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Biomedical subjects

A Nicholson

Publications and source records attributed to A Nicholson.

At least 55 records · Page 3Linked to original sources
PubMed1996

Diet and the prevention and treatment of breast cancer.

The role of diet in breast cancer has been considered since the 1940s. However, most epidemiological studies on the incidence of the disease have been limited by their focus on one dietary component-fat-at the expense of a balanced consideration of the effect of the total diet. Further, only the intercultural comparison studies examine a wide range of fat intakes. These studies indicate a dearth of breast cancer in populations with diets in which less than 10% of calories are from fat. Although dietary fat, estrogenic food additives, and alcohol increase the risk of breast cancer, fiber, indoles, flavonols, vitamins C and E, beta carotene, and selenium are associated with a decreased risk. Except for alcohol, factors that increase risk predominate in animal products, whereas those that decrease risk abound in plant products. These factors have similar effects on progression and prognosis in breast cancer. Mechanistically, higher serum levels of estrogen have been linked with risk of breast cancer. Dietary fat, insecticide residues, and alcohol result in higher estrogen activity. A variety of plant nutrients have estrogen-blocking activity. Current evidence justifies recommending that women of all ages follow a plant-based diet in which fat provides no more than 10% of calories, with the goals of preventing breast cancer and improving its prognosis in a low-cost, safe manner.

Adult↗
PubMed1995

Factors that facilitate compliance to lower fat intake.

The success of dietary interventions that are prescribed to reduce the risk of heart disease depends on the degree to which patients actually change their diets. A review of research trials using different diets and various means of fostering dietary change to reduce cardiac risk factors identified specific factors that are associated with a greater degree of dietary change. Contrary to the common conception that strict diets are unacceptable to patients, those research studies that set stricter limits on fat intake achieved a greater degree of dietary change than did studies with more modest goals. Additional factors used by studies that achieved a lower fat intake include monitoring dietary intake at least monthly, family involvement, group support, provision of food, initial residential treatment, the use of vegetarian diets, and symptomatic subjects. These factors may be useful to researchers and to clinicians seeking to improve dietary compliance in patients.

Cardiovascular Diseases↗
PubMed1995

The medical costs attributable to meat consumption.

OBJECTIVE: To estimate the medical costs that are attributable to the health effects of meat consumption. METHODS: The prevalence of hypertension, heart disease, cancer, diabetes, gallstones, obesity, and foodborne illness among omnivores and vegetarians are compared in studies that have controlled for other lifestyle factors, and the corresponding attributable medical costs are calculated in 1992 dollars. RESULTS: Direct health care costs attributable to meat consumption are estimated to be +2.8-8.5 billion for hypertension, +9.5 billion for heart disease, +0-16.5 billion for cancer, +14.0-17.1 billion for diabetes, +0.2-2.4 billion for gallbladder disease, +1.9 billion for obesity-related musculoskeletal disorders, and +0.2-5.5 billion for foodborne illness. The total direct medical costs attributable to meat consumption for 1992 are estimated at +28.6-61.4 billion. CONCLUSION: Health care costs attributable to meat consumption are quantifiable and substantial.

Adult↗
PubMed1995

Down's syndrome births and pregnancy terminations in 1989 to 1993: preliminary findings.

OBJECTIVE: To investigate changes in the numbers of Down's syndrome births and terminations of pregnancies from 1989 to 1993. DESIGN: Data from a national register of cytogenetic diagnoses of karyotypes associated with Down's syndrome were analysed to obtain observed numbers of births and terminations of pregnancies known to be affected. Allowance was made for those cases diagnosed prenatally for whom the eventual outcome of the pregnancies had not yet been ascertained. RESULTS: There has been an increase over the study years in the number of cytogenetic diagnoses of Down's syndrome from 1063 in 1989 to 1137 in 1993, despite an overall fall in births in England and Wales. This is largely due to the increase in antenatal screening and diagnosis, but in part also due to the rise in numbers of pregnancies at increased maternal ages. The rise in prenatally diagnosed cases, of which 92% end in termination, has been accompanied by a fall in both the estimated numbers of affected live births, from 764 in 1989 to 615 in 1993, and the rate per 1000 total live births in the same years from 1.1 to 0.9. CONCLUSIONS: Better and speedier information on the outcome of prenatally diagnosed cases of congenital anomalies such as Down's syndrome would improve the quality of information available for those auditing genetic services or those planning for the care of survivors.

Abortion, Legal↗
PubMed1995

Perceived changes in adult family members' roles and responsibilities during critical illness.

