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Biomedical subjects

Debbie A Lawlor

Publications and source records attributed to Debbie A Lawlor.

At least 55 records · Page 3Linked to original sources
PubMed2005

Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records.

BACKGROUND: Missed appointments are a common occurrence in primary care in the UK, yet little is known about the reasons for them, or the consequences of missing an appointment. This paper aims to determine the reasons for missed appointments and whether patients who miss an appointment subsequently consult their general practitioner (GP). Secondary aims are to compare psychological morbidity, and the previous appointments with GPs between subjects and a comparison group. METHODS: Postal questionnaire survey and prospective medical notes review of adult patients missing an appointment and the comparison group who attended appointments over a three week period in seven general practices in West Yorkshire. RESULTS: Of the 386 who missed appointments 122 (32%) responded. Of the 386 in the comparison group 223 (58%) responded, resulting in 23 case-control matched pairs with complete data collection. Over 40% of individuals who missed an appointment and participated said that they forgot the appointment and a quarter said that they tried very hard to cancel the appointment or that it was at an inconvenient time. A fifth reported family commitments or being too ill to attend. Over 90% of the patients who missed an appointment subsequently consulted within three months and of these nearly 60% consulted for the stated problem that was going to be presented in the missed consultation. The odds of missing an appointment decreased with increasing age and were greater among those who had missed at least one appointment in the previous 12 months. However, estimates for comparisons between those who missed appointments and the comparison group were imprecise due to the low response rate. CONCLUSION: Patients who miss appointments tend to cite practice factors and their own forgetfulness as the main reasons for doing so, and most attend within three months of a missed appointment. This study highlights a number of implications for future research. More work needs to be done to engage people who miss appointments into research in a meaningful way.

Age Distribution↗
PubMed2005

Association of body mass index with suicide mortality: a prospective cohort study of more than one million men.

The authors investigated the association of body mass index (BMI) with suicide in a record linkage study based on the Swedish Military Service Conscription Register, the Population and Housing Censuses, and the Cause of Death Register. The cohort studied consisted of 1,299,177 Swedish men who were conscripted in 1968-1999, had their BMI measured at age 18-19 years, and were followed up for as long as 31 years. A strong inverse association was found between BMI and suicide. For each 5-kg/m2 increase in BMI, the risk of suicide decreased by 15% (95% confidence interval: 9, 21). The association was similar when subjects with mental disorder at baseline were excluded from the analysis. BMI-suicide associations were similar in relation to suicide deaths occurring in the first 5 years of follow-up (hazard ratio for each 5-kg/m2 increase in BMI = 0.84, 95% confidence interval: 0.73, 0.96) compared with associations > or = 10 years after baseline (hazard ratio = 0.87, 95% confidence interval: 0.79, 0.96), indicating that weight loss as a consequence of mental illness does not explain the BMI-suicide association and that factors influencing BMI may be causally implicated in the etiology of mental disorders leading to suicide.

Adolescent↗
PubMed2005

A comparison of the association between socioeconomic position and cardiovascular disease risk factors in three age cohorts of Australian women: findings from the Australian Longitudinal Study on Women's Health.

OBJECTIVES: To assess the associations between three measurements of socioeconomic position (SEP) -- education, occupation and ability to cope on available income -- and cardiovascular risk factors in three age cohorts of Australian women. METHODS: Cross-sectional analysis of three cohorts of Australian women aged 18-23, 45-50 and 70-75 years. RESULTS: In general, for all exposures and in all three cohorts, the odds of each adverse risk factor (smoking, obesity and physical inactivity) were lower in the most advantaged compared with the least advantaged. Within each of the three cohorts, the effects of each measurement of SEP on the outcomes were similar. There were, however, some notable between-cohort differences. The most marked differences were those with smoking. For women aged 70-75 (older), those with the highest educational attainment were more likely to have ever smoked than those with the lowest level of attainment. However, for the other two cohorts, this association was reversed, with a stronger association between low levels of education and ever smoking among those aged 18-23 (younger) than those aged 45-50 (mid-age). Similarly, for older women, those in the most skilled occupational classes were most likely to have ever smoked, with opposite findings for mid-age women. Education was also differently associated with physical inactivity across the three cohorts. Older women who were most educated were least likely to be physically inactive, whereas among the younger and mid-age cohorts there was little or no effect of education on physical inactivity. CONCLUSION: These findings demonstrate the dynamic nature of the association between SEP and some health outcomes. Our findings do not appear to confirm previous suggestions that prestige-based measurements of SEP are more strongly associated with health-related behaviours than measurements that reflect material and psychosocial resources.

