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Biomedical subjects

R A Cartwright

Publications and source records attributed to R A Cartwright.

At least 73 records · Page 4Linked to original sources
PubMed1991

Community lifestyle characteristics and lymphoid malignancies in young people in the UK.

Data from a specialist registry of haematopoietic malignancies in England and Wales (1984-1988) have been analysed to investigate variations of incidence by age and diagnostic subtype of lymphoid malignancies in young people (aged 0-24 years). Attention has been focussed on the role of community lifestyle indicators for small areas, derived from routine sources, in an ecological analysis. The predominant conditions were acute lymphoblastic leukaemia (ALL)--42.4%, and Hodgkin's disease (HD)--37.5%. Lowest overall incidence at approximately 8 years of age corresponded to the termination of the childhood peak for ALL. Opposite trends of incidence rates with distance from urban centres (urban distance) were observed for the two age groups: odds ratios (OR) for areas greater than 20 km from towns and cities were 1.46 (95% confidence interval 1.01-2.12) for ages 0-7 and 0.75 (95% confidence interval 0.56-0.99) for ages 8-24. For the younger group this was entirely attributable to ALL. HD, which was dominant in the older group, had highest incidence in connurbations but the gradient of risk for older onset ALL followed the overall pattern for this age group. A positive relationship with socioeconomic status was evident for both age groups but this was considerably stronger for the older cases (OR = 1.16, 95% confidence interval 1.01-1.33) than for the younger for whom it was not independent of urban distance. These results display an association between expression of lymphoid malignancies in young people and urban distance which is not attributable to socioeconomic status; for urban distances the distribution is shifted towards ALL and towards younger age at onset.

Adolescent↗
PubMed1991

A case/control study of adult haematological malignancies in relation to overhead powerlines.

A population based case control study of adult haematological malignancy and distance from, and magnetic fields associated with, overhead (OH) power lines has been carried out in the North West and Yorkshire regions of England. Three-thousand, one hundred and forty-four cases with histologically proven disease were entered into the study. One control per case, matched for age, sex, year of diagnosis and health district of residence, was selected from hospital discharges. Seven per cent of cases and controls lived near to OH power lines as defined by the study protocol. The measure of exposure used was the calculated magnetic field strength at each of these addresses due to maximum load currents carried by OH power lines in the 5 years preceding diagnosis. The odds ratio (OR) for living within 50 m of an OH line was 1.29 with a 95% Confidence Interval (CI) of 0.99-1.68 but a chi 2 test for trend with distance was not statistically significant. The analysis of calculated magnetic fields, did not produce any statistically odds ratios. The OR for magnetic fields greater than or equal to 0.1 mG was 1.03 (95% CI 0.81 1.32). Analysis of magnetic fields greater than or equal to 3.0 mG gave an OR of 1.87 (95% CI 0.79 4.42), but this result is based on small numbers. No evidence was found for confounding by the type of dwelling which was used as a partial surrogate for socio-economic status.

Age Factors↗
PubMed1991

Epidemiological evidence for the 'two-disease hypothesis' in Hodgkin's disease.

This study relates to 1803 newly diagnosed cases of Hodgkin's Disease (HD) registered between 1984 and 1988 by a specialist leukaemia-lymphoma registry covering approximately half of England and Wales. In addition to registration data the analyses use routine census data. Rye classification is available for the majority of cases with only 7% being unclassified. The data confirm that the young adult peak in HD occurrence is attributable to the nodular sclerosing subtype (NS), and there is some evidence that NS has a different geographical distribution by county to the other Rye subtypes. Because of possible geographical biases in the classification, subsequent spatial analyses are disaggregated by age at diagnosis with particular emphasis being placed on the two age groups 0-34 and 50-79 years. For these, trends of risk by areal socioeconomic status are in opposite directions and the effects of urban-rural status while in the same direction also differ significantly. Allowance for these does not, however, explain the significant difference between the county distributions of the two groups. Patterns of spatial clustering are quite distinct with evidence for local spatial aggregation amongst younger cases.

Adolescent↗
PubMed1991

Mothers' reports of childhood vaccinations and infections and their concordance with general practitioner records.

