Biomedical subjects

Kate Tilling

Publications and source records attributed to Kate Tilling.

At least 19 recordsLinked to original sources

PubMed2026

The reporting and handling of missing data in genetic epidemiological studies of mental health in childhood and adolescence: A systematic review.

BACKGROUND: Genetic epidemiological analyses of child and adolescent mental health often use data from prospective longitudinal cohorts. Missingness due to selective attrition is therefore an important potential source of bias in such analyses. Informatively reporting on missingness and taking appropriate steps to handle it in analyses can mitigate this potential bias. Here, we aim to systematically assess how researchers report and address missingness in genetic epidemiological studies of child and adolescent mental health-related outcomes using cohort data. METHODS: We systematically searched the Ovid Medline database for studies published between August 2012 and August 2025, reporting polygenic score, genome-wide association, or Mendelian randomization analyses, of data on children or adolescents participating in cohort studies. We extracted information from eligible studies based on criteria adapted from the strengthening and reporting of observational studies in epidemiology (STROBE) guidelines. RESULTS: A total of 133 eligible studies were included, of which 125 (93.98%) reported the number of complete cases in all waves, while 84 (63.16%) detailed the amount of missingness on all key variables. Most studies used complete case analysis, while 39 studies explicitly reported applying other methods to handle missingness, with multiple imputation (n = 20, 15.04%) being the most common, followed by full information maximum likelihood 10 (8.1%). Only 18 studies (13.53%) reported an assumed missing mechanism along with the method used to address missingness. Full reporting of both the extent and handling of missingness at the item level was rare, occurring in only 5 (3.76%) and 15 (11.28%) studies, respectively, among the 123 studies that used multi-item instruments. CONCLUSION: Best practice recommendations for reporting on missing data handling emphasize the importance of detailing the proportion of missingness, types of mechanisms underpinning missingness, and details of approaches used. Based on this review, these recommendations for proper reporting of missing data are rarely followed in full.

children and adolescents↗

PubMed2024

Depressive symptoms in adolescence and adult educational and employment outcomes: a structured life course analysis.

BACKGROUND: Depression is a common mental health disorder that often starts during adolescence, with potentially important future consequences including 'Not in Education, Employment or Training' (NEET) status. METHODS: We took a structured life course modeling approach to examine how depressive symptoms during adolescence might be associated with later NEET status, using a high-quality longitudinal data resource. We considered four plausible life course models: (1) an early adolescent sensitive period model where depressive symptoms in early adolescence are more associated with later NEET status relative to exposure at other stages; (2) a mid adolescent sensitive period model where depressive symptoms during the transition from compulsory education to adult life might be more deleterious regarding NEET status; (3) a late adolescent sensitive period model, meaning that depressive symptoms around the time when most adults have completed their education and started their careers are the most strongly associated with NEET status; and (4) an accumulation of risk model which highlights the importance of chronicity of symptoms. RESULTS: Our analysis sample included participants with full information on NEET status (N = 3951), and the results supported the accumulation of risk model, showing that the odds of NEET increase by 1.015 (95% CI 1.012-1.019) for an increase of 1 unit in depression at any age between 11 and 24 years. CONCLUSIONS: Given the adverse implications of NEET status, our results emphasize the importance of supporting mental health during adolescence and early adulthood, as well as considering specific needs of young people with re-occurring depressed mood.

Humans↗

PubMed2006

The relation between components of adult height and intimal-medial thickness in middle age: the Atherosclerosis Risk in Communities Study.

The authors aimed to investigate the relation between components of adult height (leg and trunk length) and atherosclerosis in middle age, using data from 12,254 participants (aged 44-65 years) in the Atherosclerosis Risk in Communities (ARIC) Study. Intimal-medial thickness (IMT) as measured by B-mode ultrasound was the outcome, and exposures were trunk and leg lengths as estimated (using sitting height and the difference between sitting and standing height) at the first study examination in 1987-1989. The mean IMT was 0.73 (standard deviation, 0.17) mm. Greater leg length was associated with lower IMT, with the largest difference being for Black men (a 0.045 (95% confidence interval: 0.023, 0.068)-mm lower IMT per 10-cm higher leg length). Greater trunk length was associated with higher IMT, with the largest difference being for White men (a 0.024 (95% confidence interval: 0.005, 0.044)-mm higher IMT per 10-cm higher trunk length). Although the effect sizes were small, leg length was inversely associated with atherosclerosis, consistent with the results of other studies with cardiovascular disease outcomes.

