PubMed Health⌕ Search

Biomedical subjects

Paul Norman

Publications and source records attributed to Paul Norman.

At least 19 recordsLinked to original sources
PubMed2006

Association of cardiovascular risk factors and disease with depression in later life.

OBJECTIVE: The objective of this study is to determine the association between established cardiovascular risk factors and depression among older men. METHODS: The authors conducted a cross-sectional study of a community-representative sample of 5,439 men aged 71-89 years. Cardiovascular disease and risk factors assessed included history of diabetes, hypertension, angina, myocardial infarction, and stroke; current smoking; total cholesterol and fractions; triglycerides; total plasma homocysteine; and MTHFR677 genotype. Depression was defined by a Geriatric Depression Scale 15 items score of 7 or greater. RESULTS: A complete data set was available for 4,204 men, of whom 212 were depressed (5%). Men who were depressed reported higher frequency of diabetes (23.1% versus 13.2%), angina (30.2% versus 20.4%), myocardial infarction (26.2% versus 16.0%), and stroke (23.6% versus 9.1%) than nondepressed men. Participants with depression were also more likely to have plasma homocysteine above 15 mumol/L (39.1% versus 25.5%) and high triglycerides (32.1% versus 20.9%) than nondepressed subjects. Depressed older men were also more likely to be active smokers (9.9% versus 4.8%). The other factors measured in the study were not significantly associated with depression. Estimation of the population-attributable fraction (PAF) after logistic regression showed that high plasma homocysteine had the highest PAF for depression (PAF:15%, 95% confidence interval [95% CI]: 5%-23%) followed by high triglycerides (PAF: 11%, 95% CI: 2%-18%), angina (PAF: 9%, 95% CI: 2%-15%), stroke (PAF: 8%, 95% CI: 3%-13%), diabetes (PAF: 7%, 95% CI: 1%-13%), myocardial infarction (PAF: 5%, 95% CI: 0%-11%), and smoking (PAF: 5%, 95% CI: 1%-9%). CONCLUSIONS: High plasma homocysteine and triglycerides appear to account for a considerable proportion of cases of depression in older men. The successful management of these risk factors may contribute to decrease the prevalence of depression in later life.

Age of Onset↗
PubMed2006

B-vitamins reduce plasma levels of beta amyloid.

Elevated plasma homocysteine (tHcy) is a risk factor for Alzheimer's disease (AD), and thus B vitamins may have a role in the prevention of AD. The objective of this study was to determine if tHcy lowering vitamins decrease the circulating levels of A-beta protein 1-40 (A beta 40). We randomized 299 older men to treatment with 2mg of folate, plus 25mg of B6 and 400 microg of B12, or placebo. After 2 years of treatment the mean (S.E.) increase of A beta 40 was 7.0 pg/ml (8.4) in the vitamin group (4.9%), and 26.8 pg/ml (7.7) (18.5%) in the placebo group. We conclude that B vitamins may decrease the plasma level of A beta 40 and have a role in the prevention of AD.

Aged↗
PubMed2006

Abdominal aortic aneurysm: pathogenesis and implications for management.

Abdominal aortic aneurysm (AAA) affects approximately 5% of elderly men and is responsible for a significant number of deaths in Western Countries. At present surgery by open or endovascular means is the only widely used therapy for this condition. In this review we examine the risk factors, serum, and genetic associations of AAA. Epidemiology studies suggest that smoking cessation and control of cholesterol and blood pressure should reduce the number of patients developing AAA. Natural history studies suggest that smoking cessation should reduce the rate of progression of AAA. Clear level 1 evidence for drug treatments of AAA are presently lacking; however, animal and human in vitro studies suggest that medication targeted at reducing inflammation and proteolysis are most likely to be beneficial, with limited data to support the use of statins, Angiotensin II inhibitors, and macrolides. Work has commenced in understanding which patients, identified by clinical, serum, and genotype, are more at risk of AAA progression and thus should be selected out for aggressive treatment. Well designed large multicenter randomized controlled trials are required to examine the medical treatment of AAA.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2006

Cognitive appraisals and psychological distress following venous thromboembolic disease: an application of the theory of cognitive adaptation.

