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Biomedical subjects

Rebecca Hardy

Publications and source records attributed to Rebecca Hardy.

At least 37 records · Page 2Linked to original sources
PubMed2005

Socio-economic position across the life course and hysterectomy in three British cohorts: a cross-cohort comparative study.

OBJECTIVE: To examine the association between indicators of lifetime socio-economic position and rates of hysterectomy in three British cohorts. DESIGN: Cross-cohort comparative study. SETTING: Two cohorts: England, Scotland and Wales. Third cohort: Aberdeen, Scotland. POPULATION: Three thousand two hundred and eight women born between 1919 and 1940, participating in the British Women's Heart and Health Study (BWHHS); 1394 women from the MRC National Survey of Health and Development (NSHD), followed up since birth in 1946; 3208 women born between 1950 and 1955, participating in the Aberdeen Children of the 1950s study, all with complete information on lifetime socio-economic position and hysterectomy status. METHODS: Relative indices of inequality were derived for markers of socio-economic position in childhood and adulthood. Cox's regression models were used to test the association between these markers and hysterectomy. MAIN OUTCOME MEASURE: Self-reported hysterectomy with or without oophorectomy. RESULTS: Adverse socio-economic position in childhood and as indicated by educational status was associated with reduced rates of hysterectomy in the oldest of the three cohorts (BWHHS), whereas conversely in the NSHD and Aberdeen cohorts it was associated with increased rates of hysterectomy. The unadjusted hazards ratios for hysterectomy comparing worst to best socio-economic position for father's social class were 0.73 (0.56, 0.96) for women from the BWHHS, 1.77 (1.19, 2.65) for those from the NSHD and 2.06 (1.46, 2.89) for those from the Aberdeen cohort. Associations between markers of adult socio-economic position and hysterectomy tended to be weaker in all three cohorts and often did not reach conventional levels of statistical significance. CONCLUSIONS: Our results show that hysterectomy rates are influenced by childhood socio-economic position and educational attainment, but that the nature of this association varies across these three British cohorts born in different decades of the 20th century. That there were no consistent or strong associations between adult SEP and hysterectomy rates suggest that social factors influencing rates of hysterectomy are likely to be those experienced or which develop in early life rather than those which develop later.

Adult↗
PubMed2004

Alcohol consumption and midlife cognitive change in the British 1946 birth cohort study.

AIMS: Cross-sectional studies suggest that alcohol consumption benefits cognitive function. However, more longitudinal studies are required to confirm that alcohol has an effect on cognitive change and to rule out the possibility that those of higher ability engage in a lifestyle that protects against cognitive decline. METHODS: We investigated the association between self-reported alcohol consumption and change in memory, speed and concentration in midlife, in 903 men and 861 women enrolled in the MRC National Survey of Health and Development (the British 1946 birth cohort). RESULTS: After controlling for educational attainment, occupational social class and general cognitive ability, it was found that alcohol consumption was associated with a slower memory decline from 43 to 53 years in men, but a more rapid decline in visual search speed for the same interval in women. These effects were not explained by a further control for health status (body water weight, smoking, exercise, cardio-respiratory disease and affective state). CONCLUSIONS: Our data suggest that alcohol consumption is associated with a slower memory decline. However, the negative association between alcohol and psychomotor function in women is a potential cause for concern.

Adult↗
PubMed2004

A systematic review and meta-analysis of the incidence and severity of postoperative fatigue.

OBJECTIVE: Postoperative fatigue is common following major abdominal surgery. Less is known about its prevalence in other surgical subgroups, and about its long-term prognosis. A systematic review of prospective cohort studies was conducted to clarify these issues. METHOD: Studies were identified from an extensive literature search. Overall estimates of pre- to postoperative change in fatigue severity and the incidence of clinically significant postoperative fatigue were calculated using meta-analyses. RESULTS: Eighty-one cohorts were identified. Type of surgery was found to be a possible predictor of fatigue severity, with major abdominal, gynaecological, cardiac and minor surgery apparently associated with greater fatigue than orthopaedic surgery. Limited data were available regarding the long-term persistence of postoperative fatigue. CONCLUSION: Postoperative fatigue appears to be an important problem following only certain forms of surgery. Why this is so remains unclear, and further work using better fatigue questionnaires is now required to confirm these differences.

Fatigue↗
PubMed2004

Birthweight, childhood growth, and blood pressure at 43 years in a British birth cohort.

