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Biomedical subjects

M Thorogood

Publications and source records attributed to M Thorogood.

122 records · Page 7Linked to original sources
PubMed1976

Risk factors for myocardial infarction in young women.

Seventy-seven women discharged from hospital with a diagnosis of myocardial infarction and 207 control patients were investigated. All were under 45 years of age at the time of admission. Heavy cigarette smoking, reported treatment for pre-eclamptic toxaemia, and type II hyperlipoproteinaemia were found to be independent risk factors for myocardial infarction. Reported treatment for hypertension and diabetes are probably also independently associated with subsequent development of the condition, but the associations between myocardial infarction and reported treatment for obesity and psychiatric illness appear to be secondary. Previous publications have suggested that use of oral contraceptives is an independent risk factor. Examination of the effect of several factors combined, suggests that they act synergistically, the presence of three or more factors increasing the risk 128-fold.

Adult↗
PubMed1975

Myocardial infarction in young women with special reference to oral contraceptive practice.

Sixty-three women discharged from hospital with a diagnosis of myocardial infarction and 189 control patients were studied. All were under 45 years of age at the time of admission. Current oral contraceptive use, heavy cigarette smoking, treated hypertension and diabetes, pre-eclamptic toxaemia, and obesity were all reported by, and type II hyperlipoproteinaemia was found more often in, patients with myocardial infarction than their controls. The relationship between myocardial infarction and oral contraceptives could not be explained in terms of an association between the use of these preparations and the other factors. The combined effect of the risk factors was clearly synergistic.

Adult↗
PubMed1975

Serum lipids in young female survivors of myocardial infarction.

Fasting serum lipids and lipoprotein patterns were studied in 44 female survivors of acute myocardial infarction under the age of 45 years, and in 84 matched control subjects. Type II hyperlipoproteinaemia was present in 41 per cent of the myocardial infarction patients and in none of the controls. There was, however, no difference in the prevalence of the type IV abnormality, which was present in 7 per cent of the myocardial infarction patients and 8 per cent of the control subjects. Mean cholesterol and triglyceride levels were both significantly higher in the women who had survived myocardial infarction than in the controls; the difference in triglyceride was attributable to the type IIb abnormality which occurred in 11 per cent of these patients. It is suggested that ovarian hormones may protect premenopausal women from type IV hyperlipoproteinaemia and its possible atherogenic sequelae.

Body Weight↗
PubMedDate not supplied

Lack of willpower or lack of wherewithal? "Internal" and "external" barriers to changing diet and exercise in a three year follow-up of participants in a health check.

The aims of this paper were to assess whether anticipated barriers to change in diet and exercise which were cited before a health check intervention were related to subsequent behaviour changes. In 1989 a health and lifestyle questionnaire was posted to 17,965 people aged 35-64 who were registered with five general practices in Bedfordshire. Taking account of non-contacts, a response rate of 80.3% was achieved and 11,090 people described their exercise and dietary habits. Those expressing an interest in changing each behaviour were asked to identify reasons why change might be difficult. Two types of barriers--"internal" and "external"--were identified. A total of 2205 respondents were invited to attend a health check in Year One and a recheck three years later and 1660 attended. In this subgroup improvement in exercise and diet was examined in relation to the participants' baseline characteristics, including the type of barriers selected. Internal barriers to change (e.g. lack of willpower, too lazy, too busy) were chosen most frequently. In a logistic regression including a range of baseline variables those who selected only internal barriers were less likely to take more exercise (OR 0.59, 95% CI 0.41, 0.86) than those who cited only external (e.g. no transport, can't afford sports facilities) or mixed barriers to changing. There was a similar but not statistically significant trend for changing diet (OR 0.78, 95% CI 0.48, 1.28). Those who are aware of external limitations may be better placed to circumvent them. Further research is needed to explore this relationship between type of barrier and behaviour change.

Adult↗
PubMedDate not supplied

The Oxford Community Diabetes Study: evidence for an increase in the prevalence of known diabetes in Great Britain.

A prevalence survey for known diabetes was conducted in a geographically defined population of nearly 40,100 in Oxford in April 1982. The age-adjusted prevalence rate was 10.4/1000 which did not differ significantly from age-adjusted rates of 9.5/1000 in Poole and 10.5/1000 in Southall. The prevalence increased with age and was higher in men than women over the age of 30 years. Our results confirm that there has been a change in the male to female sex ratio and suggest that there are about 500,000 diagnosed diabetics in England and Wales including about 190,000 insulin-treated patients. These findings are consistent with a secular increase in the prevalence of diagnosed diabetes over the last two decades which has important implications for the planning and provision of resources for care.

Age Factors↗
PubMedDate not supplied

Diabetes in the elderly: the Oxford Community Diabetes Study.

