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Biomedical subjects

R Bhopal

Publications and source records attributed to R Bhopal.

At least 19 recordsLinked to original sources
PubMed1999

Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study.

OBJECTIVE: To compare coronary risk factors and disease prevalence among Indians, Pakistanis, and Bangladeshis, and in all South Asians (these three groups together) with Europeans. DESIGN: Cross sectional survey. SETTING: Newcastle upon Tyne. PARTICIPANTS: 259 Indian, 305 Pakistani, 120 Bangladeshi, and 825 European men and women aged 25-74 years. MAIN OUTCOME MEASURES: Social and economic circumstances, lifestyle, self reported symptoms and diseases, blood pressure, electrocardiogram, and anthropometric, haematological, and biochemical measurements. RESULTS: There were differences in social and economic circumstances, lifestyles, anthropometric measures and disease both between Indians, Pakistanis, and Bangladeshis and between all South Asians and Europeans. Bangladeshis and Pakistanis were the poorest groups. For most risk factors, the Bangladeshis (particularly men) fared the worst: smoking was most common (57%) in that group, and Bangladeshis had the highest concentrations of triglycerides (2.04 mmol/l) and fasting blood glucose (6.6 mmol/l) and the lowest concentration of high density lipoprotein cholesterol (0.97 mmol/l). Blood pressure, however, was lowest in Bangladeshis. Bangladeshis were the shortest (men 164 cm tall v 170 cm for Indians and 174 cm for Europeans). A higher proportion of Pakistani and Bangladeshi men had diabetes (22.4% and 26.6% respectively) than Indians (15.2%). Comparisons of all South Asians with Europeans hid some important differences, but South Asians were still disadvantaged in a wide range of risk factors. Findings in women were similar. CONCLUSION: Risk of coronary heart disease is not uniform among South Asians, and there are important differences between Indians, Pakistanis, and Bangladeshis for many coronary risk factors. The belief that, except for insulin resistance, South Asians have lower levels of coronary risk factors than Europeans is incorrect, and may have arisen from combining ethnic subgroups and examining a narrow range of factors.

Adult↗
PubMed1999

Concepts and terminology in ethnicity, race and health: be aware of the ongoing debate.

Although the expansion of the scientific literature in the field of ethnicity, race and health is welcome, it has been weakened by the diverse and inconsistent terms used to describe a group or individual's ethnicity. Further, a clear definition of what is meant by the terms ethnicity and race in publications is often lacking, making it difficult to compare studies. This problem is leading to much debate in the USA and the UK. Journal editors and researchers need to be aware of these debates, and actively involved in resolving problems and raising standards.

Ethnicity↗
PubMed1999

Primary biliary cirrhosis once rare, now common in the United Kingdom?

There is a widespread impression that the number of patients with the autoimmune liver disease primary biliary cirrhosis (PBC) is increasing, although its incidence and prevalence vary widely. Using thorough case-finding methods and rigorous definitions to assess changes in incidence and prevalence with time and to explore the symptomatology and mortality of the disease in a large group of unselected patients, we performed a descriptive epidemiological study of PBC in a well defined population over a fixed period of time using established diagnostic criteria and with clinical follow-up of all cases. In a population of 2.05 million in northern England 770 definite or probable PBC cases were identified. Prevalence rose from 201.9 per 10(6) in the adult population and 541. 4 per 10(6) women over 40 in 1987 to 334.6 per 10(6) adults and 939. 8 per 10(6) women over 40 in 1994. Incidence was 23 per 10(6) in 1987 and 32.2 per 10(6) in 1994. Three hundred patients died in median follow-up of 6.27 years (141 liver deaths); the standardized mortality ratio was 2.85. At presumed diagnosis, 60.9% had no symptoms of liver disease. By June 1994 62% of prevalent patients had liver symptoms. PBC is apparently increasing. It is still unclear whether this is because of a true increase, case finding, or increased disease awareness. The study draws attention to (1) high mortality from liver disease and non-liver-related causes even in patients initially with no liver symptoms and (2) apparently poor diagnostic awareness of the disease.

Adult↗
PubMed1999

A comparison of proxy measures of abdominal obesity in Chinese, European and South Asian adults.

