Biomedical subjects

C Turner

Publications and source records attributed to C Turner.

At least 19 recordsLinked to original sources

PubMed2006

Using the UK primary care Quality and Outcomes Framework to audit health care equity: preliminary data on diabetes management.

BACKGROUND: The incentivization of UK primary care through the Quality and Outcomes Framework (QOF) has released an unprecedented supply of data that in theory could aid health equity audit and reduce health inequalities. The current system allows for 'exception reporting' whereby patients can be excluded from calculation of payment for reasons such as failure to attend review. We speculated that such exclusions could be linked to socioeconomic deprivation. METHODS: We assessed 'exception reporting' rates for 15 diabetes indicators using 2004/05 QOF data for 49 general practitioner (GP) practices in Brighton and Hove and related it to a deprivation ranking for each practice. RESULTS: The standardized diabetes prevalence was 26% higher (P < 0.001) in the highest compared to the lowest quintile of deprivation. Correlations between 'exception reporting' and deprivation were seen for 10 of the 15 diabetes indicators (r = 0.20-0.41, P < 0.05). Practices with a more deprived patient population were more likely to report 'exceptions' for QOF indicators, although there was no such relationship with the achievement of QOF targets. CONCLUSIONS: Strategies to reduce health inequalities need to take into account that high levels of exception reporting, particularly in practices with deprived populations, may be disguising unmet need in those populations.

Appointments and Schedules↗

PubMed2006

Acceptability of low molecular weight heparin thromboprophylaxis for inpatients receiving palliative care: qualitative study.

OBJECTIVE: To find out what inpatients with advanced cancer who are receiving palliative care think about the effect of thromoprophylaxis on overall quality of life. DESIGN: Qualitative study using audiotaping of semistructured interviews. SETTING: Regional cancer centre in Wales. PARTICIPANTS: 28 inpatients with advanced metastatic cancer receiving palliative care and low molecular weight heparin. MAIN OUTCOME MEASURES: Recurring themes on the effect of thromboprophylaxis on overall quality of life. RESULTS: Major emerging themes showed that patients knew about the risks of venous thromboembolism and the purpose of treatment with heparin. Media coverage had raised awareness about venous thromboembolism, and many had previous experience of thromboprophylaxis. All found low molecular weight heparin an acceptable intervention, and many said that it improved their quality of life by giving them a feeling of safety and reassurance. Antiembolic stockings were considered uncomfortable and had a negative impact on quality of life. Patients were concerned that because they had advanced disease they might not be eligible for thromboprophylaxis. CONCLUSION: Low molecular weight heparin is acceptable to inpatients with advanced cancer receiving palliative care and has a positive impact on overall quality of life. Antiembolic stockings are an unacceptable intervention in this patient group. Guidelines on thromboprophylaxis are urgently needed for palliative care inpatient units and hospices.

Aged↗

PubMed2006

Refining the diagnosis of mitochondrial HMG-CoA synthase deficiency.

Mitochondrial HMG-CoA synthase deficiency is an inherited metabolic disorder caused by a defect in the enzyme that regulates the formation of ketone bodies. Patients present with hypoketotic hypoglycaemia, encephalopathy and hepatomegaly, usually precipitated by an intercurrent infection or prolonged fasting. The diagnosis may easily be missed as previously reported results of routine metabolic investigations, urinary organic acids and plasma acylcarnitines may be nonspecific or normal, and a high index of suspicion is required to proceed to further confirmatory tests. We describe a further acute case in which the combination of urinary organic acids, low free carnitine and changes in the plasma acylcarnitine profile on carnitine supplementation were very suggestive of a defect in ketone synthesis. The diagnosis of mitochondrial HMG-CoA synthase deficiency was confirmed on genotyping, revealing two novel mutations: c.614G > A (R188H) and c.971T > C (M307T). A further sibling, in whom the diagnosis had not been made acutely, was also found to be affected. The possible effects of these mutations on enzyme activity are discussed.

Carnitine↗

PubMed2006

Plasma homocysteine, oxidative stress and endothelial function in patients with Type 1 diabetes mellitus and microalbuminuria.

