Peter Whincup, Derek Cook, Olia Papacosta, M Walker
Abstract
Objective - To examine cross sectional and longitudinal relations between birth weight and blood pressure in childhood.
Design - Cross sectional study of primary school children aged 9-11 years, with analysis in relation to previous measurements at 5-7 years in a subgroup.
Setting - 20 primary schools in Guildford and Carlisle.
Subjects - 1,511 children measured at 9 - 11 years (response rate 79%), including 549 who had been measured at 5 - 7 years.
Main outcome measures - Blood pressure at 9-11 years, change in blood pressure between 5-7 and 9-11 years, birth weight (based on maternal recall), and placental weight (based on birth records) .
Results - At 9-11 years birth weight was inversely related both to systolic blood pressure (regression coefficient -2.80 mm Hg/kg; 95% confidence interval -3.84 to -1.76) and to diastolic blood pressure (regression coefficient -1.42 mm Hg/kg; -2.14 to -0.70) once current height and body mass index were taken into account. Placental weight was inversely related to blood pressure after adjustment for current height and body mass index but placental ratio (placental weight to birth weight) was unrelated to blood pressure. Between 5-7 and 9-11 years systolic blood pressure rose more rapidly in children of lower birth weight (regression coefficient -1.71 mm Hg/kg; -3.35 to -0.07). This effect seemed to be stronger in girls.
Conclusions - Birth weight rather than placental ratio is the early life factor most importantly related to blood pressure in childhood. The results support the possibility of "amplification" of the relation between birth weight and blood pressure, particularly in girls.
University Department of Public Health Royal Free Hospital School of Medicine London NW3 2PF Peter Whincup senior lecturer in clinical epidemiology Olia Papacosta research statistician M Walker research administratorDepartment of Public Health Sciences St George's Hospital Medical School London SW17 0RE Derek Cook senior lecturer in epidemiology
Correspondence to: Dr Whincup.
M R Hill, A L James, J A Faux, G Ryan, J M Hopkin, P le Souef, A W Musk, W O C M Cookson
Abstract
Objective - To establish the prevalence of FceRI-Beta polymorphisms Leu181 and Leu181/Leu183 on chromosome 11q13 in the general population and to examine whether when maternally inherited they confer a risk of atopy.
Design - A population based survey for measures of atopy (skin prick test reactions, specific IgE titres, total serum IgE concentration), bronchial hyperresponsiveness, and carriage of FceRI-Beta Leu181 and Leu181/Leu183.
Setting - The rural coastal town of Busselton, Western Australia.
Subjects - 1,004 members of 230 two generation families identified through adults aged under 55.
Results - FceRI-Beta Leu181/Leu183 was identified in 45 subjects (4.5%). All 13 children who had inherited the variant maternally were atopic. Six had asthma and nine rhinitis. The odds ratio of a positive skin prick test reaction to house dust mite or grass pollen in these children compared with the other 523 children was 7.37 (95% confidence interval 1-62 to 33 60). The 95% confidence interval for the odds ratio of a positive specific IgE response (radioallergosorbent test) was 3.00 to infinity, and the odds ratio for bronchial hyperresponsiveness was 3.70 (1.21 to 11.60). By contrast, the eight children who had derived the variant paternally had negative skin prick and radioallergosorbent test results and did not have increased bronchial responsiveness.
Conclusion - FceRI-Beta Leu181/Leu183 when inherited maternally identifies a genetic risk factor for atopy and bronchial hyperresponsiveness.
Nuffield Department of Clinical Medicine University of Oxford John Radcliffe Hospital Oxford OX3 9DU M R Hill postdoctoral scientist J A Faux postdoctoral scientist W O C M Cookson Wellcome senior clinical research fellowDepartment of Respiratory Medicine Queen Elizabeth II Medical Centre Perth Western Australia 6009 A L James consultant physician G Ryan consultant physician A W Musk head of department
Osler Chest Unit Churchill Hospital Oxford OX3 7LJ J M Hopkin consultant physician
University Department of Paediatrics Princess Margaret Hospital Perth Western Australia P le Souef associate professor
Correspondence to: Dr Cookson.
M Monique Verschuren, Daan Kromhout
Abstract
Objective - To investigate the relation between total cholesterol concentration and mortality from coronary heart disease, cardiovascular diseases, non-cardiovascular causes, and all causes.
Design - Population based cohort study.
Subjects - 23,000 men and 26,000 women aged 30-54 years examined between 1974 and 1980.
Main outcome measures - Mortality for the above mentioned end points for fifths of cholesterol distribution, and relative risks estimated by using Cox's proportional hazard (survival) analysis. Adjustment was made for age, smoking, systolic blood pressure, and body mass index.
