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Biomedical subjects

A Forbes

Publications and source records attributed to A Forbes.

At least 91 records · Page 5Linked to original sources
PubMed2000

Hypnotherapy and therapeutic audiotape: effective in previously unsuccessfully treated irritable bowel syndrome?

Irritable bowel syndrome (IBS) is not always readily responsive to conventional therapy. Hypnotherapy is effective but time consuming and labour intensive. Preliminary data suggested equivalent value from a specially devised audiotape. Tape use is now compared with gut-directed hyponotherapy in a randomised controlled trial. Consenting patients (n = 52; 37 women) with established IBS were recruited to a 12-week study. All had failed dietary and pharmacological therapy. The median age was 37 years (range 19-71); median symptom duration was 60 months (8-480). Randomisation was to six sessions of individual hypnotherapy, or to the tape, with stratification according to predominant symptom. Symptom scores and validated psychological questionnaires were utilised. Twenty-five patients (18 women) received hypnotherapy, 27 the tape. Successful trance was induced in all hypnotherapy patients. By intention to treat, symptom scores improved in 76% of hypnotherapy patients and in 59% of tape patients (not significant). Amongst 45 patients providing a full set of symptom scores there was advantage to hypnotherapy, with a reduction in median score from 14 to 8.5 compared to an unchanged score of 13 in audiotape patients (P < 0.05). The assessor considered 52% in each group to have improved. Those with greater initial anxiety tended to be more compliant and more likely to respond. Gut-directed hypnotherapy and audiotapes appear valuable in resistant IBS. Although probably inferior to hypnotherapy, the ease and economy of tape use may be considered sufficient to recommend it as a second-line option in IBS, reserving hypnotherapy for failures.

Adult↗
PubMed2000

Clinical features of tiaprofenic acid (surgam) associated cystitis and a study of risk factors for its development.

A case-control study was performed to describe the clinical course and identify risk factors predisposing to the development of tiaprofenic acid associated cystitis. Cases were identified from reports to the Australian Adverse Drug Reactions Advisory Committee and a two-year (1995-1996) national surveillance programme. Definition of a case was onset of symptoms of cystitis while taking tiaprofenic acid with pyuria (>10 WBC/microl) and/or hematuria (>10 RBC/microl), and no evidence of urinary tract infection. Definitions of "prescriber-matched" and "unmatched" controls were those who had been prescribed tiaprofenic acid by the same prescriber within 12 months of the case without developing cystitis or were identified from the databases of local pharmacies of the cases respectively. 81 of 109 identified cases and 109 of 184 potential controls completed a standardised interviewer-administered questionnaire. Median time between the commencement of tiaprofenic acid and symptom onset was 6. 3 months (range 0.1-47.1 months). Median interval between presentation to doctor and drug cessation was 3.0 months (range 0-24. 5 months). In half the patients, symptoms resolved within 14 days of ceasing therapy. Increasing age was a risk factor for the development of tiaprofenic-acid associated cystitis, age >70 years-odds ratio 3.2 (95% confidence interval 1.3-7.9) compared with age <55 years. Patients taking aspirin had a reduced risk (odds ratio 0.3, 95% confidence interval 0.1-0.9). Dose and amount of fluid consumed per day were not related to the risk of cystitis. Earlier recognition of tiaprofenic acid associated cystitis can potentially reduce the morbidity related to this condition. Apart from an increased risk among older patients, it is likely that this condition represents a drug reaction that cannot be predicted from clinical variables.

Adult↗
PubMed2000

What's up with nonoxynol-9?

Advantage-S, a spermicide containing nonoxynol-9 (N-9), has recently been shown in a randomised, controlled trial sponsored by UNAIDS not to offer women protection against sexual transmission of HIV. The women in the trial, all sex workers, reported having an average of 3.6 partners per day and about 70 coital acts per month during the study period. At the end of the trial, the Advantage-S group was found to have a higher incidence of new HIV infections than the control group, who were using a vaginal lubricant. Two other recent studies have found that low dose N-9 products do not provide protection against bacterial STDs such as gonorrhoea and chlamydia--a finding that contradicts earlier wisdom based on less rigorous studies. Contrary to certain media headlines, however, the results of these trials do not suggest that effective microbicides cannot be developed, only that Advantage-S, which was developed as a spermicide and not as a microbicide, is probably not one of them. The failure of Advantage-S to show protection in the UNAIDS-sponsored trial underscores the urgent need to accelerate research to develop a safe and effective topical microbicide.

