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Biomedical subjects

V Beral

Publications and source records attributed to V Beral.

At least 163 records · Page 9Linked to original sources
PubMed1984

Epidemiological monitoring: methods for analysing routinely-collected data.

Morbidity and mortality statistics are routinely collected in many countries. These data may be arranged in a number of ways, for example, classified by area of residence, or occupation of the person concerned, or by the time-period during which the relevant event occurred. Judicious use of such data enables disease to be monitored and may draw attention to the adverse effects of harmful agents in the environment. This paper describes the different methods of analysing data for such purposes, giving examples of their application and discussing their relative merits. Particular reference is made to the data-collecting systems in England and Wales and to the statistical aspects of monitoring disease.

Communicable Diseases↗
PubMed1984

Poor reproductive outcome in insulin-dependent diabetic women associated with later development of other endocrine disorders in the mothers.

In a prospective study of insulin-dependent diabetic women who in the 1950s were involved in a drug trial, 13 (14%) of those who were still alive 27 years later were reported to have acquired thyroid disease or pernicious anaemia during the follow-up period. This suggests that their diabetes mellitus was a manifestation of a more generalised polyendocrine disorder. The pregnancy history of these 13 women differed strikingly from that of the other 82 insulin-dependent diabetic women: in the diabetic women who subsequently acquired other endocrine disease 69% of pregnancies resulted in a fetal or infant death, compared with 44% in other insulin-dependent diabetic women (p less than 0.01). This risk increased with pregnancy order, the odds ratio of an unfavourable outcome in women who later acquired thyroid disease or pernicious anaemia, compared with the other diabetic women, being 1.2 for the first pregnancy, 3.1 for the second pregnancy, 7.3 for the third pregnancy, and 14.0 for the fourth pregnancy. The mean birthweight of offspring of the women with other endocrine disease was substantially lower than the mean birthweight of offspring of other diabetic mothers (2977 g and 3430 g, respectively). These differences in birthweight and mortality could not be explained by the severity of the mothers' diabetes at the time of their pregnancies, and were evident even before the diabetes was diagnosed.

Abortion, Spontaneous↗
PubMed1984

Oral contraceptive use and malignant melanoma in Australia.

In a case control study of 287 women aged 15-24 years with malignant melanoma and 574 matched controls, findings relating to oral contraceptive use and other hormone use are reported. Ever having used oral contraceptives was not associated with an increased risk of melanoma (relative risk for ever use of the pill = 1.0). Women with melanoma were, however, more likely to have taken oral contraceptives for long periods of time in the past, the relative risk associated with oral contraceptive use for a total duration of 5 years or longer which had begun at least 10 years before the melanoma was diagnosed being 1.5 (95% confidence interval 1.03 to 2.14) This elevated risk persisted after controlling for the reported hair and skin colour, frequency of moles on the body, place of birth, and measures of sunlight and fluorescent light exposure. Cases were more likely than controls to have used hormones to regulate their periods, hormonal replacement therapy and be given hormone injections to suppress lactation, the respective relative risks being 1.9, 1.4 and 1.4, but none differed significantly from 1.0. These findings suggest that prolonged oral contraceptive use may, after a lag of 10 years or so, increase the risk of malignant melanoma.

Adolescent↗
PubMed1984

Alcohol consumption and outcome of pregnancy.

In a prospective study 1256 pregnant women at their first antenatal visit were asked if they drank alcohol every day, occasionally, or not at all, both at that time and before the diagnosis of pregnancy. There were no significant differences, among the three alcohol groups, in the proportions having miscarriages, perinatal deaths, congenital anomalies, or premature births. Women who reported drinking every day before pregnancy was diagnosed had heavier babies than those who did not drink at all, but there were no differences in mean birth weight according to alcohol use at the first antenatal visit. There were statistically significant differences among the three groups in important background characteristics, such as social class, age, smoking, and marital status. When adjustment was made for these factors, both occasional and daily consumption of alcohol before pregnancy appeared to have significantly positive effects on birth weight. These results illustrate the difficulty of evaluating the effects of alcohol in observational studies, and imply a need for caution in attributing either negative or positive effects of alcohol on the outcome of pregnancy.

