Biomedical subjects

Martin White

Publications and source records attributed to Martin White.

At least 19 recordsLinked to original sources

PubMed2006

No association between socio-economic status and white blood cell telomere length.

It has been hypothesized that more socio-economically deprived individuals age faster and, thus, have shorter telomeres than their more affluent counterparts. A weak association between white blood cell telomere length and socio-economic status in a large heterogeneous sample of females has recently been reported. In 318 individuals from a homogeneous birth cohort, we found no evidence of an association between any measure of socio-economic status and peripheral blood mononucleocyte telomere length at age 50 after control for lifestyle variables, gender and paternal age at birth. The results of this, and the previous study, suggest that there is little evidence of a strong or consistent correlation between white blood cell telomere length and markers of socio-economic status.

Adolescent↗

PubMed2006

Randomised controlled trial of welfare rights advice accessed via primary health care: pilot study [ISRCTN61522618].

BACKGROUND: Little research has directly evaluated the impact of increasing financial or material resources on health. One way of assessing this lies with assisting people to obtain full welfare benefit entitlements. In 2000-1, 2.3 million pensioners were living in poverty in the UK and estimates suggest that around one million do not claim the financial support to which they are entitled. The effectiveness of welfare rights advice services delivered via primary health care to promote health and reduce health inequalities is unknown. METHODS: The main objectives of this study were to assess the feasibility and acceptability of a randomised controlled trial of welfare rights advice in a community setting and identify appropriate health and social outcome measures in order to plan a definitive trial. This was a single blind, community-based, pilot randomised controlled trial. 126 men and women aged 60 years and over, recruited from 4 general practices in Newcastle upon Tyne, UK, participated. The intervention comprised a structured welfare rights assessment followed by active assistance with welfare benefit claims over the following 24 months. The control group received the intervention after a six month delay. A range of socio-economic, health, behavioural and psycho-social outcomes were measured. RESULTS: 126 out of 400 people invited agreed to participate and 109 were followed up at 24 months. Both the intervention and research procedures were feasible and acceptable to participants and professionals involved. 68 (58%) of all participants received a welfare benefit award (31 financial, 16 non-financial and 21 both). Median time to receipt of benefits from initial assessment was 14 (range 1 to 78) weeks and median financial award was pounds 55 (Euro 81, dollar 98) per household per week. There was little evidence of health-related differences between groups or over time, which could be due to limitations of the study design. CONCLUSION: Modification of the study design, including selection of study participants, timing of interventions and length of follow up are recommended for a definitive trial. More appropriate health and psycho-social outcome measures relevant to the elderly population should be sought, particularly focussing on those issues highlighted in the accompanying qualitative study.

Aged↗

PubMed2006

The acceptability and impact of a randomised controlled trial of welfare rights advice accessed via primary health care: qualitative study.

BACKGROUND: Qualitative research is increasingly used alongside randomised controlled trials (RCTs) to study a range of factors including participants' experiences of a trial. The need for a sound evidence base within public health will increase the need for RCTs of non-clinical interventions. Welfare rights advice has been proposed as an intervention with potential to reduce health inequalities. This qualitative study, nested within an RCT of the impact of welfare rights advice, examined the acceptability of the intervention, the acceptability of the research process and the perceived impact of the intervention. METHODS: 25 men and women aged 60 years or over were recruited from four general practices in Newcastle upon Tyne (UK), a sub-sample of those who consented to be contacted (n = 96) during the RCT baseline interview. Semi-structured interviews were undertaken and analysed using the Framework Method. RESULTS: Participants viewed the trial positively although, despite agreeing that the information leaflet was clear, some had agreed to participate without being fully aware of what was involved. Some participants were unaware of the implications of randomisation. Most thought it fair, but a few concerns were raised about the control condition. The intervention was acceptable and made participants feel confident about applying for benefit entitlements. 14 out of 25 participants received some financial award; median weekly income gain was pounds 57 (Euro 84, dollar 101). The perceived impact of additional finances was considerable and included: increased affordability of necessities and occasional expenses; increased capacity to deal with emergencies; and a reduction in stress related to financial worries. Overall, perceived independence and ability to participate in society increased. Most participants perceived benefits to their mental well-being, but no-one reported an improvement in physical health. The RCT showed little or no effect on a wide range of outcome measures. CONCLUSION: Participation in the trial and the intervention was acceptable to participants. Welfare rights advice targeted at people aged 60 years or over and accessed via primary care had a positive impact on quality of life and resulted in increased social participation. The divergence of qualitative and quantitative findings suggests that both methods make important contributions to the evaluation of complex social interventions.

