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M Thorogood

Publications and source records attributed to M Thorogood.

At least 73 records · Page 4Linked to original sources
PubMed1995

Randomised controlled trials of physical activity promotion in free living populations: a review.

OBJECTIVES: To review evidence on the effectiveness of trials of physical activity promotion in healthy, free living adults. To identify the more effective intervention programmes. METHODS: Computerised databases and references were searched. Experts were contacted and asked for information about existing work. INCLUSION CRITERIA: Randomised controlled trials of healthy, free living adult subjects, where exercise behaviour was the dependent variable were included. CONCLUSIONS: Ten trials were identified. The small number of trials limits the strength of any conclusions and highlights the need for more research. No UK based studies were found. Previously sedentary adults can increase activity levels and sustain them. Promotion of these changes requires personal instruction, continued support, and exercise of moderate intensity which does not depend on attendance at a facility. The exercise should be easily included into an existing lifestyle and should be enjoyable. Walking is the exercise most likely to fulfil these criteria.

Adult↗
PubMed1995

Emergency appendicectomy and meat consumption in the UK.

STUDY OBJECTIVE: To compare the rates of reported emergency appendicectomies in a cohort study of vegetarians and non-vegetarians by participants' history of meat consumption. DESIGN: This was a prospective cohort study in which participants were asked about their lifetime history of meat consumption/avoidance and, separately, whether they had had an appendicectomy. Appendicectomy was described as either "emergency" or "non-emergency" according to details supplied by the participant. SETTING: The United Kingdom. PARTICIPANTS: These comprised more than 11000 people, of whom 4852 (44%) completed both an appendicectomy form and a dietary questionnaire giving details of their lifetime history of meat consumption. MAIN RESULTS: The percentage who reported an emergency appendicectomy was higher among lifelong meat eaters (10.7%) than either lifelong non-meat eaters (7.8%) or those who had stopped eating meat (8.0%); and the operations were performed at an earlier age in this first group (mean values 18.9, 26.0, and 19.6 years respectively). The overall age adjusted emergency participants who did not eat mean with those who ate meat was 0.47 (95% confidence interval 0.35, 0.65). CONCLUSION: The results suggests that people who do not eat meat have a 50% lower risk of requiring an emergency appendicectomy than those who do. The data do not, however, allow the reliable testing of other hypotheses, so meat consumption may simply be a marker for another dietary, lifestyle, or socioeconomic factor.

Aged↗
PubMed1995

The type and quality of randomized controlled trials (RCTs) published in UK public health journals.

BACKGROUND: Randomized controlled trials (RCTs) are increasingly being used to evaluate the effectiveness of health care interventions. Systematic reviews of RCTs form the basis of the Cochrane Collaboration, which aims to synthesize all RCTs concerned with the provision of health care. This paper reports the quantity and methodological quality of RCTs published in five UK public health journals, which were searched as part of a planned register of RCTs in public health. METHODS: Five journals were hand searched: The International Journal of Epidemiology, Health Trends, Journal of Public Health Medicine, Public Health and The Journal of Epidemiology and Community Health. All RCTs were identified and their methodological characteristics reviewed. RESULTS: Ninety-one trials were identified from the five journals. A wide variety of topics were covered, the most common being prevention strategies )46 percent of the trials). Although the actual number of reports of RCTs published increased over time, there was no detectable improvement in the quality of reports. The aspect of bias most well controlled was control of bias at entry (randomization), in 83 (91 per cent) of trials. However, even in these trials details about the process of randomization were poor. CONCLUSION: These trials will form the basis of a register of RCTs in public health. The diversity of topics covered illustrates the broad-based nature of public health. For this reason, many other RCTs relevant to the practice of public health are likely to be found in non-public health journals.

Humans↗
PubMed1995

The carrot, the stick and the general practitioner: how have changes in financial incentives affected health promotion activity in general practice?

