ABC of rheumatology. Pain in the hand and wrist.
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Arthritis↗
Biomedical subjects
M Shipley
Publications and source records attributed to M Shipley.
Adult height and mortality in London: early life, socioeconomic confounding, or shrinkage?
STUDY OBJECTIVE: To examine in detail the cause specific associations between height and mortality. DESIGN: A prospective cohort study with an 18 year mortality follow up. SETTING AND PARTICIPANTS: The Whitehall study of 18,403 men in the civil service in London examined between 1967 and 1969 aged 40-64 and followed up for mortality until the end of January 1987. MAIN RESULTS: There was considerable variation in the strength of height-mortality association by cause. Respiratory disease showed the strongest inverse association, cardiovascular disease a moderate effect, and all neoplasms virtually no effect. Adjustment for age and civil service grade reduced the strength of these associations slightly, but had no impact on the heterogeneous pattern by cause (chi 2 3df p < 0.001). The height-mortality association declined with the length of follow up. By 15+ years, the only appreciable height affect was for respiratory disease mortality. CONCLUSIONS: The attenuation of the height-mortality association with length of follow up might be explained by differential height reduction before entry that was greatest for people who were already ill, and hence at greatest risk of dying. The cause specific variation in the height-mortality association lends little support to the contention that impaired growth in childhood is a marker of general susceptibility to disease in adulthood.
Adult↗
Sickness absence as a measure of health status and functioning: from the UK Whitehall II study.
STUDY OBJECTIVE: To investigate the relationship between self reported health status and sickness absence. DESIGN: Analysis of questionnaire and sickness absence data from the first phase of the Whitehall II study--a longitudinal study set up to investigate the degree and causes of the social gradient in morbidity and mortality. SETTING: London offices of 20 civil service departments. PARTICIPANTS: Altogether 6895 male and 3413 female civil servants aged 35-55 years. Analysis was conducted on 88% of participants who had complete data for the present analysis. MAIN RESULTS: A strong inverse relation between the grade of employment (measure of socioeconomic status) and sickness absence was observed. Men in the lowest grade had rates of sickness absence six times higher than those in the highest grade. For women the corresponding differences were two to five times higher. In general, the longer the duration of absence, the more strongly did baseline health predict rates of absence. However, the health measures also predicted shorter spells, although to a lesser extent. Job satisfaction was strongly related to sickness absence with higher rates in those who reported low job satisfaction. After adjusting for health status the association remained for one to two day absences, but was greatly reduced for absences longer than three days. CONCLUSION: There was a strong association between ill health and sickness absence, particularly for longer spells. The magnitude of the association may have been underestimated because of the strength of the association between grade of employment and sickness absence. It is proposed that sickness absence be used as an integrated measure of physical, psychological, and social functioning in studies of working populations.
Absenteeism↗
Sickness absence in the Whitehall II study, London: the role of social support and material problems.
STUDY OBJECTIVE: To investigate the role of social supports, social networks, and chronic stressors: (i) as predictors of sickness absence; and (ii) as potential explanations for the socioeconomic gradient in sickness absence. DESIGN: A prospective cohort study (Whitehall II study) with sociodemographic factors, health and social support measured at baseline, and spells of sickness absence measured prospectively. SETTING: Twenty London based non-industrial departments of the British civil service. PARTICIPANTS: Participants were civil servants (n = 10,308), aged 35-55 years at baseline, of whom 67% (6895) were men and 33% (3413) were women. The overall response rate for Whitehall II was 73% (74% for men and 71% for women). The analysis is based on 41% of the sample who had data on reasons for sickness absence and were administered all social support questions. Only 4.3% of participants did not complete all necessary questions and were excluded. MEASUREMENTS AND MAIN RESULTS: High levels of confiding/emotional support from the "closest person" predicted higher levels of both short and long spells of sickness absence. After adjusting for baseline physical and psychological health the effects were increased, suggesting that high levels of confiding/emotional support may encourage illness behaviour rather than generate illness. Social network measures showed a consistent but less striking pattern. Increased levels of negative aspects of social support resulted in higher rates of sickness absence. Material problems strongly predicted sickness absence, but the effect was diminished once adjustment for the covariables was made, suggesting that health status may be functioning as an intervening variable between chronic stressors and sickness absence. In addition, social support may buffer the effects of chronic stressors. Social support did not contribute to explaining the gradient in sickness absence by employment grade beyond that explained by the baseline covariables. CONCLUSIONS: Sickness absence from work is a complex phenomenon, combining illness and coping behaviours. High levels of confiding/emotional support, although not entirely consistent across samples, may either encourage people to stay at home when they are ill or may be accompanied by more social obligations at home prolonging sickness absence. Negative aspects of close relationships may jeopardize health and hence increase sickness absence.
