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Biomedical subjects

A Oakley

Publications and source records attributed to A Oakley.

At least 19 recordsLinked to original sources
PubMed1998

The health and welfare effects of day-care: a systematic review of randomised controlled trials.

Day-care has long been a controversial aspect of social policy in countries such as the U.K. What evidence is there about the effects of out-of-home day-care on educational, health and welfare outcomes for children and their families? This paper applies to day-care studies, the methodology of the systematic review as pioneered in the health care field, in order to establish the evidence-base for day-care provision. Randomised controlled trials of day-care for pre-school children were identified using electronic databases, hand searches of relevant literature and contacts with authors. A total of 8 trials were identified after examining 920 abstracts and 19 books. All the trials were carried out in the U.S.A. European research on this topic is extensive but we did not identify any studies using trial design. Instead observational, case controlled and cohort studies were prominent. The trials were assessed for methodological quality. Results showed that day-care promotes children's intelligence, development and school achievement. Long-term follow up demonstrates increased employment, lower teenage pregnancy rates, higher socio-economic status and decreased criminal behaviour. There are positive effects on mothers' education, employment and interaction with children. Effects on fathers have not been examined. Few studies look at a range of outcomes spanning the health, education and welfare domains. Most of the trials combined non-parental day-care with some element of parent training or education (mostly targeted at mothers); they did not disentangle the possible effects of these two interventions. The trials had other significant methodological weaknesses, pointing to the importance of improving on study design in this field. There is a need for well designed research on day-care to provide an evidence-base for British social policy.

Child Behavior↗
PubMed1998

Pellagra in a woman using alternative remedies.

A young woman presented with pellagra. Dietary intake of niacin was in excess of recommended guidelines. She had a low body mass index and was taking a number of alternative remedies. Resolution was rapid with oral nicotinic acid and discontinuation of the remedies.

Adult↗
PubMed1997

Nicotinic receptor distribution in the human thalamus: autoradiographical localization of [3H]nicotine and [125I] alpha-bungarotoxin binding.

The thalamus plays a major role in relaying and transforming information that is relayed to the cortex and in turn modulates cortical outputs. The reticular nucleus projects to the other thalamic nuclei, modulating and integrating their activity. The distribution of high affinity nicotine and alpha-bungarotoxin (alpha BTX) receptors in the human thalamus has been investigated by radioligand autoradiography in post mortem human tissue. [3H]nicotine binding in the human thalamus was high in most thalamic nuclei, especially in the lateral dorsal, the medial geniculate, lateral geniculate and anterior nuclei. The distribution of [125I] alpha BTX binding was quite distinct from [3H]nicotine binding. [125I] alpha BTX binding was generally lower (< 0.26-11.62 fmol/mg protein compared with 6.68-36.17 fmol/mg protein for nicotine binding) and concentrated in the reticular nucleus, with discrete groups of cells displaying higher binding in the latter. These results indicate differences between the distribution of nicotinic receptors in humans and those previously reported in mice and monkeys. Changes in high affinity nicotine and alpha BTX receptors in the thalamus may contribute to symptoms observed in neuropathological conditions associated with disorders of perception and movement such as Dementia with Lewy Bodies, Alzheimer's Disease and Schizophrenia.

Adult↗
PubMed1996

Informed choice for users of health services: views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers.

With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concerned that the leaflets would raise women's anxiety, reduce uptake of scans, disrupt hospital organisation, and reinforce media messages about the poor safety record of ultrasonography. Midwives thought that the leaflets would inform women, help them to talk about their care with health professionals, and help them to get better care. Women were shocked at some of the contents but thought that it was appropriate to include both advantages and disadvantages of routine scanning in the leaflet. This case study highlights the resistance of some health professionals to evidence based health care; underlying conflicts with the principle of professional autonomy; concern that informed choice may create anxiety; and professional and organisational barriers to allowing informed choice.

Attitude of Health Personnel↗
PubMed1996

A phase I clinical study of the antipurine antifolate lometrexol (DDATHF) given with oral folic acid.

Lometrexol is an antifolate which inhibits glycinamide ribonucleotide formyltransferase (GARFT), an enzyme essential for de novo purine synthesis. Extensive experimental and limited clinical data have shown that lometrexol has activity against tumours which are refractory to other drugs, notably methotrexate. However, the initial clinical development of lometrexol was curtailed because of severe and cumulative antiproliferative toxicities. Preclinical murine studies demonstrated that the toxicity of lometrexol can be prevented by low dose folic acid administration, i.e. for 7 days prior to and 7 days following a single bolus dose. This observation prompted a Phase I clinical study of lometrexol given with folic acid supplementation which has confirmed that the toxicity of lometrexol can be markedly reduced by folic acid supplementation. Thrombocytopenia and mucositis were the major toxicities. There was no clear relationship between clinical toxicity and the extent of plasma folate elevation. Associated studies demonstrated that lometrexol plasma pharmacokinetics were not altered by folic acid administration indicating that supplementation is unlikely to reduce toxicity by enhancing lometrexol plasma clearance. The work described in this report has identified for the first time a clinically acceptable schedule for the administration of a GARFT inhibitor. This information will facilitate the future evaluation of this class of compounds in cancer therapy.

