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Biomedical subjects

M Wadsworth

Publications and source records attributed to M Wadsworth.

At least 19 recordsLinked to original sources
PubMed2006

Do treated psychiatric patients become later community cases? A prospective cohort study.

BACKGROUND: There have been few attempts to link two aspects of psychiatric epidemiology, severe disorder and milder 'common' mental disorder, by ascertaining whether subjects who have received psychiatric treatment for major disorders are identified later in epidemiological community surveys. METHODS: Subjects were from a national birth cohort study and had been followed prospectively from childhood to middle age, with concurrent information on treatment from psychiatric facilities. In two successive prevalence surveys of milder disorder at 36 and 43 years, the association between earlier treatment and being a later community case was examined RESULTS: Among 102 subjects who had been treated patients up to age 35 years, 52 (51%) were identified as definite community cases (36, 35%) or subthreshold cases (16, 16%) at either one or both later points. The proportion of community subjects who were previous psychiatric patients increased systematically from community non-cases, through subthreshold cases on one or both occasions, definite cases on one occasion, to definite cases on both occasions. CONCLUSIONS: About half of subjects who have received treatment from psychiatric facilities remain with persistent symptoms such as to identify them as definite or subthreshold cases of milder common mental disorder some years later.

Adolescent↗
PubMed2005

Early growth and type 2 diabetes: evidence from the 1946 British birth cohort.

AIMS/HYPOTHESIS: We assessed whether low birthweight or early adiposity rebound was more strongly associated with type 2 diabetes, and whether any effect of low birthweight or early adiposity rebound was explained by adult BMI, adult height, social class of subject or of his/her father, or maternal or paternal diabetes. METHODS: Cox's proportional hazard models were used on data from the National Birth Cohort Study (the MRC National Survey of Health and Development), which was begun in 1946 and had self-reported physician-diagnosed diabetes with age at onset ranging from 31 to 53 years (n=78 cases, and n=47 cases in the multivariate analysis) as the outcome. RESULTS: A U-shaped association between birthweight and type 2 diabetes rates was close to statistical significance (quadratic term p value=0.08). Younger age at adiposity rebound was associated with increased rates of type 2 diabetes (test for trend p=0.002), the association being robust to adjustment for each of sex, birthweight, weight at 2 years, father's social class, parental diabetes, and own social class. The effect of early adiposity rebound was very slightly reduced by adjustment for sex and adult height (p=0.003), but considerably reduced after adjustment for sex and adult BMI (test for trend p=0.1), and further reduced (p=0.4) after additional adjustment for birthweight, weight at 2 years, adult height, social class of subject and of his/her father, and parental diabetes. CONCLUSIONS/INTERPRETATION: Early adiposity rebound was associated with an increased rate of type 2 diabetes independently of birthweight, but its effect was mostly through high adult BMI. Parental diabetes and possibly low weight at 2 years were also risks.

Adiposity↗
PubMed2005

Social outcomes in adulthood of children with intellectual impairment: evidence from a birth cohort.

BACKGROUND: Social Policy for people with intellectual disabilities (ID) continues to evolve, but little is known about the lives to which such policies are applied. We aimed to use a prospective follow-up of a British birth cohort to identify children with mild and more severe intellectual impairment, and compare a range of social outcomes in adulthood with people in the rest of the cohort. METHOD: We used data from the MRC National Survey for Health and Development. Intellectual impairment was identified by intelligence tests and educational history. Adult outcome measures included employment and social class, education, marriage and children, home ownership, social networks and community use. RESULTS: We identified 111 people with mild intellectual impairment (2.7%) and 23 with severe intellectual impairment (0.6%) at age 15/16. By the age of 43, there were 52 people remaining in the mild impairment group and 14 in the severe impairment group. In adulthood those with intellectual impairment enjoyed contact with friends and family, and joined in informal social activities. Although the mild intellectual impairment group were less likely to attain the following social outcomes than people with normal intellectual functioning, 67% had jobs, 73% were married, 62% had children and 54% owned their own homes. 12% participated in adult education. People with more severe intellectual impairment were less likely to attain these outcomes. CONCLUSIONS: These outcomes highlight issues in current social policy and suggest efforts should be directed particularly towards promoting educational opportunities and developing social inclusion for people with ID.

