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Biomedical subjects

C Jagger

Publications and source records attributed to C Jagger.

At least 91 records · Page 5Linked to original sources
PubMed1992

Dementia in Melton Mowbray--a validation of earlier findings.

In 1981 a survey of elderly persons aged 75 years and over who belonged to a general practice in Melton Mowbray, Leicestershire found a prevalence of moderate cognitive impairment of 4.7%. The criterion which determined the impairment was a score of 7 or under on the CAPE Information/Orientation (IO) sub-test. The prevalence rate has been considered to be much lower than in some key studies, notably the 13% reported in 1970 from Newcastle upon Tyne. Although rates based on cognitive scales are likely to give different results from those based on diagnostic assessment, the suggestion is that the IO sub-test is an insensitive screening instrument for dementia. Using results on the sensitivity and specificity of the CAPE IO sub-test (cut-point 8/9) to detect moderate or severe dementia as defined by clinical diagnosis using the Cambridge Mental Disorders of the Elderly (CAMDEX) schedule, the adjusted prevalence rates of moderate or severe dementia were found to be 3.4% in 1981 and 5.2% in 1988. Both these figures were lower than the observed rates scoring 8 or under on the IO sub-test, confirming that insensitivity of the IO sub-test was not the reason for the supposed low rate in Melton Mowbray in 1981. As the prevalence of dementia in those aged 75 years and over has been reported by other studies to range from 3% to 24%, it is more likely that high rates are due to screening instruments with low specificity.

Aged↗
PubMed1992

Misclassification of dementia by the mini-mental state examination--are education and social class the only factors?

The 1988 Melton Mowbray Study of the Elderly comprised an initial screen with the Mini-Mental State Examination (MMSE) followed by a detailed clinical assessment using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) for all those scoring 21 and under on the MMSE, a one in two sample of those scoring 22 or 23 and a one in ten of the remainder. A total of 1579 subjects completed the initial screen with 438 subjects undergoing the CAMDEX assessment. Analysis of those subjects who were found to be free of dementia at the clinical assessment (n = 155) demonstrated that the very elderly, those from the manual social classes and subjects with visual impairments had an increased chance of being misclassified as demented by the MMSE. Low educational level and various measures of physical disability also showed a tendency to result in misclassification as falsely positive by the MMSE when viewed alone but these effects appeared to be due solely to their association with extreme age and/or manual social class.

Activities of Daily Living↗
PubMed1992

Modification of the circadian rhythm of onset of acute myocardial infarction by long-term antianginal treatment.

OBJECTIVE: To elucidate the mechanism of the circadian pattern of onset of acute myocardial infarction by examining the effects of prior antianginal treatment upon it. DESIGN: Retrospective analysis of clock time of the onset of acute myocardial infarction by linear modelling to define the circadian distribution of hourly onset rates and to examine the deviation of treated groups of patients from this distribution. SETTING: Coronary care unit in a general hospital taking unselected acute admissions from a district of 0.9 million people. PATIENTS: A series of 2231 patients with confirmed acute myocardial infarction. RESULTS: A major 24 h cycle and smaller 12 h and 6 h cycles were present in patients not taking antianginal medication. Onset rates varied twofold over the day, with maxima around 10.00 am and 10.00 pm. This pattern was unchanged in patients on prior treatment with regular nitrates, but in those who had been taking a beta blocker or a calcium antagonist the 24 h cycle was absent. CONCLUSIONS: These results are best explained by the shared property of beta blockers and calcium antagonists to reduce blood pressure and myocardial oxygen demand. The mid-morning peak of the onset of myocardial infarction is attributable to the physiological increase in sympathetic drive and cardiac work at that time. The data are not consistent with the triggering of the 24 h periodicity by fluctuations in coronary tone or haemostatic activity.

Adrenergic beta-Antagonists↗
PubMed1992

ICAM-1 expression in renal disease.

AIM: To determine the role of intercellular adhesion molecule-1 (ICAM-1) in immune mediated damage in glomerulonephritis, and whether its expression correlates with disease activity. METHODS: Fifty three renal biopsy specimens from a range of non-immune renal disease and low grade and high grade glomerulonephritides were stained with ICAM-1. Positivity was assessed in the tubules. Tubular damage and accompanying interstitial inflammation were also noted. The ICAM-1 positivity in damaged and undamaged tubules was correlated with the three groups of renal disease. RESULTS: ICAM-1 positivity in undamaged tubules was observed in glomerulonephritis, and this showed a strong correlation with disease activity. In contrast, ICAM-1 positivity on damaged tubules correlated with evidence of chronic tubular damage, and was seen in a large proportion of cases, regardless of the underlying disease. There was no correlation between ICAM-1 positivity and a local lymphocytic infiltrate. CONCLUSION: ICAM-1 probably has an important role in the pathogenesis of glomerulonephritis. Its expression may be secondary to cytokines released by cells participating in the glomerular damage. As these cytokines also influence tubule function, tubular ICAM-1 expression may be a marker of the extent of tubular disturbance in glomerulonephritis.

