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Biomedical subjects

F Howell

Publications and source records attributed to F Howell.

At least 37 records · Page 2Linked to original sources
PubMed1997

The provision of influenza vaccine to patients over 65 years by general practitioners.

Influenza vaccination for all elderly persons is cost effective. Guidelines in Ireland recommend the vaccine for those with chronic illness and to the elderly in care. The aims of this study are to identify how influenza vaccine is provided to elderly patients and to get GPs opinions on what barriers there are to providing the vaccine to persons 65+ years. Of the 143 GPs contacted 117 (81.8%) replied, of whom 116 (99.1%) provide the vaccine to their patients. Ninety nine (85.3%) believe it to be effective in preventing influenza, and only 8 (6.9%) have reservations about the vaccine. Eighteen (15.5%) GPs had a difficulty in identifying those to be vaccinated and only 11 (9.5%) had a computerised system to assist them. Twenty two (19.0%) GPs had difficulty in getting sufficient vaccine for their patients. Ninety six (82.8%) GPs make the vaccine available to those for whom it is recommended and of these 61 make it available to all patients over 65 years. The main patient barriers to an influenza vaccination programme are the patients fear of getting influenza from the vaccine and that many patients do not consider the vaccine to be of value. Barriers identified for GPs are the low level of reimbursement to GPs for vaccinating eligible patients and the lack of proper systems that help identify and contact those who should be getting the vaccine. All of the barriers identified should be easy to overcome so that those who require influenza vaccine can reap the health and social gains that our health services advocate.

Adult↗
PubMed1995

The provision of family planning services by family doctors in a health board region.

A survey was carried out to ascertain the extent of family planning services provided by family doctors. Of the 134 doctors surveyed, 119 (88.8%) replied. Of these 97 (81.5%) were male, 30 (25.2%) were aged less than 40 and 22 (18.5%) were greater than 60. Sixty-four (53.8%) worked in single-handed practices, 52(43.7%) were vocationally trained, 101 (84.9%) had the MICGP or equivalent and 42 (35.3%) had a family planning certificate. Of the 119 respondents, 99 (83.2%) give instruction in natural family planning methods, 114 (95.8%) prescribe oral contraceptives, 102 (85.7%) prescribe the "morning after pill", 40 (33.6%) fit diaphragms and 17 (14.3%) fit intrauterine devices. Only 3 (2.5%) perform male sterilisations. Doctors aged less than 60 years were 1.3 times more likely to prescribe oral contraceptives (p < 0.0001), and were four times more likely to fit diaphragms (p < 0.01). Doctors who hold a family planning certificate were 2.4 times more likely to fit diaphragms (p < 0.001) and were 2.5 times more likely to fit intrauterine devices. As to who should provide these services, the family doctor was the preferred option for 95 (79.8%) with regard to natural family planning, 107 (89.9%) for the contraceptive pill, 76 (63.9%) for the diaphragm, 58 (48.7%) for the intrauterine device, 45 (37.8%) for male sterilisations and 4 (3.4%) for female sterilisations. Younger doctors and those with a family planning certificate were more likely to say that family doctors should provide these services.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Community mothers' programme: randomised controlled trial of non-professional intervention in parenting.

OBJECTIVE: To see whether non-professional volunteer community mothers could deliver a child development programme to disadvantaged first time mothers for children aged up to 1 year. DESIGN: Randomised controlled trial. SETTING: A regional health authority in Dublin. SUBJECTS: 262 first time mothers who were delivered during six months in 1989 and who lived in a deprived area of Dublin; 30 experienced mothers from the same community recruited as community mothers. INTERVENTIONS: All the first time mothers received standard support from the public health nurse. In addition, those in the intervention group received the services of a community mother, who was scheduled to visit monthly during the first year of the child's life. RESULTS: 232 (89%) first time mothers completed the study--127 in the intervention group, 105 controls. At the end of the study children in the intervention group were more likely to have received all of their primary immunisations, to be read to, and to be read to daily, played more cognitive games; and were exposed to more nursery rhymes. They were less likely to begin cows' milk before 26 weeks and to receive an inappropriate energy intake and inappropriate amounts of animal protein, non-animal protein, wholefoods, vegetables, fruit, and milk. Mothers in the intervention group also had a better diet than controls. At the end of the study they were less likely to be tired, feel miserable, and want to stay indoors; had more positive feelings; and were less likely to display negative feelings. CONCLUSION: Non-professionals can deliver a health promotion programme on child development effectively. Whether they can do so as effectively as professionals requires further study.

Adolescent↗
PubMed1993

A geographical distribution of mortality and deprivation.

Because of the paucity of data on the geographical distribution of mortality and deprivation in the Republic of Ireland, we calculated SMRs for each county for the years 1982-6. Two measures of mortality were used, all cause and avoidable mortality. Two indexes of deprivation were also calculated for each county, Townsend's and a new Irish index. Significant differences in mortality exist between counties. Counties that had SMRs significantly below the national standard of 100 were Meath, Donegal and Galway. Counties with significantly high SMRs were Louth, Limerick and Westmeath. County SMRs were correlated with both deprivation indexes and no significant correlation was found to explain the apparent differences in mortality.