Aged↗

PubMed2006

A systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings.

BACKGROUND: Socio-economic variations in health, including variations in health according to wealth and income, have been widely reported. A potential method of improving the health of the most deprived groups is to increase their income. State funded welfare programmes of financial benefits and benefits in kind are common in developed countries. However, there is evidence of widespread under claiming of welfare benefits by those eligible for them. One method of exploring the health effects of income supplementation is, therefore, to measure the health effects of welfare benefit maximisation programmes. We conducted a systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings. METHODS: Published and unpublished literature was accessed through searches of electronic databases, websites and an internet search engine; hand searches of journals; suggestions from experts; and reference lists of relevant publications. Data on the intervention delivered, evaluation performed, and outcome data on health, social and economic measures were abstracted and assessed by pairs of independent reviewers. Results are reported in narrative form. RESULTS: 55 studies were included in the review. Only seven studies included a comparison or control group. There was evidence that welfare rights advice delivered in healthcare settings results in financial benefits. There was little evidence that the advice resulted in measurable health or social benefits. This is primarily due to lack of good quality evidence, rather than evidence of an absence of effect. CONCLUSION: There are good theoretical reasons why income supplementation should improve health, but currently little evidence of adequate robustness and quality to indicate that the impact goes beyond increasing income.

Civil Rights↗

PubMed2006

Using quantitative and qualitative data in health services research - what happens when mixed method findings conflict? [ISRCTN61522618].

BACKGROUND: In this methodological paper we document the interpretation of a mixed methods study and outline an approach to dealing with apparent discrepancies between qualitative and quantitative research data in a pilot study evaluating whether welfare rights advice has an impact on health and social outcomes among a population aged 60 and over. METHODS: Quantitative and qualitative data were collected contemporaneously. Quantitative data were collected from 126 men and women aged over 60 within a randomised controlled trial. Participants received a full welfare benefits assessment which successfully identified additional financial and non-financial resources for 60% of them. A range of demographic, health and social outcome measures were assessed at baseline, 6, 12 and 24 month follow up. Qualitative data were collected from a sub-sample of 25 participants purposively selected to take part in individual interviews to examine the perceived impact of welfare rights advice. RESULTS: Separate analysis of the quantitative and qualitative data revealed discrepant findings. The quantitative data showed little evidence of significant differences of a size that would be of practical or clinical interest, suggesting that the intervention had no impact on these outcome measures. The qualitative data suggested wide-ranging impacts, indicating that the intervention had a positive effect. Six ways of further exploring these data were considered: (i) treating the methods as fundamentally different; (ii) exploring the methodological rigour of each component; (iii) exploring dataset comparability; (iv) collecting further data and making further comparisons; (v) exploring the process of the intervention; and (vi) exploring whether the outcomes of the two components match. CONCLUSION: The study demonstrates how using mixed methods can lead to different and sometimes conflicting accounts and, using this six step approach, how such discrepancies can be harnessed to interrogate each dataset more fully. Not only does this enhance the robustness of the study, it may lead to different conclusions from those that would have been drawn through relying on one method alone and demonstrates the value of collecting both types of data within a single study. More widespread use of mixed methods in trials of complex interventions is likely to enhance the overall quality of the evidence base.

Aged↗

PubMed2006

Successful surgical resection of intrapericardial extralobar pulmonary sequestration with congenital pulmonary adenomatoid malformation type II.

We report a 7-day-old boy referred to our institution with tachypnea and cardiomegaly who was discovered to have an intrapericardial extra-lobar pulmonary sequestration containing a cystic pulmonary adenomatoid malformation type II. He underwent successful surgical resection of the intrapericardial mass, which we believe represents the first reported case of this rare entity.

Bronchopulmonary Sequestration↗

PubMed2006

Association of glucocorticoid receptor polymorphism A3669G in exon 9beta with reduced central adiposity in women.