Venous thrombosis is a common and life-threatening disease that has received little attention in health psychology. The present study applied the theory of cognitive adaptation (TCA) to examine patients' reactions to venous thrombosis. Patients (N = 123) aged 16-84 recruited from anticoagulation units in the north of England completed measures of TCA constructs (meaning, mastery, self-esteem and optimism) and various outcome variables (anxiety, depression, thrombosis worries and quality of life) within 1 month of their thrombosis. The TCA explained large and significant amounts of variance in the outcome variables. In line with expectations, mastery, self-esteem and optimism were associated with positive adjustment. However, meaning was associated with elevated levels of distress. The results are discussed in relation to the search for meaning and the use of different control strategies in the early phases of adaptation to thrombosis.

Adaptation, Psychological↗
PubMed2006

Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty.

The aim of this study was to assess the diagnostic accuracy of radiology department-based hip aspiration for the diagnosis of infection after total hip arthroplasty. Patient selection criteria were devised so that only patients with moderate to high risk of infection were selected for hip aspiration. Seventy-three patients are included in this study, all of whom underwent revision hip surgery after aspiration. Culture results of hip aspirates were compared with the intraoperative tissue cultures at the time of revision surgery, which was used as the gold standard for diagnosing infection. Seventeen patients (23%) had infected hip joints at operative culture. The sensitivity and specificity, positive and negative predictive values, and accuracy of the hip aspiration were 0.82 and 0.91, 0.74 and 0.94, and 0.89, respectively. We conclude that hip aspiration carried out in the radiology department is reliable, but appropriate patient selection is important to obtain accurate results.

Arthroplasty, Replacement, Hip↗
PubMed2006

Successful mental health aging: results from a longitudinal study of older Australian men.

OBJECTIVE: The authors investigated the associations of medical and lifestyle factors with the mental health of men in their 80s. METHODS: This was a prospective study of a community-representative cohort of older men. Successful mental health aging was defined as reaching age 80 years with Mini-Mental State Examination score (MMSE) of 24 or more and Geriatric Depression Scale-15 items (GDS-15) score of 5 or less. RESULTS: Of 601 men followed for 4.8 years, 76.0% enjoyed successful mental health aging. Successful mental health aging was inversely associated with age (hazard ratio [HR] = 0.87; 95% confidence interval [CI]: 0.81-0.94), non-English-speaking background (HR = 0.42; 95% CI: 0.21-0.85), and the consumption of full-cream milk (HR = 0.63; 95% CI: 0.45-0.89), and directly associated with high school or university education (HR = 1.92; 95% CI: 1.34-2.75) and vigorous (HR = 1.89; 95% CI: 1.17-3.05) and nonvigorous physical activity (HR = 1.50; 95% CI: 1.05-2.14). Marital status, smoking and alcohol use, weekly consumption of meat or fish, and a medical history of hypercholesterolemia, hypertension, diabetes, myocardial infarction, and stroke were not associated with mental health outcomes in men aged 80 years or over. CONCLUSION: Three in four men who reach age 80 years undergo successful mental health aging. Factors associated with successful mental health aging include education and lifestyle behaviors such as physical activity. Lifestyle modification by means of increasing physical activity and reducing saturated fat intake may prove to be a safe, inexpensive, and readily available strategy to help maximize the successful mental health aging of the population.

Affect↗
PubMed2006

The theory of planned behaviour and binge drinking: Assessing the moderating role of past behaviour within the theory of planned behaviour.

A sample of 398 undergraduate students completed questionnaires assessing the main constructs of the theory of planned behaviour (TPB) in relation to binge drinking, as well as past binge drinking behaviour. Of these, 273 were followed up at 1 week. Regression analyses revealed attitude, self-efficacy, and perceived control (negative relationship) to be predictive of binge drinking intentions. Intention and self-efficacy were, in turn, predictive of binge drinking at 1-week follow-up. Past behaviour was found to explain additional variance in intention and behaviour. In addition, past behaviour was found to moderate the attitude-intention and intention-behaviour relationships, such that weaker relationships were observed with increasing frequency of past behaviour. The results are discussed in relation to the need to develop and test alternative measures of habit. The implications of the findings for interventions to encourage more appropriate drinking behaviour are outlined.

Adult↗
PubMed2005

Efficacy of B vitamins in lowering homocysteine in older men: maximal effects for those with B12 deficiency and hyperhomocysteinemia.

