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Biomedical subjects

E M Scott

Publications and source records attributed to E M Scott.

At least 19 recordsLinked to original sources
PubMed2006

Neel revisited: the adipocyte, seasonality and type 2 diabetes.

The modern epidemic of obesity and insulin resistance with cardiovascular risk factor clustering is related to the development of type 2 diabetes and cardiovascular disease. Over 40 years ago, Neel postulated that insulin resistance should confer survival benefit. Extrapolating Neel's hypothesis, we propose that the cluster of associated abnormalities also confers survival benefit and is related to metabolic responses seen in seasonally responsive animals. Weight gain in preparation for winter is accompanied by a range of acute metabolic changes virtually identical to the long-term changes seen in type 2 diabetes. In seasonal animals the responses are acute, physiological and protective. In man, similar responses that would once have conferred survival benefit have become chronic, pathological and harmful in modern life. We hypothesise that type 2 diabetes and cardiovascular disease in man are the result of chronic and inappropriate pineal-hypothalamic-adipocyte interactions biologically related to seasonal change.

Adipocytes↗
PubMed2006

Acute phase proteins in bovine milk in an experimental model of Staphylococcus aureus subclinical mastitis.

The objectives were to establish the origin of 2 acute phase proteins in milk during subclinical bovine mastitis and to characterize the relationship between those proteins in milk and blood. Haptoglobin (Hp) and mammary-associated serum amyloid A (M-SAA3) appear in milk during mastitis, whereas Hp and serum amyloid A increase in serum during mastitis. The concentrations of these proteins were determined in an experimental model using a field strain of Staphylococcus aureus to induce subclinical mastitis in dairy cows. The expression of mRNA coding for these proteins was assessed and the presence of M-SAA3 in mammary tissues was determined using immunocytochemistry. Increases of M-SAA3 and Hp in milk occurred within 12 h of Staphylococcus aureus infusion, with peak concentrations occurring 3 d after infusion of the bacteria. The increase of acute phase proteins in milk (15 h) preceded the increase in serum concentrations of both proteins (24 h). Expression of mRNA for M-SAA3 and Hp increased in both mammary and hepatic tissues 48 h after infusion of the mammary glands. In mammary tissue, the increase of M-SAA3 mRNA was greater than the increase in Hp mRNA expression, whereas in hepatic tissue, the increase in M-SAA3 mRNA was less than that for Hp mRNA. Immunocytochemistry demonstrated that M-SAA3 protein was present within secretory epithelial cells at significantly higher levels in infected mammary glands than in control tissues. These proteins, which have host defense and antibacterial activities, may play a significant role in the early response to invasion of mammary tissues by pathogenic bacteria.

Acute-Phase Proteins↗
PubMed2004

Disparity of autonomic control in type 2 diabetes mellitus.

AIMS/HYPOTHESIS: Acute insulinaemia activates the sympathetic drive in a nonuniform manner. The extent and nature of such activation in type 2 diabetic patients who do not have neuropathy have not yet been addressed despite evidence relating sympathetic activation to cardiovascular risk. We planned to determine the magnitude and extent of the sympathetic drive and its reflex responses in patients with type 2 diabetes and fasting hyperinsulinaemia. METHODS: We measured resting muscle sympathetic nerve activity (MSNA) as the mean frequency of multi-unit bursts and single unit muscle sympathetic nerve activity (s-MSNA) in 17 overweight patients with type 2 diabetes and two matched normal control groups comprising 17 overweight and 16 normal-weight subjects. We also tested the MSNA and s-MSNA responses to cold pressor and isometric hand-grip tests, along with the effect of sympatho-vagal balance on heart period variability. RESULTS: Both MSNA and s-MSNA in the group with type 2 diabetes (66+/-3.5 bursts/100 beats and 78+/-4.5 impulses/100 beats) were greater (at least p<0.0001) than in the overweight control group (42+/-2.6 bursts/100 beats and 48+/-3.4 impulses/100 beats) and normal-weight control group (43+/-6.2 bursts/100 beats and 51+/-7.1 impulses/100 beats), though the three groups had similar reflex responses, baroreflex sensitivity and sympatho-vagal balance controlling the heart period. CONCLUSIONS/INTERPRETATION: The patients with type 2 diabetes had no evidence of impaired reflex or autonomic control of heart period variability at a time when there was central sympathetic activation to the periphery. Furthermore, being overweight itself was not associated with sympathetic activation.