The glucocorticoid receptor (GR) may be a common link between human obesity/metabolic syndrome and Cushing's syndrome. The effects of glucocorticoids are mediated through the functional isoform, GRalpha. An alternative isoform, GRbeta, behaves as a dominant negative inhibitor of GRalpha and has been implicated as a contributing factor to glucocorticoid resistance. A naturally occurring ATTTA to GTTTA single nucleotide polymorphism (A3669G) located in the 3' end of exon 9beta results in increased stability of GRbeta mRNA and increased GRbeta protein expression. Enhanced GRbeta expression may result in greater inhibition of GRalpha transcriptional activity, resulting in glucocorticoid insensitivity. To test the hypothesis that the 3669G allele would result in a phenotype less likely to express features of glucocorticoid excess, we studied the prevalence of this polymorphism and its relationship with obesity and features of the metabolic syndrome in 322 Europid and 262 South-Asian subjects in northeast England. We report evidence that 3669G allele is associated with reduced central obesity in Europid women and a more favorable lipid profile in Europid men. These data suggest that the 3669G allele may attenuate the undesirable effects of glucocorticoids on fat distribution and lipid metabolism, although its penetrance may vary in different ethnic groups.

Adiposity↗

PubMed2006

Differences in cortisol concentrations in South Asian and European men living in the United Kingdom.

OBJECTIVE: The metabolic syndrome is more prevalent in South Asians in Britain than in the general population. Furthering our understanding of the underlying mechanisms is important because of the increased risk of cardiovascular disease associated with the metabolic syndrome. As it has been proposed that increased activity of the hypothalamic pituitary adrenal axis might underlie the metabolic syndrome, we hypothesized that plasma cortisol levels would be higher in South Asians and that increased cortisol levels would be associated with cardiovascular risk factors comprising the metabolic syndrome. The aim of the study was to examine ethnic differences in cortisol levels and to compare the relationships between cortisol levels and cardiovascular risk factors in men from different ethnic groups. DESIGN: Cross-sectional population-based study, Newcastle upon Tyne, UK. (Newcastle Heart project). Participants One hundred men, 40-67 years old, of European and South Asian (Indian, Pakistani, Bangladeshi) ancestry, with and without cardiovascular risk factors of the metabolic syndrome. MEASUREMENTS: Measurement of plasma cortisol and corticosteroid binding globulin in stored sera. RESULTS: After adjustment for age and the presence of cardiovascular risk factors, mean cortisol was 27% (95% CI, 10%, 40%) lower in South Asians compared to Europeans. Cortisol levels were higher in all men with cardiovascular risk factors than those without. CONCLUSIONS: Cortisol levels are lower in South Asian than in European men resident in the UK. Despite lower cortisol levels in South Asians, the relations between cortisol and cardiovascular risk factors remain strong.

Adult↗

PubMed2006

Quitting smoking and experience of smoking cessation interventions among UK Bangladeshi and Pakistani adults: the views of community members and health professionals.

OBJECTIVE: To explore attitudes to quitting smoking and experience of smoking cessation among Bangladeshi and Pakistani ethnic minority communities. DESIGN: Qualitative study using community participatory methods, purposeful sampling, interviews and focus groups, and a grounded approach to data generation and analysis. SETTING: Newcastle upon Tyne, UK, 2000-2002. PARTICIPANTS: 53 men and 20 women aged 18-80 years, including smokers, former smokers, and smokers' relatives, from the Bangladeshi and Pakistani communities; and eight health professionals working with these communities. RESULTS: Motivation to quit was high but most attempts had failed. "Willpower" was the most common approach to quitting. For some, the holy month of Ramadan was used as an incentive, however few had been successful in quitting. Perceived barriers to success included being tempted by others, everyday stresses, and withdrawal symptoms. Few participants had sought advice from health services, or received cessation aids, such as nicotine replacement therapy (NRT) or buproprion. Family doctors were not viewed as accessible sources of advice on quitting. Health professionals and community members identified common barriers to accessing effective smoking cessation, including: language, religion and culture; negative attitudes to services; and lack of time and resources for professionals to develop necessary skills. CONCLUSIONS: High levels of motivation do not seem to be matched by effective interventions or successful attempts to quit smoking among Bangladeshi and Pakistani adults in the UK. There is a need to adapt and test effective smoking cessation interventions to make them culturally acceptable to ethnic minority communities. UK tobacco control policies need to give special attention to the needs of ethnic minority groups.

