Showing papers by "George Davey Smith published in 2000"

Systematic Reviews in Health Care : Meta-Analysis in Context

Abstract: The second edition of this best-selling book has been thoroughly revised and expanded to reflect the significant changes and advances made in systematic reviewing. New features include discussion on the rationale, meta-analyses of prognostic and diagnostic studies and software, and the use of systematic reviews in practice.

Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions

Abstract: Studies on the health effects of income inequality have generated great interest. The evidence on this association between countries is mixed,1–4 but income inequality and health have been linked within the United States,5–11 Britain,12 and Brazil.13 Questions remain over how to interpret these findings and the mechanisms involved. We discuss three interpretations of the association between income inequality and health: the individual income interpretation, the psychosocial environment interpretation, and the neo-material interpretation. #### Summary points Income inequality has generally been associated with differences in health A psychosocial interpretation of health inequalities, in terms of perceptions of relative disadvantage and the psychological consequences of inequality, raises several conceptual and empirical problems Income inequality is accompanied by many differences in conditions of life at the individual and population levels, which may adversely influence health Interpretation of links between income inequality and health must begin with the structural causes of inequalities, and not just focus on perceptions of that inequality Reducing health inequalities and improving public health in the 21st century requires strategic investment in neo-material conditions via more equitable distribution of public and private resources We reviewed the literature through traditional and electronic means and supplemented this with correlational analyses of gross domestic product and life expectancy and of income inequality and mortality trends based on data from the World Bank,14 the World Health Organization,15 and two British sources.16 17 According to the individual income interpretation, aggregate level associations between income inequality and health reflect only the individual level association between income and health. The curvilinear relation between income and health at the individual level 18 19 is a sufficient condition to produce health differences between populations with the same average income but different distributions of income.3 20 This interpretation assumes that determinants …

Height and risk of death among men and women: aetiological implications of associations with cardiorespiratory disease and cancer mortality

Abstract: OBJECTIVES—Height is inversely associated with cardiovascular disease mortality risk and has shown variable associations with cancer incidence and mortality. The interpretation of findings from previous studies has been constrained by data limitations. Associations between height and specific causes of death were investigated in a large general population cohort of men and women from the West of Scotland. DESIGN—Prospective observational study. SETTING—Renfrew and Paisley, in the West of Scotland. SUBJECTS—7052 men and 8354 women aged 45-64 were recruited into a study in Renfrew and Paisley, in the West of Scotland, between 1972 and 1976. Detailed assessments of cardiovascular disease risk factors, morbidity and socioeconomic circumstances were made at baseline. MAIN OUTCOME MEASURES—Deaths during 20 years of follow up classified into specific causes. RESULTS—Over the follow up period 3347 men and 2638 women died. Height is inversely associated with all cause, coronary heart disease, stroke, and respiratory disease mortality among men and women. Adjustment for socioeconomic position and cardiovascular risk factors had little influence on these associations. Height is strongly associated with forced expiratory volume in one second (FEV1) and adjustment for FEV1 considerably attenuated the association between height and cardiorespiratory mortality. Smoking related cancer mortality is not associated with height. The risk of deaths from cancer unrelated to smoking tended to increase with height, particularly for haematopoietic, colorectal and prostate cancers. Stomach cancer mortality was inversely associated with height. Adjustment for socioeconomic position had little influence on these associations. CONCLUSION—Height serves partly as an indicator of socioeconomic circumstances and nutritional status in childhood and this may underlie the inverse associations between height and adulthood cardiorespiratory mortality. Much of the association between height and cardiorespiratory mortality was accounted for by lung function, which is also partly determined by exposures acting in childhood. The inverse association between height and stomach cancer mortality probably reflects Helicobacter pylori infection in childhood resulting in—or being associated with—shorter height. The positive associations between height and several cancers unrelated to smoking could reflect the influence of calorie intake during childhood on the risk of these cancers. Keywords: height; cancer; cardiorespiratory disease

Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring

Abstract: Objective: To estimate trends between 1972–6 and 1996 in the prevalences of asthma and hay fever in adults. Design: Two epidemiological surveys 20 years apart. Identical questions were asked about asthma, hay fever, and respiratory symptoms at each survey. Setting: Renfrew and Paisley, two towns in the west of Scotland. Subjects: 1477 married couples aged 45–64 participated in a general population survey in 1972-6; and 2338 offspring aged 30–59 participated in a 1996 survey. Prevalences were compared in 1708 parents and 1124 offspring aged 45-54. Main outcome measures: Prevalences of asthma, hay fever, and respiratory symptoms. Results: In never smokers, age and sex standardised prevalences of asthma and hay fever were 3.0% and 5.8% respectively in 1972-6, and 8.2% and 19.9% in 1996. In ever smokers, the corresponding values were 1.6% and 5.4% in 1972–6 and 5.3% and 15.5% in 1996. In both generations, the prevalence of asthma was higher in those who reported hay fever (atopic asthma). In never smokers, reports of wheeze not labelled as asthma were about 10 times more common in 1972–6 than in 1996. With a broader definition of asthma (asthma and/or wheeze), to minimise diagnostic bias, the overall prevalence of asthma changed little. However, diagnostic bias mainly affected non-atopic asthma. Atopic asthma increased more than twofold (prevalence ratio 2.52 (95% confidence interval 1.01 to 6.28)) whereas the prevalence of non-atopic asthma did not change (1.00 (0.53 to 1.90)). Conclusion: The prevalence of asthma in adults has increased more than twofold in 20 years, largely in association with trends in atopy, as measured indirectly by the prevalence of hay fever. No evidence was found for an increase in diagnostic awareness being responsible for the trend in atopic asthma, but increased awareness may account for trends in non-atopic asthma.

Learning to live with complexity: ethnicity, socioeconomic position, and health in Britain and the United States.

Abstract: The relation between ethnicity, socioeconomic position, and health is complex, has changed over time, and differs between countries. In the United States there is a long tradition of treating ethnic group membership simply as a socioeconomic measure, and differentials in health status between African Americans and groups of European origin have been considered purely socioeconomic. A contrary position sees the differences as either "cultural" or due to inherent "racial" differences. Although conventional socioeconomic indicators statistically explain much of the health difference between African Americans and Americans of European origin, they do not tell the full story. Incommensurate measures of socioeconomic position across ethnic groups clearly contribute to this difference. Additional factors, such as the extent of racism, are also likely to be important. The interaction of ethnicity, social position, and health in Britain is similarly complex. Studies that inadequately account for socioeconomic circumstances when examining ethnic-group differences in health can reify ethnicity (and its supposed correlates); however, the reductionist attribution of all ethnic differences in health to socioeconomic factors is untenable. The only productive way forward is through studies that recognize the contingency of the relations between socioeconomic position, ethnicity, and particular health outcomes.

How accurately are height, weight and leg length reported by the elderly, and how closely are they related to measurements recorded in childhood?

Abstract: BACKGROUND: This paper examines (1) the accuracy of self-reported height, leg length and weight in a group of subjects aged 56-78; (2) whether recent measurement of height and weight influences the accuracy of self-reporting and (3) associations between childhood and adult height, leg length and BMI measured in old age. METHODS: All 3182 surviving members of the Boyd Orr cohort were sent postal questionnaires in 1997-1998 and a sub-sample (294) was also clinically examined. RESULTS: Self-reported height was overestimated and body mass index (BMI), based on reported height and weight, underestimated. The mean difference between self-report and measured values were for height: 2.1 cm in males and 1.7 cm in females; for BMI the difference was -1.3 kg/m(2) in males and -1.2 kg/m(2) in females. Shorter individuals and older subjects tended to over-report their height more than others. The overweight under-reported their weight to a greater extent. Recent measurement appeared to decrease over-reporting of height but not weight. Correlations between self-report and measured height and BMI were generally over 0.90, but weaker for leg length (r = 0.70 in males and 0.71 in females). Adult height and leg length were quite closely related to their relative values in childhood (correlation coefficients ranged from 0.66 to 0.84), but associations between adult and childhood BMI were weak (r = 0.19 in males and 0.21 in females). CONCLUSIONS: Self-reported measures of height and weight may be used in studies of the elderly although systematic reporting errors may bias effect estimates. As overweight individuals tend to under-report and the short and underweight tend to over-report, studies investigating associations of disease with height and weight using self-reported measures will underestimate effects. The weak associations between childhood and adult BMI indicate that associations between childhood adiposity and adult cardiovascular disease found in this cohort may reflect the specific effect of childhood overweight, rather than its persistence into adulthood. This suggests that avoidance of adiposity may be as important in childhood as in adulthood.

