Showing papers by "Cyrus Cooper published in 1997"

Growth in infancy and bone mass in later life

Abstract: 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 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.

Prospective cohort study of predictors of incident low back pain in nurses

Abstract: Objective: To assess the impact of handling patients and indicators of individual susceptibility on risk of low back pain in nurses. Design: Prospective cohort study with follow up by repeated self administered questionnaires every three months over two years. Setting: NHS university hospitals trust. Subjects: 961 female nurses who had been free from low back pain for at least one month at the time of completing a baseline questionnaire. Main outcome measures: Incidence of new low back pain during follow up and of pain leading to absence from work. Results: Of 838 women who provided data suitable for analysis, 322 (38%) developed low back pain during follow up (mean 18.6 months), including 93 (11%) whose pain led to absence from work. The strongest predictor of new low back pain was earlier history of the symptom, and risk was particularly high if previous pain had lasted for over a month in total and had occurred within the 12 months before entry to the study (incidence during follow up 66%). Frequent low mood at baseline was strongly associated with subsequent absence from work for back pain (odds ratio 3.4; 95% confidence interval 1.4 to 8.2). After adjustment for earlier history of back pain and other potential confounders, risk was higher in nurses who reported frequent manual transfer of patients between bed and chair, manual repositioning of patients on the bed, and lifting patients in or out of the bath with a hoist. Conclusions: Of the indicators of individual susceptibility that were examined, only history of back trouble was sufficiently predictive to justify selective exclusion of some applicants for nursing posts. The main route to prevention of back disorders among nurses is likely to lie in improved ergonomics. Key messages A history of back trouble, particularly if recent and prolonged, is highly predictive of new episodes of back pain There are grounds for excluding nurses with recent and prolonged back pain from the most physically demanding jobs Age, height, and weight are not sufficiently discriminatory for risk of back pain to influence selection and appointment of nurses Back pain is more common in nurses who lift and move patients frequently without the use of mechanical aids Controlled trials are needed to assess the benefits of ergonomic intervention aimed at prevention of back pain in nurses

Quality of life as outcome in the treatment of osteoporosis: The development of a questionnaire for quality of life by the European foundation for osteoporosis

Abstract: The morbidity of osteoporosis is caused by fractures. Vertebral fractures lead to pain and disability and a decrease in quality of life. A Working Party of the European Foundation for Osteoporosis has developed a specific questionnaire for patients with established vertebral osteoporosis. This questionnaire is intended for use in clinical trials. The questionnaire consists of questions and visual analogue scales in the following domains: pain, activities of daily living, jobs around the house, mobility, leisure and social activities, general health perception and mood. The questionnaire has been translated from English into French, German, Italian, Hebrew, Swedish and Dutch. The questionnaire is currently being validated in a multicentre study involving patients with stable osteoporosis and control subjects. Preliminary results indicate that the reproducibility is sufficient and that the questionnaire is able to discriminate between patients with vertebral osteoporosis and control subjects.

Influence of Physical Activity on Vertebral Deformity in Men and Women: Results from the European Vertebral Osteoporosis Study

Abstract: Physical activity is associated with an increased bone mass and a reduced risk of hip fracture. There are, however, no data from population samples of men and women concerning the effect of regular levels of physical activity on the risk of vertebral deformity. The aim of this study was to determine the relationship between regular physical activity and vertebral deformity in European men and women. A population survey method was used. Thirty-six centers from 19 European countries participated. Each center recruited a population sample of men and women aged 50 years and over. Those who took part received an interviewer-administered questionnaire and lateral thoracolumbar radiographs. Subjects were asked about two dimensions of physical activity: (1) the level of physical activity undertaken either at work or at home on a daily basis at three different age periods: 15–25 years, 25–50 years, and 50+ years; and (2) the amount of time spent walking or cycling out of doors each day. Spinal radiographs were evaluated morphometrically and the presence of vertebral deformity was defined according to the McCloskey method. In total, 14,261 subjects, aged 50–79 years, from 30 centers were studied, of whom 809 (12.0%) men and 884 (11.7%) women had one or more deformities. After adjusting for age, center, smoking, and body mass index, very heavy levels of activity in all three age groups were associated with an increased risk of vertebral deformity in men (odds ratios, age adjusted [OR], 1.5–1.7; with all 95% confidence intervals [CI] excluding unity). No increased risk was observed in women. Current walking or cycling more than ½ h/day was associated with a reduced risk of vertebral deformity in women (OR 0.8; 95% CI 0.7–1.0). We conclude that regular walking in middle-aged and elderly women is associated with a reduced risk of vertebral deformity. By contrast, heavy levels of physical activity in early and middle adult life are associated with an increased risk in men. These differences are of relevance in understanding the epidemiology of vertebral deformity and planning programs of prevention.

