Biomedical subjects

P Egger

Publications and source records attributed to P Egger.

35 records · Page 2Linked to original sources

PubMed1997

Polymorphisms of the vitamin D receptor, infant growth, and adult bone mass.

Family and twin studies have demonstrated a strong genetic component to the development of peak bone mass. Early fetal and infant environment has also been shown to influence bone mass through an effect on skeletal size and mineral content. We report a retrospective study that has examined whether early infant growth is regulated by genetic factors shown to be associated with bone mass. We have determined the vitamin D receptor (VDR) gene alleles for 66 women (mean age 65.5 years) on whom detailed birth records were available. There was a statistically significant trend (P = 0.04) for VDR genotype against weight at the age of 1 year, with the "tt" homozygote group having 7% higher weight. We conclude that early fetal or infant environment may interact with an individual's underlying genotype to program early skeletal growth, and that this may track through later life to influence adult characteristics. Further prospective studies are required, however, to fully clarify the precise environmental and genetic mechanisms underlying these findings.

Absorptiometry, Photon↗

PubMed1997

Early infection and subsequent insulin dependent diabetes.

In a study of 58 children under the age of 16 with insulin dependent diabetes (IDDM) and 172 matched non-diabetic controls, infection during the first year of life was associated with a reduction in diabetes risk (odds ratio 0.81, 95% confidence interval 0.67 to 0.98, per infective episode). Decreased exposure to common infections during infancy may be linked with subsequent IDDM.

Adolescent↗

PubMed1997

Growth in infancy and bone mass in later life.

OBJECTIVE: To examine the association between weight in infancy and bone mass during the seventh decade of life in a population based cohort for which detailed birth and childhood records were preserved. METHODS: 189 women and 224 men who were aged 63-73 years and were born in East Hertfordshire underwent bone densitometry by dual energy x ray absorptiometry. Measurements were also made of serum osteocalcin and urinary excretion of type 1 collagen cross linked N-telopeptide. RESULTS: There were statistically significant associations between weight at 1 year and bone mineral content (but not bone mineral density) at the spine (P < 0.02) and femoral neck (P < 0.01) among women, and spine (P < 0.03) among men. Although serum osteocalcin was negatively correlated with bone mineral density at both sites among men and women, infant weight was not significantly associated with either biochemical marker of bone turnover. CONCLUSIONS: These data confirm our previous observations that growth in infancy is associated with skeletal size in adulthood, and suggest that skeletal growth may be programmed during intrauterine or early postnatal life.

Aged↗

PubMed1996

Childhood growth and age at menarche.

OBJECTIVE: To study the influence of birthweight, and weight and height at age seven years, on menarcheal age in a national sample of 1471 girls in England, Scotland and Wales. METHODS: We studied 1471 girls included in the MRC National Survey of Health and Development. During medical examinations carried out by school doctors in this cohort, born in the first week of March 1946, the mothers of girls were asked whether their daughters had started to menstruate, and if so, the month and year when this happened. Anthropometric measurements at birth and at age seven years were also obtained. RESULTS: Girls who were heavier at age seven years had menarche at an earlier age. The average age at menarche of those in the highest fifth of the distribution of weight at seven years was 7.3 months less than that of those in the lowest fifth of the distribution. In contrast, girls who were heavier at birth had menarche at a later age. The average age at menarche of those in the highest fifth of the birthweight distribution was 2.2 months more than those in the lowest fifth. These opposing trends of birthweight and weight at seven years on age at menarche were observed across the distribution of each variable, and exerted statistically significant (P < 0.001) independent effects in a multivariate model. CONCLUSIONS: These observations are consistent with the hypothesis that menarcheal age is linked to programmed patterns of gonadotrophin release established in utero, when the fetal hypothalamus is imprinted, and is subsequently modified by weight gain in childhood.

Adolescent↗

PubMed1996

Lateral bone density measurements in osteoarthritis of the lumbar spine.

