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Margaret Thorogood

Publications and source records attributed to Margaret Thorogood.

14 recordsLinked to original sources
PubMed2003

A review on the diagnosis, natural history, and treatment of familial hypercholesterolaemia.

BACKGROUND: Familial hypercholesterolaemia (FH) affects approximately 1 in 500 people (10 million world-wide) and the elevated serum cholesterol concentrations lead to a more than 50% risk of fatal or non-fatal coronary heart disease by age 50 years in men and at least 30% in women aged 60 years. Based on a systematic literature search, we review the natural history of FH, describe the diagnostic criteria, and consider the effectiveness of treatment. METHODS: A comprehensive review was conducted of the literature on the diagnosis of FH, the morbidity and mortality related to treated and untreated FH, and the evidence on the effectiveness of treatment of FH in adults and children. Treatment options have changed since statin treatment became available, and we have not considered pre-statin therapy studies of treatment effectiveness. FINDINGS AND DISCUSSION: A clinical diagnosis of FH is widely used, but a definitive diagnosis can be made by genetic screening, although mutations are currently only detected in 30-50% of patients with a clinical diagnosis. Under-diagnosis of FH has been reported world-wide ranging from less than 1% to 44%. The relative risk of death of FH patients not treated with statins is between three and fourfold but treatment is effective, and delays or prevents the onset of coronary heart disease. Early detection and treatment is important. Aggressive LDL therapy is more effective in the regression of the carotid intima media thickness than conventional LDL therapy. Diagnosis at birth is problematic, and should be delayed until at least 2 years of age. Statins are not generally recommended for the treatment of children up to adolescence. Resins may be used but poor adherence is a problem. Technical advances in mutation detection, and the identification of other genes that cause FH, are likely to have important implications for the cost effectiveness of genetic diagnosis of FH.

Cholesterol↗
PubMed2003

Comparing costs and benefits over a 10 year period of strategies for familial hypercholesterolaemia screening.

BACKGROUND: Approximately 110,000 people in the United Kingdom are affected with familial hypercholesterolaemia (FH). At least 75 per cent are undiagnosed. Treatment with statins is effective but effective primary prevention requires early diagnosis. The best strategy to achieve this is unclear. This paper compares the costs and benefits over a 10 year period of two strategies found in our previous modelling: population screening of 16-year-olds or tracing family members of affected patients. METHODS: Computer modelling of time-limited data was conducted. The number available for screening and the potential new cases in England and Wales aged 16-54 years were estimated. The costs (of screening and treatment) and benefits (deaths averted) that might be accrued over 10 years were assessed. RESULTS: Screening 16-year-olds results in 470 new diagnoses, and over 10 subsequent years averts 11.7 deaths at a cost of 6,176,648 pounds sterling, giving a cost per case identified and treated of 13,141 pounds sterling (including a 10 year drug cost of 1,584,918 pounds sterling). By contrast, screening first-degree relatives of known uases results in 13,248 new diagnoses, 560 deaths averted over 10 years, at a cost of 46,430,681 pounds sterling giving a cost per case identified and treated of 3,505 pounds sterling (including 10 year drug cost of 44,645,760 pounds sterling). The cost per death averted would be 3,187 pounds sterling. CONCLUSIONS: Although the two approaches appear similar in cost-effectiveness over a lifetime, the shorter-term (10 year) cost-effectiveness clearly favours family tracing. This represents good value for money compared with common medical interventions, and suggests that pilot FH family tracing programmes should be conducted.

Adolescent↗
PubMed2003

Distant past exercise in women: measures may be reliable, but are they valid?

INTRODUCTION/PURPOSE: Methods to measure lifetime physical activity have been described together with evidence suggesting that they are reliable. We present study findings that challenge the validity of such measures. METHODS: One hundred twenty-seven women aged 50-70 interviewed (31 cases, 96 controls) during a pilot case-control study about risk factors for osteoarthritis of the knee. Interviews used a life course approach with visual cues. Information obtained on past physical activity: (i) Total METs for a large range of activities within each decade between age 10 and age 50, (ii) 10-point rating scales representing level of physical activity during each decade between age 10 and age 50, and (iii) lifetime hours' participation in competitive sports. RESULTS: Any statistical correspondence between METs and activity rating scales was best in relation to women's activity when in their teens (Spearman rank correlation r = 0.40). The highest correlation thereafter related to the most recent decade (r = 0.25), which was low, but there was little or no linear association between MET values and the activity ratings when women were in their 20s or 30s. Around one fifth (20.4%) of women who reported no competitive sports participation during their teens and 18.5% who reported none during their 20s also reported total METs corresponding to the top quartile of physical activity during those periods of their lives. CONCLUSION: Retrospective reports from women of distant past activity levels will likely yield different information depending on the form of questioning. It is unclear which method, if any, is accurate and unbiased. The validity of each method is therefore also questionable.

