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Biomedical subjects

C Edwards

Publications and source records attributed to C Edwards.

At least 19 recordsLinked to original sources
PubMed2006

Patterns of presentation and diagnosis of patients with Wegener's granulomatosis: ENT aspects.

DESIGN: a cross-sectional study. PARTICIPANTS: One hundred and ninety-nine patients with Wegener's granulomatosis belonging to a patient self-help group. MAIN OUTCOME MEASURES: Mode of initial presentation; diagnosis timescales and delay; rhinologic involvement; and treatment. RESULTS: Sixty-three per cent of patients initially presented with ENT-related symptoms. Ninety-two per cent faced a delay in their diagnosis of more than one month, a pattern which has not improved over the last few decades and which compares unfavourably with North American figures. Rhinologic and otologic symptoms are a common occurrence in up to 85 and 50 per cent of Wegener's granulomatosis patients, respectively, attracting varying degrees of targeted treatment. CONCLUSIONS: As sinonasal and other ENT symptoms are so common at the presentation of Wegener's granulomatosis, it is clear that the otolaryngologist has an important role in its diagnosis and treatment. There are long delays in the diagnosis and possible under-treatment of the ENT symptoms of this condition, highlighting the need for greater awareness, particularly in the ENT community.

Adolescent↗
PubMed2006

An assessment of renal failure in an SLE cohort with special reference to ethnicity, over a 25-year period.

OBJECTIVES: Although the prognosis for patients with renal lupus has improved, a small number still progress to renal failure. Studies from the USA have found it difficult to distinguish whether the higher rate of renal failure in African-Americans is due to genetic or socio-economic factors. Our aim was to identify ethnic and other factors in a UK lupus cohort that contribute to renal failure. METHODS: The University College London (UCL) Hospitals lupus cohort of 401 patients (Whites 64%, Blacks 19%), followed since 1978, has 127 patients with renal disease, of whom 21 have gone into renal failure. We determined the characteristics and possible causes of renal failure in this group. Black patients were disproportionately represented in the renal failure group (62% vs 19% for Whites). RESULTS: Those in the renal failure group had persistently low C3 compared with the renal disease cohort. A high proportion of patients in the renal failure group were felt to be non-adherent to treatment. CONCLUSIONS: Given that health-care for patients in the UK is free at the point of delivery, we postulate that in our cohort genetic factors rather than socio-economic status are likely to be more significant in causing renal failure. However, there may be cultural and other reasons for this, which requires further study.

Adolescent↗
PubMed2006

Family-based behavioural treatment of obesity: acceptability and effectiveness in the UK.

OBJECTIVE: To assess the acceptability and impact of family-based behavioural treatment (FBBT) for childhood obesity in a clinical setting in the UK. DESIGN: Pre- and post-treatment assessment for four consecutive treatment groups. SETTING: Treatment groups took place at Great Ormond Street Hospital, London. PATIENTS: Participants were 33 families with obese (BMI >or=98th centile for age and sex) children aged 8-13 years. INTERVENTION: FBBT was delivered over 12 sessions. MAIN OUTCOME MEASURES: Overweight (percentage BMI), self-esteem, mood and eating attitudes were assessed before and after treatment; overweight was re-assessed at 3-month follow-up for those who completed treatment. RESULTS: The FBBT programme materials translated easily to the UK setting and the programme was well-liked by participants. Twenty-seven out of 33 families (82%) completed the sessions. Children lost 8.4% BMI over the time of treatment, and this was maintained at 3-month follow-up. Self-esteem and depression improved significantly and there was no change in food pre-occupation, anorexia or bulimia on the ChEAT. CONCLUSIONS: These results establish that FBBT is feasible and acceptable in a clinical setting in Britain. They indicate that significant loss of overweight can be achieved using the programme without adverse psychological consequences.

Adolescent↗
PubMed2006

Depression in adolescent obesity: cultural moderators of the association between obesity and depressive symptoms.

OBJECTIVE: Community studies relating depression to obesity in adolescents have generated inconsistent results. It has been argued that the variability in findings is due to effect modification by demographic characteristics that vary across samples. The aim of this study was to test the hypothesis that the strength of the obesity-depression association is moderated by gender, ethnicity and socioeconomic status (SES). RESEARCH METHODS AND PROCEDURES: Data were from two large, school-based, studies of adolescent health and well-being (n=4320; n=1824). Students completed one of two measures of depressive symptoms (SDQ; CES-D) in school and were weighed and measured. Gender and ethnicity were self-reported and SES was indexed by residential neighbourhood characteristics or individual family deprivation. RESULTS: There was barely any association between obesity and depressive symptoms in either sample. There was also no evidence that obese participants who were female, white or from higher SES backgrounds were especially vulnerable to depressive symptoms. DISCUSSION: The results indicate that in community samples of adolescents, regardless of gender, SES or ethnicity, reports of depressive symptoms are not significantly higher in obese than normal-weight groups. The results are discussed in terms of obese adolescents' resilience in the face of multiple social adversities.

