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Biomedical subjects

J M Starr

Publications and source records attributed to J M Starr.

At least 19 recordsLinked to original sources
PubMed2001

Mathematical modeling of Clostridium difficile infection.

Clostridium difficile diarrhea is a major cause of morbidity and mortality in hospitals. However, the number of cases in an outbreak is usually relatively small. This precludes many traditional statistical methods of modeling epidemics. Stochastic models are designed to deal with small numbers and are promising methods of understanding C. difficile epidemiology. This is illustrated by a reversible jump Markov chain Monte Carlo model based on the herd immunity hypothesis of C. difficile outbreaks.

Clostridioides difficile↗
PubMed2001

Birth weight and cognitive function at age 11 years: the Scottish Mental Survey 1932.

AIMS: To examine the relation between birth weight and cognitive function at age 11 years, and to examine whether this relation is independent of social class. METHODS: Retrospective cohort study based on birth records from 1921 and cognitive function measured while at school at age 11 in 1932. Subjects were 985 live singletons born in the Edinburgh Royal Maternity and Simpson Memorial Hospital in 1921. Moray House Test scores from the Scottish Mental Survey 1932 were traced on 449 of these children. RESULTS: Mean score on Moray House Test increased from 30.6 at a birth weight of <2500 g to 44.7 at 4001-4500 g, after correcting for gestational age, maternal age, parity, social class, and legitimacy of birth. Multiple regression showed that 15.6% of the variance in Moray House Test score is contributed by a combination of social class (6.6%), birth weight (3.8%), child's exact age (2.4%), maternal parity (2.0%), and illegitimacy (1.5%). Structural equation modelling confirmed the independent contribution from each of these variables in predicting cognitive ability. A model in which birth weight acted as a mediator of social class had poor fit statistics. CONCLUSION: In this 1921 birth cohort, social class and birth weight have independent effects on cognitive function at age 11. Future research will relate these childhood data to health and cognition in old age.

Age Factors↗
PubMed2001

Parental causes of death in primary intracerebral haemorrhage.

There are many reports of familial aggregation in stroke. Previously, examining parental causes of death, we found no evidence for familial risk in stroke once socioeconomic and socioenvironmental factors were controlled for. However, the number of patients with primary intracerebral haemorrhage (PICH) was small in this sample and we could not exclude a moderate effect of familial factors in this important subgroup. We therefore matched all cases with PICH on the Lothian Stroke Register with 2 controls per case of the same sex, born in the same year, district, and whose fathers had the same occupation. Presence on parental death certificates of cerebrovascular disease, other vascular disease, bronchial carcinoma, hypertension, diabetes mellitus and other causes of death was recorded. No significant difference in risk was found for cases with parental cerebrovascular disease (OR 0.75, 95% CI 0.40-1.40). Other forms of vascular disease in parents were not associated with significant risk either (OR 0.93, 95% CI 0.51-1.68). We conclude that familial factors do not contribute substantially to risk in most cases of PICH.

Aged↗
PubMed2000

Childhood mental ability and dementia.

OBJECTIVE: To examine links between childhood mental ability and dementia using data from a 1932 survey of the mental ability of the 1921 Scottish birth cohort. METHOD: Patients with dementia from the 1921 Scottish birth cohort were located in 1) a national survey of early-onset dementia (1974-1988), 2) local mental health services, and 3) a survey of 264 of 519 surviving Aberdeen residents who took the 1932 test. Control subjects were identified in the 1932 Scottish Mental Survey. RESULTS: Mean 1932 ability score for the Scottish 1921 cohort did not differ from early-onset dementia. Early-onset dementia was not associated with lower childhood mental ability when compared with matched control subjects. In Aberdeen, mental ability scores were significantly lower in children who eventually developed late-onset dementia when compared with other Aberdeen children tested in 1932. This difference was also detected between cases and tested subjects (controls) alive in 1994. CONCLUSIONS: Late-onset dementia is associated with lower mental ability scores in childhood. Early-onset dementia mental ability scores did not differ from locally matched control subjects or from late-onset dementia. Mechanisms that account for the link between lower mental ability and late-onset dementia are probably not relevant to early-onset dementia.