Age Distribution↗
PubMed2002

Cost effectiveness analysis of different approaches of screening for familial hypercholesterolaemia.

OBJECTIVES: To assess the cost effectiveness of strategies to screen for and treat familial hypercholesterolaemia. DESIGN: Cost effectiveness analysis. A care pathway for each patient was delineated and the associated probabilities, benefits, and costs were calculated. PARTICIPANTS: Simulated population aged 16-54 years in England and Wales. INTERVENTIONS: Identification and treatment of patients with familial hypercholesterolaemia by universal screening, opportunistic screening in primary care, screening of people admitted to hospital with premature myocardial infarction, or tracing family members of affected patients. MAIN OUTCOME MEASURE: Cost effectiveness calculated as cost per life year gained (extension of life expectancy resulting from intervention) including estimated costs of screening and treatment. RESULTS: Tracing of family members was the most cost effective strategy (3097 pounds sterling (euros 5066, $4479) per life year gained) as 2.6 individuals need to be screened to identify one case at a cost of 133 pounds sterling per case detected. If the genetic mutation was known within the family then the cost per life year gained (4914 pounds sterling ) was only slightly increased by genetic confirmation of the diagnosis. Universal population screening was least cost effective (13 029 pounds sterling per life year gained) as 1365 individuals need to be screened at a cost of 9754 pounds sterling per case detected. For each strategy it was more cost effective to screen younger people and women. Targeted strategies were more expensive per person screened, but the cost per case detected was lower. Population screening of 16 year olds only was as cost effective as family tracing (2777 pounds sterling with a clinical confirmation). CONCLUSIONS: Screening family members of people with familial hypercholesterolaemia is the most cost effective option for detecting cases across the whole population.

Adolescent↗
PubMed2002

Mortality in British vegetarians.

OBJECTIVE: To compare the mortality of British vegetarians and non-vegetarians. DESIGN: Analysis of original data from two prospective studies each including a large proportion of vegetarians--the Oxford Vegetarian Study and the Health Food Shoppers Study. Standardised mortality ratios (SMRs) compared with the population of England and Wales were calculated from deaths before age 90 for vegetarians and non-vegetarians in each study. Death rate ratios (DRRs) for vegetarians compared with non-vegetarians within each study were calculated for each of 14 major causes of death. SETTING: UK. SUBJECTS: Twenty-one thousand men and women aged 16-89 years at recruitment, including more than 8,000 vegetarians. RESULTS: SMRs for all causes of death were significantly below the reference level of 100 in both studies: 52 (95% confidence interval (CI) 49-56) based on 1,131 deaths in the Oxford Vegetarian Study and 59 (57-61) based on 2,346 deaths in the Health Food Shoppers Study. For all causes of death, the DRR for vegetarians compared with non-vegetarians was close to one in both studies: 1.01 (95% CI 0.89-1.14) in the Oxford Vegetarian Study, 1.03 (0.95-1.13) in the Health Food Shoppers Study. CONCLUSIONS: British vegetarians have low mortality compared with the general population. Their death rates are similar to those of comparable non-vegetarians, suggesting that much of this benefit may be attributed to non-dietary lifestyle factors such as a low prevalence of smoking and a generally high socio-economic status, or to aspects of the diet other than the avoidance of meat and fish.

Adolescent↗
PubMed2002

Cost-effectiveness of a community anti-smoking campaign targeted at a high risk group in London.

