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Biomedical subjects

H R Anderson

Publications and source records attributed to H R Anderson.

At least 109 records · Page 6Linked to original sources
PubMed1992

Marital status: association with social and economic circumstances, psychological state and outcomes of pregnancy.

We examined the association of marital status with economic, social and psychological factors and with the outcomes of pregnancy (defined as onset of labour, type of delivery, live and still births and birthweight). The study population was 1431 white women consecutively booking for antenatal care. Birth registrations were inspected. Of 278 women who were unmarried during pregnancy, 61 per cent were cohabiting, 26 per cent were living with adults other than the father and 13 per cent were living alone. Compared with the married women, unmarried women overall were, on average, younger, less educated, of lower social class, in poorer economic circumstances, more dependent on state support and less satisfied with their living arrangements. Irrespective of age and social class, they were less likely to have planned the pregnancy, more likely to smoke and drink, to book later for antenatal care and to miss more appointments. In general, unmarried women were more likely to have some indication of depression and to experience more serious life events during the pregnancy. Controlling for age and social class, the categories 'married', 'cohabiting' and 'on their own' showed significant trends from best to worst. Those living with adults other than the father showed intermediate results. There were no significant effects of marital status, controlled for age and social class, and associated social, economic and psychological circumstances on outcomes of pregnancy. Forty-one per cent of births to women on their own, 35 per cent to women living with other adults and 11 per cent to women cohabiting during pregnancy were registered by only one parent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The effect of nutritional intake on outcome of pregnancy in smokers and non-smokers.

The relationship between nutrient intake and pregnancy outcome (adjusted birth weight and gestational age) was investigated in randomly selected non-smokers (n97) and in heavy smokers (15 + cigarettes/d) (n72) booking for ante-natal care at a hospital in South London. Weighted dietary intakes (7d) were obtained at 28 and 36 weeks gestation. Birth weight was adjusted for gestational age, maternal height, parity and sex of infant. Compared with non-smokers, intakes of micronutrients and fibre were lower in smokers at both 28 and 36 weeks, and smokers reduced their intakes more in late pregnancy. The babies of smokers had a lower adjusted birth weight but there was no difference in length of gestation between smokers and non-smokers. After controlling for smoking, social class and alcohol consumption, nutrient intakes at 28 weeks were found to have no effect on adjusted birth weight. However, intakes of protein, zinc, riboflavin and thiamin at 36 weeks, and the change in intakes of these nutrients (plus iron) between 28 and 36 weeks, had independent positive effects on birth weight. Some of the effect of smoking on birth weight appeared to be mediated through differences in nutrient intakes. Smoking explained 14.3% of the variance in birth weight in this population and a further 2.4-7.2% was explained by change in nutrient intakes between 28 and 36 weeks. It is recommended that women in pregnancy do not reduce their dietary intakes in late pregnancy.

Analysis of Variance↗
PubMed1991

Cigarette smoking and birthweight: type of cigarette smoked and a possible threshold effect.

The effects on birthweight of the number of cigarettes smoked and their tar, nicotine and carbon monoxide yields were investigated prospectively in 1309 pregnant women of whom 414 were smokers. Several approaches to modelling the effect of smoking were tried. These suggested that while both yield and quantity smoked were important, yield had the greatest effect. This led to an empirical approach whereby consistent smokers were divided into four categories according to whether they smoked a low or high quantity of cigarettes per day and whether they smoked low or high yield cigarettes. Using these four groups it emerged that women smoking a low quantity of low yield cigarettes had babies of a similar mean birthweight to those of non-smokers whereas those smoking a low quantity of high yield cigarettes had babies whose birthweight was reduced to the same degree (6% or more) as those of mothers who smoked higher quantities. This apparent threshold was estimated as 13 cigarettes/day and 15 mg/cigarette carbon monoxide. We conclude that brand smoked is at least as important as quantity and that in this population there is evidence for a threshold for tobacco smoke intake below which no discernible effect on birthweight is seen.