Educational Status↗
PubMed1992

The epidemiology of pertussis in the Republic of Ireland.

Epidemiological data on pertussis in the Republic of Ireland have been gathered annually since 1941. However, no detailed analysis of these data has, until now, been carried out. Fifteen epidemics occurred between 1941 and 1989, an average of one per 3.1 years, which is similar to epidemic intervals observed elsewhere. After the introduction of a vaccine in the 1950s, annual pertussis notifications declined, from 175 per 100,000 in 1956 to 7.6 per 100,000 in 1972. Following adverse publicity in 1973, uptake of the vaccine fell to 30% in 1976. Although uptake has increased again in recent years, it has levelled out at only 40-45% and large epidemics of pertussis occurred in 1985 and 1989. At the same time, mortality from pertussis has fallen to almost negligible levels. Most cases occur in children more than one year of age. Changes in the vaccination schedule could have a major impact on the incidence of the disease in the Republic of Ireland. However, if a further decline in the incidence of the disease is to be achieved, parents have to be persuaded of the benefits of pertussis vaccination.

Adolescent↗
PubMed1991

Recurrent atrial arrhythmias following treatment for postoperative atrial fibrillation after coronary bypass operations.

Ambulatory Holter monitoring was performed in 58 patients during the early convalescence after myocardial revascularization in order to determine the incidence of recurrent atrial arrhythmias following treatment for postoperative atrial fibrillation. Fifteen patients who had undergone coronary bypass and had not developed spontaneous atrial fibrillation following operation served as the controls (group 1). The remaining patients developed spontaneous symptomatic atrial fibrillation after coronary bypass that required digitalization for rate control. Sixteen patients (group 2) continued taking digoxin for 8 weeks following operation, 13 patients (group 3) discontinued digoxin treatment 5 weeks following operation, and 14 patients (group 4) discontinued digoxin treatment 3 weeks following operation. Twenty-four-hour Holter monitoring indicated that asymptomatic atrial fibrillation was common in the treatment groups after digitalization just before discharge from hospital. Atrial fibrillation, however, rarely recurred following discharge from hospital and was never symptomatic. Our data indicate that patients who develop spontaneous postoperative atrial fibrillation should be treated with digoxin for 3 weeks following operation and then drug therapy may be discontinued indefinitely.

Atrial Fibrillation↗
PubMed1991

Pain and measles, mumps, and rubella vaccination.

Seventy-seven children (mean age 44.2 months) were entered in a randomised double blind study to find out if two commonly used measles, mumps, and rubella (MMR) vaccines (Pluserix and MMR II) caused pain on injection. Pain was judged by the amount of crying. Infants given MMR II were 2.31 times more likely to cry than those given Pluserix.

Child, Preschool↗
PubMed1991

Employee attitudes to involuntary smoking at the workplace.

The Dublin Healthy Cities Project carried out this survey to establish employees' attitudes to involuntary smoking. A self administered questionnaire was sent to 750 randomly selected employees from the organisations involved with the Project. A response rate of 77% was achieved. 70% were non-smokers. 80% (Non-smokers 92%, smokers 50%) are bothered by involuntary smoking and 78% (non-smokers 85%, smokers 59%) were aware that it was harmful. 93% (non-smokers 99%, smokers 84%) felt that involuntary smoking should be restricted in the workplace and 99% (non-smokers 99%, smokers 97%) felt that it should be restricted in the canteens. 77% of smokers expressed a desire to quit the habit. This survey shows that employees are bothered by involuntary smoking in the workplace, they see it as being harmful to their health and they think it should be restricted.

Adult↗
PubMed1990

Pulmonary complications following myocardial revascularization with the internal mammary artery graft.

A total of 106 patients participated in a clinical investigation to determine the incidence and etiology of pulmonary complications following myocardial revascularization with the internal mammary artery graft; 39 patients (group I), undergoing valve replacement or myocardial revascularization with vein grafts, served as control. The mammary artery was used for revascularization in the remaining patients. The pleura was opened during the dissection of the mammary graft in 34 patients (group II), but was left intact during harvesting of the internal mammary artery in 33 patients (group III). Inspiration and expiration chest X-rays were obtained during the first 3 months of convalescence to determine the presence of pleural fluid, the position of the left hemidiaphragm, and to asses diaphragmatic movement. Pleural effusions, left lower-lobe atelectasis, and elevation of the left hemidiaphragm were observed in all groups after operation, but were more commonly observed in those patients undergoing revascularization with the mammary artery graft. Postoperative chest X-rays just prior to discharge from hospital were normal in 69% of the control group, only 9% of patients in group II who had pleurotomy during mammary artery dissection, and 42% of group III. By 3 months, however, 95% of patients in groups I and II had normal chest X-rays, whereas 53% of patients in group II had persistent loss of left-lung volume related to the presence of left-lower-lobe atelectasis, left pleural effusions and organization of the postoperative hemothorax.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1990

Pulmonary tuberculosis in the Republic of Ireland: an epidemiological profile from a single unit.

