Search PubMed⌕ Search

Biomedical subjects

M Marmot

Publications and source records attributed to M Marmot.

At least 127 records · Page 7Linked to original sources
PubMed1993

Gender differences in occupational mobility and structure of employment in the British Civil Service.

In all industrialized societies health status in adults has been found to vary with social position. Attempts to explain this are usually grouped under headings of artefact, material, lifestyle and selective mobility of the healthiest. Such attempts have to date been unsuccessful in fully accounting for this relationship, and whilst they have merit have left unconsidered the effects of the process whereby social stratification occurs. The present study is a prelude to subsequent studies that will endeavour to distinguish between three separate influences on health--the effects of current social position, the long term effects stemming from one's initial class position, and the effects of the processes governing mobility. The purpose of our present investigation is to describe patterns of occupational mobility, that will enable us to identify possible predictors of subsequent mobility and therefore to indicate to what extent mobility might be a process governed by social rules. The work presented in this paper comprises part of the Whitehall II study of occupational, social and lifestyle influences upon health in a Civil Service population. Using multiple regression techniques almost half the variation in mobility is modelled in terms of educational level, fathers' social class, gender, marital status, age on entry into the Civil Service, length of time in Civil Service employment and grade of entry into the Civil Service. Using estimates derived from this model it is suggested that a number of sub-groups within the Civil Service suffer adverse mobility (mobility appears particularly restricted for women and for those entering the Civil Service above 30 years of age). The results obtained suggest that the issue of obstructed opportunity at the workplace could become a focus for fruitful investigation, linking issues of personal autonomy, expectations and control to health. A number of methodological problems in this kind of work are considered together with discussion of how the model can be used to increase our understanding of mobility.

Adult↗
PubMed1993

Smoking and blood pressure in the leg.

OBJECTIVES: To determine whether the calf:brachial ratio for systolic blood pressure is reduced in both current and ex-smokers of cigarettes. DESIGN: Cross-sectional study of the calf:brachial systolic blood pressure ratio and smoking history. SUBJECTS: Four hundred and ten male and 138 female civil servants aged 35-59 years working in the Department of the Environment Building, London. RESULTS: In men the systolic blood pressure ratio (Doppler calf:auscultatory brachial) decreased above the age of 50 years. However, different patterns were observed in those who had smoked at some time and those who had never smoked. In those who had never smoked the ratio in men aged 35-44 years was lower than that in men aged 55-59 years. In those who had smoked the average ratio rose from the age of 35-44 years to the age of 45-49 years and then fell to below the former value at the age of 55-59 years. There was a significant difference between lifelong non-smokers and current smokers at age 55-59 years. The pattern was similar in both male ex- and current smokers, and ex-smokers had results intermediate between those for current smokers and those who had never smoked. In women who had never smoked the ratio increased from the age of 35-44 years to the age of 50-59 years. In women aged 50-59 who currently smoke or used to smoke cigarettes the average ratio was close to that for women aged 35-44 years who had never smoked. CONCLUSIONS: The calf:brachial systolic blood pressure ratio is a simple measurement that may prove useful in detecting the early adverse effects of smoking on peripheral vascular disease. Lower ratios at older ages occurred in both current and ex-smokers, and the effects of smoking on peripheral arterial disease may not be easily reversible at older ages.

Adult↗
PubMed1992

Low blood pressure, low mood?