Birth Weight↗
PubMed1991

The effects of smoking and drinking on the anthropometric measurements of neonates.

This study investigated the effects of smoking and alcohol consumption in pregnancy on length, head circumference, upper arm circumference and ponderal index, of neonates born to 1513 Caucasian women who delivered at St George's Hospital, south London. All measurements were adjusted for gestational age, maternal height, parity and sex of infant. Babies of smokers were shorter, had lower ponderal index and smaller upper arm circumference than those of non-smokers. After controlling for alcohol consumption, these differences remained (but with reduced statistical significance). There was no statistically significant difference in head circumference between smokers and non-smokers. Alcohol consumption at booking had no effect on growth measurements in non-smokers but had a significant, negative effect on all measurements in smokers. Drinking later in pregnancy had less effect. Alcohol appears to enhance the growth-retarding effect of smoking. It is suggested that both smoking and alcohol also have an inhibitory effect on fat deposition in babies, which contributes to the reduction in birthweight associated with smoking and drinking.

Alcohol Drinking↗
PubMed1991

Effects on birthweight of alcohol and caffeine consumption in smoking women.

STUDY OBJECTIVE: Previous work found no effect on birthweight of alcohol and caffeine consumption in non-smokers but such an effect was found in smokers. This report investigates further the effects on birthweight of alcohol and caffeine at three stages of pregnancy in smoking women. DESIGN: This was a prospective population study. SETTING: District general hospital in inner London. PARTICIPANTS: Out of 1309 women who completed all pregnancy interviews, 895 were excluded because they did not smoke, leaving a sample of 414 smokers. MEASUREMENTS AND MAIN RESULTS: Number and brand of cigarettes smoked, and quantity of alcohol and caffeine consumed were obtained by interview at booking, 28, and 36 weeks gestation. Birthweight was corrected for gestation and adjusted for maternal height, sex of infant and parity. The effect on birthweight of alcohol consumption was not explained by the amount smoked in terms of quantity and yield. Similarly the effect of caffeine was independent of smoking. When alcohol, caffeine, and smoking were analysed together, alcohol and caffeine were both associated with reductions in birthweight. Alcohol was associated with a reduction of up to 8% after adjusting for tobacco and caffeine intake, and caffeine was associated with a reduction of up to 6.5% after adjusting for tobacco and alcohol intake. Women who at booking were heavy smokers (greater than or equal to 13 cigarettes/day or greater than or equal to 15 mg carbon monoxide/cigarette), heavy drinkers (greater than or equal to 100 g/week alcohol), and had high caffeine intake (greater than or equal to 2801 mg/week) had a predicted reduction in mean birthweight of 18% (95% CI 11% to 24%). CONCLUSIONS: It is well known that women who smoke in pregnancy have smaller babies than non-smokers. Our study suggests that if these women also drink alcohol and high quantities of caffeine then the risk of poor fetal growth is increased even further.

Alcohol Drinking↗
PubMed1990

Can the Spitzer Quality of Life Index help to reduce prognostic uncertainty in terminal care?

Data from an on-going trial of co-ordinating care for terminally ill cancer patients are used to investigate whether the Spitzer Quality of Life (QL) Index can be used to reduce prognostic uncertainty in terminal care. Four questions are addressed. First, can doctors and nurses distinguish between patients with a prognosis of more or less than 1 year? Second, do the medical and nursing staff differ in their ability to estimate prognosis? Third, are there differences in the length of life remaining between groups of patients with different QL Index scores? Fourth, how well does the QL Index predict the likelihood of individual patients dying within 6 months of assessment? Doctors and nurses assigned between 17 and 25% of patients to the wrong prognostic group and were as likely to over-estimate as to under-estimate life expectancy. Medical and nursing staff did not differ in their ability to make prognostic judgements. Patients with a low QL Index score were more likely to die within 6 months than those with higher scores, but scores on the Index were not strong predictors of 6-month survival in individual patients. The Index is not accurate enough to be used to predict what sort of treatment terminally ill patients will require in the future and for how long. Nevertheless, it may prove valuable for those planning services for terminally ill cancer patients who require information on the levels of need in a population.

