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Biomedical subjects

C Osmond

Publications and source records attributed to C Osmond.

186 records · Page 11Linked to original sources
PubMedDate not supplied

Treatment of acute myeloid leukemia in the elderly: a clinical dilemma.

Fifty-four patients representing all the cases of acute myeloid leukemia in patients aged over 60 years, presenting to three adjacent hospitals, were studied. Only 26 of the 54 patients were considered suitable for remission induction with intensive combination chemotherapy which produced seven complete remissions (CR) (26 per cent). Eighteen of the 54 patients survived longer than three months--11 of these had received remission induction chemotherapy (five CRs), two low dose cytarabine, one vincristine and vitamin A and four supportive treatment alone. By six months all the patients who had received supportive treatment had died. Patients who received intensive chemotherapy spent 77 per cent of the first 90 days in hospital and half died in hospital. Patients receiving differentiating agents or supportive care spent more time at home (37 per cent, 34 per cent of the first 90 days, respectively) but had shorter overall survival. Assessment of clinical characteristics in an attempt to predict response to treatment and survival indicated that poor performance status and the presence of infection were the most important factors. Analysis was limited by the statistically small number in the group. At present there is no reliable method of predicting which patients will respond well to treatment with intensive chemotherapy. The clinical dilemma is whether to treat more intensively to benefit a minority, or to use supportive treatment to allow more time to be spent at home albeit with a shorter overall survival.

Aged↗
PubMedDate not supplied

Age, period and cohort models applied to cancer mortality rates.

We develop the application of age, period and cohort models to the representation of tables of age- and period-specific rates. A derivation is given by way of a familiar graphical technique. The identifiability problem is discussed, identification techniques are reviewed and a new approach is recommended that is based upon the success of the three two-variable submodels. Other constraints are introduced that enhance interpretation. Examples are given for two sites of cancer. This approach is contrasted with other methods designed to demonstrate trends. Finally, standard errors of the parameters and tests of goodness of fit are discussed.

Adult↗
PubMedDate not supplied

Interpretation of time trends in disease rates in the presence of generation effects.

A comparison is made of indices used for assessing trends in mortality rates over time, and results for four types of cancer are used as examples. The approaches contrasted as measures of change over calendar years of time are the use of crude death rates, standardized death rates (both direct and indirect approaches) and period effects estimated from an age-period-cohort model (including and excluding the cohort factor). The use of these indices is also compared with examination of the original age-specific rates. Similar analyses are made of the equivalent indices for examining changes between different birth cohorts over time. Submodels of the age-period-cohort model are shown to be algebraically and empirically related to age-standardized indices. The use of the full model, as contrasted to standardization methods, can result in important modifications to the interpretation in some cases. However, there are difficulties with this approach, as with all models, if applied uncritically. It is a wise precaution to examine the age-specific rates in each instance to ensure that any summary index is appropriate.

Adult↗
PubMedDate not supplied

Height and mortality in the counties of England and Wales.

Average heights of adults and children in the counties of England and Wales were examined using national samples of people born between 1920 and 1970. Although height increased over this 50-year period the differences between counties persisted. Average height in a county is closely related to its pattern of death rates, which were derived from all deaths during 1968-78. Counties with taller populations have lower mortality from chronic bronchitis, rheumatic heart disease, ischaemic heart disease and stroke, and higher mortality from three hormone-related cancers, of the breast, prostate and ovary. The inverse relation of height with bronchitis and cardiovascular disease is further evidence of risk factors acting in early childhood. The positive relation between height and cancers of the breast, ovary and prostate could suggest that promotion of child growth has disadvantages as well as benefits.

Adolescent↗
PubMedDate not supplied

Why Londoners have low death rates from ischaemic heart disease and stroke.

OBJECTIVE: To explain the low death rates from cardiovascular disease in London. SETTING: London and the other counties of England and Wales. SUBJECTS: Women living in London during 1901-10 and people in London dying during 1968-78. RESULTS: At the beginning of the twentieth century young women aged 15-34 in London had remarkably low death rates, largely because of low rates for tuberculosis and other infectious diseases and low mortality during childbirth. Their low death rates contrasted with the high rates in girls under 15 years. CONCLUSIONS: Large numbers of young women had migrated into London from agricultural counties in southern England and went into domestic service, where the diet was usually very good. Recent findings suggest that a mother's nutrition and health has a major effect on the risk of cardiovascular disease in the next generation. The low cardiovascular mortality in London is consistent with this, and contrasts with the high mortality from other common diseases.

Cause of Death↗