AIMS: The purpose of this study was to examine the associations between endothelial function, plasma homocysteine and oxidative stress in patients with Type 1 diabetes mellitus (DM) and microalbuminuria compared with DM patients with normoalbuminuria and non-diabetic control subjects. We wished to test the hypothesis that increased cardiovascular risk in patients with Type 1 diabetes and microalbuminuria may be in part as a result of hyperhomocysteinaemia-mediated oxidative stress leading to impaired endothelial function. METHODS: We measured forearm blood flow, total plasma homocysteine, total antioxidant status (TAOS) and whole blood glutathione in 31 DM patients, 16 with microalbuminuria and 15 with normoalbuminuria, and 15 non-diabetic control subjects. RESULTS: Plasma homocysteine levels were significantly higher in the microalbuminuric diabetic patients compared with the normoalbuminuric patients and the control subjects. TAOS was significantly lower in the micoalbuminuric and normoalbuminuric diabetic patients compared with the control subjects, although TAOS levels were similar in both groups of diabetic patients. There was no difference in forearm blood flow between the groups and no association between measured endothelial function and antioxidant defence/oxidative stress and homocysteine in each group. There was no association between plasma total homocysteine and TAOS or whole blood glutathione within the groups. CONCLUSIONS: We have found mild hyperhomocysteinaemia in microalbuminuric DM patients compared with normoalbuminuric DM patients and non-diabetic subjects and some evidence for reduced antioxidant defence in DM patients. These findings add to our understanding of the increased risk of vascular disease in patients with Type 1 diabetes.

Adult↗

PubMed2005

The 'WHO Safe Communities' model for the prevention of injury in whole populations.

BACKGROUND: The safe communities approach has been embraced around the world as a model for coordinating community efforts to enhance safety and reduce injury. Over 80 communities throughout the world have been formally designated as 'Safe Communities' by the World Health Organization. It is of public health interest to determine to what degree the model is successful, and whether its application does indeed reduce injury rates in communities to which it is introduced. OBJECTIVES: To determine the effectiveness of the Safe Communities model to prevent injury in whole populations, or targeted sub-groups of populations. SEARCH STRATEGY: The search strategy was based on electronic searches, handsearches of selected journals, snowballing from reference lists of selected publications and contacting a key person from each WHO-designated Safe Community. SELECTION CRITERIA: Studies were independently screened for inclusion by two reviewers. Included studies were those conducted within a WHO Safe Community that reported changes in population injury rates within the community compared to a control community. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two reviewers. Meta-analysis was not appropriate, due to the heterogeneity of the included studies. MAIN RESULTS: Only seven WHO Safe Communities, of more than 80 worldwide, have undertaken controlled evaluations using objective sources of injury data. These communities represent only four countries from two geographical regions in the world: the Scandinavian countries of Sweden and Norway and the Pacific nations of Australia and New Zealand. Safe Communities in Sweden and Norway have resulted in significant reductions in injury rates. The Australian and New Zealand communities have been unable to replicate the same level of success. AUTHORS' CONCLUSIONS: Evidence suggests the WHO Safe Communities model is effective in reducing injuries in whole populations. However, important methodological limitations exist in all studies from which evidence can be obtained. A lack of reported detail makes it unclear which factors facilitate or hinder a programme's success, and makes uncertain, whether the success of any particular application of the model is necessarily replicable in other communities. In evaluated programmes that did not report significant decreases in injury rates, this lack of information makes it difficult to distinguish between evidence of no effect of the model, or no evidence of effect. The four countries that have evaluated their Safe Communities with a sufficiently rigorous study design have higher economic wealth and health standards and lower injury rates than much of the world. No evaluations were available from other parts of the world, despite the designation of WHO Safe Communities in countries such as South Africa, Bangladesh, China, Vietnam, Canada, UK and USA. Generalisation of results of studies conducted in just four countries, to the international population needs to be done with caution. There is a need for more high-quality, methodologically strong evaluations of the model in a range of diverse communities and detailed reporting of implementation processes.

Accident Prevention↗

PubMed2005

Population-based interventions for the prevention of fall-related injuries in older people.