Cell Adhesion Molecules↗
PubMed1992

Oncogene expression in primary myelodysplasia: correlation with haematological, karyotypic, and clinical progression.

AIMS: To see if the relative expressions of proto-oncogenes that are increased in acute myeloid leukaemia are raised in patients with myelodysplastic syndromes (MDS), and to see if they increase with progression to leukaemia. To note if there is a correlation between morphology, karyotype, and these proto-oncogene expressions and if any one proto-oncogene can predict prognosis. METHOD: Bone marrow from 130 patients was analysed at six monthly intervals over two years for relative mRNA expression of seven oncogenes, karyotype, and morphology. The technique used slot blot hybridisation and densitometric analysis. The results were compared with 14 surgical controls and 30 people with vitamin deficiency anaemia. RESULTS: Six of seven oncogenes showed increased expression which progressed with time, but did not correlate with morphological or karyotypic changes. Expression of four of the seven oncogenes was increased in megaloblastic and iron deficiency anaemia. C-mos showed differences among the five morphological subgroups; it correlated with abnormal location (p = 0.025) and seemed to influence prognosis. CONCLUSION: Increased proto-oncogenes reflect the overall marrow perturbation in MDS. C-mos may reflect persistence of monocyte pathway which confirms marrow stability.

Aged↗
PubMed1992

Incidence of dementia in Melton Mowbray: a proposed study and its problems.

This paper describes a proposed study to investigate the incidence of dementia in a population of over 75 year olds in Melton Mowbray, Leicestershire, England. The study population (n = 438) underwent a detailed psychiatric assessment using the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) as the second stage of a survey of the physical and mental health of the elderly begun in 1988. The CAMDEX assessment and the initial screening interview included information on the majority of potential risk factors for Alzheimer's disease and vascular dementias. Together with measures of incidence and risk factors, the proposed study aims to assess the effect of the decline in mental function of the elderly, on carers, family and health services and to suggest where improvements in planning and delivery of services might be made. A number of problems arise, particularly relevant for studies of the elderly, due to the frequent follow-ups necessary for incidence studies and these are discussed.

Aged↗
PubMed1992

Attitudes to and perceived use of health care services among Asian and non-Asian patients in Leicester.

A random sample of 449 Asian patients and 447 non-Asian patients were interviewed at home in their preferred language using a personally administered questionnaire comparing attitudes to and perceived use of health care services in Leicester. The overall response rate was 89.6%. There were differences in the responses of the Asian and non-Asian populations. With respect to communication, language as a barrier appears to be a diminishing problem among Asian patients in Leicester. However, Asian patients reported finding it more difficult to gain access to their general practitioners than non-Asian patients. More Asian than non-Asian patients would have preferred direct access to consultants and most respondents from both populations felt they should be able to request a hospital opinion from their general practitioner. More Asian patients disliked management of illness by telephone than non-Asian patients, the latter feeling that telephone advice could save them a trip to the surgery, or their general practitioner a home visit. However, both groups regarded home visiting as essential. Asian patients disliked deputizing services more than non-Asian patients, and there was some support for 24 hour surgeries, particularly among the Asian population, with doctors working in shifts. As Asian patients appear to differ from non-Asian patients with respect to attitudes and perceived need for health care services, this type of survey may form the basis for the more rational planning of health care delivery to ethnic minority patients in the future.

Adolescent↗
PubMed1991

Death after marital bereavement--is the risk increased?

Previous studies on the effect of marital bereavement on mortality have suggested various time periods during which the risk of mortality is increased. As many of the studies compared the widowed group with national mortality statistics for the married, there has been no opportunity to adjust for confounders which might themselves be responsible for this increased risk after bereavement. In this paper the various hypotheses proposed are reviewed and then modelled on a dataset of 344 elderly persons who were living with a spouse and who were part of a survey of a population of people aged 75 years and over. The 344 index-cases and their spouses were followed up for seven years and the times of death (for those who died) of the index-case and spouse were noted. The data were analysed by fitting a proportional hazards model to the subject's survival time after adjustment for other factors such as mental and physical health which had already been shown to be associated with mortality. The bereavement effects were fitted as time-dependent covariates. The best fitting model for females and males indicated an increased relative risk of mortality which lasted for approximately six months after bereavement. In the case of widows this relative risk was significantly increased, being 3.8 with 95 per cent confidence interval (1.4, 10.3) while for widowers the risk was 0.03 with 95 per cent confidence interval (0.00, 37.3).

