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Shah Ebrahim

Publications and source records attributed to Shah Ebrahim.

137 records · Page 8Linked to original sources
PubMed2002

Lay perceptions of a 'natural' menopause. Cross sectional study of the British Women's Heart and Health Study.

Health practitioners and researchers define a natural menopause as one not due to a hysterectomy or oophorectomy. In a large cross sectional study of postmenopausal women, we found that the majority of women who report that their menopause was not natural gave a gynaecologic reason. However, 3% gave a major life event, such as divorce or bereavement. Age at menopause for women who had had a hysterectomy/oophorectomy was the same as that of women who reported that their periods has stopped because of a major life event-on average six years younger than that of women who described their menopause as natural. We suggest that women whose periods stop 'naturally' (from a medical perspective) but at a relatively young age perceive this as unnatural and search for an explanation for the early cessation of their menses.

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PubMed2002

Agreement between measured and self-reported weight in older women. Results from the British Women's Heart and Health Study.

BACKGROUND: previous studies of the accuracy of self-reported weight have been criticised for using inadequate methods and have included only young or middle aged adults. Self-report is more likely to be relied upon in both clinical and research practice in older age groups. The cultural pressures that may cause the tendency among younger women to underestimate their weight, particularly when they are overweight, may operate differently in older women. OBJECTIVE: to determine the accuracy of self-reported weight among older women. METHODS: national cross sectional survey of women aged 60-79 from 9 towns across England, Scotland and Wales. Self-reported weight from a participant questionnaire was compared to measured weight at examination. RESULTS: of 2729 women who were invited, 1636 (60%) returned the questionnaire (of whom 1549 gave a self-reported weight) and 1384 (51%) attended for examination (of whom 1381 were weighed). In total there were 1310 (48% of the total invited sample) with complete self-report and measured weight. Self-reported and measured weight were highly correlated (Pearson's correlation coefficient, 0.982 95% confidence interval, 0.979-0.983) and self-reported weight differed from measured weight by only 1.0 kg (95% confidence interval 0.8 kg, 1.1 kg) on average. However, a difference plot, with limits of agreement at -4.0 kg to +6.0 kg (95% confidence intervals: lower limit -4.3 kg, -3.8 kg; upper limit +5.7 kg, +6.2 kg) revealed poor agreement between methods. Obese individuals, in particular, were more likely to underestimate their weight. CONCLUSIONS: though self-report of weight by women in their 60s and 70s is highly correlated, at an individual level differences between self-report and measured weight are frequently large. Obese individuals, in particular, tend to underestimate their weight. Self-report of weight should not be relied upon in prospective epidemiological studies or clinical practice when accuracy at the level of the individual is required.

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PubMed2002

Does psychological distress predict the risk of ischemic stroke and transient ischemic attack? The Caerphilly Study.

BACKGROUND AND PURPOSE: Psychological distress is common after stroke, but little is known about its etiologic importance, although the general public often ascribes stroke to the experience of stress. Therefore, we examined whether psychological distress leads to an increased risk of ischemic stroke and transient ischemic attack (TIA). METHODS: The association between the 30-item General Health Questionnaire (GHQ), a measure of psychological distress, and the incidence of nonfatal and fatal ischemic stroke and TIA was measured by Cox regression modeling in a prospective observational study of 2201 men aged 45 to 59 years in phase II of the Caerphilly cohort. Hazard ratios comparing those with high (> or = 5) and normal GHQ scores were calculated with adjustment for age and other covariates. RESULTS: Twenty-two percent of men suffered from psychological distress, indicated by a score of > or =5 on the GHQ. There were 130 incident strokes recorded, of which 17 were fatal and 113 nonfatal. The relative risk of incident ischemic stroke was 1.45 (95% CI, 0.98 to 2.14) for those who showed symptoms of psychological distress compared with those who did not. For fatal stroke the relative risk was 3.36 (95% CI, 1.29 to 8.71) and for nonfatal stroke 1.25 (95% CI, 0.82 to 1.92). The relative risk of TIA for the distressed group was 0.63 (95% CI, 0.26 to 1.53). The results were unchanged after adjustment for body mass index, systolic blood pressure, smoking, heavy drinking, social class, and marital status. However, additionally controlling for previously diagnosed ischemic heart disease, diabetes, respiratory disease, and retirement due to ill health attenuated the relative risks, but not markedly. For fatal strokes the relative risk decreased to 2.56 (95% CI, 0.97 to 6.75) when all confounding variables were included in the model. There was a graded association between degree of psychological distress and risk of fatal ischemic stroke. CONCLUSIONS: Psychological distress is a predictor of fatal ischemic stroke but not of nonfatal ischemic stroke or TIA. Further work examining the mechanisms of this association is required.