Mothers of 294 children aged 3-9 years were interviewed about their child's previous history of vaccinations and infections. The study group comprised healthy children selected at GP surgeries (n = 136) and those hospitalized for both minor and serious conditions (n = 168). The results evaluate the entire study group for the pattern of reporting vaccinations and infectious episodes under three years of age, comparing two different data sources-mothers' reports and GP records. Maternal recall accuracy is formally tested (Kappa statistic) for agreement with GP records. For vaccination history the results indicate that mothers and GPs are inadequate data sources, and suggest use of computerized health district records to improve data accuracy. Major differences on infectious history were evident for two types of questions-closed for specific infections and open-ended for 'other infections'. Specific infections (e.g. measles) were systematically over-reported by mothers compared with GP records, but mothers failed to 'time' the event. Concordance for 'other infections' was also poor, but, by contrast, GPs systematically over-recorded this range of infections, indicating substantial inaccuracy in mothers' recall. The authors suggest that GP records should be the preferred source of data for these 'other' infectious episodes, especially under one year of age. Improved questionnaire design would elicit more accurate maternal reports on specified infections for which a GP may well not be consulted and corroboration would be impossible.

Case-Control Studies↗
PubMed1991

The pattern of childhood and related adult malignancies near Kingston-upon-Hull.

A study of childhood malignancies in North Humberside for 1974-1986 has revealed significant spatial aggregations. Though no specific reason was found, certain geographical areas, tumour groups and putative risks were identified for further study. One possible risk was a tin smelter to the west of Hull. A new method of analysis (Stone's conditional Poisson maximum) was used and showed some evidence of increased risk close to the smelter. This was accounted for by the solid tumours (primarily central nervous system malignancies) and was not apparent for the leukaemias. The Poisson maximum method is a special case of isotonic regression; a more general isotonic regression method, also due to Stone, Maximum Likelihood Ratio (MLR), is also available, and for reasons described elsewhere we prefer the more general method. The present study begins by applying this to the childhood data and then to data for corresponding adult disease (leukemias and central nervous system tumours) in the same area and time period. In both children and adults the results are negative for the leukaemias. For the remaining tumour categories, there is a significant increase in risk close to the smelter, but it is not possible to identify any aspect of the smelter or feature in its vicinity as causative.

Adolescent↗
PubMed1990

Community lifestyle characteristics and risk of acute lymphoblastic leukaemia in children.

High rates of leukaemia in children and young people have been associated with features of community isolation and population growth. Incidence data collected by two specialist registries were used to compare incidence rates at ward level with relevant ward characteristics derived from routine census and Ordnance Survey data for England and Wales. An excess risk of childhood acute lymphoblastic leukaemia (ALL) was found for wards which are farthest from large urban centres. The excess was greatest for wards of higher socioeconomic status and for children aged 1-7 years (the childhood peak), for which a two-fold excess was seen. These findings in general support the hypothesis that childhood leukaemia has an infectious aetiology.

Adolescent↗
PubMed1990

The seroepidemiology of human herpesvirus-6 (HHV-6) from a case-control study of leukaemia and lymphoma.

Sera from an epidemiological case-control study of leukaemias and lymphomas conducted between 1980 and 1986 were examined for reactivity to human herpesvirus-6 (HHV-6) by an indirect immunofluorescence assay. Statistical analyses of the data revealed higher HHV-6 seroprevalence and antibody titres in the cases, particularly evident in the disease subtypes acute myeloid leukaemia, Hodgkin's disease (HD), and low-grade non-Hodgkin's lymphoma. Within the control group alone, HHV-6 seroprevalence was placed at 55% at a serum dilution of 1:40. The controls also displayed higher seropositivity in females as compared with males. Further analyses suggest an association of increased HHV-6 seropositivity and geometric mean titre ratio with HD among young adults lacking social contact in the family group. This finding might indicate late exposure to HHV-6 in such persons and could possibly signify late exposure to a number of viruses, including those hypothesized as playing a role in the aetiology of HD. Previous reports have nominated Epstein-Barr virus as a possible candidate. Our results suggest that HHV-6 should be included in further investigations of the aetiology of HD.

Antibodies, Viral↗
PubMed1990

Childhood cancer and overhead powerlines: a case-control study.

A case-control study has been carried out to examine the occurrence of childhood cancer in relation to the proximity of overhead power lines to a child's home address at birth and to the calculated magnetic field at the address. The study included 374 cases diagnosed in the Yorkshire Health Region between 1970 and 1979, together with 588 matched controls. Magnetic-field strengths at the birth addresses due to the load currents of overhead power lines were calculated on the basis of line-network maps and load records. The results indicate no association between the occurrence of childhood malignancies and either the proximity or the magnetic fields of overhead lines, although the statistical power of the study was limited by the small numbers of children living close to overhead power lines.

