A lifecourse study of risk for hyperinsulinaemia, dyslipidaemia and obesity (the central metabolic syndrome) at age 49-51 years.

AIMS: Suboptimal maternal nutrition and catch-up growth in early childhood predispose to insulin resistance and other components of metabolic syndrome in later life. A central metabolic syndrome (CMS) has been identified comprising obesity, dyslipidaemia and insulin resistance. This study was designed to investigate determinants of risk for CMS. METHODS: Persons born in Newcastle in May and June 1947 (n = 358) were followed to 1996-1998. A lifecourse approach was used to estimate the proportion of variance in a summary measure of CMS at age 49-51 years accounted for by factors operating at different stages of life. RESULTS: After adjustment for other early life variables, childhood catch-up growth in men accounted for significant variation in the CMS score independent of adult lifestyle. In adulthood, exercise level in men and smoking in both genders were independently associated with CMS. Over two-thirds of explained variation in the CMS score in women, and almost half in men, was accounted for exclusively by factors measured in adulthood. CONCLUSIONS: While risk for CMS in men is compounded by early life disadvantage, promotion of a healthier adult lifestyle and a reduction in the number of people taking up smoking would appear to be the public health interventions most likely to reduce the prevalence of CMS in middle age.

Diagnosis and treatment of severe dysplastic spondylolisthesis.

Spondylolisthesis, the anterior or posterior displacement of one vertebra on another, usually affects the lumbar region. Five percent of the population has one of the five classes of spondylolisthesis, which include dysplastic, isthmic, degenerative, traumatic, and pathologic spondylolisthesis. This article focuses on the dysplastic type, which makes up 14% to 21% of all spondylolisthesis. Dysplastic spondylolisthesis usually causes no symptoms in children; pain usually begins in adolescence. The key to diagnosis is the appropriate use of radiography in the evaluation of low back pain. This report describes a case involving a 21-year-old woman presenting with back pain to the family physician. Also, it details how the diagnosis was achieved and evaluates conservative and aggressive treatment options.

Early life and later determinants of adult disease: a 50 year follow-up study of the Newcastle Thousand Families cohort.

The relative contribution of socioeconomic, behavioural and biological factors operating in fetal and infant life, childhood and adulthood to risk for cardiovascular disease, respiratory diseases and non-insulin-dependent diabetes in middle age has become an important research issue. All 1142 babies born in Newcastle upon Tyne in May and June 1947 were recruited into a prospective cohort study of child health (the 'Thousand Families' study) and followed in great detail to the age of 15 y, with a brief further follow up at age 22 y. Children from poorer families were at greatest risk of severe respiratory tract infection in infancy. Children from professional and managerial families were on average taller and heavier throughout childhood than those from semi- and unskilled manual social classes. Repeated infections in early childhood greatly increased the risk of developing chronic respiratory disease by age 15 y. This paper outlines a new investigation designed to trace surviving members of this cohort and to chart the relationships between their socioeconomic circumstances, lifestyles, experiences and health from birth through to the present day. Existing data on socioeconomic circumstances and infections in infancy and childhood, infant nutrition, birthweight and physical development to age 22 y will be linked to information gained from a new study. This comprises a postal questionnaire survey of study members' adult health, socioeconomic circumstances and lifestyle, and a hospital based clinical examination including heart and lung function, glucose tolerance, blood lipids and anthropometric measurements at age 49-51 y. Out of a target sample of 979 people for whom sufficient data are available on the first year of life, 866 (88%) have been traced and 649 are still resident in the North of England. Those study members who have been traced are highly representative of the original cohort. The Thousand Families cohort provides a unique opportunity for detailed epidemiological study because of the wealth of data available on infant and childhood socioeconomic and family circumstances, all of which was collected prospectively. In addition, there has been comparatively little loss to follow-up since 1948.

Socioeconomic deprivation and health in Glasgow and the west of Scotland--a study of cancer incidence among male residents of hostels for the single homeless.

STUDY OBJECTIVE: To determine the incidence of cancer among homeless men in Glasgow. DESIGN: Descriptive study of cancer incidence in a defined, though individually unidentifiable, population cohort. SETTING: Glasgow and the West of Scotland Region. PARTICIPANTS: Male residents of 10 hostels for the single homeless in Glasgow, open for all or part of the period 1975-93. Estimated total man-years of risk 21,820. MAIN RESULTS: After adjusting for age and socioeconomic deprivation, the proportional incidence ratio (PIR) of tumours of the oral cavity and pharynx in hostel residents was over twice what would be expected in the male population as a whole (PIR 2.37, 95% CI 1.41, 4.00). Cancers of the oesophagus and larynx were also overrepresented (PIR 1.63 and 1.74 respectively). Estimated age standardised incidence ratios were greater than would be expected for the most socioeconomically deprived areas of the west of Scotland for tumours of the oral cavity and pharynx, larynx, oesophagus, and lung (2.39, 1.87, 1.61, and 1.23 respectively). CONCLUSIONS: The incidence of many cancers is known to be higher in lower socioeconomic groups. Within the lowest deprivation category, there is evidence from this study for a further excess risk among homeless men for cancers of the oral cavity and pharynx, oesophagus, larynx, and lung. Improvements in general health care are urgently needed for this particularly vulnerable section of the population.

