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Biomedical subjects

M Whitehead

Publications and source records attributed to M Whitehead.

At least 37 records · Page 2Linked to original sources
PubMed2000

Are randomized trials of hormone replacement therapy in symptomatic women with breast cancer feasible?

OBJECTIVE: To evaluate the feasibility of conducting a large randomized trial of HRT in symptomatic women with early-stage breast cancer. DESIGN: Open randomized study. SETTING: Outpatient clinics at The Royal Marsden and St. George's Hospitals, London. PATIENT(S): One hundred postmenopausal women with early-stage breast cancer, experiencing vasomotor symptoms and/or vaginal dryness. INTERVENTION(S): Randomization (1:1) to HRT or no HRT for 6 months. MAIN OUTCOME MEASURE(S): Acceptance, continuance rates, and the reasons eligible women declined study entry. RESULT(S): Acceptance (38.8%) and continuance rates (>80%) were encouraging. The efficacy of HRT did not appear to be antagonized with concomitant tamoxifen. Seventy-five percent of women continued HRT after the study ended. Three women developed metastatic disease. Two used HRT. CONCLUSION(S): Despite informed consent, a national UK randomized trial of HRT should be feasible and has now been planned. Successful implementation necessitates the provision of information about HRT and the estrogen deficiency side effects of breast cancer therapy to health professionals and women with breast cancer.

Adult↗
PubMed2000

Social policies and the pathways to inequalities in health: a comparative analysis of lone mothers in Britain and Sweden.

The aim of this study is to contribute to the emerging field of health inequalities impact assessment. It develops further a conceptual framework that encompasses the policy context as well as the pathways leading from social position to inequalities in health. It then uses this framework for a comparative analysis of social policies and their points of potential impact on the pathways leading from lone motherhood to ill health in Britain and Sweden. The British General Household Survey and the Swedish Survey of Living Conditions are analysed for the 17 years from 1979 to 1995/96. First, the results show that the health of lone mothers is poor in Sweden as well as in Britain and, most notably, that the magnitude of the differential between lone and couple mothers is of a similar order in Sweden as in Britain. This is despite the more favourable social policies in Sweden, which our results indicate have protected lone mothers from poverty and insecurity in the labour market to a much greater degree than the equivalent British policies over the 1980s and 1990s. Second, the pathways leading to the observed health disadvantage of lone mothers appear to be very different in the two countries in relation to the identified policy entry points. Overall, in Britain, around 50% of the health disadvantage of lone mothers is accounted for by the mediating factors of poverty and joblessness, whereas in Sweden these factors only account for between 3% and 13% of the health gap. The final section discusses the implications of the findings for future policy intervention and research in the two countries.

Cross-Cultural Comparison↗
PubMed2000

Second primary malignancies following the treatment of early stage ovarian cancer: update of a study by the National Cancer Institute of Canada--Clinical Trials Group (NCIC-CTG).

BACKGROUND: Ovarian cancer is the leading cause of death from gynecological malignancies and the fourth most frequent fatal malignancy in women. Despite improved surgical techniques as many as 20% of women with early stage disease will eventually relapse and die from their disease. The post-operative management of these women remains controversial. Here we present the long term follow-up data of our previously published study, as well as the incidence of second primary malignancies in these women. PATIENTS AND METHODS: Two hundred fifty-seven eligible patients with stage I, IIA 'high risk' ovarian carcinoma and IIB, IIIO (disease confined to pelvis) were randomized to either whole abdominal radiotherapy 2.250 rads in ten fractions (107 patients), melphalan 8 mg/m2/d x 4 weeks x 18 courses (106 patients) or intraperitoneal chromic phosphate 10-20 mCi (44 patients). All patients were initially treated with pelvic radiotherapy. RESULTS: Overall survival estimates at 10 years were: 45% in the whole abdominal radiotherapy arm; 49% in the melphalan arm and 50% in the intraperitoneal chromic phosphate arm (P = 0.30). Relapse-free survival estimates at 10 years were: 50% in the whole abdominal radiotherapy arm, 62% in the melphalan arm and 51% in the chromic phosphate arm (P = 0.147). Long term follow-up has not demonstrated a significant difference between treatment arms. Second primary malignancies developed in 29 women (11%) after 2,229 person years of follow-up. This compares to 18.7 second primary malignancies which would have been expected in this group of age-matched controls and was statistically significant (P = 0.018). There was no significant difference in the total number of second primary malignancies between treatment arms. Melphalan appeared to be associated with an increased risk of developing leukemia/myelodysplastic syndrome compared to the whole abdominal radiotherapy arm (P = 0.06). CONCLUSIONS: Long-term follow-up has not demonstrated a significant difference in overall or disease free survival between treatment arms. An excess of second primary malignancies (35%) was observed suggesting that lifelong surveillance is required in this population. Further research with newer treatment programs are needed to improve the cure rates in this population.