Retinal vascular network architecture in low‐birth‐weight men

Abstract: BACKGROUND: Low birth weight is associated with hypertension and increased cardiovascular mortality, but the mechanism of this association is not known. Hypertension is accompanied by abnormalities of the microvasculature including rarefaction. OBJECTIVE: To test the hypothesis that low birth weight is associated with an alteration in microvascular architecture. DESIGN: A stratified random sample of 100 men aged 64-74 years was selected from a cohort of men whose birth weights were known. They were of relatively high or low birth weight ('high' > or = 3700 g, 'low' or = 160 mmHg, low < or = 140 mmHg). METHODS: Retinal arteriolar geometry was defined in terms of arteriolar bifurcation angles and junction exponents (a measure of the relative diameters of parent and daughter vessels), measured from photographic diapositives using operator-directed image analysis. RESULTS: Members of low-birth-weight groups had significantly narrower bifurcation angles than did members of high-birth-weight groups (74 +/- 1 degree versus 78 +/- 1 degree, P= 0.017 by analysis of variance). There was no significant difference between angles in members of groups with high and low blood pressures. Neither birth weight nor blood pressure grouping affected junction exponents. CONCLUSIONS: Narrower bifurcation angles are associated with increased circulatory energy costs and may be related to a lower than normal microvascular density. Our finding of differences in retinal microvascular architecture might reflect a persistent alteration in vascular architecture as a result of an impairment of foetal development and could provide a mechanistic link between low birth weight and subsequently increased cardiovascular risk.

CT Findings of Mesenteric Injury After Blunt Trauma: Implications for Surgical Intervention

Abstract: The purposes of this study were to determine the spectrum of CT findings of mesenteric injury, to compare CT findings of mesenteric injury with surgical observations, and to assess the potential of CT to predict which patients with mesenteric injury require laparotomy.Blunt trauma patients admitted to our facility during a 5-year 4-month period with a CT or surgical diagnosis of mesenteric injury were identified from a radiology database and trauma registry. Patients with CT findings of full-thickness bowel injury associated with mesenteric injury or diagnostic peritoneal lavage performed before CT were excluded. CT scans of all patients were retrospectively reviewed both with and without knowledge of surgical results. Medical records of all study patients were reviewed to ascertain admission physical findings and surgical results.Twenty-seven of 29 patients meeting the study criteria underwent laparotomy, and two others were managed conservatively. Among the 27 patients who had surgery. 24 (89%) had CT f...

Occupational physical activity and long-term risk of musculoskeletal symptoms: a national survey of post office pensioners.

Abstract: The objective of this work was to address the relationship between physical activity in the workplace and subsequent musculoskeletal pain syndromes. We performed a survey of 5,042 men and women aged 70–75 years, selected from the retirement population of a large national employer (the post office). Subjects were sent a short postal questionnaire enquiring about all occupations held for at least 1 year, the physical activities performed in those jobs, and about recent rheumatic symptoms. The 1-month period prevalence of rheumatic symptoms ranged from 19.9% for hip pain or stiffness in men to 50% for knee pain or stiffness in women. Symptoms were more common in women than men at all sites and there were significant (P < 0.001) associations between symptoms at different sites. Obesity was significantly (P < 0.001) associated with the risk of pain or stiffness at the knee and hip. Prolonged occupational exposure (20+ years) to heavy lifting was associated with hip pain (RR = 1.5; 95% CI = 1.2–1.8); and prolonged exposure to working with arms elevated was associated with an increased risk of shoulder pain (RR = 1.4; 95% CI = 1.2–1.6). Tall stature (P = 0.003) and heavy lifting (P < 0.001) were both associated with increased risks of low back pain among men. This survey confirms the high prevalence of musculoskeletal symptoms observed in previous population-based studies. Associations between occupational activities and musculoskeletal symptoms were specific for activity type and skeletal site involved. Our results imply that the adverse effects of these occupational activities can be found many years after cessation of exposure. Am. J. Ind. Med. 32:76-83, 1997. © 1997 Wiley-Liss, Inc.

