Biomedical subjects

M Shipley

Publications and source records attributed to M Shipley.

At least 19 recordsLinked to original sources

PubMed1992

Serum cholesterol concentration and primary malignant brain tumors: a prospective study.

Case-control studies and a prospective study have suggested a positive relation between serum cholesterol and brain tumors. To examine this association further, mortality from malignant brain tumors among men who participated in the Multiple Risk Factor Intervention Trial (a prospective study, 1973-1986) who indicated they were not black were examined. No relation was seen between age-standardized mortality rates and baseline serum cholesterol. Excluding deaths occurring during the first 5 years or adjusting for median census tract income did not alter this finding. This suggests that no generalizable relation between serum cholesterol and primary malignant brain tumors exists. An environmental factor associated with serum cholesterol in some, but not all populations, may explain the apparently contradictory results.

Adult↗

PubMed1992

Higher blood pressure in adults with less education. Some explanations from INTERSALT.

An inverse association between social class and disease has frequently been reported; education, an indicator of social class, was negatively related to blood pressure in several studies. Reasons are not clear. INTERSALT, an international study on electrolytes and blood pressure, obtained data on years of education for 10,079 adults in 52 centers in 32 countries. Data presented here are for 47 centers, omitting five where the population in the sample had no education or no differences in educational level. Regression coefficients were calculated for the education-blood pressure association in each center. An inverse association was found for men in 28 centers and for women in 38. Center coefficients were combined to give a studywide estimate of that association. When adjusted only for age, systolic pressure in men was 1.3 mm Hg higher for 10 fewer years of education (p less than 0.05) and for women 4.5 mm Hg higher (p less than 0.001). However, when adjusted also for five lifestyle factors (24-hour sodium and potassium excretion, body mass index, alcohol intake, and smoking), these estimates were reduced by about one half, and the inverse association was no longer significant for men. Similar findings were obtained for diastolic pressure. Those with less education had on average higher sodium excretion, lower potassium excretion, greater body mass, and higher alcohol intake, all factors tending to increase blood pressure. Improvement of these factors, which help explain the differences in blood pressure related to years of education, has the potential to reduce the blood pressure disadvantage associated with lower socioeconomic status.

Adult↗

PubMed1992

Stroke risk from alcohol consumption using different control groups.

BACKGROUND AND PURPOSE: Our aim in this study was to investigate the relation between chronic alcohol consumption and stroke. METHODS: A case-control study was carried out using two hospital-based control groups and the results of a community-based survey of alcohol consumption. Hospital-based control subjects were chosen either from "general" medical admissions or a subset of "select" admissions that excluded possible alcohol-related admissions. Cases were selected from hospital inpatients. RESULTS: The relative risk for stroke associated with alcohol consumption greater than 300 grams per week for general control subjects was 0.73 (95% confidence interval [CI], 0.54-3.49) compared with 1.30 (95% CI, 0.42-4.05) for select control subjects. The odds ratio was further increased to 1.93 (95% CI, 0.87-4.28) using data from the community-based survey. None of these estimates were statistically significant. CONCLUSIONS: These results illustrate how the risk associated with alcohol consumption varies depending on the choice of control groups and may explain the contradictory results from previous case-control studies. Because of different biases associated with control selection, we believe that the results of this study are consistent with those of other studies that demonstrate a modest increased risk for stroke associated with alcohol consumption.

Adult↗

PubMed1991

Social support, disability and depression: a longitudinal study of rheumatoid arthritis.

The objectives of this study were (i) to assess aspects of the reliability and validity of an instrument measuring social support and social relationships, in the field of physical disability; (ii) to assess the impact of disability on social relationships and (iii) to examine effects of social support upon psychological well-being over time. One hundred and forty nine individuals with rheumatoid arthritis (RA) were assessed on two occasions separated by 15 months. Social support was assessed by means of the Interview Schedule for Social Interaction. The instrument was found to have satisfactory reliability and validity. It revealed that more diffuse social relationships were more affected by RA. Scores for social relationships were as strongly related to depressed mood over time as were disease and disability variables.

Arthritis, Rheumatoid↗

PubMed1991

Overweight and stroke in the Whitehall study.