Adolescent↗

PubMed2006

Changes in socioeconomic inequalities in census measures of health in England and Wales, 1991-2001.

STUDY OBJECTIVES: To investigate changes in socioeconomic inequalities in census measures of health in England and Wales between 1991 and 2001. DESIGN: Indirect standardisation was used to calculate age standardised rates of limiting long term illness and permanent sickness in men and women in all residential wards in England and Wales in 1991 and 2001. The socioeconomic position of each ward was determined using Townsend deprivation scores. SETTING: All residential wards in England and Wales in 1991 and 2001. PARTICIPANTS: All people aged 16-65 who provided census information in the 1991 or 2001 censuses. MAIN RESULTS: There was strong evidence that Townsend deprivation score quintile could predict both logged standardised permanent sickness rate and logged standardised limiting long term illness rate. There was evidence that socioeconomic inequalities in standardised limiting long term illness rates decreased between 1991 and 2001 in both men and women and that socioeconomic inequalities in standardised permanent sickness rates decreased in women but increased in men between 1991 and 2001. CONCLUSIONS: As permanent sickness rates seem to reflect labour market accessibility, this study may have found evidence that socioeconomic inequalities in self reported morbidity decreased but inequalities in labour market participation in men increased between 1991 and 2001.

Adolescent↗

PubMed2006

Does cerebral monitoring improve ophthalmic surgical operating conditions during propofol-induced sedation?

Sudden movements from over-sedation during ophthalmic surgery can be detrimental to the eye. Bispectral index (BIS) and middle-latency auditory-evoked potentials (Alaris AEP index, AAI) were reported to be accurate indicators for the level of sedation and loss of consciousness. We assessed these monitors during sedation with special emphasis on preventing over-sedation. One-hundred patients scheduled for elective eye surgery were sedated with target-controlled propofol infusion and randomly allocated to BIS-guided, AAI-guided, BIS/AAI-guided, or clinically guided groups (n = 25 each). The initial target concentration was 0.5 microg x mL(-1) in patients >70 yr and 1.0 microg x mL(-1) in all other patients. The concentration was increased every 3 min by 0.1 or 0.2 microg x mL(-1), respectively until the patient had reached a BIS value of 75 (range 70-90) or an AAI of 40 (range 35-60). The surgeon who was blinded to group allocation assessed treatment quality after the procedure. Sedation was converted into general anesthesia in four patients because of excessive head movements. BIS was out of range 7% of the time vs 58% for AAI. No significant differences in treatment quality were observed among the four groups. We conclude that propofol sedation, guided by BIS or AAI monitoring, did not enhance ophthalmic surgical operating conditions over sedation guided by clinical observation only.

Adolescent↗

PubMed2005

Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance.

AIM: To evaluate the effectiveness of lifestyle interventions in people with impaired glucose tolerance (IGT). METHODS: Participants with IGT (n=78), diagnosed on two consecutive oral glucose tolerance tests (OGTTs), were randomly assigned to a 2-year lifestyle intervention or to a control group. Main outcome measures were changes from baseline in: nutrient intake; physical activity; anthropometry, glucose tolerance and insulin sensitivity. Measurements were repeated at 6, 12 and 24 months follow-up. RESULTS: After 24 months follow-up, there was a significant fall in total fat consumption (difference in change between groups (Delta intervention-Delta control)= -17.9, 95% confidence interval (CI) -33.6 to -2.1g/day) as a result of the intervention. Body mass was significantly lower in the intervention group compared with controls after 6 months (-1.6, 95% CI -2.9 to -0.4 kg) and 24 months (-3.3, 95% CI -5.7 to -0.89 kg). Whole body insulin sensitivity, assessed by the short insulin tolerance test (ITT), improved after 12 months in the intervention group (0.52, 95% CI 0.15-0.89%/min). CONCLUSIONS: These findings complement the findings of the Finnish Diabetes Prevention Study and the American Diabetes Prevention Study, both of which tested intensive interventions, by showing that pragmatic lifestyle interventions result in improvements in obesity and whole body insulin sensitivity in individuals with IGT, without change in other cardiovascular risk factors.

