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Biomedical subjects

M Thorogood

Publications and source records attributed to M Thorogood.

At least 19 recordsLinked to original sources
PubMed1997

Modelling the effects of increased physical activity on coronary heart disease in England and Wales.

OBJECTIVE: To investigate the use of computer models as tools for policy makers in evaluating physical activity interventions aimed at reducing deaths from coronary heart disease (CHD). DESIGN: The cell-based computer model Prevent, adapted to simulate risk factor interventions for an English and Welsh population, was used to simulate the effect of two strategies for increasing physical activity levels in respect of CHD mortality over 25 years. The first strategy involved a 25% increase in the proportion of 15-64 year olds who were moderately active, while the second strategy involved a similar increase in the proportion who were vigorously active. The effects of focusing on narrower age ranges and on people at different initial activity levels were also explored. MAIN RESULTS: The simulations showed a small reduction in the CHD death rates--less than 0.15% and 0.06% for men and women respectively. The strategies would postpone up to 12,100 deaths over 25 years, comparable to the effect of a 2% reduction in smoking prevalence. The strategies seemed as if they would be more effective if they concentrated on men rather than women, on those over 45 years of age as opposed to all or younger age groups, and on the least active members of the population rather than those already taking some exercise. CONCLUSION: The use of computer modelling for stimulating physical activity strategies has shown that concentrating these interventions on older sedentary men will produce the greatest health gain, but efforts to encourage smoking cessation may be more effective in terms of years of life saved.

Adolescent↗
PubMed1997

Oral contraceptives and myocardial infarction: new evidence leaves unanswered questions.

Early epidemiological studies showed that current use of oral contraceptives was associated with a two-to four-fold increase in risk of myocardial infarction. More recent studies indicate that the risk has fallen and is probably below two-fold, probably due both to changes in the formulations and to more cautious use of the preparations. There is inconclusive evidence of a small increase in risk associated with previous use of oral contraceptives. Myocardial infarction is rare in young women, particularly in the absence of clinical risk factors and cigarette smoking. It has been estimated that the population attributable risk is less than three events in one million women years. It has been suggested that preparations containing the newer progestogens, Desogestrel and Gestodene, are not associated with any increase in risk of myocardial infarction, but there is not yet sufficient evidence to test this hypothesis.

Case-Control Studies↗
PubMed1996

Dietary habits and mortality in 11,000 vegetarians and health conscious people: results of a 17 year follow up.

OBJECTIVE: To investigate the association of dietary habits with mortality in a cohort of vegetarians and other health conscious people. DESIGN: Observational study. SETTING: United Kingdom. SUBJECTS: 4336 men and 6435 women recruited through health food shops, vegetarian societies, and magazines. MAIN OUTCOME MEASURES: Mortality ratios for vegetarianism and for daily versus less than daily consumption of wholemeal bread, bran cereals, nuts or dried fruit, fresh fruit, and raw salad in relation to all cause mortality and mortality from ischaemic heart disease, cerebrovascular disease, all malignant neoplasms, lung cancer, colorectal cancer, and breast cancer. RESULTS: 2064 (19%) subjects smoked, 4627 (43%) were vegetarian, 6699 (62%) ate wholemeal bread daily, 2948 (27%) ate bran cereals daily, 4091 (38%) ate nuts or dried fruit daily, 8304 (77%) ate fresh fruit daily, and 4105 (38%) ate raw salad daily. After a mean of 16.8 years follow up there were 1343 deaths before age 80. Overall the cohort had a mortality about half that of the general population. Within the cohort, daily consumption of fresh fruit was associated with significantly reduced mortality from ischaemic heart disease (rate ratio adjusted for smoking 0.76 (95% confidence interval 0.60 to 0.97)), cerebrovascular disease (0.68 (0.47 to 0.98)), and for all causes combined (0.79 (0.70 to 0.90)). CONCLUSIONS: In this cohort of health conscious individuals, daily consumption of fresh fruit is associated with a reduced mortality from ischaemic heart disease, cerebrovascular disease, and all causes combined.

Adolescent↗
PubMed1996

Costs and cost effectiveness of health checks conducted by nurses in primary care: the Oxcheck study.