Adolescent↗
PubMed1990

Nutrient intakes during pregnancy: observations on the influence of smoking and social class.

The influence of smoking and social class on dietary intake in pregnancy was investigated in a random sample of smokers (greater than or equal to 15 cigarettes/d) and nonsmokers. A total of 206 subjects (94 smokers and 112 nonsmokers) completed a 7-d weighed dietary intake at 28 wk gestation and 178 completed a second assessment at 36 wk. Nonsmokers had higher intakes of almost all nutrients than did smokers and the nutrient density of their diet was greater. Energy intake was nonsignificantly higher in nonsmokers. Women in higher social classes had the highest nutrient intakes. Smokers were shorter than nonsmokers and tended to be of lower social class. After maternal height and social class were controlled for, smoking had a significant effect on intake of many micronutrients. Dietary intake was reduced in late pregnancy, particularly in smokers. These data suggest that smokers in all social classes have a poorer quality of diet.

Adult↗
PubMed1990

Maternal activity and birth weight: a prospective, population-based study.

To determine the association between maternal activity and pregnancy outcome, the authors investigated the separate influences of time, physical effort, and posture at work, both at a job and in the home, on birth weight. Study subjects were 1,507 of 1,889 women appearing consecutively for antenatal care at a district general hospital in inner London, England, in 1982-1984. Data were collected prospectively by interview and examination at several stages of pregnancy. Multivariable linear regression was used to distinguish associations with physical activity from confounding by other factors. The mean birth weight of infants born to women in full-time employment was 49 g less than that for births to women not in paid work (95 percent confidence interval (Cl) 1-97 g). However, the difference was due to confounding, and after adjustment, full-time employment was associated with a 12-g increase in birth weight (95 percent Cl -39 to 63 g). There was little difference in birth weight related to gestational stage at leaving work. Duration, physical effort required, and energy expenditure in paid work and in work at home had no discernible association with birth weight. A small increase in birth weight was associated with increased hours of sleep. These data allow estimates of associations with birth weight as precise as 80 g. Within the range of activities performed by pregnant women in the population studied, birth weight is unlikely to be associated with maternal physical activity.

Adolescent↗
PubMed1990

Social determinants of nutrient intake in smokers and non-smokers during pregnancy.

STUDY OBJECTIVE: The aim was to investigate the effects of social factors (education, income, marital status, partners' employment status, housing tenure, social class), smoking, and maternal height on the dietary intake of pregnant women. DESIGN: The study was a prospective investigation on a two phase sample. SETTING: The study involved women attending the antenatal clinic at a district general hospital. PATIENTS: A group of pregnant Caucasian women, selected because they were heavy smokers (15+ cigarettes/day) (n = 94) and a randomly selected sample of never smokers (n = 112) were studied. MEASUREMENTS AND MAIN RESULTS: Data on social factors were collected by interviewer administered questionnaire. A 7 day weighed intake method was used to determine dietary intake at 28 weeks gestation. In univariate analyses, income, housing tenure and social class had significant effects on intakes of both macro- and micronutrients, and maternal education and smoking had significant effects on intakes of micronutrients. Using a stepwise multivariate analysis with income, smoking and maternal education, income was a significant factor in the intake of most nutrients but this effect disappeared when social class and housing tenure factors were entered into the model. Only social class and housing tenure had any significant effect on intakes of macronutrients--energy, protein and fat. Smoking and maternal education were the most important determinants of quality of diet (nutrient density); other factors had only negligible effects. Income was the only significant factor in alcohol intake. It is suggested that the effects of social class and income are overlapping. CONCLUSIONS: Smoking, being renters of accommodation, and being of minimum education and low social class are risk factors for poor dietary intake. It is recommended that such higher risk groups be specifically targeted for nutritional advice in pregnancy.

