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Martin White

Publications and source records attributed to Martin White.

35 records · Page 2Linked to original sources
PubMed2004

When the population approach to prevention puts the health of individuals at risk.

The population approach to prevention has been described as one of the "absolute truths" of preventive medicine. However, when the relationship between risk factor exposure levels and associated risk is J-shaped the population approach can increase risk in a small number of individuals. There is evidence that the relationship between a variety of exposures and all-cause morbidity and mortality is J-shaped. However, such relationships are often overlooked by epidemiological investigations which focus on cause-specific morbidity and mortality. Although the overall beneficial effect of population interventions may outweigh any negative effect seen, the effect on the individuals concerned should not be overlooked--especially when they can be easily identifiable before the intervention. Procedures, akin to gaining informed consent in clinical situations, may be required to ensure that individuals who are at high risk of being negatively affected by population interventions understand the risks involved and have the opportunity to opt out.

Health Status↗
PubMed2004

Biological ageing: a fundamental, biological link between socio-economic status and health?

Socio-economic differences in health appear to be universal but the precise pathways that link socio-economic status and health remain unclear. Differential exposure to specific risk and protective factors are often cited as, at least, partial explanations of socio-economic differences in health. However, risk factors are culturally specific and risk factor-specific models of socio-economic differences in health may be inadequate: as soon as prevailing risk factors change, so too must associated explanations of socio-economic differences in health. An alternative, risk factor-independent, model of socio-economic differences in health proposes that fundamental pathways to health and disease exist and that risk and protective factors act by feeding into these pathways. We propose that biological ageing is one such fundamental pathway to health, disease and, thus, socio-economic differences in health. Biological ageing is the progressive decline in physiological ability to meet demands, that occurs over time. It is due to the accumulation of damage at the cellular level and the rate of biological ageing is determined by both environmental and genetic factors. There is increasing evidence that many known disease risk and protective factors influence the rate of cellular damage accumulation and hence biological ageing and that the pathogenesis of some important diseases is related to biological ageing. We discuss these issues and hypothesize that socio-economic differences in health are partly a result of poor people ageing faster than rich people due to the unhealthy environments to which they are exposed.

Aged↗
PubMed2004

Low prevalence of the N363S polymorphism of the glucocorticoid receptor in South Asians living in the United Kingdom.

Similarities between clinical states of glucocorticoid excess and obesity have raised suspicion of a link between the two conditions. An Asn363Ser (N363S) polymorphism in exon 2 of the glucocorticoid receptor has been associated with glucocorticoid sensitivity and excess adiposity in people of European origin. Compared with Europid populations, South Asians have a higher prevalence of cardiovascular risk factors, including type 2 diabetes and central obesity. The aim of this study was to determine the prevalence of the 363S allele in people of South Asian origin living in northeast England in relation to obesity and other cardiovascular risk factors. DNA from 142 males and 153 females was characterized for 363S allele status. Two N363S heterozygotes were identified; both subjects had raised body mass index and central obesity. Despite a higher prevalence of overweight (body mass index >/==" BORDER="0"> 25 kg/m(2)) people in the South Asian group compared with the Europid population in the same geographical area (66 vs. 56%, respectively), the 363S allele frequency was significantly lower in the South Asian group (0.3 vs. 3%, respectively). Therefore, the N363S polymorphism is unlikely to be an important factor in obesity and/or dysmetabolic traits in people of South Asian origin living in the United Kingdom.

Adult↗
PubMed2003

Understanding influences on smoking in Bangladeshi and Pakistani adults: community based, qualitative study.

OBJECTIVE: To gain detailed understanding of influences on smoking behaviour in Bangladeshi and Pakistani communities in the United Kingdom to inform the development of effective and culturally acceptable smoking cessation interventions. DESIGN: Qualitative study using community participatory methods, purposeful sampling, one to one interviews, focus groups, and a grounded approach to data generation and analysis. SETTING: Newcastle upon Tyne, during 2000-2. PARTICIPANTS: 87 men and 54 women aged 18-80 years, smokers and non-smokers, from the Bangladeshi and Pakistani communities. RESULTS: Four dominant, highly inter-related themes had an important influence on smoking attitudes and behaviour: gender, age, religion, and tradition. Smoking was a widely accepted practice in Pakistani, and particularly Bangladeshi, men and was associated with socialising, sharing, and male identity. Among women, smoking was associated with stigma and shame. Smoking in women is often hidden from family members. Peer pressure was an important influence on smoking behaviour in younger people, who tended to hide their smoking from elders. There were varied and conflicting interpretations of how acceptable smoking is within the Muslim religion. Tradition, culture, and the family played an important role in nurturing and cultivating norms and values around smoking. CONCLUSION: Although there are some culturally specific contexts for smoking behaviour in Bangladeshi and Pakistani adults-notably the influence of gender and religion-there are also strong similarities with white people, particularly among younger adults. Themes identified should help to inform the development and appropriate targeting of smoking cessation interventions.

Adolescent↗
PubMed2003

Are there socio-economic inequalities in age of resection of colorectal cancer in people with HNPCC?

The relationship between socio-economic status and health has been consistently reported and is thought to be causal. Socio-economic inequalities are present in the incidence of and mortality from cancer in general, but not in the incidence of colorectal cancer in particular. However, there are socio-economic gradients in mortality from colorectal cancer. The socio-economic distribution of incidence of and mortality from colorectal cancer in individuals with hereditary non-polyposis colon cancer (Lynch syndrome) is not known. It is possible that increased awareness of and access to screening for colorectal cancer amongst this group of individuals reduces the socio-economic gradients seen in the population as a whole. We investigated the relationship between socio-economic status and age of resection of colorectal cancer in a cohort of individuals with hereditary non-polyposis colon cancer. More affluent individuals tended to undergo surgical resection for colorectal cancers earlier in their lives than less affluent individuals. This relationship was bordering on statistical significance. This trend probably represents socio-economic variations in access to treatment. In addition, age based diagnostic criteria for hereditary non-polyposis colon cancer may, inadvertently, accentuate socio-economic inequalities in outcome.