Adolescent↗
PubMed2005

Birth weight is inversely associated with incident coronary heart disease and stroke among individuals born in the 1950s: findings from the Aberdeen Children of the 1950s prospective cohort study.

BACKGROUND: Birth weight is inversely associated with cardiovascular disease risk factors, but few studies have examined the association with disease end points, in particular with stroke risk. Furthermore, previous studies demonstrating an inverse association between birth weight and coronary heart disease (CHD) risk have been conducted on populations born in the early part of the 20th century, when infant mortality rates were high. If the environmental factors associated with improvements in infant mortality rates over the last century explain the inverse association between birth weight and CHD risk, one would expect weaker associations in more contemporary birth cohorts. METHODS AND RESULTS: We have examined the association in a large birth cohort of 10,803 (with an average of 239,000 person-years of follow-up) singleton births that occurred between 1950 and 1956. Our outcomes were hospital admissions for, and fatalities from, CHD (n=296) and stroke (n=107). Birth weight was inversely associated with CHD and stroke. The age-adjusted hazards ratio for a 1-kg increase in birth weight was 0.62 (95% CI 0.50 to 0.78) for CHD and 0.38 (95% CI 0.24 to 0.60) for stroke. Adjustment for gestational age, social class at birth, height and body mass index at school entry, gravidity, maternal age at birth, pregnancy-induced hypertension, antepartum hemorrhage, and maternal height did not alter the association with CHD but attenuated the association with stroke to 0.48 (95% CI 0.30 to 0.76). This attenuation resulted largely from adjustment for gestational age, which was linearly inversely related to stroke risk. Adjusted hazard ratios per sex and gestational age standardized z score of birth weight were 0.85 (95% CI 0.73 to 0.97) for CHD and 0.74 (95% CI 0.71 to 0.88) for stroke. CONCLUSIONS: Birth weight is inversely associated with CHD and stroke in a population born at a time when environmental circumstances, as indexed by low infant mortality rates, were relatively advantageous for infants.

Adult↗
PubMed2005

Lifecourse socioeconomic position, C-reactive protein, and carotid intima-media thickness in young adults: the cardiovascular risk in Young Finns Study.

OBJECTIVE: It has been suggested that confounding by socioeconomic position from across the lifecourse together with adult risk factors explain the association between C-reactive protein (CRP) and coronary heart disease, but the evidence for this is limited to elderly subjects. We examined associations between socioeconomic position in childhood and adulthood, adult CRP, and carotid intima-media thickness (IMT), a presymptomatic predictor of coronary heart disease, in a population of young adults. METHODS AND RESULTS: The association of socioeconomic indicators at age 3 to 18 and in adulthood with CRP and IMT at age 24 to 39 were examined in a prospective cohort study of 2290 (1030 men and 1260 women) participants in the Young Finns Study. After adjustment for age and sex, both childhood and adulthood socioeconomic position were inversely associated with CRP (ps< or =0.02). There was also a direct correlation between CRP and IMT (P<0.008). However, both the association between socioeconomic position and CRP and that between CRP and IMT attenuated to the null with adjustment for BMI and waist-to-hip ratio. Controlling for other risk factors had little effect on these associations. CONCLUSIONS: In young adults, the interrelations between socioeconomic position, CRP, and carotid atherosclerosis are accounted for by adiposity.

Adiposity↗
PubMed2005

Plasma adiponectin levels are associated with insulin resistance, but do not predict future risk of coronary heart disease in women.