Anti-Infective Agents↗
PubMed2000

Philosophical problems with social research on health inequalities.

This paper offers a realist critique of social research on health inequalities. A conspectus of the field of health inequalities research identifies two main research approaches: the positivist quantitative survey and the interpretivist qualitative 'case study'. We argue that both approaches suffer from serious philosophical limitations. We suggest that a turn to realism offers a productive 'third way' both for the development of health inequality research in particular and for the social scientific understanding of the complexities of the social world in general.

Health Care Rationing↗
PubMed2000

Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain.

OBJECTIVE: To assess the intraexaminer and interexaminer reliability of a multidimensional spinal diagnostic method commonly used by chiropractors. DESIGN: An intraexaminer and interexaminer Latin square, repeated measures reliability study. The techniques of diagnosis under investigation included visual postural analysis, pain description by the patient, plain static erect x-ray film of the lumbar spine, leg length discrepancy, neurologic tests, motion palpation, static palpation, and orthopedic tests. PARTICIPANTS: Three experienced chiropractors examined 19 patients, and 2 experienced chiropractors examined 10 and 9 patients, respectively, who were suffering from chronic mechanical low-back pain. RESULTS: Intraexaminer reliability of the decision to manipulate a certain spinal segmental level was moderate (kappa = 0.47). The interexaminer agreement pooled across all spinal joints indicated fair agreement (kappa = 0.27). Interexaminer reliability for individual examiner pairs for the L4/L5 segmental level was slight (kappa = 0.09). At the L5/S1 level, the interexaminer reliability was fair (kappa = 0.25). For the sacroiliac joints, interexaminer reliability was slight (kappa = 0.04 and 0.14). CONCLUSION: This study of commonly used chiropractic diagnostic methods in patients with chronic mechanical low-back pain to detect manipulable lesions in the lower thoracic spine, lumbar spine, and the sacroiliac joints has revealed that the measures are not reproducible. The implementation of these examination techniques alone should not be seen by practitioners to provide reliable information concerning where to direct a manipulative procedure in patients with chronic mechanical low-back pain.

Adult↗
PubMed2000

Predictors of lead absorption in children of lead workers.

OBJECTIVES: This study was conducted to determine whether children of lead workers are at a higher risk of lead absorption and if so, to identify risk factors for absorption, including lifestyle, household, environmental and parental work practices with lead. METHODS: This cross-sectional study recruited 17 'lead worker' and 13 comparison 'non-lead worker' households. Companies and eligible employees were contacted using mail-out packs. Children were aged between 12 and 72 months. Data collection involved administration of a questionnaire and collection of dust, soil, water, paint-scraping samples, and blood from the children for the determination of lead and ferritin levels. Statistical analysis was performed using SPSS. RESULTS: Participants included seven of 29 eligible employees from 14 'scheduled' lead workplaces and 12 of 19 eligible employees from 19 'leadlighter' workplaces identified. The average lead level for workers was 13.9 micrograms/dl, children of lead workers 6.93 micrograms/dl (n = 22) and comparison group 3.93 micrograms/dl (n = 16). Water lead levels were all < 2.5 ppm. The lead content of three soil samples and nine dust samples was above suggested guideline levels. Lead levels were significantly higher in children of lead workers but all were within recommended levels. Inadequate practice of lead work hygiene measures, such as inadequate use of protective equipment and taking work clothes home, was a common factor in lead worker households that were found to have elevated soil and dust lead levels. The differences in lead levels between groups did not change significantly when adjustment was made for the clustering effect of more than one child per household. CONCLUSIONS: Children of lead workers are at higher risk of lead absorption. Poor work hygiene practices of lead workers suggest an association with elevated lead levels in their children. A number of other predictors were suggested by this study but the small numbers of participants made it difficult to detect statistically significant differences between subgroups.

Adult↗
PubMed2000

Intravenous nutrition: focus on delivery (3-in-1 bags or not?).

The practicalities of providing intravenous nutrition support the use of 3-in-1 bags. However, problems with stability are an important consideration, especially because the clinical consequences can be devastating. Infusion sets designed with different colored tubing to decrease peroxide formation have been investigated. Also, even though high-dose heparin should not be combined with lipid emulsions, evidence for prescribing low dose in neonatal practice has been published. Furthermore, the largest study testing lipid stability with different drugs highlights 23 that should not be combined. Generation of oxalate as a marker of vitamin C loss and degradation of cocarboxylase have been investigated. Practical guidance has been published on the prevention of copper sulfide and iron phosphate precipitates. A study demonstrating that parenteral nutrition admixture is a poor growth medium has been reported. Finally, cyclical intravenous feeding may have a beneficial effect on the liver through protecting mitochondrial function from hypoxic damage.

