Showing papers by "George Davey Smith published in 1992"
TL;DR: An in-depth, ethnographic investigation into the popular culture of prophylactic behaviour carried out in South Wales during 1988 and 1989 is based on the operation of cultural norms and practices related to the understanding of the cause and distribution of illness and death from heart ailments.
303 citations
Journal Article•
TL;DR: In this article, the authors examined the relationship between plasma cholesterol concentration and mortality from major causes of death, including coronary heart disease, lung cancer, and non-neoplastic respiratory disease.
Abstract: UNLABELLED
OBJECTIVE--To examine the relationship between plasma cholesterol concentration and mortality from major causes of death.
DESIGN
--Cohort study. SETTING--Civil service offices in London, England. PARTICIPANTS--There were 17,718 male civil servants aged 40 through 64 years at the time of study entry between 1967 and 1969. MAIN OUTCOME MEASURE--Mortality from major cause groups. RESULTS--There were 4022 deaths in the cohort over the 18 years of follow-up. Total mortality increased with cholesterol level, although mortality in the small group with very low cholesterol levels (5% of study population) was nonsignificantly higher (P greater than .5) than that of the remainder of the lowest quintile cholesterol group. Coronary heart disease mortality increased with increasing cholesterol concentration from the lowest levels (P less than .001 for trend). The cancer mortality rate in the group below the fifth centile of the cholesterol distribution was higher than in the remainder of the cohort for lung (P less than .001), pancreas (P = .05), liver (P = .09), and all smoking-related cancers (P = .02). Only for lung cancer was there a consistent inverse trend with cholesterol level (P less than .01). Rates of mortality due to non-neoplastic respiratory disease were inversely related to cholesterol level (P less than .001). Health state at the time of examination and socioeconomic position were related to cholesterol concentration--subjects in lower employment grades, with disease at baseline, with a history of recent unexplained weight loss, or who had been widowed had lower initial cholesterol levels. These associations largely accounted for the relationships between cholesterol level and noncardiovascular mortality. CONCLUSIONS--The inverse associations between plasma cholesterol concentration and mortality from certain causes of death seen in cohort studies could be because the participants with low cholesterol levels possess other characteristics that place them at an elevated risk of death.
302 citations
TL;DR: The inverse associations between plasma cholesterol concentration and mortality from certain causes of death seen in cohort studies could be because the participants with low cholesterol levels possess other characteristics that place them at an elevated risk of death.
Abstract: Objective. —To examine the relationship between plasma cholesterol concentration and mortality from major causes of death. Design. —Cohort study. Setting. —Civil service offices in London, England. Participants. —There were 17718 male civil servants aged 40 through 64 years at the time of study entry between 1967 and 1969. Main Outcome Measure. —Mortality from major cause groups. Results. —There were 4022 deaths in the cohort over the 18 years of follow-up. Total mortality increased with cholesterol level, although mortality in the small group with very low cholesterol levels (5% of study population) was nonsignificantly higher ( P >.5) than that of the remainder of the lowest quintile cholesterol group. Coronary heart disease mortality increased with increasing cholesterol concentration from the lowest levels ( P P P =.05), liver ( P =.09), and all smoking-related cancers ( P =.02). Only for lung cancer was there a consistent inverse trend with cholesterol level ( P P Conclusions. —The inverse associations between plasma cholesterol concentration and mortality from certain causes of death seen in cohort studies could be because the participants with low cholesterol levels possess other characteristics that place them at an elevated risk of death. ( JAMA . 1992;267:70-76)
284 citations
TL;DR: There's so much need for expanded access to programmes like this, even before the authors get to comprehensive reform, so I think things like insurance reform as well as community rating, eliminating pre-existing conditions, can push ahead with patchwork programmes like child health.
