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Biomedical subjects

R Lancashire

Publications and source records attributed to R Lancashire.

16 recordsLinked to original sources
PubMed2006

New postnatal urinary incontinence: obstetric and other risk factors in primiparae.

OBJECTIVE: To identify obstetric and other risk factors for urinary incontinence that occurs during pregnancy or after childbirth. DESIGN: Questionnaire survey of women. SETTING: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). POPULATION: A total of 3405 primiparous women with singleton births delivered during 1 year. METHODS: Questionnaire responses and obstetric case note data were analysed using multivariate analysis to identify associations with urinary incontinence. MAIN OUTCOME MEASURES: Urinary incontinence at 3 months after delivery first starting in pregnancy or after birth. RESULTS: The prevalence of urinary incontinence was 29%. New incontinence first beginning after delivery was associated with older maternal age (oldest versus youngest group, OR 2.02, 95% CI 1.35-3.02) and method of delivery (caesarean section versus spontaneous vaginal delivery, OR 0.28, 95% CI 0.19-0.41). There were no significant associations with forceps delivery (OR 1.18, 95% CI 0.92-1.51) or vacuum delivery (OR 1.16, 95% CI 0.83-1.63). Incontinence first occurring during pregnancy and still present at 3 months was associated with higher maternal body mass index (BMI>25, OR 1.68, 95% CI 1.16-2.43) and heavier babies (birthweight in top quartile, OR 1.56, 95% CI 1.12-2.19). In these women, caesarean section was associated with less incontinence (OR 0.39, 95% CI 0.27-0.58) but incontinence was not associated with age. CONCLUSIONS: Women have less urinary incontinence after a first delivery by caesarean section whether or not that first starts during pregnancy. Older maternal age was associated with new postnatal incontinence, and higher BMI and heavier babies with incontinence first starting during pregnancy. The effect of further deliveries may modify these findings.

Adult↗
PubMed2001

The change-in-stage and updated smoking status results from a cluster-randomized trial of smoking prevention and cessation using the transtheoretical model among British adolescents.

BACKGROUND: The transtheoretical model (TTM) and computer technology are promising technologies for changing health behavior, but there is little evidence of their effectiveness among adolescents. METHOD: Four thousand two hundred twenty-seven Year 9 (ages 13-14) pupils in 26 schools were randomly allocated to control and 4,125 in 26 schools were allocated to TTM intervention. TTM pupils received three whole class lessons and three sessions with an interactive computer program. Control pupils received no special intervention. Positive change in stage and smoking status was assessed from a questionnaire completed at baseline, 1 year, and 2 years. Random effects logistic regression was used to compare the change in stage and smoking status between the arms. RESULTS: Eighty-nine percent of the TTM group and 89.3% of the control group were present at 1-year and 86.0 and 83.1%, respectively, were present at 2-year follow-up. The adjusted odds ratio (95% confidence interval) for positive stage movement in the TTM relative to control was 1.13 (0.91-1.41) at 1 year and 1.25 (0.95-1.64) at 2 years and for regular smoking was 1.14 (0.93-1.39) at 1 year and 1.06 (0.86-1.31) at 2 years. Subgroup analysis by initial smoking status revealed no benefit for prevention or cessation. CONCLUSIONS: The intervention was ineffective.

Adolescent↗
PubMed2001

Obstetric practice and faecal incontinence three months after delivery.

OBJECTIVE: To determine whether obstetric and maternal factors relate to faecal incontinence at three months postpartum. SETTING: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). POPULATION: All women who delivered during one year in the three maternity units. METHODS: Postal questionnaire at three months postpartum, to obtain information on faecal incontinence, linked to obstetric casenote data. MAIN OUTCOME MEASURES: Prevalence of faecal incontinence. RESULTS: 7879 questionnaires were returned, a 71.7% response rate. The prevalence of faecal incontinence was 9.6%, with 4.2% reporting this more often than rarely. Logistic regression, confined to primiparae, showed that forceps delivery was a predictor of an increased risk of symptoms (OR = 1.94, 95% CI 1.30 to 2.89) while vacuum extraction was not associated. Caesarean section was marginally associated with a reduced risk (OR = 0.58, 95% CI 0.35 to 0.97). Older maternal age, Indian sub-continent ethnic origin and body mass index 'not known' also showed significant associations. No associations were found for induced labour, duration of second stage labour, episiotomy, laceration or birthweight. CONCLUSIONS: Women delivered by forceps had almost twice the risk of developing faecal incontinence, whereas vacuum extraction was not associated with faecal incontinence at three months postpartum. Caesarean section appears to offer some protection.

Adult↗
PubMed1999

Cluster randomised controlled trial of expert system based on the transtheoretical ("stages of change") model for smoking prevention and cessation in schools.

OBJECTIVES: To examine whether a year long programme based on the transtheoretical model of behaviour change, incorporating three sessions using an expert system computer program and three class lessons, could reduce the prevalence of teenage smoking. DESIGN: Cluster randomised trial comparing the intervention to a control group exposed only to health education as part of the English national curriculum. SETTING: 52 schools in the West Midlands region. PARTICIPANTS: 8352 students in year 9 (age 13-14 years) at those schools. MAIN OUTCOME MEASURES: Prevalence of teenage smoking 12 months after the start of the intervention. RESULTS: Of the 8352 students recruited, 7444 (89.1%) were followed up at 12 months. The intention to treat odds ratio for smoking in the intervention group relative to control was 1.08 (95% confidence interval 0.89 to 1.33). Sensitivity analysis for loss to follow up and adjustment for potential confounders did not alter these findings. CONCLUSIONS: The smoking prevention and cessation intervention based on the transtheoretical model, as delivered in this trial, is ineffective in schoolchildren aged 13-14.