OBJECTIVE: To measure the costs and cost effectiveness of the Oxcheck cardiovascular risk factor screening and intervention programme. DESIGN: Cost effectiveness analysis of a randomised controlled trial using clinical and economic data taken from the trial. SETTING: Five general practices in Luton and Dunstable, England. SUBJECTS: 2205 patients who attended a health check in 1989-90 and were scheduled for re-examination in 1992-3 (intervention group); 1916 patients who attended their initial health check in 1992-3 (control group). Participants were men and women aged 35-64 years. INTERVENTION: Health check conducted by nurse, with health education and follow up according to degree of risk. MAIN OUTCOME MEASURES: Cost of health check programme; cost per 1% reduction in coronary risk. RESULTS: Health check and follow up cost 29.27 pounds per patient. Estimated programme cost per 1% reduction in coronary risk per participant was between 1.46 pounds and 2.25 pounds; it was nearly twice as much for men as women. CONCLUSIONS: The cost to the practice of implementing Oxcheck-style health checks in an average sized practice of 7500 patients would be 47,000 pounds, a proportion of which could be paid for through staff pay reimbursements and Band Three health promotion target payments. This study highlights the considerable difficulties faced when calculating the costs and benefits of a health promotion programme. Economic evaluations should be integrated into the protocols of randomised controlled trials to enable judgments to be made on the relative cost effectiveness of different prevention strategies.

Adult↗
PubMed1996

Third generation oral contraceptives and risk of venous thromboembolic disorders: an international case-control study. Transnational Research Group on Oral Contraceptives and the Health of Young Women.

OBJECTIVE: To test whether use of combined oral contraceptives containing third generation progestogens is associated with altered risk of venous thromboembolism. DESIGN: Matched case-control study. SETTING: 10 centres in Germany and United Kingdom. SUBJECTS: Cases were 471 women aged 16-44 who had a venous thromboembolism. Controls were 1772 women (at least 3 controls per case) unaffected by venous thromboembolism who were matched with corresponding case for age and for hospital or community setting. MAIN OUTCOME MEASURES: Odds ratios derived with stratified analyses and unconditional logistic regression to adjust for potential confounding variables. RESULTS: Odds ratios (95% confidence intervals) for venous thromboembolism were: for any oral contraceptives versus no use, 4.0 (3.1 to 5.3); for second generation products (low dose ethinyl-oestradiol, no gestodene or desogestrel) versus no use, 3.2 (2.3 to 4.3); for third generation products (low dose ethinyloestradiol, gestodene or desogestrel) versus no use, 4.8 (3.4 to 6.7); for third generation products versus second generation products, 1.5 (1.1 to 2.1); for products containing gestodene versus second generation products, 1.5 (1.0 to 2.2); and for products containing desogestrel versus second generation products, 1.5 (1.1 to 2.2). Probability of death due to venous thromboembolism for women using third generation products is about 20 per million users per year, for women using second generation products it is about 14 per million users per year, and for non-users it is five per million per year. CONCLUSIONS: Risk of venous thromboembolism was slightly increased in users of third generation oral contraceptives compared with users of second generation products.

Adolescent↗
PubMed1996

Third generation oral contraceptives and risk of myocardial infarction: an international case-control study. Transnational Research Group on Oral Contraceptives and the Health of Young Women.

OBJECTIVE: To test whether use of combined oral contraceptives containing third generation progestogens is associated with altered risk of myocardial infarction. DESIGN: Matched case-control study. SETTING: 16 centres in Austria, France, Germany, Switzerland, and the United Kingdom. SUBJECTS: Cases were 153 women aged 16-44 with a myocardial infarction event. Controls were 498 women (at least 3 controls per case) unaffected by myocardial infarction who were matched with their corresponding case for age and for hospital or community setting within four months of the index infarction. MAIN OUTCOME MEASURES: Odds ratios derived with stratified analyses and unconditional logistic regression to adjust for potential confounding variables. RESULTS: The estimated odds ratio for myocardial infarction of third compared with second generation oral contraceptives among all 651 study subjects was 0.36 (95% confidence interval 0.1 to 1.2) (P = 0.11). The odds ratio for the United Kingdom and Germany alone was 0.45 (0.1 to 1.8) (P = 0.26). Other odds ratios for the five countries were 3.1 (1.5 to 6.3) (P = 0.003) for use of second generation products v no current use and 1.1 (0.4 to 3.4) (P = 0.9) for use of third generation products v no current use. Among the confounding variables the independent contribution of smoking (for which adjustment was made in the above estimates) proved to be important (10.1 (5.7 to 17.9), P < 0.001). CONCLUSION: An odds ratio of 0.45 with wide confidence intervals shows that third generation oral contraceptives compared with second generation products are associated with a reduced risk of myocardial infarction or with no difference. This finding from an interim analysis should be interpreted with extreme caution. However, the excess risk of venous thromboembolism associated with the use of third generation products may be balanced by the reduced risk of myocardial infarction associated with the same products.

Adolescent↗
PubMed1996

A systematic review of physical activity promotion strategies.

