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Biomedical subjects

G Rose

Publications and source records attributed to G Rose.

At least 91 records · Page 5Linked to original sources
PubMed1992

The Small Area Health Statistics Unit: a national facility for investigating health around point sources of environmental pollution in the United Kingdom.

STUDY OBJECTIVE: The Small Area Health Statistics Unit (SAHSU) was established at the London School of Hygiene and Tropical Medicine in response to a recommendation of the enquiry into the increased incidence of childhood leukaemia near Sellafield, the nuclear reprocessing plant in West Cumbria. The aim of this paper was to describe the Unit's methods for the investigation of health around point sources of environmental pollution in the United Kingdom. DESIGN: Routine data currently including deaths and cancer registrations are held in a large national database which uses a post code based retrieval system to locate cases geographically and link them to the underlying census enumeration districts, and hence to their populations at risk. Main outcome measures were comparison of observed/expected ratios (based on national rates) within bands delineated by concentric circles around point sources of environmental pollution located anywhere in Britain. MAIN RESULTS: The system is illustrated by a study of mortality from mesothelioma and asbestosis near the Plymouth naval dockyards during 1981-87. Within a 3 km radius of the docks the mortality rate for mesothelioma was higher than the national rate by a factor of 8.4, and that for asbestosis was higher by a factor of 13.6. CONCLUSIONS: SAHSU is a new national facility which is rapidly able to provide rates of mortality and cancer incidence for arbitrary circles drawn around any point in Britain. The example around Plymouth of mesothelioma and asbestosis demonstrates the ability of the system to detect an unusual excess of disease in a small locality, although in this case the findings are likely to be related to occupational rather than environmental exposure.

Asbestosis↗
PubMed1992

Emergency admissions under Section 4 of the Mental Health Act 1983: reasons for a high rate.

One of the aims of the Mental Health Act 1983 was to discourage the use of emergency orders; the criteria for using the emergency provisions provided by Section 4 of the Act are stricter than those of the corresponding Section 29 of the previous Mental Health Act 1959. In 1986-87 the Mental Health Act Commissioners found a comparatively high level of admission under Section 4 in Cambridge. This study was undertaken to examine the hospital careers of all Section 4 admissions in Cambridge over a two-year period, and to compare these with admissions for assessment by two doctors under Section 2 of the 1983 Act and informal admissions. Almost 50% of all the Section 4 admissions were not continued on a compulsory admission by the end of the 72 hour duration of the Section. The findings suggest that these patients might have been more appropriately admitted informally or not at all.

Commitment of Persons with Psychiatric Disorders↗
PubMed1991

Strategies of prevention revisited: effects of imprecise measurement of risk factors on the evaluation of "high-risk" and "population-based" approaches to prevention of cardiovascular disease.

Imprecise measurement of risk factors causes misclassification of individuals, limits sensitivity to detect those with high true levels, and dilutes associations between risk factors and disease. The implications of these effects for two particular examples were explored using data from a large prospective study relating plasma cholesterol to coronary heart disease (CHD) mortality and diastolic blood pressure (DBP) to fatal stroke. The absolute and relative effectiveness of three "high-risk" strategies of screening and treatment and a "population-based" shift in the risk factor distribution were compared, assuming different degrees of measurement error. The absolute benefits of each strategy were greater than suggested by unadjusted estimates from survey data. For cholesterol and CHD (a linear relationship in this cohort), uncorrected estimates tended to exaggerate the effectiveness of "high-risk" strategies relative to the "population-based" approach. For DBP and stroke (an exponential relationship), the relative effectiveness of screening and treatment was underestimated if no allowance was made for measurement error. These findings are strictly applicable only to the middle-aged men from whom they were derived, but the effects of misclassification and regression dilution need to be considered in any assessment of preventive strategies.

Adult↗
PubMed1991

Evaluation of a laboratory health examination programme in a Swedish industry (Volvo).

The records of 117 subjects, workers who had participated in a health examination at a Swedish industry, were studied retrospectively in order to find out which measures had been taken as a consequence of the results from the different examinations. The extensive laboratory examination programme that had been carried out seemed to be of limited value. It is concluded that the extensive examination programmes carried out in many industries should be re-evaluated more critically.

Blood Glucose↗
PubMed1991

Socioeconomic differentials in cancer among men.

The relationship between cancer and socioeconomic position is examined for men using data from three sources--the Whitehall Study of London civil servants, the OPCS Longitudinal Study and the Registrar General's Decennial Supplement. Mortality from, or registration for, malignant neoplasms was higher overall in lower socioeconomic groups. There was considerable variation in the strength, and to a lesser extent direction, of the association of specific cancer sites and socioeconomic position within each of the studies. However, between the studies the relationships between socioeconomic position and the particular cancers were very similar. The similarity in results, taken in conjunction with the differences in design and methods of the three studies, makes it very unlikely that these consistent associations are due to artefacts. The heterogeneity in relationships between specific cancer sites and socioeconomic position suggests that no single factor--such as differences in general susceptibility or differences in smoking behaviour--can account for these associations. However socioeconomic differentials displayed by a particular malignancy do offer clues to its aetiology, and provide an indication of the scope that exists for reducing the burden of cancer within a population.