Abstract: enrolling children because we ran out ofmoney. It was only at the very last moment, at this last special legislative session, through extraordinary efforts by some really committed folks in the governor's office, that a deal was struck to expand the programme so we could reopen enrolment. The programme provides subsidised health insurance to children who do not qualify for Medicaid for primary ambulatory care-not hospital care, no medications, no high-tech procedures, just basic routine care, getting the infection treated before it turns into a major problem. It's a very narrow, circumscribed programme. But we need to expand it to all eligible children. The legislators chose children because frankly, from a political standpoint, children are easiest to sell. But as we discussed, there's so much need for expanded access to programmes like this, even before we get to comprehensive reform. It can be effective, I think, in targeting the most needy populations and solving some of the biggest inequities in the system. So I think we can push ahead with things like insurance reform as we did in this legislative sessioncommunity rating, eliminating pre-existing conditions. We can push ahead with patchwork programmes like child health. Any amount of resources we can commit to that while we're trying to deal with the larger issues-how we're going to control costs in the major programmes and expand access and make sure that quality doesn't suffer at the same time. We have to do both. So I'd look forward to a lot of beneficial changes. I'd look forward to a more enlightened AIDS policy if we get a change of administration in Washington. I would hope even ifwe don't get a change ofadministration we would get a more enlightened AIDS policy, but I don't really see much prospect of that.
168 citations
TL;DR: A role for asymptomatic hyperglycemia in the etiology of cancer is not supported by the results of the present study, and there was no association between post-load glucose and cancer mortality, except for pancreatic cancer.
Abstract: The possibility that diabetes is associated with an elevated risk of cancer mortality has been discussed for many years. Recently, Levine et al. (Am J Epidemiol, 1990; 131:254-62) approached this issue by relating post-load plasma glucose concentration to cancer mortality. For men, there appeared to be a positive association between post-load glucose and mortality from cancer for all sites combined and for some specific sites. However, that analysis was based on only 298 cancer deaths among 11,521 men followed for 12 years. The current authors explored this issue in a cohort of 18,274 male civil servants, among whom there were 1,282 cancer deaths over 18-20 years of follow-up. There was no association between post-load glucose and cancer mortality, except for pancreatic cancer. A role for asymptomatic hyperglycemia in the etiology of cancer is not supported by the results of the present study.
122 citations
TL;DR: It is concluded that insertion of the laryngeal mask airway is accompanied by smaller cardiovascular responses than those after laryngoscopy and intubation and that its use may be indicated in those patients in whom a marked pressor response would be deleterious.
Abstract: We have compared, in 40 healthy patients, the cardiovascular responses induced by laryngoscopy and intubation with those produced by insertion of a laryngeal mask. Anaesthesia was induced with thiopentone and maintained with enflurane and nitrous oxide in oxygen; vecuronium was used for muscle relaxation. Arterial pressure was measured with a Finapres monitor. The mean maximum increase in systolic arterial pressure after laryngoscopy and tracheal intubation was 51.3% compared with 22.9% for laryngeal mask insertion (p less than 0.01). Increases in maximum heart rate were similar, (26.6% v 25.7%) although heart rate remained elevated for longer after tracheal intubation. We conclude that insertion of the laryngeal mask airway is accompanied by smaller cardiovascular responses than those after laryngoscopy and intubation and that its use may be indicated in those patients in whom a marked pressor response would be deleterious.
120 citations
TL;DR: A series of graphs is presented that show the estimated degree of bias in logistic coefficient estimates for two correlated continuous exposures measured with imprecision, indicating that even when the correlation coefficient between the exposure of interest and a correlated exposure is as low as 0.2, imprecISION in the measurement of the latter exposure can result in at least as serious bias in the logistic coefficients estimate.
Abstract: A series of graphs is presented that show the estimated degree of bias in logistic coefficient estimates for two correlated continuous exposures measured with imprecision. These graphs indicate that even when the correlation coefficient between the exposure of interest and a correlated exposure is as low as 0.2, imprecision in the measurement of the latter exposure can result in at least as serious bias in the logistic coefficient estimate for the exposure of interest as measurement imprecision in the exposure of interest itself The implications for the design and interpretation of epidemiological studies are discussed.
