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Biomedical subjects

A Hinds

Publications and source records attributed to A Hinds.

At least 19 recordsLinked to original sources
PubMed2004

A cross-sectional survey to estimate the prevalence of family history of colorectal, breast and ovarian cancer in a Scottish general practice population.

A cross-sectional survey of all patients aged 30-65 in four general practices within one Local Health Care Co-operative in Fife, Scotland was undertaken to measure the prevalence of family history of colorectal, breast and ovarian cancer. A total of 7619 patients aged 30-65 responded to a postal questionnaire (response rate 59%). In all, 17% of respondents (1324, 95% Cl 16-18%) reported a relative affected by colorectal, breast or ovarian cancer. Of those, 6% (78, 95% CI 5-7%) met the Scottish guidelines for referral for genetics counselling. In all, 2% (24, 95% CI 1-3%) of all individuals with an affected relative had received genetic counselling and risk assessment. Of these, 25% (6, 95% CI 8-42%) met the moderate- or high-risk criteria for developing a cancer. In conclusion, the number of patients who are at a significantly increased risk of cancer on the basis of a family history is small (approximately 10 per General Practitioner (GP) list). It is therefore unrealistic to expect GPs to develop expertise in genetic risk estimation. A simple family history chart or pedigree is one way that a GP can, within the constraints of a GP consultation, determine which patients should be reassured and which referred to the local cancer genetic clinic.

Adult↗
PubMed2004

Ten years of glaucoma blindness in Fife 1990-99 and the implications for ophthalmology, optometry and rehabilitation services.

The aim of this study was to determine the characteristics of the patients in Fife who were registered as blind with a main diagnosis of glaucoma between 1990 and 1999. The case notes of 87 people were studied. The average age at registration was 78 years (S.D. = 14). By the time of first referral to hospital, more than half were already aware of visual loss. Forty-five per cent of referrals had no optometry input. Compliance with treatment was poor in at least 26% of patients. Only 44% had glaucoma surgery. There were significant findings with regard to mental health, particularly dementia, which was eventually present in 24%. At least one-third of patients had a hearing impairment. One-third of those registered as blind could have been registered earlier. However, staff from the local provider of rehabilitation and social work services for the blind were shown to have provided prompt and helpful support to 95% of those registered. Consideration should be given to the way in which elderly patients with advanced glaucoma are managed, with awareness of mental health and hearing problems and emphasis on early referral to rehabilitation services.

Aged↗
PubMed2004

Acceptability of universal hepatitis B vaccination among school pupils and parents.

The World Health Organisation (WHO) recommends universal hepatitis B (hepB) vaccination for all countries, but this policy has not been adopted in the UK and its acceptability there is unknown. We investigated the attitudes of secondary one (S1) school pupils aged 12-13 years (n = 50) and parents (n = 39) using semi-structured focus group discussions. There was a lack of awareness of hepB among most participants prior to the study. Parents sought further information, including the risks of infection and vaccine side effects. No participants identified cultural or socioeconomic barriers to being vaccinated against hepB. The majority of pupils and nearly all parents were in favour of universal hepB vaccination. Offering hepB vaccination to all S1 pupils, in school, should therefore be highly acceptable, providing that sufficient information on the risk of hepB infection and vaccine safety is provided. A facility for answering questions and a forum for pupil education should also be offered.

Adolescent↗
PubMed2003

Impact of an interdisciplinary low vision service on the quality of life of low vision patients.

AIM: To investigate the impact of an interdisciplinary low vision service on the vision related quality of life of service users. METHODS: 71 patients were interviewed 2 weeks before their appointment with the service and again 6 months later to assess any changes in their vision related quality of life. The majority of these patients had age related macular degeneration. RESULTS: After contact with the service the majority of patients indicated a reduction in concern about most quality of life issues. They were significantly less anxious about deterioration of their vision, safety within the home, and coping with everyday life. CONCLUSION: Improvements in many areas of their vision related quality of life indicate that this interdisciplinary low vision service has a positive impact on the lives of service users. However many patients were still unable to carry out their preferred everyday activities, and feelings of loneliness and isolation were unchanged. The identification of issues unrelieved by input from the service will be important in planning future service delivery.