AIMS: To assess whether four proxy measures of abdominal obesity (waist circumference; waist-to-hip ratio (WHR); waist-to-height ratio and C index, a measure of body shape) were uniformly associated with features of the metabolic syndrome (triglycerides, high density lipoprotein (HDL) cholesterol, 2-h glucose) in three ethnic groups. METHODS: Anthropometric and biochemical data were collected in 629 Europeans (320 men, 309 women), 380 Chinese (183 men, 197 women) and 597 South Asians (275 men, 322 women) aged 25-64 years in Newcastle upon Tyne, UK. Linear regression models were used to determine whether relationships differed between ethnic groups. RESULTS: Linear regression analysis showed that most proxy measures of abdominal obesity were associated with features of the metabolic syndrome. There were significant interactions between WHR and ethnicity and C index and ethnicity in the relationship with log triglycerides when comparing European and Chinese women. Interactions existed between all proxy measures and ethnicity in the relationship with log triglycerides and HDL cholesterol when comparing European and South Asian women. In men, interactions between ethnicity and waist circumference, WHR and C index when comparing Europeans and South Asians, and between ethnicity and WHR and C index when comparing South Asian and Chinese for log 2-h glucose were significant (P < 0.001). All interactions remained significant when differences in smoking, alcohol and physical activity were taken into account. CONCLUSIONS: Not all the proxy measures of abdominal obesity were consistently related to features of the metabolic syndrome across the ethnic groups studied. However, waist circumference and waist to height ratio were the most consistent and WHR the least when comparing across the ethnic groups.

Abdomen↗
PubMed1999

Paradigms in epidemiology textbooks: in the footsteps of Thomas Kuhn.

This article attempts to contribute to the debate on the future of epidemiology by combining Thomas Kuhn's ideas on scientific paradigms with the author's observations on some epidemiology textbooks. The author's interpretations were based on his readings of Kuhn's The Structure of Scientific Revolutions, epidemiology textbooks, and papers on the future of epidemiology. Thomas Kuhn's view is that sciences mostly work with a single paradigm driven by exemplars of successful work, and that proposals for paradigm change are resisted. Sciences that are maturing or changing do not have a dominant paradigm. Epidemiology textbooks showed diversity in their concepts, content, and approach. Most exemplars related to etiologic research rather than public health practice. One key focus of the recent controversy regarding the role of epidemiology has been the increasing inability of epidemiology to solve socially based public health problems. Kuhn's views help explain the polarization of views expressed. Kuhn's philosophy of science offers insights into controversies such as whether a paradigm shift is needed or imminent and the gap between epidemiology and public health practice. Interaction between science philosophers, epidemiologists, and public health practitioners may be valuable.

Epidemiologic Methods↗
PubMed1998

Comparison of the current WHO and new ADA criteria for the diagnosis of diabetes mellitus in three ethnic groups in the UK. American Diabetes Association.

The American Diabetes Association have recommended that the fasting plasma glucose level for the diagnosis of diabetes is lowered and that this becomes the main diagnostic test. We have used population-based data from three ethnic groups in Newcastle upon Tyne to examine the implications of this change. Data were available on 824 European (25-74 years), 375 Chinese (25-64 years), and 680 South Asian (25-74 years) subjects. All subjects apart from those reporting a prior diagnosis of diabetes underwent a standard 75 g oral glucose tolerance test (WHO criteria) which included the measurement of fasting glucose. The prevalence of diabetes was higher in all three ethnic groups using the new ADA criteria compared to the WHO criteria: 7.1% vs 4.8% in Europeans; 6.2% vs 4.7% in Chinese; and 21.4% vs 20.1% in South Asians. There was much variation in individuals categorized by the ADA and WHO criteria. Agreement between the two for the diagnosis of previously unknown diabetes was only moderate (kappa statistics 0.42 to 0.59). Thus in the populations studied the new criteria would increase the prevalence of diabetes in addition to classifying some individuals diabetic by current criteria as non-diabetic. It should be stressed however that diagnosis of the individual should not be based on a single test.

Adult↗
PubMed1998

The context and role of the US school of public health: implications for the United Kingdom.

Several UK medical schools have reorganized academic public health in 'schools of public health' or 'health sciences'. This paper considers the implications for the United Kingdom of the US concept of schools of public health independent of medical schools. These schools provide multidisciplinary research environments with scientists from laboratory and population-based disciplines competing successfully for federal research funds on projects ranging from basic science (e.g. biochemistry or genetics) to public health policy. Few public health academics see the expenditure of a trillion dollars per year on health care as a priority for public health. These schools have excelled in research, but not in leadership of service public health, so academic and service public health goals have diverged. In seeking the research advantages of the US system, the strengths of the UK one, including the relatively close links between public health and medicine and academia and service, together with a focus on applied work, should not be lost.

Curriculum↗