CONTEXT: Low adiponectin levels predict type 2 diabetes, and one prospective study in men reported its independent prediction of vascular events. Many observers thus already consider adiponectin to be a major part of the "common soil" underpinning diabetes and vascular disease. OBJECTIVE: The objective of this study was to assess the association between adiponectin and incident coronary heart disease (CHD) risk in the British Women's Heart and Health Study. DESIGN: This was a prospective (4 yr) case (n = 167) control (n = 334) study nested within the 4286 women in British Women's Heart and Health Study. SETTING: The study was performed in a primary care setting. PARTICIPANTS: The study consisted of women (n = 4286) randomly selected from 23 British towns between 1999 and 2001, who were 60-79 yr of age at baseline. MAIN OUTCOME MEASURES: Association of adiponectin with CHD risk factors and incident CHD events were the main outcome measures. RESULTS: Among both cases and controls, adiponectin positively correlated with age and high-density lipoprotein cholesterol and inversely correlated with waist to hip ratio, fasting insulin, fasting glucose, homeostasis model assessment of insulin resistance scores, C-reactive protein, and triglycerides. However, despite adequate power and these associations with CHD risk factors, adiponectin did not predict CHD events in unadjusted or adjusted analyses. The relative risk ratio for a doubling of adiponectin was 0.93 (95% confidence interval, 0.78, 1.11). CONCLUSIONS: It is premature to consider adiponectin as a root for vascular disease in women despite its association with insulin resistance and diabetes. Additional prospective studies are required to determine whether there is a true sex difference in the effect of adiponectin on CHD.

Adiponectin↗
PubMed2005

Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study.

OBJECTIVES: To examine the association between socioeconomic position and insulin resistance in children from three countries in northern Europe (Denmark), eastern Europe (Estonia), and southern Europe (Portugal) that have different physical, economic, and cultural environments. DESIGN: Cross sectional study. PARTICIPANTS: 3189 randomly selected schoolchildren aged 9 and 15 years from Denmark (n = 933), Estonia (n = 1103), and Portugal (n = 1153). MAIN OUTCOME MEASURE: Insulin resistance (homoeostasis model assessment). RESULTS: Family income and parental education were inversely associated with insulin resistance in Danish children but were positively associated with insulin resistance in Estonian and Portuguese children. Among Danish children, insulin resistance was 24% lower (95% confidence interval -38% to -10%) in those whose fathers had the most education compared with those with the least education. The equivalent results were 15% (2% to 28%) higher for Estonia and 19% (2% to 36%) higher for Portugal. These associations remained after adjustment for a range of covariates: -20% (-36% to -5%) for Denmark, 10% (-4% to 24%) for Estonia, and 18% (-1% to 31%) for Portugal. Strong statistical evidence supported differences between the associations in Denmark and those in the other two countries in both unadjusted and adjusted models (all P < 0.03). CONCLUSIONS: Among Danish children, those with the most educated and highest earning parents had least insulin resistance, whereas the opposite was true for children from Estonia and Portugal.

Adolescent↗
PubMed2005

Sex differences in the association between birth weight and total cholesterol. A meta-analysis.

PURPOSE: Determine whether a sex difference exists in the association between birth weight and total cholesterol later in life. METHODS: Meta-analysis of within-study differences in regression coefficients of cholesterol on birth weight. RESULTS: A total of 34 regression coefficients from 30 studies were included in the analyses; these provided data on 33,650 males and 23,129 females. There was evidence that the inverse association between birth weight and total cholesterol was stronger in males compared to females. The pooled within-study difference in age-adjusted regression coefficients was -0.03 mmol/l (-0.06, -0.01), p = 0.02 and the pooled within-study difference in age and body mass index adjusted regression coefficients was -0.04 mmol/l (-0.07, -0.02), p = 0.002. There was no evidence of heterogeneity in these meta-analyses (both p values > 0.6). CONCLUSIONS: These results provide some evidence for a sex difference in the birth weight-total cholesterol association. This is consistent with studies of fetal growth which suggest that birth size reflects different biological processes for females and males. However, other very large studies are required to confirm this finding.

Adolescent↗
PubMed2005

The associations of physical activity and adiposity with alanine aminotransferase and gamma-glutamyltransferase.