An exploratory design was used to study the effects of critical care hospitalization on family roles and responsibilities of adult family members and how these effects changed over time. A convenience sample of 52 subjects from pediatric, neonatal, surgical, medical, and cardiovascular intensive care units was used. Data were collected using an open-ended question contained in the Iowa ICU Family Scale (IIFS). Using qualitative techniques, seven themes were identified: (a) Pulling together, (b) Fragmentation of families, (c) Increased dependence, (d) Increased independence, (e) Increased responsibilities, (f) Change in routine, and (g) Change in feelings. These findings indicate that nurses need to implement family-centered interventions such as role supplementation programs or identification of support systems to decrease role strain and role overload in families during a crisis.

Adolescent↗
PubMed1994

Gynaecological care for women with intellectual disability.

Optimal gynaecological care for women with intellectual disability is complex. Many of these women suffer unique problems with regard to menstrual hygiene, sexuality, contraception and susceptibility to sexual abuse. Complex medical, ethical, social and legal issues must be carefully considered to address these problems. We discuss the "gynaecological" management of intellectually disabled women, with particular reference to contraception and menstrual suppression. We advocate endometrial ablation as an alternative to hysterectomy for women with intractable menstrual problems. Some ethical issues are reviewed which must be addressed to determine which approach is in the patient's "best interest" and adopts the "least restrictive option". Finally, we present Federal and State laws governing informed consent for medical procedures for women and children with intellectual disabilities.

Adult↗
PubMed1994

Prognostic value of cytological grading of fine-needle aspirates from breast carcinomas.

Because neoadjuvant therapy, including preoperative chemotherapy and tamoxifen, is becoming increasingly common for early breast cancer, it is desirable to grade tumours before surgery so that the most appropriate medical regimen can be selected. We have used a cytological grading system for ductal carcinoma of type not otherwise specified (NOS). Wet-fixed Papanicolaou-stained breast aspirates are examined for the extent of cell dissociation, cell size and uniformity, and the appearance of nucleoli, the nuclear margin, and chromatin. 377 invasive breast carcinomas were removed after preoperative diagnostic fine-needle aspiration cytology (FNAC) during the 25 months of the study. 286 tumours were ductal carcinomas NOS on histology. We established three cytological grades and found that cytological grade corresponded well with the established histological grades (Elston's modified Bloom and Richardson method). All cytological features included in the score were equally important on regression analysis. This study shows that grading of breast cancer on FNAC is feasible and reproducible. Cytological grade may substitute for histological grade, so a combination of FNAC and mammography can provide information on tumour type, grade, and size before surgery. We recommend this grading system to centres that use FNAC for the diagnosis of breast cancers.

Biopsy, Needle↗
PubMed1994

Emotional responses of family members during a critical care hospitalization.

BACKGROUND: The needs and satisfaction levels of family members of critically ill patients have received much attention in the literature. The feelings of family members, however, have not been thoroughly investigated. To develop appropriate nursing interventions to assist family members in coping with a critical care hospitalization, accurate information about their emotional response to the situation is needed. OBJECTIVE: To examine emotional responses of family members and their descriptions of supportive behaviors of others during a critical care hospitalization. METHODS: An exploratory design was used to study 52 subjects with critically ill family members in the pediatric, neonatal, medical, surgical and cardiovascular intensive care units in a large tertiary care hospital. The subjects kept daily logs of their feelings and the supportive behaviors of others. Thematic analysis was used to identify major themes. RESULTS: Analysis revealed a broad range of powerful emotions throughout the intensive care unit stay. Negative and positive emotions such as despair and joy were sometimes identified by subjects within a 24-hour period. Although fear, worry, anger and exhaustion were dominant themes during the first 24 hours and when the family received bad news about the patient, there was no pattern of emotional response evident as the stay progressed. Some differences between subjects drawn from the medical and neonatal intensive care units were evident. CONCLUSIONS: The findings suggest that family members of critically ill patients experience deep emotional turmoil throughout the intensive care unit stay. Specific nursing interventions to promote adaptive coping are needed throughout the experience.

Adolescent↗
PubMed1993

Are accidents poisson distributed? A statistical test.

The common and convenient assumption in accident count analysis, that accidents are Poisson-distributed, is reexamined. Two statistical tests, for evaluating the assumption are described and compared. It is shown that a test based upon a combinatorial analysis is much more accurate than the alternative chi-square test when accident counts are expected to be small. The more accurate test is used to reinterpret data on accident count variability, the results indicating that the Poisson distribution is appropriate for the analysis of accidents at individual sites.

Accidents↗
PubMed1993

Group functioning of a collaborative family research team.

