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Biomedical subjects

F Kee

Publications and source records attributed to F Kee.

At least 55 records · Page 3Linked to original sources
PubMed1994

A community outbreak of echovirus infection associated with an outdoor swimming pool.

Forty-six people became ill with vomiting, diarrhoea and headache within days of an outdoor swimming pool opening for the summer season in a small seaside village. During the weekend of the outbreak, 185 tickets to the pool had been sold. It was found that 34 bathers were ill, and one subject had vomited into the pool. All other cases arose after this incident. The risk of infection was greatest among those who swallowed pool water (24/28 versus 10/17, p = 0.07). Echovirus 30 was isolated from the case who vomited into the pool and from six other cases. Normal chlorine levels had not been adequate to contain the infection risk from vomitus, and, in future, pool attendants witnessing such incidents should consider closing the pool to the public and seeking advice on superchlorination.

Adolescent↗
PubMed1994

Is choice of general practitioner important for patients having coronary artery investigations?

OBJECTIVE: To determine whether particular sociodemographic characteristics of patients with stable angina affected their general practitioners' (GPs') decisions to refer them for revascularisation assessment. DESIGN: Postal questionnaire survey. SETTING: Collaborative survey by the departments of public health medicine in each of the four health boards in Northern Ireland, serving a total population of 1.5 million. SUBJECTS: All (962) GPs. MAIN MEASURES: The relation between GPs' referral decisions and patients' age, sex, employment status, home circumstances, smoking habits, and obesity. RESULTS: 541 GPs replied (response rate 56%). Most were "neutral" towards a patient's sex (428, 79%), weight (331, 61%), smoking habit (302, 56%), employment status (431, 80%), and home circumstances (408, 75%) in making decisions about referral. In assigning priority for surgery most were neutral towards the patient's sex (459, 85%), employment status (378, 70%), and home circumstances (295, 55%). However, most GPs (518, 95%) said that younger patients were more likely to be referred, and a significant minority were less likely to refer patients who smoked (202, 37%) and obese patients (175, 32%) and more likely to refer employed patients (97, 18%) and those with dependents (117, 22%) (compared with patients with otherwise comparable clinical characteristics); these views paralleled the priority which GPs assigned these groups. The stated likelihood of referral of young patients was independent of the GPs' belief in ability to benefit from revascularisation, but propensity to refer and perception of benefit were significantly associated for all other patient characteristics. CONCLUSION: GPs' weighting of certain characteristics in reaching decisions about referral for angiography is not uniform and may contribute to unequal access to revascularisation services for certain patient groups.

Age Factors↗
PubMed1994

Polymorphisms of the angiotensin-converting-enzyme gene in subjects who die from coronary heart disease.

It has been shown that myocardial infarction survivors are more likely to carry an insertion/deletion polymorphism (I/D) of the angiotensin-converting-enzyme (ACE) gene than age-matched population controls. To test whether the association with coronary risk had been under-estimated, the frequency of the ACE I/D was studied in 213 fatal cases of definite and possible myocardial infarction which came to autopsy in the Belfast MONICA Project area. In comparison to controls from the same population, the autopsy cases had an increased frequency of the ACE D allele (p < 0.02). The overall odds ratios were 2.2 for DD vs. II, and 1.8 for ID vs II (test for trend p = 0.01). The findings bear out the hypothesis that the ACE I/D polymorphism is a risk factor for fatal myocardial infarction and sudden cardiac death.

Adult↗
PubMed1994

The role of the general practitioner hospital in inpatient care.

The rationale of the general practitioner hospital continues to be questioned. A study of the services and case-mix of two of the four remaining general practitioner hospitals in Northern Ireland was undertaken to determine whether the nature and cost of inpatient care in these hospitals was comparable to the available alternatives. The case-notes of all non-maternity admissions (n = 509) were reviewed. The two hospitals provide acute medical care for a wide range of patients. The majority of patients appeared to require hospitalisation. It is likely that the beds at the two hospitals were mainly a substitute for district general hospital care. The general practitioner hospitals were estimated to be less costly than alternative forms of care, although it was doubtful whether they fulfilled all the structural criteria of quality generally regarded as important for hospitals of this type.