STUDY OBJECTIVE: The aim was to examine the risk of increasing overweight for death from stroke. DESIGN: This was a prospective cohort study, in which the main outcome measure was the mortality ratio for stroke with increasing body mass index. SETTING: Civil service departments, Whitehall, London. SUBJECTS: Participants were 17,753 men aged 40 to 64 years. MEASUREMENTS AND MAIN RESULTS: 208 stroke deaths were recorded. Men aged 40 to 54 in the most overweight quintile of body mass index had a mortality ratio of 2.01 (95% confidence interval 0.9 to 4.7) compared to the thinnest quintile. The mortality ratio was 1.19 (95% CI 0.7 to 2.0) in men aged 55 to 64. The increase in risk was more apparent in non-smokers: age adjusted mortality ratio 2.58 (95% CI 1.2 to 5.7). When smoking status and overweight were considered in combination a gradient of the age adjusted mortality ratio was observed, from 1.0 in thinner/non-smokers up to 3.15 in fatter/current smokers. On the assumption that smoking and obesity cause strokes, an estimated 60% of strokes could be prevented if these two easily identifiable risk factors could be avoided. CONCLUSIONS: The risks of overweight for death from stroke were more apparent in younger subjects and non-smokers. A substantial proportion of stroke deaths occurring under the age of 80 years would probably be prevented if cigarette smoking and overweight could be avoided.

Adult↗

PubMed1990

Effects of coronary risk reduction on the pattern of mortality.

Control of coronary risk factors is associated with lower age-specific risks, but people will then live longer, with increased exposure to the higher mortality rates of the elderly. Expected changes in pattern of mortality, based on the 15-year follow-up of men in the Whitehall study, have been calculated. Non-smokers live longer than smokers, but death (when it comes) is more likely to be due to heart attack and less likely to be due to cancer. By contrast a lower level of plasma cholesterol, which is also associated with longer life, is expected to reduce the lifetime risk of fatal heart attack, its place then being taken by a typical mixture of other causes of death.

Age Factors↗

PubMed1990

Body mass index versus height and weight in relation to blood pressure. Findings for the 10,079 persons in the INTERSALT Study.

In INTERSALT, an international study of electrolytes and blood pressure, body mass index (kg/m2) was found to relate independently to blood pressure. These relations were assessed in 10,079 men and women aged 20-59 years from 52 centers around the world, based on a standardized protocol, central training of observers, a central laboratory, and extensive quality control. The purpose of the present analyses was to determine whether weight, directly adjusted for height, related to blood pressure as strongly as did body mass index. For all men and women combined, with adjustment for age, sex, alcohol intake, smoking, and sodium and potassium excretion in addition to height, the partial correlations of blood pressure with weight were 0.221 for systolic blood pressure and 0.238 for diastolic blood pressure. These values were slightly larger than the partial correlations for body mass index with blood pressure, which were 0.215 and 0.229, respectively. Although the regression coefficients for body mass index with systolic pressure had been larger in men than in women, suggesting a stronger association of systolic pressure with weight in men, the models with weight directly adjusted for height indicated that the difference in systolic pressure associated with a 10-kg difference in weight was 3.0 mmHg in both men and women. The corresponding weight-associated diastolic pressure differences ranged from 2.00 mmHg in women aged 40-59 years to 2.7 mmHg in men aged 20-39. In addition, with control for weight, height had a significant inverse association with blood pressure. The results of these analyses support the use of weight, with direct adjustment for height, as a useful and practical substitute for body mass index in analyses of the association of adiposity with blood pressure.

Adult↗

PubMed1990

Association between intraocular pressure and loss of visual field in chronic simple glaucoma.

This paper reports the analyses on data from 747 patients with chronic simple glaucoma (CSG) recorded in the King's College Hospital glaucoma data base between January 1970 and February 1985, having a mean follow-up time of 5.1 years (mode 8 years) with the object of determining the relationship of intraocular pressure (IOP) and visual field loss in CSG. A highly significant negative relationship was found between the presenting visual field coefficient (FC) and the untreated IOP (r = -0.26, p = 0.0001) - that is, the higher the IOP on detection, the worse is the visual field. A weak negative correlation was present between the change of FC per year and the treated IOP (r = -0.06), p = less than 0.05). At treated IOPs less than or equal to 18 mmHg visual field loss averaged 0.6 unit per year and for IOPs greater than 18 mmHg the average loss was 1.2 units per year. The data confirm both the importance of a raised IOP in the causation of chronic glaucomatous visual field loss and the importance of reducing the IOP in patients with chronic simple glaucoma.