Collaborative research teams are an attractive means of conducting nursing research in the clinical setting because of the many opportunities that collaboration can supply. These opportunities include a chance to: (1) network with other nurses who have similar interests, (2) share knowledge and expertise for designing clinical studies that directly affect daily practice, (3) develop instruments, (4) write grant proposals, (5) collect and analyze data, and (6) prepare manuscripts for publication. The effectiveness of research teams, however, is strongly influenced by group functioning. This article describes the functioning of a collaborative family interventions research team of nursing faculty members and CNSs at a large Midwestern university setting. The formation of the group and membership characteristics are described, along with strategies used to identify the research focus and individual and group goals. Aspects related to the influence of the group on members and the internal operations of the group are also addressed. Future strategies to be explored will focus on the size of the group and joint authorship issues. The authors also set forth a number of recommendations for development of collaborative research groups.

Clinical Nursing Research↗
PubMed1993

Behavioral responses of family members during critical illness.

This articles describes the behavioral responses of adult family members to critical illness and how these responses change over the course of the hospitalization. A convenience sample of 52 family members of patients in intensive units completed the Iowa ICU Family Scale, a self-report tool measuring sleep, eating, activity, family role, and support behaviors. Scales were completed by family members each day during the first week and then weekly throughout the patient's ICU stay. Family members reported sleeping less with a poorer quality of sleep, less nutritional intake, an increased use of cigarettes, alcohol, and over-the-counter and prescription medications, and spending more time talking, visiting the patient, and waiting. Stress was highest at the time of the ICU admission, began to plateau at Day 6, and then dropped considerably by Day 28. These findings suggest that crisis intervention is important during the early phase of caring for critically ill patients and their family members.

Adaptation, Psychological↗
PubMed1992

Driver behaviour at horizontal curves: risk compensation and the margin of safety.

A study involving unobtrusive observation of drivers at horizontal curves before and after realignment is described. The speeds and path radii adopted by drivers in the curves before and after realignment are compared, as are the levels of side friction demanded by each driver while negotiating the curves before and after realignment. The results reveal substantial variations between drivers (with respect to speed, path radius, and side friction demand) and between the path and curve radii. While vehicle speeds increased markedly, the side friction demand was reduced for all curves except one. It is concluded that the margin of safety was increased for all curves, and this is supported by the accident data.

Automobile Driving↗
PubMed1992

Oat cell carcinoma of urinary bladder.

Oat cell carcinoma of the urinary bladder is extremely uncommon. There have been 52 reported cases in world literature to date. On light microscopic, histochemical, and ultrastructural grounds, these tumors are similar to oat cell carcinoma of the bronchus and other extrapulmonary oat cell carcinomas. Furthermore, they may be grouped together as a clinical entity characterized by an aggressive clinical course with early and extensive metastases, and partial remission with certain chemotherapeutic agents. We report a case of primary small cell carcinoma of the urinary bladder in a forty-two-year-old man and review previous reports with similar histology. The importance of establishing this diagnosis and the optimum forms of therapy are discussed.

Adult↗
PubMed1992

Prediction of the number of Down's syndrome infants to be born in England and Wales up to the year 2000 and their likely survival rates.

Using current demographic projection of maternal age-structure, age-specific fertility rates, and the availability, detection and utilization rates of prenatal diagnosis and subsequent termination rates, predictions are made of the likely numbers of births with Down's syndrome (DS) in England and Wales to be expected up to the year 2000. Further predictions are made of age-specific prevalence of the condition bearing in mind recent trends in survival. These figures show that, despite current screening policies based on maternal age alone, the observed live birth prevalence of DS will rise to levels higher than have been seen for 20 years. Together with consistently increased survival, this will mean that, throughout the next century, the population prevalence of DS will be higher than ever before. Work based in other countries has reached similar conclusions. As the prevention of all births affected by DS is not possible in the forseeable future, and some would argue that it is not desirable, society will need to provide for those affected.

Abortion, Legal↗
PubMed1992

Cerebral palsy--an increasing contributor to severe mental retardation?

It is estimated that the prevalence of nongenetic SMR associated with cerebral palsy has risen from 0.7 to about 0.9 per 1000 live births in the last decade. This is due to the predicted rise in total cerebral palsy prevalence to 2.5/1000 live births. This predicted prevalence of cerebral palsy is similar to that given for Western Australia in 1979-82, allowing for postnatal causes, but is higher than prevalence data from England and Sweden for that period. The estimated rise is due largely to improved survival and increased proportion of low birthweight babies since 1983 and also reflects the use of prevalence rates based on Mersey data. Improvements in prenatal diagnosis, and a parental choice of selective termination may lead to reductions in other causes of SMR, such as Down's syndrome and neural tube defects, so it seems that children both physically and mentally handicapped due to brain damage will contribute a greater proportion of the SMR population. The careload of these children is greater than that associated with many other causes of SMR and most survive into adult life. The implications for planning future services will need to be recognised.

Cerebral Palsy↗