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Biomedical subjects

A O Hughes

Publications and source records attributed to A O Hughes.

At least 19 recordsLinked to original sources
PubMed2000

The sensitivity to change over time of the Bristol Activities of Daily Living Scale in Alzheimer's disease.

Activities of daily living scales can be a useful tool in assessing change in people with dementia, either as the disease progresses or in response to treatment. However, little data exist as to the sensitivity to change of instruments used. The Bristol Activities of Daily Living Scale was developed with assistance from the carers of community dwelling people with dementia to be completed by such people and has been shown to have internal consistency as well as face and construct validity. This study aimed to analyse the sensitivity to change of the Bristol Activities of Daily Living Scale in people with Alzheimer's disease receiving anticholinesterase medication. Using the Clinician's Global Rating of Change as a gold standard for change, differences between Bristol Activities of Daily Living Scale scores before and after medication were compared with change in Mini-Mental State Examination, Alzheimer's Disease Assessment Scale - Cognitive and the Nurses Observation Scale for Geriatric Patients, in 61 older adults receiving anticholinesterase medication for Alzheimer's disease. Both the Bristol Activities of Daily Living Scale and the Nurses Observation Scale for Geriatric Patients are sensitive and specific in predicting improvement or stability as measured by the clinician's global rating of change. However, unlike the Nurses Observation Scale for Geriatric Patients, change over time in the Bristol Activities of Daily Living Scale significantly correlates with change in the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale - Cognitive. The Bristol Activities of Daily Living Scale is sensitive to change in activities of daily living and shows the expected and desirable relationship with measures of cognition.

Activities of Daily Living↗
PubMed1996

The age-related decline in female fecundity: a quantitative controlled study of implanting capacity and survival of individual embryos after in vitro fertilization.

OBJECTIVE: To determine strictly comparable rates per embryo of implantation and birth of a baby related to the woman's age, which would be representative of natural fertility at least in relative terms. DESIGN: Comparative study of IVF-ET results controlling for confounding variables including cause and duration of infertility, history of previous pregnancy, hormonal treatment, rank cycle of treatment, and numbers of embryos transferred and available. SETTING: University comprehensive fertility service. PATIENTS: All couples (n = 561) in their first cycle of treatment reaching oocyte collection, women with normal uterus and ovulatory cycles, and men with normal sperm. INTERVENTIONS: Standardized methods of pituitary desensitization, ovarian stimulation, and IVF-ET, and maximum of three embryos transferred. MAIN OUTCOME MEASURES: Oocytes, pregnancies, and live births per cycle; fertilization and cleavage rates; embryo implantation and live baby rates. RESULTS: The numbers of oocytes and consequent embryos declined with age but fertilization and cleavage rates rose slightly. Embryo implantation rates were reduced when no more than three embryos were available (9.3 percent), especially in women aged 35 to 39 years (6.2 percent) or older compared with four or more embryos (17.1 percent) but were equally low in all women over 40 years even with more embryos (6.1 percent). In the age bands 25 to 29, 30 to 34, 35 to 39, and 40 to 44 years, the rates per embryo of implantation were 18.2 percent, 16.1 percent, 15.3 percent, and 6.1 percent, respectively, and of a live baby were 15.7 percent, 12.1 percent, 12.0 percent, and 3.5 percent. CONCLUSIONS: Embryo implanting ability and survival decline gradually after 30 years of age, but by more than two thirds after 40 years and in younger women with reduced ovarian capacity.

Adult↗
PubMed1996

Cervical spine imaging in trauma patients: a simple scheme of rationalising arm traction using zonal divisions of the vertebral bodies.

OBJECTIVE: To evaluate the effectiveness of arm traction for cervical spine imaging in trauma patients and devise a scheme to predict the probability of visualising the C7/T1 level in trauma patients. METHODS: 98 trauma patients were studied. Each vertebral body was divided into three equal horizontal zones, the disc space between vertebral bodies being equivalent to one zone. The fifth cervical vertebra was used as the starting level (zone 1). Zones obtained pre and post arm traction on the lateral cervical spine radiographs were recorded. Results were analysed to show the probability of imaging the lower cervical spine, including the cervico-thoracic junction. RESULTS: If the initial film showed less than zone 10 (mid-C7 vertebra), the probability of showing zone 13 (upper body of T1) with arm traction was only 7.7%, that is, one success in every 13 pulls; or conversely, 12 failures in every 13 pulls. CONCLUSIONS: Unless an initial cervical spine radiograph includes the upper one third of the body of the C7 vertebra, the probability of attaining the C7/T1 level with arm traction is < 15%. It is suggested that all initial radiographs of the lateral cervical spine in major trauma patients be done with arm traction, and where the upper one third of the body of C7 vertebra is not seen, then computerised tomography, swimmer's, or oblique views be considered.