Atherosclerosis↗

PubMed2006

Estimating prevalence of injecting drug use: a comparison of multiplier and capture-recapture methods in cities in England and Russia.

We consider the question of what method should be recommended to estimate the prevalence of injecting drug use (IDU); and compare multiplier and capture-recapture (CRC) methods of estimating prevalence of injecting drug use (IDU). The prevalence of injecting drug use in four cities (Brighton, Liverpool, London and Togliatti) was estimated using similar methods: covariate capture-recapture (CRC) and multipliers. The multipliers, generated either from a community recruited survey or historical/literature-based, were applied to a range of 'benchmarks': specialist drug treatment, arrests, accident and emergency department (A&E), syringe exchange, HIV tests and opiate overdose deaths. The CRC estimates were assumed to be 'preferred/gold standard' [2,304 (95% confidence interval 1,514 - 3,737) in Brighton, 2,910 (2,546 - 4,977) in Liverpool, 16,782 (13,793 - 21,620) in 12 London boroughs and 15,039 (12,696 - 18,515) male IDU in Togliatti]. The ranges given by the multiplier estimates obtained through the community survey varied from 200 to 770 in Brighton, 530 to 1,300 in Liverpool, 2,900 to 10,600 in London and 12,400 to 91,000 in Togliatti. Several multipliers gave implausible results, lower than the observed data collected for another benchmark, and in the three English cities all these multiplier estimates were below the lower 95% confidence interval of the CRC estimate. In Togliatti, only one multiplier estimate was close to the preferred CRC estimates, with the rest implausibly high. The multiplier estimates based on historical/literature multipliers also ranged widely from 390 to 4,800 for Brighton, from 1,645 to 2,800 in Liverpool, from 4,650 to 12,600 in the 12 London boroughs and 12,800 to 32,000 in Togliatti. In the three UK cities the mortality multiplier estimates were closest to the capture-recapture estimates. The study was a practical demonstration comparing a range of multiplier estimates with a single CRC study. In almost all the individual comparisons the multiplier estimates performed poorly. CRC methods should be preferred as the means of estimating numbers of drug users with multiplier methods being used with caution and only where CRC is not possible.

AIDS Serodiagnosis↗

PubMed2005

Survival differences after stroke in a multiethnic population: follow-up study with the South London stroke register.

OBJECTIVES: To identify ethnic differences in survival after stroke and examine the factors that influence survival. DESIGN: Population based stroke register with follow-up. SETTINGS: South London stroke register. PARTICIPANTS: 2321 patients with first stroke registered between January 1995 and December 2002. MAIN OUTCOME MEASURES: Sociodemographic factors, risk factors for stroke and their management, severity of stroke, and acute service provision factors. Survival analysis with Kaplan-Meier curves, log rank test, and Cox's proportional hazard model with stratification. RESULTS: In univariable analyses of survival, outcome was better for black people than white people (median 33.7 v 20.0 months). After stratification by socioeconomic status, type of stroke, and Glasgow coma score, and adjustment for other potential confounders, being black was generally associated with better survival, taking into account the interaction between ethnicity and age, and ethnicity and prior Barthel score. Of the risk factors for stroke considered, current smoking (hazard ratio 1.21, 95% confidence interval 1.01 to 1.45, P = 0.044), untreated atrial fibrillation (1.36, 1.08 to 1.72, P = 0.009), untreated diabetes (1.53, 1.05 to 2.22, P = 0.027), and treated diabetes (1.61, 1.27 to 2.03, P < 0.001) were associated with reduced survival. CONCLUSION: In general, black patients in a south London population with first ever stroke are more likely to survive than white patients, the exceptions being in those aged < 65 and those with a prior Barthel score < 15. Some pre-stroke risk factors that have the potential to be modified, including the appropriate treatment of existing health problems, have a strong impact on survival.