Abortion, Spontaneous↗
PubMed1983

Parity and susceptibility to cancer.

Since fetal antigens are produced by tumour cells and pregnant women may have had contact with certain of these antigens, it is important to establish whether parous women have an altered susceptibility to cancer. Cancers of the breast, ovary and endometrium are less common in parous than nulliparous women. The more children a woman has, the greater is her protection from these cancers. The protection lasts throughout life. The only time when the reverse seems to be true is at childbearing ages, suggesting that in the short term pregnancy may increase cancer risk. There is no direct evidence that pregnancy protects against cancers of non-reproductive sites. Nevertheless, for most sites women have lower incidence rates than do men, and married women have lower rates than single women. The incidence of cancers of the stomach, gall bladder and thyroid, and possibly colon cancer and melanoma, may be increased in parous women (although the evidence is contradictory). Except for stomach cancer, tumours at these sites are more common in women than men. Most of the explanations for the relationship between childbearing and cancer have stressed the role of endocrine and metabolic factors. Immunological factors may well be relevant and need to be taken into consideration in future studies of cancer in human populations.

Breast Neoplasms↗
PubMed1983

Cutaneous factors related to the risk of malignant melanoma.

In a case-control study, 287 women with malignant melanoma were compared with 574 age-matched controls. Red hair colour at age 5 years was associated with a tripling of risk [relative risk (RR) = 3.0], blonde hair with a 60% increase (RR = 1.6) and fair skin with a doubling (RR = 2.1). Women with melanoma also reported that they tended to burn (RR = 1.4) and to freckle (RR = 1.9) after exposure to sunlight. Since fair skin, red hair, and the tendency to burn or freckle after exposure to sunlight all cluster in the same individuals, the extent to which each of these factors had an independent influence on susceptibility to melanoma was investigated. Hair colour, especially red hair, proved to be the major determinant, followed by skin colour. The reporting of above average numbers of naevi on the body was as strong a predictor of melanoma as was red hair colour (RR = 3.4). A history of psoriasis was also more common in cases than controls (RR = 3.0) as was a history of vitiligo (RR = 1.8). A history of acne appeared to be protective (RR = 0.4) as did a history suggestive of chloasma (RR = 0.6) and premature greying of the hair (RR = 0.6). These relationships were irrespective of hair and skin colour.

Adolescent↗
PubMed1982

Malignant melanoma and exposure to fluorescent lighting at work.

In a study of 274 women with malignant melanoma, aged 18--54 years, and 549 matched controls in New South Wales, Australia, reported exposure to fluorescent light at work was associated with a doubling of melanoma risk (relative risk [RR] = 2.1; 95% confidence limits 1.32--3.32). The risk grew with increasing duration of exposure to fluorescent light and was higher in women who had worked mainly in offices (RR = 2.6) than in women whose main place of work was indoors but not in offices (RR = 1.8). The findings could not be explained by the differences in histories of sunlight exposure, in skin or hair colour, or in any other factor. There was a relative excess of lesions on the trunk in the group exposed to fluorescent light at work. 27 men with melanoma and 35 similarly aged controls were studied, and a significant increase in risk was also found: the RB in those exposed for greater than or equal to 10 years compared with those exposed for less than 10 years was 4.4 (95% confidence limits 1.1--17.5). Such an association has not been reported before, but it is plausible and could explain many of the paradoxical features of the epidemiology of melanoma. Until more data accumulate it must, however, be viewed cautiously.

Adolescent↗
PubMed1982

Mortality of Shipham residents: 40-year follow-up.