BACKGROUND AND PURPOSE: A higher plasma concentration of total homocysteine (tHcy) is associated with a greater risk of cardiovascular events. Previous studies, largely in younger individuals, have shown that B vitamins lowered tHcy by substantial amounts and that this effect is greater in people with higher tHcy and lower folate levels. METHODS: We undertook a 2-year, double-blind, placebo-controlled, randomized trial in 299 men aged > or =75 years, comparing treatment with a daily tablet containing 2 mg of folate, 25 mg of B6, and 400 microg of B12 or placebo. The study groups were balanced regarding age (mean+/-SD, 78.9+/-2.8 years), B vitamins, and tHcy at baseline. RESULTS: Among the 13% with B12 deficiency, the difference in mean changes in treatment and control groups for tHcy was 6.74 micromol/L (95% CI, 3.94 to 9.55 micromol/L) compared with 2.88 micromol/L (95% CI, 0.07 to 5.69 micromol/L) for all others. Among the 20% with hyperhomocysteinaemia, the difference between mean changes in treatment and control groups for men with high plasma tHcy compared with the rest of the group was 2.8 micromol/L (95% CI, 0.6 to 4.9 micromol/L). Baseline vitamin B12, serum folate, and tHcy were significantly associated with changes in plasma tHcy at follow-up (r=0.252, r=0.522, and r=-0.903, respectively; P=0.003, <0.001, and <0.001, respectively) in the vitamin group. CONCLUSIONS: The tHcy-lowering effect of B vitamins was maximal in those who had low B12 or high tHcy levels. Community-dwelling older men, who are likely to be deficient in B12 or have hyperhomocysteinemia, may be most likely to benefit from treatment with B vitamins.

Aged↗
PubMed2005

Association of osteoprotegerin with human abdominal aortic aneurysm progression.

BACKGROUND: Abdominal aortic aneurysm (AAA) is characterized by destruction of the arterial media associated with loss of vascular smooth muscle cells, infiltration of mononuclear cells, and high concentration of metalloproteinases (MMPs) and cytokines. Osteoprotegerin (OPG) has recently been identified in atherosclerosis. The presence and functional importance of OPG in human AAA was investigated. METHODS AND RESULTS: In 146 men with small AAA followed up by ultrasound for 3 years, serum OPG was weakly correlated with aneurysm growth rate. Western analysis showed 3-, 8-, and 12-fold-greater OPG concentrations in human AAA biopsies compared with biopsies of atherosclerotic narrowed aorta (1.4+/-0.1 versus 0.5+/-0.1 ng/mg tissue; P=0.002), postmortem nondiseased abdominal aorta (1.4+/-0.1 versus 0.2+/-0.1 ng/mg tissue; P<0.001), and nondiseased thoracic aorta (1.4+/-0.1 versus 0.1+/-0.06 ng/mg tissue; P<0.001). Healthy human aortic vascular smooth muscle cells incubated with recombinant human (rh)OPG (0 to 20 ng rhOPG/10(5) cells per 1 mL per 24 hours) developed an aneurysmal phenotype defined by impaired cell proliferation (P<0.001), increased apoptosis (P<0.01), and increased MMP-9 (92 kDa) expression (P<0.001). Incubation of monocytic THP-1 cells with 1 ng rhOPG/10(5) cells per 1 mL per 24 hours induced a 2-fold increase in MMP-9 expression (P<0.001), a 1.5-fold increase in MMP-2 activity (P=0.005), and a 2-fold stimulation of IL-6 production in these cells (P=0.02). Finally, secretion of OPG from human AAA explant was abrogated by treatment with the angiotensin II blocker irbesartan, with the reduction in secreted levels averaging 63.0+/-0.9 ng/mg tissue per 48-hour period. CONCLUSIONS: These findings support a role for OPG in the growth of human AAA and suggest a potential benefit for angiotensin II blockade in slowing aneurysm expansion.

Adult↗
PubMed2005

An application of an extended health belief model to the prediction of breast self-examination among women with a family history of breast cancer.