BACKGROUND: Fall-related injuries are a significant cause of morbidity and mortality in the older population. Summary information about counter-measures that successfully address the risk factors for fall-related injuries in research settings has been widely disseminated. However, less available is evidence-based information about successful roll-out of these counter-measures in public health programmes in the wider community. Population-based interventions in the form of multi-strategy, multi-focused programmes are hypothesised to result in a reduction in population-wide injury rates. This review tests this hypothesis with regards to fall-related injuries among older people. OBJECTIVES: To assess the effectiveness of population-based interventions, defined as coordinated, community-wide, multi-strategy initiatives, for reducing fall-related injuries among older people. SEARCH STRATEGY: The search strategy was based on electronic searches, handsearches of selected journals and snowballing from reference lists of selected publications. SELECTION CRITERIA: Studies were independently screened for inclusion by two reviewers. Included studies were those that reported changes in medically treated fall-related injuries among older people following the implementation of a controlled population-based intervention. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two reviewers. Meta-analysis was not appropriate, due to the heterogeneity of the included studies. MAIN RESULTS: Out of 23 identified studies, five met the criteria for inclusion. There were no randomised controlled trials. Significant decreases or downward trends in fall-related injuries were reported in all five of the included studies with the relative reduction in fall-related injuries ranging from 6 to 33%. AUTHORS' CONCLUSIONS: Despite methodological limitations of the evaluation studies reviewed, the consistency of reported reductions in fall-related injuries across all programmes support the preliminary claim that the population-based approach to the prevention of fall-related injury is effective and can form the basis of public health practice. Randomised, multiple community trials of population-based interventions are indicated to increase the level of evidence in support of the population-based approach. Research is also required to elucidate the barriers and facilitators in population-based interventions that influence the extent to which population programmes are effective.

Accident Prevention↗

PubMed2005

Team-based occupational stress reduction: a European overview from the perspective of the OSCAR Project.

Work-related stress is a significant impediment to job satisfaction and healthy psycho-social functioning. It can alter the behaviour of the person involved and impair the quality of their life. In the European Union (EU), over the last decade, work-related stress has been consistently identified as one of the major workplace concerns--a challenge not only to the health of working people but also to the healthiness of their organizations. The study reported below attempted to address the issue of work-related stress through whole team training programmes, on a background of largely ineffective stress reduction training programmes offered to individuals within the workplace. This EU 'framework 5 Quality of Life' project focused instead on tackling the organizational level through training of mental health teams in five countries. The findings have significant implications to the conceptual, methodological and everyday organizational practice levels of tackling this central issue to the health of the workplace.

Adult↗

PubMed2005

Cardiovascular risk in women with polycystic ovarian syndrome (PCOS).

AIMS: Studies have suggested that polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk. The aim of this study was to examine cardiovascular risk profiles in women with PCOS compared with healthy age and weight matched control subjects using novel biochemical and biophysical markers. METHODS: After ethics committee approval, 11 women with PCOS and 12 controls were recruited (mean age, 32; SD, 6.5 years; mean body mass index (BMI), 33.1; SD, 5.9 kg/m2). Serum was analysed for lipid and lipoprotein profile (total and high density lipoprotein cholesterol, triglycerides, apolipoprotein B-100, apolipoprotein A1, lipoprotein (a)), and sialic acid, fibrinogen, homocysteine, and C reactive protein (CRP) concentrations. Endothelial function was also assessed by a standard venous occlusion plethysmography technique to measure reactive hyperaemic forearm blood flow (RH), and expressed as per cent increase from baseline. RESULTS: There were no significant differences in glucose, lipid, or lipoprotein concentrations between the two groups. Furthermore, sialic acid (PCOS: mean, 70.5; SD, 149 mg/litre; controls: mean, 71.3; SD, 112 mg/litre), fibrinogen (PCOS: mean, 3.1; SD, 1.0 g/litre; controls: mean, 3.3; SD, 0.7 g/litre), CRP (PCOS: mean, 4.6; SD, 4.2 mg/litre; controls: mean, 5.41 SD, 5.5 mg/litre), and RH (PCOS: mean, 158.7; SD, 135.5%; controls: mean, 200.1; SD, 114.2%) were similar. CONCLUSIONS: There were no differences in surrogate markers of the processes linked to enhanced cardiovascular risk between patients with PCOS and weight matched controls.

