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Biomedical subjects

C Victor

Publications and source records attributed to C Victor.

At least 19 recordsLinked to original sources
PubMed2001

Deletion of the cell-division inhibitor MinC results in lysis of Neisseria gonorrhoeae.

The minCDE genes involved in division site selection in Neisseria gonorrhoeae were identified using raw data from the N. gonorrhoeae genome project and are part of a cluster of 27 genes. When gonococcal min genes were heterologously expressed as a cluster in Escherichia coli, minicells and filaments were produced, indicating that gonococcal min genes disrupted cell division in other genera. The insertional inactivation of the minC gene of N. gonorrhoeae CH811 resulted in a strain (CSRC1) with decreased viability and grossly abnormal cell division as observed by phase-contrast and electron microscopy analysis. Western blot analysis of N. gonorrhoeae CSRC1 confirmed that MinC(Ng) was not produced. Complementation of CSRC1 by integrating a minC-6xHis tag fusion at the proAB locus by homologous recombination restored viability and 1.9 times wild-type levels of MinC(Ng) expression. This slight increase of expression caused a small percentage of the complemented cells to divide aberrantly. This suggested that the 6xHis tag has partially affected the stability of MinC, or that the chromosomal position of minC is critical to its regulation. Comparison of MinC proteins from different bacteria showed a homologous region corresponding to residues 135-230 with five conserved amino acids. Overexpression of MinC(Ng) in wild-type E. coli cells induced filamentation and an E. coli minC mutant was successfully complemented with minC(Ng). Therefore, the evidence indicates that MinC from N. gonorrhoeae acts as a cell-division inhibitor and that its role is essential in maintaining proper division in cocci.

Bacterial Proteins↗
PubMed2000

Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study.

BACKGROUND: Evidence-based health policy is urgently needed to meet the increasing demand for health services among elderly people, particularly for expensive technologies such as renal-replacement therapy. Age has been used to ration dialysis, although not always explicitly, despite the lack of rigorous empirical evidence about how elderly people fare on dialysis. We undertook a comprehensive assessment of outcomes in patients 70 years or over. METHODS: We did a 12-month prospective cohort study of outcomes in 221 patients with end-stage renal failure aged 70 years or over recruited from four hospital-based renal units. We assessed 1-year survival in 125 incident patients (70-86 years) and disease burden (hospital admissions, quality of life, costs) in 174 prevalent patients (70-93 years). FINDINGS: 1-year survival rates were: 71% overall; 80%, 69%, and 54% in patients 70-74 years, 75-79 years, and 80 years and older, respectively (p=0.008); and 88%, 71%, and 64% in patients with no, one, or two or more comorbid conditions, respectively (p=0.056). Cox regression analyses showed that mortality was significantly associated with age 80 years and older (relative risk 2.79 [95% CI 1.28-6.93]) and peripheral vascular disease (2.83 [1.29-6.17]), but not with diabetes, ischaemic heart disease, cerebrovascular disease, chronic obstructive airways disease, sex, or treatment method. In terms of disease burden, hospital admissions represent a low proportion of costs and was not required by a third of patients, mental quality of life in elderly dialysis patients was similar to that of elderly people in the general population, and the average annual cost per patient of 20802 (US$31200) (68% dialysis treatment, 1% transport, 19% inpatient hospital admissions, 12% medications) was within the range of other life-extending interventions. INTERPRETATION: Our results suggest that age alone should not be used as a barrier to referral and treatment and emphasise the need to consider the benefits of dialysis in elderly people. Indicators of the ability to benefit from treatment, rather than chronological age, should be used to develop policies that ensure equal access to care for all.

Aged↗
PubMed2000

Organization and transcription of the division cell wall (dcw) cluster in Neisseria gonorrhoeae.

A cluster of genes involved in cell division and cell wall (dcw) biosynthesis was identified in Neisseria gonorrhoeae using genomic analysis and through verification of gene order by polymerase chain reaction (PCR) analysis. The gonococcal dcw cluster consists of 17 genes, in the order 5'-mraZ-mraW-ftsI-murE-hyp1-murF- mraY-hyp2-murD-ftsW-murG-murC-ddl -ft sQ-ftsA-ftsZ-hyp3-3'. The gene organization of the dcw cluster of N. gonorrhoeae is more similar to that observed in Gram-negative rods such as Escherichia coli and Haemophilus influenzae than in Gram-positive bacteria. The cluster is characterized by several intergenic spaces. Compared with E. coli, two genes, ftsL and envA, are absent in the gonococcal dcw cluster and three hypothetical genes are novel to the cluster. The cluster is flanked by two transcriptional terminators consisting of paired neisserial uptake sequences and also includes four internal terminators, three of which are paired neisserial uptake sequences. We also found that a repeated sequence on the gonococcal genome, commonly called a Correia element, acts as the fourth transcriptional terminator. All termination sequences were shown to be fully functional by using reverse transcription PCR experiments. Transcriptional start sites upstream of ftsQ, ftsA and ftsZ were determined by primer extension and six promoters were identified; three promoters were located upstream of ftsZ in the intergenic space, two were upstream of ftsA within ftsQ and one was upstream of ftsQ within ddl. Some of these promoters were preferentially used under anaerobic conditions. The location of these promoters differed from those described in E. coli indicating dissimilar transcriptional regulation.

