PubMed Health⌕ Search

Biomedical subjects

I J Perry

Publications and source records attributed to I J Perry.

At least 19 recordsLinked to original sources
PubMed2006

Adverse childhood experiences and lifetime suicide ideation: a cross-sectional study in a non-psychiatric hospital setting.

We have assessed the effect of adverse childhood experiences on the lifetime prevalence of suicide ideation in a cross-sectional study involving 182 patients aged 18 to 44 years, consecutive attenders at an A&E review clinic. All participants were interviewed by a psychologist using standardised questionnaire instruments addressing participants' demographic characteristics, drug use, depressed mood, eight major categories of adverse childhood experiences (including physical, emotional and sexual abuse) and suicide ideation. The response rate was 73%. In multivariate logistic regression analyses, those with a history of two or more forms of childhood adversity relative to those with none were at increased risk of depressed mood (OR = 5.5, 95% CI = 2.3-13.3) and suicide ideation (OR = 3.5, 95% CI = 1.5-8.3). The findings emphasise the need to set suicide prevention within the broader context of society's obligation to protect children from physical, emotional and sexual abuse.

Adolescent↗
PubMed2005

Clustering of protective factors for glucose intolerance and insulin resistance: a cross-sectional study.

AIMS: A cluster of interrelated factors: a body mass index (BMI) < 25 kg/m(2), moderate exercise and alcohol intake, non-smoking and a favourable dietary pattern has been linked with markedly reduced risk of Type 2 diabetes. The aim of this study was to estimate the prevalence of a similar low-risk group in a sample of middle-aged Irish men and women, and determine whether this cluster is associated with a reduced risk of glucose intolerance (IFG and Type 2 diabetes according to ADA/WHO criteria) and insulin resistance [homeostasis model assessment (HOMA) score in upper quartile of distribution]. METHODS: A cross-sectional study involving a stratified random sample of 1018 general practice patients, aged 50-69 years. We defined a low-risk group based on the following variables: BMI < 25 kg/m(2); waist-hip ratio < 0.85 for women and 0.90 for men; never smoking status; participation in medium to high level of physical activity; light drinking (3.5-7 units of alcohol per week) and a 'prudent' dietary pattern. Valid data were available for glucose tolerance status and HOMA score and all exposure variables from 684 and 671 participants, respectively. RESULTS: A total of 7.5% of participants had none of the 'protective factors', 24.9% had one, 31.0% two, 23.3% three, 10.0% four, 3.0% five and 0.3% had six protective factors. In multivariate analyses the odds ratios for insulin resistance were 0.59, 0.48, 0.14 and 0.04 in persons with one, two, three and four or more low-risk factors, respectively, relative to those with none. Similar linear inverse trends were observed for glucose intolerance. CONCLUSIONS: The findings are consistent with an inverse linear relation between a cluster of core protective, lifestyle-related factors and the prevalence of both glucose intolerance and insulin resistance.

Aged↗
PubMed2005

Acute coronary syndrome and chronic infection in the Cork coronary care case-control study.

OBJECTIVE: To examine the association between chronic infection and cumulative burden of infection and acute coronary syndrome. DESIGN: The 5C (Cork coronary care case-control) study was a community based case-control study. Patients and controls underwent a standard physical examination and had blood samples taken for serological analysis for Helicobacter pylori (IgG), Chlamydia pneumoniae (IgA, IgM, and IgG), cytomegalovirus (IgG), and herpes simplex virus types 1 and 2 (IgG). SETTING: Patients were recruited from four hospitals in Cork City and Mallow Town. Controls, individually matched on age and sex, were selected by incident density sampling from the same general practices as the referent case. MAIN OUTCOME MEASURES: Age and sex adjusted and fully adjusted odds ratios for acute coronary syndrome by seropositivity and by increasing number of infections. RESULTS: Cases and controls did not differ significantly in seropositivity to C pneumoniae, cytomegalovirus, herpes simplex viruses, and H pylori. In unconditional logistic regression analysis adjusted for age, sex, waist to hip ratio, smoking, physical activity, alcohol consumption, and social class there was no evidence of an increasing risk for acute coronary syndrome with increasing burden of infection. CONCLUSIONS: The findings do not support an association between specific infectious agents and acute coronary syndrome and do not provide evidence of a burden of infection effect.

Adult↗
PubMed2005

Writing to patients: 'putting the patient in the picture'.