Ethnic inequalities in health: A review of UK epidemiological evidence

Abstract: (2000). Ethnic inequalities in health: A review of UK epidemiological evidence. Critical Public Health: Vol. 10, No. 4, pp. 375-408.

Social capital and the third way in public health

Abstract: The construct of social capital has recently captured the interest of researchers in social epidemiology and public health We review current hypotheses on the social capital and health link, and examine the empirical evidence available as well as its implications for health policy With regard to theory, we contend that the construct as currently employed in the public health literature, lacks depth compared to its uses in social science In addition, social capital presents itself as an alternative to materialist structural inequalities (class, gender and race) by bringing to the forefront of social epidemiology an appealing common sense idealist social psychology to which everyone can relate (eg, good relations with your community are good for your health) The use of social capital invokes a romanticized view of communities without social conflict (eg, Neo - Tocquevillian nineteenth century associationalism) and favours an idealist psychology over a psychology connected to both material resources

The Ghost of Christmas Past: health effects of poverty in London in 1896 and 1991

Abstract: Objectives: To compare the extent to which late 20th century patterns of mortality in London are predicted by contemporary patterns of poverty and by late 19th century patterns of poverty. To test the hypothesis that the pattern of mortality from causes known to be related to deprivation in early life can be better predicted by the distribution of poverty in the late 19th century than by that in the late 20th century. Design: Data from Charles Booth9s survey of inner London in 1896 were digitised and matched to contemporary local government wards. Ward level indices of relative poverty were derived from Booth9s survey and the 1991 UK census of population. All deaths which took place within the surveyed area between 1991 and 1995 were identified and assigned to contemporary local government wards. Standardised mortality ratios for various causes of death were calculated for each ward for all ages, under age 65, and over age 65. Simple correlation and partial correlation analysis were used to estimate the contribution of the indices of poverty from 1896 and 1991 in predicting ward level mortality ratios in the early 1990s. Setting: Inner London. Results: For many causes of death in London, measures of deprivation made around 1896 and 1991 both contributed strongly to predicting the current spatial distribution. Contemporary mortality from diseases which are known to be related to deprivation in early life (stomach cancer, stroke, lung cancer) is predicted more strongly by the distribution of poverty in 1896 than that in 1991. In addition, all cause mortality among people aged over 65 was slightly more strongly related to the geography of poverty in the late 19th century than to its contemporary distribution. Conclusions: Contemporary patterns of some diseases have their roots in the past. The fundamental relation between spatial patterns of social deprivation and spatial patterns of mortality is so robust that a century of change in inner London has failed to disrupt it.

Comparison of Risk Factors for Stroke Incidence and Stroke Mortality in 20 Years of Follow-Up in Men and Women in the Renfrew/Paisley Study in Scotland

Abstract: Background and Purpose —The aim of this study was to relate risk factors in middle-aged men and women to stroke incidence (defined by having a hospital discharge with a main diagnosis of stroke) and compare this with the associations between risk factors and stroke mortality. Methods —In the early to mid-1970s, when they were 45 to 64 years of age, 7052 men and 8354 women from the Renfrew/Paisley prospective cohort study in Scotland were screened. Risk factors measured included blood pressure, blood cholesterol and glucose, respiratory function, cardiothoracic ratio, smoking habit, height, body mass index, preexisting coronary heart disease, and diabetes. These were related to stroke incidence over 20 years of follow-up. Results —Diastolic and systolic blood pressure, smoking, cardiothoracic ratio, preexisting coronary heart disease, and diabetes were positively related to stroke incidence for men and women, whereas adjusted FEV1 (forced expiratory volume in 1 second) and height were negatively related. Cholesterol was not related to stroke. Glucose for nondiabetic subjects had a U-shaped relationship with stroke. Body mass index was not clearly related to stroke, although participants with the highest body mass index had the highest stroke rate. Former smokers had similar stroke rates to never-smokers. Tests between the associations of risk factors and stroke incidence revealed these were not statistically different from the associations with stroke mortality. Conclusions —The risk factors had a similar effect on stroke incidence as on stroke mortality. Epidemiological studies with information on stroke mortality are likely to give results applicable to stroke incidence.