OBJECTIVE: To investigate whether spinal osteoarthritis (OA) is responsible for the common finding that lumbar spine bone mineral density (BMD) is greater when measured in the anteroposterior plane than when measured in the lateral plane. METHODS: We studied lateral spine radiographs from 63 women who attended a hospital outpatient department for bone density measurement and who also underwent lumbar spine radiography. Osteoarthritis was assessed using both the Kellgren and Lawrence scale and a scoring system for osteophytosis. Bone density was measured in the anteroposterior and lateral planes using a Hologic QDR-2000 instrument. RESULTS: The mean anteroposterior BMD (0.92 g/cm2) was significantly greater than the lateral BMD (0.59 g/cm2) (p < 0.01), and the difference between antero-posterior and lateral measurements was significantly associated with both increasing Kellgren and Lawrence score and osteophyte score, even after adjustment for age. CONCLUSION: These data suggest that spinal OA is a major cause of the difference between anteroposterior and lateral BMD and that lateral BMD may provide a more accurate representation of true vertebral body bone density in patients with OA of the lumbar spine.

Absorptiometry, Photon↗

PubMed1996

Cigarette smoking and bone mineral density in the elderly.

OBJECTIVE: To test the hypothesis that cigarette smoking is associated with reduced bone mineral density in elderly men and women. DESIGN: Cross sectional study. SUBJECTS: These comprised 224 men and 186 women aged 61-73 years, born and resident in East Hertfordshire. MEASUREMENTS: Lumbar spine and femoral neck bone mineral density (BMD) were determined by dual energy x ray absorptiometry. RESULTS: After adjusting for potential confounding variables, men who were current smokers were found to have a lumbar spine BMD that was 7.3% (95% CI 0.4, 14.2) lower than men who had never smoked. Similarly, women who were current smokers had a BMD value that was 7.7% (95% CI 0.3, 15.6) lower than in women who had never smoked. The difference at the femoral neck was smaller and not statistically significant. For both men and women, each decade of smoking was associated with a reduction of 0.015 g/cm2 in BMD at the lumbar spine (95% CI: men 0.002, 0.027; women 0.003, 0.028). At the femoral neck the reduction in BMD was 0.011 g/cm2 (95% CI 0.003, 0.020) for men and 0.004 g/cm2 (95% CI -0.003, 0.012) for women with each decade of smoking. CONCLUSIONS: The results show an adverse effect of smoking on BMD which was most noticeable at the lumbar spine, and seemed stronger in men than women. This effect could not be explained by differences in life style between smokers and nonsmokers.

Absorptiometry, Photon↗

PubMed1996

Generalized osteoarthritis in women: pattern of joint involvement and approaches to definition for epidemiological studies.

OBJECTIVE: To ascertain whether clustering between joint sites in osteoarthritis (OA) is more common than would be expected simply from the rising prevalence of the disorder with age, and to explore a definition of generalized OA (GOA) by determining the pattern of joint group involvement, in a population sample of peri and postmenopausal women. METHODS: Radiographs of the hands, knees, and hips were obtained in a population sample of 702 women aged 45 to 64 years. Distal interphalangeal, proximal interphalangeal, carpometacarpal, knee, and hip OA were assessed using the Kellgren-Lawrence grading system. Logistic regression was used to test for overall clustering of OA between joint sites, and log linear models were used to study the patterns of association between different sites. RESULTS: Multiple involvement of the 5 joint groups studied occurred significantly more frequently than could be expected by chance alone (chi 2 = 52.3, df = 5, p < 0.001), and this clustering remained significant after age adjustment (chi 2 = 26.1, df = 5, p < 0.001). Thresholds could be defined for the number of involved joint groups that distinguished a polyarticular subset of OA. These thresholds varied with age and the radiographic cutoff at which OA was assigned. Thus, for grade 2+ disease, GOA could be defined by involvement of 2 or more joint groups at age 45-47 years, but required involvement of all 5 joint groups at age 60-64 years. Symmetry within joint groups was the most pronounced feature in the pattern of joint involvement in the sample as a whole, with associations between different joint groups being substantially weaker than those for symmetrical bilateral involvement of a particular joint. CONCLUSION: There is a clear tendency towards polyarticular OA among women aged 45-64 years. However, there is no single threshold number of joint sites that can be used to define GOA. The pattern of joint involvement in OA is primarily symmetrical, and this pattern strongly suggests a systemic etiology in this subset of postmenopausal women.