Black People↗

PubMed2005

A family support organiser for stroke patients and their carers: a randomised controlled trial.

BACKGROUND: Previous trials of interventions to support stroke survivors and their families in the community have had contradictory and inconclusive results. Using the MRC Framework for Complex Interventions we developed a family support organiser (FSO) service and refined outcome measures for evaluation. We tested the effects of the intervention in a randomised controlled trial. METHODS: From 1 March 1999 to 1 April 2001 all first-in-a-lifetime strokes (n = 513) were identified and 340 (96%) of eligible strokes randomised to receive FSO or usual care. Patients and their carers were followed up at 3 months and 1 year post-stroke. Outcomes included satisfaction (main outcome) with hospital staff and outpatient services, use of social services, reintegration to normal living (RNLI) and feelings about life after the stroke. RESULTS: The mean number of contacts with the FSO was 15 (SD = 9.8) per patient. More intervention than control patients received some social services and had increased patient and carer satisfaction in most aspects, particularly with information about recovery and feeling that someone had listened. There was little evidence at 3 or 12 months of differences in RNLI. CONCLUSIONS: A meta-analysis of trials in this area is now needed along with further trials of interventions in subgroups of the stroke population to fully identify any benefits of the FSO role.

Aged↗

PubMed2005

Capturing crack cocaine use: estimating the prevalence of crack cocaine use in London using capture-recapture with covariates.

AIM: To estimate the prevalence of crack cocaine use in 12 London Boroughs (and London as a whole). SETTING: Twelve London Boroughs, 2000-01. METHODS: (1) Covariate capture-recapture techniques applied to three data sources of subjects reporting crack cocaine use: specialist drug treatment (2905), arrest referral (1188) and accident and emergency and community survey (531); and (2) ratio-estimation multiplier, using an estimate of number of injecting drug users and proportion that use crack cocaine. FINDINGS: After matching, 4117 individuals aged 15-44 were identified. The best-fitting model estimated 16 855 unobserved crack cocaine users, giving an overall estimate of approximately 21 000 [95% confidence interval (CI) 13 000-43,000] and a prevalence of 1.5% (95% CI 1.0-3.2%). Prevalence of crack cocaine use was 2.4% (95% CI 1.5-5.0%) among men and 0.7% (95% CI 0.5-1.0%) among women, and similar by age groups 15-29 and 30-44 years. Overall, approximately 11 900 (57%) of the estimated number of crack cocaine users were also opiate users. In London as a whole there may be 46,000 (1.3%) crack cocaine users aged 15-44 years, with 28 000 (1.9%) in inner London-four times higher than estimates from population surveys. Some corroboration was provided by the ratio-estimation method, which estimated 23 000 users in the 12 Boroughs. CONCLUSIONS: Capture-recapture can be applied to crack cocaine and obtain better estimates than population surveys. The size of the crack cocaine-using population in London is large, although currently the majority are also opiate users. Given that half of current users are under 30 the problems associated with crack cocaine use are likely to increase in the future.

Adolescent↗

PubMed2004

Are there inequalities in the provision of stroke care? Analysis of an inner-city stroke register.

BACKGROUND AND PURPOSE: There is evidence of unequal access to health care interventions even where universal health systems operate. We investigated associations between patients' sociodemographic characteristics and the provision of acute and longer-term stroke care in a multiethnic urban population. METHODS: We used data from 1635 patients with first-ever stroke, collected by a population-based stroke register from 1995 to 2000. Using multivariable analyses, controlled for sociodemographic and clinical factors, we investigated access to 22 evidence-based components of care. RESULTS: 1392 patients (85.1%) were admitted to hospital; of these, 354 (25.4%) were admitted or transferred to a stroke unit. Of those with clinical need, 607 (70.7%) received physical therapies; 477 (59.8%) received speech and language therapy. Older age was associated with lower odds of hospitalization (odds ratio [OR], 0.50; 95% CI, 0.32 to 0.77, P=0.02) and diagnostic brain imaging (OR, 0.15; 95% CI, 0.08 to 0.30, P<0.01) but higher odds of receiving physical therapy (OR, 4.24; 95% CI, 1.22 to 14.73, P<0.01). Black ethnicity was associated with higher odds of stroke unit admission (OR, 1.59; 95% CI, 1.01 to 2.49, P<0.04). There was a weak association between socioeconomic status and admission to hospital and stroke unit. Gender was associated only with treatment of hypertension before stroke. CONCLUSIONS: Provision of individual components of care over 1 year varied for specific sociodemographic categories, but there was no consistent pattern of inequality. Clinical decision-making processes are likely to influence these patterns. Further information about clinician and patient roles in decision making is required.

