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Biomedical subjects

Paul Wilkinson

Publications and source records attributed to Paul Wilkinson.

At least 19 recordsLinked to original sources
PubMed2006

Teenage conceptions, abortions, and births in England, 1994-2003, and the national teenage pregnancy strategy.

BACKGROUND: The aim of this study was to quantify the change in the number of conceptions and abortions among women younger than 18 years in England in relation to the government's national teenage pregnancy strategy. METHODS: We undertook geographic analysis of data for 148 top-tier local authority areas. The main outcomes were changes in under-18 conceptions, abortions, and births between the 5-year period before implementation of the strategy (1994-98) and the period immediately after implementation (1999-2003). FINDINGS: The number of teenage conceptions peaked in 1998, then declined after the implementation in 1999 of the teenage pregnancy strategy. Under-18 conception rates fell by an average of 2.0% (95% CI 1.8 to 2.2) per year between 1998 and 2003, below the rate needed to achieve the target of 50% reduction by 2010. The net change between 1994-98 and 1999-2003 was a fall in conceptions of 3.2% (2.6 to 3.9) or 1.4 per 1000 women aged 15-17 years, a rise in abortions of 7.5% (6.5 to 8.6) or 1.4 per 1000, and a fall in births of 10.6% (9.9 to 11.3) or 2.8 per 1000. The change in the number of conceptions was greater in deprived and more rural areas, and in those with lower educational attainment. The change was greater in areas where services and access to them were poorer, but greater where more strategy-related resources had been targeted. INTERPRETATION: The decline in under-18 conception and birth rates since 1998 and evidence that the declines have been greatest in areas receiving higher amounts of strategy-related funding provides limited evidence of the effect of England's national teenage pregnancy strategy. The full effect of local prevention will be clear only with longer observation, and substantial further progress is needed to remedy England's historically poor international position in teenage conceptions.

Abortion, Induced↗
PubMed2006

Patterns of respiratory drug use in the Lombardy region of Italy, 1995-1997.

OBJECTIVE: To examine the patterns of respiratory drugs use in the Lombardy region of Italy, and to quantify the period prevalence of different drug-dose combinations defined by reference to international guidelines for prescription in asthma and chronic obstructive pulmonary disease. DESIGN: Analysis of records from an anonymised population-based database of dispensed prescriptions. SETTING: Lombardy, 1995-1997. METHODS: Analyses were made of prescription records of patients who had at least one respiratory drug dispensed during the study period. Prescriptions for the same individual were linked using a unique identifier. MAIN OUTCOMES: Number of patients using respiratory drugs; number of visits to the pharmacy; defined daily doses. MAIN RESULTS: 1,387,004 or 15.5% of the resident Lombardy population had at least one dispensed prescription of a respiratory drug in the three years of study. The annual percentage increased from 6.6% in 1995 to 7.9% in 1997. 808,786 patients (58.3% of respiratory drug users) had only one visit to the pharmacy during this period, while the 25.1% of respiratory drug-user (3.9% of the resident population) who had three or more visits to the pharmacy in three years, accounted for 86.1% of all respiratory drug use in terms of defined daily doses. When combinations of prescribed drugs were examined in the light of published guidelines, we estimated that <2.8%> of the population had patterns of drug prescription appropriate for mild intermittent or persistent forms of asthma/chronic obstructive pulmonary disease, and <1.1%> had prescription patterns appropriate for moderate or severe disease. CONCLUSIONS: The definition of specific drug use patterns by individual can provide prevalence measures that are broad proxies for varying categories of respiratory disease. However, a very high proportion of people who receive respiratory drugs do so for one-off or very infrequent episodes of illness. Analysis of the infrequent and more regular users of respiratory drugs may be useful for comparative research.

Adolescent↗
PubMed2006

Declining vulnerability to temperature-related mortality in London over the 20th century.