Arm↗
PubMed1995

Abu Dhabi third stage trial: oxytocin versus Syntometrine in the active management of the third stage of labour.

OBJECTIVE: To compare the effect of oxytocin and Syntometrine when used as part of active management of third stage of labour on postpartum haemorrhage, hypertension, nausea/vomiting and retained placenta. STUDY DESIGN: A randomised double blind trial was conducted in the Obstetric Unit of Corniche Hospital, Abu Dhabi in the United Arab Emirates. Between 1 January 1991 and 30 June 1991, 2040 women were randomly allocated either to the oxytocin (n = 1017) or the Syntometrine (n = 1023) group. Twelve patients had to be excluded from the trial (oxytocin, 5; Syntometrine, 7) after randomisation because they no longer fulfilled the inclusion criteria. All women in the trial received either oxytocin 10 units or Syntometrine 1 ml (oxytocin 5 units+ergometrine (ergonovine) 0.5 mg) by intramuscular injection with delivery of the anterior shoulder of the baby. Relative risk with 95% confidence intervals was calculated for each variable. RESULTS: Oxytocin (10 units) alone was as effective as Syntometrine (1 ml) in preventing post-partum haemorrhage without an increase in the incidence of retained placenta. Median blood loss was similar in both groups. The incidences of nausea, vomiting and headache were significantly lower in the oxytocin group, as was the occurrence of a mean rise in diastolic and systolic blood pressures of 20 and 30 mmHg or more, respectively. CONCLUSION: Prophylactic administration of oxytocin 10 U in the third stage of labour, as part of active management, reduces the incidence of maternal nausea, vomiting, headache and rise in blood pressure than does Syntometrine 1 ml without adversely affecting the rate of post partum haemorrhage.

Adult↗
PubMed1995

Strategies for sampling black and ethnic minority populations.

BACKGROUND: The objective of the study was to describe the design and sampling methods used to carry out face-to-face interviews with a sample of the black and ethnic minority population of the area. This study was conducted in the city of Bristol, England (part of Bristol and District Health Authority). METHODS: The sample was based on up to 1000 interviews with black Caribbean/African, South Asian and Far-East Asian residents. The design of the study focuses on the problems of definition of the appropriate group to sample and the various sampling techniques that were necessary to procure the interviews. RESULTS: A total of 574 interviews were carried out by bilingual interviewers matched for sex and ethnicity of the respondent, thereby allowing analysis that would be beneficial to the Health Authority in its planning and decision-making. CONCLUSIONS: The use of name spotting and 'snowball' sampling proved the most productive. The Electoral Register was preferred to the Family Health Services Authority lists. Interviewers must be carefully selected and adequately trained to work in this difficult area. The questionnaire must be culturally and linguistically acceptable across all the ethnic groups.

Africa↗
PubMed1994

The sight test fee: effect on ophthalmology referrals and rate of glaucoma detection.

OBJECTIVE: To assess changes, if any, in the numbers of referrals and outcome of glaucoma referrals to the hospital eye service since the introduction of the sight test fee on 1 April 1989. DESIGN: Review of referral records and clinical notes. SETTING: Referrals to the Bristol Eye Hospital. SUBJECTS: 51,919 patients referred to the Bristol Eye Hospital between 1984 and 1992. 9438 case notes of patients referred between 1987 and 1991 were examined in detail. MAIN OUTCOME MEASURES: Numbers of referrals; rate of adult true positive glaucoma referrals. RESULTS: Referrals to the Bristol Eye Hospital were between 13.7% and 19.0% fewer than expected after the introduction of the sight test fee. True positive glaucoma referrals were reduced by the same proportion. CONCLUSIONS: The numbers of patients being identified as requiring treatment or follow up for potentially blinding glaucoma have declined by nearly one fifth since the introduction of the sight test fee. An increased prevalence of preventable blindness may result.

Adult↗
PubMed1994

Smoking, the environment and meningococcal disease: a case control study.