Aged↗

PubMed2004

Ethnic differences in risk factors for ischemic stroke: a European case-control study.

BACKGROUND AND PURPOSE: The aim is to estimate the relative risk and population attributable risk (PAR) of risk factors for ischemic stroke by ethnic group. METHODS: In this case-control study, cases of first ischemic stroke were taken from the South London Stroke Register and controls from a cross-sectional prevalence survey covering the same area. PAR was determined for each risk factor by ethnic group. Multivariable analysis was used to examine the association between risk factors and ischemic stroke across all ethnic groups. RESULTS: 664 cases and 716 controls aged 45 to 74 years were included, with ethnicity of white 78%:42%, black Caribbean 16%:43%, and black African 6%:15%, respectively. For the white group, high PAR was found for ischemic heart disease (IHD) on ECG (56% [95% CI, 49% to 62%]), obesity (49% [95% CI, 40% to 56%]), hypertension (HT) (38% [95% CI, 29% to 46%]), smoking (31% [95% CI, 19% to 41%]), transient ischemic attack (TIA) (23% [95% CI, 19% to 27%]), and atrial fibrillation (AF) (16% [95% CI, 10% to 21%]). In the black Caribbean compared with the white group, PAR was higher for HT (46% [95% CI, 21% to 63%]) and diabetes mellitus (DM) (29% [95% CI, 14% to 42%]), and lower for current smoking (18% [95% CI, 1% to 32%]) and AF (10% [95% CI, 0% to 18%]). In the black African group HT had a higher PAR (59% [95% CI, 91% to 82%]) than the other groups. PAR for AF (11% [95% CI, -11% to 29%]), obesity (30% [95% CI, -20% to 60%]), and DM (4% [95% CI, -25% to 26%]) was low compared with the other groups. In multivariable analysis, risk factors associated with ischemic stroke included TIA, AF, IHD on ECG, smoking, excess alcohol, obesity, HT, and DM. CONCLUSIONS: In the first European case-control study examining risk factors for ischemic stroke in black Caribbean and African populations, some differences were demonstrated in the impact of risk factors between these groups. It may be important to address such differences when developing stroke preventative strategies.

Aged↗

PubMed2004

Breastfeeding and cardiovascular mortality: the Boyd Orr cohort and a systematic review with meta-analysis.

AIMS: To investigate the association of breastfeeding with all-cause, cardiovascular, and ischaemic heart disease mortality. METHODS AND RESULTS: A long-term follow-up of 4999 children originally surveyed from 1937 to 1939 was undertaken (Boyd Orr cohort). Four thousand three hundred and seventy-nine subjects (88%) were traced in adulthood and 3555 (71%) had complete data on all covariates. The results were combined with a meta-analysis of the published literature. In the Boyd Orr study, there was little evidence that breastfeeding was associated with all-cause (hazard ratio: 1.04 [95% CI: 0.90-1.20]), cardiovascular (1.04 [0.83-1.30]), or ischaemic heart disease (1.02 [0.77-1.36]) mortality, compared with bottle-feeding. Meta-analyses of observational studies showed little evidence of an association of breastfeeding with all-cause (pooled rate ratio: 1.01 [95% CI: 0.91-1.13]) or cardiovascular (1.06 [0.94-1.20]) mortality. There was a moderate-to-high degree of between-study heterogeneity for the association between breastfeeding and ischaemic heart disease mortality (I2 value-indicating the degree of between-study variation attributable to heterogeneity-66%), and estimates were consistent with both an important beneficial or adverse effect of breastfeeding. CONCLUSION: There is little consistent evidence that breastfeeding influences subsequent all-cause or cardiovascular disease mortality. Results from other well-designed cohorts may clarify residual uncertainty.