We present a retrospective epidemiological analysis of 1011 adults with a first time diagnosis of pulmonary TB seen between 1980-1985. Most (98.7%) were from the Republic of Ireland and 68.4% were male. Both males and females showed a bimodal age distribution with 37.6% of females and 18.8% of males aged younger than 30 years. More than half (58.6%) of patients smoked cigarettes and 63.7% consumed alcohol. Two patients indulged in the use of hard drugs. Only 5% of patients were asymptomatic and 0.9% of patients had symptoms for longer than 1 year. Radiologically, 54.7% of patients had bilateral disease; 58.5% had cavities and 10% had pleural effusions. Mantoux testing was positive to 1 tuberculin unit Mantoux in 76%; to 10 tuberculin units Mantoux in 15.3%; to 100 tuberculin units Mantoux in 3.7%; and negative to 100 tuberculin units in 5.0%. Primary drug resistance occurred in 0.9% of patients. Ninety (9.0%) of patients died before completing antituberculous treatment and in 40 patients tuberculosis was the principle or main cause of death.

Adolescent↗
PubMed1989

Short course chemotherapy for pulmonary tuberculosis. A randomised controlled trial of a six month versus a nine month oral regimen.

We report on the first trial in the Republic of Ireland to look at chemotherapy for TB. This management trial, carried out in single unit, which treats a third of all TB cases in the Republic of Ireland compared to effectiveness of a three drug/nine month regimen (Rifampicin (R), Isoniazed (R), supplemented with Ethambutol (E) for the first two months = RHE9) with a four drug six months regimen (R, H supplemented with E and Pyrazinamide (Z) for the first two months = RHEZ6). Two hundred and eighty eight patients (288) were entered into the study. A total of 143, (76 were in the RHE9 group and 67 in the RHEZ6 group) completed the trial as planned. At the end of the third month, significantly more patients in the RHEZ6 regimen (98%) were culture negative compared to the RHE9 regimen (88%). All were culture negative at the end of chemotherapy. Drug intolerance was seen in 35 (12%) patients with no significant difference in hepatitis between the two regimens. Toxicity from Pyrazinamide was minimal. One hundred and forty five (145) patients were invalid for analysis for the following reason:- bacteriologically negative TB (41), drug intolerance (35), death (23), non-compliance (19), diagnosis not TB (10), drug resistance (7), extrapulmonary disease (4), consent withdrawn (3), Mycobacteria other than tuberculosis (3). All patients are being followed to monitor relapse rates.

Administration, Oral↗
PubMed1986

Oral problems in patients with Sjögren's syndrome.

Minor salivary gland biopsies are important in confirming the diagnosis of Sjögren's syndrome (SS) and in understanding its pathogenesis. Biopsies should be obtained through clinically intact mucosa and contain at least 4 evaluable lobules. Immunohistologic studies using monoclonal antibodies demonstrated that the majority of infiltrating lymphocytes are T cells (CD3+) of the helper/inducer (CD4+) subset. Transmission electron microscopy (EM) and scanning EM emphasize the presence of high endothelial venules in SS biopsis and do not reveal immune complexes at the basement membranes. Taken together, these results suggest that T cell mediated immune mechanisms are responsible for salivary gland destruction. Patients with SS present specific therapeutic problems. First, their decreased saliva production predisposes them to increased oral infections and periodontal disease. These causes of increased oral pain must be distinguished from flares of the underlying disease including vasculitis and from medication side effects. Difficulty in eating solid foods may contribute to poor nutrition and to stress in social situations. In certain patients, dental restorations and prosthetic implants may improve cosmetic appearance and oral function.

Humans↗
PubMed1985

Salivary gland lymphocytes in primary Sjogren's syndrome lack lymphocyte subsets defined by Leu-7 and Leu-11 antigens.

Primary Sjogren's Syndrome (SS) is an autoimmune disease characterized by dry eyes and dry mouth due to lymphocytic infiltration of lacrimal and salivary glands. Biopsies of their salivary glands provided an opportunity to characterize the phenotypic and functional properties of inflammatory site lymphocytes. We found that the salivary gland lymphocytes (SGL) of SS patients differed from the peripheral blood lymphocytes of the same patients because: a) SGL lacked lymphocytes reactive with anti-Leu-7 and anti-Leu-11 monoclonal antibodies; b) SGL lacked natural killer (NK) activity; and c) SGL lacked the ability to suppress polyclonal B cell responses in the presence of complement fragment C3a, a function that requires the presence of Leu-7+ cells. These studies also showed that the SGL of SS patients differed from tonsillar lymph node (LN) lymphocytes of immunologically normal individuals because tonsillar LN contained Leu-7+ T cells, and tonsillar LN could suppress polyclonal B cell responses in the presence of the complement fragment C3a. The absence of this regulatory subset in the salivary glands of SS patients may contribute to pathogenesis, because these cells may be important in the suppression of polyclonal antibody synthesis and in the elimination of neoplastic or viral infected cells.

Adolescent↗