101 citations
TL;DR: The physiology or mechanisms of causation of PonV, the patient and surgical factors contributing to, or the treatment of PONV, are dealt with elsewhere in this supplement.
Abstract: This article reviews the anaesthetic contribution to postoperative nausea and vomiting (PONV). It does not discuss the physiology or mechanisms of causation of PONV, the patient and surgical factors contributing to, or the treatment of PONV, which are dealt with elsewhere in this supplement
93 citations
TL;DR: This editorial considers recent socioeconomic differences in mortality and their causes in the United Kingdom and the United States.
Abstract: This editorial considers recent socioeconomic differences in mortality and their causes in the United Kingdom and the United States. (ANNOTATION)
88 citations
TL;DR: The angle formed by the vocal cords decreased after induction of anaesthesia in both groups and the difference may be explained by greater depression of laryngeal reflexes by propofol or thiopentone.
Abstract: Using a fibreoptic laryngoscope, we have recorded on video tape the movements of the vocal cords after induction of anaesthesia with either propofol or thiopentone. The angle formed by the vocal cords decreased after induction of anaesthesia in both groups. This reduction in angle was significantly greater in the thiopentone group. The vocal cords closed completely in four patients in the thiopentone group and one patient in the propofol group. This difference may be explained by greater depression of laryngeal reflexes by propofol and this may account for the lower incidence of laryngospasm after induction of anaesthesia with propofol in comparison with thiopentone.
69 citations
TL;DR: The mortality and morbidity rates of infants after maternal in utero exposure to the Dutch famine of 1944-1945 are studied.
Abstract: Medical Journal, 1992. 14 Campbell JM, Cameron D, Jones DM. High maternal mortality in certain areas. London: HMSO, 1932. (Ministry of Health reports on public health and medical subjects No 68.) 15 Local Government Board. Thirty-ninth annual report 1909-10. Suppkment on infant and child mortality. London: HMSO, 1910. 16 Booth C. Life and labour of the people in London. First series: poverty. Volume 1. East, central and south London. London: MacMillan. 1902. 17 Registrar General of Births, Deaths, and Marriages in England and Wales. Suppkment to the seventy fifth annual report. Part III, registration summary tables 1901-10. London: HMSO, 1919. 18 Registrar General of Births, Deaths, and Marriages in England and Wales. Seventy fourth annual report(1911). London: HMSO, 1913. 19 Census of England and Waks 1911. Volume VII. Ages and condition as to marriage. London: HMSO, 1913. 20 Census ofEngland and Waks 1911. Volume IX. Birthplaces. London: HMSO, 1913. 21 Registrar General of Births, Deaths, and Marriages in England and Wales. Suppkment to the sixty fifth annual report. Part I, registration summary tables 1891-1900. London: HMSO, 1907. 22 Booth C. Life and labour ofthe people in London. First series: poverty in London. Volume 3. Blocks of buildings, schools and immigration. London: MacMillan, 1902. 23 Booth C. Life and labour ofthe people in London. Second series: industry. Volume 5. Comparisons, survey and conclusions. London: MacMillan, 1903. 24 Lumey LH. Decreased birthweights in infants after maternal in utero exposure to the Dutch famine of 1944-1945. Pediatric and Perinatal Epidemiology 1992;6:240-53. 25 Ariouat J, Barker DJP. The dit of girls and young women at the beginning of the century, Nutrition and Health (in press). 26 Booth C. Life and labour of the people in London. Second series: industny in London. Volume 4. Public professional and domestic service, unsuccessful classes. London: MacMillan, 1903. 27 The new survey ofLondon life and labour. Volume II. London industries. London: P S King and Son, 1931. 28 London County Council. Annual report of council 1915-19. Volume III, public health. London: LCC, 1919. 29 Wail R. Some inequalities in the raising ofboys and girls in nineteenth and twentiethcentuy England and Wales. Cambridge: Cambridge Group for the History of Population and Social Structure, 1990.