Anthropometric Measurements and Vertebral Deformities

Abstract: To investigate the association between anthropometric indices and morphometrically determined vertebral deformity, the authors carried out a cross-sectional study using data from the European Vertebral Osteoporosis Study (EVOS), a population-based study of vertebral osteoporosis in 36 European centers from 19 countries. A total of 16,047 EVOS subjects were included in this analysis, of whom 1,973 subjects (915 males, 1,058 females) (12.3%) aged 50 years or over had one or more vertebral deformities ("cases"). The cases were compared with the 14,074 subjects (6,539 males, 7,535 females) with morphometrically normal spines ("controls"). Data were collected on self-reported height at age 25 years and minimum weight after age 25 years, as well as on current measured height and weight. Body mass index (BMI) and height and weight change were calculated from these data. The relations between these variables and vertebral deformity were examined separately by sex with logistic regression adjusting for age, smoking, and physical activity. In females, there was a significant trend of decreasing risk with increasing quintile of current weight, current BMI, and weight gain since age 25 years. In males, subjects in the lightest quintile for these measures were at increased risk but there was no evidence of a trend. An ecologic analysis by country revealed a negative correlation between mean BMI and the prevalence of deformity in females but not in males. The authors conclude that low body weight is associated with presence of vertebral deformity.

Influence of hormonal and reproductive factors on the risk of vertebral deformity in European women

Abstract: The aim of this study was to determine whether variation in the level of selected hormonal and reproductive variables might explain variation in the occurrence of vertebral deformity across Europe. A population-based cross-sectional survey method was used. A total of 7530 women aged 50–79 years and over were recruited from 30 European centres. Subjects were invited to attend for an interviewer-administered questionnaire and lateral spinal radiographs which were taken according to a standard protocol. After adjusting for age, centre, body mass index and smoking, those in the highest quintile of menarche (age 2=16 years) had an increased risk of vertebral deformity (odds ratio [OR]=1.48; 95% confidence interval [CI] 1.16, 1.88). Increased menopausal age (>52.5 years) was associated with a reduced risk of deformity (OR=0.78; 95% CI 0.60, 1.00), while use of the oral contraceptive pill was also protective (OR=0.76; 95% CI 0.58, 0.99). There was a smaller protective effect associated with one or more years use of hormone replacement therapy, though the confidence limits clearly embraced unity. There was no apparent effect of parity or breast-feeding on the risk of deformity. We conclude that oestrogen status is an important determinant of vertebral deformity. Ever use of the oral contraceptive pill was associated with a 25% reduction in risk of deformity though the effect may be a result of the higher-dosage oestrogen pills used in the past. Parity and breast-feeding do not appear to be important and would appear to have little potential for identification of women at high risk of vertebral deformity.

Acetabular dysplasia and osteoarthritis of the hip in elderly white women

Abstract: OBJECTIVES—To examine the association of acetabular dysplasia and osteoarthritis (OA) of the hip among elderly white women. METHODS—Pelvic radiographs from a sample of 165 white women aged 65 and above with radiographic hip OA and 88 white women aged 65 and above without radiographic changes of hip OA were read for evidence of acetabular dysplasia by a single trained investigator. Acetabular dysplasia was assessed using measurements of the centre edge angle and the acetabular depth, which are both reduced in this condition. Odds ratios for the association between acetabular dysplasia and hip OA were estimated using logistic regression analysis. RESULTS—Fourteen (3.4%) hips had a centre edge angle < 25°, 46 (11.2%) hips had an acetabular depth of < 9 mm, and 54 (13.2%) hips had acetabular dysplasia defined as either of the above. Hips with OA had a small, but not statistically significant, increased prevalence of abnormal centre edge angle (odds ratio: 1.43; 95% confidence intervals: 0.46, 4.46), abnormal acetabular depth (1.47; 0.78, 2.77) and acetabular dysplasia (1.33; 0.74, 2.40). CONCLUSION—These results do not support the hypothesis that mild acetabular dysplasia accounts for a substantial proportion of hip OA in elderly white women. A study with a much larger sample size would be required to rule out a weak association between dysplasia and hip OA of the magnitude actually observed in our study.