Aged↗
PubMed1991

A comparison of the clinical features and vascular complications of diabetes between migrant Asians and Caucasians in Leicester, U.K.

907 consecutive patients, (456 Asian and 451 Caucasian) were assessed, employing a similar methodology to the multi-centre WHO study. The Asians were older at diagnosis (46.5 years compared with 40.6 years, P less than 0.01); they had a shorter duration of diabetes (6.3 years versus 11.4 years, P less than 0.1), a higher rate of diabetes in the first degree relatives (29.5% compared with 16%, P less than 0.1), less ketonuria at presentation (85.3% compared with 47.8%, P less than 0.1), and fewer were treated with insulin (31.4% compared with 68.7%). Comparing the prevalence of complications between Asians and Caucasians, the ischaemic heart disease rate was similar; peripheral vascular disease was less (3.7% Asian, 9.3% Caucasian, P less than 0.05); retinopathy was less (11.6% Asian, 32.3% Caucasian, P less than 0.01) but renal disease was more (22.3% Asian, 12.6% Caucasian, P less than 0.01). After adjusting for age, sex, duration of diabetes, age at diagnosis, hypertension, smoking and treatment with or without insulin, these differences remained significant. Multivariate logistic regression failed to reveal a significant contribution due to any of the above variables, or due to body mass index (BMI), haemoglobin A (HbA1), or physical activity in the prevalence of complications in Asians compared with Caucasians. Marked heterogeneity in the complications of diabetes in the two ethnic groups studied was found, but must be confirmed from population-based studies.

Adult↗
PubMed1991

The prevalence of dementia in a total population: a comparison of two screening instruments.

Two short screening tests for dementia, the Information/Orientation (IO) sub-test of the Clifton Assessment Scale (CAPE) and the Mini-Mental State Examination (MMSE) were included in a survey of 1579 elderly people of a large general practice. All those scoring 21 and under on the MMSE, a one in two sample of those scoring 22, 23 and a one in ten sample of the remainder were investigated further using the Cambridge Examination for Mental Disorders of the elderly (CAMDEX). The prevalences of moderate to severe dementia and mild to severe dementia determined from the CAMDEX interview were 4.8% and 14.2%, respectively. For detection of moderate to severe dementia, a cut-point of 21/22 on the MMSE gave a sensitivity of 100%, specificity of 85% and an overall prevalence of 19.7%; mild to severe dementia was best detected by a cut-point of 23/24 giving a sensitivity of 89%, specificity of 81% and prevalence of 28.5%. A cut-point of 7/8 on the IO sub-test gave a sensitivity and specificity for detecting moderate to severe dementia of 87% and 97%, respectively, with a prevalence of 7.3%; for mild to severe dementia a cut-point of 10/11 gave a sensitivity of 67%, specificity of 94% and prevalence of 14.7%.

Aged↗
PubMed1991

Getting older--feeling younger: the changing health profile of the elderly.

In 1981 a survey was undertaken of the physical and mental health and social status of all those aged 75 years and over belonging to a large general practice which alone served the town of Melton Mowbray and its surrounding area. Seven years later the survey was repeated. This elderly population had increased by almost 30% in number between the two surveys despite a relatively stable practice population over this time period. After adjustment for the different age and sex distributions of the two survey populations, significant increases in independence levels were found over the time period for: getting in and out of a chair and bed, dressing, bathing and getting to and from the toilet. No differences were found for mobility around the home, feeding or continence of urine or faeces. A higher prevalence of cognitive impairment was found in 1988 than in 1981, 7.0% compared with 4.5%, but this appeared to be due to the larger number of unclassifiable respondents in 1981. A re-analysis of the data, excluding those living in the area less than five years confirmed that the differences found in health over time were not due to a group of elderly migrating into the area. This study provides evidence that the elderly of today appear fitter than previous cohorts of elderly. Service planners will need to take this into account if sensible provision of resources for this age group are to be made.

Activities of Daily Living↗
PubMed1991

Arterial neuroeffector responses in early and mature spontaneously hypertensive rats.

Intramural sympathetic neuroeffector responses and presynaptic regulation of neurotransmission by amine uptake and alpha 2-adrenergic receptors were examined in young (5-week-old) and mature (12-week-old) spontaneously hypertensive rats (SHR) and were compared with those of age-matched Wistar-Kyoto (WKY) control rats. Electrical field stimulation (20 V, 0.2-msec pulse width, 3-second pulse train each minute, 5-100 Hz) elicited contractile responses from isolated mesenteric arteries mounted in a myograph. There was a significant difference between the sensitivity of arteries to electrical field stimulation in the two age groups, with arteries from 12-week-old rats being more sensitive than arteries from 5-week-old animals. Also, there was a significant age-strain interaction: the sensitivity of arteries from SHR to electrical field stimulation increased dramatically with age compared with that of WKY rat arteries. Cocaine significantly increased the sensitivity to electrical field stimulation after inhibition of presynaptic alpha 2-adrenergic receptors, and had a significantly greater effect in arteries from 5-week-old SHR compared with WKY controls. This would reflect an overactive neuronal amine uptake mechanism in young SHR. At 12 weeks there was no significant interstrain difference in the effect of cocaine. Yohimbine increased the sensitivity to electrical field stimulation both before and after inhibition of neuronal amine uptake, but there was no difference in its effect with age or strain. Therefore, although sensitivity to sympathetic nerve stimulation varies with age in the SHR, there is no evidence that this can be ascribed to alpha 2-adrenergic receptor function.