Arthrography↗

PubMed1995

Childhood growth, physical activity, and peak bone mass in women.

Peak bone mass is an important determinant of the risk of osteoporotic fracture, and preventive strategies against osteoporosis require a clear understanding of the factors influencing bone gain in early life. We report a longitudinal study aiming to identify the relationships between childhood growth, lifestyle, and peak bone mass in women. One hundred and fifty-three women born in a British city during 1968-1969 were traced and studied in 1990. Data on their growth in childhood was obtained from linked birth and school health records; current bone mineral measurements were made by dual X-ray absorptiometry. There were statistically significant associations between weight at 1 year and BMC (but not BMD) at the lumbar spine (r = 0.32, p < 0.01) and femoral neck (r = 0.26, p < 0.01). These remained significant after adjusting for current weight. There were also strong relationships between childhood height measurements and adult BMC at the two skeletal sites. Physical activity was the major lifestyle determinant of BMD after allowing for body build. We conclude that infant growth and physical activity in childhood are important determinants of peak bone mass in women. Growth primarily determines the size of the skeletal envelope, and its trajectory is established by age 1 year. Activity, in contrast, modulates the mineral density within the skeletal envelope and may contribute to the consolidation of bone following the end of linear growth.

Absorptiometry, Photon↗

PubMed1995

Osteoarthritis of the hip joint and acetabular dysplasia in women.

OBJECTIVE: To investigate the suggestion that osteoarthritis (OA) of the hip joint is often caused by subclinical acetabular dysplasia among elderly British women. METHODS: We examined 393 hip joints from the radiographs of a sample of women aged 60-75 years undergoing intravenous urography. Acetabular dysplasia was assessed using measurements of the centre-edge (CE) angle and acetabular depth (AD), which are both reduced in this condition. OA was assessed using an overall grade based on the Kellgren and Lawrence system and by measurement of minimum joint space (MJS). RESULTS: MJS was the more repeatable measure of OA, and showed a strong correlation with overall grade (Spearman rank correlation coefficient rs = -0.61, p < 0.01). MJS was significantly negatively correlated with CE angle (Pearson correlation coefficient r = -0.25, p < 0.001) and AD (r = -0.11, p < 0.05). Consistent with these findings, there was a weak but significant positive correlation between overall grade of OA and one of the two measures (CE angle) of acetabular dysplasia. CONCLUSIONS: These results do not support the hypothesis that mild degrees of acetabular dysplasia account for a substantial proportion of hip OA in elderly women. Changes in hip joint geometry as a result of OA may be responsible for the weak negative association observed.

Aged↗

PubMed1995

Low back pain in Hong Kong: prevalence and characteristics compared with Britain.

STUDY OBJECTIVE: To compare the prevalence of low back pain and associated disability in Hong Kong with that in Britain, and to explore whether differences could be explained by certain known risk factors. DESIGN: A cross sectional survey with information collected at interview. Findings were compared with those from an earlier survey in Britain. SETTING: Two housing blocks in Hong Kong. SUBJECTS: Altogether 288 men and 364 women aged 18 years or older, who were resident in the two housing blocks and agreed to interview (response rate = 80%). MAIN RESULTS: Thirty nine per cent (95% confidence interval (CI) 34%, 44%) of interviewees reported having had low back pain at some time, and 21% (95% CI 18%, 25%) had had low back pain in the past 12 months. After standardisation for age and sex, all of the back symptoms examined were substantially less common in Hong Kong than in Britain. The one year period prevalence of low back pain was associated with occupational lifting (in both sexes) and with tall stature (in men only). Subjects tended to carry out less heavy lifting at work and to be shorter than participants in the earlier British study but these differences did not completely explain their lower prevalence of back pain. CONCLUSIONS: The findings indicate a lower prevalence of back symptoms in Hong Kong than Britain that is partly explained by differences in stature and occupational lifting. In addition, Hong Kong people may have a higher threshold for reporting symptoms, or they may differ in their exposure to other, unrecognised risk factors.

Adolescent↗

PubMed1995

Manual handling activities and risk of low back pain in nurses.

