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Biomedical subjects

C Cooper

Publications and source records attributed to C Cooper.

At least 181 records · Page 10Linked to original sources
PubMed1998

Individual risk factors for hip osteoarthritis: obesity, hip injury, and physical activity.

Hip osteoarthritis is a major cause of pain and disability. The authors explored individual risk factors for hip osteoarthritis in a population-based case-control study. The study was performed in two English health districts (Portsmouth and North Staffordshire) from 1993 to 1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period were compared with an equal number of controls selected from the general population and individually matched for age, sex, and family practitioner. Information about suspected risk factors was obtained by a questionnaire administered at interview and a short physical examination. Obesity (odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.3-2.4; highest vs. lowest third of body mass index), previous hip injury (OR = 4.3, 95% CI 2.2-8.4), and the presence of Heberden's nodes (OR = 1.6, 95% CI 1.2-2.2) were independent risk factors for hip osteoarthritis among men and women. Hip injury was more closely related to unilateral as compared with bilateral disease. There were a negative association between cigarette smoking and osteoarthritis among men and a weak positive association with prolonged regular sporting activity. Obesity and hip injury are important independent risk factors for hip osteoarthritis, which might be amenable to primary prevention. Hip osteoarthritis may also arise as part of the polyarticular involvement found in generalized osteoarthritis.

Aged↗
PubMed1998

Osteoarthritis of the hip and occupational lifting.

To test the hypothesis that occupational lifting is a cause of hip osteoarthritis, the authors examined associations with lifting and other occupational activities in a case-control study. The study was performed in two English health districts (Portsmouth and North Staffordshire) from 1993 to 1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period were compared with an equal number of controls selected from the general population and individually matched for age, sex, and general practice. Information about suspected risk factors was obtained by a questionnaire administered at interview and a short physical examination. Analysis was by conditional logistic regression. After adjustment for potential confounders, the risk in men increased progressively with the duration and heaviness of occupational lifting. Relative to those with low exposure, men who had regularly lifted weights in excess of 50 kg for 10 years or longer had an odds ratio of 3.2 (95% confidence interval 1.6-6.5). No comparable association was found in women. Of the other occupational activities examined, only frequent climbing of stairs showed a pattern suggestive of a causal relation. These findings are consistent with the results of other studies, and there is now a strong case for regarding hip osteoarthritis as an occupational disease in men whose work has involved prolonged and frequent heavy lifting.

Aged↗
PubMed1998

Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS).

Clinically apparent vertebral deformities are associated with reduced survival. The majority of subjects with radiographic vertebral deformity do not, however, come to medical attention. The aim of this study was to determine the association between radiographic vertebral deformity and subsequent mortality. The subjects who took part in the analysis were recruited for participation in a multicentre population-based survey of vertebral osteoporosis in Europe. Men and women aged 50 years and over were invited to attend for an interviewer-administered questionnaire and lateral spinal radiographs. Radiographs were evaluated morphometrically and vertebral deformity defined according to established criteria. The participants have been followed by annual postal questionnaire--the European Prospective Osteoporosis Study (EPOS). Information concerning the vital status of participants was available from 6480 subjects, aged 50-79 years, from 14 of the participating centres. One hundred and eighty-nine deaths (56 women and 133 men) occurred during a total of 14,380 person-years of follow-up (median 2.3 years). In women, after age adjustment, there was a modest excess mortality in those with, compared with those without, vertebral deformity: rate ratio (RR) = 1.9 (95% confidence interval (CI) 1.0,3.4). In men, the excess risk was smaller and non-significant RR = 1.3 (95% CI 0.9,2.0). After further adjusting for smoking, alcohol consumption, previous hip fracture, general health, body mass index and steroid use, the excess risk was reduced and non-significant in both sexes: women, RR = 1.6 (95% CI 0.9,3.0); men RR = 1.2 (95% CI 0.7,1.8). Radiographic vertebral deformity is associated with a modest excess mortality, particularly in women. Part of this excess can be explained by an association with other adverse health and lifestyle factors linked to mortality.