A linear quadratic analysis of gynaecological brachytherapy.

Four hundred and fourteen patients were treated by radical radiotherapy alone for cervical carcinoma at the Western Infirmary and the Royal Beatson Memorial Hospital between April 1982 and December 1987. All patients received external beam radiotherapy in addition to brachytherapy, using either manually inserted caesium (n = 107) or the Selectron afterloading machine (n = 307). Three mean Selectron dose rates were used: 0.91 Gy/h, 1.195 Gy/h and 1.74 Gy/h. During this period of time, the cumulative radiation effect formula was used to calculate an overall brachytherapy dose reduction to compensate for the increase in point 'A' dose rate. We have compared the local control rates and the incidence of late effects seen in these patients with theoretical parameters calculated using the linear quadratic (LQ) model. This model predicts a small rise in late effects as the dose rate increases, which is also seen in clinical practice; it also predicts a reduction in local control, partially offset by the addition of external beam radiotherapy, which would be most marked for early stage disease. There was a small fall in local control associated with Selectron treatment, but of a smaller size than predicted by the LQ model.

Relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer.

OBJECTIVE: To investigate the relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer as a possible explanation for socioeconomic differences in survival. DESIGN: Retrospective analysis of data from cancer registry and from pathology and biochemistry records. SETTING: Catchment areas of two large teaching hospitals in Glasgow. SUBJECTS: 1361 women aged under 75 who had breast cancer diagnosed between 1980 and 1987. MAIN OUTCOME MEASURES: Tumour size, axillary lymph node status, histological grade, and oestrogen receptor concentration in relation to deprivation category of area of residence. RESULTS: There was no significant relation between socioeconomic deprivation and four pathological prognostic factors: 93 (32%) women in the most affluent group presented with tumours less than 20 mm in size compared with 91 (31%) women in the most deprived group; 152 (48%) of the most affluent group presented with negative nodes compared with 129 (46%) of the most deprived group; 23 (22%) of the most affluent group presented with grade I tumours compared with 12 (17%) of the most deprived group; and 142 (51%) of the most affluent group had a low oestrogen receptor concentration at presentation compared with 148 (52%) of the most deprived group. None of these differences was statistically significant. CONCLUSIONS: Differences in survival from breast cancer by socioeconomic deprivation category could not be accounted for by differences in tumour stage or biology. Other possible explanations, such as differences in treatment or in host response, should be investigated.

The treatment of stage I carcinoma of the cervix in the west of Scotland 1980-1987.

OBJECTIVE: To examine the results of different treatments for Stage IA and IB carcinoma of the cervix in patients treated in the West of Scotland between 1980 and 1987. DESIGN: A retrospective review of case records. SETTING: The Beatson Oncology Centre, Western Infirmary and Belvidere Hospital, Glasgow, and the departments of gynaecology of hospitals in the west of Scotland. SUBJECTS: One hundred and five patients with Stage IA and 420 patients with Stage IB carcinoma of the cervix. RESULTS: A variety of treatments were used for women with Stage IA disease, with an overall actuarial five year survival of 100%. The overall actuarial five year survival for women with Stage IB disease was 79.5%. Patients with Stage IB disease treated by radical hysterectomy (n = 123) or radical radiotherapy (n = 229) had similar five year survival rates (86.3% and 79.5%, respectively), whereas patients treated initially by nonradical surgery (n = 68) had a significantly worse five year survival (68.1%; P = 0.008). CONCLUSIONS: These results emphasize the need for adequate and appropriate surgery and the centralisation of treatment for early cervical cancer.

Asbestos and lung cancer in Glasgow and the west of Scotland.

OBJECTIVE: To quantify the relation between lung cancer and exposure to asbestos in men in west Scotland and to estimate the proportion of lung cancer which may be attributed to exposure to asbestos. DESIGN: An ecological correlation study of the incidence of lung cancer in men and past asbestos exposure. The unit of analysis was the postcode sector. Correction was made for past cigarette smoking, air pollution, and deprivation. SETTING: The region covered by the west of Scotland cancer registry, containing 2.72 million people and including Glasgow and the lower reaches of the River Clyde, where shipbuilding was once a major industry. SUBJECTS: All men diagnosed with lung cancer between 1975 and 1984 whose residence at the time of registration was within the west of Scotland. MAIN OUTCOME MEASURE: The population attributable risk for asbestos related lung cancer. RESULTS: An estimated 5.7% (95% confidence interval 2.3 to 9.1%) of all lung cancers in men registered in the west of Scotland during the period 1975-84 were asbestos related, amounting to 1081 cases. CONCLUSIONS: A considerable proportion of cases of lung cancer in men in Glasgow and the west of Scotland from 1975 to 1984 were asbestos related. Most of these may not have been considered for compensation by the Department of Social Security. Given the very small annual number of recorded cases of asbestosis this condition is probably not a prerequisite for the development of asbestos related lung cancer. A heightened awareness of the increasing incidence of asbestos related neoplasms and their more thorough investigation are recommended.