The degree to which population vulnerability to outdoor temperature is reduced by improvements in infrastructure, technology, and general health has an important bearing on what realistically can be expected with future changes in climate. Using autoregressive Poisson models with adjustment for season, the authors analyzed weekly mortality in London, United Kingdom, during four periods (1900-1910, 1927-1937, 1954-1964, and 1986-1996) to quantify changing vulnerability to seasonal and temperature-related mortality throughout the 20th century. Mortality patterns showed an epidemiologic transition over the century from high childhood mortality to low childhood mortality and towards a predominance of chronic disease mortality in later periods. The ratio of winter deaths to nonwinter deaths was 1.24 (95% confidence interval (CI): 1.16, 1.34) in 1900-1910, 1.54 (95% CI: 1.42, 1.68) in 1927-1937, 1.48 (95% CI: 1.35, 1.64) in 1954-1964, and 1.22 (95% CI: 1.13, 1.31) in 1986-1996. The temperature-mortality gradient for cold deaths diminished progressively: The increase in mortality per 1 degree C drop below 15 degrees C was 2.52% (95% CI: 2.00, 3.03), 2.34% (95% CI: 1.72, 2.96), 1.64% (1.10, 2.19), and 1.17% (95% CI: 0.88, 1.45), respectively, in the four periods. Corresponding population attributable fractions were 12.5%, 11.2%, 8.7%, and 5.4%. Heat deaths also diminished over the century. There was a progressive reduction in temperature-related deaths over the 20th century, despite an aging population. This trend is likely to reflect improvements in social, environmental, behavioral, and health-care factors and has implications for the assessment of future burdens of heat and cold mortality.

Adolescent↗
PubMed2006

The association of respiratory syncytial virus infection and influenza with emergency admissions for respiratory disease in London: an analysis of routine surveillance data.

BACKGROUND: The importance of respiratory syncytial virus (RSV) infection in adults is not well known, because laboratory testing for RSV infection is not routine. Both RSV infection and influenza are seasonally related, and it is difficult to disentangle one from the other and to disentangle infection from the season and the cold. METHODS: Emergency hospitalizations for respiratory disease from April 1994 to March 2001 were analyzed in relation to surveillance data on RSV infection and influenza, using Poisson regression models adapted for time series and adjusted for season, outdoor temperature, and other covariates. Age-specific admission rates attributable to the viruses were also estimated. RESULTS: Most of the crude relationships of emergency admissions of patients with RSV infection were confounded by season and, to a lesser extent, by cold temperatures. After adjustment for all covariates, including influenza, a 10th-90th percentile increase in RSV counts (defined as the daily number of laboratory reports of RSV) was associated with a rate ratio of 1.36 (95% CI, 1.27-1.45) for emergency admissions for respiratory disease in infants. The rate of hospitalization attributable to RSV infection in children aged <1 year was 5 per 1000 infants per year. The association in people > or =65 years old was much smaller (rate ratio, 1.09; 95% CI, 1.04-1.14; attributable rate of hospitalization , 0.7 per 1000 population); but unlike the association in infants, this association became smaller as the lag (interval) between infection and hospital admission became shorter. Admission rates attributable to influenza were highest in the > or =65-year age group (1.1 per 1000 population), but it was very small at younger ages. CONCLUSIONS: RSV infection appears to be an important determinant of hospitalization in infants in this data set but appears less certain for older persons and requires further investigation.

Adolescent↗
PubMed2005

Air pollution and respiratory drug use in the city of Como, Italy.

UNLABELLED: STUDY OBJECTIVE AND SETTING: Particulate air pollution has a known negative effect on human respiratory health, often studied with hospital admissions, emergency room access, or mortality as health indicators. We evaluate respiratory drug dispensing data as health indicators for the effects of total suspended particles (TSP) air pollution in the city of Como (84,713 inhabitants). DESIGN: Weekly count of individual patients with respiratory drug dispensed (Cases) and weekly dispensed daily defined doses (DDD) of drugs were modelled with weekly air mean concentrations of TSP using a Poisson regression model adjusted for long-term trends, seasonal variations, calendar variations due to holidays, and weather. MAIN RESULT: Relative risks (RR) were expressed for a variation from 10th to 90th percentile of TSP (29-92 microg/m3). Weekly aggregation was used in consideration of the complexity of drug dispensing data and potential biases of daily aggregation. For weekly mean concentrations of TSP, RR = 1.082 (95% Confidence level (CI) 1.002-1.169) for Cases and RR = 1.137 (95% CI 1.044-1.238) for DDD. CONCLUSION: Our study concludes that both Cases and DDD of dispensed respiratory drugs could be useful for epidemiological surveillance of air pollutant health effects. Further investigation may routinely allow health and economics considerations, producing a stimulating new tool for health policy makers.

Air Pollutants↗
PubMed2005

Influence of alpha-linolenic acid and fish-oil on markers of cardiovascular risk in subjects with an atherogenic lipoprotein phenotype.