We have explored consultant, general practitioner and patient attitudes toward the proposal that following an outpatient consultation, consultants should consider communicating directly with patients in the form of a summary letter, with a copy to the referring general practitioner or other professionals as appropriate. We conducted in-depth interviews with a purposive sample of 20 consultants, 16 patients and 12 general practitioners. The consultants and general practitioners were both involved in the care of participating patients. Patients highlighted the likely value of summary letters including, increased knowledge, improvement recall of the clinical encounter, and reassurance. Clinicians were concerned that patients would not understand letters from consultants. Additional concerns included the impact of letter on consultant-general practitioner relationship and medico-legal issues. These findings reflect fundamental differences in expectations about the nature and quality of communications between doctors and their patients.

Adult↗
PubMed2004

Prudent diet and the risk of insulin resistance.

BACKGROUND AND AIM: Diet is a potentially modifiable risk factor for diabetes. Dietary patterns may exert greater effects on health than individual foods, nutrients or food groups. Data on associations between dietary patterns and the risk of insulin resistance and type 2 diabetes are sparse. The aim of the study was to examine associations between dietary patterns and the risk of insulin resistance. METHODS AND RESULTS: We performed a cross sectional study involving a group of 1018 men and women, sampled from 17 general practice lists in the South of Ireland, with a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and provided fasting blood samples for analysis of glucose, insulin and lipids. Dietary intake was assessed using a food frequency questionnaire. The food frequency questionnaire was a modification of the UK arm of the European Prospective Investigation into cancer, EPIC study, which was based on that used in the US Nurses' Health Study. Dietary patterns were assessed by K cluster analysis. Insulin resistance was estimated on the basis of fasting glucose and insulin, using the glucose homeostasis model (HOMA scores). Insulin resistance was defined as the upper quartile of the HOMA scores. Three dietary patterns were identified by cluster analysis (traditional Irish diet, a prudent diet and an alcohol and convenience foods diet). Participants in clusters 1 (traditional Irish diet) and 3 (high alcohol and convenience foods) had a lower intake of more 'healthy' food groups (such as fruit, vegetables, low fat dairy products, poultry, fish and whole grain products) and higher intake of foods richer in total and SFA content (such as high fat dairy products, butter, meat and meat products). Cluster 2 (prudent dietary pattern) was characterized by a higher intake of food groups that are typically recommended in health promotion programs and a lower intake of meat (read meat), meat products, sweets, high fat dairy and white bread (white bread and unrefined cereal). The prudent diet had the lowest HOMA scores in analysis of covariance. The prevalence of insulin resistance in the prudent diet was lower than that in the traditional diet (OR=0.53; 95%CI, 0.33-0.85 in fully adjusted analysis). CONCLUSION: A prudent diet may be associated with enhanced insulin sensitivity and a lower risk of type 2 diabetes.

Aged↗
PubMed2004

Alcohol intake and insulin resistance. A cross-sectional study.

BACKGROUND AND AIM: The development of insulin resistance is a critical step in the pathogenesis of type 2 diabetes. The effect of alcohol intake on insulin sensitivity/resistance is not well defined. The aim of this study was to examine the association between alcohol intake and insulin resistance in a sample of middle-aged men and women with data on a wide range of potential confounding factors, including diet. METHODS: We performed a cross sectional study involving a group of 1018 men and women, sampled from 17 general practice lists in the South of Ireland, with a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and a food frequency questionnaire and provided fasting blood samples for analysis of glucose and insulin. Insulin resistance was estimated on the basis of fasting glucose and insulin, using the glucose homeostasis model (HOMA scores). Insulin resistance was defined as the upper quartile of the HOMA scores. RESULTS: We found evidence of a U-shaped relationship between alcohol intake and insulin resistance fitted as a continuous variable (HOMA scores) with lowest levels in light drinkers (between 0.5 to 0.99 units per day) relative to the other drinking categories. However no significant association between alcohol intake and HOMA score was observed in fully adjusted analyses, including adjustment for dietary saturated fat and fruit and vegetables intake. In logistic regression analysis with insulin resistance (categorical) as the dependent variable, we observed that ex-drinkers were at higher risk of insulin resistance compared to occasional drinkers independently of age, sex, BMI and waist circumference, (OR=2.4, 95% CI, 1.1-5.7, p=0.04). On further adjustment for potential confounders including diet this association was also attenuated and was non-significant. CONCLUSIONS: The reported effects of alcohol intake on insulin resistance may be confounded by other aspects of lifestyle, especially diet.

Alcohol Drinking↗
PubMed2004

Dietary patterns in middle-aged Irish men and women defined by cluster analysis.