Aged↗
PubMed2000

Seven-year follow-up of blood pressure in the Healthy Old People in Edinburgh (HOPE) cohort.

The relationship between blood pressure and health in old age is complex and influenced by socio-economic factors. The Healthy Old People in Edinburgh cohort were initially disease-free and untreated, providing a sample in which directionality in this relationship could be examined. Subjects' health status, medication use and blood pressure was ascertained at baseline, after 4 years, and again after 7 years. Socio-demographic and socio-economic data were also collected. A total of 603 subjects were seen at baseline, 429 at 4 years and 301 at 7 years; complete blood pressure data were available for 294. Mean blood pressures were 157/85 mm Hg, 159/87 mm Hg and 162/86 mm Hg at baseline, 4 years and 7 years respectively. When subjects with diagnosed hypertension were excluded, the presence of disease (P = 0.009) and medication use (P = 0.047) at 7 years were associated with a relative reduction in blood pressure over time. For these subjects disease was predicted by deprivation index of residential area (OR 1.24, 95% CI 1.10-1.40 per Carstairs unit) and occupational group (OR 0.85, 95% CI 0.74-0.97 per major group). In this cohort disease, excluding hypertension itself, significantly attenuated the age-related rise in systolic blood pressure; the longer disease has been present the less the increase. In addition, socio-economic variables are important predictors of blood pressure change in those with disease. Deprivation index of residential area was a better predictor of disease than previous occupation in these subjects who had retired over a decade previously. Journal of Human Hypertension (2000) 14, 773-778

Aged↗
PubMed2000

Mental ability age 11 years and health status age 77 years.

OBJECTIVES: to measure the effects of childhood mental ability on health in old age. DESIGN: longitudinal cohort study. SETTING: community-based. PARTICIPANTS: survivors of the 1932 Scottish Mental Survey cohort randomly selected from the Community Health Index in North East Scotland. MEASUREMENTS: (i) presence of disease by diagnostic category; (ii) cardiovascular, respiratory, anthropomorphic, sensory and locomotor physiological variables; (iii) Barthel index of functional independence; (iv) socio-demographic and socio-economic variables as health status predictors; and (v) score on the Moray House Test in 1932. RESULTS: There was no significant difference in Moray House Test score in 1932 between those with (mean 39.7, S.D. 13.8) and without (mean 40.1, S.D. 12.1) current disease (F = 0.04, P = 0.84). Physiological health status was predicted by demi-span (F = 6.87, P< 0.001), sex (F = 3.69, P = 0.001), deprivation category (F = 1.45, P = 0.05) and the interaction between sex and deprivation category (F = 2.01, P = 0.002). Moray House Test score in 1932 correlated significantly and positively with Barthel score (r = 0.24, P < 0.001). No additional general linear models added any other significant socio-economic variable once Moray House Test Score in 1932 was entered. Moray House Test score in 1932 remained significant (beta = 0.16, P = 0.024) after Mini Mental State Examination score was entered and found to be significant (beta = 0.21, P = 0.003). CONCLUSION: socio-economic and socio-environmental factors are important determinants of some aspects of inequalities in health in old age in this cohort. Pre-morbid mental ability was an important independent predictor of late-life functional independence.

Aged↗
PubMed1999

Blood pressure and cognitive decline in the elderly.

Elevated blood pressure is associated with cognitive decline in elderly people. Classically, hypertension was thought to lead to end-organ damage of the brain manifested by neuropsychological deficits. This review examines recent evidence for this hypothesis and also considers other possible causal mechanisms for the observed relationship between blood pressure and mental ability.

Aged↗
PubMed1997

Hospital-acquired Clostridium difficile diarrhoea and herd immunity.

Clostridium difficile diarrhoea represents a significant health-service burden. We recently experienced an outbreak of C difficile diarrhoea associated with increased use of cefotaxime. The question we pose in this paper is how did the introduction and withdrawal of a single antibiotic so greatly affect rates of C difficile diarrhoea? Other antibiotics had nearly as high a risk of causing diarrhoea as cefotaxime, and the majority of patients never received cefotaxime. We believe that such outbreaks of C difficile diarrhoea are best understood in terms of a population model, and that taking antibiotics like cefotaxime should be thought of as a population rather than an individual risk factor. We postulate a herd-immunity model of C difficile diarrhoea, and examine the implications of this hypothesis.