Journal Article↗
PubMed2000

The safe use of percutaneous gastrostomy for enteral nutrition in patients with Crohn's disease.

OBJECTIVE: To determine the safety of percutaneous endoscopic gastrostomy (PEG) tube placement for nutritional support and/or defined therapeutic enteral nutrition (TEN) in adult patients with Crohn's disease. DESIGN: A prospective, observational study of patients with Crohn's disease in whom PEG tubes were placed for nutritional support or TEN. SETTING: A specialist nutrition clinic at a gastroenterology tertiary referral centre in Harrow, UK. PARTICIPANTS: Nine patients with Crohn's disease. Seven patients had nutritional failure and were unable to tolerate nasogastric feeding, and two patients were recruited in whom TEN therapy for active disease was indicated. The age range was 21-52 years (median, 30 years). Five patients were female; all had had previous ileo-colonic resections, one had a gastro-enterostomy and one had a non-healing Crohn's-related gastric ulcer. INTERVENTIONS: PEG insertion (Fresenius, Frecka 9 Fr) was performed at endoscopy with intravenous sedation. Follow-up with tubes in situ was for a median of 37 weeks (range, 4-276 weeks), and for a further median of 80 weeks (range, 52-120 weeks) in those whose tubes have been removed. MAIN OUTCOME MEASURES: The level of disease activity, nutritional status/body mass index and any complications associated with PEG tube placement were recorded. RESULTS: PEG was achieved in all patients; the only complication was a minor superficial entry site infection. Five patients continue to use PEG feeding to good effect, including healing of the Crohn's-associated ulcer. One patient now eats normally having regained target weight, and three require parenteral nutrition, having failed to achieve nutritional sufficiency despite an optimal enteral regimen via the PEG. An adverse body image in one of these patients (an opiate abuser with a long psychiatric history) was probably contributory to PEG failure. There was no peristomal or fistulous disease. CONCLUSIONS: Although nutrition via PEG is not always successful, failures are of enteral nutrition, and not of the means. PEG use in selected patients with Crohn's disease appears safe and can prove a useful addition to therapeutic options.

Adult↗
PubMed2000

How well does a telephone questionnaire measure drinking water intake?

BACKGROUND: Few studies have assessed the validity or reliability of drinking water intake estimations. In studies investigating potential waterborne disease, this is very important. METHODS: We carried out a validity and reliability study to evaluate water intake estimations. The validity part of the study compared a telephone questionnaire to a diary. The reliability part of the study compared two telephone questionnaires. RESULTS: 253 participants were recruited. The most commonly consumed water intake categories were plain and boiled tap water. For persons aged less than 12 years, the median volume of plain water consumption was 2.9 glasses/day according to the diary. For persons aged 12 years and over, the median volume of plain water consumption was 3.0 glasses/day and for boiled water 3.0 glasses/day according to the diary. There was negligible systematic over or under reporting by participants for the telephone questionnaire in comparison to the diary and for the comparison of both telephone questionnaires. Water intake estimates were converted to categorical variables and the per cent agreement and weighted kappa statistics were calculated. For both the validity and reliability parts of the study the per cent agreement was 57-78% and the weighted kappa was 0.57-0.81. CONCLUSION: Water intake estimates show only moderate levels of validity and reliability when using a telephone questionnaire in comparison to a diary. IMPLICATIONS: Investigators of potential waterborne disease or nutritional research should exercise some caution in drawing conclusions from minor differences in drinking water intake that are obtained from a telephone questionnaire.

Adolescent↗
PubMed2000

A paired comparison of tuberculin skin test results in health care workers using 5 TU and 10 TU tuberculin.

BACKGROUND: Historically, 10 TU has been employed in Australia and the United Kingdom to perform the tuberculin skin test (TST). However, this makes it difficult to compare the rates of TST positivity with other countries such as the USA who use 5 TU. To assess the impact of the dose of tuberculin on the TST a comparison was made of TST responses in health care workers given a TST with both 5 and 10 TU. METHODS: Two TSTs were performed simultaneously in each health care worker using 5 and 10 TU. Each dose was randomly assigned in a blinded manner to the right or left forearm and read at 48-72 hours by a single nurse who was blinded to the assignment of the 5 and 10 TU doses. RESULTS: A total of 128 health care workers were enrolled, 119 (93%) of whom had a past history of BCG vaccination. The overall mean difference in paired reaction sizes for the two doses was 1.5 mm with 95% limits of agreement of -3.6 to 6.5 mm. CONCLUSION: A slightly larger TST reading was seen with 10 TU than with 5 TU. The mean difference of 1.5 mm between the two doses should be considered when comparing rates of TST positivity between countries who use different doses of tuberculin to perform the tuberculin skin test.