OBJECTIVE: To determine whether a set of physical symptoms is associated with low blood pressure and to investigate the possible role of psychological factors in their occurrence. DESIGN: Analysis of data collected by questionnaire and physical screening from the first phase of the Whitehall II study, a cohort study of an employed population. SETTING: 23 civil service departments in London. SUBJECTS: 10,314 male and female London based civil servants aged between 35 and 55. MAIN OUTCOME MEASURES: Symptoms of dizziness-giddiness and unexplained tiredness; psychological functioning as measured by the 30 item general health questionnaire in which the response "no more than usual" to an item about disease was scored as indicating chronic illness. RESULTS: Dizziness-giddiness in men and unexplained tiredness in both men and women were significantly related to low systolic blood pressure. There was a highly significant inverse relation between general health questionnaire score and systolic blood pressure for both men and women, which persisted after controlling for potentially confounding variables, including age, body mass index, drug treatment, physical illness, and exercise. This association of low blood pressure with physical symptoms was no longer significant when general health questionnaire score was controlled for. CONCLUSIONS: There seems a strong relation between low systolic blood pressure and minor psychological dysfunction. Associated physical symptoms seem to be secondary to the primary disturbance in mental state.

Adult↗
PubMed1992

Deriving a survey measure of social support: the reliability and validity of the Close Persons Questionnaire.

The development of a new questionnaire to measure social support, the Close Persons Questionnaire is described from the Whitehall II Study, a longitudinal study of the impact of psychosocial factors on health. The Close Persons Questionnaire includes items on three types of support from up to four nominated close persons and social networks. Its repeatability over a four week period and its validity against the Self Evaluation and Social Support Interview is reported in a sample of British Civil Servants. The difficulties of satisfactorily validating measures of social support are discussed.

Adult↗
PubMed1992

Occupation and hospitalization with ischaemic heart diseases: a new nationwide surveillance system based on hospital admissions.

A cohort of all people in Denmark aged 20-59 years on 1 January 1981 was followed up for four years for emigration, death and hospital admission for ischaemic heart disease (IHD) as the primary diagnosis. The data set allows tabulation of rates of hospitalization by occupation, position and industry. Well-known classic associations for IHD have been reproduced. Examples are: male bus drivers had a standardized hospitalization ratio (SHR) of 136; for male urban bus drivers SHR = 143, male taxi drivers SHR = 168, fishermen SHR = 129, men occupied in hotels and restaurants SHR = 140, women in hotels and restaurants SHR = 157. The consistency with previous findings is an argument that new significant associations should be treated as substantiated hypotheses if no selection bias is known. Examples of groups at significant excess risk of IHD are those self-employed in the textile industry, self-employed hairdressers, foremen in the construction industry, bakers, medical and industrial laboratory technicians, telephone assistants and unskilled tube and sheet workers in shipyards.

Adult↗
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↗
PubMed1989

INTERSALT study findings. Public health and medical care implications.

INTERSALT found a significant association between 24-hour urine sodium excretion and systolic blood pressure in individuals. There was also a significant association between sodium and slope (increase) of blood pressure with age across population samples. The weight of evidence from animal-experimental, clinical, intervention, and epidemiological data favors a causal relation. INTERSALT data from 52 centers in 32 countries permit an estimate of effect on average population blood pressure of lower sodium intake. Based on the sodium-blood pressure association in individuals, it was estimated that a habitual population sodium intake that was lower by 100 mmol/day (e.g., 70 vs. 170 mmol/day) would correspond to an average population systolic pressure that was lower by at least 2.2 mm Hg. This size difference in systolic blood pressure in major US and UK population studies is associated with 4% lower risk of coronary death and 6% lower risk of stroke death in middle age. If habitual diet is both lower in sodium and higher in potassium with lower alcohol intake and less obesity, INTERSALT data estimate average population systolic pressure would be lower by 5 mm Hg. This was calculated to correspond to a 9% lower risk of coronary death and a 14% lower risk of stroke death. INTERSALT cross-population data also suggest that, with a 100 mmol/day lower sodium intake over the life span, the average increase in population systolic pressure from age 25 to 55 years would be less by 9 mm Hg, corresponding at age 55 to a 16% lower risk of subsequent coronary death and 23% lower risk of stroke death.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The INTERSALT study: main results, conclusions and some implications.