Aged↗
PubMed1997

Risk of diarrhoea, Clostridium difficile and cefotaxime in the elderly.

Clostridium difficile diarrhoea is an increasingly important nosocomial infection. Clostridium difficile infection is associated with antibiotic use. The elderly are at greatest risk. We reported an outbreak associated with the use of cefotaxime, a third-generation cephalosporin. We review the extent of this association, putative causal mechanisms and suggest an integrated approach to the control of C difficile infection which focuses on both limiting environmental contamination and reducing patient susceptibility. Future developments are also considered, especially the potential for vaccination.

Aged↗
PubMed1997

Blood pressure and cognitive decline in healthy old people.

Both hypertension and cognitive decline are common in old age. We sought to examine the effects of blood pressure (BP) on rates of cognitive decline in a longitudinal study of community-resident healthy old people. A total of 603 initially healthy old people aged over 69 years were visited at home. Subject's age, years of full-time education, Social Occupational Classification, health status and medication use were recorded. Sitting systolic and diastolic BP was measured, and the Mini-Mental State Examination (MMSE) and National Adult Reading Test (NART) administered. Follow-up was planned after 4 years: 69 subjects were dead, 15 were too unwell and 12 had moved away; 78 subjects either refused or failed to reply. Psychometric tests were administered to the remaining 429 (71.1%) after a median period of 4.20 years. Forty-two subjects had significant sensory impairment or interrupted testing. No significant differences in cognitive decline were found between those who had started medication (n = 163) and those remaining untreated (n = 224). Mean MMSE score change was 0.44 points (s.d. 2.07, P < 0.001). Entering all baseline variables into a stepwise regression analysis significant positive effects were found for initial MMSE score (beta = 0.50, P < 0.001), age (beta = 0.17, P < 0.001), systolic BP (beta = 0.16, P < 0.001) and period between testing (beta = 0.14, P = 0.004), and negative effect for NART-predicted IQ (beta = -0.16, P = 0.003).). We conclude that (1) older people exhibit faster age-associated cognitive decline as measured by MMSE; (2) people with higher NART-predicted IQs are relatively protected; (3) people with high systolic BPs are at greater risk of cognitive decline.

Aged↗
PubMed1997

Acute phase proteins, C-reactive protein and serum amyloid A protein, as prognostic markers in the elderly inpatient.

AIM: to study the clinical significance and potential utility of measuring serum amyloid A protein (SAA) compared with the classical acute phase protein, C-reactive protein (CRP). METHOD: a 3 month prospective study on 66 women, mean age 83 years (range 69-106) and 33 men, mean age 84 years (range 69-95), admitted to the geriatric medicine unit at Hammersmith Hospital. CRP and SAA were determined on admission and at intervals throughout hospital stay; outcome end-points were death during the study, detection of infection, duration of admission and early re-admission to hospital after discharge. RESULTS: CRP and SAA responses were highly correlated (r = 0.75, P = 0.0001). However, the SAA response was greater than that of CRP in most individuals, with a median ratio of initial SAA to CRP of 2.2 in patients with infective pathology and 1.6 in those with inflammatory pathology. Median (range) SAA on admission was 98 (0.1-940) mg/ml in patients with infection and was twice that observed in patients with other causes of inflammation, median value 50 (0.6-699) mg/l. There was no difference between median CRP on admission in patients with infection or inflammation, median value 53 (0.1-235) and 51.5 (5-246) mg/l respectively. Initial and peak levels of CRP, but not of SAA, were significantly greater in patients who subsequently died, whereas high levels of both proteins predicted length of admission and early re-admission. CONCLUSION: major elevations of the serum concentrations of CRP and SAA indicated serious disease and predicted poor outcome. Measurement of SAA as well as CRP enhanced the clinical utility of monitoring the acute phase response in 7% of patients with a diagnosis of infection.

Acute-Phase Proteins↗
PubMed1997

Age-associated cognitive decline in healthy old people.

