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Biomedical subjects

P Whincup

Publications and source records attributed to P Whincup.

12 recordsLinked to original sources
PubMed1995

Birth weight and blood pressure: cross sectional and longitudinal relations in childhood.

OBJECTIVE: To examine cross sectional and longitudinal relations between birth weight and blood pressure in childhood. DESIGN: Cross sectional study of primary school children aged 9-11 years, with analysis in relation to previous measurements at 5-7 years in a subgroup. SETTING: 20 primary schools in Guildford and Carlisle. SUBJECTS: 1511 children measured at 9-11 years (response rate 79%), including 549 who had been measured at 5-7 years. MAIN OUTCOME MEASURES: Blood pressure at 9-11 years, change in blood pressure between 5-7 and 9-11 years, birth weight (based on maternal recall), and placental weight (based on birth records). RESULTS: At 9-11 years birth weight was inversely related both to systolic blood pressure (regression coefficient -2.80 mm Hg/kg; 95% confidence interval -3.84 to -1.76) and to diastolic blood pressure (regression coefficient -1.42 mm Hg/kg; -2.14 to -0.70) once current height and body mass index were taken into account. Placental weight was inversely related to blood pressure after adjustment for current height and body mass index but placental ratio (placental weight to birth weight) was unrelated to blood pressure. Between 5-7 and 9-11 years systolic blood pressure rose more rapidly in children of lower birth weight (regression coefficient -1.71 mm Hg/kg; -3.35 to -0.07). This effect seemed to be stronger in girls. CONCLUSIONS: Birth weight rather than placental ratio is the early life factor most importantly related to blood pressure in childhood. The results support the possibility of "amplification" of the relation between birth weight and blood pressure, particularly in girls.

Aging↗
PubMed1995

Does the Hawksley random zero sphygmomanometer underestimate blood pressure, and by how much?

The study objective was to compare blood pressure (BP) measurement by the Hawksley random-zero sphygmomanometer and the standard mercury sphygmomanometer. Comparison of simultaneous 'blind' BP measurements were made using the Hawksley random-zero sphygmomanometer and the standard mercury sphygmomanometer linked by a Y-connector to a single cuff, in the general practice and office environments. Sixty five healthy volunteers and general practice patients, aged between 20 and 50 years (SBP range 82-184 mm Hg, DBP range 38-112 mm Hg), were studied. Each had three blood pressure measurements taken. Mean BPs recorded by the Hawksley random-zero sphygmomanometer were lower than those recorded by the standard mercury sphygmomanometer. The Hawksley random-zero sphygmomanometer underestimated SBP by 1.3 mm Hg (95% CI 0.9-1.8 mm Hg) and DBP by 1.7 mm Hg (95% CI 1.1-2.3 mm Hg). These differences between instruments were independent of BP level both for systolic and diastolic measurements. An overview including this study and six other published reports describing nine studies examining the performance of the Hawksley random-zero sphygmomanometer suggested a similar degree of underestimation for SBP (mean difference 1.35 mm Hg, 95% CI 1.24-1.46 mm Hg). Underestimation of DBP appeared greater (mean difference 2.54 mm Hg, 95% CI 2.43-2.65 mm Hg) but was reduced when two outlying studies were removed from analysis (mean 1.97, 95% CI 1.85-2.09 mm Hg). We conclude that the Hawksley random-zero sphygmomanometer underestimates systolic and diastolic pressure, when compared with the standard mercury sphygmomanometer. However, the degree of underestimation is small and appears consistent across a wide range of blood pressure levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

A slow death or eternal life? Future directions for annual public health reports.

Several years after their reintroduction, district public health reports continue to face questions about purpose, content and evaluation. As public health embraces the wider vision of the World Health Organisation's 'Health for All' strategy, and the consequent need for collaboration with other sectors and participation with communities, there is a need for the reports to respond accordingly. This theme is explored in relation to the needs of the report's diverse audience, the type of local research required to make the report relevant and effective, and approaches to evaluation. A growing local research function has resource and training implications for Departments of Public Health. The demands of producing a report every year suggest that biennial publication of the main report, with other targeted products over the intervening period, would be a more realistic and effective option.

Annual Reports as Topic↗
PubMed1994

Maternal factors and development of cardiovascular risk: evidence from a study of blood pressure in children.