Adult↗
PubMed2000

Glucagon-like peptide-2 increases sucrase-isomaltase but not caudal-related homeobox protein-2 gene expression.

To determine the effect of glucagon-like peptide-2 (GLP-2) on sucrase-isomaltase and caudal-related homeobox protein-2 (Cdx-2) gene expression, male Wistar rats were divided into total parenteral nutrition (TPN)-fed and GLP-2-treated, TPN-fed groups. TPN was given via a jugular line, inserted under anesthesia, for 7 days. The treatment group received 40 microg/day of GLP-2 intravenously with the TPN diet. The small intestine and colon were weighed and measured. Tissue was obtained from the jejunum, terminal ileum, and midcolon. RNA analysis, morphometry, and microdissection were performed. The weight of the small intestine of GLP-2-treated rats was greater than that of TPN-fed rats (P < 0.001). GLP-2 increased the mean metaphase arrests/crypt in both the jejunum and ileum (P < 0.001). Ileal expression of sucrase-isomaltase was increased by 1. 6-fold (P < 0.05). Jejunal expression was increased by a similar amount, although not significantly (P = 0.08). There was no change in Cdx-2 gene expression. Thus GLP-2 can maintain small intestinal morphology and function, but effects on gene expression are not mediated by gross changes in the level of the mRNA for the homeobox protein Cdx-2.

Animals↗
PubMed2000

A community nurse-led project to tackle health inequalities.

The Government has emphasized the importance of reducing inequalities in health and health care by giving those working with deprived communities the opportunity to develop new initiatives to address inequalities. Community nurses, although laying claim to the wider public and community health agenda, have yet to clarify the nature of their contribution in reducing inequalities and demonstrate it in practice. This article reports on an evaluation of a community-based nursing initiative in a deprived inner-city community. The findings suggest that community nurses can play an important role in supporting people to access health care more effectively. In addition, by contextualizing health messages and initiatives to reflect the local culture, community nurse can make it easier for people to participate in health-enhancing activities. It is also suggested that some of the theoretical models developed to guide practice in addressing community health issues like inequalities need to be more rigorously tested and evaluated in practice.

Adolescent↗
PubMed2000

Effect of anti-tuberculosis treatment on the tuberculin interferon-gamma response in tuberculin skin test (TST) positive health care workers and patients with tuberculosis.

SETTING: Public hospital, Victoria, Australia. OBJECTIVE: To evaluate the effect of multidrug treatment and isoniazid (INH) chemoprophylaxis on the tuberculin interferon-y assay (QIFN) in 19 patients with culture-confirmed Mycobacterium tuberculosis and 119 health care workers (HCWs) with tuberculin skin tests (TST) > or =15 mm. DESIGN: Patients with M. tuberculosis were treated with standard medication and tested with QIFN at diagnosis and at regular intervals over a 12-month period. All HCWs, 59 (50%) of whom were prescribed INH chemoprophylaxis, were tested with QIFN at baseline, 2, 4, 6 and 12 months. RESULTS: QIFN results in patients with tuberculosis were consistent and reproducible. At the initial time point QIFN assays were positive for M. tuberculosis in 67%, and once positive, the QIFN assay remained so over the 12-month period. In the HCWS, initial QIFN assays were positive in 73 (61%). During the 12-month study, 91 HCWs had a QIFN assay on at least two occasions. The overall reproducibility between tests was fair (kappa statistic = 0.45), and was little affected by administration of INH. CONCLUSION: These data suggest that although the QIFN assay is generally positive in patients with proven tuberculosis, it does not provide clinically useful information during the first 12 months of treatment with multidrug chemotherapy or INH chemoprophylaxis.

Adult↗
PubMed1999

Heparin, cell adhesion, and pathogenesis of inflammatory bowel disease.

