Showing papers by "Debbie A Lawlor published in 2002"

The association between components of adult height and Type II diabetes and insulin resistance: British Women's Heart and Health Study.

Abstract: Aims/hypothesis. The aim of this study was to investigate the associations between components of adult height (leg length, trunk length, ratio of leg to trunk length) and Type II (non-insulin-dependent) diabetes mellitus and insulin resistance. Methods. A cross sectional study was carried out on 4286 women of age 60 to 79 years from 23 towns across England, Scotland and Wales. Results. Total height was weakly and inversely associated with diabetes but this masked differences in the association with leg and trunk length. Leg length was inversely associated with Type II diabetes [age adjusted odds ratio (95% CI) for diabetes for each standard deviation (4.3 cm) increase in leg length: 0.81 (0.73, 0.90)] whereas trunk length was not associated with diabetes [age adjusted odds ratio (95% CI) for diabetes for each standard deviation (3.6 cm) increase in trunk length: 1.05 (0.94, 1.18)]. Adjustment for potential confounding factors attenuated but did not remove the inverse association between leg length and the prevalence of diabetes: fully adjusted odds ratio (95% CI) per standard deviation increase in leg length was 0.87 (0.77, 0.98) and that per standard deviation increase in the ratio of leg to trunk length was 0.88 (0.78, 0.99). In non-diabetic women leg length was inversely associated with insulin resistance, whereas trunk length was positively associated with insulin resistance. Conclusion/interpretation. Leg length is an indicator of early childhood environmental circumstances, in particular of infant nutrition. These results suggest that poor infant nutrition is an important causal factor in the development of Type II diabetes and insulin resistance in later life.

Socioeconomic position in childhood and adulthood and insulin resistance: cross sectional survey using data from British women's heart and health study

Abstract: Objective: To assess the associations between childhood and adulthood social class and insulin resistance. Design: Cross sectional survey. Setting: 23 towns across England, Scotland, and Wales. Participants: 4286 women aged 60-79years. Main outcome measures: Insulin resistance and other cardiovascular disease risk factors. Results: Belonging to manual social classes in childhood and in adulthood was independently associated with increased insulin resistance, dyslipidaemia, and general obesity. The association between childhood social class and insulin resistance was stronger than that for adult social class. The effect, on insulin resistance and other risk factors, of belonging to a manual social class at either stage in the life course was cumulative, with no evidence of an interaction between childhood and adult social class. Women who were in manual social classes in childhood remained at increased risk of insulin resistance, dyslipidaemia, and obesity—even if they moved into non-manual social classes in adulthood—compared with women who were in non-manual social classes at both stages. Conclusions: Adverse social circumstances in childhood, as well as adulthood, are strongly and independently associated with increased risk of insulin resistance and other metabolic risk factors.

Is housework good for health? Levels of physical activity and factors associated with activity in elderly women. Results from the British Women's Heart and Health Study

Abstract: Objective: To determine the prevalence of achieving new recommended levels of physical activity, the types of activity involved, and their determinants among elderly British women. Design: National cross sectional survey. Participants: 2341 women aged 60 to 79 from 15 British towns. Main outcome measures: Prevalence of subjects achieving recommended levels of physical activity. Results: Over two thirds of the participants were active at new recommended levels. This was mainly achieved through participation in heavy housework. If domestic activities were excluded only 21% were regularly active. Women who participated in brisk walking for at least 2.5 hours per week had reduced odds of being overweight: odds ratio (95% confidence intervals) 0.5 (0.3 to 0.6) after adjustment for other forms of activity, health status, smoking, and socioeconomic position. Participating in at least 2.5 hours of heavy housework was not associated with reduced odds of being overweight 1.1 (0.8 to 1.4). Age, self reported poor health status, coronary heart disease, and respiratory disease were independently associated with reduced odds of participating in all types of activity. In addition participation in brisk walking and physical exercise were less likely in current smokers, those from the lowest socioeconomic class, and those living in the north of the country. Participation in heavy housework was less likely in women reporting depression but was not associated with smoking, socioeconomic class, or area of residence. Conclusions: If new physical activity recommendations, which include domestic activities, are used to assess population levels of physical activity then it seems that the majority of elderly women are sufficiently active. Heavy housework is not associated with reduced levels of being overweight and prospective studies are necessary to demonstrate an independent health benefit of participating in domestic activities.