OBJECTIVES: This study reports an application of the health belief model (HBM) to the prediction of breast self-examination (BSE) among women with a family history of breast cancer. The study also considered the influence of breast cancer worries and past behaviour. METHODS: Eight hundred and thirty-three women completed questionnaires, based on the HBM, to assess their beliefs about breast cancer and BSE. Of these women, 567 were followed-up at 9 months when BSE frequency was assessed. RESULTS: Discriminant function analysis was employed to discriminate among infrequent, appropriate and excessive BSE. Two functions were calculated which were predictive of group membership. The first function maximally discriminated between the infrequent BSE group and the other two groups, with infrequent selfexaminers reporting a greater number of self-efficacy and emotion barriers, fewer benefits and less frequent BSE at Time 1. The second function maximally discriminated between the excessive BSE group and the appropriate BSE group, with excessive selfexaminers reporting higher levels of breast cancer worries and perceived severity and fewer self-efficacy barriers. CONCLUSIONS: The results highlight the importance of focusing on excessive as well as infrequent BSE. Interventions designed to enhance women's confidence in their ability to perform BSE, coupled with attempts to reduce breast cancer worries, may encourage more appropriate and effective BSE.

Adolescent↗
PubMed2005

Making an estimate of the number of people and households for Output Areas in the 2001 Census.

This article describes an investigation into the best way to estimate robust totals for people and households at Output Area level. We show that computing the average of people and household counts across the set of tables in which the same count appears is a good strategy. When we compare the mean or median person and household counts with those produced by summing from the postcode directory, the two sets of numbers are usually very close. Using averages in this way for other population bases in the sets of tables is therefore recommended. This technique can also be applied to larger areas.

Censuses↗
PubMed2004

Selective migration, health and deprivation: a longitudinal analysis.

Population migration is a major determinant of an area's age-sex structure and socio-economic characteristics. The suggestion that migration can contribute to an increase or decrease in place-specific rates of illness is not new. However, differences in health status between small geographical locations that may be affected by the inter-relationships between health, area-based deprivation and migration are under-researched. Using the Office for National Statistics (ONS) England and Wales Longitudinal Study (LS) 1971-1991, this research tracks individuals to identify any systematic sorting of people that has contributed to the area-level relationships between health (limiting long-term illness and mortality) and deprivation (Carstairs quintiles). The results demonstrate that among the young, migrants are generally healthier than non-migrants. Migrants who move from more to less deprived locations are healthier than migrants who move from less to more deprived locations. Within less deprived areas migrants are healthier than non-migrants but within deprived areas migrants are less healthy than non-migrants. Over the 20 year period, the largest absolute flow is by relatively healthy migrants moving away from more deprived areas towards less deprived areas. The effect is to raise ill-health and mortality rates in the origins and lower them in the destinations. This is reinforced by a significant group of people in poor health who move from less to more deprived locations. In contrast, a small group of unhealthy people moved away from more deprived into less deprived areas. These countercurrents of less healthy people have a slight ameliorating effect on the health-deprivation relationship. Whilst health-deprivation relationships are more marked for migrants there are also health (dis-) benefits for non-migrants if their location becomes relatively more or less deprived over time. Overall we found that between 1971 and 1991, inequalities in health increased between the least and most deprived areas, compared with the health-deprivation relationship which would have existed if peoples' locations and deprivation patterns had stayed geographically constant. Migration, rather than changes in the deprivation of the area that non-migrants live in, accounts for the large majority of change.

Adolescent↗
PubMed2004

C-reactive protein levels and the expansion of screen-detected abdominal aortic aneurysms in men.

BACKGROUND: C-reactive protein (CRP) levels have been shown to predict a number of cardiovascular outcomes. CRP levels have also been found to be elevated in patients with abdominal aortic aneurysms (AAAs). The aim of this study was to assess the relation between CRP levels and rates of expansion of small AAAs. METHODS AND RESULTS: A cohort of men with small aneurysms was identified in a trial of screening with ultrasound scanning. After initial screening, men were rescanned at 6- to 12-month intervals. CRP levels were measured at the first follow-up visit. Rates of expansion and risk factors for expansion were assessed with the use of data from 545 men who attended for at least 1 scan after CRP levels were measured. These men were followed for a median of 48 (range, 5 to 69) months. The mean annual rate of expansion was 1.6 mm. The median CRP level was 2.6 mg/L in men with the smaller AAAs (30 to 39 mm, n=433) compared with 3.5 mg/L in men with larger AAAs (40 to 54 mm, n=112) (P=0.007). The multivariate age-adjusted logistic model confirmed initial aortic diameter to be the only factor associated with rapid expansion with an odds ratio of 7.2 (95% CI, 4.3,12.2) for an initial diameter of 40 to 54 mm relative to one of 30 to 39 mm. CONCLUSIONS: Most small aneurysms expand slowly. CRP levels are elevated in larger aneurysms but do not appear to be associated with rapid expansion. The most useful predictor of aneurysmal expansion in men is aortic diameter.