BACKGROUND: Low birthweight is associated with high blood pressure in later life, but it is unclear whether the association is confounded with or modified by maternal and socioeconomic factors or childhood growth. METHODS: A total of 3157 men and women from a British birth cohort study where the survey members have been followed up regularly since their birth in 1946 were included in analyses. The associations between birthweight, childhood growth and blood pressure at 43 years of age were assessed using multiple regression models. RESULTS: Systolic blood pressure (SBP) decreased by 2.3 mmHg (95% CI: 0.8, 3.5) for men and 1.8 mmHg (95% CI: 0.1, 3.5) for women per 1-kg increase in birthweight. The effect was stronger in first born or those born to younger mothers. There was no confounding with any maternal, socioeconomic, or childhood growth variable. SBP increased by 1.45 mmHg (95% CI: 0.11, 2.78) in women and 0.46 mmHg (95% CI: -0.70, 1.62) in men per standard deviation of body mass index (BMI) change between ages 7 and 15 years. Among women this effect was not completely accounted for by adult size and was independent of birthweight. CONCLUSIONS: The determinants of birthweight, possibly related to maternal health during pregnancy, may impact on the relationship with SBP in middle life. The importance of tackling the increasing levels of childhood obesity seen in later cohorts is highlighted by the detrimental impact on SBP of large increases in BMI during adolescence.

Adolescent↗
PubMed2004

Childhood cognitive ability and deaths up until middle age: a post-war birth cohort study.

BACKGROUND: Childhood IQ has been related to mortality in later life in four studies. Cognitive ability may be a mediator between early disadvantage and mortality, a marker of the efficiency of information processing in the central nervous system, or predict entry to safe adult environments or healthy behaviours. We examined mortality in relation to cognitive ability at age 8 years in a birth cohort and investigated these possible reasons. METHODS: Cox's proportional hazards models were used to investigate the effect of early cognitive ability on all-cause mortality in 2057 women and 2192 men born in England, Scotland, and Wales in March 1946 and followed until age 54 years. We tested whether the relationship was accounted for by childhood socioeconomic conditions or serious illness, education, adult socioeconomic conditions, or smoking. RESULTS: Cognitive ability was related to mortality in men but not women. The excess mortality rate in men was concentrated in the bottom quarter of the cognitive score (hazard ratio [HR] for bottom versus top quarter 1.8, 95% CI: 1.0, 3.0) and there was no gradient across the range of ability. Adjustment for childhood socioeconomic conditions and serious illness had a small effect on the HR for deaths between 9 and 54 years while adjustment for education or early adult socioeconomic conditions halved the HR for deaths from age 26 years. Smoking was not a mediator of the effect of early ability on adult mortality. CONCLUSIONS: Greater cumulative exposure to poor lifetime socioeconomic conditions is the most likely explanation for the observed relationship between low cognitive ability in childhood and mortality. This relationship may therefore be elucidated further by studying the causes of lifelong socioeconomic inequalities in health.

Adult↗
PubMed2003

Birthweight, childhood social class, and change in adult blood pressure in the 1946 British birth cohort.

BACKGROUND: The negative effect of birthweight on systolic blood pressure has been suggested to be initiated in utero and amplified with age. We aimed to investigate this hypothesis. METHODS: A sample of 3634 people from a birth cohort study of men and women born in Britain in 1946 were included in analyses. Cohort members have been contacted regularly since birth, and systolic and diastolic blood pressures were measured at ages 36, 43, and 53 years. Multilevel models, with blood pressure as a repeated outcome, were used to test the amplification hypothesis and to compare results for birthweight with those for childhood social class. FINDINGS: Considering both men and women together, a consistent negative association between birthweight and systolic blood pressure was noted from age 36 to 53 years, but no evidence was recorded of substantial amplification with age. A 1 kg higher birthweight was associated with a slower mean increase in systolic blood pressure by -0.4 mm Hg (95% CI -1.3 to 0.4; p=0.3) per 10-year increase in age. Birthweight was not associated with diastolic blood pressure at any age. People from a manual social class in childhood had higher systolic and diastolic blood pressure than did those from a non-manual class. The effect on systolic blood pressure rose with age, by 1.0 mm Hg (95% CI 0.1 to 2.0; p=0.03) per 10 years, but was largely accounted for by current body-mass index, which was an increasingly strong determinant of blood pressure. INTERPRETATION: These findings suggest that weight control throughout life is key to prevention of raised blood pressure during middle age. Understanding the link between the early childhood socioeconomic environment and adult obesity could make this strategy more effective.