Too much too young? Teenage pregnancy is not a public health problem

Abstract: In this paper authors argue that teenage pregnancy should not be conceptualized as a public health problem and suggest that this label is rather a reflection of what is considered to be socially culturally and economically acceptable. The authors contend that age might not be as strong a factor in determining a positive outcome on the health of mothers and their babies as is supposed.

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

Abstract: 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 arc 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 arc 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.

Birth weight of offspring and insulin resistance in late adulthood: cross sectional survey

Abstract: Objective: To investigate the association between birth weight of offspring and mothers9 insulin resistance in late adulthood. Design: Cross sectional survey. Setting: General practitioner9s surgeries in 23 towns in Great Britain. Participants: 4286 women aged 60-79 years Main outcome measures: Maternal insulin resistance Results: Birth weight of offspring was inversely related to maternal insulin resistance in late adulthood. For each 1 kg higher birth weight of offspring, women had a 15% reduction in the odds of being in the fourth with highest insulin resistance, compared to other fourths (odds ratio 0.85; 95% confidence interval 0.71 to 1.00). This increased to 27% (0.73; 0.60 to 0.90) after adjusting data for potential confounders. A U shaped relation between birth weight of offspring and diabetes in older age was found; women with the lightest and heaviest offspring had the highest prevalence of diabetes Conclusions: Birth weight of offspring is inversely related to the mother9s insulin resistance in late adulthood, despite the association of glucose intolerance during pregnancy with heavier offspring at birth. Common genetic factors contribute to the relation between birth weight and risk of cardiovascular disease and diabetes in adults

Is There a Sex Difference in the Association between Birth Weight and Systolic Blood Pressure in Later Life? Findings from a Meta-Regression Analysis

Abstract: The aim of this study was to determine whether a sex difference exists in the association between birth weight and systolic blood pressure. A meta-analysis of all observational studies (n = 57) in which the study population contained both males and females and the association between birth weight and blood pressure was presented as a linear regression coefficient was undertaken. There were no differences in the pooled regression coefficients between males and females combining all studies; the regression of blood pressure on birth weight for males was -1.27 (95% confidence interval: -1.77, -0.77) mmHg/kg and for females was -1.24 (95% confidence interval: -1.90, -0.58) mmHg/kg. When studies in which blood pressure had been measured in childhood were considered separately from those in which it was measured in adulthood, there were no sex differences in either age group. The pooled regression coefficient tended to be weaker in studies reporting sex-specific results than in those reporting combined results. These findings suggest that reports of sex differences in the association between birth weight and blood pressure are chance findings.

Rurality, deprivation, and excess winter mortality: an ecological study

Abstract: The reasons for the higher levels of excess winter mortality in Britain, compared with countries with colder winters, are unclear. Ecological studies suggest that both increased outdoor and indoor cold exposure relating to poor housing energy efficiency and lack of adequate clothing and physical activity when outdoors are important.1,2 It seems plausible that excess winter mortality would be greater in more deprived areas as deprived populations are more likely to live in poor quality energy inefficient housing and are less likely to be car owners. Two British studies have found no association between area deprivation and excess winter mortality, but both were based in single district health authorities and may not have had the power to detect an association.3,4 Furthermore, both studies were based in urban areas and were unable to assess the association between excess winter mortality and rurality. It has been suggested that rural areas in Britain are at increased risk of excess winter mortality and that government action should be targeted at these areas. A range of features—poor quality housing, high proportion of detached houses, lack of access to gas networks, and low take up of government energy efficiency grants—may make rural populations vulnerable to indoor cold exposure. Outdoor occupations and poor public transport systems in rural areas may increase outdoor cold exposure. The aim of this study was to assess the association between both rurality, and area deprivation, and excess winter mortality in a large region …

Role of endogenous oestrogen in aetiology of coronary heart disease: analysis of age related trends in coronary heart disease and breast cancer in England and Wales and Japan.