Activities of Daily Living↗
PubMed2001

Stenting of partial and total coronary occlusions in Trinidad and Tobago.

In order to evaluate the efficacy and safety of coronary stenting, we reviewed the first 32 consecutive patients (34 vessels) who underwent elective coronary stenting during the period August 1999 to August 2000 inclusive at the Digital Lab installed at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Aspirin, heparin and ticlopidine were used routinely. Abciximab was used in selected cases (38%). The mean age of patients was 55 +/- 10 years. Eighty-one per cent were male, 52% were hypertensive and 21% were diabetic. Sixty-five per cent had severe angina. Prior Coronary Artery Bypass Grafting (CABG) was performed in 3% and previous Percutaneous Transluminal Coronary Angioplasty (PTCA) in 3%. Multivessel disease was present in 43%. The mean left ventricular ejection fraction was 53 +/- 12%. The culprit lesion was located in either the native left anterior descending (LAD) coronary artery (53%), right coronary artery (RCA) (31%), circumflex artery 13% and saphenous vein graft (3%). The mean baseline diameter stenosis was 91 +/- 9% and this was reduced to 13 +/- 33% after stenting. Procedural success was 100% for 26 partially occluded vs 50% for 8 totally occluded vessels. For the total occlusions, procedural success was inversely related to the duration of the occlusion. There were no cases of death, acute vessel closure, Q-wave myocardial infarction, repeat PTCA or emergent Coronary Artery Bypass Graft (CABG) during and following the procedure. Distal embolization occurred in one patient. The mean duration of hospital stay was one day (for 30 outpatient cases). One patient had recurrence of symptoms with a negative stress test. No patient underwent repeat angiography during the first year of follow-up. Coronary stents were successfully implanted at a tertiary care facility in the Caribbean with low in-hospital morbidity and mortality. Stents markedly reduced the diameter stenosis of the coronary lesion during PTCA. The incidence of clinical restenosis was low. Coronary revascularisation can be successfully achieved by coronary stenting in the Caribbean.

Angioplasty, Balloon, Coronary↗
PubMed1999

Child sexual abuse: what the urologist needs to know.

PURPOSE: We define what the urologist needs to know regarding child sexual abuse. MATERIALS AND METHODS: Based on our experience in treating numerous child victims of sexual assault and a review of the contemporary literature, the data concerning child sexual abuse incidence, risk factors, clinical presentation, child interview, physical examination and management were analyzed. RESULTS: It is estimated that at least 1 in 4 girls and 1 in 10 boys will suffer victimization by age 18 years. There are no predicting socioeconomic factors. In legally proved cases of child sexual abuse the majority of victims have no diagnostic physical findings. Examination findings change depending on the position of the child, degree of relaxation, amount of labial traction and time to perform the evaluation. Findings that are consistent but not independently diagnostic of abuse include chafing, abrasions or bruising of inner thighs or genitalia, scarring, tears or distortion of the hymen, a decreased amount of or absent hymenal tissue, scarring of the fossa navicularis, injury to or scarring of the posterior fourchette/posterior commissure and scarring or tears of the labia minora. In all 50 states physicians are mandated by law to report to child protection services whenever they suspect that a child has been sexually abused. CONCLUSIONS: The urologist must routinely examine the anogenital area of children during routine urethral evaluation and include child sexual abuse as part of the routine urological history.

Adolescent↗
PubMed1999

Influence of the metabolic sequelae of liver cirrhosis on nutritional intake.