OBJECTIVE: To investigate the risk factors for low back pain in hospital nurses, with particular emphasis on the role of specific nursing activities. METHODS: A cross sectional survey of 2405 nurses employed by a group of teaching hospitals was carried out. Self administered questionnaires were used to collect information about occupational activities, non-occupational risk factors for back symptoms, and history of low back pain. RESULTS: The overall response rate was 69%. Among 1616 women, the lifetime prevalence of back pain was 60% and the one year period prevalence 45%. 10% had been absent from work because of back pain for a cumulative period exceeding four weeks. Rates in men were generally similar to those in women. In women back pain during the previous 12 months was weakly associated with height, and was significantly more common in those who reported frequent non-musculoskeletal symptoms such as headache and low mood. After adjustment for height and non-musculoskeletal symptoms, significant associations were found with frequency of manually moving patients around on the bed, manually transferring patients between bed and chair, and manually lifting patients from the floor. In contrast, no clear increase in risk was found in relation to transfer of patients with canvas and poles, manually lifting patients in and out of the bath, or lifting patients with mechanical aids. Confirmation of these findings is now being sought in a prospective study of the same population. CONCLUSIONS: This study confirms that low back pain is highly prevalent among nurses and is associated with a high level of sickness absence. People who often report non-musculoskeletal symptoms were significantly more likely to report low back pain. Specific manual handling tasks were associated with an increased risk of back pain; however, no such association was found with mechanised patient transfers.

Adult↗

PubMed1995

Patterns of joint involvement in osteoarthritis of the hand: the Chingford Study.

OBJECTIVE: The hand is the major site of joint involvement in osteoarthritis (OA), but the clustering of this condition at different joint sites within the hand as part of an entity known as generalized OA remains contentious. We examine this issue in a population sample of 967 peri and postmenopausal women. METHODS: The pattern of radiographic involvement of hand joints was examined using the Kellgren and Lawrence system in a sample of women aged 45-64 years, selected from the general population in Chingford, East London. Log linear modelling techniques were used to examine clustering of OA in different joint sites and to examine whether this clustering remained significant after age adjustment. RESULTS: There was clear evidence of clustering in joint involvement: Thus 20 women had 4 or more affected joints compared with only 2 expected (chi 2 = 72.0, 4df, p < 0.001). The risk of multiple distal interphalangeal (DIP) joint involvement, after age adjustment, in a woman with a single affected DIP joint was significantly increased (OR 10.0, 95% CI 7.3-13.7) and was substantially greater than the corresponding risk for proximal interphalangeal joint (OR 3.1, 95% CI 1.4-6.8) involvement. Symmetry was the strongest determinant of pattern with an OR 38.8 (95% CI 14.5-103.5) for corresponding DIP joint involvement in the contralateral hand. CONCLUSION: These data provide clear evidence for a polyarticular subset of hand OA in women. There are 3 major determinants of the pattern of polyarticular involvement; symmetry, clustering by row and clustering by ray, in descending order of importance.

Female↗

PubMed1994

Cutaneous warts in butchers.

Several studies have indicated a high prevalence of hand warts in meat handlers, although the reasons for this are not clear. The high prevalence may be partly due to HPV7, a virus found almost exclusively in meat handlers, but the source of HPV7 is not known. We have carried out a cross-sectional survey of hand warts in male meat workers and controls from other occupational groups, to investigate the reasons for the high prevalence of warts, and particularly of HPV7, in butchers. We studied 240 abattoir workers, 246 retail and wholesale butchers, 308 engineering fitters and 292 office workers. Each subject was interviewed using a standard questionnaire, and his hands were examined by a dermatologist. Scrapings from the warts were tested for HPV1, HPV2 and HPV7 by a polymerase chain reaction method. The prevalence of hand warts was 33.3% in the abattoir workers, 34.1% in the butchers, 19.5% in the engineers and 14.7% in the office workers. Scrapings were taken from 247 of 267 subjects with warts, and HPV DNA was detected in 151 samples. The most common viruses were HPV2 (94 men) and HPV7 (76 men). The excess of warts in meat workers was largely due to HPV7, which was found in only two of the office workers, and was not found in any of the engineers. Logistic regression analysis showed no association between the prevalence of hand warts (or HPV2 and HPV7 specifically) and hand trauma, cold and wet working conditions, smoking, atopy, or handling any particular kind of meat. We suggest that some constituent of animal flesh predisposes to replication of HPV7 in keratinized epithelium.