Animals↗
PubMed1990

Handicaps associated with incontinence: implications for management.

STUDY OBJECTIVE: The aim was to explore the relationship between dementia, impairment of mobility, and incontinence and the implications for management. DESIGN: The study was a survey of a sample population drawn from a general practice register. SETTING: A large general practice serving the entire population of Melton Mowbray, Leicestershire, UK. PARTICIPANTS: Of 1329 persons aged 75 or over, 1203 (90%) took part in the survey. Of non-responders, refusers accounted for 5%, deaths 4%, and failure to trace 1%. MEASUREMENTS AND MAIN RESULTS: 12% of the population complained of incontinence. No more than 24% of these cases were demented. Dementia and isolated locomotor problems were significantly associated with presence of incontinence, but 31% of cases were completely free of either problem. A minimum estimate of 56% of cases of incontinence were considered to be due to local physical disorders of the bladder. CONCLUSIONS: A search for local disorders causing incontinence is important, and more attention should be paid to the management of locomotor problems and possibly depression in the relief of incontinence.

Activities of Daily Living↗
PubMed1990

Comparing trainer and trainee referral rates: implications for education and allocation of resources.

Referral rates and urgency of referral to hospital by six pairs of trainers and trainees were compared over one month in 1986. From 5846 consultations, 327 resulted in referral to hospital. Overall, the referral rates was low at 5.6 per 100 consultations; however, there was considerable variation in individual referral rates with trainees tending to follow their trainer's referral patterns, despite statistical adjustment for sharing the same practice. This paper critically examines the wisdom of using general practitioner referral rates for the purpose of resource allocation and education.

Ambulatory Care↗
PubMed1989

Consultations in general practice: a comparison of patients' and doctors' satisfaction.

OBJECTIVE: To provide an objective means of assessing patients' and doctors' satisfaction with a consultation. DESIGN: Questionnaire study of patients and general practitioners after consultations. SETTING: Urban general practice. SUBJECTS: 250 Patients attending consecutive consultations conducted by five general practitioners. MAIN OUTCOME MEASURE: Identification of deficiencies within a consultation as perceived by both doctors and patients. RESULTS: The doctor's and patient's questionnaires for each consultation were matched and the results analysed on a group basis. The response rate for individual questions was high (81-89%). The doctors and patients significantly disagreed about the doctors' ability to assess and put patients at ease, to offer explanations and advice on treatment, and to allow expression of emotional feelings and about the overall benefit that the patients gained from the consultation. In all cases of disagreement the doctor had a more negative view of the consultation than the patient. CONCLUSIONS: The results of giving structured questionnaires on consultations to both patients and doctors could be a useful teaching tool for established doctors or those in training to improve the quality and sensitivity of care they provide.

Attitude of Health Personnel↗
PubMed1989

The effect of ageing on the pharmacokinetics of dihydrocodeine.

Although poor renal function reduces clearance of dihydrocodeine in man, and renal impairment occurs with ageing, no significant differences occurred in the handling of single doses of dihydrocodeine between elderly patients and young, normal subjects. After multiple dosing, the maximum concentration was significantly different between the groups, being higher in the elderly. The increase in the area under the curve in the elderly was 25% greater than in the young on chronic therapy. This difference was not statistically significant, but was likely to be of clinical significance. The elderly patients' mean creatinine clearance (61.8 ml per min) was significantly lower than that in the young (137 ml per min), and there was a significant correlation between the half-life at single dosing and the blood urea concentration. Variability in all measurements was marked in both groups, and hence no clear guidelines can be given on therapeutic dosing. The small initial dose with alterations thereafter depending on clinical effect is the best advice.

Adult↗
PubMed1989

Mental and physical health of elderly people: five-year follow-up of a total population.

The change in mental and physical functioning over 5 years for 594 survivors of a community survey of the elderly is described. An increase in cognitive impairment, physical disability and incontinence over the period was found with increasing age. Women in the two oldest age groups had a significantly greater increase in physical disability than men. An annual incidence of cognitive impairment of 1.4% was found and the implications of this are discussed.

Aged↗