Adolescent↗
PubMed2006

General and rhinosinusitis-related quality of life in patients with Wegener's granulomatosis.

OBJECTIVES: The objectives of this cross-sectional study were to outline the pattern of sinonasal morbidity and determine its effects on the quality of life (QOL) of patients with Wegener's granulomatosis (WG). METHODS: The authors conducted a survey of 199 patients with WG, including two validated (QOL) instruments to assess general (SF-36) and rhinosinusitis-specific quality of life (Sinonasal Outcome Test [SNOT-22]). RESULTS: Patients with WG who have sinonasal involvement reported significantly lower general QOL scores than their unaffected counterparts (P = .000006-0.04) for all SF-36 subsets except for emotional role. WG-related sinonasal morbidity was comparable to the high levels previously demonstrated in the general rhinosinusitis population. A total of 38.2% of all patients with WG reported a nasal symptom as their most troublesome from a list of nasal and constitutional symptoms. Twenty-three percent of all patients with WG rated nasal crusting and 17% rated epistaxis as one of their top three most troublesome symptoms even in the setting of multisystem disease. The inclusion of crusting, bleeding, and nasal deformity in the SNOT scoring significantly increased average scores of patients with WG (P = .024, paired t test). CONCLUSIONS: Sinonasal involvement impacts significantly on the general QOL of patients with WG and is at least as significant as that of the general rhinosinusitis population. Nasal symptoms that are of particular relevance to this patient group include nasal crusting and epistaxis.

Adolescent↗
PubMed2006

Modulation of ultraviolet (UV) transmission by emollients: relevance to narrowband UVB phototherapy and psoralen plus UVA photochemotherapy.

BACKGROUND: Patients with psoriasis undergoing or about to undergo ultraviolet (UV) phototherapy and photochemotherapy often have thick scale on their plaques which can prevent the penetration of UV radiation. Emollients are used to moisturize the skin and to prevent or reduce some of the milder side-effects ('dryness', itching) sometimes experienced during UV therapy. However, emollients can alter the UV transmission of skin and thus may alter the clinical effects of phototherapy and photochemotherapy. OBJECTIVES: We tested 30 of the topical emollients in the British National Formulary (BNF) using a standard in vitro technique used to test sunscreens. We also surveyed U.K. phototherapy units to establish routine practice for emollient use in phototherapy and photochemotherapy. METHODS: We used a standard in vitro technique to measure the monochromatic protection factors (MPFs) of 30 non-bath emollients from the BNF. An application rate of 2 mg cm-2 was used. For the assessment of effects during narrowband UVB (TL-01) phototherapy, the mean of the protection factors at 310 and 315 nm was calculated; for psoralen plus UVA photochemotherapy the mean UVA protection factor was used. A questionnaire survey was used to assess routine practice concerning emollient use prior to phototherapies in phototherapy units throughout the U.K. RESULTS: In the UVA range, 17 of the 30 emollients gave protection factors of 1.2 or above. In the UVB range, 23 of 30 had an MPF of 1.2 or above. Yellow soft paraffin had the highest protection factor in the UVB range. Of 78 centres surveyed, 57 returned completed questionnaires (73%). Seventeen of 57 (30%) centres routinely used emollients immediately prior to administering phototherapy treatments. The remaining 40 of 57 (70%) did not. Forty-five (79%) responding centres recommended the use of emollients after phototherapy. CONCLUSIONS: This study has revealed considerable variability in the practice of emollient use before phototherapy treatments. Although the majority of centres included in this study did not routinely use emollients, almost one third did. Our in vitro measurement of 30 emollients revealed marked variation in UV transmission, with many emollients blocking sufficient UV to affect the response to therapy.

Drug Utilization↗
PubMed2006

Validation of a semiautomated method of minimal erythema dose testing for narrowband ultraviolet B phototherapy.