Adolescent↗
PubMed2003

Patterns of interphalangeal hand joint involvement of osteoarthritis among men and women: a British cohort study.

OBJECTIVE: To characterize the pattern of involvement of osteoarthritis (OA) of the hand among men and women of the same age. METHODS: Structured hand examinations were performed on 1,467 men and 1,519 women who were age 53 years and born in England, Scotland, or Wales during the first week of March 1946 (identified through the United Kingdom National Survey of Health and Development). OA at each joint site was characterized using a previously validated examination schedule. The interrelationship of involvement of different hand joints was analyzed by logistic regression and cluster analyses. RESULTS: There was clear evidence of polyarticular involvement in the hand joints of both the men and the women. Among the women, 161 subjects had >/=4 joints involved, compared with only 41 subjects expected in this category (P < 0.001). Among the men, 87 subjects were observed to have >/=4 joints involved, in contrast with only 7 subjects expected (P < 0.001). The pattern of hand joint involvement (characterized by clustering primarily by row and symmetric joint involvement, rather than clustering by ray) was found to be almost identical between the men and the women. CONCLUSION: This study confirms the existence of a polyarticular subset of OA among men that has characteristics similar to those of the variant observed among women. The data suggest that the genetic or metabolic influences underlying this particular variant of OA acts similarly in both sexes.

Cluster Analysis↗
PubMed2003

Does active leisure protect cognition? Evidence from a national birth cohort.

Social, physical and intellectual activities are thought to facilitate cognitive performance and slow the rate of age associated cognitive decline, but little is known about this association in younger adulthood. We used multiple regression to test the association between two kinds of activity at 36 years-physical exercise and spare-time activity-and verbal memory at 43 and 53 years in 1919 males and females enrolled in the MRC National Survey of Health and Development (the British 1946 birth cohort). Both kinds of activities were significantly and positively associated with memory performance at 43 years, after controlling for sex, education, occupational social class, IQ at 15 years, and recurrent ill health and significant mental distress. Furthermore, physical exercise at 36 years (but not spare-time activity) was associated with a significantly slower rate of decline in memory from 43 to 53 years, after controlling for the same factors, with evidence that continuing physical exercise after 36 years was important for protection. We conclude that physical exercise and spare-time activity are significantly associated with benefit to memory in midlife, although these two kinds of voluntary activity may exert their effects on cognition via different paths.

Adult↗
PubMed2003

Women's body satisfaction at midlife and lifetime body size: a prospective study.

The relationship between past body size and current body dissatisfaction among 933 middle-aged women from a prospective birth cohort study was examined. Women provided self-report data on weight esteem at age 54. Height and weight data were collected at ages 7, 11, 15, 20, 26, 36, 43, and 54. Data on reproductive variables were also collected prospectively. Hierarchical linear modeling and multiple regression analyses were used. Women who were dissatisfied at midlife were heavier at age 7 and showed a more rapid increase in body mass index with age. A late menarche, being postmenopausal, and having started hormone replacement therapy before menopause were associated with less dissatisfaction. Attention to these factors across the life span is necessary to understand body dissatisfaction in women at midlife.

Adolescent↗
PubMed2003

A life-course approach to assess the relationship between social and psychological circumstances and gingival status in adolescents.

BACKGROUND: Several models have been proposed to explain the causes of periodontal diseases. None have adopted the life-course approach. OBJECTIVE: To investigate the relationship between social, psychosocial and biological conditions experienced in early life and through the life course and gingival bleeding on probing. METHODS: A two-phase study was carried out in Brazil. In Phase I, 652 13-year-olds were clinically examined and interviewed. In Phase II, 311 families were randomly selected for an interview to collect information on the teenager's state at birth and selected impacts in their early years of life. Clinical examination included assessment of dental caries, periodontal and dental trauma status. The data analysis used logistic regression and the models were determined using stepwise procedure. FINDINGS: Adolescents who were born in a non-brick house, who were living in an overcrowded house at 13 years of age, those whose mother had less than 8 years of education, who were at a lower school grade for their age, those who reported high levels of paternal punishment and those who were from reconstituted families were significantly more likely to experience high levels of bleeding gums after probing. CONCLUSION: Early life and life-course experiences were important determinants of the level of gingival bleeding after probing in adolescents.

Adolescent↗
PubMed2003

Relationship between birthweight and blood lipid concentrations in later life: evidence from the existing literature.