OBJECTIVES: To identify and characterise dietary patterns in a middle-aged Irish population sample and study associations between these patterns, sociodemographic and anthropometric variables and major risk factors for cardiovascular disease. DESIGN: A cross-sectional study. SUBJECTS AND METHODS: A group of 1473 men and women were sampled from 17 general practice lists in the South of Ireland. A total of 1018 attended for screening, with a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and provided a fasting blood sample for glucose, lipids and homocysteine. Dietary intake was assessed using a standard food-frequency questionnaire adapted for use in the Irish population. The food-frequency questionnaire was a modification of that used in the UK arm of the European Prospective Investigation into Cancer study, which was based on that used in the US Nurses' Health Study. Dietary patterns were assessed primarily by K-means cluster analysis, following initial principal components analysis to identify the seeds. RESULTS: Three dietary patterns were identified. These clusters corresponded to a traditional Irish diet, a prudent diet and a diet characterised by high consumption of alcoholic drinks and convenience foods. Cluster 1 (Traditional Diet) had the highest intakes of saturated fat (SFA), monounsaturated fat (MUFA) and percentage of total energy from fat, and the lowest polyunsaturated fat (PUFA) intake and ratio of polyunsaturated to saturated fat (P:S). Cluster 2 (Prudent Diet) was characterised by significantly higher intakes of fibre, PUFA, P:S ratio and antioxidant vitamins (vitamins C and E), and lower intakes of total fat, MUFA, SFA and cholesterol. Cluster 3 (Alcohol & Convenience Foods) had the highest intakes of alcohol, protein, cholesterol, vitamin B(12), vitamin B(6), folate, iron, phosphorus, selenium and zinc, and the lowest intakes of PUFA, vitamin A and antioxidant vitamins (vitamins C and E). There were significant differences between clusters in gender distribution, smoking status, physical activity, body mass index, waist circumference and serum homocysteine concentrations. CONCLUSION: In this general population sample, cluster analysis methods yielded two major dietary patterns: prudent and traditional. The prudent dietary pattern is associated with other health-seeking behaviours. Study of dietary patterns will help elucidate links between diet and disease and contribute to the development of healthy eating guidelines for health promotion.

Alcohol Drinking↗
PubMed2003

Randomized clinical trial and economic analysis of four-layer compression bandaging for venous ulcers.

BACKGROUND: The aim of this study was to compare the cost-effectiveness of four-layer compression bandaging for venous leg ulcers with that of other available treatments. METHODS: In this pragmatic trial, 200 patients with a venous leg ulcer were randomized either to four-layer bandaging (intervention group; n = 100) or to continue their usual system of care (control group; n = 100). The follow-up for each patient was 12 weeks. Analysis was by intention to treat; the main outcome measures were time to healing and cost to the health board per leg healed. RESULTS: Baseline characteristics were well matched in the two groups. The Kaplan-Meier estimate of the healing rate at 3 months was 54 per cent with four-layer bandaging and 34 per cent in the control group. Throughout the 3 months, four-layer bandaging healed leg ulcers significantly earlier (P = 0.006). There was a significant reduction in the median cost per leg healed with four-layer bandaging (euro 210 versus euro 234; P = 0.040). CONCLUSION: Four-layer bandaging is currently the most effective method of treating venous leg ulcers in a community setting.

Aged↗
PubMed2002

Healthy diet and lifestyle clustering and glucose intolerance.

Glucose intolerance represents a spectrum of abnormalities, including impaired fasting glucose, impaired glucose tolerance and type 2 diabetes. It is a major public health challenge worldwide, with rapidly increasing prevalence rates in both developed and developing countries. This global epidemic of diabetes is largely driven by the globalisation of Western culture and lifestyles. Specifically, there is now evidence from large-scale observational studies, and from intervention studies, of powerful synergistic interactions between diet, obesity, exercise, smoking and alcohol in the development of glucose intolerance. It is estimated that >90% of cases of type 2 diabetes in the population could be prevented with the adoption of a prudent diet (high in cereal fibre and polyunsaturated fatty acids and low in trans-fatty acids and glycaemic load), avoidance of overweight and obesity (BMI<25 kg/m2), engagement in moderate to vigorous physical activity for at least 0.5 h/d, non-smoking and moderate alcohol consumption. These findings are biologically plausible and have major public health implications. They form the basis for a clear, simple and coherent message for health promotion and public policy. However, to make progress on these issues health will need to be placed at the centre of public policy and relevant vested interests tackled, notably in the food, entertainment, tobacco and automobile industries.