TL;DR: It is concluded that insertion of the laryngeal mask airway is accompanied by smaller cardiovascular responses than those after laryngoscopy and intubation and that its use may be indicated in those patients in whom a marked pressor response would be deleterious.
Abstract: We have compared, in 40 healthy patients, the cardiovascular responses induced by laryngoscopy and intubation with those produced by insertion of a laryngeal mask. Anaesthesia was induced with thiopentone and maintained with enflurane and nitrous oxide in oxygen; vecuronium was used for muscle relaxation. Arterial pressure was measured with a Finapres monitor. The mean maximum increase in systolic arterial pressure after laryngoscopy and tracheal intubation was 51.3% compared with 22.9% for laryngeal mask insertion (p less than 0.01). Increases in maximum heart rate were similar, (26.6% v 25.7%) although heart rate remained elevated for longer after tracheal intubation. We conclude that insertion of the laryngeal mask airway is accompanied by smaller cardiovascular responses than those after laryngoscopy and intubation and that its use may be indicated in those patients in whom a marked pressor response would be deleterious.
TL;DR: It is concluded that a dietary theory accords with current knowledge regarding MS as well as an infective theory and thus should not be dismissed in research examining the aetiology of MS.
Abstract: Epidemiological studies have demonstrated that environmental influences contribute to determining the risk of multiple sclerosis (MS). The nature of this influence has not been established, although infectious agents have received the most attention with relative neglect of alternative hypotheses. This paper critically reviews the evidence implicating dietary fat in altering susceptibility to MS. It is concluded that a dietary theory accords with current knowledge regarding MS as well as an infective theory and thus should not be dismissed in research examining the aetiology of MS.
16 Nov 1992
TL;DR: In this paper, a simple Monte Carlo model was used to simulate diffusional phase transformations occurring in binary alloys during thermal ageing and the results of the simulation were compared directly with atomic-scale chemical information obtained from position-sensitive atom probe microanalysis.
Abstract: A simple Monte Carlo model has been used to simulate diffusional phase transformations occurring in binary alloys during thermal ageing. The results of the simulation are compared directly with atomic-scale chemical information obtained from position-sensitive atom probe microanalysis. A simple pair potential model is found to give a good match with the ageing behaviour of spindodally decomposing iron-chromium alloys. Initial results on the modelling of nucleation and growth are presented, and compared with phase separation of copper-cobalt alloys.
TL;DR: The authors concluded that known to be an important risk factor for severe their study represented "but the first step in a longer hypoglycaemia," was significantly better with animal process of investigations of its actions, validation of insulin in the early trials.
Abstract: The synthesis of insulin chemically identical to human Randomised clinical trials: little power insulin was first achieved in 1974.' It was shown to be What is the evidence from randomised clinical trials active in diabetic patients,2 but its production costs of the risk of severe hypoglycaemia during treatment were prohibitive for general clinical use. Human with human and animal insulins? Table I summarises insulin produced by recombinant DNA technology or five randomised double blind crossover trials in insulin by amino acid substitution of pork insulin became treated diabetic patients.5' I5 None of them was available in the late 1970s.3 The first trial of the efficacy specifically designed to test whether there is a difference of human insulin synthesised by recombinant DNA in the risk of severe hypoglycaemia. The main outcome technology in six healthy men was published in 1980.4 variables were metabolic and immunological variables In comparison with highly purified porcine insulin the in the earlier trials and hypoglycaemic symptoms in study showed a similar efficacy and no severe side the more recent ones. Glycaemic control, which is effects of human insulin. The authors concluded that known to be an important risk factor for severe their study represented \"but the first step in a longer hypoglycaemia,'5 was significantly better with animal process of investigations of its actions, validation of insulin in the early trials. Owing to the small sample clinical efficacy in diabetics, and continuing vigilant sizes and short follow up periods the statistical power surveillance for unexpected adverse effects.