We have reviewed randomised controlled trials of physical activity promotion to provide recent and reliable information on the effectiveness of physical activity promotion. Computerised databases and references of references were searched. Experts were contacted and asked for information about existing work. Studies assessed were randomised controlled trials of healthy, free living, adult subjects, where exercise behaviour was the dependent variable. Eleven trials were identified. No United Kingdom based studies were found. Interventions that encourage walking and do not require attendance at a facility are most likely to lead to sustainable increases in overall physical activity. Brisk walking has the greatest potential for increasing overall activity levels of a sedentary population and meeting current public health recommendations. The small number of trials limits the strength of any conclusions and highlights the need for more research.

Adult↗
PubMed1996

Hand searching the Journal of Epidemiology and Community Health as part of th Cochrane Collaboration.

STUDY OBJECTIVE: To identify randomised controlled trials (RCTs) published in the Journal of Epidemiology and Community Health and to explore the contribution of these to the evaluation of public health issues. DESIGN: Hand searching of the journal by both authors with independent assessment of topics of the reports and of their relevance to the Cochrane Collaboration. Agreement was assessed using kappa scores. SETTING: All papers and letters published in the journal from the first issue to the end of 1994. SUBJECTS: Reports that might be RCTs were collected and classified into seven categories: definitely/probably/possibly RCTs or quasi-RCTs; or none of these. MAIN RESULTS: Eighty two definite RCTs were identified and a further 23 were probably/possibly RCTs or quasi-RCTs. Most reports dealt with health education, drug treatments, or "other" health service interventions. Both authors failed to identify a number of trials on hand searching. CONCLUSIONS: The journal has published many trials of importance to the development of evidence-based public health policy. Hand searching may need to be done independently by more than one person.

Information Storage and Retrieval↗
PubMed1995

Strategies for reducing coronary risk factors in primary care: which is most cost effective?

OBJECTIVE: To examine the relative cost effectiveness of a range of screening and intervention strategies for preventing coronary heart disease in primary care. SUBJECTS: 7840 patients aged 35-64 years who were participants in a trial of modifying coronary heart disease risk factors in primary care. DESIGN: Effectiveness of interventions assumed and the potential years of life gained estimated from a risk equation calculated from Framingham study data. MAIN OUTCOME MEASURE: The cost per year of life gained. RESULTS: The most cost effective strategy was minimal screening of blood pressure and personal history of vascular disease, which cost 310 pounds-930 pounds per year of life gained for men and 1100 pounds-3460 pounds for women excluding treatment of raised blood pressure. The extra cost per life year gained by adding smoking history to the screening was 400 pounds-6300 pounds in men. All strategies were more cost effective in men than in women and more cost effective in older age groups. Lipid lowering drugs accounted for at least 70% of the estimated costs of all strategies. Cost effectiveness was greatest when drug treatment was limited to those with cholesterol concentrations above 9.5 mmol/l. CONCLUSIONS: Universal screening and intervention strategies are an inefficient approach to reducing the coronary heart disease burden. A basic strategy for screening and intervention, targeted at older men with raised blood pressure and limiting the use of cholesterol lowering drugs to those with very high cholesterol concentrations would be most cost effective.

Adult↗
PubMed1995

Randomised trial of lipid lowering dietary advice in general practice: the effects on serum lipids, lipoproteins, and antioxidants.

OBJECTIVE: To determine the relative efficacy in general practice of dietary advice given by a dietitian, a practice nurse, or a diet leaflet alone in reducing total and low density lipoprotein cholesterol concentration. DESIGN: Randomised six month parallel trial. SETTING: A general practice in Oxfordshire. SUBJECTS: 2004 subjects aged 35-64 years were screened for hypercholesterolaemia; 163 men and 146 women with a repeat total cholesterol concentration of 6.0-8.5 mmol/l entered the trial. INTERVENTIONS: Individual advice provided by a dietitian using a diet history, a practice nurse using a structured food frequency questionnaire, or a detailed diet leaflet sent by post. All three groups were advised to limit the energy provided by fat to 30% or less and to increase carbohydrate and dietary fibre. MAIN OUTCOME MEASURES: Concentrations of total cholesterol and low density and high density lipoprotein cholesterol after six months; antioxidant concentration and body mass index. RESULTS: No significant differences were found at the end of the trial between groups in mean concentrations of lipids, lipoproteins, and antioxidants or body mass index. After data were pooled from the three groups, the mean total cholesterol concentration fell by 1.9% (0.13 mmol/l, 95% confidence interval 0.06 to 0.22, P < 0.001) to 7.00 mmol/l, and low density lipoprotein cholesterol also fell. The total carotenoid concentration increased by 53 nmol/l (95% confidence interval 3.0 to 103, P = 0.039). CONCLUSIONS: Dietary advice is equally effective when given by a dietitian, a practice nurse, or a diet leaflet alone but results in only a small reduction in total and low density lipoprotein cholesterol. To obtain a better response more intensive intervention than is normally available in primary care is probably necessary.

