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Biomedical subjects

C Jagger

Publications and source records attributed to C Jagger.

At least 55 records · Page 3Linked to original sources
PubMed1998

Mental health expectancy--the European perspective: a synopsis of results presented at the Conference of the European Network for the Calculation of Health Expectancies (Euro-REVES). Medical Research Council Cognitive Function and Ageing Study Group.

The increase in life expectancy observed over the last decade has particular relevance for mental health conditions of old age, such as dementia. Although mental disorders have been estimated to be responsible for 60% of all disabilities, until recently population health indicators such as health expectancies have concentrated on calculating disability-free life expectancy based on physical functioning. In 1994, a European Network for the Calculation of Health Expectancies (Euro-REVES) was established, one of its aims being the development and promotion of mental health expectancies. Such indicators may have an important role in monitoring future changes in the mental health of populations and predicting service needs. This article summarizes the proceedings and recommendations of the first European Conference on Mental Health Expectancy.

Aged↗
PubMed1997

Residential care for elderly people: the prevalence of cognitive impairment and behavioural problems.

AIMS: to investigate the prevalence of and interrelationship between cognitive impairment and behavioural problems in older people in residential care. SUBJECTS: all those aged 65 years and over resident on one night in any type of residential care within the Leicestershire District Health Authority. METHODS: an assessment form for each resident was completed by care staff. The assessment included demographic information and functioning (both mental and physical) during the previous week. Cognitive impairment was measured by the confusion sub-scale of the Crichton Royal Behavioural Rating Scale. RESULTS: 6079 people were enumerated in 241 establishments, including hospitals, homes and hostels provided by the National Health Service (NHS), local authority social services and private and voluntary agencies. Thirty-eight percent (2219) were moderately or severely cognitively impaired and behavioural problems were present in 11.5%, most being associated with the presence of cognitive impairment. Compared with elderly people in private residential homes, residents in local authority (part III) homes had significantly higher odds of demonstrating offensive behaviour of 1.40 (95% confidence interval 1.11-1.78) after adjustment for age, sex and cognitive impairment. No significant association between number of patients in the home and the proportion exhibiting offensive behaviour was found in any of the non-NHS facilities. CONCLUSIONS: this survey of old people in institutional care found that most of those with behavioural problems were cognitively impaired. This has implications for staff training in the management of behavioural problems in demented people.

Aged↗
PubMed1997

Pregnancy nausea related to women's obstetric and personal histories.

We report the correlation between total hours of nausea in early pregnancy, as a continuous variable, and various factors in women's obstetric and personal histories. Positive correlations for increased nausea were found with heavier placentae (p = 0.005), non-smoking status (p = 0.004), women with nausea in previous pregnancies (p = 0.005), and women whose mothers experienced trouble with nausea in their pregnancies (p = 0.001). 17 other factors did not relate to pregnancy nausea at the p < 0.01 level.

Female↗
PubMed1997

The Mini-Mental State Examination (MMSE) in an elderly immigrant Gujarati population in the United Kingdom.

OBJECTIVE: The principal aim of this pilot study was to evaluate the performance of a Gujarati version of the MMSE as a screening instrument for dementia. The effect of ethnicity on MMSE performance was also examined. DESIGN: Two-stage cross-cultural survey. SETTING: Elderly immigrant Gujarati and British-born white communities in Leicester. SUBJECTS: First stage: 149 Gujaratis and 148 whites. Second stage: 27 Gujaratis and 42 whites. MEASURES: English and Gujarati versions of the MMSE, validated against clinical diagnosis following psychiatric interview (ICD-10 criteria). RESULTS: Mean MMSE scores were lower in the Gujarati group, but most of this difference was due to the effects of age, education and visual impairment. Ethnic group had an independent effect on three orientation items; when these were omitted, there was no difference in the mean MMSE scores of the groups after adjustment for age, education and visual impairment. The MMSE performed comparably in both groups as a screen for moderate-severe dementia, but was less efficient at detecting milder and less certain cases in the Gujarati group. The estimated prevalence of confirmed dementia was higher in the Gujarati group, but this was not statistically significant. CONCLUSIONS: This Gujarati version of the MMSE performed adequately as a screen for dementia in this immigrant community population. Further evaluation of its performance is required in larger community samples, clinical samples and in native Indian Gujaratis.