BACKGROUND: The most widely used method for establishing the minimal erythema dose (MED) before narrowband ultraviolet (UV) B phototherapy is time-consuming, inconvenient and may yield inconsistent results. OBJECTIVES: To assess the equivalence of MED assessment using a filtered xenon arc lamp UV source, a semiautomated MED tester, and a UV-opaque template method of MED determination with a panel of TL-01 311-nm UVB fluorescent tubes. Secondly, to gauge the current usage of MED testing, and the method used, in a large sample of U.K. phototherapy units. Thirdly, to assess variation in UV output of the semiautomated skin tester immediately after switching on to identify optimum warm-up time. Finally, to assess reproducibility of MED testing by assessing within-patient variability and interobserver variability of MED test results. METHODS: Sixty-five patients about to undergo UVB phototherapy had their MED determined using three different methods. Within each patient we compared the values of MED determined by a semiautomated Durham MED tester, a panel of narrowband UVB lamps with a UV-opaque template constructed by a phototherapist, and a 310-nm filtered xenon arc lamp with a liquid light guide. MED test results were assessed by clinical evaluation using a 6500 K colour temperature examination lamp. The output of the semiautomated MED tester was measured by spectroradiometer over a period of 20 min in order to identify the time to steady output. Reproducibility of MED testing with the semiautomated MED tester was carried out in 25 normal volunteers. All MEDs were assessed by at least two independent observers. A postal questionnaire was sent to 78 U.K. phototherapy units to assess routine practice concerning MED testing prior to narrowband UVB phototherapy. RESULTS: The semiautomated MED tester showed consistency with the panel method (r = 0.92, panel MED = -0.57 + 1.14 x Durham MED). The semiautomated MED tester produced a slightly lower MED result than the panel MED. Reproducibility tests showed high interobserver agreement (kappa value = 0.79), and high consistency for successive day testing (kappa value = 0.79). Questionnaires were returned from 67 of 78 phototherapy units (85%) and revealed that 19 units (28%) were routinely using MED testing prior to UVB therapy. CONCLUSIONS: This study has shown the Durham MED tester to be a convenient, valid and reproducible method for determining patient MED values prior to narrowband UVB phototherapy when used under carefully controlled lighting, by experienced observers.

Adolescent↗
PubMed2005

Parental perceptions of overweight in 3-5 y olds.

OBJECTIVE: To assess the accuracy of parents' perceptions of their 3 to 5 y old children's weight status in a large UK sample. METHOD: Parental perception and concern about child weight, demographic variables, and children's height and weight were obtained for 564 parent-child dyads. RESULTS: Only 1.9% of parents of overweight children and 17.1% of parents of obese children described their child as overweight. The odds of parents perceiving the child as overweight were increased for overweight (2.7; 95% CI 0.4, 16.5) and obese (28.5; 7.1, 115.4) compared with normal weight children, but were not associated with parental weight or with any demographic factors. Although few parents perceived their overweight children as overweight, more (66.2%) expressed concern about their overweight child becoming overweight in the future. Odds of concern were progressively higher for overweight (2.5; 1.6, 3.9) and obese children (4.6; 2.2, 9.7), and were also higher for parents who were themselves overweight (1.9; 1.2, 2.9) or obese (2.5; 1.3, 4.8). CONCLUSION: These findings suggest that parents of 3-5 y olds show poor awareness of their child's current weight status. Reframing discussions in terms of preventing future overweight may be an effective way to engage parents.

Body Height↗
PubMed2005

Survey of Salmonella and Campylobacter contamination of whole, raw poultry on retail sale in Wales in 2003.

A survey of the Salmonella and Campylobacter contamination of raw, whole chickens available to consumers in Wales was performed between March and December 2003. In total, 736 samples were taken, and overall contamination rates of 73.1% for Campylobacter and 5.7% for Salmonella were found. This survey follows a survey performed during 2001 to 2002 by Welsh local authorities and the National Public Health Service for Wales that established updated baseline rates for both pathogens in raw, whole chicken available to consumers in Wales. This survey indicated no difference in Campylobacter rates between fresh and frozen samples or between samples taken from retailers and local butchers, but significant differences existed in Salmonella rates between fresh and frozen samples and between those sampled from retailers and butchers, with frozen chickens and samples taken from retailers having significantly higher rates. However, the difference in Salmonella isolation rate between retailers and butchers was found to be due to the differences in the proportions of fresh and frozen chickens sampled from these locations, with a significantly higher number of frozen chickens (with a higher Salmonella rate) being sampled from retailers.

Animals↗
PubMed2005

Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma-related cellulitis.

