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Biomedical subjects

M S Gilthorpe

Publications and source records attributed to M S Gilthorpe.

13 recordsLinked to original sources
PubMed1999

Risk factors for oral epithelial dysplasia--the role of smoking and alcohol.

The present study provides an assessment of the importance of tobacco and alcohol consumption upon the development of oral epithelial dysplasia (OED) in a large group of European patients. Data were collected in a case-control study based upon 630 patients with OED and 643 control subjects selected from UK dental hospital patients with oral disease not caused by tobacco or alcohol. Logistic regression was used to determine the association of several independent factors on the risk of OED. No relationship emerged between patient's gender, age or ethnicity and risk of OED. The regression model demonstrated a combined effect of tobacco smoking and alcohol drinking upon the risk of OED. Non-filter cigarette smoking was a significant predictor of OED, as was alcohol consumption, and the two habits compounded one another in the overall risk of disease. When both factors combined were included in the model through interaction terms, their individual impact was only moderately reduced, illustrating the importance of both factors in their own right. However, more detailed analysis of tobacco smoking habits revealed that the increased risk of OED from smoking was largely attributable to heavy smoking (20 cigarettes per day, OR = 4.38, 95% C.I. = 2.6, 7.2) especially non-filter cigarettes (OR = 1.95, 95% C.I. = 0.9, 4.0) relative to non-smoking. Both heavy smoking and non-filtered tobacco were higher risks for OED than alcohol consumption alone. Tobacco cessation was associated with a significant decline in risk of OED, the reduction being rapid and marked. For alcohol consumption the association with OED was considerably stronger for drinkers of fortified wines and spirits (OR = 3.75, 95% C.I. = 1.40, 10.05 and OR = 1.36, 95% C.I. = 0.76, 2.45, respectively). It is concluded that, while tobacco and alcohol synergistically influence the development of OED, exclusive tobacco consumption is more likely than exclusive alcohol consumption to give rise to OED. The risk of OED may thus be significantly reduced by behavioural changes such as moderation of tobacco and alcohol use.

Adult↗
PubMed1999

Variations in admissions to hospital for head injury and assault to the head. Part 1: Age and gender.

The study retrospectively investigated variations in the use of secondary healthcare for head injury, particularly assault. A total of 25,300 emergency head-related admission were examined over a two-year period, of which 3756 were for assault. More males were admitted during summer and holiday periods, while there were fewer female patients with head injuries and the incidence varied less. The largest number of admissions was among men aged 15-44 and most assaults occurred at weekends. Females were more likely than males to die from all head injuries (OR=1.31) and violent head injuries (OR=2.38). Women (15+) stayed longer in hospital than males. Injuries among males are primarily associated with social occasions. Females experience head injuries all the year round suggesting that these injuries are the result of domestic violence. There are important demographic differences in numbers of patients and duration of hospital care required to treat these avoidable injuries.

Adolescent↗
PubMed1999

Variations in admission to hospital for head injury and assault to the head. Part 2: Ethnic group.

This study retrospectively investigated variations in the use of secondary healthcare for head injury, particularly assault. A total of 25,300 emergency head-related admissions were examined over a two-year period, of which 3756 were assaults. There were seasonal differences according to ethnic group: far more injuries, particularly assault, occurred amongst the black and minority ethnic groups during the summer months and holidays. Black males had two to three times the rate of admission for assault than any other group. Among whites, females stayed longer in hospital after a head injury. White women stayed significantly longer than South Asian women following a head injury and South Asian men stayed significantly longer than white men after an assault. There are substantial seasonal variations and differences in the length of hospital stay after a head injury, particularly assault, depending on ethnic group. These differences require clarification and more detailed studies of head injuries ought to record the patient's ethnic background.

Black or African American↗
PubMed1998

The role of alcohol in non-smokers and tobacco in non-drinkers in the aetiology of oral epithelial dysplasia.

