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Papers by Alan Craft

Epidemiology, Nov 1, 2009

Background: Studies of social inequalities in common mental disorders-anxiety and depression-ofte... more Background: Studies of social inequalities in common mental disorders-anxiety and depression-often use measures that do not discriminate between conditions, but these disorders may differ from one another in their social patterning across the lifecourse. The Twenty-07 Study includes the Hospital Anxiety and Depression Scale (HADS), which has sub-scales for each condition, allowing possible differences in patterning to be examined. Objective: To investigate the age trajectories for anxiety and depression by social class. Design and Setting: Prospective cohort study of 4150 men and women, living in Clydeside, aged 15, 35 and 55 at baseline in 1987/8 and interviewed at five-year intervals for 20 years. HADS scores were obtained at each of four follow-up visits and growth curve modelling was used to assess the relationship between HADS caseness, age, sex and baseline social class across 10 629 measurement occasions from 3846 respondents. This sample is representative of those interviewed at baseline. Results: There was a higher prevalence of anxiety than depression: 39.4% of the measurement occasions were defined as anxiety cases, 12.5% as depression cases, and 10.4% as cases for both disorders. There were significant non-linear age trajectories in caseness. The probability of anxiety caseness was relatively high in youth to middle-age and decreased with age thereafter. This age-related improvement was slower for those in manual, compared to nonmanual, classes, and this class difference was larger for females. The probability of depression caseness was low in youth, and increased with age with a steeper increase for those in manual classes than for those in non-manual classes. The probability of having both anxiety and depression exhibited an inverse U-shaped trajectory, peaking in middle age, with a class difference in the age gradient similar to that for depression. Sensitivity analyses indicated that these findings were robust to period and cohort effects as well as sample attrition. Conclusion: Anxiety and depression exhibit quite different trajectories across the lifecourse; the probability of anxiety reduces with age, whilst depression becomes more probable. There is a significant interaction between social class and age in both conditions, with those in manual classes having a slower reduction in anxiety and a faster increase in depression as they age than more affluent respondents. Future work should be sensitive therefore to how the social patterning of the two disorders differs across the lifecourse.

Archives of Disease in Childhood, Feb 1, 1989

Archives of Disease in Childhood, Oct 1, 1999

Population screening for unsuspected heart disease The infrequency of prodromal symptoms and the ... more Population screening for unsuspected heart disease The infrequency of prodromal symptoms and the absence of physical signs in children who die suddenly and are found to have a cardiac problem may lead to calls for screening of the general population. There is no evidence that screening for hypertrophic cardiomyopathy is either feasible or appropriate, and no evidence that either early detection or treatment in the absence of symptoms has any eVect on outcome. 23 24 To my knowledge the only prospective screening programme of normal children has been in place in Tokyo, Japan: the prevalence of hypertrophic cardiomyopathy is around 1 in 15 000, 25 and children identified seemed to be at particularly low risk. 26 The programme does also detect children with long QT syndrome, atrioventricular block, and WolV-Parkinson-White syndrome by routine electrocardiography but these problems are rare. So far it has not been possible to show that screening prevents sudden death. 27 Conclusions Sudden death in children is rare. About 10% of all deaths are sudden but most occur in children with previously recognised disease. Syncope is very common but is only rarely a clue to the presence of a significant cardiovascular abnormality. A detailed history is of paramount importance and the ECG is a useful screening test. There is no evidence at present to support screening of all children for unsuspected cardiac problems.