Most diabetic patients are elderly but their clinical characteristics remain poorly defined. A population survey identified 259 known diabetic patients aged 60 years or more giving a prevalence of 3% in this age group. A total of 193 patients (75%) were interviewed and examined, 155 (80%) of whom had been diagnosed at under 70 years of age. Forty-two patients (22%) were insulin-treated but clinical characteristics suggested that at least 95% of all elderly patients had Type 2 diabetes. Blood glucose control was poor with median HbA1 9.7% (range 4.9-17.1%, normal reference range 5.0-7.5%), and 55% were either overweight or obese. There was a high morbidity from diabetes and other conditions: the prevalence of hypertension (untreated blood pressure of 160/95 mmHg or more or antihypertensive medication) was 52%, of stroke 5%, of nephropathy (urinary albumin concentration greater than or equal to 300 mg l-1) 3%, of lower limb amputations 4%, and of foot ulcers 7%. The prevalence of symmetrically impaired distal vibration perception was 23%, and 54% of patients either needed or were receiving chiropody. The prevalence of a corrected distant visual acuity of 6/12 or worse was 32% and of retinopathy of any degree was 26%. There was extensive co-morbidity which was not confined to a single subgroup of patients.

Adult↗
PubMedDate not supplied

The prevalence and treatment of hypertension in the elderly population of the Mexican Institute of Social Security.

OBJECTIVE: To assess the prevalence and treatment of high blood pressure among elderly people in Mexico. MATERIAL AND METHODS: A cross-sectional study was conducted from February to July 1998 among the elderly people covered by the Instituto Mexicano del Seguro Social (IMSS) healthcare services in Mexico City. The study population consisted of 4,777 subjects aged 60 years and over, selected from a cohort of 5,433 people, representative of the population of Mexico City. Trained nurses carried out three blood pressure measurements at home. Diagnosis of high blood pressure was established if systolic pressure was equal to or higher than 160 mmHg, and/or diastolic pressure was equal or higher than 90 mmHg, or by self-report of a medical diagnosis of hypertension. Demographic and risk factor information was also collected. RESULTS: A total of 4,777 subjects were screened; 2,036 (43%) of them reported that they had been previously diagnosed as hypertensive. Of these, 1,954 (96%) were already on pharmacological treatment. A further 273 (5.7%) subjects were found to be hypertensive at screening. Among those receiving treatment, 1,399 (68.5%) had a blood pressure reading of less than 160/90 mmHg, and this was also the case for 59 (72%) of the known hypertensives not on treatment. A single drug was used by 1,556 (79.6%) of those on treatment. Risk factors for hypertension were more frequent in the hypertensive group (p 0.05 Pound). CONCLUSIONS: Almost half of the elderly population is hypertensive, most of them are already on treatment, but about one third of those on treatment do not have an adequate control of high blood pressure.

Aged↗
PubMedDate not supplied

Blood pressure-measuring devices in rural South Africa: an audit conducted by the SASPI team in the Agincourt field site.

BACKGROUND: Cardiovascular disease is an important cause of morbidity and mortality in South Africa. The Southern Africa Stroke Prevention Initiative (SASPI) found a high prevalence of stroke in the rural Agincourt subdistrict, Limpopo province. Hypertension is the commonest vascular risk factor in our population and it is essential that primary care services be adequately equipped to detect and treat hypertension. The aim of this study was to assess the number, accuracy and working condition of blood pressure measuring devices (BMD) in the clinics that serve the field site, and to assess the clinic sisters' perceptions of the availability of antihypertensive medication and aspirin. METHODS: In each of the clinics serving the site we assessed the BMDs and cuffs using the following criteria: general condition, bladder size, state of rubber components, operation of the inlet valve and control of valve operation. The legibility of the gauge, level and condition of the mercury, and the condition of the glass tube were checked when relevant. The performance of the BMD was then assessed both with the cuff used in the clinic and with a new functioning cuff, against an accurate mercury sphygmomanometer. By interviewing the clinic sister we could assess the availability of antihypertensive medication and aspirin, as well as the state of the drug delivery system. RESULTS: All BMDs were mercury sphygmomanometers. Four clinics had one BMD each, one clinic had two, and one clinic had four. In one clinic the device was not functional at all until the study cuff was used. None of the clinics had spare cuffs and only one clinic had access to a large cuff. Nine out of 10 (90%) cuffs tested had unsatisfactory valve function, and none was of the size recommended by the guidelines. Although the condition of the mercury was only considered satisfactory in 40% of BMDs, once a new cuff had been fitted to the BMDs all of them were accurate to within 4 mmHg between 50 and 250 mmHg. Fifty per cent of clinic sisters felt they always had sufficient stock of hydrochlorothiazide and alpha-methyldopa, but the supply of more expensive medication was less reliable. Only one clinic always had sufficient aspirin. CONCLUSION: Although none of the primary care clinics had fully functioning BMDs, almost all the defects related to malfunctioning and inappropriately sized cuffs, which would be inexpensive to repair or replace. A procedure for routine servicing or replacement of both BMDs and cuffs is needed, as well as optimisation of medication delivery to remote areas.

Ambulatory Care Facilities↗
PubMedDate not supplied

Genotypic and phenotypic variation in familial hypercholesterolemia.

Familial hypercholesterolemia is characterized by an increase in low density lipoprotein (LDL) cholesterol, tendon xanthomata, and premature atherosclerosis. In homozygotes, phenotypic expression of the disorder is dominated by genotypic variation at the LDL-receptor gene locus, with other influences, like gender, exerting relatively little effect. In contrast, phenotypic variation in heterozygotes is influenced not only by the nature of the underlying gene mutation but also by gender, diet, and other forms of genetic polymorphism, including the apolipoprotein E genotype.

Age Factors↗