Showing papers by "Debbie A Lawlor published in 2000"

Sex differences in risk factors, treatment and mortality after acute myocardial infarction: an observational study.

Abstract: BACKGROUND—Coronary heart disease is the major cause of death of postmenopausal women in industrialised countries. Although acute myocardial infarction (AMI) affects men in greater numbers, the short-term outcomes for women are worse. In the longer term, studies suggest that mortality risk for women is lower or similar to that of men. However, length of follow up and adjustment for confounding factors have varied and more importantly, the association between treatment and outcomes has not been examined. STUDY OBJECTIVE—To investigate the association between sex differences in risk factors and hospital treatment and mortality after AMI. DESIGN—A prospective observational study collecting demographic and clinical data on cases of AMI admitted to hospitals in Yorkshire. The main outcome measures were mortality status at discharge from hospital and two years later. SETTING—All district and university hospitals accepting emergency admissions in the former Yorkshire National Health Service (NHS) region of northern England. PARTICIPANTS—3684 consecutive patients with a possible diagnosis of AMI admitted to hospitals in Yorkshire between 1 September and 30 November 1995. MAIN RESULTS—AMI was confirmed by the attending consultant for 2196 admissions (2153 people, 850 women and 1303 men). Women were older and less likely than men to be smokers or have a history of ischaemic heart disease. Crude inhospital mortality was higher for women (30% versus 19% for men, crude odds ratio of death before discharge for women 1.78, 95% confidence intervals 1.46, 2.18, p=0.00). This difference persisted after adjustment for age, risk factors and comorbidities (adjusted OR 1.29, 95% CI 1.04, 1.63, p=0.02), but was not significant when treatment was taken into account. Women were less likely to be given thrombolysis (37% versus 46%, p<0.01) and aspirin (83% versus 90%, p<0.01), discharged with β blockers (33% versus 47%, p<0.01) and aspirin (82% versus 88% p<0.01) or be scheduled for angiography, exercise testing or revascularisation. Adjustment for age removed much of the disparity in treatment. Crude mortality rate at two years was higher for women (OR 1.81, 95%CI 1.41, 2.31, p=0.00). Age, existing risk factors and acute treatment accounted for most of this difference, with treatment on discharge having little additional influence. CONCLUSIONS—Patients admitted to hospital with AMI should be offered optimal treatment irrespective of age or sex. Women have a worse prognosis after AMI and under-treatment of older people with aspirin and thrombolysis may be contributing to this. Keywords: sex inequalities; acute myocardial infarction

Can general practitioners influence the nation's health through a population approach to provision of lifestyle advice?

Abstract: BACKGROUND: Lifestyle advice from general practitioners (GPs) has been shown to have a positive effect on population health. In practice, GPs provide lifestyle advice to a minority of their patients only, those who are high risk or already have symptoms. AIM: To look in depth at GPs' attitudes towards adopting a population approach to lifestyle advice and to use these results to identify ways of maximising the potential of GPs to affect population health. METHOD: Thirty-six GPs, purposively sampled by identifying characteristics likely to affect their health promotion activity, participated in a focus group study. Data from the focus groups were transcribed verbatim and analysed using standard methods. RESULTS: The main themes that emerged suggested that GPs do not take a population approach to lifestyle advice because they prefer a high risk approach and doubt their ability to be effective in a population approach. GPs believed that social, cultural, and environmental factors were the most important determinants of population health. Furthermore, they were concerned about the detrimental effects on the doctor-patient relationship of providing lifestyle advice to all patients. GPs believed that a multi-agency, centrally co-ordinated approach was the preferred way to improve population health and that their role should be limited to secondary prevention. CONCLUSION: Large amounts of resources would be necessary to convince GPs to adopt a population approach to lifestyle advice. Measures to tackle the social and environmental determinants of health may be a more effective and efficient means of improving the nation's health.

Effective management of the elderly hearing impaired--a review.

Abstract: In the United Kingdom, two and a half million people over 70 are thought to have hearing impairment that would benefit from an aid. Only one-third of these will possess one, and as many as 10 per cent probably never use their aid. Although it is important to examine the relative merits of different aids, there is also a need to look at how audiological services may reduce the unmet need that results from underuse of aids. This review examines the important question of 'what is the most effective way of providing hearing aids for the elderly affected by presbyacusis?' Extensive searching of four electronic databases and hand searching of relevant journals revealed the paucity of evidence to guide audiology practice. In particular there is little consensus on the best outcome measures for evaluating audiological rehabilitation or hearing aid fitting. Audiological services for the elderly are another example of an area where there is a need to fund research and development rather than continue to commission services that are variable and poorly evaluated.

Investigation of the association between excess winter mortality and socio-economic deprivation.

Abstract: Background Excess winter mortality is higher in England and Wales than in other European countries with similar or lower average winter temperatures. It might be expected that excess winter mortality would be higher in areas with greater socio-economic deprivation, and if this were so preventive interventions could be directed at populations in these areas. The association between deprivation and excess winter mortality has not been adequately investigated in the past. The aim of this study was to look at the association between excess winter mortality and socio-economic deprivation, so that policy decisions to reduce this excess mortality could be appropriately directed. Methods Super Profile groups derived from the 1991 Census were used as a measure of socio-economic status. The age-standardized excess winter death index (EWDI) was calculated for each Super Profile group, for the population of Bradford. The EWDI was also calculated for the manufacturing districts (Office for National Statistics area classification), a relatively deprived group, and compared with that for England and Wales. Results No significant trend was found in age-standardized excess winter mortality across the Super Profile groups. The manufacturing districts had a similar EWDI to the national value. Conclusion Excess winter mortality is not associated with deprivation. Further research to identify the important aetiological factors and appropriate interventions to reduce excess winter mortality is needed.

Do British travel agents provide adequate health advice for travellers

Abstract: Travel-related illness is a burden for primary care, with more than two million travellers consulting a general practitioner each year. The annual cost of travel-related illness in the United Kingdom is 11 million Pounds. Travel agents are in a unique position to influence this burden as the most common and most serious problems are preventable with simple advice and/or immunisation. This study, using covert researchers, suggests this potential is not being fully utilised.