The mechanisms linking obesity and inactivity to diabetes mellitus are unclear. Recent studies have shown associations of alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) with diabetes. In a random sample of 3,789 British women aged 60-79 years, the authors examined the associations of obesity and physical activity with ALT and GGT (1999-2001). Both body mass index and waist:hip ratio were independently (of each other, physical activity, alcohol consumption, smoking, and childhood and adulthood social class) positively and linearly associated with ALT and GGT. In adjusted models, a one-standard-deviation increase in body mass index was associated with a 0.46-units/liter (95% confidence interval (CI): 0.16, 0.75) increase in ALT and a 2.14-units/liter (95% CI: 0.99, 3.30) increase in GGT. Similar results for a one-standard-deviation increase in waist:hip ratio were 13.96 (95% CI: 10.44, 17.48) for ALT and 39.44 (95% CI: 25.89, 52.98) for GGT. Frequency of physical activity was inversely and linearly associated with GGT in fully adjusted models, but the inverse association with ALT was attenuated towards the null after adjustment for body mass index and waist:hip ratio. Adjustment for ALT and GGT resulted in some attenuation of the strong linear associations of body mass index and waist:hip ratio with diabetes. These findings provide some support for the suggestion that the relation between obesity and diabetes is, at least in part, mediated by liver pathology.

Adipose Tissue↗
PubMed2005

Effect of body mass index changes between ages 5 and 14 on blood pressure at age 14: findings from a birth cohort study.

Weight reduction in clinical populations of severely obese children has been shown to have beneficial effects on blood pressure, but little is known about the effect of weight gain among children in the general population. This study compares the mean blood pressure at 14 years of age with the change in overweight status between ages 5 and 14. Information from 2794 children born in Brisbane, Australia, and who were followed up since birth and had body mass index (BMI) and blood pressure measurements at ages 5 and 14 were used. Systolic and diastolic blood pressure at age 14 was the main outcomes and different patterns of change in BMI from age 5 to 14 were the main exposure. Those who changed from being overweight at age 5 to having normal BMI at age 14 had similar mean blood pressures to those who had a normal BMI at both time points: age- and sex-adjusted mean difference in systolic blood pressure 1.54 (-0.38, 3.45) mm Hg and in diastolic blood pressure 0.43 (-0.95, 1.81) mm Hg. In contrast, those who were overweight at both ages or who had a normal BMI at age 5 and were overweight at age 14 had higher blood pressure at age 14 than those who had a normal BMI at both times. These effects were independent of a range of potential confounding factors. Our findings suggest that programs that successfully result in children changing from overweight to normal-BMI status for their age may have important beneficial effects on subsequent blood pressure.

Adolescent↗
PubMed2005

Association of body mass index and obesity measured in early childhood with risk of coronary heart disease and stroke in middle age: findings from the aberdeen children of the 1950s prospective cohort study.

BACKGROUND: There is concern that the childhood epidemic of obesity will result in increases in the risk of cardiovascular disease in the future; however, there is currently little direct evidence on this issue. METHODS AND RESULTS: We assessed the association of body mass index, measured when subjects were a mean age of 4.9 years old, with the future risk of coronary heart disease (CHD) and stroke in a large Scottish birth cohort (born in the 1950s) who have been linked to hospital admissions and mortality data. At the start of the follow-up period (1981), there were 11,106 (91%) members of the cohort alive and believed to be resident in Scotland. Over the follow-up period, they contributed 245,000 person-years of risk. Among these subjects, there were 302 (53 fatal) cases of CHD, 109 (4 fatal) cases of stroke, and 397 (57 fatal) cases of either a CHD or stroke. There was no association between childhood body mass index and CHD risk. There was no linear association between childhood body mass index and stroke risk, but those who were obese in childhood (top 2.5% of the body mass index distribution) compared with all others had an increased risk of stroke; the adjusted (for gender, father's occupational social class at birth, number of siblings, and birth weight) hazards ratio was 2.41 (95% CI 1.00 to 5.86). CONCLUSIONS: Body mass index in early childhood does not appear to be associated with increased CHD risk in later life.

Body Mass Index↗
PubMed2005

Association of C-reactive protein with blood pressure and hypertension: life course confounding and mendelian randomization tests of causality.