Oral epithelial dysplasia (OED) is an important risk factor in predicting subsequent development of invasive carcinoma. Despite the malignant potential of OED, the current state of knowledge regarding aetiological risk factors associated with OED is limited. The aim of our study was to evaluate the aetiological role of alcohol consumption in non-tobacco smokers and smoking behaviour in non-drinkers, in patients presenting with OED. Data from a hospital-based case-control study of OED were used to analyse the risk associated with alcohol in non-smokers and with tobacco in non-drinkers. A total of 140 cases and 236 controls were included. In the non-drinkers, the risks of OED increased with tobacco smoking of more than 20 cigarettes per day, particularly non-filter cigarettes. The risk of OED declined following smoking cessation, with ex-smokers of 10 or more years demonstrating no excess risk relative to non-smokers. In the nonsmokers, consumption of alcohol was not a significant predictor of OED. However, there was a synergistic effect of alcohol when combined with some aspects of tobacco smoking. Our results confirm that tobacco has an independent role in the aetiology of OED. The role of alcohol, however, is principally only important in conjunction with tobacco use.

Adult↗
PubMed1998

Variations in hospitalization rates for asthma among black and minority ethnic communities.

In response to the introduction of ethnic monitoring within the U.K. hospital inpatient data set, this study investigates the variations in secondary healthcare utilization by Black and minority ethnic communities whose cause of admission is related to asthma. The study examines all residents of the West Midlands: over 5 million people, of whom 8.5% are from Black and minority ethnic groups. A retrospective study of 15,921 asthma-related hospital admissions, from 1 April 1995 to 31 March 1996, was carried out. Age-standardized admission rates were higher in all Black and minority ethnic groups studied than in the White group. There were elevated rates in Black children aged 5-14 years, and particular differences were observed for Indian and Bangladeshi men and women aged 65 years or over. Emergency admissions to hospital for asthma were strongly associated with patients' socioeconomic background but this was largely observed for Black and minority ethnic groups that also generally experience high levels of deprivation. The findings support previous studies which suggest that hospital utilization rates for asthma among people from Black and minority ethnic groups are high compared with the White group, despite little evidence in measured prevalence. This study suggests that ethnic background is more important in asthma admissions than deprivation, which raises serious concerns on the appropriateness and quality of asthma care for these patient groups within our society. Future studies need to examine pathways to care, that is the health-seeking behaviour of Black and minority ethnic groups, the type of treatment received at the primary care level and referral patterns to secondary care.

Adolescent↗
PubMed1997

A sociodemographic analysis of inpatient oral surgery: 1989-1994.

This retrospective study was designed to assess the socioeconomic status of patients who underwent inpatient oral operations from 1989 to 1994 in the area covered by the West Midlands Regional Health Authority and to compare the distribution with those people treated by other specialties. A total of 4,926,438 hospital inpatient finished consultant episodes within 56 specialties that were recorded on the Hospital Episode Statistics database, of which 61,360 (1.25%) were dental (coded as oral surgery, restorative dentistry, orthodontics, and paediatric dentistry). The main outcome measure was the socioeconomic status of patients as assessed by the Townsend score (a measure of material deprivation that covers car ownership, home ownership, overcrowding, and unemployment). There was a highly significant correlation between the use of all inpatient services and social deprivation (R2 = 0.98, P < 0.001). This observation was consistent across all specialties except oral surgery, in which the correlation was reversed (R2 = 0.69, P < 0.001), indicating that patients who avail themselves of inpatient oral surgery are from a higher socioeconomic group. The application of a deprivation index to hospital episode data will enable purchasers and providers to measure more accurately the impact of their services on groups within the community.

Automobiles↗
PubMed1997

Application of the Mantel-Haenszel odds ratio in validation of hospital episode statistics data.

The National Health Service reforms have led to a growing need to determine the efficiency and cost effectiveness of health care provision. Resource utilization and the factors that influence it form a vital part of the information procured by commissioners of health care. Currently the most comprehensive source of routinely collected data is the Hospital Episode Statistics database. This database provides the most complete coverage of all areas of hospital inpatient services; these services account for up to 70% of the health care budget. Several studies have investigated the integrity of these data, but they have been concerned only with a subset of the data or with particular hospitals. This paper derives a method of data validation that can be applied either regionally or nationally to two key fields within the database: in this instance, consultant specialty and principal diagnosis. The process uses the Mantel-Haenszel odds ratio estimate to reveal large anomalies within either specialty of diagnostic coding. Within the West Midlands, it was generally observed that diagnosis codes are coded more consistently than consultant codes. However, problems occur due to incomplete or incorrect diagnostic entries and these anomalies are irregular across provider units. In contrast, anomalies within Korner specialty codes are associated predominantly with maternity, obstetrics, geriatric and general medicine. A large number of these anomalies are well understood within the context of local practice variation. Nevertheless, many anomalies remain within a wide range of other specialties where further investigation is warranted. Where systematic error is found, provider units should be notified in order to improve data consistency and enhance quality for future data users and health care planners.