Base Sequence↗
PubMed2000

Women's sexual health after childbirth.

OBJECTIVE: To investigate the impact of childbirth on the sexual health of primiparous women and identify factors associated with dyspareunia. DESIGN: Cross-sectional study using obstetric records, and postal survey six months after delivery. SETTING: Department of Obstetrics and Gynaecology, St George's Hospital, London. POPULATION: All primiparous women (n = 796) delivered of a live birth in a six month period. METHODS: Quantitative analysis of obstetric and survey data. MAIN OUTCOME MEASURES: Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire); consultation for postnatal sexual problems. RESULTS: Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre-pregnancy levels of 38% . Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (P = 0 x 01) and previous experience of dyspareunia (P = 0 x 03). At six months the association with type of delivery was not significant (P = 0 x 4); only experience of dyspareunia before pregnancy (P < 0 x 0001) and current breastfeeding were significant (P = 0 x 0006). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional. CONCLUSIONS: Sexual health problems were very common after childbirth, suggesting potentially high levels of unmet need.

Adolescent↗
PubMed2000

Primary care-based evaluation of patient education for osteoarthritis of the knee.

Primary healthcare research in the UK has expanded in conjunction with the wider agenda of a primary care led National Health Service (NHS). This reflects international reconsideration of the place of primary healthcare within national healthcare systems. However the role and standing of research in primary care tends to be marginal and less influential than that originating in research establishments or medical schools pursuing biomedical investigations. There are many reasons for this, some of which this paper attempts to elucidate. We address the perspectives and relationships between 'stakeholder' groups in the field of primary care and highlight the ways in which such relationships affect research in this area. The development of a primary care research project concerned with osteoarthritis of the knee (the OAK project) is used as an exemplar of these stresses and we suggest ways in which the difficulties encountered may be overcome.

Controlled Clinical Trials as Topic↗
PubMed1999

Women's sexuality after childbirth: a pilot study.

A pilot study was carried out investigating women's sexual health in the postnatal period. Postal questionnaires were sent to a cohort of 158 primiparous women approximately 7 months after delivery. Women who had resumed sexual intercourse were asked a detailed set of questions about problems experienced, sexual practices, frequency of intercourse, satisfaction with sex life, and consultation for postnatal sexual problems. All women were asked about the information they received on postnatal health prior to the birth and any information or help and advice they received from health professionals on the subject after the birth. Ninety-eight women (62%) responded. Women experienced significant levels of morbidity in the postnatal period; 3 months after delivery 58% experienced dyspareunia, 39% experienced vaginal dryness, and 44% suffered loss of sexual desire. These figures had reduced to 26, 22, and 35%, respectively, by the time of answering the questionnaire (approximately 8 to 9 months after delivery). Compared to before pregnancy, there was a decrease in frequency and satisfaction with sexual intercourse, although sexual practices changed little. Of the 67 women who reported a postnatal sexual problem, only 19% discussed this with a health professional. Conversations with health professionals in routine postnatal health contacts were mainly about contraception, and only rarely discussed problems with intercourse.

Adolescent↗
PubMed1995

The prevalence of behavioural problems amongst homeless primary school children in an outer London borough: a feasibility study.

OBJECTIVES: To investigate the prevalence of behavioural problems amongst homeless primary school-age children in an outer London borough. DESIGN: Cross-sectional study of homeless primary school children and permanently housed control children. SETTING: Selected primary schools in an outer London borough. SUBJECTS: Children from non-refugee families officially accepted as homeless by the local authority, and housed controls from the same schools. OUTCOME MEASURE: Rutter behavioural rating scale. RESULTS: Fewer homeless children (38%, 18 of 48) than housed (88%, 50 of 57) were born in the UK, or spoke English at home. Only 19 (40%) of the fathers of homeless children compared with 43 (75%) of housed children's fathers lived with them. Some 49% of homeless children's scores suggested a behavioural problem, compared with 11% of controls. Altogether, 94% of homeless and 100% of housed children were registered with a general practitioner. CONCLUSIONS: High levels of behavioural problems were found in homeless children. With numbers of homeless children expected to rise in the 1990s this finding merits urgent attention.