Surveys of Turkish speaking people in London found 74% of men and 45% of women were smokers, and knowledge of the health effects of smoking was low. Camden and Islington Health Authority has a substantial Turkish community. We report an economic evaluation of a community smoking cessation intervention, aimed at the Turkish community, undertaken by Camden and Islington Health Promotion Agency. The intervention aimed to highlight the dangers of smoking, and to reduce the amount smoked and the number of current smokers. It included a play, a poster and media campaign, and purpose-designed leaflets. A panel survey of the Turkish population determined smoking habits, attitudes to smoking and knowledge about the health effects at baseline and 12 months. The intervention effect was estimated from the changes between baseline and final surveys. To allow for the non-response to the second survey we analysed effectiveness in two ways: first by assuming that the responders represented the true situation, and secondly by making a more pessimistic assumption that there was no change in the non-responders. Fifty-seven per cent of the Turkish population were smokers at baseline, compared with 39% in the general population of Camden and Islington. Levels were particularly high in younger women. At follow-up there was a net reduction in smokers of 6.4% [95% confidence interval (CI) 0-13.6%] in responders. When all study subjects were included the net reduction was 2.9% (CI 0-6.3%). Most quitters were light smokers to start with. At follow-up, 51% of respondents recognized at least one of the Turkish language interventions. The estimated cost-effectiveness of this intervention was 105 pound (range 33-391 pound) per life year gained. Campaigns targeted at groups with high smoking prevalence may be more cost-effective than general population campaigns.

Adolescent↗
PubMed2002

Advising people to take more exercise is ineffective: a randomized controlled trial of physical activity promotion in primary care.

BACKGROUND: Over the last 10 years 'exercise referral schemes' have been popular even though the evidence for effectiveness of any one-to-one intervention in primary care is deficient. We report the results of a primary care based one-to-one intervention that compared the effect of two communication styles with a no-intervention control group on self-reported physical activity at 12 months. METHODS: In all, 1658 middle-aged men and women were randomly assigned to 30 minutes of brief negotiation or direct advice in primary care or a no-intervention control group. The main outcome was self-reported physical activity at 12 months. Secondary outcome measures included change in blood pressure and body mass index. RESULTS: Intention-to-treat analysis revealed no significant differences in physical activity between groups. Brief negotiation group participants who completed the study increased their physical activity significantly more than controls. There was no change in body mass index in any group. The brief negotiation group produced a greater reduction in diastolic blood pressure than direct advice. CONCLUSION: If patients whose health may benefit from increased physical activity seek advice in primary care, 20-30 minutes of brief negotiation to increase physical activity is probably more effective than similar attempts to persuade or coerce. However, blanket physical activity promotion in primary care is not effective. The most effective way of increasing physical activity in primary care has yet to be determined.

Energy Metabolism↗
PubMed2002

The prevalence of foot problems in older women: a cause for concern.

BACKGROUND: Painful feet are an extremely common problem amongst older women. Such problems increase the risk of falls and hamper mobility. The aetiology of painful and deformed feet is poorly understood. METHODS: Data were obtained during a pilot case-control study about past high heel usage in women, in relation to osteoarthritis of the knee. A total of 127 women aged 50-70 were interviewed (31 cases, 96 controls); case-control sets were matched for age. The following information was obtained about footwear: (1) age when first wore shoes with heels 1, 2 and 3 inches high; (2) height of heels worn for work; (3) maximum height of heels worn regularly for work, going out socially and for dancing, in 10-year age bands. Information about work-related activities and lifetime occupational history was gathered using a Life-Grid. The interview included a foot inspection. RESULTS: Foot problems, particularly foot arthritis, affected considerably more cases than controls (45 per cent versus 16 per cent, p = 0.001) and was considered a confounder. Cases were therefore excluded from subsequent analyses. Amongst controls, the prevalence of any foot problems was very high (83 per cent). All women had regularly worn one inch heels and few (8 per cent) had never worn 2 inch heels. Foot problems were significantly associated with a history of wearing relatively lower heels. Few work activities were related to foot problems; regular lifting was associated with foot pain (p = 0.03). CONCLUSION: Most women in this age-group have been exposed to high-heeled shoes over many years, making aetiological research difficult in this area. Foot pain and deformities are widespread. The relationship between footwear, occupational activities and foot problems is a complex one that deserves considerably more research.

Age Factors↗
PubMed2002

Measuring perceptions of synergistic circulatory disease risk due to smoking and the oral contraceptive pill.

