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Biomedical subjects

C Harland

Publications and source records attributed to C Harland.

10 recordsLinked to original sources
PubMed2000

Evaluation of primary prevention initiatives for skin cancer: a review from a UK perspective.

To ensure effective primary prevention of skin cancer, aimed at changing behaviour in the sun, and ultimately at reducing the incidence and mortality rates from skin cancer, sufficient information needs to be known about the relationship between sun exposure and skin cancer, the effectiveness of sun protection measures, and the acceptability and uptake of protective measures by the general public. This review specifically addresses the quality and outcome of studies designed to evaluate the impact of primary prevention initiatives in the U.K. Four main areas of concern are highlighted: (i) teenage behaviour in the sun is difficult to change; (ii) fashion, in part, dictates adult and adolescent behaviour in the sun; (iii) there are practical problems related to response rates, follow-up and interpretation of self-reported behaviour; and (iv) a strategy for primary prevention in the U.K. may be falsely based on the experience and results of Australian and American programmes. Standardized methods for monitoring general population behaviour are needed in the U.K. Evaluation of interventions targeting specific groups, especially parents and young children, and the relative costs of different strategies should be reported. Primary prevention messages and strategies should be adapted to the type of ultraviolet radiation exposure experienced, and the overall low risk of melanoma, while addressing controversies on the health effects of sun exposure and sun screens.

Adolescent↗
PubMed2000

Feasibility of targeted early detection for melanoma: a population-based screening study.

The feasibility of targeted screening for cutaneous malignant melanoma in the UK using a postal questionnaire and invitation to screening by a consultant dermatologist was investigated in a population based cross-sectional survey. A total of 1600 people aged 25-69 years, stratified by the social deprivation score of wards within one general practice, were randomly selected from a population of 8000.1227 (77%) returned the questionnaire and 896 (56%) attended the screening clinic. Uptake was lower for men (P<0.001), those aged under 50 (P<0.001), people from deprived areas (P<0.001) and skin types III and IV (men only, P<0.001). Twenty per cent of women and 10% of men felt nervous about attending the clinic, but only 4% were worried by the questionnaire. The level of agreement between the self- and dermatologist's assessments of risk factors was best for hair colour (Kappa = 0.67, sensitivity 73% and specificity 98%). People tended to under-report their level of risk. Over 95% knew about at least one major sign, but 54% reported incorrect signs of melanoma. Targeted screening for melanoma in the UK will be hampered by difficulties in accurately identifying the target population. Strategies to improve skin self-awareness rather than screening should be developed and evaluated.

Adult↗
PubMed2000

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening.

OBJECTIVES: To study the feasibility of developing targeted screening for those at high risk of melanoma by examining how attitudes relate to (a) acceptance of an invitation for a free skin check and (b) self assessed and clinically assessed risk factors for developing cutaneous melanoma. DESIGN: A population based cross sectional survey. SETTING: A general practice with a broad mix of socioeconomic groups in one district health authority. SUBJECTS: A total of 1600 subjects aged 25-69 years stratified using the social deprivation score of wards were randomly selected from a population of 8000; 77% (1227) returned the questionnaire and 56% (896) attended for screening. MAIN OUTCOME MEASURES: Questionnaire measures of confidence in own ability to self assess risk factors for melanoma, attitudes to seeking medical help for skin abnormalities, and self assessment of relative risk of developing melanoma. RESULTS: Clinic attenders were less confident in their ability to self assess risk factors (p<0.005), more favourable towards seeking help (p<0.001), and more pessimistic about developing melanoma (p<0.001) than non-attenders. Those from more affluent wards were more willing to seek help (p<0.001). Those clinically assessed as at higher risk were more pessimistic about developing melanoma (p<0.001) but clinical assessments were inconsistently related to help seeking attitudes and self assessment confidence. CONCLUSIONS: Barriers to the uptake of screening included greater optimism about not developing melanoma, confidence in self assessment, and reluctance to seek professional help. Such reluctance was greater in more deprived social groups. Targeting screening at high risk groups cannot depend on self identification and self referral.

Attitude to Health↗
PubMed1989

Serum neopterin patients with X-linked and acquired 'common variable' hypogammaglobulinaemia.

Serum neopterin was measured in patients with acquired 'common variable' hypogammaglobulinaemia (CVH), X-linked agammaglobulinaemia (XLA) and healthy subjects. There was a highly significant increase in neopterin levels in the CVH patients as compared with that of the other groups, particularly in those CVH patients with non-A non-B or granulomatous hepatitis. There was no association between raised neopterin levels and chronic infective lung disease. Since chronic viral infections are associated with raised serum neopterin, this data add some support to a viral aetiology for CVH.

Adolescent↗
PubMed1988

Dipeptidyl peptidase IV--subcellular localization, activity and kinetics in lymphocytes from control subjects, immunodeficient patients and cord blood.

Dipeptidyl peptidase IV (DPIV), a T cell enzyme, has been implicated in the regulation of lymphocyte proliferation in response to lectins and allogeneic cells. A sensitive fluorimetric assay has been established for the enzyme and used to investigate DPIV activity, kinetics and the subcellular localization in lymphocytes from control subjects, cord blood and patients with common variable hypogammaglobulinaemia (CVH) and chronic lymphatic leukaemia (CLL). Using sucrose density gradient centrifugation and organelle marker enzyme assays, in conjunction with digitonin as a selective plasma membrane perturbant and diazotized sulphanilic acid as a non-permeant enzyme inhibitor, DPIV was shown to be a plasma membrane ecto-enzyme. A significant decrease in lymphocyte DPIV activity was observed in cord blood and in patients with CVH and CLL compared to controls. Kinetic analysis showed a marked decrease in the Vmax of lymphocyte DPIV from cord blood and patients with CVH and CLL compared to controls. The apparent Km for the substrate was unaffected in cord blood and patients with CLL. However, in patients with CVH the Km was significantly reduced. Various enzyme inhibitors showed no differences between control subjects and CVH lymphocyte activities. The decreased Km for DPIV provides further evidence for a stem cell defect rather than cell immaturity in CVH.

Agammaglobulinemia↗
PubMed1985

Type 1 free perforation of the gallbladder.

A series of 4 cases of free perforation of the gallbladder into the peritoneal cavity associated with peritonitis are reported. Two were diagnosed at laparotomy and 2 at post-mortem. The 3 patients who died were men who were either elderly or had serous concomitant diseases, including diabetes, atherosclerosis or alcoholism. The sole survivor was a fit young woman.

Adult↗