Infant mortality, stomach cancer, stroke, and coronary heart disease: ecological analysis.

Abstract: Editorial by Forman and Goodman Mortality from stomach cancer and stroke shows an international correlation, consistent inverse socioeconomic gradients, a particular dependence on socioeconomic circumstances in childhood,1 and parallel patterns of decline in most industrialised countries over the past 30–40 years. The plausibility of the hypothesis that salt intake underlies this similarity has been weakened over the past decade as evidence for Helicobacter pylori as the key factor in the aetiology of non-cardia stomach cancer has increased.2 H pylori is thought to be acquired in childhood, and risk of infection is closely related to living conditions, hygiene, and housing standards. Geographical, socioeconomic, and secular variations in the prevalence of H pylori fit well with the corresponding trends and differences in mortality from stomach cancer between and within countries.2 Infant mortality in the early part of the 20th century indicates living conditions and, …

Influence of Socioeconomic Circumstances in Early and Later Life on Stroke Risk Among Men in a Scottish Cohort Study

Abstract: Background and Purpose —The purpose of the study was to investigate stroke risk by socioeconomic measures. Methods —The analysis was based on a large cohort study of 5765 working men, from 27 workplaces in Scotland, who were screened between 1970 and 1973. Stroke was defined as having a hospital admission with a main diagnosis of stroke or dying of stroke in the 25-year follow-up period. Results —There were 416 men who had a stroke. Men with manual occupations when screened, on first entering the workforce, men with manual occupations, and men whose fathers had manual occupations had significantly higher rates of stroke than men in the nonmanual categories. Men who left full-time education at age 16 years or under also had significantly higher rates of stroke. Men living in more deprived areas had higher rates of stroke, but the rates were not statistically significant. The most marked difference was in relation to father’s social class, and although adjusting for risk factors for stroke attenuated the relative rates, men whose fathers were in manual social classes had higher relative rates of stroke than men whose fathers were in nonmanual classes (adjusted relative rate for father’s social class III manual was 1.37 [95% CI 1.03 to 1.81] and for father’s social class IV or V was 1.46 [1.09 to 1.96]). Men who were upwardly mobile (father’s social class manual, own social class nonmanual) had a rate of stroke similar to that of stable manual men. Conclusions —Poorer socioeconomic circumstance was associated with greater stroke risk, with adverse early-life circumstances of particular importance.

Cancer and insulin-like growth factor-I: A potential mechanism linking the environment with cancer risk

Abstract: Insulin-like growth factor-I acts as an important mediator between growth hormone and growth throughout fetal and childhood development. Its effects and those of the other insulin-like growth factors are modulated by at least six different binding proteins. The role of insulin-like growth factor-I in promoting cancer has been investigated for many years, but recently the quality and quantity of evidence has increased.1 In particular, a number of prospective studies using stored blood collected up to 14 years before the onset of disease have shown associations between insulin-like growth factor-I and prostate cancer, premenopausal breast cancer, and colon cancer.2-4 The risk of cancer is higher among people with raised concentrations of insulin-like growth factor-I, and it is lower among those with high concentrations of insulin-like growth factor binding protein-3 (the main binding protein). The associations are similar when people whose blood samples were taken soon before diagnosis are excluded from analyses, suggesting that the observed relations are not due to the release of the growth factor by preclinical cancers.2-4 The effects are sizeable and stronger than the effects seen in relation to most previously reported risk factors.1 Weaker evidence from case-control studies suggests that the ratio of insulin-like growth factor-I to insulin-like growth factor binding protein-3 may …

The contribution of risk factors to stroke differentials, by socioeconomic position in adulthood: the Renfrew/Paisley Study.