Aged↗
PubMed1996

Selection criteria for preoperative endoscopic retrograde cholangiopancreatography in the laparoscopic era.

BACKGROUND: Indicators for cholangiography were originally designed to select patients at risk for common bile duct (CBD) stones for intraoperative cholangiography. OBJECTIVE: To refine these criteria to apply to the much more invasive procedure of preoperative endoscopic retrograde cholangiopancreatography (ERCP). DESIGN: Retrospective review of selection criteria for ERCP in consecutive patients referred over 18 months following the introduction of laparoscopic cholecystectomy. SETTING: Two ERCP units in adjacent teaching hospitals. PATIENTS: Three hundred seventeen patients with gallstones and in situ gallbladders. INTERVENTION: Common bile duct imaging at ERCP. MAIN OUTCOME MEASURES: Abnormalities justifying ERCP. RESULTS: Abnormalities justifying ERCP were found in 66% of patients. This group differed significantly from those with normal ducts, with more being referred with abnormal results of all liver function tests (P < .001), jaundice (P < = .001), a dilated CBD on ultrasound (P < .001), or CBD stones on ultrasound (P < .001). On the other hand, patients with normal ducts were significantly more likely to have been referred with pancreatitis (P = .003) or elevated results of individual liver function tests (P < .001). A logistic regression model using age, presence of jaundice at ERCP, levels of alkaline phosphatase and albumin, and ultrasonography showing dilated ducts or visible CBD stones was found to have a specificity of 75% and a sensitivity of 89%. Past pancreatitis or elevated results of individual liver function tests were not predictive factors. CONCLUSION: The use of such a model rather than individual criteria would improve the selection of patients for preoperative ERCP, optimizing its role in the laparoscopic era.

Adult↗
PubMed1996

Annual visits to patients over the age of 75--who is missed?

BACKGROUND: In the UK, the GP contract requires annual consultations and offers of home visits to the elderly. However, as many as 50% of elderly people refuse the offer of a health screen. OBJECTIVE: To describe the characteristics of elderly people who declined the offer of an annual home visit. METHOD: All elderly people aged 75 years and over, registered with a general practice of 13 full time and 3 part time doctors with a list size of 33,000 people, were offered a home visit. Data from this prospective cohort were linked with data from a community survey two years previously, which had achieved a 95% response rate. The main outcome measures were perceived health status, perceived loneliness, morale score, physical and mental disability, use of primary care and social services. RESULTS: Thirty-six percent of all elderly people registered with the practice declined to take up the offer of a home visit. Those refusing a visit had not recently joined the practice and had very similar distributions of all demographic and most health and wellbeing characteristics to those who took up the offer. However, those declining appeared to have higher levels of morale (P = 0.010) and less contact with the general practitioner (P = 0.021) including an average of three weeks longer since last consultation with their general practitioner than those accepting the visit. CONCLUSIONS: There appears little evidence in this population that elderly people who decline a home visit are necessarily part of an 'iceberg' of unmet need.

Activities of Daily Living↗
PubMed1996

Patients' knowledge of anatomical location of major organs within the human body: a comparison between Asians and non-Asians.