Adult↗
PubMed2003

Social networks and coronary heart disease risk factors in South Asians and Europeans in the UK.

OBJECTIVES: To compare the social networks of South Asian (Indians, Pakistanis and Bangladeshis) and European-origin participants in the Newcastle Heart Project, and to examine the relationships between social network sizes and coronary heart disease (CHD) risk factors in both groups, testing the hypothesis that part of the reason for high rates of CHD in the South Asian UK population may be social isolation. DESIGN: Participants were 684 South Asian (259 Indians, 305 Pakistanis, 120 Bangladeshis) and 825 European men and women aged 25-74 years, who completed a questionnaire and were screened for CHD risk factors in a cross-sectional study. RESULTS: South Asians were more likely to be married than Europeans, had bigger households and were more likely to attend a place of worship regularly. Europeans saw more friends and relatives on a regular basis than did South Asians. There was also some heterogeneity between the South Asian groups. Europeans who reported bigger social networks were less likely to smoke than those with smaller networks, but there was little evidence of an association between social network size and waist circumference, blood pressure or TC:HDL ratio in either Europeans or South Asians. CONCLUSION: The results provided only partial support for the hypothesis that South Asians in the UK are socially isolated, and suggest that South Asians and Europeans in the UK utilise different sources of social support. Future work should acknowledge variation in sources of social support between ethnic groups, and should explore the possibility that different mechanisms link social support and health in different ethnic groups.

Adult↗
PubMed2002

Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians.

BACKGROUND: The aim of this study was to test the hypothesis that in Europeans and South Asians (Indians, Pakistanis, Bangladeshis) alike, worse socio-economic status is associated with a higher prevalence of coronary heart disease (CHD), glucose intolerance (impaired glucose tolerance and diabetes) and related risk factors (the predicted direction of association). METHODS: Cross-sectional data were analysed from a community-based prevalence study seeking associations between social class, education and Townsend deprivation score and ECG evidence of CHD, glucose tolerance test and 12 cardiovascular risk factors. The study population consisted of South Asians (n = 684) comprising Indians (n = 259), Pakistanis (n = 305) and Bangladeshis (n = 120), and Europeans (n = 825), aged 25-74 years in Newcastle. The analysis examined up to 84 associations for each ethnic group. Interactions between ethnicity and socio-economic variables were examined using regression analysis. The main outcome measure was the number of associations in the predicted direction. RESULTS: Europeans fared better in some indicators of socio-economic position, South Asians in others. Indians were socio-economically advantaged compared with Pakistanis and Bangladeshis. Most measures of socio-economic position were associated with health measures in the predicted direction in Europeans [71/84 (85 per cent) associations, 25 statistically significant] and less so in the South Asians combined [58/84 (69 per cent) associations, 12 statistically significant]. In South Asian men 25/42 (60 per cent) of associations were as predicted, seven significantly so, in women 33/42 (79 per cent) were, five being statistically significant. There were apparent differences between Indians 152/78 (67 per cent) of associations as predicted, seven statistically significant], Pakistanis [41/84 (49 per cent), four statistically significant] and Bangladeshis [39/79 (49 per cent), one statistically significant]. In Indians, Townsend deprivation score was mostly associated as predicted [23/27 (85 per cent), five associations statistically significant], more so than social class [14/27 (52 per cent), none statistically significant]. In South Asian men and women combined, associations with anthropometric [18/24 (75 per cent)], biochemical [15/18 (83 per cent)], and lifestyle 114/18 (78 per cent)] measures were often as predicted, but those with blood pressure (4/12, 33 per cent) and CHD and glucose intolerance (7/12, 58 per cent) were less often so. Interactions between socio-economic position and ethnicity were found. CONCLUSIONS: The European pattern of inequalities is being established in South Asian men and women, possibly at a different pace in different subgroups. Future studies of inequalities should be large, separate Indian, Pakistani and Bangladeshi populations, study men and women separately and track changes over time.

Adult↗
PubMed2002

Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population.

BACKGROUND: Differences in level of physical activity between European, Indian, Pakistani and Bangladeshi populations living in the UK might contribute to differences in the prevalence of diabetes and cardiovascular disease risk markers that exist in these populations. METHODS: Type and level of physical activity (measured by a multidimensional index) and its relationship with selected cardiovascular disease and diabetes risk factors were assessed in a cross-sectional, population-based study of European, Indian, Pakistani and Bangladeshi men and women, aged 25-75, resident in Newcastle upon Tyne. RESULTS: Europeans were found to be more physically active than Indians, Pakistanis or Bangladeshis. On our physical activity index 52 per cent of European men did not meet current guidelines for participation in physical activity compared with 71 per cent of Indians, 88 per cent of Pakistanis and 87 per cent of Bangladeshis. Similar findings are reported for women. In particular, European men and women participated more frequently in moderate and vigorous sport and recreational activities. In general, level of physical activity was inversely correlated with body mass index (BMI), waist measurement, systolic blood pressure, and blood glucose and insulin in all ethnic groups, but did not correlate with high-density lipoprotein (HDL) cholesterol. CONCLUSIONS: South Asians in Newcastle report significantly lower levels of habitual physical activity than Europeans. This is likely to contribute to the higher levels of diabetes and cardiovascular risk in these populations. Measures to increase physical activity in these populations are urgently needed.

Adult↗