We tested the hypothesis that dietary alpha-linolenic acid (ALA) can exert effects on markers of cardiovascular risk similar to that produced by its longer chain counterparts in fish-oil. A dietary intervention study was undertaken to examine the effects of an ALA-enriched diet in 57 men expressing an atherogenic lipoprotein phenotype (ALP). Subjects were randomly assigned to one of three diets enriched either with flaxseed oil (FXO: high ALA, n = 21), sunflower oil (SO: high linoleic acid, n = 17), or SO with fish-oil (SOF n = 19) for 12 weeks, resulting in dietary intake ratios of n-6:n-3 PUFA of 0.5, 27.9 and 5.2, respectively. The relative abundance of ALA and EPA in erythrocyte membranes increased on the FXO diet (p < 0.001), whereas both EPA and DHA increased after fish-oil (p < 0.001). There were significant decreases in total plasma cholesterol within (FXO -12.3%, p = 0.001; SOF -7.6%, p = 0.014; SO -7.3%, p = 0.033) and between diets (p = 0.019), and decreases within diets after 12 weeks for HDL cholesterol on flaxseed oil (FXO -10%, p=0.009), plasma TG (-23%, p < 0.001) and small, dense LDL (-22% p = 0.003) in fish-oil. Membrane DHA levels were inversely associated with the changes in plasma TG ( p= 0.001) and small, dense LDL (p<0.05) after fish-oil. In conclusion, fish-oil produced predictable changes in plasma lipids and small, dense LDL (sdLDL) that were not reproduced by the ALA-enriched diet. Membrane DHA levels appeared to be an important determinant of these fish-oil-induced effects.

Adult↗
PubMed2005

Mortality displacement of heat-related deaths: a comparison of Delhi, São Paulo, and London.

BACKGROUND: Mortality increases with hot weather, although the extent to which lives are shortened is rarely quantified. We compare the extent to which short-term mortality displacement can explain heat deaths in Delhi, São Paulo, and London given contrasting demographic and health profiles. METHODS: We examined time-series of daily mortality data in relation to daily ambient temperature using Poisson models and adjusting for season, relative humidity, rainfall, particulate air pollution, day of the week, and public holidays. We used unconstrained distributed lag models to identify the extent to which heat-related excesses were followed by deficits (mortality displacement). RESULTS: For each city, an increase in all-cause mortality was observed with same-day (lag 0) and previous day (lag 1) temperatures greater than a threshold of 20 degrees C. At lag 0, the excess risk was greatest in Delhi and smallest in London. In Delhi, an excess was apparent up to 3 weeks after exposure, after which a deficit was observed that offset just part of the overall excess. In London, the heat excess persisted only 2 days and was followed by deficits, such that the sum of effects was 0 by day 11. The pattern in São Paulo was intermediate between these. The risk summed over the course of 28 days was 2.4% (95% confidence interval = 0.1 to 4.7%) per degree greater than the heat threshold in Delhi, 0.8% (-0.4 to 2.1%) in São Paulo and -1.6% (-3.4 to 0.3%) in London. Excess risks were sustained up to 4 weeks for respiratory deaths in São Paulo and London and for children in Delhi. CONCLUSIONS: Heat-related short-term mortality displacement was high in London but less in Delhi, where infectious and childhood mortality still predominate.

Adolescent↗
PubMed2004

Long-chain conversion of [13C]linoleic acid and alpha-linolenic acid in response to marked changes in their dietary intake in men.

We studied the long-chain conversion of [U-13C]alpha-linolenic acid (ALA) and linoleic acid (LA) and responses of erythrocyte phospholipid composition to variation in the dietary ratios of 18:3n-3 (ALA) and 18:2n-6 (LA) for 12 weeks in 38 moderately hyperlipidemic men. Diets were enriched with either flaxseed oil (FXO; 17 g/day ALA, n=21) or sunflower oil (SO; 17 g/day LA, n=17). The FXO diet induced increases in phospholipid ALA (>3-fold), 20:5n-3 [eicosapentaenoic acid (EPA), >2-fold], and 22:5n-3 [docosapentaenoic acid (DPA), 50%] but no change in 22:6n-3 [docosahexanoic acid (DHA)], LA, or 20:4n-6 [arachidonic acid (AA)]. The increases in EPA and DPA but not DHA were similar to those in subjects given the SO diet enriched with 3 g of EPA plus DHA from fish oil (n=19). The SO diet induced a small increase in LA but no change in AA. Long-chain conversion of [U-13C]ALA and [U-13C]LA, calculated from peak plasma 13C concentrations after simple modeling for tracer dilution in subsets from the FXO (n=6) and SO (n=5) diets, was similar but low for the two tracers (i.e., AA, 0.2%; EPA, 0.3%; and DPA, 0.02%) and varied directly with precursor concentrations and inversely with concentrations of fatty acids of the alternative series. [13C]DHA formation was very low (<0.01%) with no dietary influences.