Aged↗
PubMed2004

Infrarenal aortic diameter predicts all-cause mortality.

OBJECTIVE: To assess the relationship between infrarenal aortic diameter and subsequent all-cause mortality in men aged 65 years or older. METHODS AND RESULTS: Aortic diameter was measured using ultrasound in 12 203 men aged 65 to 83 years as part of a trial of screening for abdominal aortic aneurysms. A range of cardiovascular risk factors was also documented. Mortality over the next 3 to 7 years was assessed using record linkage. Initial aortic diameter was categorized into 10 intervals, and the relationship between increasing diameter and subsequent mortality was explored using Cox proportional hazard models. Median diameter increased from 21.4 mm in the youngest men to 22.1 mm in the oldest men. The cumulative all-cause mortality increased in a graded fashion with increasing aortic diameter. Using the diameter interval 19 to 22 mm as the reference, the adjusted hazard ratio for all-cause mortality increased from 1.26 (95% CI: 1.09, 1.44; P=0.001) for aortic diameters of 23 to 26 mm to 2.38 (95% CI: 1.22, 4.61; P=0.011) for aortic diameters of 47 to 50 mm. Analysis of causes of death indicated that cardiovascular disease was an important contributor to this increase. CONCLUSIONS: Infrarenal aortic diameter is an independent marker of subsequent all-cause mortality.

Aged↗
PubMed2004

The value of hip aspiration versus tissue biopsy in diagnosing infection before exchange hip arthroplasty surgery.

The exclusion of infection is the most important factor in determining treatment options in a failed hip arthroplasty. Preoperative biopsy in the form of aspiration or tissue biopsy can be used to diagnose infection. Preoperative aspiration and tissue drill biopsy were performed in 273 consecutive patients under general anesthesia 3 months before exchange arthroplasty surgery. The results of the preoperative aspiration and tissue biopsy cultures were compared with the definitive intraoperative tissue cultures obtained at surgery. Seventy-one of 273 (26%) hips were infected. Overall accuracy of aspiration was 90.1% and tissue biopsy 87.9%. The sensitivity and specificity was 80% and 94% for aspiration and 83% and 90% for tissue biopsy. Positive predictive value and negative predictive values were 81.4% and 93.1% for aspiration and 73.8% and 93.8% for tissue biopsy. The more invasive tissue drill biopsy offers no advantage over aspiration in terms of bacterial accuracy and results in more false positives.

Arthroplasty, Replacement, Hip↗
PubMed2004

Changing places. Do changes in the relative deprivation of areas influence limiting long-term illness and mortality among non-migrant people living in non-deprived households?

Numerous studies have investigated the relative importance of contextual (place) and compositional (person) factors in explaining health and mortality variations. Commonly, these studies control for a range of individual characteristics before testing whether one or more contextual variables have a significant impact on the health or mortality outcome. The findings have been inconsistent, although the growing consensus is, first, that contextual effects are significant but are less important than compositional factors and, second, that contextual effects have a stronger impact in studies of morbidity than in studies of mortality. Here we use longitudinal data to examine a related, but rather different, question. Extracting a select group of people from the ONS Longitudinal Study for England and Wales who had not moved house between 1971 and 1991 and who were living in non-deprived households throughout the 20-year period, we tested whether a change in the relative deprivation of the area in which they were living influenced their health and mortality status. The results demonstrate that changes in the relative deprivation of areas are related to health and mortality outcomes in a consistent way for both outcomes, although the results were more significant for morbidity. These findings suggest that neighbourhood-based public health and regeneration programmes may have demonstrable effects on the health of the residents who live there.

Adult↗