Breast Feeding↗

PubMed2004

The relation between birth weight and intima-media thickness in middle-aged adults.

BACKGROUND: Birth weight has been found to be inversely associated with the risk of coronary heart disease and stroke, although the mechanisms for this association remain unclear. Here, we investigate the relation between reported birth weight and atherosclerosis in middle age. METHODS: We included the 9817 participants (age 44-65) in the Atherosclerosis Risk in Communities (ARIC) study who were neither a twin nor born prematurely. Carotid atherosclerosis was assessed as intima-media thickness measured by B-mode ultrasound. We studied the association with recalled exact birth weight, and for those unable to recall exact birth weight, with recalled birth weight category. RESULTS: Mean intima-media thickness (+/- standard deviation) was 0.73 +/- 0.17 mm. Mean birth weight for the 4635 participants recalling exact birth weight was 3.49 +/- 0.71 kg. A further 4946 participants recalled birth weight category, with 4730 (96%) reporting "medium" birth weight. In univariate analysis, birth weight and intima-media thickness were positively related. However, adjustment for confounding factors reduced the association to only a 0.004 mm higher intima-media thickness (95% CI = - 0.003 to 0.011) mm per 1 kg of birth weight. The same pattern of univariate positive relationship and attenuation with adjustment was seen for birth weight category and intima-media thickness. There was no evidence of interaction between adult body mass index (BMI) and birth weight, or of interaction between category of adult BMI and birth weight category. An inverse relation between birth weight category and intima-media thickness was seen only for those in the lowest category of adult BMI (BMI <25 kg/m). CONCLUSIONS: We found no evidence of a clinically significant relation between birth weight and carotid atherosclerosis.

Adult↗

PubMed2004

The prevalence of injecting drug use in a Russian city: implications for harm reduction and coverage.

AIM: This study sought to estimate the prevalence of injecting drug users (IDU) in Togliatti city and to examine the implications of these estimates for HIV prevalence and harm reduction. DESIGN: Routine data sources of IDUs were identified. Covariate capture-recapture techniques were used on the individuals identified on the three data sources and used to estimate the number of IDU 'not observed' by the data sources, and thereby estimate the prevalence of IDU. SETTING: Togliatti City, Samara Oblast, Russian Federation. PARTICIPANTS: IDUs recorded on three data sources (narcology records, HIV positive test results and police arrest data) during 2001. MEASUREMENTS: Poisson regression models were fitted to the observed data, with interactions between data sources fitted to replicate 'dependencies' between those data sources. To select the best model the goodness of fit was approximated by chi2 distribution and the best-fitting model was selected on the basis of standard information criteria and log likelihood ratio tests. FINDINGS: The total estimated population of IDUs is 20 226 [95% confidence interval (CI): 16 971-24 749] giving a population prevalence of 5.4% (95% CI: 4.5-6.6%) of the registered population and 2.7% (95% CI: 2.4-3.5%) of the population (including migrants) aged 15-44 years. For every one IDU in contact with a service there were three out of contact. CONCLUSIONS: There is a high prevalence of IDU which, in the context of a fast-emerging IDU-associated HIV epidemic, will have serious public health implications.

Adolescent↗

PubMed2004

Injecting drug use in Brighton, Liverpool, and London: best estimates of prevalence and coverage of public health indicators.