Adult↗
PubMed2004

Vulnerability to winter mortality in elderly people in Britain: population based study.

OBJECTIVE: To examine the determinants of vulnerability to winter mortality in elderly British people. DESIGN: Population based cohort study (119,389 person years of follow up). SETTING: 106 general practices from the Medical Research Council trial of assessment and management of older people in Britain. PARTICIPANTS: People aged > or = 75 years. MAIN OUTCOME MEASURES: Mortality (10,123 deaths) determined by follow up through the Office for National Statistics. RESULTS: Month to month variation accounted for 17% of annual all cause mortality, but only 7.8% after adjustment for temperature. The overall winter:non-winter rate ratio was 1.31 (95% confidence interval 1.26 to 1.36). There was little evidence that this ratio varied by geographical region, age, or any of the personal, socioeconomic, or clinical factors examined, with two exceptions: after adjustment for all major covariates the winter:non-winter ratio in women compared with men was 1.11 (1.00 to 1.23), and those with a self reported history of respiratory illness had a winter:non-winter ratio of 1.20 (1.08 to 1.34) times that of people without a history of respiratory illness. There was no evidence that socioeconomic deprivation or self reported financial worries were predictive of winter death. CONCLUSION: Except for female sex and pre-existing respiratory illness, there was little evidence for vulnerability to winter death associated with factors thought to lead to vulnerability. The lack of socioeconomic gradient suggests that policies aimed at relief of fuel poverty may need to be supplemented by additional measures to tackle the burden of excess winter deaths in elderly people.

Aged↗
PubMed2004

Effect of influenza vaccination on excess deaths occurring during periods of high circulation of influenza: cohort study in elderly people.

OBJECTIVE: To estimate the protection against death provided by vaccination against influenza. DESIGN: Prospective cohort follow up supplemented by weekly national counts of influenza confirmed in the community. SETTING: Primary care. PARTICIPANTS: 24,535 patients aged over 75 years from 73 general practices in Great Britain. MAIN OUTCOME MEASURE: Death. RESULTS: In unvaccinated members of the cohort daily all cause mortality was strongly associated with an index of influenza circulating in the population (mortality ratio 1.16, 95% confidence interval 1.04 to 1.29 at 90th centile of circulating influenza). The association was strongest for respiratory deaths but was also present for cardiovascular deaths. In contrast, in vaccinated people mortality from any cause was not associated with circulating influenza. The difference in patterns between vaccinated and unvaccinated people could not easily be due to chance (P = 0.02, all causes). CONCLUSIONS: This study, using a novel and robust approach to control for confounding, provides robust evidence of a protective effect on mortality of vaccination against influenza.

Aged↗
PubMed2004

Environmental and social factors as determinants of respiratory dysfunction in junior schoolchildren in Moscow.

BACKGROUND: The process of industrialization of the USSR has left a legacy of widespread and often poorly controlled pollution which is widely believed to have adverse implications for health, in particular for respiratory disease among children. OBJECTIVES: To assess the relationship between area of residence and respiratory function in junior schoolchildren in different districts of Moscow. METHODS: A survey was conducted of 539 children aged 6-12 years who attend school and live in one of three districts of Moscow with varying ambient pollution levels. Spirometry [forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)] was assessed at school by trained school health staff. Parents of the children completed a questionnaire asking about respiratory function and factors potentially associated with it, as well as about social and other factors that could influence respiratory development and the health status of their children. RESULTS: There was appreciable difference in the characteristics of the children from the three districts. Children from the lower pollutant districts were generally younger, had higher parental income, and were less frequently exposed to cigarette smoke at home. They were also less likely to report heavy lorry traffic in the streets outside their homes. After adjustment for age, gender and height the FVC was 7.6 per cent (3.6-11.5 per cent) lower in children from the medium pollution district and 9.9 per cent [95 per cent confidence interval (CI) 5.6-14.0 per cent] lower in children from the high pollution district compared with those in the least polluted district (p < 0.001 for trend). These differences were little affected by further adjustment for household income or exposure to household smoking. In contrast, FEV1 showed comparatively little variation across districts. The odds of a forced expiratory ratio (FER) <75 per cent were substantially lower in the high pollution compared with the low pollution district (odds ratio 0.10, 95per cent CI 0.03-0.32 after adjustment for age, gender and height), and there was clear evidence of a trend across pollution categories (p < 0.001). The frequency of reported allergy was also lower in the high pollution district. FVC increased, and the probability of a low FER decreased, with household income. CONCLUSION: Children from areas of high environmental pollution had lower lung capacity but also smaller risk of a low FER compared with those from cleaner areas. The extent to which these differences can be attributed to environmental pollution is unclear without more detailed study. However, socio-economic deprivation, which was associated with pollution, appears to be an important determinant of respiratory function although it was associated with a lower risk of an obstructive pattern of lung function tests.