This case control study investigated environmental factors in 74 confirmed cases of meningococcal disease (MD). In children aged under 5, passive smoking in the home (30 or more cigarettes daily) was associated with an odds ratio (OR) of 7.5 (95% confidence interval (CI) 1.46-38.66). ORs increased both with the numbers of cigarettes smoked and with the number of smokers in the household, suggesting a dose-response relationship. MD in this age group was also significantly associated with household overcrowding (more than 1.5 persons per room) (OR 6.0, 95% CI 1.10-32.8), with kisses on the mouth with 4 or more contacts in the previous 2 weeks (OR 2.46, 95% CI 1.09-5.56), with exposure to dust from plaster, brick or stone in the previous 2 weeks (OR 2.24, 95% CI 1.07-4.65); and with changes in residence (OR 3.0, 95% CI 1.0-8.99), marital arguments (OR 3.0, 95% CI 1.26-7.17) and legal disputes in the previous 6 months (OR 3.10, 95% CI 1.24-7.78). These associations were independent of social class. Public health measures to lower the prevalence of cigarette smoking by parents of young children may reduce the incidence of MD. The influence of building dust and stressful life events merits further investigation.

Adolescent↗
PubMed1994

Apparent lack of seasonal variation in implantation rates after in-vitro fertilization.

It has been suggested that seasonal variation in endometrial receptivity may occur in women, which could affect the likely success of in-vitro fertilization (IVF) treatment. We therefore studied implantation rates (fetal sacs as a proportion of embryos transferred) as an indirect index of receptivity in a narrowly defined population of women under 40 years old with normal ovulatory cycles and normal uterus and men with normal sperm function. A total of 577 cycles of IVF treatment were undertaken using a standard protocol of pituitary desensitization and ovarian stimulation during the 3 years 1990-1992. Results were compared between calendar months and 3-month seasons. The overall implantation rate was 14.9% of embryos, and the clinical pregnancy rate was 30.3% of cycles reaching egg collection. There were no significant differences in the monthly rates of eggs collected, fertilization and cleavage, or embryos transferred. Implantation rates varied to a greater extent but analysis of variance showed no seasonal variation. These findings do not support a seasonal variation in ovarian responsiveness or endometrial receptivity when stimulated for IVF treatment, but larger studies are needed for firm conclusions to be drawn.

Adult↗
PubMed1993

Prevalence and family risk of ulcerative colitis and Crohn's disease: an epidemiological study among Europeans and south Asians in Leicestershire.

The family history of patients identified during incidence studies in Leicestershire were investigated and the prevalence and comparative risks calculated; 1254 patients aged 15 to 80 years were sent a questionnaire about their family history. All cases with a positive family history were reviewed and confirmed cases included in the study. In Europeans the standardised prevalence of Crohn's disease was 75.8/10(5) and that of ulcerative colitis 90.8/10(5). The prevalence of Crohn's disease among South Asians was 33.2/10(5) and that of ulcerative colitis 135/10(5). The prevalence of Crohn's disease in Europeans was significantly greater than that in Hindus (chi 2 = 16, p < 0.001), while the prevalence of ulcerative colitis was significantly lower in Europeans than Hindus (chi 2 = 27, p < 0.001) and Sikhs (chi 2 = 4.4, p < 0.05). The comparative risk of developing ulcerative colitis in first degree relatives of Europeans patients with ulcerative colitis was increased by approximately 15, but the risk of Crohn's disease was not increased. The comparative risk of developing Crohn's disease among first degree relatives of patients with Crohn's disease was increased by up to 35, the comparative risk of ulcerative colitis was approximately 3. The risk among relatives of South Asian patients with Crohn's disease was not increased, but the risk of ulcerative colitis to relatives of patients with ulcerative colitis was. This study supports the view that Crohn's disease and ulcerative colitis arise in people with a genetic predisposition and exposed to some, as yet unknown, environmental factor.

Adolescent↗
PubMed1993

The contribution of respiratory function tests to clinical diagnosis.

The purpose of this study was to investigate the amount of diagnostic information contained in a set of routine lung function studies and to attempt to determine which tests could be omitted without significant loss of discrimination. Cluster analysis was performed on a set of physiological and questionnaire data, collected prospectively in 1,542 male patients, referred consecutively for measurement of forced expired volumes, static lung volumes and measurements of the transfer factor for carbon monoxide. A respiratory questionnaire was completed for each patient. A physician assigned the patients to a rigorously defined diagnostic category, based on supporting clinical information, as well as pulmonary function, apart from 241 patients with unusual diagnoses and those in whom the criteria did not apply satisfactorily. This diagnosis was never included as a classification variable. Basing the classification on three independent measurements, total lung capacity, the ratio of forced expiratory volume in one second (FEV1) to vital capacity, and the transfer factor for carbon monoxide, the computer generated six groups: one normal, one showing an isolated gas exchange defect, and four with varying degrees of restriction and obstruction. This classification performed well in separating the patients with the clinical diagnoses of chronic airflow obstruction, bronchial asthma and interstitial lung disease from those with ischaemic and valvular heart disease and other miscellaneous disorders. Omitting total lung capacity resulted in some loss of specificity, but valid information was still obtained. The inclusion of all the static and dynamic lung volumes and of carbon monoxide transfer coefficient made little difference.(ABSTRACT TRUNCATED AT 250 WORDS)

Cluster Analysis↗
PubMed1993

Trends in urban violence: a comparison of accident department and police records.