Cost-Benefit Analysis↗
PubMed1997

An exploratory study combining hospital episode statistics with socio-demographic variables, to examine the access and utilisation of hospital oral surgery services.

OBJECTIVE: To examine the socio-economic background of patients who underwent inpatient and day-case oral operations from 1989-1994 in the West Midlands. DESIGN: Retrospective. SETTING: National Health Services Executive West Midlands; with a population of approximately 5.5 million. SUBJECTS: A total of 4,926,438 hospital inpatient finished consultant episodes, within 56 specialties recorded in the hospital episode statistics database, of which 60,904 (1.24 per cent) were dental; oral surgery. OUTCOME MEASURE: Standardised hospital inpatient activity ratios. RESULTS: The overall levels of activity rose moderately over the five year study period, although the type of activity remained consistent. Surgical removal of teeth was the third most common activity of all surgical procedures. Patients who availed themselves of elective inpatient oral surgery were generally from a higher socio-economic group, in marked contrast to those patients admitted for emergency oral surgery. This observation was highlighted even further by the procedure 'removal of impacted wisdom tooth', which accounted for 41 per cent of all oral surgery activity. The most deprived communities (15 per cent of the regional population) utilised this service 50 per cent less than all other groups. CONCLUSIONS: The application of a deprivation index to hospital episode data enables more accurate assessment of service utilisation by differing socio-economic groups. The inequality of the oral surgery provision to the 15 per cent of the population which were most deprived adds to the overall debate on the appropriateness of this service. Further examination of the pattern of behaviour and referrals amongst primary dental care services is clearly needed.

Adolescent↗
PubMed1995

The importance of normalisation in the construction of deprivation indices.

STUDY OBJECTIVES: Measuring socio-economic deprivation is a major challenge usually addressed through the use of composite indices. This paper aims to clarify the technical details regarding composite index construction. The distribution of some variables, for example unemployment, varies over time, and these variations must be considered when composite indices are periodically re-evaluated. The process of normalisation is examined in detail and particular attention is paid to the importance of symmetry and skewness of the composite variable distributions. DESIGN: Four different solutions of the Townsend index of socioeconomic deprivation are compared to reveal the effects that differing transformation processes have on the meaning or interpretation of the final index values. Differences in the rank order and the relative separation between values are investigated. MAIN RESULTS: Constituent variables which have been transformed to yield a more symmetric distribution provide indices that behave similarly, irrespective of the actual transformation methods adopted. Normalisation is seen to be of less importance than the removal of variable skewness. Furthermore, the degree of success of the transformation in removing skewness has a major effect in determining the variation between the individual electoral ward scores. Constituent variables undergoing no transformation produce an index that is distorted by the inherent variable skewness, and this index is not consistent between re-evaluations, either temporally or spatially. CONCLUSIONS: Effective transformation of constituent variables should always be undertaken when generating a composite index. The most important aspect is the removal of variable skewness. There is no need for the transformed variables to be normally distributed, only symmetrically distributed, before standardisation. Even where additional parameter weights are to be applied, which significantly alter the final index, appropriate transformation procedures should be adopted for the purpose of consistency over time and between different geographical areas.

Data Collection↗
PubMed1995

Mortality of copper cadmium alloy workers with special reference to lung cancer and non-malignant diseases of the respiratory system, 1946-92.