Case-Control Studies↗
PubMed1994

Needs assessment for older people.

Assessments of need carried out so far have concentrated on single diseases or interventions rather than care groups or on people who have multiple pathologies. We therefore began a needs assessment for older people in a central London health authority. The health district--then called Parkside--covered 25 square miles in north London and had a resident population of 432,600 people, of which 7% were aged 75 years and over and 2% were aged 85 years and over. Estimates of the number of people with different disabilities and diseases were calculated using data from the General Household Survey, the office of Population Census Survey (OPCS) Disability Survey or other national or reliable surveys. Although the majority of older people were well--indicating a need for health promotion and disease prevention--we estimated the number of disabled older people in the district was in excess of 25,000, with the most common types of disability being those concerned with locomotion, hearing and personal care. Using data from the OPCS survey we were able to estimate there were 7328 people aged 75 years and over who were in the OPCS top five severity rating, which would mean that they probably required services. For mental health we estimated there would be approximately 6000 older people suffering from clinically significant depression, 6000 older people suffering from anxiety, and between 2740 and 4441 suffering moderate to severe dementia. A next step is to match an assessment of the prevalence of disease and disability, with an estimate of that being served locally.

Activities of Daily Living↗
PubMed1993

The inappropriate use of acute hospital beds in an inner London District Health Authority.

The requirement for District Health Authorities to assess the health care needs of their population implies that they must consider how well acute hospital care meets these identified needs. This study, which was conducted in an inner London health district, identified that 123 (14.6%) patients were perceived by medical and/or nursing staff to be inappropriately located in an acute bed. This group was dominated by patients aged 65 years or above, those in general and geriatric medicine, those with a length of stay of 30 days or more, and those with high levels of physical and mental dependency. The main reasons for patients being labelled as 'inappropriate' were the need for non-acute health services (eg rehabilitation, terminal care etc), a need for nursing home places or because of social or housing problems. Five months after identification, the notes of 100 of the 123 inappropriate patients were traced. Retrospective classification of these notes using the more 'objective' Oxford Bed Study Instrument showed that 97 patients were still defined as inappropriate. Details of the length of inappropriate stay were available for 74 patients who accrued 7,519 inappropriate bed days at a cost of 836,547 pounds. These patients are an illustration of the potential failings of current health and social care systems and highlight the need for imaginative care solutions which bridge this divide.

Adult↗
PubMed1992

The efficacy of a national Family Health Services Authority based cervical cytology system.

District health authorities have been instructed to operate a cervical cytology call and recall screening programme using the age-sex registers held by the Family Health Services Authority. This paper reports the results of a 1989 survey of women from two diverse health districts to determine the uptake of cervical screening between these health districts. The results show a low uptake in all areas, even after accounting for inaccurate information. Many invitations were sent to the wrong address, or to women who were not eligible for a smear test. The former was a particular problem in the inner city district of Parkside. The provision of an effective scheme will depend on all those involved addressing the problems found by this study. This is essential if general practitioners are to meet the new targets for payment set by the government for cervical cytology screening.

Appointments and Schedules↗
PubMed1991

Utilisation by homeless people of acute hospital services in London.

OBJECTIVES: To estimate the numbers and distribution of homeless people in London; to quantify the utilisation of acute inpatient services by homeless people in two health authorities; and to predict the total numbers of admissions in homeless people in district health authorities across London. DESIGN: Data were collected from various sources on the distribution of homeless people across London boroughs. All unplanned acute inpatient admissions during November 1990 to relevant hospitals were identified. SETTING: Bloomsbury and Paddington and North Kensington, two former inner London district health authorities. SUBJECTS: Homeless people in London residing in bed and breakfast and private sector leased accommodation, residing in hostels, and of no fixed abode. MAIN OUTCOME MEASURES: Number and cost of acute unplanned admissions in homeless people in two health authorities in November 1990; predicted number of such admissions each year in district health authorities in London. RESULTS: There were at least 60,000 homeless people in London in March 1990. The majority were housed in temporary accommodation (55,412). There were at least 3295 hostel dwellers and 651 people sleeping rough. Homeless people accounted for 105 (8%) of the 1256 acute unbooked admissions in residents of Bloomsbury and Paddington and North Kensington health authorities in November 1990. Considerable variations in the pattern of acute unplanned admissions in homeless people were observed in the two districts with respect to housing status and specialty of admission. The total number of acute unplanned admissions in homeless people across London each year was estimated at 7598, ranging from 38 in Bexley to 1515 in Parkside. CONCLUSIONS: The results have fundamental implications for resource allocation across London. Allocation must take better account of the heterogeneity, uneven distribution, and extra health needs of homeless people.

Adolescent↗