Brain Ischemia↗
PubMed2002

Fibrinogen, viscosity and white blood cell count predict myocardial, but not cerebral infarction: evidence from the Caerphilly and Speedwell cohort.

Fibrinogen, plasma viscocity, and the white blood cell count predict ischaemic heart disease, but there is less certainty for their predictive power for ischaemic stroke. Studying stroke and ischaemic heart disease in the same cohort prospectively allows comparison of predictive strengths. The Caerphilly and Speedwell cohorts consist of a population sample of 4,860 men aged 45-59 years at recruitment who had baseline measurements of fibrinogen, plasma viscosity, and white blood cell counts. After 15-19 years of follow-up, men in the two cohorts experienced 312 ischaemic strokes and 557 ischaemic heart disease events. Mean fibrinogen, plasma viscosity and white blood cell counts differed significantly after adjustment for confounding factors between men with and without ischaemic heart disease, 0.25 g/l (95% CIs 0.1 8-0.32); 0.036 cp (95% CIs 0.027-0.044); 0.67 x 10(9)/l (95% CIs 0.50-0.84) respectively. The same measurements showed no significant differences after adjustment for the same confounding factors for men with and without ischaemic stroke, 0.05 g/l (95% CIs -0.04-0.14); 0.008 cp (95% CIs -0.003-0.019); 0.16 x 10(9)/l (95% CIs -0.06-0.38) respectively.

Blood Viscosity↗
PubMed1999

Social and practical strategies described by people living at home with stroke.

People with stroke are often referred to in negative terms. The phrase 'stroke victim' suggests that they are regarded as passive and deserving of pity, whilst 'the burden of care' implicates them negatively as an encumbrance to others. Much of the literature focuses on how stroke devastates peoples' lives, again casting the person with the stroke as an inactive victim of the illness, and subsequently a passive recipient of care. Against this background we aimed to find out whether people with stroke and their families take positive actions in response to the condition, and if so, to explore the nature of these actions. In-depth interviews were conducted with a consecutive sample of 40 people admitted to hospital in the East End of London, 10 months after their stroke. People with stroke were found to play an active and creative role in managing the aftermath of their illness. They (i) mobilized informal social support; (ii) created new ways of doing things; (iii) took things more slowly; (iv) began the process of relearning; (v) exercized; and (vi) 'covered up'. Families were found to be a major resource. These findings challenge the view of people with stroke as 'victims', who bring about a 'burden of care', and suggest that the majority of work after stroke is conducted not by clinicians or by formal carers, but by the person with the stroke and their families, at home. This needs to be recognized and respected by formal carers, who should base their interventions around the systems and routines established by families.

Journal Article↗
PubMedDate not supplied

Genetic epidemiology and public health: hope, hype, and future prospects.

Genetic epidemiology is a rapidly expanding research field, but the implications of findings from such studies for individual or population health are unclear. The use of molecular genetic screening currently has some legitimacy in certain monogenic conditions, but no established value with respect to common complex diseases. Personalised medical care based on molecular genetic testing is also as yet undeveloped for common diseases. Genetic epidemiology can contribute to establishing the causal nature of environmentally modifiable risk factors, through the application of mendelian randomisation approaches and thus contribute to appropriate preventive strategies. Technological and other advances will allow the potential of genetic epidemiology to be revealed over the next few years, and the establishment of large population-based resources for such studies (biobanks) should contribute to this endeavour.

Adult↗
PubMedDate not supplied

Depressive symptoms lead to impaired cellular immune response.

BACKGROUND: The association between depression and immune response is not yet clear. The biological mechanisms by which depression alters the immune system is not yet understood. The purpose of this study was to investigate the longitudinal relationship between depressive symptoms and cellular immune response. METHODS: A cohort study with a baseline measurement and three annual health assessments was set up in a residential home for elderly people in Rome, Italy. A total of 166 residents aged 65 years and older, mean age 81 years, were interviewed and blood samples were collected at each annual assessment. Percentage changes in lymphocytes and T-cell subsets related to depressive symptoms were estimated over a period of 4 years, using regression models for repeated measurements. RESULTS: Elderly people with seven or more symptoms of depression, according to the Geriatric Depression Scale, had a lower percentage of CD4+DR+ T-cells over 4 years [beta = -20.2; 95% confidence interval (CI) = -33.0 to -4.9] and CD8+DR+ T-cells (beta = -26.9; 95% CI = -42.5 to -7.0) than elderly with less than seven symptoms of depression, after adjusting for confounding factors (sex, age, marital status, education, smoking habit, nutritional status, chronic diseases, disability and the use of benzodiazepines). CONCLUSION: The results of this study suggest an adverse effect of depressive symptoms on immune response. It remains to be determined whether these depression-associated immune changes are related to the onset or course of physical illness and the increased mortality observed in depressed old people.

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