Police crime statistics and crime survey data are known to be poor indicators of levels of violence in society. Longitudinal investigations of assault injury have not been carried out in accident and emergency departments hitherto, but may provide an accurate perspective of trends in violence. The attendance of assault patients at a city centre accident and emergency department was compared with 'wounding against the person' recorded by the police between 1973 and 1990. Woundings recorded by the police increased consistently throughout the study period whereas the number of assault patients did not increase between 1977 and 1987. From 1975 to 1990, police statistics showed a 9-fold and accident and emergency data a 6-fold increase. Both data sets showed substantial overall increases in violence after 1987, and a decrease in 1979. Further epidemiological studies of violence are necessary.

Crime↗
PubMed1992

Long term follow up of women with borderline cervical smear test results: effects of age and viral infection on progression to high grade dyskaryosis.

OBJECTIVE: To follow up and assess the significance of borderline change in cervical smears. DESIGN: Retrospective study of women undergoing routine cervical cytological screening in 1981. SETTING: Avon Cervical Screening Programme, covering 250,000 women in Bristol and Weston super Mare. SUBJECTS: 437 women showing borderline cervical changes in 1981 and 437 age matched controls with normal results in 1981. MAIN OUTCOME MEASURES: Cytological progression to high grade dyskaryosis (cervical intraepithelial neoplasia grade III or invasive carcinoma). RESULTS: During follow up ranging from 13 to 106 months 98 of the 437 women (22.4%) with borderline cytological changes on routine cervical cytology screening had a subsequent smear test showing high grade dyskaryosis compared with three of the 437 women (0.9%) in the control group. The risk of progression was greater in women aged 20 to 39 than in those aged 40 and over. Human papillomavirus infection had initially been diagnosed cytologically in 101 of the 437 (23%) women with borderline results. Significantly fewer of these women developed high grade dyskaryosis (13/98 (13%) v 88/339 (26%), p less than 0.05). CONCLUSIONS: Women with borderline smear test results are at increased risk of developing high grade dyskaryosis, particularly if the borderline changes occur without cytological features of human papillomavirus infection. Progression occurs within three years in 50% of cases, although a linearly increasing risk was sustained over the nine years of follow up and was greatest in women aged 20 to 39. Careful follow up of these women is indicated.

Adult↗
PubMed1992

Alcohol consumption and its relation to cardiovascular risk factors in British women.

OBJECTIVE: To examine the relation between alcohol consumption and risk factors for coronary heart disease in women. DESIGN: Cross sectional study of a stratified random sample of the population grouped into five categories of habitual alcohol consumption. SETTING: People registered with general practitioners at two large health centres in east Bristol, England. SUBJECTS: 1048 women aged 25-69 years. MAIN OUTCOME MEASURES: Fasting plasma concentrations of insulin, total cholesterol, total triglycerides, and high density lipoprotein cholesterol, including its subfractions HDL2 and HDL3, and body mass index. RESULTS: Compared with non-drinkers women consuming a moderate amount of alcohol (1-20 g/day) had lower plasma concentrations of triglycerides, by 0.19 mmol/l (95% confidence interval 0.07 to 0.35); cholesterol, by 0.4 mmol/l (0.19 to 0.61); and insulin, by 1.4 mU/l (0.43 to 1.97) and a lower body mass index, by 1.2 kg/m2 (0.43 to 1.97). They also had higher concentrations of high density lipoprotein cholesterol, by 0.09 mmol/l (0.03 to 0.15); HDL2 cholesterol by 0.05 mmol/l (-0.02 to 0.10) and HDL3 cholesterol, by 0.06 mmol/l (0.06 to 0.11). All these were independent of body mass index, smoking habits, and taking oral contraceptives. CONCLUSIONS: Moderate alcohol consumption is associated with lower levels of cardiovascular risk factors in women. Insulin may have a central role.

Adult↗
PubMed1992

Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters.