British Journal of Cancer, Jul 22, 2014

Background: Earlier studies have shown raised risks of leukaemia and non-Hodgkin lymphoma in chil... more Background: Earlier studies have shown raised risks of leukaemia and non-Hodgkin lymphoma in children, teenagers and young adults resident either at birth or diagnosis in Seascale. Some increases in cancer risk in these age groups have also been noted among those living around Dounreay. We aimed to update previous analyses relating to areas close to these nuclear installations by considering data from an additional 16 years of follow-up. Methods: Cross-sectional analyses compared cancer incidence rates for 1963-2006 among those aged 0-24 years at diagnosis living in geographically specified areas around either Sellafield or Dounreay with general population rates. Cancer incidence for the period 1971-2006 among the cohort of Cumbrian births between 1950 and 2006 was compared to national incidence for 1971-2006 using person-years analysis. Cancer among those born in the postcode sector closest to Dounreay was compared with that among those born in the three adjoining postcode sectors. Analyses considered both cancer overall and ICD-O-3 defined diagnostic subgroups including leukaemia, central nervous system tumours and other malignancies. Results: Apart from previously reported raised risks, no new significantly increased risks for cancer overall or any diagnostic subgroup were found among children or teenagers and young adults living around either nuclear installation. Individuals born close to the installations from 1950 to 2006 were not shown to be at any increased risk of cancer during the period 1971 to date. Conclusions: Analysis of recent data suggests that children, teenagers and young adults currently living close to Sellafield and Dounreay are not at an increased risk of developing cancer. Equally, there is no evidence of any increased cancer risk later in life among those resident in these areas at birth.

Archives of Disease in Childhood, Jul 1, 1983

The deaths of 99 children under 5 years of age were studied through the coroners' records. Sixty ... more The deaths of 99 children under 5 years of age were studied through the coroners' records. Sixty nine deaths were caused by medicines-most of which were prescribed for mother, were recently dispensed, and currently in use. Household products accounted for 11 deaths, lead poisoning for 6, carbon monoxide for 5 and 'medical mishaps' for 8. Prevention lies in both education and more effective and selective use of child resistant containers. Each year accidental poisoning in children-accounts for roughly 24 000 hospital admissions,' but

Pediatric Radiology, May 19, 2011

Background-Although CT can be greatly beneficial, its relatively high radiation doses have caused... more Background-Although CT can be greatly beneficial, its relatively high radiation doses have caused public health concerns. Objective-To assess patterns in CT usage among patients aged less than 22 years in Northern England during the period 1993-2002. Materials and methods-Electronic data were obtained from radiology information systems of all nine National Health Service trusts in the region. Results-A total of 38,681 scans had been performed in 20,483 patients aged less than 22 years. The number of CT examinations rose, with the steepest increase between 1997 and 2000. The number of patients scanned per year increased less dramatically, with 2.24/1,000 population aged less than 22 years having one scan or more in 1993 compared to 3.54/1,000 in 2002. This reflects an increase in the median number of scans per patient, which rose from 1 in 1993 to 2 by 1999. More than 70% of CT examinations were of the head, with the number of head examinations varying with time and patient age. Conclusion-The frequency of CT scans in this population more than doubled during the study period. This is partly, but not wholly, explained by an increase in the number of scans per patient.

Archives of Disease in Childhood, Mar 1, 1974

Cancer Causes & Control, Apr 5, 2011

OBJECTIVES-Osteosarcoma typically occurs during puberty. Studies of the association between heigh... more OBJECTIVES-Osteosarcoma typically occurs during puberty. Studies of the association between height and/or birth-weight and osteosarcoma are conflicting. Therefore, we conducted a large pooled analysis of height and birth-weight in osteosarcoma. METHODS-Patient data from 7 studies of height, and 3 of birth-weight were obtained, resulting in 1067 cases with height and 434 cases with birth-weight data. We compared cases to the 2000 US National Center for Health Statistics Growth Charts by simulating 1000 age and gender matched controls per case. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between height or birth-weight and risk of osteosarcoma for each study were estimated using logistic regression. All of the case data were combined for an aggregate analysis. RESULTS-Compared to average birth-weight subjects (2665-4045g), individuals with high birth-weight (≥4046g) had an increased osteosarcoma risk (OR 1.35, 95%CI 1.01-1.79). Taller than average (51 st-89 th percentile) and very tall individuals (≥90 th percentile) had an increased risk of osteosarcoma (OR 1.35, 95%CI 1.18-1.54, and OR 2.60, 95%CI 2.19-3.07, respectively; P trend <0.0001).