Adolescent↗

PubMed1989

A comparison of measures of health status in rheumatoid arthritis.

One hundred and five patients with rheumatoid arthritis were assessed on two occasions separated by 15 months, by means of the ARA functional scale, the Mallya and Mace index, the Health Assessment Questionnaire (HAQ) and the Functional Limitations Profile (FLP). Thirty three per cent of patients were assessed as clinically changed in terms of the ARA scale. On both occasions cross-sectional correlations were strongest between the health status measures (HAQ and FLP) and grip strength and the Ritchie articular index. The sensitivity and specificity of the two health status measures in relation to clinical change were calculated and overall the HAQ and FLP achieved similarly modest levels of sensitivity and specificity. The greater amount of precision and information provided by the FLP has to be weighed against the simpler measurement assumptions and shorter time required to administer the HAQ.

Arthritis, Rheumatoid↗

PubMed1989

The origins of depressed mood in rheumatoid arthritis.

Most studies that have considered depressed mood in patients with rheumatoid arthritis have failed to analyze the relative contribution of psychological, social and disease state variables. Using multivariate statistical analyses we identified the role played by demographic, disease related, disability and social variables. Together these variables accounted for 44% of the variation in depressed mood. Demographic factors, disability measures, disease duration, social isolation and economic deprivation all made significant contributions to the explanation of depressed mood. The results of our study underline the importance of examining a wide range of factors in order to consider their relative influence on psychological state.

Arthritis, Rheumatoid↗

PubMed1988

Social relationships and psychological well-being in rheumatoid arthritis.

This study examines the social relationships of a sample of 158 patients attending a hospital rheumatology clinic with rheumatoid arthritis (RA). Scores of the sample were compared with those of other samples on the Interview Schedule for Social Interaction (ISSI). In addition the effects of severity of disease activity and of disability upon social relationships were examined. Diffuse social relationships such as with friends and acquaintances, rather than more intimate ones appear to be more affected in individuals with RA. Psychological well-being was assessed by means of two measures. The more favourably patients scored for social relationships, the more favourable were their scores for psychological well-being using both scores. More diffuse social relationships were more strongly correlated with psychological well-being than were the scores for more intimate relationships. Despite the strong effects of social relationships upon well-being, no buffering action on the effects of disability upon well-being were found.

Activities of Daily Living↗

PubMed1988

IgA and IgM rheumatoid factors as markers of later erosive changes in rheumatoid arthritis (RA).

Stored samples from within the first year of disease of 119 patients with rheumatoid arthritis (RA) enrolled in a long-running prospective study have been studied for the presence of IgM and IgA rheumatoid factors (RF), using agglutination of rabbit IgG-coated red blood cells to detect IgMRF and an ELISA technique using rabbit IgG coated on the microtitre plates and labelled F(aB)2 fragment of goat anti-IgA. Outcome measures at a mean follow-up of 10.1 years (range 3-20) included the Steinbrocker functional grade and grading of erosive changes on hand and feet Xrays using a modification of Lawrence's method. Both IgA and IgG levels at presentation correlated significantly with outcome measured by erosive changes and functional grade at a mean of 10 years and with the time of first appearance of erosions. In patients who are IgMRF negative early in the disease, IgARF positivity indicates a greater chance of developing both erosions and impaired function than when both tests are negative. IgARF positivity seems to precede IgMRF.

Adult↗

PubMed1987

A minority of patients with rheumatoid arthritis show a dominant rearrangement of T-cell receptor beta chain genes in synovial lymphocytes.

The clonality of T lymphocytes isolated from the synovial fluid and peripheral blood of patients with rheumatoid arthritis was investigated by restriction enzyme fragment mapping of the rearrangements of the beta chain gene of the T-cell antigen receptor. Three patients showed a dominant rearrangement amongst their synovial fluid T cells which was not seen in their peripheral blood T-cell population, suggesting the presence of a predominating T-cell clone. However, most of the patients examined (8 out of 11) demonstrated polyclonal T-cell populations in both their synovial fluid and peripheral blood. Of four synovial fluid T-cell lines investigated, one showed evidence of a dominant T-cell clone.

Arthritis, Rheumatoid↗

PubMed1986

Plasma cholesterol concentration and death from coronary heart disease: 10 year results of the Whitehall study.