OBJECTIVE: This study was designed to ascertain lay knowledge of the anatomical location of major organs within the human body amongst the Asian and non-Asian population in Leicester and to explore the relationships of this knowledge to level of education and social class. METHOD: The study was based on a cross sectional random sample stratified by from the FHSA Nominal Index Register and data was collected using a personally administered questionnaire in the preferred language of the respondent. Subjects marked the position of the major organs (heart, lungs, kidneys, bladder, liver, brain and stomach) on an image of the human body. The answers were judged against a correct 'response area' produced from a survey of 20 GPs. RESULTS: The overall response rate to the survey was 88.5% with 449 Asians and 447 non-Asians participating. After adjustment for age, sex, education and social class differences, non-Asians were significantly more likely to correctly identify the position of the lungs (P = 0.01) and less likely than Asians to correctly identify the position of the stomach (P < 0.0001). There were no differences found in the knowledge of the position of the other organs. Higher educational attainment was significantly associated with the ability to locate the kidneys (P = 0.0052) and the liver P = 0.0001) and higher social class was associated with greater ability to locate the position of the lungs P = 0.01). CONCLUSIONS: Patients show considerable lack of knowledge of the position of major organs within the body. Health professionals will need to address this before embarking upon health promotion.

Adolescent↗
PubMed1996

Physical function and perceived health: cohort differences and interrelationships in older people.

Differences between seven-year birth cohorts in physical functioning (as measured by independence in activities of daily living) are compared with corresponding inter-cohort differences in perceived health, in people aged 75 years and over. Age-period-cohort models were fitted to two linked cross-sectional surveys undertaken in 1981 (N = 1,203) and 1988 (N = 1,579). The proportion of older people who were dependent in ADLs was lower in succeeding cohorts but, by contrast, the proportion with less than good self-perceived health was higher. These inter-cohort differences in perceived health were particularly marked for the comparison between 1981 and 1988 of men aged 75-81 years in the dependent subpopulation. Furthermore, self-perceived health remained as strong a predictor of mortality in 1988 as in 1981. Self-perceived health may be indexing a higher prevalence of mild chronic conditions in newer cohorts of older people, with implications for primary health care providers.

Activities of Daily Living↗
PubMed1996

Lipid screening in an elderly population: difficulty in interpretation and in detection of occult metabolic disease.

AIMS: To determine lipid profiles and associations with other metabolic disease in a representative British elderly population. METHODS: Part of a prevalence survey of dementia in all 75+ year olds conducted from the large general practice serving the town and surrounding area of Melton Mowbray, Leicestershire (the M-old study). Patients (n = 224) aged from 75 to 98 years, and representative of the overall population, also provided pre-prandial blood samples on which various age and nutrition related analytes were determined. These included documented medical history, thyroid stimulating hormone (TSH), glucose, immunoglobulins, and lipid profile in plasma. RESULTS: Cholesterol and lipid variables showed wide scatter, with some negative trends but no significant associations with age for total cholesterol, high density lipoprotein (HDL) cholesterol, the ratio of total to HDL cholesterol or triglycerides. Women had significantly higher concentrations of total and HDL cholesterol at all ages. Serum TSH was above 6.0 mU/1 in 10/205 patients, random glucose was above 11.2 mmol/l in nine of 207 patients, borderline dysglobulinaemia was present in four of 210 patients, all without correlation with cholesterol concentrations. CONCLUSION: This British data is consistent with an inverse correlation between survival and cholesterol, but wide scatter restricts reliance on single result lipid data in individual patient management. Random lipid screening is also unhelpful, inefficient and without added value in revealing other age related and unrecognised occult metabolic disease.

Aged↗
PubMed1996

Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomised prospective study.

We performed a randomised prospective trial to compare a cemented unipolar prosthesis (Thompson) with a cemented bipolar prosthesis (Monk) in the treatment of displaced intracapsular fractures of the hip in patients over 80 years of age. Patients with a mental test score of less than 5/13 were excluded but the mortality was still about 30% at one year in both groups. We therefore feel that subjective criteria such as the level of pain and the return to the preinjury state are of paramount importance. Two years after operation there was no statistical difference between the rate of complications in the two groups. After adjusting for confounding factors such as differences in the level of function before injury between the groups, the degree of return to the preinjury state was significantly greater (p = 0.04) when using the unipolar prosthesis, which is one-quarter of the price of the bipolar. We cannot therefore justify the use of an expensive bipolar prosthesis in patients over 80 years of age.