Antineoplastic Agents, Alkylating↗
PubMed2000

Inequality in the social consequences of illness: how well do people with long-term illness fare in the British and Swedish labor markets?

The demand for unskilled labor has collapsed across industrialized societies, including Britain and Sweden, and rates of unemployment and economic inactivity have increased. The result is a reduction in total employment, primarily among men. These trends could be expected to hit particularly hard those people with chronic illness. The study tests two opposing hypotheses: (1) the increasingly flexible, deregulated labor market in Britain would result in an increased number of new jobs, and thus better employment opportunities for unskilled workers, including those with chronic illness; (2) the more regulated labor market in Sweden, with the associated health and social policies, would provide greater opportunities for jobs and job security for workers with chronic illness. Analysis of data on men from the British General Household Survey and the Swedish Survey of Living Conditions, 1979-1995, showed that employment rates were higher and rates of unemployment and economic inactivity were lower in Sweden than in Britain, and the differences in these rates across socioeconomic groups and between those with and without chronic illness were smaller in Sweden. The results support the hypothesis that active labor market policies and employment protection may increase the opportunities for people with chronic illness to remain in work.

Adult↗
PubMed2000

William Farr's legacy to the study of inequalities in health.

This section looks back to some of the ground-breaking contributions to public health, reproducing them in their original form and adding a commentary on their significance from a modern-day perspective. To complement this month's theme issue of the Bulletin, Margaret Whitehead assesses the importance of William Farr's contribution to the study of social inequalities in health.

England↗
PubMed2000

Intracanalicular meningioma.

Intracanalicular meningiomas are extremely rare and difficult to differentiate from intracanalicular vestibular schwannomas. We report an unusual case of a posterior fossa meningioma in the proximal internal auditory canal that was originally diagnosed as a vestibular schwannoma due to its appearance on magnetic resonance imaging. However, closer inspection of the preoperative neuroimages revealed features inconsistent with vestibular schwannoma that suggested the possibility of other less common lesions.

Cranial Fossa, Posterior↗
PubMed2000

Inequalities in health--development and change.

This article traces the changes that have taken place in the analysis and interpretation of health inequalities over the last 25 years. It sets these in their historic context, indicates how the debate on their validity and social context has shifted over the period and assesses the current evidence on the extent and importance of social variations.

Health Planning↗
PubMed2000

The need for continuing education of the prescriber.