There is evidence that the oral contraceptive pill (OCP) and smoking contribute independently to risk of circulatory disease. There is mixed evidence that the combined risk may be greater than the sum of these factors operating in isolation. Little is known about how the general population views the risks from OCP use, singly and in combination with smoking. Previous attempts at assessing whether the public views risks as operating synergistically have generally found evidence for subadditive models, where the combined risk is less than the sum of factors operating in isolation. However, concerns have been expressed over the validity of the measures of risk perception used. Therefore, this study used three distinct methods of measurement to assess the extent to which 241 undergraduate students perceive the risks of smoking and the OCP separately and combined, for circulatory disease. For all three methods, respondents read each of four vignettes describing information about a woman's risk factors (with high and low levels of both OCP and smoking), and then estimated risk of circulatory disease using one of the three risk measures. The three measures produced similar ratings. Consistent with the epidemiological evidence, information about smoking had more impact on estimates of overall risk than did information about the OCP For all three measures, responses were consistent with an additive model of risk from smoking and the OCP. This convergence of results from different methods suggests that all three methods of measurement employed, which all had a large number of response options, may be valid.

Adult↗
PubMed2002

Short course in pharmacoepidemiology and pharmacovigilance at the London School of Hygiene and Tropical Medicine.

Demand for education in pharmacoepidemiology is widespread, and has resulted in the short course at the London School of Hygiene and Tropical Medicine. This course is designed as an introduction but requires some scientific background to understand it. The course occurs annually, and covers basics of epidemiology, statistics and drug surveillance systems as applied particularly to drug safety issues. A successful completion results in a certificate from the University of London, and the course is accredited for continuing pharmacy and medical education purposes.

Accreditation↗
PubMed2000

The impact of the quality of family planning services on safe and effective contraceptive use: a systematic literature review.

The aim of this review is to identify the features of family planning service provision that are influential in ensuring safe and appropriate contraceptive use and optimal effectiveness of user-dependent methods. A systematic search was carried out of the published and unpublished studies available up to December 1997 that examined the relationship between family planning service provision and contraceptive use. Articles that reported primary data on long-term outcomes were scored by at least two of the authors of the present study. Particular attention was paid to evaluating methods of measuring quality of care. A total of 142 articles were identified, but only 16 reported primary data relating to long-term outcomes. The quality of provider--client exchanges was found to have a net incremental effect on contraceptive use. Evidence of effectiveness of methods to improve uptake, continuation of method use, and safe and appropriate use of fertility control is scant. The evidence that is available indicates that training in communication with clients (particularly about side-effects of contraceptive methods) and an emphasis on client choice are key components of effective interventions. The tasks of listening to clients, and tailoring services to local needs, are crucial to the success of family planning service provision.

Journal Article↗
PubMedDate not supplied

Economic analysis of a pragmatic randomised trial of home visits by a nurse to elderly people with hypertension in Mexico.

OBJECTIVE: To analyse the costs and the effectiveness of an intervention of home visits made by nurses to elderly people versus usual care given by the family medicine units. MATERIAL AND METHODS: A sample of 4,777 subjects aged 60 years and over covered by the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social, IMSS) were screened. Those with a systolic and/or diastolic blood pressure level higher or equal than 160/90 mm Hg were randomly allocated to the intervention or control groups. The intervention consisted of visits at home by nurses who gave health and lifestyle advice to the participants. The economic evaluation was considered from a health services and patient perspective. Direct and indirect costs were calculated as incremental. Effectiveness was measured in terms of cost per millimetre of mercury reduced. RESULTS: Three hundred and forty five participants were allocated to the intervention group and compared with 338 controls. At the end of the intervention period the difference in the mean change in systolic blood pressure was 3.31 mm Hg (95% CI 6.32, 0.29; p = 0.03) comparing with the control group. In diastolic blood pressure the difference was 3.67 (95% CI 5.22, 2.12; p < 0.001). The total cost of the intervention was 101 901.66 pesos. The intervention cost per patient was 34.61 pesos (US$3.78), (CI 95% 34.44, 35.46). The cost-effectiveness ratios was 10.46 pesos (US$1.14) for systolic (CI 95% 129.31, 5.51) and 9.43 (US$1.03) for diastolic (CI 95% 19.90, 2.49). CONCLUSIONS: The reduction in blood pressure obtained may well justify the small incremental cost of the intervention.

Aged↗