Action Potentials↗
PubMed2004

Demonstrating the European capability for airborne gamma spectrometry: results from the eccomags exercise.

Airborne gamma spectrometry (AGS) is being increasingly recognised as an important means for mapping environmental radioactivity in emergency response. Progress has been made in recent years towards methodological convergence and cooperation between European teams. Recently, an international comparison was undertaken in SW Scotland in 2002 to evaluate AGS and ground-based methods. Teams from 18 institutions in 10 European countries attended, collecting some 140,000 AGS spectra, with 750 laboratory gamma spectrometry analyses and 120 in situ observations from the ground sites. Comparisons between AGS and ground-based methods have confirmed the validity of AGS protocols. A composite mapping task, where AGS teams recorded data over adjacent parts of a 90 x 40 km2 area within a few days, confirmed the ability of teams to work together in an effective manner. This paper provides a summary of the results of the exercise. These demonstrate the operational capabilities of European AGS teams and confirm the quantitative nature of the method.

Aircraft↗
PubMed2002

Promoting physical activity in a socially and economically deprived community: a 12 month randomized control trial of fitness assessment and exercise consultation.

The main aim of this study was to assess the effects of a fitness assessment and exercise consultation on physical activity over 1 year in non-regularly active participants drawn from a socially and economically deprived community. Of 3000 people invited to volunteer for either intervention, 225 fitness assessment volunteers were randomly assigned to an experimental or control group; 145 exercise consultation volunteers were similarly assigned. Physical activity was measured at baseline, 4 weeks, 3 months (plus an intervention re-test), 6 months and 1 year. Analysis of variance and follow-up Bonferroni analysis showed that, for those not regularly active at baseline, physical activity increased significantly to 4 weeks, was maintained to 6 months but had fallen by 1 year. Only those receiving an exercise consultation significantly increased their physical activity after 1 year. Compared with fitness assessments, chi-square analysis showed that significantly more non-regularly active participants volunteered for an exercise consultation and those receiving an exercise consultation had significantly better long-term study adherence than those receiving a fitness assessment. The study also showed that, contrary to popular opinion, those in a socially and economically deprived community are not 'hard to reach' and respond well to physical activity interventions.

Adult↗
PubMed2001

Hypertensive left ventricular hypertrophy: relation to peripheral sympathetic drive.

OBJECTIVES: This study was designed to examine whether the occurrence of left ventricular hypertrophy (LVH) in moderate to severe essential hypertension (EHT) was associated with alteration in peripheral sympathetic drive. BACKGROUND: In hypertension, LVH is an independent predictor of increased morbidity and mortality. The reported mechanisms leading to LVH remain unclear but include hemodynamic and humoral factors. The sympathetic nervous system may be important, particularly as catecholamines have been shown to have trophic properties. We tested the hypothesis that sympathetic activity measured using microneurography could be different in patients with hypertension depending on the presence of LVH. METHODS: We examined 28 subjects with moderate to severe EHT (stages 2 to 3; Joint National Committee [JNC]-VI classification). Fourteen had echocardiographic evidence of LVH (EHT + LVH), while the other 14 subjects (EHT) did not. Subjects were matched in terms of age, body mass index and levels of arterial blood pressure. Peripheral muscle sympathetic nerve activity was measured from both multiunit bursts (MSNA) and single unit (s-MSNA) vasoconstrictor impulses via the peroneal nerve. RESULTS: The mean frequency of s-MSNA and MSNA was greater in the EHT + LVH group than it was in the EHT group (mean +/- SEM; 75.9 +/- 6.9 impulses/100 beats vs. 52.1 +/- 2.9 impulses/100 beats, p < 0.001 and 64.2 +/- 5.7 bursts/100 beats vs. 48.9 +/- 2.8 bursts/100 beats, p < 0.05). CONCLUSIONS: These results indicate that, in subjects with moderate to severe hypertension, the presence of LVH is associated with higher sympathetic discharge, evidenced by an increase in unitary firing frequency and also by fiber recruitment.