Adolescent↗

PubMed2004

Community-based interventions for the prevention of burns and scalds in children.

BACKGROUND: Burns and scalds are a significant cause of morbidity and mortality in children. Successful counter-measures to prevent burn and scald-related injury have been identified. However, evidence indicating the successful roll-out of these counter-measures into the wider community is lacking. Community-based interventions in the form of multi-strategy, multi-focused programmes are hypothesised to result in a reduction in population-wide injury rates. This review tests this hypothesis with regards to burn and scald injury in children. OBJECTIVES: To assess the effectiveness of community-based interventions, defined as coordinated, multi-strategy initiatives, for reducing burns and scalds in children in children aged 0-14 years. SEARCH STRATEGY: The search strategy was based on electronic searches, handsearches of selected journals and snowballing from reference lists of selected publications. SELECTION CRITERIA: Studies were independently screened for inclusion by two reviewers. Included studies were those that reported changes in medically attended burn and scald-related injury rates in a paediatric population (age 0 - 14 years), following the implementation of a controlled community-based intervention. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two reviewers. Meta-analysis was not appropriate, due to the heterogeneity of the included studies. MAIN RESULTS: Of 32 identified studies, only three met the criteria for inclusion. Only one of these three studies showed a significant decrease in paediatric burn and scald injury in the intervention community compared with the control community. The failure of the other two studies to show a positive result may have been due to limited time-frame for the intervention and/or failure to adequately implement the counter-measures in the communities. REVIEWERS' CONCLUSIONS: There are a very limited number of research studies allowing conclusions to be drawn about the effectiveness of community-based injury prevention programmes to prevent burns and scalds in children. There is a pressing need to evaluate high-quality community-based intervention programmes based on efficacious counter-measures to reduce burns and scalds in children. It is important that a framework for considering the problem of burns/scalds in children from a prevention perspective be articulated, and that an evidence-based suite of interventions be combined to create programme guidelines suitable for implementation in communities throughout the world.

Accident Prevention↗

PubMed2004

Community based programs to prevent poisoning in children 0-15 years.

OBJECTIVE: Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in preventing poisoning in children 0-15 years of age. METHODS: A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; target population was children under 15 years; outcome measure was poisoning rates; and either a community control or an historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. RESULTS: The review found only four studies, which met all the inclusion criteria. Only two studies used a trial design with a contemporary control and only one study provided convincing evidence of an effective community program for reducing poisoning in children. CONCLUSION: There is a paucity of research studies in the literature from which evidence regarding the effectiveness of community based childhood poisoning prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.

Adolescent↗

PubMed2004

Community based prevention programs targeting all injuries for children.

OBJECTIVE: Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing all-cause injury in children 0-14 years of age. METHODS: A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; children under 14 years; outcome measure was injury rates; and either a community control or an historical control was used in the design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. RESULTS: Thorough electronic and library search techniques yielded only nine formally evaluated community based all-cause child injury prevention programs that have reported actual injury outcomes. Of these nine studies, seven provided high level evidence where contemporary control communities were used for comparison; the remaining two used a pre and post-design or time trend analysis where historical data from the community were used as the comparison. Only three of the seven studies with contemporary control communities found significant effect of the intervention; the two studies without controls noted significant reductions in injury rates after the intervention period. CONCLUSION: There is a paucity of research from which evidence regarding the effectiveness of community based childhood injury prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.

Accident Prevention↗

PubMed2003

A clinical and genetic study of SPG5A linked autosomal recessive hereditary spastic paraplegia.

The authors performed a clinical and genetic study of a large consanguineous English family with uncomplicated autosomal recessive hereditary spastic paraplegia (ARHSP). Linkage to the previously described SPG5A locus was established with maximum multipoint lod score of 4.84. The locus was refined to a 23.6 cM interval between markers D8S1833 and D8S285. No evidence of oxidative phosphorylation defects was found in muscle biopsies from two affected individuals.