Aged↗
PubMed1998

Determinants of bone loss in a rural Japanese community: the Taiji Study.

The objective of this study was to assess the rate of bone loss and characterize its determinants, among the inhabitants of Taiji, a rural Japanese community. A cohort of 2261 inhabitants aged 40-79 years was established using resident registration in 1992. Fifty men and 50 women in each of four age strata between 40 and 79 years were randomly selected and completed a self-administered risk factor questionnaire. Baseline bone density of lumbar spine and proximal femur was measured by dual-energy X-ray absorptiometry in 1993. BMD was measured again on the same participants in 1996. The rates of change of lumbar spine BMD in men in their 40s, 50s, 60s and 70s were 0.20%, 0.34%, 0.43% and 0.28% respectively. Rates in women were -0.35%, -1.02%, -0.10% and -0.20% respectively. At the femoral neck, rates of change in BMD among men in their 40s, 50s, 60s and 70s were 0.09%, -0.07%, 0.34% and 0.31% respectively. Femoral neck rates of change among women were -0.55%, 0.02%, 0.49% and -0.25% respectively. The rate of change of lumbar spine BMD was -0.24% in premenopausal women with regular periods, -1.99% in premenopausal women with irregular periods and -0.33% in postmenopausal women. Anthropometric measurements at baseline were also related significantly to change in bone density. Baseline weight and height were statistically significant predictors of bone loss rate. These data provide estimates of the rate of bone loss among Japanese men and women aged 40-79 years. They suggest that body build and menstrual function in women are important determinants of bone loss.

Adult↗
PubMed1998

Bone loss in Great Britain and Japan: a comparative longitudinal study.

Hip fracture incidence is lower in Japan than in the West. Although differences have been found in peak bone mass and hip geometry between white and Japanese populations, these do not fully explain the difference in hip fracture rates. Variation in the rates of involutional bone loss may be an additional contributing factor. We address this issue in a prospective epidemiological study comparing bone loss rate among elderly people in Britain and Japan. Two population-based studies of bone loss rate in a British and a Japanese cohort were performed. Annual bone loss rates were obtained for 172 Hertfordshire men and 143 Hertfordshire women of mean age 66 years, and a questionnaire administered to obtain information on known confounding lifestyle factors. Eighty-six Japanese men and 90 Japanese women of mean age 69 years completed a similar study in Taiji, Japan. British men and women were heavier than Japanese men and women. Differences in lifestyle were also evident; the British men were less likely to smoke and the women more likely to consume alcohol than their Japanese counterparts. The British population also spent more time walking outdoors. Statistically significant differences between the two populations were apparent in baseline bone mineral density at lumbar spine (p < 0.05) and trochanter (p < 0.001) in men and women with Japanese subjects having lower values. There were also significant differences in bone density at the femoral neck (p < 0.001) between British and Japanese males. Men gained bone at the lumbar spine over the follow-up period in both populations. Bone loss rates were generally greater in the British female population than in Japanese women: the difference was statistically significant at the femoral neck (p < 0.05) and femoral trochanter (p < 0.001). These differences all remained significant after adjustment for differences in age between the two populations. Japanese subjects appear to have lower peak bone mass, but slower bone loss rates in later life than their European counterparts. These differences in bone loss rate help to explain the relatively low hip fracture rates found in Japan.

Absorptiometry, Photon↗
PubMed1998

A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update.

In the UK, over 250 000 patients take continuous oral glucocorticoids (GCs), yet no more than 14% receive any therapy to prevent bone loss, a major complication of GC treatment. Bone loss is rapid, particularly in the first year, and fracture risk may double. This review, based wherever possible on clinical evidence, aims to provide easy-to-use guidance with wide applicability. A treatment algorithm is presented for adults receiving GC doses of 7.5 mg day(-1) or more for 6 months or more. General measures, e.g. alternative GCs and routes of administration, and therapeutic interventions, e.g. cyclical etidronate and hormone replacement, are recommended.