Achievement↗
PubMed2004

Predictors of abdominal obesity among 31-y-old men and women born in Northern Finland in 1966.

OBJECTIVE: To find predictors of abdominal obesity (defined by >90th percentile of waist/hip ratio (WHR)) and related factors among 31-y-old men and women. DESIGN: Longitudinal study of the northern Finland birth cohort of 1966 with measurements obtained at birth, 14 and 31 y. SUBJECTS: A total of 2841 men and 2930 women with data on WHR at 31 y. RESULTS: The most important predictor of abdominal obesity among the 31-y-old men was a high body mass index (BMI), those with normal weight at 14 y who were obese at 31 y having an especially high risk of abdominal obesity at 31 y. Abdominal obesity was independently associated with current weight status, small size for gestational age, a high intake of alcohol at 31 y, physical inactivity at 31 y, unhealthy diet in the sense of infrequent consumption of fiber-rich foods and frequent consumption of sausages, and a low level of occupational training. Physical inactivity and minimal vocational training also tended to be associated with abdominal obesity among women. The analyses were controlled for maternal age and BMI, and also for hormonal contraception and parity among women. CONCLUSIONS: Some aspects of risk of adult abdominal obesity were evident during adolescence, and good advice is needed then, and in early adulthood, in order to reduce the risk of abdominal obesity in their thirties. Those who are small for gestational age are vulnerable to the development of abdominal obesity. Successful weight control from adolescence to adulthood, and healthy eating, alcohol drinking and exercise habits are important for avoiding abdominal accumulation of body fat.

Abdomen↗
PubMed2003

Weight from birth to 53 years: a longitudinal study of the influence on clinical hand osteoarthritis.

OBJECTIVE: To determine the influence of body weight throughout the life course on the development of clinical hand osteoarthritis (OA). METHODS: A British national survey was used to perform a prospective cohort study of 1,467 men and 1,519 women born in 1946. Weight was measured at birth and at subsequent followup visits through childhood and adulthood. The main outcome measure was the odds ratio for the presence of hand OA at the age of 53 years. RESULTS: Two hundred eighty men (19%) and 458 women (30%) had OA in at least 1 hand joint. Hand OA was significantly associated with increased weight at ages 26 years, 43 years, and 53 years and with decreased weight at birth in men. Birth weight and adult weight showed independent effects, such that men with the highest risk for OA represented those who had been heaviest at age 53 years and lightest at birth. These findings were not explained by grip strength. There was no significant relationship between weight and hand OA in women. CONCLUSION: The results of this study show that increased adult weight is associated with, and may precede, development of hand OA in men. An association between hand OA and weight was not observed in women. The relationship between hand OA and decreased birth weight is a new finding and may reflect the persisting influence of prenatal environmental factors on adult joint structure and function.

Adolescent↗
PubMed2003

Central and total obesity in middle aged men and women in relation to lifetime socioeconomic status: evidence from a national birth cohort.

STUDY OBJECTIVE: To investigate the influence of social class in childhood, young adulthood and middle age, and intergenerational mobility, on adult central and total obesity. DESIGN: Prospective, population based, birth cohort study. PARTICIPANTS AND SETTING: 1472 men and 1563 women born in 1946 in England, Scotland, and Wales. OUTCOME MEASURES: Waist-hip ratio, waist-height ratio, waist circumference, and body mass index at age 53 years. MAIN RESULTS: Father's social class at participant's age 4 years was inversely associated with adult central and total obesity at age 53 years in men and women. For example, the mean difference of waist-hip ratio (95% confidence intervals) between father's professional social class I and unskilled manual social class V was 2.6% (0.7 to 4.6) for men and 2.5% (0.5 to 4.4) for women. The effect of father's social class remained after adjustment for participant's own social class in young adulthood and middle age. Both adult social classes were inversely related to obesity among women, but not men, after adjustment for childhood circumstances. Upwardly mobile men and women were less obese than participants remaining in their father's social class and their levels of obesity tended to be between the class they left and the class they joined. CONCLUSIONS: The effect of social class on adult obesity differed according to the stage in the life course at which social class was measured, and gender. Childhood circumstances had enduring influences on adult obesity, although our results on intergenerational mobility indicate potential reversibility of early life disadvantage.