Humans↗
PubMed1991

The assessment of the relationship between blood pressure and sodium intake using whole-day, daytime and overnight urine collections.

The usefulness of whole-day, daytime (waking to retiring time) and overnight urine samples for assessing the relationship between blood pressure and sodium intake was examined in 301 male London civil servants, aged from 37 to 58 years old. Systolic blood pressure (SBP)/diastolic blood pressure (DBP) averaged 126/78 mmHg and the 24-h urinary excretion of sodium and potassium was 174 and 73 mmol, respectively. There was poor consistency between day- and night-time urine samples with respect to both sodium and potassium content. The urinary excretion of sodium and potassium was lower (P less than 0.001) in overnight than in daytime samples. After standardization for creatinine, the night: day ratio was 0.79 for sodium output and 0.55 for potassium excretion. Blood pressure, adjusted for age and body mass index, was significantly and positively correlated with overnight sodium excretion (SBP/DBP: slope = 0.061/0.046 mmHg/mmol) whereas the correlations with sodium excretion in daytime (0.010/0.004 mmHg/mmol) and whole-day (0.024/0.016 mmHg/mmol) urine samples were not significant. Blood pressure was significantly correlated with the sodium:potassium ratio in whole-day urine (1.941/1.968 mmHg/unit). As the agreement between daytime and overnight urine samples was low with respect to both sodium and potassium content, and due to the fact that the relationship between blood pressure and sodium in overnight samples may at least partially reflect pressure diuresis, overnight urinary sodium, even if related to sodium intake, cannot be employed to assess the association between salt in the diet and blood pressure.

Adult↗
PubMed1991

EcoRI-RFLP of the Apo B gene: a study in a sample group from south Italy.

EcoRI restriction analysis at codon 4154 of the Apo B gene was performed in a sample of 90 subjects from southern Italy (sample S), using total blood cell DNA amplified by PCR. A group of 46 subjects from northern Italy (sample N) was also investigated for comparison. Southern Italians showed an incidence of the R2 allele (absence of the cutting site) twice as high as that found in northern Italians (48 v. 21%). By ASPCR the mutation which abolishes the restriction site was confirmed as being G----A at the first base of the 4154 codon of the Apo B gene (Glu----Lys) in both S and N samples. By studying the variability of cholesterolaemia among different EcoRI genotypes in the S sample, it was estimated that the average effect of the R2 allele is to lower serum cholesterol by 8.5 mg/dl.

Alleles↗
PubMed1991

Overweight and stroke in the Whitehall study.

STUDY OBJECTIVE: The aim was to examine the risk of increasing overweight for death from stroke. DESIGN: This was a prospective cohort study, in which the main outcome measure was the mortality ratio for stroke with increasing body mass index. SETTING: Civil service departments, Whitehall, London. SUBJECTS: Participants were 17,753 men aged 40 to 64 years. MEASUREMENTS AND MAIN RESULTS: 208 stroke deaths were recorded. Men aged 40 to 54 in the most overweight quintile of body mass index had a mortality ratio of 2.01 (95% confidence interval 0.9 to 4.7) compared to the thinnest quintile. The mortality ratio was 1.19 (95% CI 0.7 to 2.0) in men aged 55 to 64. The increase in risk was more apparent in non-smokers: age adjusted mortality ratio 2.58 (95% CI 1.2 to 5.7). When smoking status and overweight were considered in combination a gradient of the age adjusted mortality ratio was observed, from 1.0 in thinner/non-smokers up to 3.15 in fatter/current smokers. On the assumption that smoking and obesity cause strokes, an estimated 60% of strokes could be prevented if these two easily identifiable risk factors could be avoided. CONCLUSIONS: The risks of overweight for death from stroke were more apparent in younger subjects and non-smokers. A substantial proportion of stroke deaths occurring under the age of 80 years would probably be prevented if cigarette smoking and overweight could be avoided.

Adult↗
PubMed1991

Ancel Keys Lecture.

Explore the source record for details and available documents.

American Heart Association↗
PubMed1991

Findings of the International Cooperative INTERSALT Study.

INTERSALT, an international cooperative study on electrolytes and other factors related to blood pressure, found, in within-population analyses involving 10,079 persons, a significant positive association between 24-hour urinary sodium excretion and systolic blood pressure and between the sodium/potassium ratio and systolic blood pressure. These significant findings were derived from analyses for individuals from all 52 centers and from the 48 centers remaining when persons from four low sodium centers were excluded. Potassium excretion of individuals was significantly and independently related inversely to their systolic blood pressure. For men and women, both separate and combined, the relation between sodium and systolic blood pressure was stronger for older than younger adults, perhaps reflecting the result of longer exposure with age or diminished capacity to handle a sodium load. Relations between electrolyte excretion and diastolic blood pressure in individuals were weaker than for systolic blood pressure. Body mass index and heavy alcohol consumption of individuals were strongly and independently related to blood pressure. In cross-population analyses with n = 52 or n = 48, sample median sodium excretion was significantly and independently related to the slope of systolic blood pressure and diastolic blood pressure with age. Other ecological analyses yielded inconsistent results. Four isolated populations showed low sodium excretion, low sodium/potassium excretion, low body mass index, and low alcohol consumption; sample median blood pressures were low, there was little or no upward slope of blood pressure with age, and high blood pressure was rare or nonexistent.