BACKGROUND: Financial incentives for increasing health promotion activity in primary care, introduced with the 1990 contract for general practitioners, were amended in 1993 and are now focused on cardiovascular disease. Payments for health promotion clinics were abolished and target payments were introduced. AIM: The study aimed to evaluate the effect of the change, in June 1993, in financial incentives for health promotion activity in primary care on the distribution of health promotion payments in two family health services authorities. METHOD: A retrospective study was undertaken in which data from two family health services authorities were used to determine the annual level of health promotion payments per 1000 practice population before and after the contractual amendment. Health promotion clinic payment data were analysed for 78 practices in Bedfordshire Family Health Services Authority and 85 practices in Kensington, Chelsea and Westminster Family Health Services Authority. Changes in health promotion payments were calculated and related to two measures of relative need: all cause standardized mortality ratios, for patients aged 74 years or less, of the electoral ward in which the practice is located; and the Jarman underprivileged area score. High relative need was defined as a standardized mortality ratio of over 100 or more than 25% of the practice population living in electoral wards with a Jarman score of over 30. RESULTS: Health promotion payments were more evenly distributed after the change in June 1993 than before between the two family health services authorities and between general practices. Single-handed practices were carrying out more clinics in 1992 than multi-partner practices and consequently were one of the greatest financial losers as a result of the change. In addition, practices located in electoral wards with high relative needs lost proportionally more than those in electoral wards with lower needs. CONCLUSION: Changes in the general practitioner health promotion contract have created new financial winners and losers. It now appears that health promotion payments are more evenly distributed but that the distribution is unrelated to need or treatment given. More evidence on the effectiveness of health promotion interventions is required before policies aimed at promoting better health through primary care can be fully evaluated.

England↗
PubMed1994

Risk of death from cancer and ischaemic heart disease in meat and non-meat eaters.

OBJECTIVE: To investigate the health consequences of a vegetarian diet by examining the 12 year mortality of non-meat eaters and meat eating controls. DESIGN: Prospective observational study in which members of the non-meat eating cohort were asked to nominate friends or relatives as controls. SETTING: United Kingdom. SUBJECTS: 6115 non-meat eaters identified through the Vegetarian Society of the United Kingdom and the news media (mean (SD) age 38.7 (16.8) years) and 5015 controls who were meat eaters (39.3 (15.4) years). MAIN OUTCOME MEASURES: Standardised mortality ratios for cancer, ischaemic heart disease, and total mortality in the two cohorts and death rate ratio in the non-meat eaters compared with meat eaters after adjustment for potentially confounding variables. RESULTS: Standardised mortality ratios (taking the value among the general population as 100) for ischaemic heart disease were 51 (95% confidence interval 38 to 66) for meat eaters and 28 (20 to 38) for non-meat eaters (P < 0.01). Values for all cancers were 80 (64 to 98) and 50 (39 to 62) for meat eaters and non-meat eaters respectively. After adjustment for the effects of smoking, body mass index, and socioeconomic status death rate ratios in non-meat eaters compared with meat eaters were 0.72 (0.47 to 1.10) for ischaemic heart disease and 0.61 (0.44 to 0.84) for all cancers. CONCLUSIONS: The reduced mortality from cancer among those not eating meat is not explained by lifestyle related risk factors, which have a low prevalence among vegetarians. No firm conclusion can be made about deaths from ischaemic heart disease. These data do not justify advice to exclude meat from the diet since there are several attributes of a vegetarian diet apart from not eating meat which might reduce the risk.

Adult↗
PubMed1994

Vegetarianism, coronary disease risk factors and coronary heart disease.

Recent studies of vegetarians confirm a lower risk of fatal heart disease amongst such subjects. Lipid levels are lower in vegetarians, even when the diet of comparable meat-eaters is low in fat. This may partly explain the lower mortality, but it is not clear whether the absence of meat or some other aspect of the vegetarian diet is causal in this relationship.

Cohort Studies↗
PubMed1993

Losing heart?

Explore the source record for details and available documents.

Aged↗
PubMed1993

Cardiovascular risk and attitudes to lifestyle: what do patients think?