Anthropometry↗
PubMed2002

Propensity to psychiatric and somatic ill-health: evidence from a birth cohort.

BACKGROUND: Somatic and psychiatric morbidity may cluster because of reciprocal effects between them but also as a result of common underlying factors. METHODS: The data come from the 1946 MRC birth cohort (N = 5362). Clustering of 20 chronic medical conditions at the participants' 43rd year was analysed using multi-morbidity coefficients. Associations of somatic and psychiatric morbidity at 43 years, with temperament and behaviour, assessed from adolescence to early adulthood, and background variables like paternal social class, were examined using structural equation modelling. The focus was on whether links applied to both morbidity types or one only, and were direct or were indirect, mediated by prior morbidity. RESULTS: Reported chronic medical conditions clustered strongly. Somatic multi-morbidity and psychiatric ill-health at 43 years were associated with temperamental and behavioural features assessed between the subjects' 13th and 26th birthday, like neuroticism and aggression, as well as with external variables like parental death before the participants' 16th birthday. However, only neuroticism holds direct links with somatic as well as with psychiatric ill-health, 28% of the former and 52% of the latter association being independent of the simultaneous presence of the other morbidity type and of participants' health status 7 years earlier. CONCLUSIONS: Personality traits like neuroticism not only raise the risk of psychiatric disorder but also, irrespective of whether manifest psychiatric disorders have developed, of a broad spectrum of chronic somatic diseases. This suggests that clinicians and researchers should focus not only on the psychiatric disorders associated with such personality traits but also on their medical consequences.

Adult↗
PubMed2001

Is "somatisation" a defense against the acknowledgment of psychiatric disorder?

OBJECTIVE: To determine whether experiencing physical symptoms is associated with a denial of psychological distress in individuals with probable psychiatric disorder. METHODS: A nested case-control study was performed using data from a national birth cohort study. All subjects who scored above threshold on a case-finding questionnaire of psychiatric disorder were identified. Those who in a separate question endorsed the presence of psychiatric disorder ("acknowledgers") were compared with those who did not. RESULTS: Acknowledgers were more likely to be female, better educated and have more severe current and past psychiatric disorder. They were also more likely to report multiple physical symptoms, even when potential confounders and severity of psychiatric disorder were controlled. CONCLUSION: There is no evidence that experiencing multiple physical symptoms helps the individual deny the presence of psychiatric disorder.

Adult↗
PubMed2001

Stability and change in milder psychiatric disorder over 7 years in a birth cohort.

BACKGROUND: Relatively little is known regarding stability or change over time in milder psychiatric disorder identified in epidemiological studies. METHODS: Data were analysed on 2890 subjects from the 1946 British birth cohort study. Psychiatric disorder was identified at age 36 years using the Present State Examination Index of Definition and 7 years later at age 43 using a symptom scale, employing a threshold to give identical 6% prevalence of disorder. Predictors were derived from recent social data and information collected earlier in childhood and younger adulthood. RESULTS: Over 7 years, there was considerable movement between case and non-case status. Only 1.7% of the sample satisfied case criteria at both points. Approximately two-thirds of cases at age 36 had fallen below case levels at age 43 and two-thirds of cases at age 43 were new cases. Most onsets and remissions were between definite case and non-case levels, rather than around the threshold. The strongest predictors of onset and remission were recent demographic, social and life stress variables, and earlier reported nervous disorder, with contributions from parental social background, and life history variables in adolescence. CONCLUSIONS: There is considerable change over 7 years in milder psychiatric disorder, with around two-thirds of it episodic or fluctuating and one-third chronic. Recent social variables are strong predictors of change or chronicity, with some lasting contributions from childhood social setting and earlier life history.

Adolescent↗
PubMed2001

Air pollution and birth weight in Britain in 1946.

Recent studies suggested that air pollution might be related to low birth weight. We tested this hypothesis on data from the British 1946 birth cohort. We found a strong association between birth weight and an air pollution index based on coal consumption. Babies born in the most polluted areas were on average 87 grams lighter than those born in the areas with the cleanest air. Adjustment for a number of sociodemographic factors did not change these estimates. While confounding by unmeasured factors cannot be ruled out, these historical data support the hypothesis that birth weight could be affected by air pollution.

