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Biomedical subjects

H M Inskip

Publications and source records attributed to H M Inskip.

16 recordsLinked to original sources
PubMed2001

Changing causes of death in the West African town of Banjul, 1942-97.

OBJECTIVE: To determine trends in the causes of death in a West African town. Mortality caused by infectious diseases is reported to be declining while degenerative and man-made mortality factors are increasingly significant. Most mortality analyses for sub-Saharan Africa have involved extrapolation and have not been derived from community-based data. METHODS: Historical data on causes of death coded by physicians were analysed for the urban population of Banjul for the period 1942-97. As the calculation of rates is not possible in the absence of a reliable population denominator, age-standardized proportional mortality ratios (PMRs) for men and women by major groups of causes of death were calculated, using the 1942-49 data for reference purposes. FINDINGS: Most deaths were attributable to communicable diseases. There was a shift in proportional mortality over the study period: the contribution of communicable diseases declined and that of noncommunicable diseases and injuries increased. These trends were more marked among men than women. CONCLUSION: The data illustrate that while noncommunicable diseases and injuries are emerging as important contributors to mortality in sub-Saharan Africa, communicable diseases remain significant causes of mortality and should not be neglected.

Adult↗
PubMed2000

Personal exposures of children to nitrogen dioxide relative to concentrations in outdoor air.

OBJECTIVES: To investigate the relation between fluctuations in personal exposure to nitrogen dioxide (NO(2)) in school children and changes in outdoor NO(2) concentrations. METHODS: 114 Asthmatic school children aged 7-12 years were recruited from the Southampton area. Weekly average personal exposures to NO(2) were measured over a 13 month period with passive diffusion tubes. At the same time, outdoor NO(2) concentrations were monitored at a fixed site in the centre of Southampton. Correlations between weekly personal exposures and mean outdoor concentrations during the same periods were examined. RESULTS: Mean duration of follow up was 32 weeks. Measurements of weekly mean personal NO(2) exposures were generally low and ranged from 2.47 to 1751 [corrected] micrograms/m(3) with a geometric mean of 60 [corrected] micrograms/m(3). Substantial variation in personal exposures occurred between children and more especially within individual children from week to week. Daily outdoor concentrations of NO(2) ranged from 15.2 to 105.2 [corrected] micrograms/m(3), with a geometric mean of 43.4 [corrected] micrograms/m(3). There was no evidence of seasonal variation in outdoor concentrations. No significant correlation was found between each child's weekly mean personal exposures to NO(2) and mean outdoor concentrations for the corresponding periods. CONCLUSION: At low outdoor NO(2) concentrations, fluctuations in NO(2) in outdoor air as measured at a central monitoring station do not contribute importantly to variations in personal exposure when averaged over a week.

Air Pollution↗
PubMed2000

Personal exposure to nitrogen dioxide and risk of airflow obstruction in asthmatic children with upper respiratory infection.

BACKGROUND: Several studies have linked air pollution by nitrogen dioxide (NO(2)) with increased hospital admissions for asthma in children. Exacerbations of asthma in children are often precipitated by upper respiratory infections. It is therefore possible that NO(2) increases the risk of airways obstruction when asthmatic children develop upper respiratory infections. METHODS: To test this hypothesis a sample of 114 asthmatic children aged 7-12 years were followed for a total of up to 13 months. Probable upper respiratory infections were identified by consensus review of daily symptom diaries, and episodes of airways obstruction from serial records of peak expiratory flow (PEF). Personal exposures to NO(2) were measured with Palmes tubes that were changed weekly. Generalised estimating equations were used to assess the relative risk (RR) of an asthmatic exacerbation starting within seven days of an upper respiratory infection according to estimated NO(2) exposure during the one week period from two days before to four days after the onset of the infection. RESULTS: The children were followed for an average of 34 weeks during which 318 upper respiratory infections and 224 episodes of reduced PEF were diagnosed. PEF episodes were much more likely to occur in the seven days following the onset of an upper respiratory infection than at other times. Estimated exposures to NO(2) at the time of infections were generally low (geometric mean 10.6 microg/m(3)). Compared with exposures of < or = 8 microg/m(3), exposures of >28 microg/m(3) were associated with a RR of 1.9 (95% confidence interval 1.1 to 3.4) for the development of an asthmatic episode within seven days of an infection. CONCLUSIONS: The findings give some support to the hypothesis that NO(2) increases the risk of asthmatic exacerbations following respiratory infections, even at relatively low levels of exposure. Further studies in populations with higher exposures would be useful.

Air Pollutants↗
PubMed1999

Risk of breast cancer and other cancers in heterozygotes for ataxia-telangiectasia.

Mortality from cancer among 178 parents and 236 grandparents of 95 British patients with ataxia-telangiectasia was examined. For neither parents nor grandparents was mortality from all causes or from cancer appreciably elevated over that of the national population. Among mothers, three deaths from breast cancer gave rise to a standardized mortality ratio of 3.37 (95% confidence interval (CI): 0.69-9.84). In contrast, there was no excess of breast cancer in grandmothers, the standardized mortality ratio being 0.89 (95% CI: 0.18-2.59), based on three deaths. This is the largest study of families of ataxia-telangiectasia patients conducted in Britain but, nonetheless, the study is small and CIs are wide. However, taken together with data from other countries, an increased risk of breast cancer among female heterozygotes is still apparent, though lower than previously thought.

Adult↗
PubMed1998

Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia.