Adolescent↗
PubMed2002

Alcohol consumption and the incidence of type II diabetes.

BACKGROUND: This study examines the relation between alcohol and type II diabetes and the possible mediating effects of HDL-cholesterol and serum insulin. METHODS: Prospective study of 5221 men aged 40-59 years with no history of coronary heart disease, diabetes, or stroke drawn from general practices in 18 British towns. RESULTS: During the mean follow up of 16.8 years there were 198 incident cases of type II diabetes. Occasional drinkers were the reference group. A non-linear relation was seen between alcohol intake and age adjusted risk of diabetes, with risk lowest in light and moderate drinkers and highest in heavy drinkers (quadratic trend p=0.03). Further adjustment for body mass index decreased risk in heavy drinkers. After additional adjustment for physical activity, smoking, and (undiagnosed) pre-existing coronary heart disease, only moderate drinkers showed significantly lower risk than occasional drinkers (RR=0.66 95% CI 0.44 to 0.99). Alcohol intake was inversely associated with serum insulin and positively associated with HDL-cholesterol. Adjustment for these factors reduced the "protective" effect in moderate drinkers (adjusted RR=0.73 95% CI 0.48 to 1.10) but the quadratic trend remained significant (p=0.02). CONCLUSION: There is a non-linear relation between alcohol intake and the risk of type II diabetes. Serum insulin and HDL-cholesterol explained a small amount (20%) of the reduction in risk of type II diabetes associated with moderate drinking. The adverse effect of heavy drinking seemed to be partially mediated through its effect on body weight.

Adult↗
PubMed2002

Testing cognitive function in elderly populations: the PROSPER study. PROspective Study of Pravastatin in the Elderly at Risk.

OBJECTIVES: For large scale follow up studies with non-demented patients in which cognition is an endpoint, there is a need for short, inexpensive, sensitive, and reliable neuropsychological tests that are suitable for repeated measurements. The commonly used Mini-Mental-State-Examination fulfils only the first two requirements. METHODS: In the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), 5804 elderly subjects aged 70 to 82 years were examined using a learning test (memory), a coding test (general speed), and a short version of the Stroop test (attention). Data presented here were collected at dual baseline, before randomisation for active treatment. RESULTS: The tests proved to be reliable (with test/retest reliabilities ranging from acceptable (r=0.63) to high (r=0.88) and sensitive to detect small differences in subjects from different age categories. All tests showed significant practice effects: performance increased from the first measurement to the first follow up after two weeks. CONCLUSION: Normative data are provided that can be used for one time neuropsychological testing as well as for assessing individual and group change. Methods for analysing cognitive change are proposed.

Aged↗
PubMed2001

Smoking as a modifiable risk factor for type 2 diabetes in middle-aged men.

OBJECTIVE: To examine the effects of cigarette smoking, giving up smoking, and primary or secondary pipe or cigar smoking on the risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: A prospective study followed 7,735 men aged 40-59 years from general practices in 24 British towns for an average of 16.8 years. Incident cases of physician-diagnosed diabetes were ascertained by repeated postal questionnaires and systematic reviews of primary care records. RESULTS: A total of 290 incident cases of diabetes were found in 7,124 men with no history of diabetes, coronary heart disease, or stroke. Cigarette smoking was associated with a significant increase in risk of diabetes, even after adjustment for age, BMI, and other potential confounders. The benefit of giving up smoking was only apparent after 5 years of smoking cessation, and risk reverted to that of never-smokers only after 20 years. The risk of diabetes in those who switched from smoking cigarettes to pipe or cigars remained equal to the risk in continuing cigarette smokers. Men who gave up smoking during the first 5 years of follow-up showed significant weight gain and subsequently higher risk of diabetes than continuing smokers. CONCLUSIONS: Cigarette smoking is an independent and modifiable risk factor for type 2 diabetes. Smoking cessation is associated with weight gain and a subsequent increase in risk of diabetes, but in the long term, the benefits of giving up smoking outweigh the adverse effects of early weight gain.

Adult↗
PubMed2000

Birth weight and 24-hour ambulatory blood pressure in nonproteinuric hypertensive pregnancy.