Abstract: OBJECTIVES: This study investigated stroke differentials by socioeconomic position in adulthood. METHODS: The relation of risk of stroke to deprivation category and social class was assessed among 6955 men and 7992 women who were aged 45 to 64 years and had been screened in 1972 to 1976. RESULTS: A total of 594 men and 677 women had a hospital admission for stroke or died from stroke. There were large differences in stroke by deprivation category or social class. Adjustment for risk factors (smoking, blood pressure, height, respiratory function, body mass index, cholesterol, diabetes, and preexisting heart disease) attenuated these differences. CONCLUSIONS: Risk factors for stroke can explain some of the socioeconomic differences in stroke risk. Women living in the most deprived areas seem particularly at risk of stroke.

Infiltration of the abdominal wall with local anaesthetic after total abdominal hysterectomy has no opioid-sparing effect

Abstract: We have measured the effect of infiltration of the deep and superficial layers of the abdominal wound on morphine consumption and pain for 48 h after operation, in 40 patients undergoing total abdominal hysterectomy, in a double-blind randomized study. Patients received wound infiltration with 0.9% normal saline 40 ml or 40 ml of 0.25% bupivacaine with epinephrine 1:200,000. There were no significant differences between groups in morphine consumption, linear analogue scores for pain at rest or on movement, nausea or sedation during the first 48 h after operation. We conclude that infiltration of the deep and superficial layers of the wound of a Pfannenstiel incision with local anaesthetic solution did not confer additional analgesia in patients undergoing major gynaecological surgery.

Telecommunications Optimization: Heuristic and Adaptive Techniques

Abstract: Heuristic and Adaptive Techniques in Telecommunications: An Introduction. NETWORK PLANNING AND DESIGN. Evolutionary Methods for the Design of Reliable Networks. Efficient Network Design using Heuristic and Genetic Algorithms. Tabu Search and Evolutionary Scatter Search for 'Tree-Star' Network Problems, with Applications to Leased Line Network Design. Addressing Optimization Issues in Network Planning with Evolutionary Computation. Node-Pair Encoding Genetic Programming for Optical Mesh Network Topology Design. Optimizing The Access Network. ROUTING AND PROTOCOLS. Routing Control in Packet Switched Networks using Soft Computing Techniques. The Genetic Adaptive Routing Algorithm. Optimization of Restoration and Routing Strategies. GA-based Verification of Network Protocols Performance. Neural Networks for the Optimization of Runtime Adaptable Communication Protocols. SOFTWARE, STRATEGY AND TRAFFIC MANAGEMENT. Adaptive Demand-based Heuristics for Traffic Reduction in Distributed Information Systems. Exploring Evolutionary Approaches to Distributed Database Management. The Automation of Software Validation using Evolutionary Computation. Evolutionary Game Theory Applied to Service Selection and Network Ecologies. Intelligent Flow Control Under Game Theoretic Framework. Global Search Techiques for problems in Mobile Communications. An Effective Genetic Algorithm for Fixed Channel Assignment. References. Index.

Real-World Applications of Evolutionary Computing

Abstract: This book constitutes the refereed proceedings of six workshops on evolutionary computation held concurrently as EvoWorkshops 2000 in Edinburgh, Scotland, UK, in April 2000 The 37 revised papers presented were carefully reviewed and selected by the respective program committees All in all, the book demonstrates the broad application potential of evolutionary computing in a variety of fields In accordance with the individual workshops, the book is divided into sections on image and signal processing; systems, controls, and drives in industry; telecommunications; scheduling and timetabling; robotics; and aeronautics

Antagonistic effects of [Nphe1]nociceptin(1-13)NH2 on nociceptin receptor mediated inhibition of cAMP formation in Chinese hamster ovary cells stably expressing the recombinant human nociceptin receptor.