Adolescent↗
PubMed1995

Childhood cancer and parental use of alcohol and tobacco.

Reported consumptions of alcohol and tobacco for the parents of 1641 children who died with cancer in England and Wales during the period 1977 to 1981 were compared with similar information for the parents of 1641 control subjects. Consumption of alcohol by fathers was not associated with an increased risk of childhood cancer (relative risk (RR)) = 1.05; 95% confidence interval (CI): 0.86 to 1.28), but for daily consumption of cigarettes was not shown to be associated with an increased risk and consumption of alcohol was associated with a relatively low cancer risk (RR = 0.82; 95% CI: 0.70 to 0.96). Relations between maternal consumption of cigarettes and birth weights suggested that the smoking data were equally reliable for case patients and control subjects.

Alcohol Drinking↗
PubMed1991

Why do UK-born Pakistani babies have high perinatal and neonatal mortality rates?

A prospective study of 4934 babies of different ethnic groups has confirmed the high perinatal mortality rate for Pakistanis and has shown that this was not due to a reluctance to terminate a fetus who is known to be seriously malformed. The major cause of early mortality was a high rate of lethal malformations, which occurred in about 1 in 100 Pakistani babies and which accounted for about half of their perinatal mortality. Many of these were autosomal recessive and occurred only in the offspring of consanguineous parents. However, there was also an excess of lethal cardiac malformations which were not associated with parental consanguinity. The remainder of the excess perinatal mortality was probably due to socio-economic factors. These causes are partly amenable to preventive measures, such as the referral of Pakistani women for expert ultrasonography at 18 to 20 weeks of pregnancy.

Cause of Death↗
PubMed1986

Perinatal mortality standards: construction and use of a health care performance indicator.

Perinatal mortality rates are an important index of the performance of perinatal health care services, but comparisons are confounded by variations in the prior risk status of the clienteles of different districts and different maternity units. A method of allowing for these differences has been devised. It is based jointly upon the exclusion of certain classes of birth, and on indirect standardisation for birthweight and a number of modifying factors. The method is described, tested, demonstrated, and proposed for more general use.

Birth Weight↗
PubMed1984

The quality of notification of congenital malformations.

The United Kingdom Congenital Malformations Notification Scheme began in 1964. It is based on notes added to birth notification forms. In Birmingham, a local scheme based on multiple sources has been run in parallel for the last 20 years. The national notification scheme records malformations noted up to the age of 7 days, whereas the Birmingham scheme collects information up to the age of 5 years. A case by case record linkage of the two registers was carried out. This operation revealed the essential completeness of the multiple-source register but gross defects among notifications. The extent and nature of the deficiencies are described. They include defects of ascertainment of malformed infants and of major additional malformations in those infants who are in fact notified, overnotification of infants without significant malformations, and misclassification of the major malformations that were, in fact, notified. The defects arise partly from the defective design of the national scheme and partly from defective implementation and a lack of designated supervisory responsibilities. The main requirements for a scheme that could indeed be relied upon to meet its monitoring objectives are set out.

Congenital Abnormalities↗
PubMed1979

Heart attacks and geomagnetic activity.

Malin and Srivastava reported a remarkable correlation between daily variations in the geomagnetic field strength and daily admissions to the cardio-thoracic wards of hospitals in Hyderabad and Secunderabad, for cardiac emergencies, during 1967--72. We have now carried out a similar enquiry in the West Midlands region of the UK for the years 1969--70, but were unable to confirm the Indian results.

England↗
PubMed1978

Association of childhood mortality with housing status and unemployment.

The association between mortality at the ages of 0-4 and 5-14 years in the county boroughs of England and Wales for 1971, using Kendall's correlation technique, and a variety of socioeconomic indicators, was computed. Kendall's partial correlation technique was used to determine whether any association remained when the effect of social class and unemployment was kept constant. At ages 0-4 years there was a significant and positive association between mortality and low socioeconomic position, high density housing, inadequate housing amenities, and the unemployment rate (P less than 0.001). A significant association with the housing variables remained when the effect of socioeconomic status and unemployment was kept constant. Between the ages 5-14 years there was a statistically significant association (P less than 0.001) between mortality and housing density which was eliminated when the effect of social class was held constant. There was no association between unemployment and mortality in this age group.

Adolescent↗
PubMedDate not supplied

Detection of minimal epidemics.

Epidemiologists seeking epidemics of events in time, and attempting to distinguish real epidemics from random clusters, need to calculate the random probability of n or more events occurring within a time window of duration w, and for any position of the window as it scans continuously across the period of observation. Exact algebraic solutions have been proposed by other workers, but, over a wide range of important values, systematic arithmetic evaluation is beyond the capacity of existing computers. This paper proposes an approximate test which is quick and simple and which achieves the same purpose. An example of its application is given.

Computers↗