OBJECTIVE: The aim of this study was to examine the relationship between maternal ambulatory blood pressure monitor measurements during pregnancy and birth weight in a population of women considered to have hypertension according to conventional antenatal clinic measurement. STUDY DESIGN: A prospective observational study was carried out within the obstetric departments of Leicester Royal Infirmary and Queen Charlotte's Hospital. A total of 237 women were found to have hypertension (blood pressure >/=140/90 mm Hg) without significant proteinuria during examination in the antenatal assessment area. Sequential-day unit blood pressure recordings and a 24-hour automated ambulatory blood pressure recording were performed, and the results were compared with the principal outcome measure of birth weight. RESULTS: A significant inverse association (gradient, -13.5; 95% confidence interval -23.4 to -3.6) was found between daytime ambulatory diastolic blood pressure measurement and birth weight. An increase of 5 mm Hg in daytime mean diastolic blood pressure was associated with a fall in birth weight of 68.5 g. This association remained after adjustment for potential confounders that included maternal age, maternal weight, smoking status, ethnicity, and gestational age at delivery. No such association was found between obstetric day unit assessment of blood pressure and birth weight. CONCLUSION: There is a significant association between blood pressure and birth weight in nonproteinuric hypertensive pregnancies. The best predictor of this association is the daytime mean ambulatory diastolic blood pressure measurement. This is further evidence that maternal blood pressure may be an important confounding and potentially genetic variable in the association between birth weight and subsequent adult hypertension.

Adult↗
PubMed2000

Secondary prevention following fractured neck of femur: a survey of orthopaedic surgeons practice.

Fractured neck of femur is one of the most common reasons for hospital admission in the elderly population. Despite this little attention is given to the area of secondary prevention. To assess the variation in clinical practice among orthopaedic surgeons with regard to the use of secondary preventive measures in relation to fractured neck of femur. A postal survey using a self-completed questionnaire among all orthopaedic surgeons throughout the Republic of Ireland. The study questionnaire addressed unit information prophylaxis for deep venous thrombosis and investigation and secondary prevention of fractured neck of femur. It gave a clinical scenario of a 72-year old female who was admitted with a fractured neck of femur after a minor fall. A reminder was sent to the non-responders. Data were analysed using chi-squared test. The number of completed questionnaires returned was 89 giving a response rate of 66%. Of these 71(82.6%) reported that they would not initiate or recommend investigation of the extent of the underlying osteoporosis in the specific case upon which the questionnaire was based. With regard to the issue of secondary prevention 16(18%) stated that they would prescribe Vitamin D and 26(29%) would prescribe calcium supplements. 15(17%) would use bisphosphonates and 15(17%) would prescribe hormone replacement therapy. Only one respondent would use an external hip protector. There is an underuse of secondary preventive measures with regard to fractured neck of femur. There needs to be clear definition of roles and perhaps the development of agreed local protocols in order that patients with hip fractures do not miss out on potentially beneficial treatment. There is an underuse of secondary preventive measures with regard to fractured neck of femur. There needs to be clear definition of roles and perhaps the development of agreed local protocols in order that patients with hip fractures do not miss out on potentially beneficial treatment.

Aged↗
PubMed2000

Dietary salt intake and cerebrovascular damage.

AIM: Diet is a major contributor to variation in the occurrence of hypertension and cardiovascular disease, including stroke, worldwide. Dietary salt intake plays a critical role in blood pressure regulation. However the question of whether high dietary salt intake increases risk of stroke, either indirectly via effects on blood pressure or directly via alternative mechanisms has received limited attention. DATA SYNTHESIS: Narrative review of evidence linking dietary salt intake with left ventricular hypertrophy and cardiovascular disease end-points. CONCLUSIONS: There is accumulating evidence that high salt intake predicts left ventricular hypertrophy, independent of other variables including body mass index and blood pressure. Data are now available from nine different studies worldwide consistent with a significant independent effect of salt intake on left ventricular hypertrophy. There is also evidence from animal experiments and ecological studies of an independent association between salt intake and risk of stroke. However, data from prospective observational studies on the relation between sodium intake and cardiovascular endpoints (including stroke) are sparse and inconsistent. Data from Alderman et al suggesting that there may be a significant inverse association between urinary sodium excretion and risk of cardiovascular disease has attracted controversy. In a number of prospective studies no association between salt intake and cardiovascular disease end-points (including stroke) has been observed. In a recent analysis from the US NHANES follow-up study, there was evidence that high salt intake is strongly and significantly associated with risk of stroke, other cardiovascular disease and all cause mortality in overweight persons, but not in those of normal weight. These findings need to be replicated. However, current data on the association between salt intake, blood pressure and left ventricular hypertrophy support public policy recommendations on the need for a moderate reduction in dietary salt intake at the population level.

Animals↗