OBJECTIVE: To examine the relation between subjects' level of cardiovascular risk and their beliefs about the harmfulness of their smoking habit, current diet, and level of exercise, together with their stated desire to modify such behaviour. DESIGN: Self administered postal health and life-style questionnaire followed by a structured health check conducted by a nurse. SETTING: Five general practices in Luton and Dunstable, Bedfordshire. SUBJECTS: 5803 people aged 35-64 years enrolled in the OXCHECK trial who attended for a health check before 1 March 1992. MAIN OUTCOME MEASURES: Perceived risk to health of lifestyle behaviours, desire to modify behaviour, and a reported serious attempt to modify behaviour in the preceding year. RESULTS: A high proportion of smokers and those who were physically inactive perceived their behaviour to be harmful (1020; (76%; 95% confidence interval 74% to 79%) and 350 (74%; 70% to 78%) respectively) and wished to modify it (1212 (79%; 77% to 81%) and 375 (74%; 71% to 78%) respectively). In contrast, only 289 (45%; 41% to 48%) of obese people and 188 (14%; 12% to 16%) of people with a high dietary fat intake perceived their current diet to be harmful. The more cardiovascular risk factors present, the more likely subjects were to perceive a health risk attached to their diet and lack of exercise (p < 0.01 in both cases) and to want to improve their diet. CONCLUSION: Awareness of the health risk from smoking and motivation to stop is high. Further efforts are required, however, to educate the public about the risks associated with a high dietary fat intake. Although the health risks of inactivity were widely recognised, motivation to take more exercise needs to be increased.

Adult↗
PubMed1993

Combined oral contraceptives: risks and benefits.

By the age of 25 years, more than 95% of sexually active women have been exposed to combined oral contraceptives (COCs). Any effects associated with their use, therefore, carry important public health implications. COCs exert major protective effects against ovarian and endometrial cancer, which continue many years after cessation of use. COCs increase the risk of cardiovascular disease, but this risk is probably confined to current users. It is unclear whether lower dose preparations carry less risk. The precise relationship between COC use and risk of breast and cervical cancer is uncertain, although it is clear that COCs do not influence the overall risk of breast cancer. The risk-benefit equation for COC use depends crucially on assumptions about the true breast cancer risk. If there is no increased risk then COCs have a net beneficial effect on mortality, mainly due to the saving in ovarian cancer deaths. However, with more pessimistic assumptions about breast cancer, COCs have an adverse effect. The risk-benefit equation will vary for individual women. Most research has related to the developed world and extrapolation of findings to developing countries is inappropriate.

Adolescent↗
PubMed1993

Alcohol intake and the U-shaped curve: do non-drinkers have a higher prevalence of cardiovascular-related disease?

The data from the Oxford Vegetarian Study consists of the observation of around 11,000 individuals followed since the early 1980s. There are around 6000 subjects who do not eat meat and 5000 roughly matched individuals who do. An assiduous questionnaire survey was conducted at recruitment which inquired about health status, diet, drinking and other habits. We have tested the hypothesis that the U-shaped curve relating quantity of alcohol consumed and health is an artefact of selection of some individuals with high consumption and high risk migrating to the no-consumption group but retaining a high risk. The Oxford Vegetarian Study consists of a high proportion of lifelong teetotallers and ex-drinkers, and hence is particularly suitable for testing this hypothesis. We have examined the standardized rates of cardiovascular risk factors among the different dietary and drinking groups separately for men and women, as the bulk of the observed relationship of alcohol with health is mediated through cardiovascular mechanisms. We were unable to find a difference in the prevalence of risk factors between ex-drinkers and teetotallers, but we did find differences associated with dietary practices, particularly among females. These data cast some doubt on the hypothesis that selection may explain the apparent protective effect of moderate drinking when compared with groups currently not drinking (for whatever reason) and heavy drinking.

Alcohol Drinking↗
PubMed1993

Factors affecting response to an invitation to attend for a health check.