BACKGROUND: C-reactive protein (CRP) has repeatedly been associated with blood pressure and prevalent and incident hypertension, but whether a causal link exists is uncertain. METHODS AND RESULTS: We assessed the cross-sectional relations of CRP to systolic blood pressure, pulse pressure, and prevalent hypertension in a representative sample of >3500 British women aged 60 to 79 years. For both outcomes, substantial associations were observed. However, these associations were greatly attenuated by adjustment for a wide range of confounding factors acting over the life course. We further investigated causality using a Mendelian randomization approach by examining the association of the 1059G/C polymorphism in the human CRP gene with CRP and with blood pressure, pulse pressure, and hypertension. The polymorphism was associated with a robust difference in CRP, and the expectation would be for higher blood pressure and pulse pressure and greater prevalence of hypertension among those carrying the genetic variant associated with higher CRP levels. This was not observed, and the predicted causal effects of CRP on blood pressure, pulse pressure, and hypertension using instrumental variables methods were close to 0, although with wide CIs. CONCLUSIONS: CRP levels are associated with blood pressure, pulse pressure, and hypertension, but adjustment for life course confounding and a Mendelian randomization approach suggest the elevated CRP levels do not lead to elevated blood pressure.

Aged↗
PubMed2005

Positive maternal attitude to the family eating together decreases the risk of adolescent overweight.

OBJECTIVES: To determine whether maternal attitude towards the family regularly eating together and maternal report of how often the family eat together are associated with adolescent offspring overweight. RESEARCH METHODS AND PROCEDURES: A cross-sectional mother-child-linked analysis was carried out using 14-year follow-up data from a population-based prospective birth cohort of 3795 children (52% males) who were participants in the Mater-University study of pregnancy, Brisbane, Australia. Maternal reports on family eating pattern reported at age 14 were used. RESULTS: The prevalence of overweight at age 14 was 24.1% (95% confidence interval (CI), 22.3, 26.1) for males and 27.1% (CI, 25.1, 29.2) for females. The majority of mothers (78%) reported that the family ate together at least once a day, but only 43% reported that they felt that family eating together was important. The offspring of women who felt that the family eating together was not important had increased odds of being overweight at age 14 (odds ratio, 1.27; 95% CI, 1.05, 1.53) in age- and sex-adjusted models. Adjustment for potential confounding factors had no substantive effect on the association. There was no association between maternal reports of how often the family actually did eat together and overweight at age 14 in the offspring. DISCUSSION: These findings suggest that maternal attitude towards family eating patterns, but not maternal report of how often the family do eat together, are associated with childhood overweight status. Maternal attitude towards family eating (as opposed to a report of actual frequency at one time-point) may reflect broader maternal influences (beyond family eating pattern) on their child's diet and eating patterns over a long time course.

Adolescent↗
PubMed2005

TAS2R38 (phenylthiocarbamide) haplotypes, coronary heart disease traits, and eating behavior in the British Women's Heart and Health Study.

BACKGROUND: Variation in the perception of bitter tastes has been associated with eating behavior, body composition, and cardiovascular disease. Recent observations have implicated 2 common haplotypes of TAS2R38 in the determination of bitter compound-tasting ability. OBJECTIVE: The objectives of the study were to examine, in the British Women's Heart and Health Study cohort, any association between TAS2R38 haplotypes, coronary heart disease (CHD), CHD risk factors, and eating behavior and to examine whether the associations allow for estimation of the effects of variation in diet on the etiology of common disease. DESIGN: We conducted a cross-sectional study of relations between TAS2R38 haplotypes and CHD, CHD risk factors, and eating behavior in 3383 women from 23 British towns. RESULTS: Genotyping at P49A and V262A in TAS2R38 (rs713598 and rs1726866) allowed construction of all 4 possible haplotypes. The 2 most common haplotypes corresponded with previously identified haplotypes related to bitter compound-tasting ability. No substantial evidence of association was found between these haplotypes and CHD (odds ratio for taste-defining haplotypes: 0.97; 95% CI: 0.78, 1.2), body mass index (difference between means of taste-defining haplotypes: -0.084; 95% CI: -0.45, 0.29), or a series of physiologic and dietary characteristics. A marginally lower risk of diabetes was observed among those with the nontaster haplotype than among those with the taster haplotype (odds ratio: 0.69; 95% CI: 0.48, 1.00). CONCLUSION: TAS2R38 status was not an important determinant of CHD, related risk factors, or eating behavior in the British Women's Heart and Health Study sample.

Aged↗
PubMed2005

Birth weight of offspring and subsequent cardiovascular mortality of the parents.