Administrative Personnel↗
Birth weight and later socioeconomic disadvantage: evidence from the 1958 British cohort study.
OBJECTIVE: To investigate the relation between birth weight and socioeconomic disadvantage during childhood and adolescence in a birth cohort study. DESIGN: Longitudinal analysis of birth weight in relation to social class, household amenities and overcrowding, and financial difficulties as reported by parents at interview when participants were aged 7, 11, and 16 years; and receipt of unemployment or supplementary benefits as reported by participants at age 23. SUBJECTS: Male participants in the 1958 birth cohort (national child development study) born to parents resident in Great Britain during the week of 3-9 March 1958. Data on birth weight and financial difficulties between birth and 23 years were available for 4321; data on housing conditions and social class at ages 7, 11, and 16 years were available for 3370. MAIN OUTCOME MEASURES: Socioeconomic disadvantage at later ages in men weighing 6 lb (2721g) or under at birth compared with those weighing over 6 lb and between fifths of the distribution of birth weight. RESULTS: Cohort members who weighed 6 lb or under at birth were more likely to experience socioeconomic disadvantage subsequently. Those in lower fifths of the distribution were more likely to experience socioeconomic disadvantage. CONCLUSION: Low birth weight is associated with socioeconomic disadvantage in childhood and adolescence. Studies of the association of indicators of early development and adult disease need to take into account experiences right through from birth to adulthood if they are to elucidate the combination of risks attributable to developmental problems and socioeconomic disadvantage.
Adolescent↗
Urinary electrolyte excretion in 24 hours and blood pressure in the INTERSALT Study. I. Estimates of reliability. The INTERSALT Cooperative Research Group.
This is the first of two reports dealing with the reliability of measurements of 24-hour urinary electrolyte excretion and blood pressure and estimates of electrolyte-blood pressure associations in INTERSALT, an international study of the relations of electrolyte excretion and other factors to blood pressure, involving more than 10,000 persons from 52 centers in 32 countries. This first report describes methods for estimating reliability, taking into account age and sex, and provides estimates for several urinary variables, blood pressure, and pulse rate. The second report (Am J Epidemiol 1994; 139:940-51) uses these estimates of reliability and multivariate procedures to correct multiple regression coefficients from regressions of blood pressure on 24-hour urinary sodium and potassium excretion, body mass index, and alcohol intake for "regression dilution bias." Age- and sex-adjusted estimates of reliability were computed from data on 805 INTERSALT participants with repeat measurements. These estimates ranged from 0.37 to 0.40 for 24-hour urinary sodium, from 0.47 to 0.52 for potassium, from 0.32 to 0.36 for the sodium:potassium ratio, from 0.64 to 0.69 for calcium, from 0.59 to 0.65 for creatinine, from 0.49 to 0.57 for urinary volume, from 0.49 to 0.51 for magnesium, from 0.58 to 0.62 for pulse, from 0.69 to 0.74 for systolic blood pressure, and from 0.63 to 0.67 for diastolic blood pressure. In addition, estimates of within- and between-person covariances among electrolytes indicated that about half of the observed covariance for sodium and potassium excretion in a single 24-hour urine collection was due to within-person covariation in excretion.
Adult↗
Urinary electrolyte excretion in 24 hours and blood pressure in the INTERSALT Study. II. Estimates of electrolyte-blood pressure associations corrected for regression dilution bias. The INTERSALT Cooperative Research Group.
This is the second of two reports dealing with the reliability of measurements of 24-hour urinary electrolyte excretion and blood pressure and estimates of electrolyte-blood pressure associations in INTERSALT, an international study of the relations of electrolyte excretion and other factors to blood pressure, involving more than 10,000 persons from 52 centers in 32 countries. The first report (Am J Epidemiol 1994; 139:927-39) described methods of estimating reliability, taking into account age and sex, and provided estimates for several urinary variables, blood pressure, and pulse rate. This second report uses these estimates of reliability and multivariate procedures to correct associations with blood pressure for "regression dilution bias." In these analyses, the estimated mean change in systolic blood pressure associated with a 100-mmol decrease in sodium intake was -3.1 mmHg with adjustment for age, sex, body mass index, and alcohol intake. For potassium, the estimated mean change in systolic pressure associated with a 15-mmol increase in potassium intake was -1.0 mmHg. These estimates are 44%-50% larger than those previously reported in INTERSALT, based on simple corrections for reliability. Furthermore, compared with previously reported INTERSALT values, the estimated mean change in systolic pressure per unit of change in body mass index decreased by about 5% and that for consumption of > or = 300 ml of absolute alcohol per week increased by about 6%. These results further clarify the observed INTERSALT associations of systolic blood pressure with 24-hour urinary sodium and potassium excretion, body mass index, and alcohol intake.