The 1939 populations of Shipham, a village in Somerset with high soil-cadmium levels, and a nearby control village have been followed for 40 years. Death certificates were obtained for those who had died, and the mortality rates were compared with those for England and Wales. Small excesses of hypertensive, cerebrovascular, and genitourinary disease were noted in Shipman but not in the control village. These conditions have been associated wih cadmium toxicity, and so it is possible that cadmium had some influence on the disease pattern in Shipham; but if so, the effect was slight. By contrast, fewer deaths than expected from respiratory disease and cancers were observed in both villages. This gave rise to all-cause mortality rates in Shipham and the control village which were similar and well below the national average.

Cadmium Poisoning↗
PubMed1982

Increasing trends of multiple myeloma mortality in England and Wales; 1950-79: are the changes real?

National statistics for England and Wales for the period of 1950-79 were examined to study the secular trends in multiple myeloma mortality and to evaluate the extent to which these changes may be due to biases associated with improvements in medical care. Age-adjusted mortality has increased more than fivefold during this 30-year period. Contrary to the impression obtained from clinical series, a slightly greater increase in age-adjusted mortality has occurred in males. Examination of age- and sex-specific mortality trends showed that the greatest apparent increase in myeloma mortality occurred in individuals over 70 years of age. The data are consistent with either a cohort effect, indicating a true increase in mortality, or an age-dependent diagnostic effect in which a greater percentage of deaths among the elderly are now being certified as myeloma. Analyses of mortality data by social class and region point toward improved case ascertainment being responsible for at least part of the apparent increase in reported mortality. The increase in reported mortality in the younger age groups may reflect a true increase in the incidence of this disease. This increase, however, would account for only a proportion of the total increase, even when extrapolated to the older age groups.

Adult↗
PubMed1981

Cholecystectomy and changing mortality from gallbladder cancer.

Over the past decade, mortality from gallbladder cancer has declined sharply in England and Wales, Scotland, the United States, and Canada, but has risen by 33% in Sweden. In all these countries, gallbladder cancer mortality rates are inversely related to cholecystectomy rates in the previous year. It is suggested that changes in cholecystectomy rates produce changes in the prevalence of cholelithiasis, and consequently in gallbladder cancer incidence and mortality. It is estimated that 1 fewer death from gallbladder cancer occurs for about every 100 cholecystectomies done during the preceding year. The possibility of preventing death from gallbladder cancer in the patient with asymptomatic cholelithiasis must be balanced, however, against the risks of surgery.

Cholecystectomy↗
PubMed1981

The relationship of malignant melanoma, basal and squamous skin cancers to indoor and outdoor work.

An analysis of occupational incidence data for malignant melanomas and squamous-and basal-self carcinomas of the skin in England and Wales from 1970 to 1975 is reported. The occupational pattern for melanomas of the trunk and limbs differed markedly from the pattern for melanomas of the head, face and neck. Office work was associated with a large excess of melanomas of the trunk and limbs. In contrast, outdoor work was associated with an excess of melanomas of the head, face and neck; and was also associated with an excess of squamous-and basal-cell carcinomas of the skin. This suggests that prolonged occupational exposure to sunlight is an important cause of squamous-and basal-cell carcinomas and of melanomas of the head, face and neck, but not of melanomas on other parts of the body. The high rate of lesions on the trunk and limbs in office workers may reflect their sunbathing or other recreational habits; but it contrasts clearly with other indoor work, where there is a generally low rate of all forms of skin cancer.

Adolescent↗
PubMed1981

Comparison of cause of death coding on death certificates with coding in the Royal College of General Practitioners Oral Contraception Study.