Action Potentials↗
PubMed2001

Sympathetic neural mechanisms in normal and hypertensive pregnancy in humans.

BACKGROUND: Direct recordings from peripheral sympathetic nerves have shown an increased sympathetic drive in pregnancy-induced hypertension (PIH) and preeclampsia (PE). It is unknown whether sympathetic drive is altered in normal pregnancy, when arterial blood pressure can be normal or relatively low. The aim of this study was to measure and compare peripheral sympathetic discharge, its vasoconstrictor effect and its baroreceptor control, during pregnancy and postpartum in women with normal pregnancy (NP) and PIH and in normotensive nonpregnant (NN) women. METHODS AND RESULTS: Twenty-one women with NP, 18 women with PIH, and 21 NN women had muscle sympathetic nerve activity assessed from multiunit discharges (MSNA) and from single units with defined vasoconstrictor properties (s-MSNA). The s-MSNA in NP (38+/-6.6 impulses/100 beats) was greater (P<0.05) than in NN women (19+/-1.8 impulses/100 beats) despite similar age and body weight but less than in PIH women (P<0.001) (146+/-23.5 impulses/100 beats). MSNA followed a similar trend. Cardiac baroreceptor reflex sensitivity (BRS) was impaired in NP and PIH women relative to NN. After delivery, sympathetic activity decreased to values similar to those obtained in NN, and there was an increase in BRS. In women with NP, the decrease in sympathetic output occurred despite an insignificant change in blood pressure. CONCLUSIONS: Central sympathetic output was increased in women with normal pregnancy and was even greater in the hypertensive pregnant group. The findings suggest that the moderate sympathetic hyperactivity during the latter months of normal pregnancy may help to return the arterial pressure to nonpregnant levels, although when the increase in activity is excessive, hypertension may ensue.

Action Potentials↗
PubMed2001

Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial.

BACKGROUND: Wound infection after clean surgery is an expensive and often underestimated cause of patient morbidity, and the benefits of using prophylactic antibiotics have not been proven. Warming patients during colorectal surgery has been shown to reduce infection rates. We aimed to assess whether warming patients before short duration, clean surgery would have the same effect. METHODS: 421 patients having clean (breast, varicose vein, or hernia) surgery were randomly assigned to either a non-warmed (standard) group or one of two warmed groups (local and systemic). We applied warming for at least 30 min before surgery. Patients were followed up and masked outcome assessments made at 2 and 6 weeks. FINDINGS: Analysis was done on an intention-to-treat basis. We identified 19 wound infections in 139 non-warmed patients (14%) but only 13 in 277 who received warming (5%; p=0.001). Wound scores were also significantly lower (p=0.007) in warmed patients. There was no significant difference in the development of haematomas or seromas after surgery but the non-warmed group were prescribed significantly more postoperative antibiotics (p=0.002). INTERPRETATION: Warming patients before clean surgery seems to aid the prevention of postoperative wound infection. If applied according to the manufacturers guidelines these therapies have no known side-effects and might, with the support of further studies, provide an alternative to prophylactic antibiotics in this type of surgery.

Body Mass Index↗
PubMed2001

Development of a simple screening tool for common mental disorders in general practice.