Body Weight↗
PubMed1990

Regional variations in wheezing illness in British children: effect of migration during early childhood.

STUDY OBJECTIVE: The aim was to examine the regional distribution of wheezing illness among British children, and the age at which geographical differences may be determined. DESIGN: Cross sectional analyses and study of interregional migrants were used. SUBJECTS: The subjects were national cohorts of British children born in 1958 and 1970. MEASUREMENTS AND MAIN RESULTS: The regional distribution of wheezing illness showed significant heterogeneity at age 5 (1970 cohort) and 7 (1958 cohort). In both cohorts, children in Scotland had a low prevalence of wheeze, which could not be attributed to underreporting of mild cases. There was a less consistent tendency for high prevalence in Wales, and in the South Western and Midlands regions of England. In the 1958 cohort, the regional differentials diminished progressively with age and were negligible at age 23. There was a poor correlation between the regional distribution of childhood asthma and the common geographical pattern shown by eczema in infancy and hay fever at age 23. Analysis of interregional migrants suggested that the regional variation in each cohort at age 5-7 was primarily related to the region of current residence, and not to the region of birth. CONCLUSIONS: Genetic constitution, perinatal exposures, or early childhood experiences are unlikely to account for the regional variation in wheezing illness. Although local patterns of symptom reporting or disease labelling may be acquired by parents who move to a new region, environmental factors operating at a regional level probably determine the prevalence of asthma in primary school children. These influences do not appear to have long lasting effects upon the tendency to wheeze in adolescence and early adulthood.

Adolescent↗
PubMed1990

Why are hospital admission and mortality rates for childhood asthma higher in New Zealand than in the United Kingdom?

New Zealand has higher mortality and hospital admission rates for asthma than England and Wales. To determine the reasons for this the available data on asthma mortality and hospital admissions from the Auckland region of New Zealand were compared with data from the South West Thames Region of England for 1979-86 and data from previous surveys on prevalence of wheeze (Auckland 1985, Croydon 1978). In addition, a survey of general practitioners was carried out to determine their approach to the management of asthma, patient simulations being used. Asthma mortality in children of European descent aged 5-14 years was 2.5 times higher in Auckland than in South West Thames. The reported lifetime, 12 month, and one month prevalences of wheeze were also higher in Auckland (by 18.5%, 32.1%, and 87.5%). Unexpectedly, the hospital admission rate for asthma in children of European descent aged 5-14 years was 5% less in Auckland than in South West Thames. Comparative studies of hospital case notes and of the replies from general practitioners showed that in Auckland the duration of illness before admission was greater and that general practitioners were less likely to admit patients with acute asthma. The overall standard of general practitioner care in Auckland was, if anything, higher than in South West Thames but in both areas there was considerable variation. On balance it was concluded that the higher mortality rate in New Zealand is explained by higher levels of morbidity rather than relative deficiencies in care. Nevertheless, the implications of the lesser use of hospital care for acute asthma observed in Auckland need further consideration.

Acute Disease↗
PubMed1990

Trends and district variations in the hospital care of childhood asthma: results of a regional study 1970-85.