Family Practice↗
PubMed1993

Reliability of reported family history of myocardial infarction.

OBJECTIVE: To assess the reliability of reported family histories of myocardial infarction. DESIGN: A case-control study in which reported histories of first degree relatives were validated from death certificates, general practitioners' records, and hospital notes. SETTING: Participants enrolled in the Belfast centre of the World Health Organisation's study monitoring trends and determinants in cardiovascular disease (MONICA). SUBJECTS: 200 men who survived myocardial infarction and 200 age matched controls drawn randomly from the population. MAIN OUTCOME MEASURES: The sensitivity, specificity, positive predictive value, and proportion of overall agreement with validated records of reported family histories of myocardial infarction in first degree relatives; odds ratios for myocardial infarction, given at least one reported relative or at least one verified relative being affected. RESULTS: 349 of the 400 probands provided detailed family histories, reporting on 2812 first degree relatives. The overall sensitivity, specificity, and positive predictive value of reported histories were 67.3%, 96.5%, and 70.5% for cases and 68.5%, 97.7%, and 73.8% for controls. The kappa coefficients were modest: 0.65 for cases and 0.68 for controls. The odds ratios for myocardial infarction, given at least one affected relative, were not substantially inflated by recall bias. Some recall bias was evident for the probands' reports of their siblings' histories of myocardial infarction, the odds ratio for a reported history being 1.67 (95% confidence interval 1.09 to 2.57) and for the validated history 1.54 (1.01 to 2.37). CONCLUSIONS: Although the relative risk of disease is correctly estimated, the predictive accuracy of a casual family history of myocardial infarction may limit the effectiveness of targeted screening programmes. They may, however, complement other strategies based on genetic testing.

Case-Control Studies↗
PubMed1993

Access to coronary catheterisation: fair shares for all?

OBJECTIVE: To determine the effects of patient's sex and area's material deprivation on utilisation rates of coronary catheterisation and angiography in the investigation of ischaemic heart disease. DESIGN: Retrospective analysis of routinely collected hospital statistics. SETTING: Acute hospitals throughout Northern Ireland. SUBJECTS: 24,179 episodes of patients discharged from hospital with a primary diagnosis of ischaemic heart disease and 1270 episodes relating to patients with an underlying diagnosis of ischaemic heart disease who had either coronary catheterisation or angiography. MAIN OUTCOME MEASURES: Age standardised admission rates for heart disease and age standardised utilisation rates for catheterisation or angiography, or both, for 566 electoral wards ranked by Townsend "deprivation" scores. RESULTS: Catheterisation-angiography rates in men were over fivefold those of women, ranging from 85.5/100,000 v 16/100,000 in patients from "well off" areas to 123/100,000 v 22/100,000 for patients from deprived areas. After admission rates for heart disease were controlled for, the overall rate ratio for women was 0.48 (95% confidence interval 0.38 to 0.60). After differential admission rates for heart disease and other potential clinical confounders were controlled for, the investigation rates of patients from the least and most "deprived" areas were not significantly different (rate ratio 1.04 (0.87 to 1.25)). CONCLUSION: Although investigation rates were significantly lower in women than in men, further clinical data would be required before labelling this underutilisation as evidence of bias. There was no significant difference in invasive investigation rates for heart disease in areas of varying deprivation or affluence.

Adult↗
PubMed1993

Deletion polymorphism in angiotensin-converting enzyme gene associated with parental history of myocardial infarction.

In a European study an insertion (I)/deletion (D) polymorphism in the angiotensin converting enzyme (ACE) gene has been shown to be associated with the risk of myocardial infarction (MI). In the same study, we investigated the association of the polymorphism with a parental history of fatal MI. There was an excess of both DD (odds ratio 2.6, p = 0.02) and ID (odds ratio = 1.9, p = 0.08) genotypes among those having a parental history of MI, confirming that genetic variation in the ACE locus could be involved in the risk of MI.

Adult↗
PubMed1993

Referrals for coronary angiography in a high risk population.