Bone Resorption↗
PubMed1998

Who should assess medical students' communication skills: their academic teachers or their patients?

The objective of this study was to compare the assessment of medical students communication skills made by their academic teachers, with the assessment made by their role-playing 'patients'. It was a cross-sectional study, conducted at the Department of General Practice, University of Sydney, Australia, and consisted of 519 undergraduate medical students. Teachers rated students' communication skills using ten specific criteria, each marked on a five-point Likert scale. Teachers then rated students' overall performance using a 10-point scale. Patients rated students' overall performance on the same 10-point Likert scale. Only two of the 10 criteria, as rated by the academic teachers, correlated with the role-playing patients' overall score, and all 10 criteria accounted for only 10.1% of the variance in that score. The academic assessors' overall score accounted for only 9.7% of the variance of the patients' overall score. The communications skills emphasized by academic teachers do not reflect the skills considered to be important by role-playing patients.

Clinical Competence↗
PubMed1998

Visual acuity and its relationship to early growth, eye disease, and aging in north Hertfordshire.

We investigated the relationship between visual acuity, early growth and eye disease in a retrospective cohort study of 700 individuals in North Hertfordshire. Records of birth weight and weight at one year were used to determine early growth. We measured visual acuity and age-related eye diseases using standard instruments in those same individuals (now aged 63 to 73). Visual acuity below the legal threshold for driving in the UK (6/11 or poorer) was present in 13% of subjects. There was no clear association between birth weight or weight at one year and visual acuity. Vision impairment was found to be associated with refractive error, cataract, age-related maculopathy, and elevated macular threshold. After controlling for the effects of eye disease, increasing age remained a significant predictor of poorer visual acuity.

Aged↗
PubMed1998

Are rates of ageing determined in utero?

BACKGROUND: epidemiological studies have shown that poor early growth is associated with cardiovascular and other degenerative diseases. This has been explained by programming, whereby undernutrition and other influences which restrict early growth permanently change the structure and physiology of the body. The long-term effects of poor early nutrition on ageing have been demonstrated in animals but not studied in man. OBJECTIVES: to determine if poor early growth was associated with increased markers of ageing in later life. METHODS: we traced 1428 men and women, born in Hertfordshire between 1920 and 1930, for whom records of early weight were available. 824 (58%) were interviewed at home and 717 (50%) attended clinic for eye examination, audiometry, grip strength measurement, skin thickness ultrasound and anthropometry. RESULTS: lower weight at 1 year was associated with increased lens opacity score, higher hearing threshold, reduced grip strength and thinner skin. Visual acuity, macular degeneration and intraocular pressure were not related to early growth. CONCLUSIONS: the associations between early growth and markers of ageing suggest that in some systems, ageing may be programmed by events in early life. A potential mechanism is the impaired development of repair systems.

Adolescent↗
PubMed1998

The t(8;13)(p11;q11-12) rearrangement associated with an atypical myeloproliferative disorder fuses the fibroblast growth factor receptor 1 gene to a novel gene RAMP.

A recently described atypical myeloproliferative disorder is invariably associated with reciprocal translocations involving 8p11-12. The most common rearrangement is a t(8;13)(p11;q11-12). Here we determine that this translocation results in the fusion of the fibroblast growth factor receptor 1 gene (FGFR1), a member of the receptor tyrosine kinase family at 8p11, to a novel gene at 13q11-12 designated RAMP . The predicted RAMP protein exhibits strong homology to the product of a recently cloned candidate gene for X-linked mental retardation, DXS6673E . We also provide the first report of a novel, putative metal-binding motif, present as five tandem repeats in both RAMP and DXS6673E. RT-PCR detected only one of the two possible fusion transcripts, encoding a product in which the N-terminal 641 amino acids of RAMP become joined to the tyrosine kinase domain of FGFR1. Receptor tyrosine kinases are not commonly involved in the formation of tumour-specific fusion proteins. However, the previous reports of involvement of receptor tyrosine kinases in fusion proteins in non-Hodgkin's lymphoma, chronic myelomonocytic leukaemia and papillary thyroid carcinoma described similar rearrangements. By analogy with these, we propose that the RAMP-FGFR1 fusion product will contribute to progression of this myeloproliferative disorder by constitutive activation of tyrosine kinase function.