Trends and district variations in the pre-hospital and hospital care of children aged 0-14 years admitted with acute asthma were surveyed in all 13 districts of a health region by examining case notes for 1970, 1978, and 1985. From 1970 to 1985 there was a substantial increase in admissions and some reduction of hospital stay. Over this time adrenergic drugs remained the most frequently used treatment with a large shift towards selective beta2 agonists administered by nebulisation. Use of corticosteroids fell in the under 5s with a decrease in the parenteral route of administration but rose in the 5-14 age group with an increase in the oral route of administration. There was an increase the use of oral xanthines but this was outweighed by falls in the use of suppositories and in parenteral administration. The use of antibiotics became less frequent and that of sedatives and antihistamines fell to almost nil. There were also important changes in other aspects of management, notably an increase in the use of lung function tests (from 3% to 70%) and falls in the use of chest radiographs, blood tests, bacteriology, and physiotherapy. In nearly all aspects of management there were significant and often very extreme variations in practice between districts, which were unlikely to be explained by differences in morbidity. These variations would be a suitable focus for medical audit, with the aim of establishing which treatment regimens have the best outcome and avoiding unnecessary cost and discomfort. Because early hospital drug treatment is closely related to the type of treatment given before admission such audit activities would need to include general practitioners.

Acute Disease↗
PubMed1989

Effects on birth weight of smoking, alcohol, caffeine, socioeconomic factors, and psychosocial stress.

OBJECTIVE: To investigate the effects of smoking, alcohol, and caffeine consumption and socio-economic factors and psychosocial stress on birth weight. DESIGN: Prospective population study. SETTING: District general hospital in inner London. PARTICIPANTS: A consecutive series of 1860 white women booking for delivery were approached. 136 Refused and 211 failed to complete the study for other reasons (moved, abortion, subsequent refusal), leaving a sample of 1513. Women who spoke no English, booked after 24 weeks, had insulin dependent diabetes, or had a multiple pregnancy were excluded. MEASUREMENTS: Data were obtained by research interviewers at booking (general health questionnaire, modified Paykel's interview, and Eysenck personality questionnaire) and at 17, 28, and 36 weeks' gestation and from the structured antenatal and obstetric record. Variables assessed included smoking, alcohol consumption, caffeine consumption, and over 40 indicators of socio-economic state and psychosocial stress, including social class, tenure of accommodations, education, employment, income, anxiety and depression, stressful life events, social stress, social support, personality, and attitudes to pregnancy. Birth weight was corrected for gestation and adjusted for maternal height, parity, and baby's sex. MAIN RESULTS: Smoking was the most important single factor (5% reduction in corrected birth weight). Passive smoking was not significant (0.5% reduction). After smoking was controlled for, alcohol had an effect only in smokers and the effects of caffeine became non-significant. Only four of the socioeconomic and stress factors significantly reduced birth weight and these effects became non-significant after smoking was controlled for. CONCLUSIONS: Social and psychological factors have little or no direct effect on birth weight corrected for gestational age (fetal growth), and the main environmental cause of its variation in this population was smoking.

Adolescent↗
PubMed1989

Increase in hospital admissions for childhood asthma: trends in referral, severity, and readmissions from 1970 to 1985 in a health region of the United Kingdom.

Admissions to hospital for childhood asthma have continued to increase, but the reasons are unknown. Because the incidence of acute asthmatic attacks in the community greatly exceeds the admission rate, this increase could be a result of changes in medical practice shifting the balance of care towards the hospital without there being any underlying change in morbidity. In the South West Thames Region (population 2.9 million) over the eight years 1978-85 the number of hospital admissions among those aged 0-4 and 5-14 rose by 186% and 56%. A random sample of case notes from all hospitals in the region was examined for evidence of changes in mode of referral, severity on admission (duration of episode, vital signs on admission), and readmission ratio. The findings indicate that there has been no reduction in severity on admission or increase in readmission rate since 1978. The findings for the 5-14 age group contrast with those from an earlier study (1970-8) in the same region, in which a substantial increase in self referral was observed together with an increase in readmissions and a reduction in the duration of the attack; pulse and respiration rates on admission have, however, remained unchanged over the 16 year period. Overall, these findings indicate that the increase in admissions cannot be satisfactorily explained by changes in medical practice alone and may be due to an increase in the number of asthmatic children experiencing severe attacks. This points to a change in the epidemiology of childhood asthma.

Acute Disease↗