Adult↗
Nystagmus and joint position sensation: their importance in posterior occipitocervical fusion in rheumatoid arthritis.
It is widely believed that brain stem dysfunction and cranial nerve palsies in patients with rheumatoid arthritis (RA) are common and related to the vertical translocation of the odontoid process. In our database of 235 patients with seropositive RA and craniocervical junction involvement, we have found a very low incidence of such problems. Long tract signs were common, but loss of proprioception (joint position sensation) as the sole neurologic deficit was rare. Nystagmus was found to be associated with the tonsillar herniation of a Chiari 1 malformation and loss of joint position sensation with severe compression of the posterior aspect of the spinal cord at the craniocervical junction. The implications for posterior occipitocervical fusion, particularly by sublaminar wiring, are discussed.
Adolescent↗
Body mass index and associations of sodium and potassium with blood pressure in INTERSALT.
This report further examines the relation of body mass index (BMI) to associations of 24-hour urinary sodium, potassium, and sodium-potassium ratio with blood pressure in INTERSALT, a 52-center international study of electrolytes and blood pressure. Analyses without adjustment for BMI indicated average systolic pressure greater by 6.00 mm Hg per 100 mmol higher sodium and diastolic by 2.52 mm Hg. With adjustment for BMI, these values were reduced to 3.14 and 0.14 mm Hg, respectively. For the sodium-potassium ratio, blood pressure associations were stronger when not adjusted for BMI, and for potassium, adjustment generally had little effect. To explore possible interactions of these variables with BMI in relation to blood pressure, the 52 centers were divided into two groups of 26 based on whether the center median for BMI was less than or greater than or equal to 24.5 kg/m2, and individuals within each of the 52 centers were classified into lower- or higher-BMI groups based on individual BMI less than or greater than or equal to 24.1 kg/m2. Sodium and the sodium-potassium ratio were positively and significantly and potassium inversely and significantly related to systolic pressure in all four of these subgroups, and the sodium-potassium ratio and potassium were related to diastolic pressure in two and three subgroups, respectively. Electrolyte-blood pressure associations did not differ significantly between the two subgroups of centers or between the two subgroups based on individuals.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Psychological aspects of rheumatic diseases.
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Humans↗
Factors predicting death, survival and functional outcome in a prospective study of early rheumatoid disease over fifteen years.
Sixty-four survivors from a prospective study of early rheumatoid disease were assessed again at a mean of 15.2 years from presentation and their status compared with 29 patients who had died. Eleven of the dead and only two of the survivors had been treated with steroids. There was a small increase in mortality due to the disease itself but only one death was directly caused by it. As might be expected, those who died were older. In the first year of disease, they had lower haemoglobin levels, a lower body mass, higher sedimentation rates and higher levels of blood urea. One-fifth at entry to the study and two-fifths by the time of death, had poor functional capacity. Of 64 survivors, six had poor functional capacity at entry and nine after 15 years. Discriminant analysis was performed to identify the most powerful combination of early features predicting a poor functional outcome. A combination including early erosive change, seropositivity, poor grip strength and cervical subluxation predicted the outcome correctly in 73% of survivors. Almost 60% of survivors remained with or improved to normal function at 15 years suggesting that morbidity is not as bad as has been suggested in the past.
Adult↗
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↗
Radiological progression in rheumatoid arthritis: how many patients are required in a treatment trial to test disease modification?
OBJECTIVE: To determine whether the number of patients required in a therapeutic trial that uses progression of radiological abnormalities as the outcome measure would be similar for multiple centres. METHODS: The progression of radiological damage to the fingers and wrists of patients with rheumatoid arthritis in five centres, three in North America and two in Europe, was examined. The reproducibility of repeated readings by the same and multiple observers was examined. The number of patients required in a two group trial was calculated for several combinations of power and significance. RESULTS: Scoring progression of radiological abnormalities in sequential films taken between 0.5 and 2.1 years was found to be highly reproducible. When the scores of a single reader were used the rate of change of radiological scores was similar in all centres. Based on the mean progression rate for all centres it was estimated that 153 patients in each group would be required to assure 90% power for detecting a 50% slowing of radiological progression at a significance of 0.05. Review of the experience in three trials showed a large variability in the radiological progression rates. CONCLUSION: The progression of scores for radiological damage in rheumatoid arthritis is relatively uniform in North America and Europe and thus the number of patients required in a trial would be similar. Experience in three trials showed that patient selection is of paramount importance in setting up a successful study.
Adult↗
Magnitude and causes of mortality differences between married and unmarried men.