BACKGROUND: The liver plays a central role in ingestive behavior; alterations in metabolic signaling to the brain stem as a result of chronic liver disease could influence intake. OBJECTIVE: We examined the influence of metabolic sequelae of liver disease on nutrient intake and nutritional status. DESIGN: Nutritional status and spontaneous dietary intake were examined in 65 cirrhotic patients and 14 control subjects. The response to feeding was investigated in 14 control subjects and a subgroup of 31 cirrhotic patients. Comparisons were made between patients with primary biliary cirrhosis (PBC) and hepatocellular cirrhosis (HC). RESULTS: Patients were nutritionally depleted. The fasting rate of lipid oxidation in the HC group was greater than in the control group (P < 0.01). In the fasting state, only HC patients were hyperinsulinemic [121.2+/-78.5 compared with 41.3+/-18.6 pmol/L in control subjects (P < 0.001) and 64.7+/-15.8 pmol/L in PBC patients (P < 0.05)] and this persisted during the response to feeding. In the fed state, the magnitude of change in carbohydrate oxidation was greatest in the HC group (HC: 34.6%; control: 23.1%; PBC: 25.2%). Carbohydrate and energy intakes of the HC group were lower than in control subjects (carbohydrate: 193+/-38.3 compared with 262+/-48.1 g/d, P < 0.05; energy: 6.29+/-1.40 compared with 9.0+/-2.12 MJ/d, P < 0.05). CONCLUSIONS: Reductions in carbohydrate intake could be mediated by hyperinsulinemia and compounded by preferential uptake of carbohydrate. This may enhance gastrointestinal satiety signaling and contribute to hypophagia.

Analysis of Variance↗
PubMed1998

Dermatomyositis: a dermatology-based case series.

BACKGROUND: Dermatomyositis is associated with significant morbidity and occasional mortality. Currently there is no consensus on treatment for patients with dermatomyositis. OBJECTIVE: Our purpose was to review the clinical features and response to therapy of patients with dermatomyositis and compare these data with previous series of patients with dermatomyositis/polymyositis. METHODS: Clinical characteristics of 65 patients seen during a 10-year period were reviewed retrospectively. Twenty-one of these patients were enrolled in a prospective, uncontrolled study of treatment with high-dose prednisone followed by slow tapering. RESULTS: Clinical features were similar to those previously described; however, muscle strength at diagnosis was on average greater in patients in this series than in patients previously reported. Malignancy was present in 5 of 43 adult patients (12%), but was not found in patients with juvenile dermatomyositis. Another connective tissue disease was present in 19% of patients. Twelve patients had dermatomyositis sine myositis. Eighteen of 21 patients (85%) in the prednisone study group had resolution of myositis. CONCLUSION: Patients with dermatomyositis in this series had less active myositis at presentation, but were otherwise similar to patients with dermatomyositis/polymyositis previously reported. Treatment with high-dose daily prednisone followed by slow tapering was effective.

Adult↗
PubMed1997

Identification of a cohort of male and female twins aged 65 years or more in the United States.

In this paper, a method with which to identify a national cohort of elderly twins is proposed. Record linkage algorithms were developed and applied to the > 30 million records contained in the Medicare beneficiary file. The matching algorithm for male/male pairs used race (black or white), last name, date of birth, and state of issuance of the Social Security number. Female/female and male/female pairs were selected with matching on race, date of birth, and the first seven digits of the Social Security number to compensate for the absence of maiden names. A stratified random sample of same-sex and opposite-sex white and black pairs (six groups) were selected and surveyed for determination of the actual prevalence of twins. On the basis of these results, the authors conclude that this method could identify an estimated 18,308 male/male, 7,544 female/female, and 204 male/female pairs of twins aged 65 years or more. This would be the largest sample of older twins ever assembled in the United States and represents a significant new resource for epidemiologic studies of the aging population.

Aged↗
PubMed1997

Total energy expenditure in 9 month and 12 month infants.

OBJECTIVES: To measure the total energy expenditure of 9 and 12 month old infants and compare with current recommendations for energy intake. DESIGN: Cross-sectional study. Total energy expenditure assessed using the doubly labelled water technique over a 10 d period. Classical anthropometric measurements taken. SETTING: Community based study in and around Cambridge, UK. SUBJECTS: Twenty infants aged 9 months of age and 20 infants aged 12 months of age recruited via local hospital birth records. MAIN OUTCOME MEASURES: Total energy expenditure calculated via the doubly labelled water technique. RESULTS: Measurements of total energy expenditure was successful in 34 cases. Mean total energy expenditure was 73.5 kcal/kg, 73.2 kcal/kg, 77.1 kcal/kg and 77.6 kcal/kg in the nine month old boys, nine month old girls, twelve month old boys and twelve month old girls respectively. These measurements are approximately 17% below current recommendations (FAO/WHO/UNU, 1985) at nine months of age and 22% below at one year of age. CONCLUSION: The data are consistent with findings in younger infants and older children in that the measurements of total energy expenditure are about 20-25% below current recommendations. It is unlikely that contemporary infants are being underfed and thus more likely that changes in feeding practices and modification of infant formula composition has led to the reduction in energy intake and energy expenditure in such infants.