Adolescent↗
PubMed1990

Leukaemia incidence, social class and estuaries: an ecological analysis.

Leukaemia incidence data for 1984-1986 for 22 counties of England and Wales have been collected by a specialist registry. The present study is an ecological analysis in which incidence in electoral wards has been tested for association with two predefined ward characteristics: socio-economic status and proximity to estuaries. Small but statistically significant associations have been observed with relative risks in the range 1.05-1.50. Adjustments have been made in the analysis for variation in the underlying regional incidence and also for statistical artefacts consequent upon the rarity of the condition. The results for socio-economic status confirm those of other recent studies, with increased incidence linked to higher status. The results for estuaries are new although derived from a prior hypothesis.

Adolescent↗
PubMed1990

Bladder cancer screening in the United Kingdom.

Attempts to control industrial bladder cancer in the United Kingdom started with studies in the 1920s and 1930s among workers in the dye manufacturing industry. Annual cystoscopy examinations were attempted in some work forces. In addition, studies on microscopic hematuria were under way when Papanicolaou's method was published. In the United Kingdom this method was tested and refined and became standardized. Use of the Papanicolaou method spread through the high-risk industries, including dye manufacture, some other parts of the organic chemical industry, and rubber-related industries. Current mandatory screening programs in the United Kingdom are summarized, and consideration is given as to how screening might be changed in the future. Clinical practice associated with bladder cancer screening is reviewed. The identification of possible new high-risk groups is used to highlight future trends.

Humans↗
PubMed1990

Chronic myeloid leukaemia in Yorkshire: a case control study.

The results of a case-control study of chronic myeloid leukaemia in adults are reported. 122 cases and 241 controls were interviewed. Excess risks associates with heart disease and related drugs were revealed. In addition a weak association with occupational and/or hobby exposure to irradiation emerged.

Case-Control Studies↗
PubMed1990

The inter-regional epidemiological study of childhood cancer (IRESCC): case-control study of children with central nervous system tumours.

Tumours of the central nervous system comprise 23% of all childhood cancers and form the most common group of solid malignancies. Little is know about their aetiology. The present report concerns the results of a case-control study of 78 incident cases of central nervous system tumours in children. No case-control differences were detected for the following: pre-natal diagnostic X-rays, general anaesthetics during pregnancy, pregnancy infections, pregnancy drugs (including sedatives, tranquillizers and anti-convulsants), alcohol consumption in pregnancy, child's birthweight, breast-feeding, childhood illnesses, previous medication in the child. A significant excess of case mothers had suffered from diseases of the nervous system (RR 2.6). There was a deficit of children who had been immunised among the case children which approached significance, and an excess of congenital abnormalities among cases which also approached significance. There was a small excess of neoplastic disease among case parents. The results of this study suggest that in our patients genetic rather than environmental factors are more important, but the small numbers included in the present study meant that no definite conclusions could be reached.

Abnormalities, Multiple↗
PubMed1989

A specialist leukaemia/lymphoma registry in the UK. Part 1: Incidence and geographical distribution of Hodgkin's disease. Leukaemia Research Fund Data Collection Study Group.

This paper describes the epidemiology of Hodgkin's disease occurring in parts of the United Kingdom between 1984 and 1986. The cases were carefully diagnosed and the data rigorously cross-checked as part of the larger Leukaemia Research Fund Data Collection Survey of all lymphoid and haematogenous malignancies. The age-specific rates show the lack of an older adult second peak. Spatial variation is examined in some detail. At county and district levels there is little heterogeneity in the distribution of cases. However, at the electoral ward level there were real differences for the younger age group (0-34).

Adolescent↗
PubMed1989

A specialist leukaemia/lymphoma registry in the UK. Part 2: Clustering of Hodgkin's disease.

Part 1 describes the epidemiology of Hodgkin's disease occurring in those parts of the United Kingdom which are included in the Leukaemia Research Fund data collection survey. A total of 1,023 cases diagnosed between 1984 and 1986 were available for analysis. At county and district levels there was little heterogeneity in the distribution of cases. However, at the electoral ward level there were real differences for the younger age group (0-34). In this paper methods of investigation which are not dependent on census boundaries are applied and the presence of localised spatial clustering is confirmed. There is some evidence that the pattern of clustering relates to the nodular sclerosing subtype. These results are related to hypotheses of an infectious aetiology.

Adolescent↗