OBJECTIVE: To develop and validate a self-report screening tool for common mental disorders. DESIGN AND SETTING: Sequential development and validation studies in three cohorts of patients in general practice and one cohort of patients in a specialist psychiatry clinic. PARTICIPANTS: 1585 patients in general practice examined cross-sectionally and longitudinally; 46515 patients attending 386 general practitioners nationwide; 364 patients participating in a longitudinal study of psychiatric disorders in general practice; and 522 patients attending a specialist psychiatry clinic. MAIN OUTCOME MEASURES: Performance of the 12 items from the 34-item SPHERE questionnaire against DSM-III-R and DSM-IV diagnoses of psychiatric disorder, self-reported Brief Disability Questionnaire findings, GPs' ratings of patients' needs for psychological care and degree of risk resulting from mental disorder, and patients' and GPs' reports of reasons for presentation. RESULTS: Six somatic and six psychological questions identify two levels (and three types) of mental disorder: patients reporting both characteristic psychological and somatic symptoms (Level 1, Type 1), and patients reporting either psychological symptoms (Level 2, Type 2) or somatic symptoms (Level 2, Type 3). This classification system predicts disability ratings (Level 1, 8.2 "days out of role in the last month" and Level 2, 4.1 and 5.4 "days out of role in the last month" for Types 2 and 3, respectively), rates of lifetime psychiatric diagnoses (Level 1, 63% and Level 2, 59% and 48%, respectively), both patients' and GPs' report of reasons for presentation, and doctors' ratings of risk as a result of mental disorder. There are important and differing sociodemographic correlates for the three types of mental disorders. CONCLUSION: A classification system based on the 12 items from the 34-item SPHERE questionnaire can be used to identify common mental disorders. This system has acceptable validity and reliability, and is suited specifically for general practice settings.

Adult↗
PubMed2001

Unmet need for recognition of common mental disorders in Australian general practice.

OBJECTIVE: To determine the rate and predictors of unmet need for recognition of common mental disorders in Australian general practice. DESIGN AND SETTING: Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS: 46 515 ambulatory care patients attending 386 GPs. SCREENING TOOLS: Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; prevalence of recognition of mental disorders by GPs--GPs reporting whether patients had depression, anxiety, mixed depression/anxiety, somatoform, or other psychological disorder; predictors of unmet need for recognition of mental disorders--self-report questions about demography for patients and GPs, and about practice organisation for GPs. MAIN OUTCOME MEASURES: Reported recognition of psychological disorders by GPs; actual prevalence of disorders; and patient, GP and practice characteristics predicting the failure to recognise disorders. RESULTS: GPs did not recognise mental disorder in 56% (11922/21210) of patients. These comprised 46% (5134/11060) of patients in the higher level of mental disorders, and (in the second level of disorders) 58% (2906/5036) of patients with predominantly psychological symptoms, and 76% (3882/5114) of those with predominantly somatic symptoms. Patients more likely to have their need for psychological assessment met had the following characteristics: middle-aged (odds ratio [OR], 1.76; 95% CI, 1.59-1.96), female (OR, 1.19; 95% CI, 1.12-1.27), Australian-born (OR, 1.16; 95% CI, 1.08-1.24), unemployed (OR, 1.75; 95% CI, 1.64-1.89), single (OR, 1.52; 95% CI, 1.41-1.61), presenting with mainly psychological symptoms (OR, 3.54; 95% CI, 3.28-3.81), and presenting for psychological reasons (OR, 4.20; 95% CI, 3.02-5.82). Characteristics of doctors associated with meeting patients' need for assessment were being aged over 35 years (OR, 1.51; 95% CI, 1.09-2.08), having an interest in mental health (OR, 1.27; 95% CI, 1.15-1.41), having had previous mental health training (OR, 1.29; 95% CI, 1.15-1.45), being in part-time practice (OR, 1.23; 95% CI, 1.09-1.39), seeing fewer than 100 patients per week (OR, 1.29; 95% CI, 1.13-1.47), working in practices with fewer than 2000 patients (OR, 1.28; 95% CI, 1.13-1.45) and working in regional centres (OR, 1.16; 95% CI, 1.05-1.28). CONCLUSION: Unmet need for recognition of common mental disorders remains high. Predictors of unmet need include a somatic symptom profile and practitioner and organisational characteristics which impede the provision of high quality mental health services.