Tissue repair involves a close interplay between growth factors and cell adhesion molecules. The normal healing process may be disrupted by pathophysiological states such as inflammation, due to loss of growth factors, cell adhesion molecules, or both, which results in a reduced rate of healing. Such events may occur in inflammatory bowel disease during mucosal restitution. We postulate that the beneficial response to heparin observed in inflammatory bowel disease may result from mechanisms in addition to anticoagulation. These include the restoration of high-affinity receptor binding by antiulcerogenic growth factors, such as basic fibroblast growth factor, that normally rely on the presence of heparan sulphate proteoglycans, such as syndecan-1, as co-receptors. Loss of syndecan-1 has been observed in the ulcerated mucosa of patients with inflammatory bowel disease. This loss may lead to impaired binding of basic fibroblast growth factor and a reduced rate of ulcer healing. We suggest that heparin restores high-affinity receptor binding of basic fibroblast growth, and so increases the rate of mucosal recovery.

Anticoagulants↗
PubMed1999

Risk of primary intracerebral haemorrhage associated with aspirin and non-steroidal anti-inflammatory drugs: case-control study.

OBJECTIVE: To examine the association between use of aspirin or other non-steroidal anti-inflammatory drugs and intracerebral haemorrhage. DESIGN: Case-control study. SETTING: 13 major city hospitals in the Melbourne and metropolitan area. SUBJECTS: 331 consecutive cases of stroke verified by computed tomography or postmortem examination, and 331 age (+/- 5 years) and sex matched controls who were community based neighbours. INTERVENTIONS: Questionnaire administered to all subjects either directly or by proxy with the next of kin. Drug use was validated by reviewing prescribing records held by the participants' doctors. MAIN OUTCOME MEASURES: Previous use of aspirin or other non-steroidal anti-inflammatory drugs. RESULTS: Univariate analysis showed no increased risk of intracerebral haemorrhage with low dose aspirin use in the preceding 2 weeks. Using multiple logistic regression to control for possible confounding factors, the odds ratio associated with the use of aspirin was 1.00 (95% confidence interval 0.60 to 1. 66, P=0.998) and the odds ratio associated with the use of other non-steroidal anti-inflammatory drugs was 0.85 (0.45 to 1.61, P=0. 611) compared with respective non-users in the preceding fortnight. Moderate to high doses of aspirin (>1225 mg/week spread over at least three doses) yielded an odds ratio of 3.05 (1.02 to 9.14, P=0. 047). There was no evidence of an increased risk among subgroups defined by age, sex, blood pressure status, alcohol intake, smoking, and the presence or absence of previous cardiovascular disease. CONCLUSIONS: No increase in risk of intracerebral haemorrhage was found among aspirin users overall or among those who took low doses of the drug or other non-steroidal anti-inflammatory drugs. These data provide evidence that doses of aspirin usually used for prophylaxis against vascular disease produce no substantial increase in risk of intracerebral haemorrhage.

Adolescent↗
PubMed1999

Changes in the expression of syndecan-1 in the colorectal adenoma-carcinoma sequence.

Syndecan-1, a transmembrane heparan sulphate proteoglycan (HSPG), functions as a matrix receptor on the basal surface of epithelial cells. It also co-localizes with E-cadherin at the lateral cell surface where its function is uncertain. Tumour development in the large bowel is associated with loss of normal epithelial adhesion and altered patterns of expression of cell adhesion molecules, possibly including syndecan-1. To evaluate changes in syndecan-1 expression during the development of colorectal neoplasia, 59 adenomas and 20 carcinomas arising from adenomas were investigated by immunohistochemistry. The staining intensity and distribution of syndecan-1 and E-cadherin in sequential sections was examined, semi-quantified and compared. Staining of syndecan-1 and E-cadherin was uniform in normal colorectal epithelial cells, and located at the basolateral surface. No significant change was seen in either molecule in mildly or moderately dysplastic adenomas. A significant reduction in expression of both syndecan-1 and E-cadherin was seen in severely dysplastic epithelium as compared to moderate dysplasia (P = 0.001 and P = 0.004 respectively). Similarly, there was a significant reduction of both molecules in carcinomas compared with associated adenomas (syndecan-1 P = 0.00003; E-cadherin P = 0.002). In both cases the loss of syndecan-1 expression was more striking than that of E-cadherin. Previous in vitro studies have shown that epithelial cells made deficient in syndecan-1 cease to express E-cadherin, suggesting a causal association. Our results support these findings and indicate that disruption of cell-matrix adhesion is critical in colorectal carcinogenesis, probably preceding changes in the purely homotypic cell-cell adhesion mediated by E-cadherin.

Adenoma↗