INTERSALT is an epidemiological study of electrolyte excretion and blood pressure in 10,079 men and women from 52 centres and 32 countries. The data were collected according to strict protocol with extensive quality control, and were analysed both in individuals and across centres. In the individual analysis, with adjustment for confounding variables, significant positive associations were observed between blood pressure and twenty-four hour sodium excretion, body mass index and alcohol intake, and significant negative associations between blood pressure and potassium excretion. For a number of reasons, it is likely that the size of these relationships was underestimated. Across centres, linear slope of blood pressure with age was positively related to median sodium excretion. These observations imply that a policy combining changes in sodium and potassium intake with reductions in obesity and alcohol consumption could bring important public health benefits.

Adult↗
PubMed1988

Can general practitioners use training in relaxation and management of stress to reduce mild hypertension?

To see whether general practitioners could effectively carry out training in relaxation and management of stress to reduce mild hypertension a study was carried out with a subsample of phase 2 of the Medical Research Council's treatment of mild hypertension trial. In the main mild hypertension trial patients had been receiving either an active drug or placebo for six years. In phase 2 a subsample of these patients were randomly allocated either to continue or to stop receiving the active drug or placebo. In a further subsample patients were again randomised to receive or not to receive relaxation therapy. This factorial design presented an additional opportunity to assess whether patients controlled with active drugs might have their blood pressure maintained by this behavioural therapy once drug treatment was stopped and to assess whether blood pressure might be further reduced by this therapy in patients who had been under regular medical supervision for as long as six years and who had already received non-pharmacological advice. The therapy was conducted by general practitioners in group sessions once a week for eight weeks. The training in relaxation was accompanied by galvanic skin resistance biofeedback. At one year follow up blood pressure in the relaxation subgroups was either maintained (in the group who had stopped receiving drugs) or reduced further (in the group who had continued receiving drugs and in both placebo groups), while in the control group it had increased in all the subgroups, but particularly in those who had stopped receiving drugs. Differences in changes in blood pressure between the relaxation and control groups were significant. There were five new cardiovascular events, including evidence of myocardial ischaemia in blindly coded electrocardiograms in the control group, compared with one in the treatment group. General practitioners, if motivated, can successfully apply this technique of training those with mild hypertension in relaxation and management of stress.

Adult↗
PubMed1988

Could Parkinson's disease follow intra-uterine influenza?: a speculative hypothesis.

Patients with idiopathic Parkinson's disease do not appear to be distributed smoothly with respect to year of birth. Individuals born within the years 1892, 1904, 1909, 1918, 1919 and 1929 appear to have had an increased risk of developing idiopathic Parkinson's disease in later life. These years are close to those of the influenza pandemics of the period 1890-1930. The estimated risk of an individual developing idiopathic Parkinson's disease shows a significant correlation with the crude influenza mortality for the year of his birth, within the range 1900 to 1930. It is suggested that intra-uterine influenza may be cytotoxic to the developing foetal substantia nigra, and that an affected individual may be born without evident disability but with limited striatal neurochemical reserves and a reduced nigral cell count. In later life normal cellular involution with ageing or exposure to environmental neurotoxic factors may further erode these reserves to a level where the substantia nigra fails and idiopathic Parkinson's disease becomes clinically apparent.

Aged↗
PubMed1988

Social class and cardiovascular disease: the contribution of work.

Low social class has been identified as a risk factor for coronary heart disease in highly industrialized countries. The authors discuss the social class concept in relation to psychosocial working conditions. Most of those psychosocial work characteristics that are of relevance to cardiovascular risk, namely, skill discretion, authority over decisions, and social support at work, are unevenly distributed across social classes--the lower the social class, the fewer the resources for coping with psychosocial stressors. Furthermore, biomedical risk factors for cardiovascular illness are also unevenly distributed across social class and associated with psychosocial work characteristics. The main conclusion is that part of the association between social class and cardiovascular illness risk may be due to differences in psychosocial work conditions. The psychosocial work conditions may affect the risk through either neuroendocrine mechanisms or lifestyle. Excessive tobacco smoking, for instance, may be enforced by poor working conditions.

Coronary Disease↗