Air Pollution↗
PubMed2001

Long-term affective disorder in people with mild learning disability.

BACKGROUND: Increased risk of affective disorder in learning disability has been reported, although the extent to which this is due to adverse social and material circumstances is uncertain and there have been potential limitations in the measurement of affective disorder. AIMS: To determine risk of affective disorder in those classified with mild learning disability in the British 1946 birth cohort and to investigate whether this risk was accounted for by disadvantage in childhood and adulthood. METHOD: Learning disability was defined as the equivalent of an IQ < or =69 at age 15 years. The Present State Examination at age 36 years and the Psychiatric Symptom Frequency Scale at age 43 years provided psychiatric outcome measures. RESULTS: Learning disability was associated with a fourfold increase in risk of affective disorder, not accounted for by social and material disadvantage or by medical disorder. CONCLUSIONS: Learning disability is strongly associated with risk of affective disorder, persisting well into midlife.

Adolescent↗
PubMed2000

The influence of childhood weight and socioeconomic status on change in adult body mass index in a British national birth cohort.

OBJECTIVE: To investigate the effect of childhood weight and childhood socioeconomic status on the pattern of change in body mass index (BMI) between 20 and 43 years. METHODS: A British birth cohort study where the survey members have been followed up regularly since their birth in 1946, with the most recent of 19 follow-ups when the cohort were aged 43 years. BMI was available at 20, 26, 36 and 43 years of age and thus multilevel models for repeated outcome measures were used to model the patterns of change in BMI. RESULTS: The rate of increase in BMI with age was non-linear, with the rate of increase in mean BMI accelerating with increasing age at different rates for men and women. The mean BMI for men was higher than that for women at all ages. Childhood manual social class, defined in terms of father's occupation, and high relative weight at 14 years of age were associated with higher mean BMI across adult life, and these effects increased with age. The effects of childhood relative weight and social class were independent of educational attainment and adult social class. CONCLUSION: The study provides evidence of a long-term effect of childhood social and biological circumstances on BMI. The pathways underlying these relationships may be social or biological, but are not yet fully understood.

Adolescent↗
PubMed2000

Birthweight, childhood growth and risk of breast cancer in a British cohort.

We have examined the relationship between birthweight and risk of breast cancer, taking into account growth in childhood, using data on a total of 2221 women born in 1946 and followed up to 1997. Thirty-seven breast cancers occurred during follow-up. There was evidence of greater risk of breast cancer with greater birthweight (rate ratio = 1.76 (95% CI: 0.92, 3.35) for birthweight >/= 3.5 kg vs birthweight < 3.5 kg), which was more marked at pre-menopausal ages (RR = 2.31, 95% CI: 0.93, 5.74). The relation with birthweight was not substantially confounded by any of the measured adult risk factors. A significant interaction was observed between the effects of birthweight and height at age 7 years. Relative to those born lighter than 3.5 kg, women who were heavy at birth (>/= 3.5 kg) and short or average at 7 years (< 1.22 m) had a 21% increase in breast cancer rates (RR = 1.21; 95% CI = 0.49-2.99), while women who were heavy at birth (>/= 3.5 kg) but tall at 7 years (>/= 1.22 m) had a four-fold increase (RR = 4.01; 95% CI = 1.82-8.83). These results suggest that the effect of birthweight on breast cancer risk may be modulated by childhood growth.

Adolescent↗
PubMed2000

Smoking, body mass index, socioeconomic status and the menopausal transition in a British national cohort.

BACKGROUND: This study investigates whether cigarette smoking, body mass index (BMI) and socioeconomic status are independently associated with age at menopausal transition. METHODS: Menopausal status and risk factor information were collected prospectively from 1572 British women followed up since their birth in 1946, so far until 50 years. Cox's regression models were used to investigate the relationships of interest. RESULTS: Cigarette smokers started the perimenopause and reached the menopause earlier than ex-smokers and non-smokers. The relative risk for smokers compared with non-smokers was 1.31 (95% CI : 1.09-1.56) for perimenopause and 1.63 (95% CI : 1.17-2.27) for menopause. Body mass index was associated with the age at inception of the perimenopause only among smokers and ex-smokers, with underweight women having the earliest perimenopause. No association was observed between BMI and age at menopause. Smokers and underweight women were more likely than others to start hormone replacement therapy (HRT) before becoming postmenopausal. There was no effect of education or social class on age at inception of the perimenopause or age at menopause. Single women had an earlier perimenopause but the effect was confounded by parity. CONCLUSIONS: Smoking was independently related to an earlier menopausal transition, although the effect on inception of the perimenopause was particularly observed among underweight women. There was no independent effect of socioeconomic status. The popularity of HRT use in this cohort may have had an impact on the findings.