Antioxidants↗
PubMed1995

Hormone replacement therapy: characteristics of users and non-users in a British general practice cohort identified through computerised prescribing records.

STUDY OBJECTIVE: To assess the feasibility of recruiting a cohort of women, including long term users of postmenopausal hormone replacement therapy (HRT), through computerised general practice prescribing records, and to compare clinical and demographic characteristics of users and non-user controls. DESIGN: Cross sectional analysis of questionnaire data. SETTING: Subjects were recruited through 17 general practices in the Oxfordshire, south west Thames, and north west Thames regions that contributed to the VAMP Research Database. PARTICIPANTS: A total of 2964 women aged 45-64 years were identified. Altogether 1482 were long term (> 1 year) users of HRT and 1482 were non-user controls: 1037 (70%) of the users and 819 (55.3%) of the controls agreed to participate and provided questionnaire data. MAIN RESULTS: Users of HRT were more likely to have undergone hysterectomy than controls. Most women with a history of hysterectomy used unopposed oestrogen, while those with intact uteri generally used a combination of oestrogen and a progestagen. Among women who had undergone hysterectomy, HRT users did not differ significantly from controls over a range of demographic and clinical characteristics but they were more likely to be past users of oral contraceptives. Among women with intact uteri, users were similar to controls in terms of reported clinical characteristics, but were of higher social class and were more likely to be past users of oral contraceptives and to have had a mammogram after the age of 50. Compared with the general population, all categories of women recruited to the study were of higher social class and exhibited more health conscious behaviours. CONCLUSIONS: Electronic general practice prescribing records provide a feasible and efficient method for recruiting women to a cohort of HRT. Women who agreed to participate in this study were not representative of the general population, emphasising the importance of internal controls in such a study. Among participants, HRT users who had not undergone hysterectomy showed evidence of better health than non-users on some dimensions. In the whole sample, however, there were no appreciable differences in social class and self reported health indicators between users and controls.

Cohort Studies↗
PubMed1995

Randomised controlled trials of physical activity promotion in free living populations: a review.

OBJECTIVES: To review evidence on the effectiveness of trials of physical activity promotion in healthy, free living adults. To identify the more effective intervention programmes. METHODS: Computerised databases and references were searched. Experts were contacted and asked for information about existing work. INCLUSION CRITERIA: Randomised controlled trials of healthy, free living adult subjects, where exercise behaviour was the dependent variable were included. CONCLUSIONS: Ten trials were identified. The small number of trials limits the strength of any conclusions and highlights the need for more research. No UK based studies were found. Previously sedentary adults can increase activity levels and sustain them. Promotion of these changes requires personal instruction, continued support, and exercise of moderate intensity which does not depend on attendance at a facility. The exercise should be easily included into an existing lifestyle and should be enjoyable. Walking is the exercise most likely to fulfil these criteria.

Adult↗
PubMed1995

Emergency appendicectomy and meat consumption in the UK.

STUDY OBJECTIVE: To compare the rates of reported emergency appendicectomies in a cohort study of vegetarians and non-vegetarians by participants' history of meat consumption. DESIGN: This was a prospective cohort study in which participants were asked about their lifetime history of meat consumption/avoidance and, separately, whether they had had an appendicectomy. Appendicectomy was described as either "emergency" or "non-emergency" according to details supplied by the participant. SETTING: The United Kingdom. PARTICIPANTS: These comprised more than 11000 people, of whom 4852 (44%) completed both an appendicectomy form and a dietary questionnaire giving details of their lifetime history of meat consumption. MAIN RESULTS: The percentage who reported an emergency appendicectomy was higher among lifelong meat eaters (10.7%) than either lifelong non-meat eaters (7.8%) or those who had stopped eating meat (8.0%); and the operations were performed at an earlier age in this first group (mean values 18.9, 26.0, and 19.6 years respectively). The overall age adjusted emergency participants who did not eat mean with those who ate meat was 0.47 (95% confidence interval 0.35, 0.65). CONCLUSION: The results suggests that people who do not eat meat have a 50% lower risk of requiring an emergency appendicectomy than those who do. The data do not, however, allow the reliable testing of other hypotheses, so meat consumption may simply be a marker for another dietary, lifestyle, or socioeconomic factor.

Aged↗