It has been suggested that risks of hypertension and cardiovascular disease begin in utero and that maternal nutrition plays an important role. We have examined the relation between maternal factors and BP in a study of 1,311 children in which physical measurements at 9-11 years of age have been linked to a parental questionnaire; birth record data were also available in a subsample of 662 children. Maternal height was inversely related to childhood BP after adjustment for the child's current height. However, several social factors related to maternal nutrition in pregnancy in earlier studies (including social class, housing tenure, maternal educational attainment and maternal smoking in pregnancy) showed weak and inconsistent relations with BP at 9-11 years. Minimum maternal haemoglobin in pregnancy and change in mean corpuscular volume in pregnancy (identified as potentially important markers of maternal nutrition in earlier studies) showed no consistent relationships either with placental weight to birthweight ratio or with childhood BP, although both factors showed strong inverse associations with birthweight. The association between maternal height and childhood BP may reflect the influence of early life factors on cardiovascular risk. However, the absence of consistent relationships between social factors and BP in offspring provides little support for the possibility that maternal diet is an important influence on cardiovascular risk factors in childhood. Minimum maternal haemoglobin and change in maternal mean corpuscular volume are unlikely to be specific markers of maternal nutrition in pregnancy. More specific hypotheses relating maternal nutrition to the development of cardiovascular risk in offspring are required.

Adult↗
PubMed1991

Early life experience and adult cardiovascular disease: longitudinal and case-control studies.

It has been postulated that experiences early in life influence cardiovascular risk in later adult life. This article considers 15 longitudinal and four case-control studies which, directly or indirectly, have examined the hypothesis concerning the prenatal and childhood origins of adult cardiovascular disease. Criteria laid down by Bradford Hill were used to assess whether these epidemiological studies provided sufficient evidence for a causal relation between experiences early in life and subsequent cardiovascular risk. No consistent dose-response relationship was found between the index of early life experience and adult cardiovascular disease. The relationships were usually non-specific with the index of early life experience being correlated with several causes of death, not only cardiovascular disease. The formulation of the hypothesis varied between the studies. Most reports dealt inadequately with the fact that the relation between adult cardiovascular risk and early life experience was confounded by persisting social and economic disadvantage. Overall these studies do not provide strong support for the hypothesis that experiences early in life determine the subsequent risk of cardiovascular disease. While future epidemiological studies may resolve this issue, the very nature of the hypothesis presents methodological problems that may prove to be insurmountable. Further progress in this field urgently requires the formulation of a clear and specific hypothesis.

Adult↗
PubMed1988

Alcohol and blood pressure in middle-aged British men.

The relationships between alcohol intake and blood pressure have been examined in 7,735 middle-aged men drawn at random from general practices in 24 British towns. Both mean systolic and diastolic BP are increased in moderate (16-42 drinks/week) and heavy (greater than 42 drinks/week) drinkers. The alcohol-blood pressure relationship is independent of age, body mass index and social class despite their associations with both alcohol intake and BP. The prevalence of hypertension (systolic greater than or equal to 160 mmHg or diastolic greater than or equal to 90 mmHg) is increased in both moderate and heavy drinkers. Non-drinkers have higher rates of diastolic hypertension than occasional or light drinkers, probably due to changes in drinking habits made by those diagnosed as hypertensives. Furthermore, recall of doctor diagnosis of hypertension and of anti-hypertensive treatment is highest among non-drinkers. It is estimated that about 10% of hypertension (systolic or diastolic) can be attributed to moderate or heavy drinking. There is a clear need for increased awareness of the alcohol-blood pressure relationship. Current drinking status should be determined in all hypertensive subjects, and assessment of alcohol effect by temporary withdrawal should be the first step in the management of anyone with sustained hypertension who drinks.

Adult↗
PubMedDate not supplied

Standards for the hospital management of stroke patients.

To examine the extent to which current guidelines for the hospital management of stroke are being met, a series of 15 specific standards covering initial assessment and management, rehabilitation, discharge and secondary prevention was developed from the guidelines suggested by the King's Fund and the Royal College of Physicians. This article describes these standards, their interobserver agreement on their use in practice. The interobserver agreement on the application of most standards was good (80% or more). A survey of 100 consecutive patients with stroke showed that certain standards were well met (adequate social history, routine investigation, prevention of pressure sores and monitoring of blood pressure), whereas others were poorly met (diagnosis, rapid referral to therapists, functional reassessment, liaison with general practitioners, documentation of multidisciplinary rehabilitation programmes, and communication with patients and relatives). Several standards, especially those central to the rehabilitation process, were met significantly more frequently in patients managed by geriatricians than in those managed by general physicians. This may be attributable to geographical concentration of patients and to rehabilitation led by consultants trained in stroke management. It is suggested that these standards are verifiable measures which can be used more widely to audit the process of care.

Adult↗