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Biomedical subjects

B McWilliams

Publications and source records attributed to B McWilliams.

10 recordsLinked to original sources
PubMed2006

Need for and receipt of hip and knee replacement--a national population survey.

OBJECTIVES: Hip and knee joint replacements are effective, and yet little is known about how closely the need for joint replacement matches supply in different population groups. Our objective was to compare the prevalence of existing joint replacements with that of need in population groups in England. METHODS: A total of 7101 people aged 60 yrs or older, representative of the population of England, were interviewed. Participants were asked about both receipt and need for joint replacement, socio-economic status and co-morbidity. 'Need' classification was based on hip or knee pain and difficulty walking, with adjustment for potential surgical contraindications. Associations between participants' characteristics and both need and receipt were estimated. RESULTS: The prevalence of existing joint replacement (receipt) was 6% [95% confidence intervals (CI) 5, 6], and this was lower in the North than the South [adjusted odds ratio (OR) 0.72, CI 0.53, 0.96]. In contrast, the prevalence of estimated need was higher in the North (OR 1.27, CI 1.03, 1.58). Need was greater in women than men (OR 1.30, CI 1.09, 1.53), and showed an increasing gradient from the wealthiest to poorest quintile (ORs 1.00, 1.52, 2.18, 2.49, 3.23). In contrast, receipt did not differ significantly by sex or socio-economic group. CONCLUSIONS: People living in the North of England, women and the less wealthy experience relatively high levels of need, yet do not receive relatively more hip and knee joint replacements.

Aged↗
PubMed2000

Socioeconomic status and the expectation of disability in old age: estimates for England.

OBJECTIVES: The longer life expectancy in old age of more privileged socioeconomic groups is well established, but less clear is whether the net effect of additional years of life is a lengthened, stable or reduced duration of disability. Estimates of healthy and disabled life expectancy (using definitions including dependency in activities of daily living and cognitive impairment) were made, contrasting occupational classes I and II (professional and managerial) with the rest. DESIGN: Disability prevalence was estimated from the Medical Research Council Cognitive Function and Ageing study. Sullivan's method was used to calculate health expectancy. SUBJECTS: 10,377 people aged 65 years or over in Cambridgeshire, Newcastle, Nottingham and Oxford. Subjects were classified as disabled if they had evidence of dementia (using the Automated Geriatric Examination Computer Assisted Taxonomy) or scored 11 or more on the modified Townsend Disability scale, at baseline screen. RESULTS: The prevalence of disability overall and need for "constant care" was lower in both men and women in social classes I and II compared with the rest. Men aged 65 to 69 in classes I and II can expect nearly 14 years of life free of disability compared with 11.5 years for those in classes III to V: for women the equivalent expectations are 15.5 and 13.8 years. Men aged 65 to 69 in classes I and II can also expect a shorter duration of disability: 1 year compared with 1.6 years for classes III to V. In women expectation of disability is higher overall, but shows little difference by occupational class. CONCLUSIONS: Relatively privileged socioeconomic groups in England, especially men, can expect fewer years of disability despite longer overall life expectancy. These findings lend weight to optimistic scenarios for the future numbers of older people with disability.

Aged↗
PubMed1999

Profile of disability in elderly people: estimates from a longitudinal population study.

OBJECTIVES: To provide estimates of the numbers of cognitively impaired and physically disabled elderly people in England and Wales, subdivided by a range of sociodemographic, dependency, care receipt, and survival variables, to support debates on the form and funding of health and welfare programmes. DESIGN: Interviews at baseline and 2 year follow up plus data on resource use extracted from records for those with disability. SUBJECTS: 10 377 people aged 65 years and over in Cambridgeshire, Newcastle, Nottingham, and Oxford. All estimates weighted to population of England and Wales in 1996. RESULTS: 11% of men and 19% of women aged 65 and over were disabled, totalling 1.3 million people; 38% of these were aged 85 or over and a similar percentage were cognitively impaired. Overall, more than 80% of elderly disabled people needed help on at least a daily basis. Over a third of people with limitations to daily activity living in private households were wholly or partly dependent on formal services for help. 63% of disabled elderly people used acute hospitals during the 2 year follow up, 43% as inpatients. 53% of those with cognitive impairment and limitations to daily activity were living in institutions. CONCLUSIONS: Very elderly people and those with cognitive impairment make up a large proportion of those in need of long term care. A large proportion of even the most disabled elderly people currently live outside institutions and depend on formal services as well as informal care givers. Disabled elderly people use acute hospitals extensively, underlining the interrelations between acute and long term care.