BACKGROUND: The lifetime risks of suicide are generally quoted as 15% for affective disorder and alcoholism and 10% for schizophrenia, based on data from 1921-1975 and on calculations performed before computerised modelling techniques became available. This study recalculates the risk using contemporary data and modern techniques. METHOD: Twenty-seven mortality studies provided data for affective disorder, 27 for alcohol dependence and 29 for schizophrenia. The proportion of the cohort who had died was plotted against the proportion of deaths from suicide. Modelling techniques fitted curves through the data points extrapolating them to cohort extinction, thus estimating the lifetime risk of suicide for each disorder. RESULTS: The lifetime risk was estimated at 6% for affective disorder. 7% for alcohol dependence and 4% for schizophrenia. CONCLUSIONS: The lifetime suicide risk figures often quoted in the literature appear to be too high.

Alcoholism↗
PubMed1994

Do bedbugs transmit hepatitis B?

An intervention study was done over two years in seven Gambian villages to determine the contribution of bedbugs to hepatitis B transmission. In addition, fortnightly questionnaires were completed for each child to assess other possible routes of transmission. The intervention, insecticide spraying of the child's dwelling, was highly effective in reducing exposure to bedbugs but there was no effect on hepatitis B infection. No other risk factor for transmission was identified despite a consistent village-to-village variation in the rate of childhood infection. The major mode of transmission of hepatitis B in childhood remains unknown.

Animals↗
PubMed1993

Efficacy of hepatitis B vaccine in the Gambian expanded programme on immunisation.

Because of the high prevalence of hepatitis B virus (HBV) infection in The Gambia, HBV vaccination has been incorporated into the national expanded programme on immunisation. We have assessed the efficacy of the vaccine against HBV infection and chronic carriage by examining 720 3-4-year-old children who had received the vaccine in infancy and 816 who had not received it. The vaccine was 84% (95% CI 78-89%) effective against infection and 94% (84-98%) effective against chronic carriage. Vaccinated infants of mothers positive for hepatitis B surface and e antigens were at greater risk of breakthrough infection and chronic carriage than infants of uninfected mothers. The high vaccine efficacy against the HBV carrier state, the main risk factor for the development of chronic liver disease and liver cancer, offers hope that the prevalence of these diseases may be reduced in the future.

Carrier State↗
PubMed1992

The Gambia Hepatitis Intervention Study: follow-up of a cohort of children vaccinated against hepatitis B.

Hepatitis B vaccine has been introduced into The Gambia's national Expanded Programme on Immunization, with the aim of evaluating the impact on chronic liver diseases and in particular on hepatocellular carcinoma. As part of the project, a cohort of 1000 children was recruited to assess the long-term protection induced by the vaccine. The first 3 years of follow-up are described. By the age of 3 years, 95% of the children had protective antibody levels; 4 (0.6%) are known to be carriers in contrast to the 90-140 that would be expected in the absence of vaccination. The protective effectiveness of vaccine in preventing chronic carriage in the first 3 years of life is thus estimated as 95%. Since the risk of becoming a carrier is highest in those infected early in life, these results are encouraging.

Antigens, Viral↗
PubMed1991

Hepatitis B vaccine in the Gambian Expanded Programme on Immunization: factors influencing antibody response.

Data on over a thousand Gambian children have been analysed to examine factors influencing their antibody levels following immunization with hepatitis B vaccine administered during the first year of life. The dominant effect was the time between the last dose of vaccine and taking the blood sample. There was considerable variation in vaccine response by area of residence which could not be explained by any other factor. The hepatitis B surface antigen (HBsAg) status of the mother and the age at vaccination did not appear to have an effect, but there was some indication that a delay in receiving the second dose of vaccine led to a marginally lower response.

Antibodies, Viral↗
PubMed1991

Response to hepatitis B vaccine in relation to the hepatitis B status of family members.

The influence of the hepatitis B status of family members on the response to hepatitis B vaccine of an infant has been examined in 395 families. The presence of one or more HBsAg-positive family members did not appear to have any effect on the vaccine response. This is an encouraging finding as children born into carrier families are at an increased risk of becoming carriers themselves. That the vaccine response of such children is as good as for those born into non-carrier families means that they are likely to be protected against the carrier state by the vaccine.

Family↗
PubMed1991

Accuracy of answers obtained using a one-year recall period compared to a series of fortnightly recalls.

In a study to examine factors influencing transmission of hepatitis B virus, a comparison has been made between answers obtained about events occurring over a one-year period and the summation of the results from fortnightly questionnaires administered over the same period. Complete data were available for 532 children and the results showed that for an estimate of rates within the population, the results from both methods were similar. At the individual level, however, the differences between the one-year recall and fortnightly questions were large. Thus it appears that for population estimates longer recall periods may be satisfactory, but in any study requiring accurate data at the individual level shorter recall periods are required.

Child, Preschool↗
PubMed1990

Risk factors for transmission of hepatitis B virus to Gambian children.

Risk factors for hepatitis B virus transmission were examined in 973 Gambian children aged 6 months to 5 years. 33% had evidence of infection with hepatitis B virus and a third of these were carriers. A significant association was found between infection and tropical ulcer scars, and between e antigenaemia and the presence of bedbugs in each child's bed. There was no association between infection and traditional scarring, circumcision, or injections. Skin disease and arthropods are the two most likely modes of transmission of hepatitis B virus between children in West Africa.

Acute Disease↗
PubMed1990

The first 2 years of the Gambian National Cancer Registry.

We describe the creation, and the first 2 years experience, of the Gambian National Cancer Registry. The major problems involved in the creation of such a registry in a developing country are discussed. The data accumulated show a low overall rate of cancer incidence compared to more developed parts of the world and indicate that the prevalent cancers, hepatoma, carcinoma of the cervix and lymphoma, are likely to be due to infectious agents. It is hoped that immunisation of children under one year against hepatitis B will drastically reduce the incidence of hepatocellular carcinoma.

Adolescent↗