Acyltransferases↗
PubMed1995

Cutaneous adverse drug reactions in a hospital setting.

AIMS: A prospective survey of the number and nature of cutaneous adverse drug reactions in a hospital setting. METHOD: Six month survey of cutaneous adverse drug reactions in hospital inpatients (April to October 1992). All patients were reviewed by a specialist dermatologist who assessed the adverse drug reaction as being: (1) type A adverse reaction (ie, expected, eg, acne vulgaris from systemic steroids; (2) type B adverse reaction (ie, unexpected, eg, allergic reaction; (3) not drug related; and (4) other/do not know. RESULTS: Sixty patients were reviewed; 38/60 patients (63%) had a cutaneous reaction related to their drug therapy or in-patient care. Of these, 7 had a nonallergic adverse drug reaction (type A). A further 31 had a type B adverse reaction: 27 had an allergic reaction to a systemic drug and 4 had an allergic contact dermatitis to a topical agent. 17 patients had cutaneous signs unrelated to their drug therapy, mostly a primary skin disorder (eg, eczema, psoriasis, etc). Of the remaining 5 patients it was not possible to determine the cause of the cutaneous reaction. The most common drugs associated with adverse drug reactions were the penicillin group of antibiotics, followed by frusemide, prednisone, allopurinol and carbamazepine. CONCLUSIONS: Adverse drug reactions are common and may result in additional morbidity to patients. However, only half of the cutaneous adverse reactions seen were secondary to allergy. As the diagnosis of an allergic reaction to drugs may have important therapeutic implications, review by a specialist dermatologist may be indicated.

Adolescent↗
PubMed1995

Health and cancer prevention: knowledge and beliefs of children and young people.

OBJECTIVE: To collect information from children and young people about their knowledge of and attitudes towards cancer and their understanding of health and health related behaviours to inform future health promotion work. DESIGN: Questionnaire survey of 15-16 year olds, and interviews with play materials with 9-10 year old children. SETTING: Six inner city, suburban, and rural schools. SUBJECTS: 226 children aged 15-16 years and 100 aged 9-10 years. MAIN OUTCOME MEASURES: Knowledge about different types of cancer; beliefs about health; sources of information; quality of research data obtainable from young children about cancer and health. RESULTS: Both samples knew most about lung cancer, but there was also some knowledge of breast and skin cancer and leukaemia. Smoking, together with pollution and other environmental factors, were seen as the dominant causes of cancer. Environmental factors were mentioned more often by the inner city samples. Television and the media were the most important sources of information. Young people were more worried about unemployment than about ill health. More than half the young people did not describe their health as good, and most said they did not have a healthy lifestyle. Children were able to provide detailed information about their knowledge and understanding by using drawings as well as interviews. CONCLUSIONS: Children and young people possess considerable knowledge about cancer, especially about lung cancer and smoking, and show considerable awareness of predominant health education messages. Despite this knowledge, many lead less than healthy lifestyles. Health is not seen as the most important goal in life by many young people; the circumstances in which many children and young people live are not experienced as health promoting.

Adolescent↗
PubMed1995

Sexual health education interventions for young people: a methodological review.

OBJECTIVES: To locate reports of sexual health education interventions for young people, assess the methodological quality of evaluations, identify the subgroup with a methodologically sound design, and assess the evidence with respect to the effectiveness of different approaches to promoting young people's sexual health. DESIGN: Survey of reports in English by means of electronic databases and hand searches for relevant studies conducted in the developed world since 1982. Papers were reviewed for eight methodological qualities. The evidence on effectiveness generated by studies meeting four core criteria was assessed. Judgments on effectiveness by reviewers and authors were compared. PAPERS: 270 papers reporting sexual health interventions. MAIN OUTCOME MEASURE: The methodological quality of evaluations. RESULTS: 73 reports of evaluations of sexual health interventions examining the effectiveness of these interventions in changing knowledge, attitudes, or behavioural outcomes were identified, of which 65 were separate outcome evaluations. Of these studies, 45 (69%) lacked random control groups, 44 (68%) failed to present preintervention and 38 (59%) postintervention data, and 26 (40%) omitted to discuss the relevance of loss of data caused by drop outs. Only 12 (18%) of the 65 outcome evaluations were judged to be methodologically sound. Academic reviewers were more likely than authors to judge studies as unclear because of design faults. Only two of the sound evaluations recorded interventions which were effective in showing an impact on young people's sexual behaviour. CONCLUSIONS: The design of evaluations in sexual health intervention needs to be improved so that reliable evidence of the effectiveness of different approaches to promoting young people's sexual health may be generated.

Adolescent↗