BMJ, Jul 3, 1982

Mannitol and lactulose were used as probe molecules to measure intestinal permeability in childre... more Mannitol and lactulose were used as probe molecules to measure intestinal permeability in children with active small-bowel Crohn's disease and with untreated coeliac disease. Mannitol and lactulose were administered by mouth in a moderately hypertonic solution (580 mmol (mosmol)/l), and results were expressed as the ratio of the molecules excreted in urine over five hours. Patients with Crohn's disease had a sixfold increase in permeability (due to increased lactulose permeability) and those with coeliac disease a fivefold increase (due to decreased mannitol permeability). From these results the test offers potential as a noninvasive investigation in children with small-bowel disease.

BMJ, Dec 1, 2001

Objective To determine whether being overweight in childhood increases adult obesity and risk of ... more Objective To determine whether being overweight in childhood increases adult obesity and risk of disease. Design Prospective cohort study. Setting City of Newcastle upon Tyne. Participants 932 members of thousand families 1947 birth cohort, of whom 412 attended for clinical examination age 50. Main outcome measures Blood pressure; carotid artery intima-media thickness; fibrinogen concentration; total, low density lipoprotein, and high density lipoprotein cholesterol concentrations; triglyceride concentration; fasting insulin and 2 hour glucose concentrations; body mass index; and percentage body fat. Results Body mass index at age 9 years was significantly correlated with body mass index age 50 (r = 0.24, P < 0.001) but not with percentage body fat age 50 (r = 0.10, P = 0.07). After adult body mass index had been adjusted for, body mass index at age 9 showed a significant inverse association with measures of lipid and glucose metabolism in both sexes and with blood pressure in women. However, after adjustment for adult percentage fat instead of body mass index, only the inverse associations with triglycerides (regression coefficient = − 0.21, P < 0.01) and total cholesterol (− 0.17, P < 0.05) in women remained significant. Conclusions Little tracking from childhood overweight to adulthood obesity was found when using a measure of fatness that was independent of build. Only children who were obese at 13 showed an increased risk of obesity as adults. No excess adult health risk from childhood or teenage overweight was found. Being thin in childhood offered no protection against adult fatness, and the thinnest children tended to have the highest adult risk at every level of adult obesity.

BMJ, Aug 2, 2007

Pathologist who identified emphysema as a danger to miners Bob Ryder laid the foundation for comp... more Pathologist who identified emphysema as a danger to miners Bob Ryder laid the foundation for compensation for ex-coal miners and coal miners' widows by showing that emphysema was directly caused by working in coal mines.

Journal of Epidemiology and Community Health, Aug 1, 2011

Conclusions This is the first study to analyse putative associations between PBC and fluoride in ... more Conclusions This is the first study to analyse putative associations between PBC and fluoride in drinking water across GB at small-area level. No statistically significant relationships were found.

Journal of Epidemiology and Community Health, Sep 1, 2010

within and between the three successive calendar periods were also examined. Results For patients... more within and between the three successive calendar periods were also examined. Results For patients diagnosed during 1996, 1-year survival in the most deprived group was lower than the most affluent group for 34 of the 35 cancer-sex combinations examined (27 significant at 5%). The figure was almost identical a decade later, in 2006, with lower survival in the most deprived group for 32 of the 35 cancer-sex combinations (23 significant at 5%). Although trends in the deprivation gap fluctuated between calendar periods, overall, between 1996 and 2006, the deprivation gap widened for 14 cancer-sex combinations (increasing by more than 2% for 3 cancers in women and 5 cancers in men), and narrowed for 21 (decreasing by more 2% for 6 cancers in women and 1 cancer in men). Conclusion For most cancers, the deprivation gap in survival has changed very little since the introduction of the NHS Cancer Plan. Despite small reductions in the deprivation gap for some cancers, there was no obvious acceleration in the reduction since the NHS Cancer Plan. Inequalities in cancer survival were still large for many cancers in 2006.