Adult↗

PubMed2005

Year-round daylight saving and serious or fatal road traffic injuries in children in the north-east of England.

BACKGROUND: It has been suggested that year-round daylight saving would reduce road traffic injuries. METHODS: and results Using 15 years of police data from north-east England, we estimate that 6.9 (95 per cent CI 1.5-12.6) fewer serious or fatal road traffic injuries to child pedestrians would have occurred in this area over this period had year-round daylight saving operated (equivalent to 0.5 per year). CONCLUSION: The results suggest that operating daylight saving year-round would have a small but tangible effect on the number of serious and fatal road traffic injuries in children in this area. Further work is required to assess the community wide impact of year round daylight saving.

Accidents, Traffic↗

PubMed2005

Socio-economic deprivation is associated with increased proximity to general practices in England: an ecological analysis.

BACKGROUND: As health status is consistently negatively correlated with socio-economic deprivation, the need for health services is generally assumed to be greater in more deprived communities. The Inverse Care Law predicts that access to good quality primary care services in more deprived wards will be less than that in affluent wards. However, the relationship between deprivation and geographical proximity to health services has received little attention. METHODS: We investigated the relationship between geographical proximity to general practices and a number of markers of socio-economic deprivation at the electoral ward level in the North East of England using various domains of the Index of Multiple Deprivation 2000 (IMD2000). RESULTS: More deprived wards, as measured by the employment, education and income domains of the IMD2000, had greater proximity to general practices, as measured by the access domain of the IMD2000, than affluent wards. This results held in both urban and rural wards. CONCLUSIONS: Contrary to our expectations and the predictions of the Inverse Care Law, geographical proximity to general practices was greater in more deprived, compared to more affluent wards. However, geographical proximity to services does not necessarily ensure that services will be accessed or that they are of good quality.

Catchment Area, Health↗

PubMed2005

Self-reported work strain is lower in South Asian than European people: cross-sectional survey.

OBJECTIVE: Jobs with high levels of demand and low levels of control have been linked to the risk of coronary heart disease (CHD). Limited evidence is available about the contribution of job characteristics to the increased risk of CHD in UK South Asian people. We aimed to describe psychosocial work characteristics in South Asian compared with European people. DESIGN: Cross-sectional study in Newcastle upon Tyne, UK, using self-reported measures of job demand, decision latitude, skill utilisation and social support at work in an age and sex stratified representative population sample of 652 adults of European (391) and South Asian (261) ethnic origin. RESULTS: Compared to European people, fewer South Asian men (57% vs 47%) but more South Asian women (22% vs 48%) were employed. South Asian people were more likely than European people to be self-employed (33% vs 7% among men). Employed South Asian people were better educated and had higher income than European people. Compared to European men, more South Asian men had high job control (42% vs 35%) but similar proportions had high job demand (42% vs 41%). Fewer South Asian men had jobs that allowed a high use of skill, but more had high decision latitude. These differences were partly explained by higher rates of self-employment among South Asian people. South Asian people were more likely to be in low demand/high control jobs, while European people occupied a wider range of jobs, in low control and in high demand/high control occupations. More detailed sub-group analyses were not reliable because of small numbers. CONCLUSION: In a representative population sample the overall balance of job demand and control was similar in South Asian and European people, though South Asian people tended to be in jobs characterised by low skill and high decision latitude. These findings do not support the suggestion that increased work strain contributes to the increased risk of CHD in UK South Asian people.

Adult↗

PubMed2005

Predicted and observed cardiovascular disease in South Asians: application of FINRISK, Framingham and SCORE models to Newcastle Heart Project data.