Age, socio-economic status and survival from cancer of cervix in the West of Scotland 1980-87.

The outcome of treatment by age and socio-economic status was examined for 1,588 women with invasive cancer of cervix resident in the West of Scotland and diagnosed between 1980 and 1987. There was no difference in prognosis according to either variable once analysis was controlled for stage at presentation, treatment type and tumour grade. Tumour histology, date of treatment and health board of residence had no significant effect on survival independent of other variables. A strong correlation was found between socio-economic status and the incidence of cervical cancer in the West of Scotland. Women aged 45 and over and living in deprived areas were more likely to present with later stage tumours and to survive less well than younger patients from the more affluent parts of the region. Any additional resources which may be made available for cervical cancer screening should be directed more effectively towards those most at risk.

Problems in the interpretation of small area analysis of epidemiological data: the case of cancer incidence in the West of Scotland.

STUDY OBJECTIVE: The aim was to examine the extent to which random variation alone will produce differences in observed incidence rates between small areas which will affect measures of spatial clustering and estimates of relative risk. DESIGN: This was a study of changes in the pattern of spatial concentration of cancer incidence over a five year time period. A comparison was made of observed incidence rates for 34 tumour sites with randomly generated values and, where possible, with expected values derived from known relative risks. SETTING: Twenty six local government districts in the West of Scotland. MAIN RESULTS: A statistically significant relationship was observed between sample size and the stability of a summary measure of spatial concentration. Almost all observed highest:mean rate ratios were within the 95% confidence interval of the simulated distribution of these values. In three cases examined, both observed and simulated highest:lowest rate ratios were larger than those expected on the basis of known exposures to risk. CONCLUSIONS: In the absence of a prior hypothesis, small area analysis of epidemiological data for periods of less than 10 years will almost always give misleading results for all but the most common diseases.

Primary hepatocellular carcinoma in an area of low incidence: evidence for a viral aetiology from routinely collected data.

In recent years a strong case has been made in support of a viral aetiology for at least some primary hepatocellular carcinoma (PHC) in areas of low incidence. By pooling routinely collected cancer registration and infection data, study of the relationship between hepatitis B virus (HBV) infection and the incidence of PHC in Scotland over the period 1972-1985 has confirmed this view. Over this period the incidence of PHC in men increased, there was a relationship between the incidence of notification of HBV infection and that of hepatocellular carcinoma in different parts of the country, and an increased risk attached to those chronically infected with the virus. Given the recent introduction of lower cost yeast derived vaccines, there may now be more scope for prevention both of primary liver cancer and of other liver disease.

A comparison of remote afterloading and manually inserted caesium in the treatment of carcinoma of cervix.

Between 1982 and 1985, 240 patients with carcinoma of cervix were treated by radical radiotherapy, 140 using the selectron at the Royal Beatson Memorial Hospital (RBMH) and 100 with conventional caesium at the Western Infirmary. To allow for the increased dose rate to point A (1.2-1.4 Gy/h) during selectron treatment the overall intracavity dose was reduced by a mean value of 25%. Local recurrence rates were similar: 15% (selectron) against 14% (conventional). Three-year survival with local control was somewhat worse in the selectron group (77% against 81%) mainly because of an increased frequency of metastatic disease with local control (19.3% against 12.0%. The use of remote afterloading has not increased late morbidity (15.7% selectron, 15.0% conventional). The introduction of the selectron has brought about a marked reduction in staff radiation exposure. At the RBMH the mean recorded dose to nurses fell from 19 mSv in 1981 to 2.4 mSv in 1985.

Incidence of mesothelioma in Glasgow 1981-1984.

Considerable public concern exists about the effects of exposure to asbestos both at the workplace and in the general environment. In addition, the recording of mesothelioma in health registers is questionable both in terms of accuracy and completeness. This paper compares nine different sources of data for mesothelioma in an attempt to establish the true incidence of the disease in the geographical area of the Greater Glasgow Health Board between 1981 and 1984. Although 113 cases were identified, no single source identified more than 86 per cent of this total, thus presenting a case for a special mesothelioma register. A questionnaire-based study of the occupational exposures and residential histories of the cases was also carried out. It confirmed the findings of similar studies in that mesothelioma occurs predominantly in those exposed by reason of their occupation. No relationship with place of residence was apparent independent of occupation.

Survival of younger cervical carcinoma patients treated by radical radiotherapy in the west of Scotland 1964-1984.

Between 1964 and 1984, 2011 patients in the West of Scotland were treated by radical radiotherapy for carcinoma of cervix. In keeping with the rise in incidence amongst younger patients nationally, the number of women aged less than 35 years seen during the 20-year period has doubled. Younger women (aged less than 35 or less than 45) have a better prognosis mainly because more present with earlier disease. Stage for stage there has been no change in survival of women of all ages treated by identical radiotherapy during this period. The rise in mortality of younger patients from carcinoma of cervix may be due to the increased incidence of the condition rather than a more virulent form of the disease.