Amino Acid Sequence↗
PubMed1998

Upper limb disorder due to manual pipetting.

This case report describes the occurrence of non-specific upper limb symptoms, in a 47-year-old female scientific officer, associated, with manual pipetting. The discussion considers the difficulty of risk assessment and reduction for this common procedure.

Arm↗
PubMed1998

Is screening for osteoporosis worthwhile?

Osteoporosis is a common condition, which is recognised by the occurrence of fragility fractures and leads to considerable mortality and morbidity with huge financial implications world-wide. Based on predicted demographic changes, the implications of this disease are set to increasingly affect the healthcare budgets of all nations. The determinants of fracture are skeletal factors, such as peak bone mass, the rate of bone loss and extra-skeletal factors, which include trauma and the response to that trauma. Some of these factors are genetically determined, but several have environmental origins, which could, theoretically, be manipulated. There are two potential means whereby osteoporotic fractures might be prevented. Measures could be targeted at the entire population, with the aim of shifting the distribution of bone mass in a beneficial direction, through modifying the behaviour of all individuals. The alternative is a high risk approach, whereby intervention is targeted only at those considered to have the greatest risk of future fracture. Mass bone density screening falls into the second approach. Bone density is a good predictor of future fracture risk, and cost-effectiveness analyses of the high risk approach suggest economic benefits of policies targeting pharmacological treatment to those individuals at highest risk. However, there are important concerns about the levels of compliance achievable with such therapeutic interventions, the balance of risks and benefits for some of these interventions (for example, hormone replacement therapy), and the outcome when treatment is discontinued. On current evidence, it is certainly not appropriate to target hormone replacement therapy for women at the menopause on the basis of a bone density screening programme. However, newer bone-specific agents are being developed which might be administered at later ages, closer to the time when fracture incidence rates rise steeply. Bone densitometry has been shown to predict fractures even in the elderly, and high risk strategies for the targeting of such agents (for example, the bisphosphonates or selective oestrogen receptor modulators) will remain important research issues for the future.

Bone Density↗
PubMed1998

Hip fracture incidence and mortality in an English Region: a study using routine National Health Service data.

BACKGROUND: We investigated the validity of routine hospital and mortality hip fracture data in one English Region and estimated trends in hip fracture between 1978-1981 and 1993-1995. METHODS: We identified from Hospital Episode System (HES) data for 1993-1995 all hip fracture episodes relating to individual patients aged over 65 years resident in Wessex. We determined from the discharge method code whether an individual had died during that admission. The number of individual regional and district admissions and deaths were compared with those presented in the Public Health Common Data Set. We compared regional admission rates with data for 1978-1981 from a previous study. RESULTS: National comparative indicators for hip fracture overestimated individual admissions in Wessex by 17 per cent (in health authorities by 1-56 per cent). National comparative indicators for hip fracture mortality underestimated individual deaths in Wessex by 48 per cent. Between 1978-1981 and 1993-1995 the age-sex-standardized hip fracture rates rose from 1.90 to 2.63 per 1000 per year for men and from 5.70 to 7.70 per 1000 per year for women. Rates increased in all age groups except those aged 65-69 years. There was also a small fall in absolute mean annual numbers in this age group. The rates also fell in females aged 70-74. CONCLUSIONS: It is possible to adjust routine national HES data to take account of multiple episodes within a single admission. These methods should be applied to national comparative indicators for hip fracture admission and deaths. Hip fracture rates continue to rise in those aged over 70 years. There may be a cohort effect with those born after 1925 showing stable rates which needs further investigation.

Age Distribution↗