Because the prevalence of the irritable bowel syndrome (IBS) in the general population is unknown, a questionnaire of intestinal symptoms was administered to a stratified random sample of 1058 women and 838 men. Subjects were asked if they had consulted a physician about such symptoms. One or more symptoms occurred frequently in 47% of women and 27% of men. Diagnosable IBS, defined as three or more symptoms, was present in 13% of women and 5% of men. Abdominal pain was the most common symptom, and recurrent intestinal pain was reported by 20% of women and 10% of men. All symptoms were more common in women except runny or watery stools. Most symptoms including pain were unrelated to age. Only half the people with diagnosable IBS had consulted a physician about it. The likelihood of consulting a physician was directly proportional to the number of symptoms and was similar in men and women after controlling for the number of symptoms. Of individual symptoms, the one most strongly associated with consulting was abdominal pain, especially in men. It is concluded that IBS is prevalent at all ages, especially in women, that it is nearly always painful, and that people with multiple symptoms are more likely to consult a physician.

Adult↗
PubMed1992

Statistical awareness of research workers in British anaesthesia.

A survey was made of simple statistical errors in the precirculated booklets of abstracts to the Anaesthetic Research Society. In the five booklets June 1988-November 1989, only four of 19 figures included clearly labelled error bars when necessary; in four figures there was no indication of variability. In a more detailed survey of the 115 abstracts presented in 1990, errors were placed in categories: the presentation of method or choice of statistical test; variability; probability. There was a total of 115 errors in 61 abstracts, which was 65% of the 94 abstracts presenting numerical information. The most common errors were: failure to identify tests of inferential statistics (n = 29 abstracts); failure to present data to allow interpretation of P values (n = 21); misuse of SEM (n = 13). Confidence limits were given in seven abstracts. Type II (beta) error was not searched for formally, but no abstract that reported a negative result included the power of the study. With this level of elementary errors, there is considerable room for improvement in the use of straightforward guidelines to the presentation of statistical information. The problem is not confined to British anaesthesia: in more than 30% (25 of 71) of the figures contained in abstracts of the International Anesthesia Research Society in 1990, plots of variables against time showed only mean values.

Anesthesia↗
PubMed1992

Defecation frequency and timing, and stool form in the general population: a prospective study.

Because the range of bowel habits and stool types in the community is unknown we questioned 838 men and 1059 women, comprising 72.2% of a random stratified sample of the East Bristol population. Most of them kept records of three consecutive defecations, including stool form on a validated six point scale ranging from hard, round lumps to mushy. Questionnaire responses agreed moderately well with recorded data. Although the most common bowel habit was once daily this was a minority practice in both sexes; a regular 24 hour cycle was apparent in only 40% of men and 33% of women. Another 7% of men and 4% of women seemed to have a regular twice or thrice daily bowel habit. Thus most people had irregular bowels. A third of women defecated less often than daily and 1% once a week or less. Stools at the constipated end of the scale were passed more often by women than men. In women of child bearing age bowel habit and the spectrum of stool types were shifted towards constipation and irregularity compared with older women and three cases of severe slow transit constipation were discovered in young women. Otherwise age had little effect on bowel habit or stool type. Normal stool types, defined as those least likely to evoke symptoms, accounted for only 56% of all stools in women and 61% in men. Most defecations occurred in the early morning and earlier in men than in women. We conclude that conventionally normal bowel function is enjoyed by less than half the population and that, in this aspect of human physiology, younger women are especially disadvantaged.

Adult↗
PubMed1991

Symptomatic and silent gall stones in the community.

The prevalence of gall stone disease in a stratified random sample of 1896 British adults (72.2% of those approached) was established using real time ultrasound. The prevalence rose with age, except in women of 40-49 years, so that at 60-69 years, 22.4% of women and 11.5% of men had gall stones or had undergone cholecystectomy. The cholecystectomy rate of people with gall stone disease was higher in women than in men (43.5% v 24%, p less than 0.05). Very few subjects with gall stones had convincing biliary symptoms. In women, 10.4% had symptoms according to a questionnaire definition of biliary pain and 6.3% according to conventional history taking, while no men at all admitted to biliary pain. Nevertheless, cholecystectomy in men had nearly always been preceded by convincing biliary symptoms. The age at cholecystectomy was, on average, nine years less than the age at detection of silent gall stones in both sexes. It is concluded that either gall stones are especially prone to cause symptoms in younger people or that there are two kinds of cholelithiasis - symptomatic and silent. The lack of symptomatic gall stones in cross sectional surveys is probably due to their rapid diagnosis and treatment.

Adult↗