Abattoirs↗

PubMed1994

Butchers' warts: no evidence for person to person transmission of HPV7.

The distribution of warts due to HPV7 in workers in six abattoirs and 103 retail and wholesale butcheries has been studied to determine whether the high prevalence of HPV7 in the meat trade is the result of enhanced person to person transmission, or whether it is a ubiquitous virus which is activated by an unknown factor in meat. Warts were detected in 164 of 486 men. Scrapings were taken from 156 men, and HPV DNA was found in 112 samples, 74 of which contained HPV7. HPV7 was found in 36 workplaces, and there was no evidence of clustering of cases, as would be expected if person to person transmission was occurring in the workplace. This suggests that HPV7 is widely distributed in the community, but only causes clinical disease under specific conditions. We suggest that some unknown factor in meat enhances viral replication.

Abattoirs↗

PubMed1994

Occupational activity and osteoarthritis of the knee.

OBJECTIVES: To test the hypothesis that specific occupational physical activities are risk factors for knee osteoarthritis (OA). METHODS: A population-based case-control study of knee osteoarthritis was carried out in which 109 men and women with painful, radiographically confirmed knee OA were compared with 218 age and sex matched controls who had not suffered knee pain and had normal radiographs. Information collected included a lifetime occupational history and details of specific workplace physical activities. RESULTS: After adjustment for obesity and Heberden's nodes, the risk of knee OA was significantly elevated in subjects whose main job entailed more than 30 minutes per day squatting (OR 6.9, 95% CI 1.8-26.4) or kneeling (OR 3.4, 95% CI 1.3-9.1), or climbing more than ten flights of stairs per day (OR 2.7, 95% CI 1.2-6.1). The increase in risk associated with kneeling or squatting appeared to be more marked in subjects whose jobs entailed heavy lifting, but the size of the study did not permit precise delineation of any such interaction. CONCLUSIONS: These data suggest that prolonged or repeated knee bending is a risk factor for knee OA, and that risk may be higher in jobs which entail both knee bending and mechanical loading.

Activities of Daily Living↗

PubMed1994

Defining osteoarthritis of the hand for epidemiological studies: the Chingford Study.

OBJECTIVES: To explore the relative merits of clinical and radiological examination in defining hand osteoarthritis (OA) for epidemiological purposes. METHODS: A total of 976 women aged 45-64 years were selected from the general population and underwent a structured interview, clinical examination of the hand joints and radiography of the hands and knees. The inter-relationship of the clinical and radiological findings was examined, and also the association of each with hand symptoms and the presence of knee OA. RESULTS: Clinical and radiographic signs of hand OA generally correlated with each other, and each was associated with hand symptoms to a similar degree. When analysed in combination, they were only marginally better at predicting symptoms than when tested individually. However, when they were examined in relation to radiographic features of knee OA, there was a significantly stronger association with radiographic features of hand OA than with clinical features. CONCLUSIONS: Hand radiology provides a better overall assessment of osteoarthritis than physical examination of the interphalangeal joints or carpo-metacarpal joint; in situations where radiology is not available clinical examination is a viable substitute.

England↗

PubMed1990

Evaluation of two ELISA tests for the rapid detection of group A streptococci.

We examined 579 oropharyngeal swab specimens from children presenting with pharyngitis in order to compare two rapid diagnostic ELISA tests for group A streptococcal antigen: the TestPack Strep A (TPSA), and the Direct Strep A EIA (DSAE), with an anaerobically incubated sheep blood agar culture. The sensitivities of the methods were respectively 60.8% (TPSA) and 64.4% (DSAE), the specificities 98.3% (TPSA) and 93.2% (DSAE), the positive predictive values 88.6% (TPSA) and 70.3% (DSAE) and the negative predictive values 92.0% (TPSA) and 91.2% (DSAE). We conclude that the TPSA is easy to interpret and is sufficiently specific to initiate treatment in patients with a positive test. It is not sufficiently sensitive to ensure negative or intermediate results. The performance of the DSAE test is similar but the specificity is slightly lower and more false positive results occur.

Chi-Square Distribution↗