\" of detecting clinically important differences in the The first trial in diabetic patients was published in incidence of severe hypoglycaemia was limited. Table I 1982.5 It aimed at \"ensuring\" the safety of biosynthetic gives the number of patients that would need to have human insulin. Though the insulin was shown to be been included to make it possible to detect an increase more soluble and absorbed more quickly when subin the risk of severe hypoglycaemia of 100% and cutaneously injected, diabetologists agreed that human 50%, corresponding to a relative risk of 2-0 and 1-5 insulin in general has no advantages over highly respectively. The studies would have needed to have purified animal insulins.36-8 Human preparations been up to 70 times larger for this purpose. These nevertheless largely replaced animal insulins within calculations clearly indicate that only very large relative less than a decade, and many patients whose diabetes risks can be excluded on the evidence available from was well controlled with animal insulin have been randomised controlled trials. transferred to human insulin. More recently, evidence has come forward that human insulin may reduce awareness of hypoglycaemia and thus lead to an Responses to induced hypoglycaemia: less increased risk of severe hypoglycaemia.9-'3 In this pronounced with human insulin? article we review the findings relevant to this issue, Another area of research has focused on counter-
TL;DR: A new class of atom-probe instruments has recently been developed which combine single atom sensitivity mass spectrometry with position sensing, and have the potential of reconstructing nanometre-scale composition variations in three-dimensions as mentioned in this paper.
TL;DR: Mortality from malignant brain tumors among men who participated in the Multiple Risk Factor Intervention Trial (a prospective study, 1973-1986) who indicated they were not black were examined, and no relation was seen between age-standardized mortality rates and baseline serum cholesterol.
Abstract: Case-control studies and a prospective study have suggested a positive relation between serum cholesterol and brain tumors. To examine this association further, mortality from malignant brain tumors among men who participated in the Multiple Risk Factor Intervention Trial (a prospective study, 1973-1986) who indicated they were not black were examined. No relation was seen between age-standardized mortality rates and baseline serum cholesterol. Excluding deaths occurring during the first 5 years or adjusting for median census tract income did not alter this finding. This suggests that no generalizable relation between serum cholesterol and primary malignant brain tumors exists. An environmental factor associated with serum cholesterol in some, but not all populations, may explain the apparently contradictory results.
TL;DR: In this article, a numerical solution to the nonlinear diffusion equation and a Monte Carlo simulation are presented to visualize and parameterize the microstructures determined from position sensitive atom probe (POSAP) data.
TL;DR: The survey was conducted in 10 different diabetes centers in Germany including Berlin, where patient management and antigenic properties of insulins are known to have been different until recently.
Abstract: W e read with interest the paper by Miihlhauser et al. (1) reporting a retrospective survey of hypoglycemia symptoms and incidence of severe hypoglycemia in patients treated with human and animal insulin. However, due to serious methodological limitations in design and conduct and inappropriate analysis of the data, this study does not make a valid contribution to the field. The survey was conducted in 10 different diabetes centers in Germany including Berlin, where patient management and antigenic properties of insulins are known to have been different until recently. The largest proportion (45%) of human insulin-treated patients came from center one (name not given, possibly Diisseldorf), whereas the most animal insulin-treated patients came from center two (possibly Berlin). Despite this important imbalance in patient recruitment, the characteristics of the patients are generally not presented by center. The only center-specific information given reveals important differences between human and animal insulin-treated patients. Among eight centers that contributed > 1 patient on human and > 1 on animal insulin, seven reported higher mean levels of HbA: or HbAlc in human insulin-treated patients and one reported equal levels (P = 0.012 by sign test). The only center that reported higher levels in animal insulin—treated patients was the one that contributed 165 patients on animal but only 1 patient on human insulin. This significant difference in glycemic control is crucial for the assessment of both hypoglycemia symptoms and the frequency of severe hypoglycemia because strict glycemic control blunts awareness of hypoglycemia and increases the risk of severe hypoglycemia (2-5). Other information, e.g., age, sex, and diabetes duration, is not given by center but important differences are likely to exist between human and animal insulin-treated patients, both within and between centers. The results derived from combining all centers cannot be accepted as valid unless confirmed by center-specific analyses.