Ten year mortality from coronary heart disease in 17,718 middle aged men was related to their initial plasma cholesterol concentrations. The relative risk of death from coronary heart disease declined with age, but the absolute excess risk did not. The risk gradient was continuous over the whole range of cholesterol concentrations, the lowest mortality being among men with concentrations below the lowest decile. It seems that, as with blood pressure, the average cholesterol concentration in the blood pressure, the average cholesterol concentration in the population is too high: lowest concentrations are prognostically the best. A quarter of all deaths from coronary heart disease related to cholesterol occurred among men with concentrations above the top decile, but 55% occurred among men with concentrations in the middle three fifths of the distribution; this figure of 55% could be reduced only by a policy aimed at lowering concentrations in the whole population.

Adult↗

PubMed1986

Association between cheiroarthropathy and frozen shoulder in patients with insulin-dependent diabetes mellitus.

Twenty-nine patients with insulin-dependent diabetes mellitus (IDDM) were identified as having cheiroarthropathy. They were compared for the presence of shoulder problems with 28 controls with normal hands, matched for age, sex and duration of diabetes mellitus. Frozen shoulder was diagnosed in 13 of the 29 patients with cheiroarthropathy--10 with bilateral frozen shoulder, and in two of the 28 control patients--one bilateral (p = 0.0025). The increased incidence of frozen shoulder in patients with cheiroarthropathy has not been described previously. There was an increased frequency of microvascular complications in the diabetic patients with cheiroarthropathy compared with the controls. Advanced retinopathy was present in 18 of the 29 cheiroarthropathy patients, of whom six were blind, compared with seven of the 28 controls, of whom none was blind (p = 0.003). Peripheral neuropathy was found in 28 of the 29 cheiroarthropathy patients and in seven of the 28 controls (p = 0.001). There was no significant difference between the two groups in the frequency of nephropathy or in the degree of diabetic control.

Adult↗

PubMed1986

HLA antigens in palindromic rheumatism and palindromic onset rheumatoid arthritis.

Fifty patients who presented with typical palindromic rheumatism of at least 6 months' duration were tissue-typed for HLA A, B, C antigens. DR typing was also performed but was not possible for technical reasons in three patients. Twenty-three patients who had progressed to definite or classical rheumatoid arthritis (RA) after a mean interval of 5 years were compared with 20 patients whose palindromic attacks had persisted over a similar period. Both groups showed a significantly higher frequency of DR4 antigen than a control population. The RA group also showed an increased frequency of DR1. There was no significant difference in the frequency of DR4 or any other DR antigen between the two patient groups. The frequency of B27 antigen was significantly higher in the palindromic group compared with the controls. It is suggested that although DR4 may be associated with a tendency to inflammatory joint problems, environmental or other unrelated genetic factors may be more important in determining the progression of palindromic rheumatism to RA.

Arthritis, Rheumatoid↗

PubMed1986

Distribution and determinants of the difference between diastolic phase 4 and phase 5 blood pressure.

Auscultatory blood pressure measurements from 18 325 male British civil servants were used to examine the relationship between diastolic phase 4 (D4) and phase 5 (D5). The two measures are highly correlated (r = 0.98) and this is unaffected by age. The distribution of the difference between the two indices is skewed with a median difference of 1 mmHg. Phase 4 and D5 were recorded at the same level in 31% of subjects. The difference was 5 mmHg or more in 9% of subjects, and 10 mmHg or more in 1%. The difference between the two diastolic indices depends partly on the level of blood pressure and body mass index.

Adult↗

PubMed1986

HLA frequency and haplotype analysis in a family study of adult onset rheumatoid arthritis.

Twenty-five families with probands who have rheumatoid arthritis (RA) were studied for clinical evidence of disease and for HLA status. This confirmed an association between RA and DR4 in 19/25 probands (76 per cent, p = 0.008). These 19 probands carried 24 haplotypes which contained DR4. There was no significant increase of DR4 haplotypes bearing B15(Bw62) or B44 when compared with published control haplotype data. The rare complement allele C4 B3 was detected as part of the extended haplotype A2 Cw3 B15(Bw62) DR4 C4 A*3B*3 in three probands with severe RA. Further studies to examine disease severity and autoantibody expression are in progress.

Arthritis, Rheumatoid↗