A comparison has been made between the coding of the cause of death by (a) the Royal College of General Practitioners (RCGP) during the Oral Contraception Study and (b) the Office of Population Censuses and Surveys (OPCS) or the General Register Office for Scotland (GRO) on death certificates for the same subjects. Broad grouping of the International Classification of Diseases (ICD) showed close agreement between RCGP and OPCS or GRO coding for all deaths which occurred from the start of the Oral Contraception Study in 1968 up to December 1978. Moreover, where discrepancies occurred there were no systematic differences between ever-users of oral contraceptive and non-users. Detailed examinations of discrepancies in the coding of the causes of those deaths included in the RCGP publication of October 1977 shows that our previous estimate of mortality risk associated with oral contraceptives would not be materially altered by the use of death certificate information.

Cardiovascular Diseases↗
PubMed1981

Randomised trial of high doses of stilboestrol and ethisterone therapy in pregnancy: long-term follow-up of the children.

The 27-year follow-up is reported of 136 children whose mothers were involved in a randomised trial of high doses of stilboestrol and ethisterone therapy during pregnancy. The children were not contacted directly. Information about them was obtained from hospitals, general practitioners, and other official sources; and the persons who responded to our inquiries were unaware of who had been exposed to hormones in utero and whose mothers had received an inactive tablet. All children were traced. Urogenital anomalies were reported more frequently in the hormone-exposed than the unexposed children (14% and 9% respectively). The earlier in pregnancy the therapy began, the higher the prevalence rate of abnormalities (X2 for trend, p less than 0.02). No malignant tumours were reported. For males, the proportion reported to be married or living as married was lower in the exposed than in the unexposed group (32% and 62% respectively). The proportion was lower the earlier in pregnancy hormonal exposure occurred and the higher the total hormone dose to which they were exposed (X2 for trend, p less than 0.02). These findings suggest that some interference with sexual function may not be uncommon in males exposed to high doses of stilboestrol and ethisterone while in utero.

Abnormalities, Drug-Induced↗
PubMed1981

Trends in pelvic inflammatory disease in England and Wales.

Hospital admissions for pelvic inflammatory disease increased by 8.7% a year among women aged 15-44 in England and Wales between 1966 and 1976. Acute disease was three times as frequent as chronic disease, although admissions for the chronic condition are increasing more rapidly than for the acute. Peak incidence of acute disease is at ages 20-24 and of chronic disease at ages 25-29. Divorced women had the highest rates of both forms. Single women had higher rates of acute disease than married women but the latter had higher admission rates for chronic disease. In general, the pattern of acute disease follows that of sexually transmitted disease. The pattern of chronic disease in turn reflects the long-term effects of acute disease. The increase in chronic disease is of concern because hospital discharge rates are increasing more rapidly than for acute disease, and in 1976 one in every eight cases mentioned infertility in association with the disease.

Acute Disease↗
PubMed1980

Randomised trial of high doses of stilboestrol and ethisterone in pregnancy: long-term follow-up of mothers.

In 1950 a trial was set up to evaluate the effects of large doses of stilboestrol and ethisterone on rates of fetal loss in pregnant diabetic women. Eighty women were allocated at random to receive the hormonal treatment and 76 to receive inactive tablets of identical appearance. At follow-up 27 years later, information was obtained about 97% of the women, all but four being traced. All respondents were unaware of who had received hormones. The overall mortality was 4.5 times that of women of comparable age in England and Wales, most deaths being from complications of diabetes. More tumours, mainly benign, of the reproductive tract were reported in the hormone-exposed than the non-exposed group (14 (18%) and two (3%) respectively). Four cases of malignant breast disease were reported in the hormone-exposed women and none in the non-exposed. These findings support other evidence linking oestrogen treatment and breast cancer and suggesting that the latent period before the tumour becomes clinically apparent may be 15 years or longer.

Breast Neoplasms↗
PubMed1980

Nitrate and human cancer: a review of the evidence.

Nitrites, derived mainly from ingested nitrates, may react in vivo with secondary nitrogen compounds occurring naturally in certain foods to form N-nitroso compounds, which are potent carcinogens in laboratory animals. This paper reviews the mechanism of their formation and the evidence from epidemiological studies that high nitrate ingestion is involved in the aetiology of human cancer.

Animals↗