OBJECTIVE: To describe the characteristics of general practice patients who fail to respond to an invitation to attend for a health check, in relation to demographic variables, risk factor status, health status, and attitudes to behaviour modification. DESIGN: Postal questionnaire before invitation to attend a health check and subsequent record of attendance. SETTING: Five urban general practices in Bedfordshire, UK. SUBJECTS: A total of 2678 patients aged 35-64 years were invited for a health check in 1989-90. RESULTS: The number of patients who did not attend was low overall but was higher among men than women (21 v 15%, p < 0.001), and in unmarried than married patients (24 v 16%, p < 0.001). Failure to attend was also higher among people in manual than in non-manual occupations (21 v 15%, p < 0.001), in people living in rented accommodation than in homeowners (29 v 16%, p < 0.001), and in those without access to a car than in car users (27 v 16%, p < 0.001). There was no difference in non-attendance rate according to age at completion of full time education. After adjustment for age, sex, marital state, and social class, the odds ratio for non-attendance was 1.74 (95% confidence interval (CI) 1.41, 2.14) for smokers; 1.07 (95% CI 0.76, 1.51) for heavy drinkers; 1.91 (95% CI 1.41, 2.58) for those with a less healthy diet; and 1.50 (95% CI 1.09, 2.07) for those who were obese. Patients who had visited their general practice more frequently and those who indicated a willingness to change their behaviour were significantly more likely to attend the health check. CONCLUSIONS: Health check attendance was lowest among patients who rarely attended the surgery and those who reported higher risk behaviour. Attendance was not, however, confined to the 'worried well'. Equal numbers of those with and without chest pain attended, as did at least three quarters of those in each risk group. This high rate of attendance reflects the time and effort invested in systematic recruitment. The development of a robust recruiting strategy is essential if substantial numbers, and particularly those at highest risk, are to be reached.

Adult↗
PubMed1993

A prospective population-based study of microalbuminuria as a predictor of mortality in NIDDM.

OBJECTIVE: To assess prospectively the relationship between microalbuminuria and mortality in a geographically defined population of NIDDM patients and to determine the relative importance of microalbuminuria as a risk factor for mortality. RESEARCH DESIGN AND METHODS: A survey of known diabetes undertaken in 1982 identified a cohort of 249 NIDDM patients. Follow-up information was available for 246 patients who contributed 1498 person-yr exposure and were followed up for a mean period of 6.1 yr. The median age of the cohort at entry was 68 yr (range 28-89 yr), and the median duration of diabetes was 7 yr (range 1-41 yr). At baseline, a clinical examination was performed and a random daytime urine specimen was obtained for measurement of urinary albumin concentration. RESULTS: UAC results were available for 236 patients: 45 (19%) patients had a UAC > 15- < 40 mg/L; 36 (15%) had a UAC 40-200 mg/L; 10 (4%) had a UAC > 200 mg/L; and 145 (61%) had a normal UAC < or = 15 mg/L. During the follow-up period, 93 patients died. All-causes mortality, expressed as standardized mortality ratio (SMR = 149) and coronary heart disease mortality (CHD SMR = 166) were significantly increased. This excess mortality was significant in women (all-causes SMR = 194, CHD SMR = 234) but not in men (all-causes SMR = 118, CHD SMR = 128). On univariate analysis, systolic blood pressure was the only significant association with albumin concentration (P = 0.0002). An age-stratified log-rank test was conducted to determine the effect of potential explanatory variables on survival. Survival distributions were significantly different for known duration of diabetes (P = 0.045), intermittent claudication (P = 0.012), severity of retinopathy, lens opacity (P < 0.001) and UAC (P = 0.013) and diastolic blood pressure approached significance (P = 0.051). After adjusting for the effects of these potentially confounding variables identified by the log-rank analysis, significant predictors of early mortality on multivariate survival analysis were age, UAC of 40-200 mg/L (relative risk = 2.2, 95% confidence interval 1.3-3.7), more severe retinopathy (relative risk = 3.4, 95% confidence interval 1.9-6.0), and lens opacity (relative risk = 2.4, 95% confidence interval 1.6-3.8). CONCLUSIONS: The findings from this population-based cohort confirm the predictive power of microalbuminuria as a risk factor for mortality in NIDDM. In contrast to prospective studies of conventional cardiovascular risk factors in NIDDM, consistent evidence indicates that microalbuminuria is an independent predictor of excess mortality regardless of the collection procedure used.

Adolescent↗
PubMed1992

Fatal myocardial infarction and use of psychotropic drugs in young women.

We have observed an unexpected 17-fold increase in risk of fatal [corrected] myocardial infarction (relative risk 16.9, 95% confidence interval 3.9-72.8) associated with current use of psychotropic drugs. This incidental finding, in a case-control study of cardiovascular mortality in women aged 16-39 not designed to test any hypothesis about psychotropic drugs, should be treated cautiously. There is, however, evidence of a relation between psychiatric morbidity and cardiovascular disease and the association recorded here requires further investigation.