BACKGROUND: disease often confounds the identification of risk factors for age-associated cognitive decline in elderly subjects. If the cognitive effects of ageing are to be distinguished from those of disease, healthy people need to be studied. METHODS: we examined the effects of incident disease and drug prescription on cognitive change in a sample of initially healthy old people in a longitudinal study and related these to age, education, social class and blood pressure. We screened general practice case notes of 10,000 patients aged 70 years and over resident in Edinburgh to identify potentially healthy subjects. We visited 1467 potential subjects at home and enquired directly about health problems and medications, administered the Mini-Mental State Examination (MMSE) and National Adult Reading Test and recorded educational attainment, occupation and blood pressure. RESULTS: 603 subjects (237 male, 366 female), mean age 75.7 years (range 70-88 years), reported no health problems and were taking no regular medications. Four years after the initial visit we determined the outcome of all 603 subjects and retested available survivors. Psychometric tests were then administered to the 429 (71.1%) available survivors after a median period of 4.2 years (69 subjects were dead, 15 were too unwell, 12 had moved away and 78 either refused or failed to reply). Forty-two subjects had significant sensory impairment or interrupted testing, 195 remained in good health, 29 reported or had documented disease but were on no regular medication and 163 were on regular medication for diseases diagnosed during the follow-up period. MMSE score declined by 0.3 points in the healthy group (P < 0.048). However, once a single outlier whose MMSE score fell from 29 to 22 was excluded, the mean decline for the remainder was non-significant at 0.2 points (P = 0.079). There was no significant difference in cognitive decline between those who had and those who had not started medication (P = 0.59). CONCLUSIONS: the study fails to support the hypothesis that cognitive decline can be attributed to age alone in healthy old people. If such a decline exists, we consider that it is unlikely to account for loss of more than 0.1 MMSE point per year.

Aged↗
PubMed1997

Death certification in treated cases of presenile Alzheimer's disease and vascular dementia in Scotland.

INTRODUCTION: although death certification data are commonly used in dementia epidemiology, their reliability has been questioned. METHODS: death certificates were available from the Registrar General for Scotland for all patients with Alzheimer's disease/presenile dementia (AD PSD) or vascular dementia (VaD) who had died in Scotland up until 31 December 1994. Primary (immediate and underlying) and contributory causes of death were noted as well as place of death. Occupations of male patients were obtained from death certificates or from case notes and classified according to the Standard Occupational Classification. Bronchopneumonia was considered a non-specific cause of death and specific causes of death were classified as: cardiac disease, dementia, cerebrovascular disease, neoplasms, other vascular diseases and other diseases. Place of death was recorded as psychiatric hospital, district general hospital, nursing home or private residence. RESULTS: death certificates of 398 people who had been treated for AD PSD and 348 who had been treated for VaD were identified. Bronchopneumonia was the most common immediate cause of death in the AD PSD group (70.9%) but less so for the VaD group (51.7%). For both groups place of death was associated with significant differences in pneumonia being reported as the immediate cause of death as well as specific underlying and contributory causes of death. Dementia was recorded for 90.5% of AD PSD patients but for only 49.7% of the VaD group. CONCLUSIONS: Scottish death certificate data significantly underestimate the prevalence of presenile VaD. Changes in patterns of institutional care may affect dementia rates estimated from death certificate data.

Aged↗
PubMed1997

Survival in early onset dementia: effects of urbanization and socio-economic deprivation.

We estimated survival of patients with early onset Alzheimer's disease (AD) or vascular dementia (VaD) presenting to psychiatric hospitals in Scotland (1974-1988) and related this to age, gender and socio-economic variables. Hospital records of 1794 early onset dementia patients were reviewed. We identified 451 patients with early onset AD and 384 with VaD. Survival to death was calculated from symptom onset and presentation. Small geographical areas (postcode sectors) were classified by urban/rural category and deprivation score. Five-year survival from presentation of early onset AD was 32% for men and 43% for women compared to 22% for men and 36% for women with VaD. We conclude that increased age at presentation was associated with shorter survival in early onset AD and VaD. Socio-economic deprivation was associated with longer survival in VaD. The effects of urban/rural score were accounted for by the major effects of socio-economic deprivation.

Adult↗