BACKGROUND: South Asian populations in the United Kingdom have a high risk of cardiovascular disease (CVD) mortality. Risk prediction models appear to be inaccurate in South Asians. OBJECTIVE: To explore the predictive capacity of the FINRISK, Framingham (1991) and SCORE risk prediction models in the Newcastle Heart Project population (n = 1301). METHODS: Mortality data for England and Wales were used to define the expected ranking of CVD risk by country of birth. CVD mortality in the Newcastle Heart Project sample was examined. Risk factor measures were obtained from the Newcastle Heart Project, where 90 percent of South Asians were born in the Indian Subcontinent. The predicted outcomes for FINRISK were acute myocardial infarction and CHD mortality, for Framingham CHD mortality, myocardial infarction, new angina and coronary insufficiency and for SCORE CHD and non-CHD CVD mortality. RESULTS: The FINRISK model predicted in South Asian men combined, compared with Europeans, a risk ratio of 122 per cent (SMR 142) with substantial subgroup heterogeneity, e.g. 154 per cent in Bangladeshis (SMR 151), 129 per cent in Pakistanis (SMR 148), 99 per cent in Indians (SMR 142). The FINRISK risk ratios for South Asian women combined were 160 per cent (SMR 145), for Bangladeshis 184 per cent (SMR 91), Pakistanis 172 per cent (SMR 111) and for Indians 145 per cent (SMR 158). The Framingham model results were very similar to FINRISK, but the SCORE model showed comparatively low 10 year risk in all South Asian groups. Both the Framingham stroke model and the SCORE non-CHD CVD model predicted comparatively low rates, while national data showed these to be high. Control of the five major risk factors was modelled by FINRISK to reduce risk by about 59 per cent in South Asian men and 67 per cent in South Asian women, with some subgroup heterogeneity, compared to 50 per cent in European men and 48 per cent in European women. The Framingham model results were similar. The absolute rates for each ethnic group varied by model. CONCLUSION: The Framingham and FINRISK models gave similar results, mostly following expected patterns, but the SCORE model did not, probably reflecting its lack of inclusion of HDL and diabetes as risk factors. National mortality data and modelled predictions agreed reasonably well for South Asians combined, and Bangladeshi and Pakistani men, but not for Indian men and Pakistani and Bangladeshi women. The varying rates show the limits of modelling. The models suggest the potential gains from controlling major established risk factors could be substantial in South Asians and greater than in Europeans.

Adult↗

PubMed2005

Is the rate of biological aging, as measured by age at diagnosis of cancer, socioeconomically patterned?

STUDY OBJECTIVE: To investigate the hypothesis that biological aging, as measured by age at diagnosis of some common cancers, is socioeconomically patterned. DESIGN: A cross sectional analysis of the association between an area based measure of material deprivation and age at diagnosis of four common cancers (breast, prostate, colorectal, and lung cancers). A further analysis, restricted to breast and colorectal cancer, adjusted for stage and grade of cancer at diagnosis. SETTING: The Northern and Yorkshire cancer registry and information service, Northern and Yorkshire region, UK. PARTICIPANTS: All people living in the Northern and Yorkshire region diagnosed with breast, prostate, colorectal, or lung cancer in 1986-1995. All people living in the Northern and Yorkshire region diagnosed with breast or colorectal cancer in 1998-2000 with data on stage and grade of cancer at diagnosis. MAIN RESULTS: There was evidence that greater material deprivation was associated with younger age at diagnosis of cancer in prostate (beta coefficient -0.073), colorectal (women: -0.042; men: -0.063), and lung cancer (women: -0.214; men: -0.161). The opposite association was found in women with breast cancer (0.149). Adjusting for stage and grade at incidence, where possible, had little effect on the magnitude of the beta coefficients. CONCLUSIONS: Age at diagnosis of some common cancers seems to be socioeconomically patterned with people from more deprived areas being diagnosed with prostate, colorectal, and lung cancers earlier in life. The opposite was seen in women with breast cancer. Further work is required to investigate the socioeconomic distribution of more accurate measures of biological aging.

Age of Onset↗

PubMed2004

Age-related variations in progression of cancer at diagnosis and completeness of cancer registry data.

There is some evidence that stage and grade at diagnosis of cancer decreases with age and that the availability of data on stage and grade of cancer decreases with age. This may be because older people tend to receive less intensive investigation of cancer but this has not been confirmed. We investigated the relationship between age at diagnosis of cancer and both stage and grade at diagnosis, and the chances of data on stage or grade at diagnosis being unavailable, in people with colorectal cancer (n=12,419) and women with breast cancer (n=12,793) using 2 years of cancer registry data from the north of England. Stage and grade decreased with increasing age in colorectal cancer. Grade decreased but stage increased with increasing age in women with breast cancer. The chances of data on stage and grade at diagnosis being unavailable increased with age in all cases.

Age Factors↗