The Millennium will be seen as an important time of change in the doctor-patient relationship. Until very recently, many patients, male and female, expected not only advice from their doctor, but also to be told which treatment would be best for them. This paternalistic approach, however, is rapidly disappearing. Nowadays, early post-menopausal women expect to make decisions about their treatment, after being fully informed of all the possible benefits and risks. Provision for this requires the doctor to keep abreast of the literature. Occasionally, new data are released that challenge established beliefs. It was thought, for example, that hormone replacement therapy (HRT) would reduce the risk of coronary heart disease. This still applies to apparently fit and healthy women but data from the Heart and Estrogen/progestin Replacement Study (HERS) have shown that the use of HRT in women with established risk factors for coronary heart disease increases mortality in the short term. A protective effect of HRT on the risk of coronary heart disease was not observed until after 2-3 years of treatment. Patient access to medical information has been revolutionized during the last decade. The availability of books, magazines and newspaper articles, which have always been an important source of patient information, has greatly increased. In addition, the Internet has transformed patient knowledge. According to surveys, these forms of communication provide the major source of information for 50% of women seeking advice about HRT. Indeed, the patient is often aware of the latest medical information before her doctor, possibly because she has more time. With such a large readership, these forms of communication have to report accurately. Unfortunately, they frequently do not and errors in reporting change the emphasis of a piece of medical research. The result is women are frightened and continuance suffers. It is worth remembering that 'bad news', suitably publicized, sells more newspapers and magazines than 'good news'. Competition is growing for 'alternative' products. 'Natural' treatments are 'in'. These treatments are widely claimed to reduce menopausal complaints in older patients and patients are keen to take them. But where is the evidence of efficacy and safety from robust and rigorous studies? All too often it is lacking. The doctor therefore has to advise the patient accurately about products for their treatment, and may also have to provide an opinion on 'alternative' remedies. Knowledge of alternative medical literature is therefore becoming essential. If doctors wish to continue to be respected by patients, they must remain knowledgeable and communicate their knowledge in an unbiased manner. They must emphasize the benefits and risks of different treatments according to the concerns of the patient. Failure of the doctor to provide this service will result not only in loss of respect, but alas, too often, in medico-legal consequences.

Attitude to Health↗
PubMed1999

Narrowing social inequalities in health? Analysis of trends in mortality among babies of lone mothers (abridged version 1).

OBJECTIVES: To examine trends in mortality among babies registered solely by their mother (lone mothers) and to compare these with trends in infant mortality for couple registrations overall and couple registrations subdivided by social class of father. DESIGN: Analysis of trends in infant death rates from 1975 to 1996 for the three groups. The data source was the national linked infant mortality file, containing all records of infant death in England and Wales linked to the respective birth records. SETTING: England and Wales. PARTICIPANTS: All live births (n=14.3 million) from 1975 to 1996; all deaths of infants from birth to 12 months of age over the same period (n=135 800). MAIN OUTCOME MEASURES: Death rates in the perinatal, neonatal, and postneonatal periods and for infancy overall. RESULTS: For the babies of lone mothers infant mortality has fallen to less than a third of the 1975 level, with a clear reduction in the gap between the mortality in these babies compared with all couple registrations: the excess mortality in solely registered births was 79% in 1975 reducing to 33% in 1996. Most of the narrowing of the sole-couple differential was associated with the neonatal period, for which there is now no appreciable gap. For couple registrations analysed by social class of father, infant death rates have more than halved in each social class from 1975 to 1996. The reductions in mortality were greater in the late 1970s and early 1990s. Infant death rates in classes IV-V remained between 50% and 65% higher than in classes I-II. Differentials between social classes were largest in the postneonatal period and smallest in the perinatal and neonatal periods. The gap in perinatal and neonatal mortality between the babies of lone mothers and couple parents in social classes IV-V has disappeared. CONCLUSIONS: The differential in infant mortality between social classes still exists, whereas the differential between sole and couple registrations has decreased, showing positive progress in the reduction of inequalities. As the reduction in the differential was confined to the neonatal period these improvements may be more a reflection of healthcare factors than of factors associated with lone mothers' social and economic circumstances.

