complicate any comparison of their levels of mortality. Many methods exist which provide death rates or mortality indices adjusted for age and other factors. Such summary measures inevitably lose information, but they are useful for the initial examination of large quantities of data and for the presentation of results. This paper reviews a number of techniques available for producing age-adjusted death rates or mortality indices, emphasizing their historical development. Formulae are given for their calculation. The appropriate context for using each method, and its associated disadvantages are described.

Age Factors↗
PubMedDate not supplied

A comparison of standardized and proportional mortality ratios.

Proportional mortality analyses are traditionally considered to be unreliable because they lack information on persons at risk. Standardized mortality ratios (SMRs) are often used in preference to proportional mortality ratios ( PMRs ) even when the denominator or numerator of rates is known to be biased. Examination of data from 30 randomly selected occupational units described by the U.K. Office of Population Censuses and Surveys ( OPCS ) revealed, however, that age-standardized cause-specific SMRs and PMRs have an almost constant relationship: the ratio of the cause-specific PMR closely approximating the all-cause SMR of the group under consideration. Hence, a PMR above 100 almost always indicates that the corresponding cause-specific SMR is greater than the all-cause SMR (and vice versa). Furthermore, approximately 70 per cent of conditions with significantly high PMRs above 200 have corresponding SMRs which are also significantly high. When cautiously interpreted, the PRM may, therefore, be a useful indicator of an increased frequency of disease in a particular occupational or other group.

England↗
PubMedDate not supplied

Cost-effectiveness of hepatitis B vaccine in The Gambia.

Hepatitis B vaccine has been progressively introduced into the Gambian programme of immunization since 1986. Other African countries are considering introduction but require evidence of cost-effectiveness to justify such a decision. The cost of the Expanded Programme on Immunization in The Gambia, which includes hepatitis B vaccine, was calculated for 1988. Estimates of the effects of this programme on the incidence of liver cancer were made, based on the national cancer registry and a case control study of primary liver cancer and hepatitis B, regarding hepatitis B vaccine costs as incremental. This gave an estimate of the cost of averting a death from liver cancer in the range US$150-200 (assuming a vaccine cost of US$1 per dose). This indicates that universal hepatitis B immunization is comparable, in terms of cost-effectiveness, to other health interventions in less developed countries.

Adolescent↗