Adolescent↗
PubMed1992

Lifestyle advice in general practice: rates recalled by patients.

OBJECTIVE: To document how often patients with varying cardiovascular risk levels reported receiving lifestyle advice from general practice. DESIGN: Cross sectional descriptive survey by postal questionnaire. SETTING: 5 general practices in Bedfordshire. SUBJECTS: 4941 people aged 35-64 years who had consulted a general practitioner at least once during the 12 months before completing the questionnaire and who subsequently attended for a health check as part of the OXCHECK trial. MAIN OUTCOME MEASURES: Report of having received advice from a general practitioner or practice nurse about smoking, alcohol consumption, exercise, or diet during the 12 months before completing the questionnaire. Cardiovascular risk assessed by a nurse during structured health check. RESULTS: The overall reported rate of advice was 27% for smoking, 4.5% for exercise, 12% for diet, and 3% for alcohol consumption. Those with unhealthy behaviour profile or at increased cardiovascular risk received more advice--for example, 47% of smokers with a history of cardiovascular disease received advice on smoking. Among those at increased risk, men were more likely than women to receive advice about exercise (11% v 4%, p = 0.04) and alcohol consumption (10% v 4%, p = 0.007), while women received more advice about weight (17% v 23%, p < 0.001). The rate of receiving advice was unaffected by age, marital status, or social class. CONCLUSION: The low rate of lifestyle advice reported by patients implies that more preventive advice could be provided in primary care.

Adult↗
PubMed1992

Fatal stroke and use of oral contraceptives: findings from a case-control study.

A case-control study of women less than 40 years of age in England and Wales was performed to evaluate the risk of fatal stroke associated with the use of the newer, low-dose oral contraceptives. Included were 296 cases with subarachnoid hemorrhage, 105 cases with other hemorrhagic stroke, and 21 cases with occlusive stroke, all of which occurred during 1986-1988. Two living controls per case, matched for age and marital status, were chosen from the general practice lists. The power of the study was such that the minimum significant increased relative risk of subarachnoid hemorrhage associated with ever having used oral contraceptives that could have been detected with 90% certainty was 1.6; the equivalent value for occlusive stroke was 28.4. Relative risk was estimated by conditional logistic regression allowing for matching. The adjusted relative risk of subarachnoid hemorrhage associated with oral contraceptives was estimated to be 1.1 (95% confidence interval (CI) 0.6-1.9) for current use and 1.3 (95% CI 0.9-1.8) for ever use, while the equivalent relative risk of an occlusive stroke associated with ever use was 4.4 (95% CI 0.8-24.4). Oral contraceptive use may be associated with a small increase in the risk of subarachnoid hemorrhage. These data are consistent with a substantial increase in the risk of occlusive stroke associated with oral contraceptive use.

Adolescent↗
PubMed1992

Risk factors for fatal venous thromboembolism in young women: a case-control study.

A case-control study of fatal venous thromboembolism in young women is described. Sixty women aged between 16 and 39 who died from thromboembolism in England and Wales between 1986 and 1988 were included in the study. Two living controls matched for age and marital status were sought from the records of the general practitioner with whom each case was registered. Some 115 controls were included in the study. The cases had a significantly higher prevalence of a history of major illness, particularly thrombotic episodes, than the controls. The odds ratio (OR) of a fatal thromboembolism in women who had a history of venous thrombosis was 4.0 (95% Cl: 1.4-11.5). There was also a significantly higher frequency of a recent operation or accident amongst the cases than the controls (OR = 11.1, 95% Cl: 1.3-92.5). There was no significant excess or oral contraceptive use amongst the cases. The overall OR associated with current use of oral contraceptives was 1.6 (95% Cl: 0.7-3.4), while the corresponding OR for 'idiopathic' diseases was 2.1 (95% Cl: 0.8-5.2). These risks are considerably smaller than those observed in previous studies. The observed risk may be low because the dosage of oestrogen in modern oral contraceptive preparations has been reduced, but it may also be because the cases of fatal venous thromboembolism included in this study represent only a small proportion of all cases of venous thrombeombolism; a disease which is rarely fatal in young women. These results cannot necessarily be extrapolated to nonfatal venous thromboembolism.

Adolescent↗