England↗
PubMed1999

Narrowing social inequalities in health? analysis of trends in mortality among babies of lone mothers (abridged version 2)

Objectives: To examine trends in mortality among babies registered solely by their mother (lone mothers) and to compare these with trends in infant mortality for couple registrations overall and couple registrations subdivided by social class of father. Design: Analysis of trends in infant death rates from 1975 to 1996 for the three groups. The data source was the national linked infant mortality file, containing all records of infant death in England and Wales linked to the respective birth records. Setting: England and Wales. Participants: All live births (n=14.3 million) from 1975 to 1996; all deaths of infants from birth to 12 months of age over the same period (n=135 800). Main outcome measures: Death rates in the perinatal, neonatal, and postneonatal periods and for infancy overall. Results: For the babies of lone mothers infant mortality has fallen to less than a third of the 1975 level, with a clear reduction in the gap between the mortality in these babies compared with all couple registrations: the excess mortality in solely registered births was 79% in 1975 reducing to 33% in 1996. Most of the narrowing of the sole-couple differential was associated with the neonatal period, for which there is now no appreciable gap. For couple registrations analysed by social class of father, infant death rates have more than halved in each social class from 1975 to 1996. The reductions in mortality were greater in the late 1970s and early 1990s. Infant death rates in classes IV-V remained between 50% and 65% higher than in classes I-II. Differentials between social classes were largest in the postneonatal period and smallest in the perinatal and neonatal periods. The gap in perinatal and neonatal mortality between the babies of lone mothers and couple parents in social classes IV-V has disappeared. Conclusions: The differential in infant mortality between social classes still exists, whereas the differential between sole and couple registrations has decreased, showing positive progress in the reduction of inequalities. As the reduction in the differential was confined to the neonatal period these improvements may be more a reflection of healthcare factors than of factors associated with lone mothers' social and economic circumstances.

Journal Article↗
PubMed1999

Diurnal variation in uterine artery blood flow in post-menopausal women on oestrogen hormone replacement therapy.

Doppler ultrasound was used to investigate circadian variations in uterine artery blood flow in 20 post-menopausal women in the oestrogen-only phase of combined oestrogen hormone replacement therapy with cyclical oral norethisterone or dydrogesterone. All women were examined between 0800 and 0830 h and then again between 1800 and 1830 h on the same day. Mean arterial blood pressure, heart rate and a blood sample for measurement of serum oestradiol were taken at each visit. Indices of uterine artery blood flow included the pulsatility index, resistance index, peak systolic velocity and time-averaged maximum velocity. No significant differences in the mean arterial blood pressure, pulse rate and oestradiol concentrations were detected between morning and evening visits. Significant fluctuation was observed in the pulsatility index (P < 0. 001), resistance index (P < 0.001) and time-averaged maximum velocity (P < 0.01). The assessment of uterine artery blood flow in post-menopausal women should take into account the presence of circadian variations to ensure accuracy and reproducibility of Doppler investigations.

Arteries↗
PubMed1999

Acceptability and patterns of uterine bleeding in sequential trimegestone-based hormone replacement therapy: a dose-ranging study.

Trimegestone is a norpregnane progestogen which is being developed in combination with oral oestradiol as postmenopausal hormone replacement therapy (HRT). In this multicentre dose-ranging study using randomized parallel groups, four doses of trimegestone were used to compare data on the patterns of uterine bleeding, the endometrial histology, and the control of menopausal symptoms in 203 women who completed treatment for 6 months. The treatment consisted of micronized oestradiol (2 mg/day) and one of four doses of trimegestone, which was administered sequentially for days 15-28 of the treatment cycle. Higher doses of trimegestone were associated with later onset of bleeding, which was lighter and of shorter duration than that observed with lower doses. The variability of the day of onset of bleeding in individual women was greater when bleeding occurred before the end of the progestogen phase (early bleeders) than when it occurred afterwards (late bleeders). All women enrolled in the study experienced good control of menopausal symptoms, with minimal progestogenic adverse effects, there being no statistically significant difference between the four dose groups.

Aged↗
PubMed1999

A randomised comparison of the effects of oral versus transdermal 17beta-oestradiol, each combined with sequential oral norethisterone acetate, on serum lipoprotein levels.