STUDY OBJECTIVE: To determine the effect of marital status on mortality for men. In particular, to examine whether subgroups of unmarried men (widowed, single, and divorced/separated men) have a similar mortality to married men. DESIGN: Cohort study. SETTING: Whitehall civil service, London, between 1967 and 1969. PARTICIPANTS: A total of 18,403 men aged 40-64 years with 18 years' follow up. MEASUREMENTS AND MAIN RESULTS: Cause-specific mortality rates and risk factors at baseline were determined. Overall mortality was greater for all groups of unmarried men. Patterns of mortality were different in the subgroups of unmarried men. Widowed men had a significantly greater risk of dying from ischaemic heart disease (relative risk (RR) 1.46, 95% confidence interval (CI) 1.08, 1.97) which persisted after exclusion of deaths that occurred in the first two years. Divorced men had greater cancer mortality (RR 1.49; 95% CI 1.06, 2.10) that could not be explained simply by their greater consumption of cigarettes. The initial increased mortality for single men was no longer evident after adjustment for other risk factors, suggesting that single status in itself may not increase the risk. The risk for single men may have been underestimated, however, by over adjustment for possible intermediary factors. CONCLUSIONS: Previous studies, which have examined total mortality only or have grouped all unmarried men, have masked interesting differences in the cause of death between subgroups of unmarried men. The extent to which the findings are explicable by psychosocial factors or the role of other environmental factors, which may also differ in relation to marital status, is unclear. Future work should not assume that all unmarried men have similar mortality risks and must examine the life course of each subgroup to advance our understanding of the possible causal role of marital status in disease aetiology.
Adult↗
Serum cholesterol concentration and primary malignant brain tumors: a prospective study.
Case-control studies and a prospective study have suggested a positive relation between serum cholesterol and brain tumors. To examine this association further, mortality from malignant brain tumors among men who participated in the Multiple Risk Factor Intervention Trial (a prospective study, 1973-1986) who indicated they were not black were examined. No relation was seen between age-standardized mortality rates and baseline serum cholesterol. Excluding deaths occurring during the first 5 years or adjusting for median census tract income did not alter this finding. This suggests that no generalizable relation between serum cholesterol and primary malignant brain tumors exists. An environmental factor associated with serum cholesterol in some, but not all populations, may explain the apparently contradictory results.
Adult↗
Higher blood pressure in adults with less education. Some explanations from INTERSALT.
An inverse association between social class and disease has frequently been reported; education, an indicator of social class, was negatively related to blood pressure in several studies. Reasons are not clear. INTERSALT, an international study on electrolytes and blood pressure, obtained data on years of education for 10,079 adults in 52 centers in 32 countries. Data presented here are for 47 centers, omitting five where the population in the sample had no education or no differences in educational level. Regression coefficients were calculated for the education-blood pressure association in each center. An inverse association was found for men in 28 centers and for women in 38. Center coefficients were combined to give a studywide estimate of that association. When adjusted only for age, systolic pressure in men was 1.3 mm Hg higher for 10 fewer years of education (p less than 0.05) and for women 4.5 mm Hg higher (p less than 0.001). However, when adjusted also for five lifestyle factors (24-hour sodium and potassium excretion, body mass index, alcohol intake, and smoking), these estimates were reduced by about one half, and the inverse association was no longer significant for men. Similar findings were obtained for diastolic pressure. Those with less education had on average higher sodium excretion, lower potassium excretion, greater body mass, and higher alcohol intake, all factors tending to increase blood pressure. Improvement of these factors, which help explain the differences in blood pressure related to years of education, has the potential to reduce the blood pressure disadvantage associated with lower socioeconomic status.
Adult↗
Stroke risk from alcohol consumption using different control groups.
BACKGROUND AND PURPOSE: Our aim in this study was to investigate the relation between chronic alcohol consumption and stroke. METHODS: A case-control study was carried out using two hospital-based control groups and the results of a community-based survey of alcohol consumption. Hospital-based control subjects were chosen either from "general" medical admissions or a subset of "select" admissions that excluded possible alcohol-related admissions. Cases were selected from hospital inpatients. RESULTS: The relative risk for stroke associated with alcohol consumption greater than 300 grams per week for general control subjects was 0.73 (95% confidence interval [CI], 0.54-3.49) compared with 1.30 (95% CI, 0.42-4.05) for select control subjects. The odds ratio was further increased to 1.93 (95% CI, 0.87-4.28) using data from the community-based survey. None of these estimates were statistically significant. CONCLUSIONS: These results illustrate how the risk associated with alcohol consumption varies depending on the choice of control groups and may explain the contradictory results from previous case-control studies. Because of different biases associated with control selection, we believe that the results of this study are consistent with those of other studies that demonstrate a modest increased risk for stroke associated with alcohol consumption.
Adult↗