Abstract: The sex difference in mortality from coronary heart disease decreases with increasing age, suggesting a protective effect of oestrogen in premenopausal women. This decrease is, however, the result of a deceleration in death rates in men, with no change in rates in women around the age of menopause.1 The age specific rate of breast cancer—a condition associated with endogenous oestrogen—does show a change around the age of menopause among women in the United States.2 The relatively low rates of coronary heart disease in premenopausal women may make it difficult to detect an effect of the menopause.3 Rates of breast cancer among Japanese women are low. If low rates of coronary heart disease around the time of the menopause explain the lack of an effect of the menopause on age related …

What a difference a year makes? Too little too late

Abstract: '… if we could successfully intervene and change a woman's age at first birth and n oth in g else about her up to that point'? 1 Scally argu es th at we do n ot deal with th e m u ch m ore im port-an t issu es of th e edu cation al an d social effects of early m oth er-h ood an d focu s on a n arrow m edical defin ition of pu blic h ealth. We wou ld argu e th at we deal prim arily with th e detrim en tal effects, for m oth er an d ch ild, of social deprivation. However, we do n ot feel th at th ese problem s are th e preserve of on e particu lar age grou p. We agree with Scally, Rich-Edwards an d Sm ith th at som e teen age m oth ers in th e UK, US an d Nepal h ave bligh ted lives, bu t we do n ot believe th at labellin g a wom an wh o ch ooses to h ave a baby u n der th e age of twen ty as a pu blic h ealth problem actu ally h elps th e m oth er or h er ch ild. We believe th at th e u n derlyin g problem lies in society's attitu des towards you n g people an d specifically in attitu des towards wom en 's repro-du ctive lives. It seem s th at we are all agreed th at th ere are n o in h eren t h ealth or m edical problem s associated with becom in g pregn an t an d h avin g a ch ild before th e age of twen ty. Th erefore, if society were su ch th at a 16-year-old cou ld begin h er fam ily at th at age, an d th en say in h er m id-twen ties, retu rn to edu cation or a ch osen career path , with ou t preju dice an d u n du e u ph ill stru ggle, th ere wou ld be n o problem. Referrin g to very differen t con texts

Trends in sex differences in mortality from heart disease: sex is not same as gender, and theory was first proposed in 1950s, say authors

Abstract: Editor—In referring to our paper, Editor's choice of 8 September states that “A group from Bristol grabs attention by arguing that the fact that men have much higher rates of heart disease than women may be nothing to do with gender.”1,2 This shows the current confusion over the use of the words sex and gender. The Oxford English Dictionary (http://dictionary.oed.com/entrance.dtl) gives the following definition for gender: “Intended to emphasize the social and cultural, as opposed to the biological, distinctions between the sexes.” We would agree with this distinction. In our study we argued that the fact that men have much higher rates of heart disease than women may be nothing to do with sex—that is, biology such as the female hormone oestrogen—but something to do with gender. Indeed, although the data presented in our study cannot test such a hypothesis, in the discussion we raised the possibility that gender differences in dietary habits (related to social and cultural influences on the way that women prepare, eat, and serve food to themselves and men) may be part of the reason why death rates from heart disease differ between women and men. After our paper was published we discovered a letter published in the Lancet in 1956 that put forward the same theory.3 The author's suggestion was based on his observations of variations in the sex difference between different ethnic groups in the United States and between different geographical areas. Our analysis of secular trends over the past century and contemporary geographical variations suggested to us the same likely cause for the emergence of the difference between women and men in the occurrence of coronary heart disease. We were not aware of this letter at the time our paper was published; had we been, we would have cited it.

Water, tobacco, and global inequalities

Abstract: These photographs are used to illustrate the public health impact of lack of water and global inequalities. Southern Africa experienced one of the worst droughts in history in the early 1990s. For Mozambique, one of the world's poorest countries and at the time devastated by the effects of a US and South African backed guerrilla war the impact was immense. The first photo shows the Cahora Bassa dam …