BACKGROUND: It has been suggested that there is a link between fetal growth and chronic diseases later in life. Several studies have shown a negative association between birthweight and cardiovascular diseases, as well as cardiovascular disease risk factors, such as blood pressure and type 2 diabetes. Far fewer studies have focused on the association between size at birth and blood lipid concentrations. We have conducted a qualitative assessment of the direction and consistency of the relationship between size at birth and blood lipid concentrations to see whether the suggested relationship between intrauterine growth and cardiovascular diseases is mediated by lipid metabolism. METHODS: A literature search covering the period January 1966 to January 2003 was performed using Medline, Embase, and Web of Science. All papers written in English and reporting the relationship between size at birth and lipid levels in humans were assessed. Bibliographies were searched for further publications. RESULTS: From an initial screen of 1198 references, 39 papers were included involving 28 578 individuals. There was no consistent relationship between size at birth and blood lipid levels; the one exception being triglyceride concentration, which showed statistically significant negative or U-shaped, but not positive, relationships with birthweight. CONCLUSION: This review does not strongly support a link between birthweight and blood lipid levels in later life. However, the research in this area is limited and in order to make any definitive conclusions, longitudinal studies with sufficient power, data, and prospective follow-up are needed.

Birth Weight↗
PubMed2003

Influence of height, leg and trunk length on pulse pressure, systolic and diastolic blood pressure.

OBJECTIVE: To compare the effects of height, leg and trunk length on pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP) in men and women. DESIGN: Prospective, population-based, birth cohort study. SETTING: England, Scotland and Wales. PARTICIPANTS: A total of 1472 men and 1563 women aged 53 years and followed since their birth in 1946. MAIN OUTCOME MEASURES: PP, SBP and DBP at age 53 years. RESULTS: PP increased linearly with decreasing height and leg length in men and women [shortest compared with the tallest height (leg length) group, men 54.6 versus 51.0 mmHg (55.8 versus 50.7 mmHg), women 52.9 versus 48.4 mmHg (53.3 versus 48.6 mmHg); P for trend < or = 0.001 in each case]. Adjustment for adult confounding factors and childhood social class or birth weight only slightly weakened these results (P for trend < or = 0.01 in each case). SBP, but not DBP, showed similar but weaker trends in men and women, except for the association with height in men, which lost statistical significance after adjustment. Trunk length was not associated with any outcome measure in men or women. CONCLUSIONS: Short height and leg length are associated with increased PP and SBP, but not DBP, in middle-aged men and women. PP is a potential mediator between short height and leg length and increased risk of coronary heart disease. Future studies of the association between shortness and coronary heart disease should consider the role of arterial hemodynamics.

Blood Pressure↗
PubMed2003

Women's health in midlife: findings from a British birth cohort study.

The Medical Research Council's National Survey of Health and Development (MRCNSHD) is a prospective cohort study of 2547 women and 2815 men, a sample of all the births that took place in England, Scotland and Wales between 3-9 March 1946. It is one of the longest running large-scale studies of human development in the world, aiming to identify lifetime biological, social and psychological pathways to health and disease, from early life to ageing. A special study of women's health in midlife and the menopausal transition in this cohort was undertaken by sending to women study members eight annual postal questionnaires from when they were 47 to when they were 54 years old. The findings from the women's health study so far have highlighted associations between multiple risk factors at each life stage, and women's health and disease in later life. The authors suggest that a life course approach may provide a better understanding of women's health during the middle years of life than an approach which restricts itself to contemporary social or hormonal experiences. Of particular interest are their results linking ovarian ageing to developmental factors. Replication of these findings in other life course cohorts is being sought.

Aging↗
PubMed2002

Mortality in adults aged 26-54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study.

OBJECTIVE: To examine premature mortality in adults in relation to socioeconomic conditions in childhood and adulthood. DESIGN: Nationally representative birth cohort study with prospective information on socioeconomic conditions. SETTING: England, Scotland, and Wales. STUDY MEMBERS: 2132 women and 2322 men born in March 1946 and followed until age 55 years. MAIN OUTCOME MEASURES: Deaths between 26 and 54 years of age notified by the NHS central register. RESULTS: Study members whose father's occupation was manual at age 4, or who lived in the worst housing, or who received the poorest care in childhood had double the death rate during adulthood of those living in the best socioeconomic conditions. All indicators of socioeconomic disadvantage at age 26 years, particularly lack of home ownership, were associated with a higher death rate. Manual origins and poor care in childhood remained associated with mortality even after adjusting for social class in adulthood or home ownership. The hazard ratio was 2.6 (95% confidence interval 1.5 to 4.4) for those living in manual households as children and as adults compared with those living in non-manual households at both life stages. The hazard ratio for those from manual origins who did not own their own home at age 26 years was 4.9 (2.3 to 10.5) compared with those from non-manual origins who were home owners. CONCLUSIONS: Socioeconomic conditions in childhood as well as early adulthood have strongly influenced the survival of British people born in the immediate post war era.