STUDY OBJECTIVE: To estimate the prevalence of injecting drug use (IDU) in three cities in England and to measure the coverage of key public health indicators. DESIGN: Capture-recapture techniques with covariate effects. SETTING: Liverpool, Brighton, and 12 London boroughs, 2000/01. PARTICIPANTS: IDU collated and matched across five data sources-community recruited survey, specialist drug treatment, arrest referral, syringe exchange, and accident and emergency-896 in Brighton, 1224 in Liverpool, and 6111 in London. MAIN RESULTS: It is estimated that in 2000/01 the number and prevalence of IDU aged 15-44 was 2300 (95%CI 1500 to 3700) and 2.0% (95%CI% 1.3% to 3.2%) in Brighton; 2900 (95%CI 2500 to 5000) and 1.5% (95%CI 1.3% to 2.6%) in Liverpool; 16 700 (95%CI 13 800 to 21 600) and 1.2% (95%CI 1.0% to 1.6%) in 12 London boroughs; with a prevalence of 1.7% (95%CI 1.2% to 3.3%) in inner London. It is estimated that: less than one in four IDU are in treatment in the three areas; syringe exchange programmes covered about 25% of injections in Brighton and Liverpool and 20% in London; and that the annual opioid mortality rate among IDU was 2% in Brighton compared with less than 1% in Liverpool and London. CONCLUSIONS: Credible estimates of the prevalence of injecting drug use (and key public health indicators) can be determined using covariate capture-recapture techniques. These suggest that: targets to double the number in treatment are possible: syringe distribution should be increased; and further attention, especially in Brighton, given to reducing overdose mortality.

Adolescent↗

PubMed2003

Cause of stroke recurrence is multifactorial: patterns, risk factors, and outcomes of stroke recurrence in the South London Stroke Register.

BACKGROUND AND PURPOSE: This article examines stroke recurrence and whether the subtype of the initial stroke influences the risk and subtypes of further strokes. The proportion of recurrences attributable to conventional risk factors is quantified. METHODS: From January 1995 to August 2000, all first-in-a-lifetime strokes (n=1626) were identified and prospectively followed up in a defined multiethnic inner city population of 234 533. Twelve overlapping referral sources and face-to-face follow-up at 3 months and 1 and 3 years were used to attain complete registration of stroke recurrence. Index and recurrent stroke were classified according to the Oxford Community Stroke Project classification. RESULTS: In 2744 person-years of follow-up, 153 recurrences were observed. At 5 years, the cumulative risk of first stroke recurrence was 16.6% (95% CI, 13.5 to 20.4), and the combined risk of death or stroke recurrence was 65.3% (95% CI, 61.9 to 68.6). Ethnicity and subtype of index stroke were not associated with stroke recurrence. A change in subtype between index and recurrent stroke occurred in 45.5% (95% CI, 35.8 to 55.2) of cases and was most frequent among index lacunar strokes and primary intracerebral hemorrhages. In multivariable analyses, diabetes mellitus and atrial fibrillation were associated with both stroke recurrence and recurrence-free survival. In the stroke population, 9.1% (95% CI, -2.0 to 20.2) of recurrences were attributable to diabetes and 4.9% (95% CI, -7.3 to 17.2) to atrial fibrillation during the first year after the index stroke. CONCLUSIONS: The cause of stroke recurrence is multifactorial, and the subtypes of index and recurrent strokes are often not identical. Most recurrences remain unexplained by conventional risk factors.

Aged↗

PubMed2003

Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED Stroke Project.

BACKGROUND AND PURPOSE: Although diabetes is a strong risk factor for stroke, it is still unclear whether stroke subtype, severity, and prognosis are different in diabetic and nondiabetic patients. We sought to evaluate stroke features, prognosis, and functional outcome in patients with diabetes compared with patients without diabetes. METHODS: In a European Union Concerted Action involving 7 countries and 4537 patients hospitalized for a first-in-a-lifetime stroke, defined according to the Oxfordshire Community Stroke Project criteria, we collected data on demographics, risk factors, clinical presentation, and outcome. We used logistic regression to examine the relationship between diabetes and outcome at 3 months (disability, handicap, and death), controlling for risk factors, clinical presentation, and demographics. RESULTS: Overall, diabetes was present in 937 patients (21%). Diabetic patients, compared with those without diabetes, were more likely to have limb weakness (P<0.02), dysarthria (P<0.001), ischemic stroke (P<0.001), and lacunar cerebral infarction (P=0.03). At 3 months, the case fatality rates were not higher in the diabetic groups (P=0.33). Handicap (Rankin Scale) and disability (Barthel Index) were significantly higher in diabetic patients (P=0.005 and P=0.016, respectively). CONCLUSIONS: Stroke in diabetic patients has a specific clinical pattern and a poor prognosis in terms of motor function, which emphasizes the need for early diagnosis and treatment of every case of diabetes.