Anthropometry↗
PubMed1997

Free-living energy expenditure and behaviour in late infancy.

OBJECTIVES: The energy requirements of infants are determined by body size, growth rate, and physical activity. Little is known of the determinants of energy expended on activity. The relation between free-living energy expenditure and behaviour was investigated in infants aged 9 and 12 months. METHODS: Total energy expenditure (TEE) was estimated by the doubly labelled water method and fat free mass was estimated from the 18O dilution space. Behaviour was assessed by two 24 hour activity diaries. SUBJECTS: Thirty four normal healthy infants. RESULTS: TEE was negatively related to the time spent feeding and negatively related to the time spent upset. Body size, represented by fat free mass, accounted for only 19% of the variation in TEE, whereas the combination of fat free mass and two behavioural variables explained 46% of the variation in TEE. CONCLUSIONS: Behaviour contributed significantly to TEE. The energy requirements of individual subjects in this age group cannot be predicted with accuracy from body size alone.

Anthropometry↗
PubMed1996

Sleep history is neglected diagnostic information. Challenges for primary care physicians.

Sleep problems are treatable causes of morbidity and mortality, but little is known about how often the history fundamental to diagnosis is obtained. We recorded the frequency of sleep histories during encounters with simulated patients by 20 experienced primary care practitioners, 23 uninstructed medical interns, and 22 interns who had previous instruction about sleep disorders. Sleep histories were uncommonly obtained by uninstructed physicians (0% of practitioners, 13% of interns), but trained interns more often (81.8%) asked about sleep. If sleep problems are to be prioritized, major changes in physician education and behaviors are essential. Focused instruction about sleep influences physician behavior.

Education, Medical, Continuing↗
PubMed1996

T1 alpha protein is developmentally regulated and expressed by alveolar type I cells, choroid plexus, and ciliary epithelia of adult rats.

T1 alpha is the first marker gene known to be expressed in the adult lung solely by the alveolar type I epithelial cell. Previous studies showed that T1 alpha transcripts are abundant in early rat embryos where they are found in the nervous system and in the foregut and certain of its derivatives including the primitive lung. By mid- to late gestation T1 alpha messenger RNA (mRNA) expression is lost from neural tissues but appears to increase in the lung throughout fetal life. To determine whether the T1 alpha transcripts are translated into protein, especially in early embryos which sometimes express transcripts that are translationally silent, we performed immunohistochemistry on embryos and fetal tissues and analyzed certain tissues by western blotting using a monoclonal antibody against T1 alpha protein. T1 alpha protein is present at all sites that have previously been shown to express the mRNA and at similar developmental stages. As estimated from western blots, T1 alpha protein abundance peaks at about fetal day 16 in the brain and decreases thereafter to a relative level in the adult that is lower than that of the neural tube of the day 13 embryo. Relative protein abundance in the lung is very low, although detectable, on embryonic day 13 but increases slowly until fetal day 20 when there is a dramatic increase. At the time of birth, restriction to the type I cell is not complete and therefore must occur during postnatal lung development. Immunostaining reveals additional sites of expression in fetal and adult rats that had not been clearly visualized in previous in situ hybridization studies. T1 alpha is present in mesonephric tubules and apparently in primitive germ cells but is not detectable in specific cells in the adult kidney, ovary, or testis. However, cells of the choroid plexus of the central nervous system and the ciliary epithelium of the eye express T1 alpha in both fetuses and adults. The well-known functions of these epithelia are to elaborate cerebrospinal fluid and aqueous humor respectively by processes of active ion transport and water fluxes, probably through the aquaporin 1 (channel-forming integral membrane protein [CHIP] 28). We speculate therefore that T1 alpha protein may modulate or participate in these types of cellular functions in the lung.

Age Factors↗
PubMed1995

Tolbutamide causes a modest increase in insulin secretion in cystic fibrosis patients with impaired glucose tolerance.