TL;DR: In this paper, a multilayer sample of Fe-Cr has been prepared by sputter deposition and analysed using the Oxford position-sensitive atom probe, which has made it possible to observe the quality of interfaces in the material, and also accurately determine local compositions at each layer within the multi-layer stack.
Abstract: Atom-probe techniques have been used to characterise nanostructured metallic materials prepared by thermal evaporation and by sputtering. Multilayer samples of Fe-Cr have been prepared by sputter deposition and analysed using the Oxford position-sensitive atom probe. This has made it possible to observe the quality of interfaces in the material, and also accurately determine local compositions at each layer within the multilayer stack. Preliminary experiments aimed at producing dual phase nanocrystalline films by thermal evaporator deposition are also reported.
TL;DR: In this paper, a simple dynamical Ising model on a fixed lattice with a single bond energy parameter has been used to simulate the kinetics of diffusion during solid-state phase transformations in binary metallic alloys.
Abstract: A simple dynamical Ising model on a fixed lattice with a single bond energy parameter has been used to simulate the kinetics of diffusion during solid-state phase transformations in binary metallic alloys. Results of these simulations are compared with direct real-space measurements of the atomic distributions of elements in alloys, obtained with the position-sensitive atom probe. Despite the simplicity of the model, there is good quantitative agreement between the development of microstructure in the simulation and the nucleation and growth of cobalt-rich precipitates in copper-cobalt alloys.
TL;DR: It is suggested that the association between cigarette smoking and the risk of HIV-1 infection in Haitian women that remained after adjustment for "all known risk factors" is not due to an unknown confounder, but rather the inability to properly measure a well-known confoundinger—frequency of unprotected sexual intercourse with an HIV-infected man or men.
Abstract: To the Editor. —Halsey et al 1 reported an association between cigarette smoking and the risk of HIV-1 infection in Haitian women that remained after adjustment for "all known risk factors." The authors suggest two alternative explanations for their results: First, that there is a "hidden" or "unrecognized" confounder that has not been accounted for and, second, that there is a biologic effect of cigarette smoking on the risk of HIV transmission. We would like to suggest a third possibility, namely, that the association is not due to an unknown confounder, but rather the inability to properly measure a well-known confounder—frequency of unprotected sexual intercourse with an HIV-infected man or men. The dichotomous variable "≥3 lifetime sexual partners" that was used in the study is only a poor proxy measure of this true confounder and thus considerably underestimates its association with risk of HIV infection. 2-4 The underestimation of the
TL;DR: Comparing coronary heart disease primary prevention trials suggests that drug, but not dietary, lowering of plasma cholesterol is associated with increased noncardiovascular disease mortality, and the cholesterol lowering itself is unlikely to be the culprit.
Abstract: In Reply. —We disagree with Dr Goldstein's interpretation of our report regarding plasma cholesterol and mortality in the Whitehall Study. 1 As we discussed, the increased noncardiovascular disease mortality among the men with low plasma cholesterol levels is likely to be due to two factors: (1) the illness existing at the time of screening is associated with low plasma cholesterol, and (2) the sociodemographic correlates of low plasma cholesterol are themselves associated with elevated mortality risk. A recent analysis of coronary heart disease primary prevention trials 2 suggests that drug, but not dietary, lowering of plasma cholesterol is associated with increased noncardiovascular disease mortality. Thus, the cholesterol lowering itself is unlikely to be the culprit. Considerably more attention should be paid to the possibility that cholesterol-lowering drugs increase noncardiovascular disease mortality, however.