OBJECTIVE: To investigate the effects of oral versus transdermal 17beta-oestradiol, given in both cases with sequential addition of oral norethisterone acetate, on serum lipid and lipoprotein levels in postmenopausal women. DESIGN: Open, randomised, parallel groups study. SETTING: University Clinical Research Group. POPULATION: Sixty-four postmenopausal women with climacteric complaints who were otherwise healthy were screened. Of these, 58 fulfilled the entry criteria. METHODS: Fifty-eight postmenopausal women were randomised to receive either oral 17beta-oestradiol/oestriol (Trisequens) or transdermal 17beta-oestradiol (Estrapak) together with cyclical addition of norethisterone acetate for 48 weeks. MAIN OUTCOME MEASURES: Serum levels of total cholesterol, triglycerides, high density lipoproteins (HDL), low density lipoproteins (LDL), very low density lipoproteins (VLDL), apolipoproteins, and lipoprotein(a) at baseline, and after 46 weeks (oestrogen-alone phase), and 48 weeks (oestrogen-progestogen phase) of treatment. RESULTS: Oral oestradiol therapy did not affect serum total cholesterol levels during the oestrogen-alone phase, but during the combined phase there was a 5% fall (P < 0.05) due to a 7% decrease in LDL cholesterol levels (P < 0.01). Oral therapy also increased serum triglyceride levels by 9.4% during the oestrogen-alone phase (P < 0.05). During the combined phase of transdermal therapy, there was a 19% fall in serum triglyceride levels (P < 0.05) and a 6% fall in HDL levels (P < 0.05). Oral oestradiol reduced lipoprotein(a) levels by 31% during the oestrogen-alone phase and by 37% with norethisterone acetate addition (P < 0.05). Transdermal therapy had no significant effect on lipoprotein(a). CONCLUSIONS: Other than a minor fall in HDL3 in women receiving transdermal 17beta-oestradiol, coadministration of oral progestogen in general improved, rather than worsened, this serum lipoprotein profile.

Administration, Cutaneous↗
PubMed1999

Lone mothers in Sweden: trends in health and socioeconomic circumstances, 1979-1995.

STUDY OBJECTIVE: To study trends in the health and socioeconomic circumstances of lone mothers in Sweden over the years 1979-1995, and to make comparisons with couple mothers over the same period. DESIGN: Analysis of data from the annual Survey of Living Conditions (ULF), conducted by Statistics Sweden from 1979-1995. Comparison of demographic, socioeconomic and health status of lone and couple mothers and how these have varied over the 17 years of the study. Main outcome measures include prevalence of self perceived general health and limiting longstanding illness. PARTICIPANTS AND SETTING: All lone mothers (n = 2776) and couple mothers (n = 16,935) aged 16 to 64 years in a random sample of the Swedish population in a series of cross sectional surveys carried out each year between 1979 and 1995. MAIN RESULTS: The socioeconomic conditions of lone mothers deteriorated during the period 1979-1995, with increasing unemployment and poverty rates. Lone mothers had worse health status than couple mothers throughout the period. In comparison with the first two periods, the prevalence of less than good health increased among both lone and couple mothers from the late 1980s onwards. For lone and couple mothers who were poor, their rates of less than good health were similar in the early 1980s, but in 1992-95 poor lone mothers were significantly more likely to report less than good health than poor couple mothers. Unemployed lone mothers had particularly high rates of ill health throughout the study period. CONCLUSIONS: As in other European countries, lone mothers are emerging as a vulnerable group in society in Sweden, especially in the economic climate of the 1990's. While they had very low rates of poverty and high employment rates in the 1980s, their situation has deteriorated with the economic recession of the 1990's. The health status of lone mothers, particularly those who are unemployed or poor, appears worse than that of couple mothers and in some circumstances may be deteriorating. Further study is needed to elucidate the mechanisms mediating their health disadvantage compared with couple mothers.

Adolescent↗
PubMed1999

The health and socio-economic circumstances of British lone mothers over the last two decades.

This article examines the trends in the socio-economic circumstances and health of lone mothers compared to couple mothers from 1979 to 1995 in Great Britain using secondary analysis of data from General Household Survey and covering 9,159 lone mothers and 51,922 couple mothers living in private households. The main measures are self perceived general health, limiting long-standing illness, poverty and working status.

Adolescent↗