Adult↗
PubMed1991

Prevention of coronary heart disease: putting theory into practice.

The two main approaches to delivering preventive care for coronary heart disease, ie to reducing its causal risk factors, depend upon an understanding of the major causes of this disorder. One is population based and involves educating the public in healthier behaviour and making changes in the environment to facilitate this. In the other, persons at high risk are identified and provided with individual counselling and ongoing care; the diagnostic and therapeutic components of this approach must proceed in parallel, and resources will be needed to permit this. Both strategies are necessary: they are complementary; they are not competitive either conceptually or for funding. Personal risk varies widely. Hence a system of priorities is required for phasing the provision of care according to need. High risk is mot often due to the presence of multiple risk factors but also results from single, pronounced risk factors. Those in greater need include persons with coronary disease, those with multiple sources of risk, and those with severe hypercholesterolaemia, hypertension, or diabetes. So-called selective testing differs little, in practice, from such a prioritized system of comprehensive risk factor control.

Coronary Disease↗
PubMed1991

Environmental health: problems and prospects.

Public health has benefited greatly from control of some major sources of environmental pollution, but newer and more subtle types of pollution have led to a major loss of public confidence. This has often been aggravated by the tendency of authorities to issue quite improper reassurances in order to protect their own interests, as well as by the failure of medical experts to explain risks in an intelligible way. Control measures have mainly been focused on protecting individuals from conspicuous or hazardous levels of exposure. This may be grossly insufficient if--as with radiation--the dose-response curve is considered to be linear or threshold-free: it is then the total emissions which need to be controlled, since many people exposed to a small risk may generate a large total of cases, albeit with no conspicuous risk to any one person or group. Unfortunately it is generally impossible to measure these all-important low-dose effects. Environmental policy should take account of this uncertainty.

Environmental Health↗
PubMed1991

Contralateral tension pneumo/hemothorax resulting from left subclavian vein cannulation under general anesthesia.

A patient had a subclavian vein catheter placed under general endotracheal anesthesia with positive pressure ventilation. During placement, the superior vena cava, pleura, and pulmonary tissue were punctured, resulting in a tension pneumo/hemothorax, the detection of which was complicated by its slow onset and unusual location. The lesion required an emergent thoracotomy for repair.

Aged↗
PubMed1990

Follow-up study of participants in an extensive health examination programme at a Swedish industry.

Two years after an extensive health examination at a Swedish industry, a follow-up study was carried out in 110 employees (94% of those initially examined). The control included a history of the subject's health, a physical examination, an electrocardiogram, urine and faeces examinations and 16 chemical analyses of whole blood or serum. Except for repeat examinations of those who had had initial values outside reference values, most of the chemical analyses meant nothing, leading to unnecessary expense and possible risk of either worried or complacent participants. The history and physical and laboratory examinations, aimed at finding factors which can be improved by changing the life style seem to be most beneficial. It is concluded that extensive health examinations, including a large number of laboratory examinations which are carried out at many industries as a health control, should be critically evaluated at these industries.

Adult↗
PubMed1990

The population mean predicts the number of deviant individuals.

OBJECTIVE: To examine the relation between the prevalence of deviation and the mean for the whole population in characteristics such as blood pressure and consumption of alcohol. DESIGN: Re-examination of standardised data from the Intersalt study, an international, multicentre study on the determinants of blood pressure. SETTING AND SUBJECTS: Samples of adults representing 52 populations in 32 countries. MAIN OUTCOME MEASURES: The relations, expressed as correlation coefficients, between the mean population values for blood pressure, body mass index, alcohol consumption, and sodium intake and the prevalence of, respectively, hypertension (greater than or equal to 140 mm Hg), obesity (body mass index greater than or equal to 30 kg/m2), high alcohol intake (greater than or equal to 300 ml/week), and high sodium intake (greater than or equal to 250 mmol/day). RESULTS: There were close and independent associations between the population mean and the prevalence of deviance for each of the variables examined: correlation coefficients were 0.85 for blood pressure, 0.94 for body mass index, 0.97 for alcohol intake, and 0.78 for sodium intake. CONCLUSIONS: These findings imply that distributions of health related characteristics move up and down as a whole: the frequency of "cases" can be understood only in the context of a population's characteristics. The population thus carries a collective responsibility for its own health and well being, including that of its deviants.

Adult↗