Air Pollutants↗
PubMed2004

Association of quality of life in old age in Britain with socioeconomic position: baseline data from a randomised controlled trial.

STUDY OBJECTIVE: To identify socioeconomic differentials in quality of life among older people and their explanatory factors. DESIGN: Baseline data from a cluster randomised controlled trial of the assessment and management of older people in primary care. Outcome measures were being in the worst quintile of scores for, respectively, the Philadelphia geriatric morale scale and four dimensions of functioning from the sickness impact profile (home management, mobility, self care, and social interaction). SETTING: 23 general practices in Britain. PARTICIPANTS: People aged 75 years and over on GP registers at the time of recruitment, excluding those in nursing homes or terminally ill. Of 9547 people eligible, 90% provided full information on quality of life and 6298 also did a brief assessment. RESULTS: The excess risk of poor quality of life for independent people renting rather than owning their home ranged from 27% for morale (95% CI 9% to 48%) to 62% for self care (95% CI 35% to 94%). Self reported health problems plus smoking and alcohol consumption accounted for half or more of the excess, depending on the outcome. Having a low socioeconomic position in middle age as well as in old age exacerbated the risks of poor outcomes. Among people living with someone other than spouse the excess risk from renting ranged from 24% (95% CI -10% to 70%) for poor home management to 93% (95% CI 30% to 180%) for poor morale. CONCLUSIONS: Older people retain the legacy of past socioeconomic position and are subject to current socioeconomic influences.

Activities of Daily Living↗
PubMed2004

Local area deprivation and urban-rural differences in anxiety and depression among people older than 75 years in Britain.

OBJECTIVES: We sought to determine the association of depression and anxiety with "area deprivation" (neighborhood socioeconomic deprivation) and population density among people older than 75 years in Britain. METHODS: Postal codes were used to link census area information to individual data on depression and anxiety in 13349 people aged 75 years and older taking part in a trial of health screening. RESULTS: Living in the most socioeconomically deprived areas was associated with depression (OR=1.4), but this relation disappeared after adjusting for individual deprivation characteristics. There was no association with anxiety. Living in the highest density and intermediate low-density areas was associated with depression (OR=1.6 and 1.5) and anxiety (OR=1.5 and 1.3) compared with the lowest density areas. CONCLUSIONS: An association between area deprivation and depression in older people was explained by individual health, demographic, and socioeconomic factors. Higher population density was consistently associated with increased depression and anxiety.

Aged↗
PubMed2003

Chaotic ray dynamics in slowly varying two-dimensional photonic crystals.

We use Hamiltonian optics to investigate chaotic ray dynamics in a photonic crystal whose lattice parameters vary slowly with position. The ray dynamics are chaotic even in regimes where only stable motion has been found in previous studies of energy band transport. Stable ray paths provide dynamical barriers that localize chaotic motion to certain regions of the photonic crystal.

Journal Article↗
PubMed2003

Health, wealth, and air pollution: advancing theory and methods.

The effects of both ambient air pollution and socioeconomic position (SEP) on health are well documented. A limited number of recent studies suggest that SEP may itself play a role in the epidemiology of disease and death associated with exposure to air pollution. Together with evidence that poor and working-class communities are often more exposed to air pollution, these studies have stimulated discussion among scientists, policy makers, and the public about the differential distribution of the health impacts from air pollution. Science and public policy would benefit from additional research that integrates the theory and practice from both air pollution and social epidemiologies to gain a better understanding of this issue. In this article we aim to promote such research by introducing readers to methodologic and conceptual approaches in the fields of air pollution and social epidemiology; by proposing theories and hypotheses about how air pollution and socioeconomic factors may interact to influence health, drawing on studies conducted worldwide; by discussing methodologic issues in the design and analysis of studies to determine whether health effects of exposure to ambient air pollution are modified by SEP; and by proposing specific steps that will advance knowledge in this field, fill information gaps, and apply research results to improve public health in collaboration with affected communities.

Air Pollution↗