We examined the effect of intravenous (i.v.) tolbutamide administration on glucose and hormone levels in cystic fibrosis (CF) patients with impaired first-phase insulin secretion and oral glucose tolerance (oral glucose tolerance test [OGTT]) and compared them with CF patients with only an impaired first-phase insulin secretion and healthy control subjects. Five CF patients with an impaired OGTT, ie, a serum glucose value of 7.8 mmol/L or greater 120 minutes after an oral glucose load (group I), five CF patients with a normal OGTT, ie, a serum glucose not exceeding 7.8 mmol/L 120 minutes after oral glucose (group II), and five healthy control (CON) subjects underwent IV glucose tolerance tests with glucose alone (IVGTT) and glucose administered in conjunction with tolbutamide ([IVTTT] 25 mg/kg; maximum dose, 1 g). Serum glucose levels were measured using the glucose oxidase method; insulin, C-peptide, and glucagon levels were measured by the double-antibody radioimmunoassay (RIA) technique. Serum immunoreactive trypsin (IRT) and hemoglobin A1 (HbA1) levels and height and weight were measured for each subject, and in addition, pulmonary function was assessed in those with CF. There were no significant differences in the area under the curve (AUC) for glucose or glucose or glucagon levels or the serum glucose disappearance rate (k value) between group I, group II, or CON subjects during the IVGTT. First-phase insulin and C-peptide secretion was abnormal during IVGTT and IVTTT in the CF groups: in group I it was severely impaired, whereas in group II it was between group I and CON values. During the IVTTT serum glucose levels and glucose k values were not significantly altered in any of the three groups as compared with the IVGTT.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1995

Multicenter trial for long-term safety and efficacy comparison of 0.05% desonide and 1% hydrocortisone ointments in the treatment of atopic dermatitis in pediatric patients.

BACKGROUND: Desonide, a class 6 nonfluorinated topical corticosteroid, has been available for more than two decades. Hydrocortisone is widely used in the treatment of dermatoses in children. OBJECTIVE: Our purpose was to compare the safety and efficacy of desonide ointment and 1.0% hydrocortisone ointment in children with atopic dermatitis. METHODS: One hundred thirteen children (mean age, 4.8 years) with mild to moderate atopic dermatitis were enrolled in a multicenter, randomized, investigator-masked, parallel-group study. Treatments were applied twice daily for 5 weeks and extended to 6 months in 36 of the patients. Signs of atrophy were evaluated. Efficacy was determined by measuring global improvement, erythema, lichenification, excoriations, oozing or crusting, pruritus, and induration. RESULTS: No differences in safety were observed between hydrocortisone and desonide. The investigator's global assessment of improvement significantly favored desonide over hydrocortisone during 3 months of treatment (p < 0.05). CONCLUSION: Desonide ointment showed greater efficacy, produced more rapid improvement, and demonstrated an equivalent cutaneous safety profile when compared with 1% hydrocortisone ointment for up to 6 months.

Child↗
PubMed1995

WHAM!: a forms constructor for medical record access via the World Wide Web.

WWW-EMRS is an architecture that provides a set of abstractions of electronic medical record systems (EMRS). This architecture has enabled us to implement interfaces to heterogeneous EMRS via the World-Wide Web that provide consistent visual presentations and functionality. We describe WHAM!, a program that allows rapid generation of customized interfaces to WWW-EMRS that therefore deliver the customized functions across multiple EMRS.

Computer Communication Networks↗
PubMed1993

The effect of increasing levels of dietary fish oil rich in eicosapentaenoic and docosahexaenoic acids on lymphocyte phospholipid fatty acid composition and cell-mediated immunity in the mouse.

The influence of increasing intakes of fish oil on spleen leucocyte phospholipid fatty acid composition and cell-mediated immunity was studied in the mouse using a popliteal lymph node assay technique. The immune response was suppressed by 160 g fish oil/kg diet, but not by lower doses. The proportion of 20:5n-3 in spleen leucocyte phospholipid increased from 0.14 in the controls to 3.8, 7.2, 8.5 and 9.4% in the animals fed on 25, 50, 100 and 160 g fish oil/kg diet; the proportion of 22:6n-3 increased from 5.1 in the controls to 12.1, 12.2, 12.8 and 12.9% respectively. It is concluded that moderate intakes of fish oil are not immunosuppressive.

Animals↗