Prenatal Factors Influencing Long-Term Outcome

Abstract: Animal studies have shown that undernutrition before birth programmes persisting changes in a range of metabolic, physiological and structural parameters. Studies in humans have shown that men and wom

The Relationship Between Childhood Growth, Bone Mass, and Muscle Strength in Male and Female Adolescents

Abstract: In this population-based study, the relationship between childhood weight and height, and adolescent bone mass and muscle strength have been studied in 39 girls and 48 boys. Total body and femoral neck bone mass measurements (bone mineral content, BMC and bone mineral density, BMD) were made by dual X-ray absorptiometry. Quadriceps muscle strength was measured. Mean age at the time of measurement was 15.1 years for girls and boys. Results were individually linked to data on childhood (birth to 6 years of age) weight and height, taken from community health records. Childhood weight was found to be predictive of adolescent total body BMC (TBMC). However, this was not the case when correlating childhood weight and total body BMD (TBMD), suggesting that growth determines the size of the skeleton, whereas the density within that bone envelope is to a greater extent governed by other factors. Further, in a multiple regression model we found that the combined effect of childhood weight and height was significantly correlated with adolescent quadriceps muscle strength.

Is lifespan determined in utero

Abstract: Low rates of growth in early life are now known to be associated with an increase in age related disease in later life.1 This is thought to reflect programming, the process whereby a stimulus or insult acting at a critical period of development in early life, has lasting or lifelong importance.2 In animal experiments that have examined the mechanisms responsible for programming, attention has focused on prenatal undernutrition and its influence on gene expression, cell division and differentiation, and tissue structure. Epidemiological studies have shown that markers of poor fetal growth, including low early weight, thinness, and shortness at birth, are associated with increased mortality and morbidity from cardiovascular disease in later life.1 3 Correlations have also been shown between poor early growth and the major cardiovascular risk factors—raised blood pressure,4raised plasma fibrinogen5 and serum cholesterol concentrations,6 impaired glucose tolerance7and reduced arterial compliance.8 These associations were first established by studies in Hertfordshire, where from 1911 to 1948, every newborn baby was weighed and followed up to the age of 1 year. The prevalence of non-insulin diabetes and impaired glucose tolerance, for example, falls threefold between men who weighed 5.5 pounds at birth and those who weighed 9.5 pounds.7 These associations have been replicated in several different countries including the United States9 and India10 as well as in Britain. The associations are independent of adult lifestyle, and are not limited to cardiovascular disease. Chronic obstructive pulmonary disease11 and reduced bone mineral content12 13 are both associated with reduced growth in utero and during infancy. The major determinant of fetal growth is nutrition14-16 and the fetal origins hypothesis proposes that fetal undernutrition programmes the long term adverse sequelae of small size at birth. Cardiovascular disease, impaired …

Validity of a questionnaire for assessing occupational activities.

Abstract: The objective of this article is to assess the validity of data on occupational activities obtained by a questionnaire, 152 employees from 16 jobs were interviewed independently about activities in their work, using a structured questionnaire. For 11 of the jobs, two further workers were observed during a typical shift, and their activities recorded. The agreement of reporting between subjects doing the same job and with observation was assessed. There was good agreement between subjects and with observation for most of the activities examined when the activities were classified dichotomously. However, frequency of heavy lifting was reported inconsistently. Questionnaires are able to distinguish major differences in physical activity that occur between jobs in the general population, but do not allow more detailed quantification of activities. Am. J. Ind. Med. 31:422–426, 1997. © 1997 Wiley-Liss, Inc.

Undernutrition and aging.

Abstract: Diet restriction is a well-recognised method of slowing aging and prolonging life span in animals. However, previous studies of this have tended to start after weaning and the effects of prenatal or early postnatal diet restriction have rarely been considered. Here we summarise the existing literature, which suggests that reducing nutrition at this earlier stage of life has opposite effects, resulting in accelerated aging and a reduction in life span. These findings support emerging epidemiological evidence in man that poor nutrition in early life may programme accelerated aging and predispose to a variety of age-related diseases.