Adult↗
PubMed2002

Birth weight, childhood size, and muscle strength in adult life: evidence from a birth cohort study.

Environmental influences during gestation may have long-term effects on adult muscle strength. It is not known how early in adult life such effects are manifest and whether they are modified by childhood body size. The authors examined the relation between birth weight and hand grip strength in a prospective national birth cohort of 1,371 men and 1,404 women from the Medical Research Council National Survey of Health and Development who were aged 53 years in 1999. A positive relation between birth weight and adult grip strength remained after adjustment first for adult height and weight and then additionally for childhood height and weight (p = 0.006 for men and p = 0.01 for women). The effects of birth weight on grip strength did not vary by childhood or current body size and were not confounded by social class. To the authors' knowledge, this is the first study to show that birth weight has an important influence on muscle strength in midlife independent of later body size and social class. It suggests that birth weight is related to the number of muscle fibers established by birth and that even in middle age compensating hypertrophy may be inadequate. As the inevitable loss of muscle fibers proceeds in old age, a deficit in the number of fibers could threaten quality of life and independence.

Birth Weight↗
PubMed2002

Lifetime risk factors for women's psychological distress in midlife.

Research on the causes of psychological distress in women in midlife has focused on current adversity and hormonal changes associated with menopause and paid less attention to possible risk factors across the life course. We examined the factors in childhood, adolescence and earlier adult life that show persisting effects on psychological symptoms reported annually over a 6 year period (47-52 years) using prospective data on a cohort of 1500 British women who have been followed since their birth in 1946. Even after taking into account the powerful effect of recent life stress, this study found that women with a high level of psychological distress had different life course trajectories than those with less distress. They were more likely to have scored highly on the neuroticism scale or exhibited antisocial behaviour when they were teenagers, and to have had prior experience of mental and physical health problems in adult life. Those whose parents had divorced reported more distress in midlife, particularly if they too had experienced marital breakdown. These factors accounted for the associations between some of the adult sources of risk, particularly those to do with interpersonal difficulties or poor adult socioeconomic circumstances, and psychological distress in midlife. There was no evidence that concurrent menopausal status had any effect on the level of psychological symptoms except for those women on hormone replacement therapy who had a small and independent additional risk. More attention to a long term temporal perspective is warranted in research on the causes of psychological distress in women at midlife.

Adolescent↗
PubMed2002

Change in psychological and vasomotor symptom reporting during the menopause.

There remains uncertainty regarding what health symptoms can be directly attributed to the menopause. The association between changes in menopausal status and changes in vasomotor symptom and psychological symptom reporting was investigated and the effects of changing menopausal status were compared with those related to life events and difficulties. Reports of common health symptoms, menopausal status and life events and difficulties have been collected prospectively from 1572 British women followed up since their birth in 1946, every year between 47 and 52 years. Regression models for repeated measures were fitted with the change in symptom scores between consecutive years as the outcome. Estimates from these models were obtained using generalised estimating equations, thus allowing appropriately for the correlation between repeated measures on the same woman. Vasomotor symptoms were found to be strongly related to changes in menopausal status with increases being observed as women move through the menopause. Psychological symptoms were more strongly associated with current life events and difficulties, particularly those experienced in family life, than with menopausal status. An increase in symptoms was, however, observed in premenopausal and perimenopausal women starting hormone replacement therapy. These effects were not confounded or modified by previous psychological morbidity, social or behavioural factors. The findings suggest that vasomotor symptoms are dependent on changing hormone levels associated with the menopause, while psychological symptoms are not. The possibility that there is a small subgroup of women who experience increased psychological problems at the time of the menopause, and who in this cohort are identified by their use of HRT, is suggested. The mechanism behind this rise remains unclear. Factors other than the menopause should be considered, such as concurrent life events and past experiences and behaviours, when considering the treatment of psychological symptoms in women during middle life.

Cohort Studies↗