Adult↗
PubMed2000

Social and behavioural influences on the uptake of hormone replacement therapy among younger women.

OBJECTIVE: To describe the social and behavioural influences on the uptake of hormone replacement therapy before the age of 50. DESIGN: Nationally representative birth cohort study with detailed hormone replacement therapy histories and prospective data on health, social and behavioural factors collected throughout life. SETTING: England, Scotland and Wales. POPULATION: General population sample of 1,572 women followed to the age of 50 years. MAIN OUTCOME MEASURE: Age at first hormone replacement therapy use RESULTS: By the age of 50 years, 45% of women had tried hormone replacement therapy and one third were current users. Over two-fifths of users had tried more than one preparation and over one quarter had episodic use. For the vast majority, prescribing conformed to current guidelines. More educated women took hormone replacement therapy for long term prevention compared with their less educated peers. Hysterectomy increased the chances of taking hormone replacement therapy, particularly where an oophorectomy had also been performed, and was associated with longer and more continuous use. Results of a Cox's proportional hazards model showed that the age at which first hormone replacement therapy is used by women who have not had a hysterectomy was influenced by previous contact with health services for menstrual disorders, previous use of oral contraception and cigarettes, past reporting of health problems and low social class. The relation between smoking and low social class with early use of hormone replacement therapy may be due to their association with early menopause. CONCLUSIONS: The trend over the last two decades towards greater use of hormone replacement therapy has continued unabated for younger women. So far, hormone replacement therapy users in this generation have had less healthy lifestyles and social advantages than nonusers, in contrast to many older mainly American studies based on earlier generations. This may have long term implications for health and health care as the postwar baby boom generation ages.

Adult↗
PubMed2000

Childhood predictors of adult medically unexplained hospitalisations. Results from a national birth cohort study.

BACKGROUND: It has been suggested that adults with medically unexplained physical symptoms experienced greater ill-health then others (either in themselves or their families) during childhood. AIMS: To test these hypotheses. METHOD: We used data from the Medical Research Council (MRC) National Survey of Health and Development, a population-based cohort study established in 1946 (n = 5362). Subjects were followed from birth in 1946 until 1989 (age 43 years). As outcome, we used operationally defined medically unexplained hospital admissions at age 15-43 years. Exposure variables included childhood illness, and illness in parents during the childhood of the subjects. RESULTS: The risk set (n = 4603) comprised individuals still in the Survey at age 15. Ninety-five unexplained hospital admissions were identified. Subjects whose mothers reported below-average health in the father were at increased risk of subsequent unexplained admissions. Below average reported health in the mother was not associated with this increased risk. Defined physical diseases in childhood were not associated, but persistent abdominal pain at age 7-15 years was. CONCLUSIONS: Unexplained hospital admissions are associated with certain childhood experiences of illness, but defined physical illness in childhood is not a risk factor.

Abdominal Pain↗
PubMed2000

Bereavement support. The occupational health nurse's role when death comes to work.

1. Providing bereavement support for grieving employees can positively impact their adjustment and productivity. 2. Good bereavement care follows the nursing process approach: assessment, analysis, planning (goal setting), intervention/implementation, and evaluation. It acknowledges the five dimension of optimal health, and incorporates them into the nursing process. 3. The occupational health nurse, as clinician and advisor, can provide care to the bereaved individual and guidance to the manager and coworkers about the grief process and how to interact with the grieving employee. 4. Grief work is necessary for healing. The occupational health nurse can play a valuable role in facilitating the work by offering clinical support, a "safe" place for the grieving employee to talk about the death, referrals to the Employee Assistance Program or other professional support, and education about the process.

Adaptation, Psychological↗