Adolescent↗

PubMed2003

Injury related risk behavior--a study of Australian skydivers.

Risk taking behaviour has been identified as an important host-related determinant of injury in young adults. The aim of this study is to clarify the relationship between the two key elements of risk taking behaviour--ie, risk assessment and risk acceptance--in participants of a high risk sporting activity. Skydivers registered with the Australian Parachute Federation were sampled at several jump meetings held at three 'drop-zones' in North Eastern Australia. A cross sectional survey of 215 skydivers ascertained each subject's risk assessment of each of nine hypothetical sky diving scenes and whether or not they would jump in the described conditions. Variables which independently predicted an individual's risk assessment were age group (p < 0.05). gender (p < 0.05) and scene details (p < 0.001). Risk assessment was found to be a statistically significant predictor of the decision to jump, with a 22% decrease in the odds of jumping with every unit increase in risk assessment (OR = 0.78: 95% CI: 0.76, 0.80). Gender was also found to be a statistically significant predictor of the decision to jump, with males being 19% more likely to jump than females, after controlling for age, experience, currency and risk assessment (OR = 1. 19: 95% CI; 1.04, 1.38). The importance of these results is that, by quantifying the relationship between two key elements of risk taking behaviour and several important host factor determinants, they facilitate more informed discussion about the possible role of risk taking behaviour in the causation of injury.

Adult↗

PubMed2003

Macrophage-mediated clearance of cells undergoing caspase-3-independent death.

Little is known of the functions of caspases in mediating the surface changes required for phagocytosis of dying cells. Here we investigate the role played by the effector caspase, caspase-3 in this process using the caspase-3-defective MCF-7 breast carcinoma line and derived caspase-3-expressing transfectants. Our results indicate that, while certain typical features of apoptosis induced by etoposide--namely classical morphological changes and the ability to degrade DNA into oligonucleosomal fragments - are caspase-3-dependent, loss of cell adhesion to plastic and the capacity to interact with, and to be phagocytosed by, human monocyte-derived macrophages - both by CD14-dependent and CD14-independent mechanisms--do not require caspase-3. Furthermore, both etoposide-induced caspase-3-positive and -negative MCF-7 cells suppressed proinflammatory cytokine release by macrophages. These results demonstrate directly that cell surface changes that are sufficient for anti-inflammatory clearance by human macrophages can be regulated independently of stereotypical features of the apoptosis programme that require caspase-3.

Annexin A5↗

PubMed2003

A one-quarter reduction in the salt content of bread can be made without detection.

OBJECTIVE: To determine if it is possible to deliver a one-quarter reduction in the sodium content of bread without detection. DESIGN: Single-blind, randomized, controlled trial. SETTING: The Royal North Shore Hospital in Sydney, Australia. PARTICIPANTS: One-hundred and ten volunteers from the hospital staff that completed 94% of scheduled assessments. INTERVENTION: Six consecutive weeks of bread with usual sodium content or six consecutive weeks of bread with cumulating 5% reductions in sodium content each week. MAIN OUTCOME MEASURE: The proportion of participants reporting a difference in the salt content of the study bread from week to week. RESULTS: The intervention group were no more likely than the control group to report a difference in the salt content of the bread from week to week (P=0.8). Similarly, there were no differences between randomized groups in the scores for flavour (P=0.08) or liking of the bread (P=0.95) over the study follow-up period. However, the saltiness scores recorded on a visual analogue scale did decline in the intervention group compared with the control group (P=0.01) CONCLUSIONS: A one-quarter reduction in the sodium content of white bread can be delivered over a short time period, while maintaining consumer acceptance. Over the long term, and particularly if achieved for multiple foods, a decrease in sodium content of this magnitude would be expected to reduce population levels of blood pressure and the risks of stroke and heart attack.

Adult↗

PubMed2003

Clonal analysis of a human antimouse antibody (HAMA) response.