Medical and Pediatric Oncology, 1993

Ten patients (age range 3.2-26.3 yrs) with relapsed or resistant malignancies received a total of... more Ten patients (age range 3.2-26.3 yrs) with relapsed or resistant malignancies received a total of 20 courses of low dose continuous infusion doxorubicin (3 mg/m2/day for 28 days) delivered by portable Graseby infusion pumps via central venous catheters. Each patient received a median dose of 144 mg/m2 (range 87-261). Four patients responded to treatment (1 complete response (CR) and 3 partial response (PR)) and performance status improved in seven patients. Overall toxicity was minimal: WHO Grade 4 anaemia in 2/18 courses, Grade 4 neutropenia in 1/18, Grade 3-4 thrombocytopenia in 3/18, nausea and vomiting of Grades 2 and 4 in 4/20 and 1/20 respectively, and mucositis of Grades 2 and 4 in 2/20 courses each. Cardiac toxicity was assessed using echocardiography, and fractional shortening remained within normal limits in all patients. Low dose continuous infusion doxorubicin is a feasible, well tolerated, ambulatory therapy in children and may be an effective way of delivering doxorubicin with less toxicity, thus enabling the development of more dose intensive regimens.

British Journal of Cancer, Nov 20, 2014

zone: all were between 1 year and 6 years old. A relative risk of RR ¼ 3.4 was found, which was n... more zone: all were between 1 year and 6 years old. A relative risk of RR ¼ 3.4 was found, which was not statistically significant using a two-sided test. However, with the one-sided test, which we use here as we test for an increase, the increase of childhood leukaemia near La Hague is statistically significant (P ¼ 0.042). We have pooled the data for leukaemia in children and young adults aged under 24 in the vicinities of Sellafeld, Dounreay, and La Hague (study areas: the wards Seascale, Thurso/Reay, and Beaumont-Hague). We compared the leukaemia rates in the combined study areas with the rates in the combined respective control areas and found a significantly increased relative risk of 2.40 (P ¼ 0.0010). The results are shown in Table 1. In 2012, we analysed the pooled data of leukaemia cases near nuclear power stations in Germany, Great Britain, Switzerland, and France, and found a 37% increased risk in young children living near them (Koerblein and Fairlie, 2012). Since radiation exposures near nuclear reprocessing plants are likely to be greater than those near nuclear power stations, higher leukaemia risks would also be expected. The result in Table 1 is in line with this expectation.

Medical and Pediatric Oncology, 2001

To the Editor: We read with interest a report based on SEER data, in the CCG Quarterly, Newslette... more To the Editor: We read with interest a report based on SEER data, in the CCG Quarterly, Newsletter, Summer 1999, which suggested that the decline in cancer mortality in young people in North America would stop by 2010 if the current trend continues [1]. However, we consider that there may be an alternative interpretation. Data on childhood cancer mortality from England and Wales [2] clearly show a linear fall from around 8 to 3 deaths per 100,000 children age 0-14 per year from 1958 to 1995 (Fig. 1). Extrapolation of this curve would suggest the possibility of zero deaths from malignancy in this age group with the next 20 years. Perhaps a little optimistic? The data from 1975-1995 from England and Wales (the same time period as presented for the SEER data) are equally well described by a straight line (r ‫ס‬ 0.97) which extrapolates to zero deaths in 2018, or a second order polynomial (r ‫ס‬ 0.97) which, in agreement with the presentation of SEER data, suggests no further reduction in mortality after around 2018 (Fig. 2). It is probable that both scenarios are equally unlikely. Deaths will not be eliminated completely within the next two decades and, conversely, progress in curing these children of their disease will not cease. Since these data support both the worst case and best case scenario equally well, it is clearly an important reminder of the dangers of extrapolation into the unknown. The inspection and interpretation of such complex things as mortality rates are probably best done in retrospect.