Abstract: Nociceptin/orphanin FQ (NC) is the endogenous ligand for the nociceptin receptor (NCR) which is negatively coupled to adenylyl cyclase to inhibit the formation of cAMP. In this study we describe the inhibitory action of the novel NC analogue, [Nphe1]nociceptin(1-13)NH2 on cAMP formation in Chinese hamster ovary cells expressing the human NCR. NC, NC(1-13)NH2, the pseudopeptides [Phe1psi(CH2-NH)Gly2]NC(1-17)NH2 and [Phe1psi(CH2-NH)Gly2]NC(1-13)NH2, the hexapeptide, acetyl-Arg-Tyr-Tyr-Arg-Trp-Lys-NH2 and buprenorphine all produced a concentration dependent inhibition of forskolin stimulated cAMP formation. This inhibition was competitively reversed by [Nphe1]NC(1-13)NH2 with essentially identical pA2 values (6.12-6.48). [Nphe1]NC(1-13)NH2 showed per se a negligible residual agonist activity (alpha < 0.15).

How accurate is self reported birth weight among the elderly

Abstract: The effect of early life influences on adult health is a central topic in current epidemiological research. For instance, growth and development in utero and in infancy have been linked to cardiovascular disease.1 In empirical research in this field, birth weight is often used as an indicator of health and nutrition in utero. There are two main sources of birthweight data: birth records and the memories of subjects or their families, or both. Where the subjects are elderly, however, early birth records with recorded birth weights are not easy to find and the recovery rate is generally low.2Where there are no surviving birth records with birthweight data and where the subject's parents cannot be asked, the subject's own testimony is the only possible source of such data. But can self reported birth weight be relied upon in the absence of data from clinical or administrative sources? Birth weights recalled by mothers have been found to correlate highly with those found in official records.3 The accuracy of self reported birth weights, however, is less certain—some studies have reported a poor degree of correspondence between birth weights recorded in official records and self reported birth weights.4 Other researchers have found that birth weights from these two sources correlate reasonably well.5 Most investigations of the validity of self reported birth weight have typically used subjects who were middle aged or younger. In the investigation reported here, we use data collected in a study of childhood diet and health and disease in later life to estimate the accuracy of the self reported birth weights for an older age group of 57 to 77 year old women and men. It is important to note that the results reported are only …

Mortality variations as a measure of general practitioner performance: implications of the Shipman case

Abstract: Changes in the organisation of the NHS or in the management of health professionals are often made within the context of inquiries into specific medical catastrophes rather than through a measured process of policy formulation. Examples include changes in the scrutiny of psychiatric services after the Ely report into malpractice at a Cardiff hospital 1 and, more recently, changes in doctors' self regulation after the high mortality in Bristol paediatric cardiac surgery.2 Harold Shipman's conviction for 15 murders committed during the course of his work as a general practitioner will result in several changes in the management of UK general practice. Some external monitoring of primary care is already routine. In the wake of the Shipman case there is pressure to introduce formal monitoring of mortality in general practitioners' patients.3 Here we consider the …

Adult height is inversely associated with ischaemic stroke. The Caerphilly and Speedwell Collaborative Studies

Abstract: There is much interest in the association between exposures over the life course and risk of later disease. Attained adult height is determined by both genetic potential and growth in childhood. The latter is a useful marker of childhood circumstances, and consequently if associations between adult height and stroke are found they provide support for the hypothesis that exposures acting in childhood are important determinants of risk of stroke. Findings on this have been mixed although more recent studies have reported inverse associations for risk of stroke in men.1 2 A British study reported similar, although less impressive, associations.3 Only one of these studies could distinguish between ischaemic and haemorrhagic strokes, but adjustment for socioeconomic position—an important potential confounder—could not be made.1 We report on the association between attained height and risk of stroke in a representative sample of middle age British men.

Research and Inspection: Hmi and OFSTED, 1981-1996 - a commentary

Abstract: This paper traces the changing relationship between research and inspection under both HMI and OFSTED, from the early 1980s to 1996. Drawing on a mix of internal and external sources it describes the changes within HMI to make traditional inspection methods more transparent and consistent and to make more use of quantitative data and performance indicators in the 1980s. However, changes within HMI were overtaken by events as education moved rapidly up the political agenda from the mid-1980s. With the demise of HMI in 1992, research within OFSTED took on a more prominent role and a modest but innovative research programme was established. However, the shift by OFSTED in the mid-1990s to take on a more explicit campaigning role to raise educational standards, rather than simply be a regulatory organisation, put the research under pressure to fit in with this new style. The paper draws on examples of the way these pressures worked out in both externally commissioned and internal research exercises. The resul...