Adolescent↗

PubMed2003

Cognitive functioning as a predictor of ischemic stroke incidence.

BACKGROUND: Some studies have suggested that cognitive impairment is related to subsequent stroke incidence. The present study investigated the role of cognitive impairment as a predictor of ischemic stroke incidence in the Atherosclerosis Risk in Communities (ARIC) cohort. METHODS: The study population consisted of 11,958 men and women 48-67 years of age in 4 U.S. communities, followed from January 1, 1990 through December 31, 1997. Cognitive performance was evaluated at the second (1990-1992) visit of the ARIC Study using 3 instruments. We identified incident strokes by means of hospital record and death certificate reviews, as well as annual telephone follow up. RESULTS: We found no consistent associations or trends between any of the cognitive test results and ischemic stroke incidence after multiple adjustment for confounding variables. Hazard ratios for the lowest compared with the highest quartiles were 1.5 (95% confidence interval [CI] = 0.9-2.6), 1.1 (95% CI = 0.6-2.1), and 1.0 (95% CI = 0.6-1.8) for the Delayed Word Recall Test, Digit Symbol Subtest of the Wechsler Adult Intelligence Scale-Revised, and Word Fluency Test, respectively. CONCLUSIONS: The findings of the present study of relatively young subjects did not replicate the association between cognitive impairment and stroke incidence found in studies in older populations. This could be the result of the younger ages of our cohort members or the differences in cognitive tests.

Aged↗

PubMed2002

Admissions for myocardial infarction and World Cup football: database survey.

OBJECTIVES: To examine hospital admissions for a range of diagnoses on days surrounding England's 1998 World Cup football matches. DESIGN: Analysis of hospital admissions obtained from English hospital episode statistics. SETTING: England. PARTICIPANTS: Population aged 15-64 years. MAIN OUTCOME MEASURES: Ratio of number of admissions for acute myocardial infarction, stroke, deliberate self harm, and road traffic injuries on the day of and five days after England's World Cup matches, compared with admissions at the same time in previous and following years and in the month preceding the tournament. RESULTS: Risk of admission for acute myocardial infarction increased by 25% on 30 June 1998 (the day England lost to Argentina in a penalty shoot-out) and the following two days. No excess admissions occurred for other diagnoses or on the days of the other England matches. The effect was the same when only the two days after the match were treated as the exposed condition. Individual analyses of the day of and the two days after the Argentina match showed 55 extra admissions for myocardial infarctions compared with the number expected. CONCLUSION: The increase in admissions suggests that myocardial infarction can be triggered by emotional upset, such as watching your football team lose an important match.

Adolescent↗

PubMed2002

Estimating the effect of cardiovascular risk factors on all-cause mortality and incidence of coronary heart disease using G-estimation: the atherosclerosis risk in communities study.

Standard methods for analysis of cohort studies may give biased estimates of exposure effects in the presence of time-varying confounding. Such effects may instead be estimated by using G-estimation. This study aimed to examine the relations between important cardiovascular risk factors and all-cause mortality and risk of coronary heart disease (CHD), accounting for confounding between exposures over time using G-estimation. Results were compared with those from standard survival analyses (e.g., Weibull regression) with time-updated covariates. The dataset consisted of all participants in the Atherosclerosis Risk in Communities cohort study who had complete data on the first two of four visits, giving a sample of 13,898 people at baseline. Death and occurrence of CHD or stroke were recorded. G-estimated associations between several risk factors and mortality/CHD incidence differed from those estimated using standard survival analysis. The associations between mortality/CHD incidence and smoking, presence of diabetes, and use of antihypertensives were stronger than the standard survival estimates, while the G-estimated effect of low density lipoprotein and high density lipoprotein cholesterol on CHD incidence were more linear than the standard estimate. Complex relations between exposures over time may lead to biased exposure effect estimates in standard survival analyses. G-Estimation can be used to overcome such biases, and thus may have important implications for the analysis of observational studies.

Cardiovascular System↗