Circulating human antimouse antibodies (HAMAs) directed to mouse immunoglobulin G (IgG) are clinically significant, compromising mouse antibody therapy and imaging, and interfering in immunological assays. To investigate the HAMA response, 20 stable cell lines secreting human monoclonal antibodies reactive with mouse IgG were established from a donor with a history of exposure to mice. Their subclass and domain specificities were established by solid-phase binding, indirect haemagglutination assays and immunoblotting, using Igs of known subclass and Ig fragments. The heavy-chain variable region gene usage was determined for 12 HAMAs. Eight HAMAs were IgM, 11 HAMAs were IgG4 and one HAMA was IgG1, indicating an IgG4-dominated response. All of the IgG HAMAs reacted with epitopes present on the Fc portion; one was subclass-specific, nine were subclass-restricted and two were pan-IgG-reactive. Measurement of their affinities gave dissociation constants typically in the nanomolar range. Seven and five HAMAs were derived from variable heavy-chain 3 (VH3) and VH1 gene segments, respectively. The IgG HAMAs used different VH segments to the IgM HAMAs. JH regions were coded by JH4 in eight HAMAs. DH segment usage appeared to be restricted in the IgM HAMAs. Two IgG HAMAs were clonally related. These monoclonal HAMAs are potentially useful as reagents for detecting mouse IgG and as reference reagents for the investigation of the HAMA response in patients undergoing mouse monoclonal antibody therapy and for the investigation of the influence of HAMAs on immunodiagnostic tests.

Amino Acid Sequence↗

PubMed2003

Competitive enzyme-linked immunoassay of monoclonal immunoglobulin G anti-D preparations.

The development of monoclonal immunoglobulin G (IgG) anti-D for prophylaxis necessitates estimation of their potency in terms of their red cell-binding ability, but it is unclear which quantification methodology is most suitable for this. The aim of this study was to assess 50 monoclonal anti-D from the 4th International Workshop for quantitative and qualitative binding to red cells in a competitive enzyme-linked immunoassay (EIA) in which varying amounts of monoclonal antibodies (MoAbs) and a constant amount of biotinylated monoclonal anti-D (BRAD-5) compete for red cell binding. The potencies of the MoAb were estimated against the International Reference Preparation (IRP) for anti-D Ig. Two MoAbs as supplied were insufficiently inhibitory of biotinylated BRAD-5 binding to be quantified; the potencies of the remainder ranged from 4 to 343 IU mL-1 and included 11 MoAbs showing dose-responses that were nonparallel to those of other MoAb and the IRP. Estimation of the concentration of antibody in the supernatants by radial immunodiffusion ranged from 0.5 to 61 micro g mL-1, giving specific activities of <1-24 IU micro g-1. The results show that competitive EIA is suitable for quantitating most monoclonal anti-D for development and quality control purposes, regardless of their D epitope reactivity.

Antibodies, Monoclonal↗

PubMed2003

Composting under controlled conditions.

Three cylindrical reactors, each with a working capacity of approximately 200 litres, were used to investigate composting. The process was optimised and conditions were controlled so that composting on a laboratory-scale thermally resembled that occurring in the core of large open heaps. A baseline flow of humidified air aerated the reactors in five-minute bursts. The reactors operated as closed systems with facilities to analyse the composition of the off-gas for ammonia, oxygen and carbon dioxide. Temperature was used to monitor the progress of the process. Heat loss from the reactor surface was compensated for with an external heat source. A basic model of radial conductive heat losses showed that 53 watts per square-metre would be the maximum heat flux needed to keep the temperature difference across the reactor to within a degree when running at 60 degrees C. A heating cable was used, which could supply 150 watts per square-metre, and the radial temperature difference was reduced to within a degree in more than 60% of the recorded temperatures in the case studies presented. The temperature of the composting material was held at 60 degrees C using a high flow rate 'cooling' aeration with temperature feedback. This, however, led to a mean vertical temperature difference of at least 10 degrees C. The aeration strategy resulted in a well-aerated material, which favoured aerobic microbial activity and the temperature increased as a result of the internally generated heat associated with composting. Three-quarters of the ammonia was emitted in the first week.

Bacteria, Aerobic↗