Adolescent↗
PubMed2001

Treatment of common mental disorders in Australian general practice.

OBJECTIVE: To determine the rates and predictors of treatments for patients with common mental disorders in Australian general practice. DESIGN AND SETTING: Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS: 46 515 ambulatory care patients attending 386 GPs. SCREENING TOOLS: Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; pharmacological and non-pharmacological treatment provided, as reported by the GPs--questions relating to treatments provided; predictors of treatments--self-report questions about demography for patients and GPs, and about practice organisation for GPs. MAIN OUTCOME MEASURES: GPs' reported provision of pharmacological and nonpharmacological treatments; and patient, GP and practice characteristics predicting treatment provision. RESULTS: There were complete data on treatment for 39 983 patients. 27% (10752) of all patients received some form of intervention; 21% (8304) received non-pharmacological and 12% (4765) received pharmacological treatments. Non-pharmacological treatments were mostly non-specific counselling and support (83%; 6892/8304). Among the 10303 patients with the most severe level of psychological disorders, only 50% (5152) received any intervention (38% [3872] received non-pharmacological and 27% [2766] pharmacological treatments). Evidence-based treatments were provided to only 12% (4961) of all patients (and only 27% [2802] of the 10303 with the most severe disorders). Although the newer antidepressant agents were commonly prescribed, older medications (mainly tricyclic antidepressants) were prescribed to older (OR, 1.29; 95% CI, 1.07-1.56), less educated (OR, 1.41; 95% CI, 1.12-1.79) and female (OR, 1.44; 95% CI, 1.23-1.70) patients. Among the 8304 patients receiving non-pharmacological treatments, specific (evidence-based) treatments were provided to only 17% (1412); these patients were typically middle-aged (OR, 2.94; 95% CI, 2.32-3.73) and the providing GPs were typically not in full-time practice (OR, 3.34; 95% CI, 2.56-4.17). CONCLUSION: Practitioners largely provide non-specific, non-pharmacological interventions for patients with common mental disorders. Even among those with the most severe disorders, only a minority receive pharmacological or specific evidence-based non-pharmacological treatments.

Adult↗
PubMed2001

Comorbidity of common mental disorders and alcohol or other substance misuse in Australian general practice.

OBJECTIVE: To determine in patients attending general practice 1) the extent of comorbidity of mental disorders and alcohol or other substance misuse, and consequent disability; and 2) GPs' diagnosis and management of patients with comorbidity. DESIGN AND SETTING: Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS: 46 515 ambulatory care patients attending 386 GPs. SCREENING TOOLS: Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; prevalence of alcohol or other substance misuse--two self-report screening questions, defining "probable" misuse (a positive response to both questions) and "possible" misuse (a positive response to one of the questions); disability--four items from the Brief Disability Questionnaire, and self-reported "days out of role" and "days in bed" in the past month; and rates of psychological diagnosis, treatment and referral by GPs, and GPs' rating of patients' psychological risk. MAIN OUTCOME MEASURES: Comorbidity of mental disorders and alcohol or other substance misuse; disability; and correlation with GPs' diagnosis and management. RESULTS: The screening questions revealed possible alcohol or other substance misuse in 11% of patients (5171/46515), and probable misuse in an additional 8% of patients (3593/46515). Comorbidity of mental disorders and substance misuse occurred in 12% (5672/46515) of patients. Patients with comorbidity (compared with those with alcohol or other substance misuse alone) were: more disabled--mean "days out of role in the last month", 8.4 (95% CI, 7.7-9.1) v 3.6 (95% CI, 2.9-4.3); at greater psychological risk (as rated by GPs)--22% v 7%, respectively; more frequently given psychological diagnoses by GPs--51% v 21%; more frequently treated for a psychological condition by GPs--47% v 17%; and more frequently referred to mental health specialists by GPs--9% v 2%. CONCLUSION: Comorbidity of mental disorders and alcohol or other substance misuse is common in patients attending general practice, and results in considerable disability. Such patients receive inadequate attention (diagnosis and management) from GPs. GPs identifying one of these two types of behaviour disorder in a patient should ascertain whether the other type is also present.

