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Articles by D. Webb
Total Records ( 3 ) for D. Webb
  D. Webb

The paper's point of departure is the residential care of children—and especially girls and young women—during the 1950s. The approach of what was then known as The Church of England Children's Society is reviewed in light of its origins in Victorian philanthropy, and this is linked to the author's memories of the life of a person responsible for running one of the Society's homes. Her working life stretched from when the Society's founder was still an influential force to the late 1950s by which time the foundations for the ‘modern’ approach to looked-after children had been laid. The moral certainties that underpinned the approach at the home are considered, including the merits of such clarity, despite these appearing to contemporary eyes so limiting. This ‘backwardness’ is set alongside the concerns that are voiced today about the widely seen failings of modern residential care, particularly for girls and young women. Drawing on the work of Gramsci, the paradoxical inversion of the ‘reactionary’ past and the ‘progressive’ present are considered in terms of a contrast between an earlier clarity borne of faith and conviction and a contemporary hesitancy towards the enforcement of norms and values that are unendingly contested.

  S. A. Mostafa , M. J. Davies , D. Webb , L. J. Gray , B. T Srinivasan , J. Jarvis and K. Khunti
  Aims There are calls to simplify the diagnosis of Type 2 diabetes mellitus (T2DM) to reduce the burden of undiagnosed disease. Glycated haemoglobin (HbA1c) is therefore being considered as a preferred diagnostic tool to replace the need for an oral glucose tolerance test (OGTT), considered by many as cumbersome and inconvenient. The aim of this study was to examine the potential impact of the preferred use of HbA1c as a diagnostic tool on the prevalence and phenotype of T2DM.
Methods Analysis of the Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) cohort for previously undiagnosed individuals between 40 and 75 years of age who had OGTT, repeated if within the diabetes range, and HbA1c results. We compared the prevalence and phenotype of subjects with T2DM based on either HbA1c≥6.5% or OGTT using 1999 World Health Organization criteria.
Results From the total population of 8696, we detected 291 (3.3%) with T2DM from using an OGTT, and 502 (5.8%) had HbA1c≥6.5%. Of those diagnosed with T2DM by OGTT, 93 (1.2%) had HbA1c <6.5% and therefore would not have been classified as having T2DM using proposed criteria. Using HbA1c criteria resulted in 304 (3.5%) additional cases of T2DM, approximately doubling the prevalence. Of these 304 additional people, 172 (56.7%) had impaired glucose tolerance/impaired fasting glycaemia according to 1999 World Health Organization criteria. Using HbA1c criteria there was an increase of 2.2- and 1.4-fold in south Asians and white Europeans detected, respectively.
Conclusions Within this multi-ethnic cohort, we found that introducing HbA1c≥6.5% as the preferred diagnostic test to diagnose T2DM significantly increased numbers detected with T2DM; however, some people were no longer detected as having T2DM.
  K. Khunti , N. Taub , D. Webb , B. Srinivasan , J. Stockman , S. J. Griffin , R. K. Simmons and M. J. Davies
  Aims  To investigate validity of waist circumference measurements obtained by self-report and self-measurement with non-verbal pictorial instructions among a multi-ethnic population.

Methods  Five hundred and twenty-six individuals aged 40-75 years (91 South Asian, 430 White European and five other), who attended a screening programme for Type 2 diabetes, estimated their waist circumference and measured their waist with a paper tape measure. Participants were also provided with simple pictorial instructions for measurement of waist circumference in their preferred language and remeasured their waist circumference. We calculated 95% limits of agreement with measures undertaken by a healthcare professional unaware of prior measures.

Results  Mean age was 56.8 years (sd 9.0), mean BMI 30.0 kg/m2 (sd 5.6) and mean waist circumference 98.4 cm (sd 14.1). Seventy-nine per cent had high waist circumference according to International Diabetes Federation criteria. The mean of participants' self-reported value was 6.8 cm lower than the healthcare professional measure (sd 8.8; 95% limits of agreement -10.4 to 24.0 cm), with significant differences by sex and ethnicity (South Asian men 7.5 cm, South Asian women 0.1 cm, White European men 7.8 cm, White European women 7.0 cm, P < 0.001). Compared with healthcare professional measures, mean self-measured waist circumference was very similar, both with instructions (0.4 cm higher; sd 5.5 cm; -11.1 to 10.4 cm) and without instructions (0.5 cm lower; sd 5.6; -10.4 to 11.4 cm), but with significant differences by sex and ethnicity (P < 0.001).

Conclusions  There was systematic underestimation of self-reported waist circumference in this multi-ethnic UK population. The magnitude of underestimation might reduce the performance of risk scores; however, this can be corrected through self-measurement with pictorial instructions.

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