Results - Mortality from coronary heart disease in men was five times higher than that in women. A strong positive association between total cholesterol concentration and mortality from coronary heart disease and cardiovascular diseases was observed in both men and women. The relative risk for the highest compared with the lowest fifth of the cholesterol distribution was for mortality from coronary heart disease (3.0 (95% confidence interval 1.8 to 5.1) in men and 3.8 (1.1 to 13.1) in women) and for mortality from cardiovascular disease (2.8 (1.8 to 4.2) in men and 2.9 (1.4 to 6.0) in women). No increase of non-cardiovascular mortality at low cholesterol concentration was observed. All cause mortality was significantly higher in the highest compared with the lowest fifth of the cholesterol distribution: relative risk 1.6 (1.3 to 2.0) in men and 1.5 (1.1 to 1.9) in women.
Conclusion - Total cholesterol concentration is a strong predictor of mortality from coronary heart disease, cardiovascular diseases, and all causes in women as well as in men. Low cholesterol concentrations are not associated with increased mortality from non-cardiovascular causes.
Department of Chronic Diseases and Environmental Epidemiology NationalInstitute of Public Health and Environmental Protection PO Box 1,3720 BA Bilthoven Netherlands W M Monique Verschuren researcher Daan Kromhout professor
Correspondence to: Dr Verschuren.
John N Newton, Jane Henderson, Michael J Goldacre
Abstract
Objective - To determine how changes in the number of admissions from waiting lists and changes in the number of additions to the lists are related to list size and waiting times, in the context of local waiting list initiatives.
Design - Review of national and Korner statistics.
Setting - England (1987-94) and districts of the former Oxford region (1987-91) .
Main outcome measures - Correlation of quarterly changes in the number of admissions from waiting lists in England with changes in total list size, numbers of patients waiting one to two, or over two years, and number of additions to the lists; examination of changes in waiting list statistics for individual district specialties in one region in relation to funding for waiting list initiatives.
Results - Nationally, changes in the number of admissions to hospital from lists closely correlated with changes in the number of additions to lists (r equal to 0.84; P is less than 0.01). After adjusting for changes in the number of additions to lists, changes in the number of admissions correlated inversely with changes in list size (r equal to 0.62; P less than 0.001). Decreases in the number of patients waiting from one to two years were significantly associated with increases in the number of admissions (r equal to 0.52; P less than 0.01); locally, only six of 44 waiting list initiatives were followed by an increase in admissions and a fall in list size, although a further 11 were followed by a fall in list size without a corresponding increase in admissions.
Conclusions - An increase in admissions improved waiting times but did not reduce list size because additions to the list tended to increase at the same time. The appropriateness of waiting list initiatives as a method of funding elective surgery should be reviewed.
Unit of Health Care Epidemiology University of Oxford Oxford OX3 7LF John N Newton consultant epidemiologist Jane Henderson research officer Michael J Goldacre director
Correspondence to: Dr Newton.
Tim Crayford, John Shanks, Madhavi Bajekal, Stephen Langford
Abstract
Objective - To estimate the effect of calculating the Jarman index using the smaller geographical unit of the census enumeration district on the changes in deprivation payments made to general practitioners. The Jarman index, or underprivileged area score, is used to calculate the allowance that general practices in the United Kingdom receive for each patient registered with them who lives in an area of relative social deprivation. Current values of the Jarman score are derived from the 1981 census and are based on electoral wards. The change in payments to some practices brought about by using data from the 1991 census may cause severe financial hardship.
Design - Jarman indices for wards and enumeration districts from the 1981 and 1991 censuses were used to calculate the payments made to 169 practices in Lambeth, Southwark, and Lewisham; the changes in payments under ward and enumeration district based schemes were then compared.
Main outcome measures - Standard deviations of the changes in payments to practices. Extreme values of changes in payments.
Results - The standard deviation of the change in payment between the two censuses was £6,365 with the enumeration district Jarman index, whereas it was £9,452 under the ward based scheme. If the ward based scheme is used 10 practices would find their payments changed by over £20,000, whereas only two practices would have changed by more than this amount under the scheme based on enumeration districts.
Conclusion - The Jarman index could be more sensitively and appropriately applied to calculate the deprivation payments that practices receive using the census enumeration district as its unit for calculation. This would result in fewer precipitate changes in payments when census data change every 10 years.
Department of Public Health King's College Hospital London SE5 9RS Tim Crayford senior registrarDepartment of Primary Care and General Practice St Mary's Hospital Medical School London W2 1PG Madhavi Bajekal research fellow
Lambeth, Southwark, and Lewisham Health Commission London SE1 7NT John Shanks consultant in public health medicine Stephen Langford director of commissioning for primary and community services
Correspondence to: Dr Crayford.