Adolescent↗
PubMed2001

Variability and predictors of mental disorder rates and medical practitioner responses across Australian general practices.

OBJECTIVE: To determine the variation in prevalence of common mental disorders and general practitioner (GP) responses across Australian general practices, and to identify practice characteristics that predict these rates. DESIGN: Cross-sectional national audit of general practices throughout Australia in 1998-1999. PARTICIPANTS: 46515 ambulatory care patients attending 386 GPs. MAIN OUTCOME MEASURES: Practice-based prevalence of mental disorders (based on patient-reported symptoms) and GP-reported rates of psychological diagnoses and treatment (median and range, excluding the upper and lower 10% of practices); practice characteristics (patient, doctor and organisational) that predict prevalences and rates, determined by multiple regression analysis. RESULTS: Even after omitting the upper and lower 10% of practices, there were large variations between practices in prevalence of common mental disorders (range, 39% to 59% of patients; median, 48%), and substance misuse (range, 3%-13%; median, 7%). There were also large variations between practices in rates at which GPs made psychological diagnoses in each practice (range, 12%-51%; median, 27%), judged patients to be at risk to self or others (range, 6%-54%; median, 23%), provided psychological treatments (range, 8%-41%; median, 22%) and referred patients to specialist services (range, 1%-10%; median, 4%). Practice-based rates of disorders and GP responses were predicted not only by sociodemographic characteristics of patients in each practice (eg, mean age or proportion of unemployed people), but also by doctor characteristics (eg, age and sex) and practice organisation characteristics (eg, urban versus regional or rural location). CONCLUSION: We identified patient, GP and practice characteristics that predict rates of mental disorder and treatments provided. These could be used to guide mental health service reform in general practice and assist with targeting relevant education and practice support programs.

Adult↗
PubMed2001

Effects of mental health training and clinical audit on general practitioners' management of common mental disorders.

OBJECTIVE: To evaluate the effects of a seminar-based training program and clinical practice audit on general practitioners' (GPs') knowledge and management of common mental disorders. DESIGN: Survey of GPs' knowledge before and after training, and clinical practice audit and re-audit after feedback. PARTICIPANTS AND SETTING: GP volunteers from around Australia in 1998-1999: 1008 completed the pre-training test, 190 the post-training test, 386 the first audit (33235 patients), and 157 of these the re-audit (13280 patients), with 57 undertaking both audit and training. INTERVENTIONS: Four-seminar, 12-hour training program focused on improving GPs' capacity to identify and manage patients with depression and anxiety; practice audit with patient- and practice-based feedback on diagnosis and treatment of common mental disorders. MAIN OUTCOME MEASURES: Scores on pre- and post-training knowledge tests; self-rated improvements in confidence in managing patients with mental disorders after training; rates of psychological diagnoses and treatment by GPs on first audit and re-audit. RESULTS: GPs' knowledge of pharmacological treatments and clinical management improved after the training program (P<0.001), and 97% of GPs reported increased confidence in their management skills. GPs who undertook training had higher diagnosis rates for common mental disorders in the first audit than those who did not undertake training (36% versus 29%; P<0.001), and their diagnosis rates increased over time (36% to 39%; P<0.01), while those of GPs who did not undertake training were unchanged. Similarly, GPs who undertook training provided more mental health treatments than those who did not (30% versus 27% in the first audit [P<0.001], and 31% versus 24% at reaudit [P<0.001]). They also place greater emphasis on use of nonpharmacological treatments (24% versus 21% at first audit [P<0.001], and 25% versus 19% at re-audit [P<0.001]). CONCLUSION: Clinical audits may heighten awareness of mental disorders, but, on their own, they do not improve mental health practice. A relatively brief but skills-based training program may contribute to better management of patients with common mental disorders by increasing GPs' confidence and competence.

Adult↗