BACKGROUND: Restricted fetal growth has been associated with increased blood pressure, insulin resistance, and cardiovascular disease in later life. These associations may be due to processes during fetal development with long-term consequences for metabolic and cardiovascular function (the fetal origins hypothesis). However, it has also been hypothesized that common genetic factors could underlie both restricted fetal development and disease risk (the fetal insulin hypothesis). METHODS: We have investigated associations between offspring size at birth and parental mortality in a record linkage study including all 783,814 children born in Sweden between 1973 and 1980. The deaths of 10,368 mothers and 22,807 fathers had been recorded by date and causes of death. Data were analyzed using Cox proportional hazards regression models, with parents' age as the time axis. RESULTS: Offspring birth weight (adjusted for gestational age) was inversely associated with all-cause mortality and cardiovascular mortality in the parents, with weaker associations for fathers than for mothers. The inverse association between birth weight and cardiovascular disease mortality was greatest for parents who died at younger ages. Cancer and alcohol-related causes of death were also related to offspring birth weight. A sensitivity analysis suggests that confounding by smoking is unlikely to entirely explain the associations. CONCLUSION: Associations between offspring birth characteristics and parents' mortality could, at least in part, reflect genetic factors that influence both birth weight and cardiovascular disease risk.

Adult↗
PubMed2005

Early life determinants of adult blood pressure.

PURPOSE OF REVIEW: While treating high blood pressure in middle age is beneficial in terms of reducing the occurrence of cardiovascular disease, treated and well controlled hypertensive adults still have a substantial excess mortality and reduced survival compared with normotensives. Therefore, identification of the means of preventing hypertension in earlier life is an important objective. There is increasing evidence that adult blood pressure is determined by a range of characteristics from the intrauterine period, through infancy and childhood. The purpose of this review is to provide a summary of the current evidence concerning the early life determinants of adult blood pressure. RECENT FINDINGS: Children from poorer socioeconomic positions, those whose mothers experience pregnancy-induced hypertension, those whose mothers smoke throughout pregnancy, those with low birthweight, who are not breast-fed, who have high sodium diets in infancy and who are obese in childhood or adolescence tend to have higher blood pressure in adulthood. However, the mechanisms linking these early life factors to later blood pressure and the most appropriate means of preventing adult hypertension by intervening in early life are unclear. SUMMARY: There is clear evidence that early life factors are important determinants of adult blood pressure. However, there is a need for randomized trials with sufficient resources for long-term follow-up to assess the effects that interventions such as preventing pregnancy-induced hypertension, reducing maternal smoking, increasing breast-feeding, reducing salt consumption in infancy and preventing childhood obesity have on adult blood pressure and cardiovascular disease.

Adult↗
PubMed2005

Is there really a 'J-shaped' curve in the association between alcohol consumption and symptoms of depression and anxiety? Findings from the Mater-University Study of Pregnancy and its outcomes.

AIMS: To determine the nature of the association between alcohol consumption and symptoms of anxiety and depression in women. DESIGN: Prospective cohort study of women (n = 4527) who received antenatal care at a major public hospital (Mater Misericordiae Hospital) in South Brisbane between 1981 and 1984 and who have follow-up data on alcohol use, depressive and anxiety symptoms over a 14-year period. FINDINGS: At the 5-year follow-up there was a 'J-shaped' association between alcohol consumption and both symptoms of depression and of anxiety. However, at the baseline assessment and the 14-year follow-up alcohol consumption was linearly and positively associated with depressive symptoms with increasing prevalence of symptoms with greater consumption. At the 5-year follow-up the prevalence of depressive and anxiety symptoms among those who were abstainers at both baseline and 5-year follow-up was similar to that among those who had been previous drinkers and then become abstainers (P = 0.67). Similarly, the prevalence of these symptoms was the same at the 14-year follow-up comparing those who had been abstainers at baseline, 5-year and 14-year follow-up to those who had previously consumed alcohol but were then abstainers. CONCLUSIONS: The nature of the association between alcohol consumption and symptoms of depression and anxiety may vary across their life course in women. Previous drinkers who become abstainers do not appear to be at any higher risk of symptoms of depression or anxiety compared to those who always abstained, suggesting that increased symptoms in abstainers at age 30 is not due to 'sick quitters'. The association of high alcohol consumption with symptoms of depression and anxiety may be confounded by low income and smoking.

Adult↗