Activities of Daily Living↗
PubMed1996

Views of Asians and non-Asians on sources of drug information and the desirability for medication to be made available over the counter.

Differences do exist between Asians and non-Asians on the range of products they feel should be available over the counter (OTC) and the amount of information they wish to receive. This should be taken into account when considering proposals for changes in the legal status of prescription-only medicines. The profile of the pharmacist as a provider of drug information to patients could be raised in both groups.

Asia↗
PubMed1995

Vascular emergencies: what's in season?

Seasonality in ischaemic coronary artery disease is well documented with a winter/summer variation the commonest pattern. The influence of seasonal variation on events in other vascular territories is less well documented. The incidence of ruptured abdominal aortic aneurysm and emergency lower-limb ischaemia was analysed on a monthly basis over a 5-year period. A total of 372 ruptured abdominal aortic aneurysms occurred with a peak incidence in spring and autumn; however, no seasonal pattern was seen in the rate of emergency admissions with lower-limb ischaemia (n = 606). The explanation for this seasonal pattern in ruptured aneurysms is unknown. The haemodynamic adjustments to changes in climate require further study.

Aortic Aneurysm, Abdominal↗
PubMed1995

Predictors of survival with Alzheimer's disease: a community-based study.

Factors associated with reduced survival were investigated in elderly people diagnosed as having Alzheimer's disease (AD) and in those free of dementia at diagnosis. The study population comprised 155 people free of dementia and 222 with AD; all were aged 75 years and over and were part of a two-stage prevalence study of dementia during 1988 in Melton Mowbray, Leicestershire. An increased risk of death was found for those with a history of heavy alcohol use, lower cognitive function, a history of heart failure and those in institutional care, these factors acting in the same manner for persons free of dementia and those with AD. For the non-demented group a greater risk of death was found with increasing age and for those with a history of cancer. A greater risk of death was found for males with AD compared to females with the risk increasing over time. The longer survival of women over men may explain the sex differences found in the prevalence of AD without accompanying differences in incidence.

Activities of Daily Living↗
PubMed1995

Diabetes and cognitive impairment: a community-based study of elderly subjects.

To ascertain whether diabetes in elderly people is associated with cognitive impairment, we offered all residents of Melton Mowbray aged 75, 80 and 85 years both a modified glucose tolerance test (1985 WHO criteria) and Folstein mental state examination (MMSE, 23/24 cut-off). Analysis of the results, stratified by age, revealed that subjects with known diabetes were more likely than normal subjects to have low MMSE [odds ratio 3.30 (95% CI 1.3 to 8.5)], whilst newly found diabetic subjects were less likely to have low MMSE [odds ratio 5(-14) (95% CI 9(-25) to 0.003)]. The difference between known and newly found diabetic subjects might relate to duration of diabetes. The increased frequency of cognitive impairment in known diabetic subjects may be pertinent to the safe use of hypoglycaemic agents.

Aged↗
PubMed1995

Parents' views of health surveillance.

The aim of the study was to discover the views of parents about the 1991 Leicestershire child health surveillance programme, its organisation, and content. The study design was a postal questionnaire survey to parents of a sample of children eligible for the new surveillance programme. One thousand parents received questionnaires, of which 66% (660) were returned. Poor access for prams and wheelchairs (595 responses) and inadequate general cleanliness (249 responses) caused most criticism of clinic premises. The experiences of parents from ethnic minorities were significantly worse for some professional consultation factors, but they received significantly more health advice than other parents. Parents lacked sufficient information about the surveillance programme and their most frequent reasons for non-attendance were time related factors. Minimum standards for child health surveillance premises are required. At present, many fail to reach adequate standards of privacy and accessibility. Schemes to ensure an equal partnership in child health surveillance between parents and professionals are essential.

Asia↗