Seroma formation has been documented as a common complication in laparoscopic ventral herniorraphy. However, there are no recent studies documenting the incidence of or protective strategies against seroma-related cellulitis. The purpose of this study was to evaluate 65 laparoscopic ventral herniorraphies and to determine if seroma-related cellulitis can be prevented by the routine use of postoperative prophylactic antibiotics. A retrospective case review of 65 laparoscopic ventral herniorraphies was done at our institution from February 2002 to January 2004. All were performed using either Gore-Tex DualMesh or Bard Composix mesh and performed under the direct supervision of a single surgeon. Twenty patients received only preoperative third-generation cephalosporins or fluoroquinolones. All other patients received either 7 days of postoperative oral cephalosporins or fluoroquinolones in addition to preoperative antibiotics. Sixty-five patients underwent laparoscopic ventral hernia repair. There were 45 patients in the postoperative antibiotic group and 20 patients in the preoperative-only antibiotic group. Twenty-one patients developed seromas. Twelve of these developed cellulitis. The rates of seroma formation were similar in the two groups with 30 per cent in the preoperative only group and 33 per cent in the postoperative antibiotic group. However, 100 per cent of the seromas in the preoperative antibiotic group developed seroma-related cellulitis. Only 40 per cent of seromas in the postoperative antibiotic group developed cellulitis. In addition, two seromas in the preoperative antibiotics-only group progressed to frank mesh infection necessitating operative removal. There were no complications related to antibiotic administration. Laparoscopic ventral hernia repair is a safe and effective procedure. Our seroma rate is 30 per cent and compares equally with prior reported studies. Seroma-related cellulitis is a common problem that can lead to mesh infection, postoperative morbidity, and further need for operative care. The administration of 7 days of postoperative prophylactic antibiotics appears to be a safe and effective means to limit seroma-related cellulitis.

Antibiotic Prophylaxis↗
PubMed2004

An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report.

Summary These guidelines for use of narrowband (TL-01) ultraviolet B have been prepared for dermatologists by the British Photodermatology Group on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment of patients with a variety of dermatoses and photodermatoses, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of background photobiology.

Combined Modality Therapy↗
PubMed2004

The molecular diversity of the methanogenic community in a hypereutrophic freshwater lake determined by PCR-RFLP.

AIMS: To combine database-held sequence information with a programme of experimental molecular ecology to define the methanogenic community of a hypereutrophic lake by a PCR-restriction fragment length polymorphism (RFLP) analysis. METHODS AND RESULTS: Methanogen diversity in a hypereutrophic freshwater lake was analysed using 16S rDNA PCR-RFLP. Database-held 16S rRNA gene sequences for 76 diverse methanogens were analysed for specific restriction sites that permitted unequivocal differentiation of methanogens. Restriction digestion and agarose gel electrophoresis of the 16S rDNA from selected methanogen pure cultures generated observed restriction profiles that corroborated the expected patterns. This method was then tested by analysing methanogen diversity in samples obtained over 1 year from sediment and water samples taken from the same sampling site. CONCLUSIONS: Restriction analysis of the 16S rRNA gene sequences from 157 methanogen clones generated from lakewater and sediment samples showed that over 50% were similar to Methanoculleus spp. Furthermore, a total of 16 RFLP types (1-16) were identified, eight of which contained no cultured representative archaeal 16S rRNA gene sequences. SIGNIFICANCE AND IMPACT OF THE STUDY: This RFLP strategy provides a robust and reliable means to rapidly identify methanogens in the environment.

DNA, Bacterial↗
PubMed2004

Baseline rates of Campylobacter and Salmonella in raw chicken in Wales, United Kingdom, in 2002.

The Public Health Laboratory Service in Wales, in cooperation with local authorities and the Food Standards Agency Wales, carried out a survey to establish baseline figures for the contamination of raw retail chicken with Salmonella and Campylobacter available within Wales, a devolved part of the United Kingdom with a population of approximately 3 million. Seven hundred thirty-nine samples were obtained between November 2001 and December 2002. Overall, 71% of samples were contaminated with Campylobacter, and 8% were contaminated with Salmonella. There were no significant differences between fresh and frozen carcasses and between samples taken from retailers or butchers. There was seasonal variation in the level of Campylobacter contamination of fresh chicken, with a peak in June and the lowest positive rates in January, March, and December. There was no similar peak observed in frozen samples or for Salmonella.

Animals↗
PubMed2003

Effects of levodopa on motor sequence learning in Parkinson's disease.

BACKGROUND: Dopaminergic therapy with levodopa improves motor function in PD patients, but the effects of levodopa on cognition in PD remain uncertain. OBJECTIVE: To use H(2)(15)O and PET to assess the effect of levodopa infusion on motor sequence learning in PD. METHODS: Seven right-handed PD patients were scanned "on" and "off" levodopa while performing a sequence learning task. The changes in learning performance and regional brain activation that occurred during this intervention were assessed. RESULTS: During PET imaging, levodopa infusion reduced learning performance as measured by subject report (p < 0.05). This behavioral change was accompanied by enhanced activation during treatment in the right premotor cortex and a decline in the ipsilateral occipital association area (p < 0.01). Levodopa-induced changes in learning-related activation responses in the occipital association cortex correlated with changes in learning indexes (p < 0.01). CONCLUSIONS: Levodopa treatment appears to have subtle detrimental effects on cognitive function in nondemented PD patients. These effects may be mediated through an impairment in brain activation in occipital association cortex.

Aged↗