OBJECTIVES: To identify and quantify any relations between occupational exposure to cadmium oxide fume and mortalities from lung cancer and from chronic non-malignant diseases of the respiratory system. METHODS: The mortality experience of 347 copper cadmium alloy workers, 624 workers employed in the vicinity of copper cadmium alloy work (vicinity workers), and 521 iron and brass foundry workers (all men) was investigated for the period 1946-92. All subjects were first employed in these types of work in the period 1922-78 and for a minimum period of one year at one of two participating factories. Two analytical approaches were used, indirect standardisation and Poisson regression. RESULTS: Compared with the general population of England and Wales, mortality from lung cancer among copper cadmium alloy workers was close to expectation (observed deaths 18, expected deaths 17.8, standardised mortality ratio (SMR) 101, 95% confidence interval (95% CI) 60 to 159). A significant excess was shown for lung cancer among vicinity workers but not among iron and brass foundry workers (vicinity workers: observed 55, expected 34.3, SMR 160, 95% CI 121 to 209, P < 0.01; iron and brass foundry workers: observed 19, expected 17.8, SMR 107, 95% CI 64 to 167). Increased SMRs for non-malignant diseases of the respiratory system were shown for each of the three groups (alloy workers: observed 54, expected 23.5, SMR 230, 95% CI 172 to 300, P < 0.001; vicinity workers: observed 71, expected 43.0, SMR 165, 95% CI 129 to 208, P < 0.001; iron and brass foundry workers: observed 34, expected 17.1, SMR 199, 95% CI 137 to 278, P < 0.01). Work histories of the copper cadmium alloy workers were combined with independent assessments of cadmium exposures over time to develop individual estimates of cumulative exposure to cadmium; this being a time dependent variable. Poisson regression was used to investigate risks of lung cancer and risks of chronic non-malignant diseases of the respiratory system in relation to three levels of cumulative cadmium exposure (< 1600, 1600-4799, > or = 4800 micrograms.m-3.y). After adjustment for age, year of starting alloy work, factory, and time from starting alloy work, there was a significant positive trend (P < 0.01) between cumulative exposure to cadmium and risks of mortality from chronic non-malignant diseases of the respiratory system. Relative to a risk of unity for the lowest exposure category, risks were 4.54 (95% CI 1.96 to 10.51) for the middle exposure category and 4.74 (95% CI 1.81 to 12.43) for the highest exposure category. There was a non-significant negative trend between cumulative cadmium exposure and risks of mortality from lung cancer. Relative to a risk of unity for the lowest exposure category, risks were 0.85 (95% CI 0.27 to 2.68) for the middle exposure category and 0.81 (95% CI 0.18 to 3.73) for the highest exposure category. Similar findings were obtained when adjustment was made for age only. CONCLUSIONS: The findings are consistent with the hypothesis that exposure to cadmium oxide fume increases risks of mortality from chronic non-malignant diseases of the respiratory system. The findings do not support the hypothesis that exposure to cadmium oxide fume increases risks of mortality for lung cancer.

Alloys↗
PubMed1995

The prevalence of betel-quid and tobacco chewing among the Bangladeshi community resident in a United Kingdom area of multiple deprivation.

PURPOSE OF THE STUDY: This study set out to examine the prevalence of betel-quid chewing with or without the inclusion of tobacco and to provide baseline information on the experience, behaviour and perceptions of risk of first generation Bangladeshi adults. POPULATION STUDIED: A total of 127 households, which formed the sample base for this study, were selected by a systematic sampling procedure. Each household was visited by two interviewers and all adults resident in the home were asked to participate in the study. METHOD: A pretested questionnaire which explored the use, attitudes, knowledge of the health risk, and behaviour towards betel-quid chewing and the use of tobacco was used. FINDINGS: A total of 92% of males and 96% of females chewed betel-quid on a daily basis with 39% and 82% respectively including tobacco within their quid. There was a general acceptance of the use of tobacco, that is, males on the whole, smoking and females chewing tobacco. The perception of health risk, with regard to tobacco chewing, was low. CONCLUSION: The general acceptance of tobacco use and low perceived health risk in those engaged in tobacco chewing is a major concern that health professionals involved in health education need to address. General dental practitioners should be aware there is a high level of use in this community.

Adolescent↗
PubMedDate not supplied

Monitoring purchaser expenditure patterns.

This study outlines the development and application of a methodology that allows direct comparison of the elements that make up in-patient healthcare across the West Midlands Regional Health Authority. The methodology produces a model which monitors the mechanism of resource utilization within the Region and the factors that influence it. The model shows how the uptake of healthcare varies by treatment specialty, between each provider unit, and across all purchasing authorities in the Region. The methodology accounts in all instances for demography and where appropriate for socio-economic deprivation. The novelty of this study is the generation of provider unit specialty costs that reflect both recorded activity and expenditure in the locality. The results of the investigation are made available to the purchasers to assess the levels of the services they are buying.

Adult↗