Activities of Daily Living↗
PubMed1997

Pulmonary ventilatory function decreases in proportion to increasing altitude.

The objective of this study was to examine how pulmonary ventilatory function, including response to bronchodilation, is related to altitude during high-altitude trekking. This cohort experiment consisted of multiple spirometric tests before and after bronchodilation in participants at baseline (1624 m) and at different altitudes (3404-4896 m) during a 2-week trek. The setting was in the Himalayas. Eleven men (ages 22-68 years) and eight women (ages 19-42 years) participated. Interventions were at altitudes of 1624 m to 5265 m; albuterol was administered via Rotahaler. Forced vital capacity (FVC) decreased by an average of 3.8% [95% confidence interval (CI) 1.6 to 6.0] per 1000-m altitude increment. Forced expiratory volume in 1 second (FEV1.0) decreased 3.7% (95% CI 1.9 to 5.5) per each 1000-m altitude increment. Maximal midexpiratory flow rate (FEF25-75%) decreased by 3.6% (95% CI 0.9 to 6.3) per each 1000-m altitude increment. Small, postalbuterol flow increases were present at baseline and at altitude. Ventilatory function returned quickly toward baseline upon descent. One trekker developed cough, dyspnea at rest, extreme weakness, rales, tachycardia, and oxygen desaturation to 71%. His ventilatory measurements did not differ significantly (p > 0.32) from the group means. We concluded that changes in some pulmonary ventilatory parameters (FVC, FEV1.0, and FEF25-75%) were proportional to the magnitude of altitude during a high-altitude trek. These were tolerated well and do not seem to relate to acute mountain sickness. A bronchodilator effect was not increased at altitude.

Adult↗
PubMed1990

Rate-adaptive cardiac pacing in children using a minute ventilation biosensor.

Chronotropic integrity is required for a normal cardiac output response to exercise. We evaluated a rate-adaptive ventricular demand pacemaker (Telectronics, META-MV) which uses minute ventilation as the sensed physiological variable for adjusting pacing rate, in seven young patients with a mean age of 11.4 years. All patients had clinically significant bradycardia related to complete heart block (n = 4) or sinus node dysfunction (n = 3). For the entire group, paced heart rates increased from 70 +/- 10 beats/min to 151 +/- 19 beats/min with exercise testing. The onset of rate adaptation took less than 30 seconds. Changes in paced rate were linearly related to workload, VO2 (5.9 to 20.7 mL/min/kg) and minute ventilation (8-65 L/min). The decline in pacing rate after exercise was related directly to the gradual decrease in minute ventilation and VO2. Our data show that minute ventilation closely and accurately reflects the metabolic demands of varying workloads in children and can be used to achieve physiological, rate-adaptive pacing.

Adult↗
PubMed1988

Bronchopulmonary dysplasia in the pediatric intensive care unit.

Bronchopulmonary dysplasia (BPD) is an important cause of chronic respiratory disease in infants and children. Infants with BPD are frequently readmitted to the hospital during the first 2 years of life usually because of infectious exacerbations of their chronic lung disease. This article is a review of the multisystem pathology of BPD and therapeutic approaches to the management of these infants in the PICU.

Bronchopulmonary Dysplasia↗
PubMed1976

Variations in electroencephalographic alpha activity under conditions of differential lighting and auditory feedback.

The electroencephalographic alpha activity of 13 college students was monitored under conditions of darkness or dim light for six sessions, and for a seventh under the opposite condition. Auditory feedback was given for the presence of alpha activity during a 5-min orientation period and when during ten 2-min trial periods. The results indicate that: (1) alpha production in the presence of feedback did not exceed initial eyes-closed base line production; (2) introducing feedback immediately enhances alpha activity, rather than increasing production gradually; (3) under certain circumstances, dim light is sufficient to suppress alpha; and (4) after many sessions of alpha production in darkness, subjects maintain a given amount of alpha even when visual stimulation is present.

Adult↗