OBJECTIVES: To examine variations in referral for coronary angiography within Northern Ireland and relate these to local death rates from coronary artery disease (ICD rubrics 410-414). DESIGN: A descriptive retrospective analysis of aggregate hospital activity data for 1979-88 and corresponding mortality rates in the local population. SETTING: Two regional referral hospitals and 26 local district council areas. PATIENTS: 5173 patients aged 35-74 years with an underlying diagnosis of ischaemic heart disease, whose records contained complete information on their age, sex, and home address. MAIN MEASURES: Age-standardised angiography rates and corresponding standardised death rates derived from the registrar general's reports. RESULTS: Among the 26 constituent district council areas there was significant heterogeneity in the angiography rates, ranging from 62 to 335/100,000 in men and from 7 to 62/100,000 in women (likelihood ratio statistic 856 and 359 respectively). There was no significant association between these angiography rates and the local death rates from ischaemic heart disease. CONCLUSION: The results suggest a non-uniform threshold for referral for angiography. IMPLICATIONS: Clinicians need to examine the appropriate indications for referral for invasive investigation.

Adult↗
PubMed1993

Enhancing mammography uptake: who do women listen to?

Previous work has established that women who attend for mammography differ from non-attenders in a number of socio-demographic and attitudinal characteristics. The present study was conducted to determine whether women who attended for mammography differed from non-attenders in a number of key areas: (1) in how they obtained information about screening; (2) in their understanding of the disease and basic screening precepts; and (3) in the extent to which they perceived their general practitioners (GPs) and other members of the primary case team, such as practice nurses, had actively promoted the programme. Three hundred attenders and 300 non-attenders were interviewed in their own homes using a structured questionnaire. Only 5% of women interviewed had ever asked their GP for any advice about breast screening, and only 18% recalled their family doctor every discussing or raising the subject with them. Although attenders and non-attenders differed significantly in their understanding of the scope and purpose of screening, both groups obtained information more often from friends and relatives and broadcast media than from official sources. Attenders were more likely to cite material in the GP's surgery as an important source of information (chi 2 = 5.1, p = 0.02). Attenders were marginally more likely than non-attenders to have previously attended a well-woman clinic in primary care (chi 2 = 3.1, p = 0.08) and were more likely to say that such clinics were being offered by their family doctor (chi 2 = 9.8, p = 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed1993

Evaluating the breast screening programme: the need for surgical audit.

It is to be anticipated that a reduction in population mortality attributable to mammographic screening would be heralded by an increasing proportion of breast cancer cases diagnosed at earlier stages and by an improvement in case fatality. Few cancer registers routinely produce incidence or survival data by stage at diagnosis and thus improvement in these will be the harder to assess. By thorough casenote review and follow up, this study has determined the usual presentation and survival of breast cancer in Northern Ireland in 1986 before the introduction of screening. Overall, 85% of cases were Manchester stage I or II, figures which accord with other British studies. Five-year survival ranged from 77.8% for stage I (95% confidence limits 71.7%, 82.7%) to 35.7% for stage IV (95% confidence limits 13.0%, 59.4%). Forty-three per cent of cases treated in non-teaching hospitals could not be pathologically staged, more than twice the figure for teaching hospitals (Chi-squared = 15.7, df = 1, P < 0.001). Since many tumours not detected by screening will be treated outside teaching centres, this difference will reduce the statistical power to detect the true shift in stage distribution and improvement in survival from screening. Comprehensive surgical audit would help to resolve the inadequacies in existing data collection and improve the ability to evaluate the outcome of the screening programme.

Adult↗
PubMed1992

Trends in the relative frequency of histologically diagnosed epithelial dysplasia and intra-oral carcinoma in Northern Ireland, 1975-1989.

Trends in the incidence of histologically diagnosed dysplastic lesions of the intra-oral mucosa have been investigated for the period 1975-89 in a well defined population of 1.5 million. These have been contrasted and compared with trends in the incidence of intra-oral carcinoma. Cases were ascertained from the records of all the histopathology laboratories that serve the Northern Ireland population. Over the 15-year period, there were 135 cases of histologically diagnosed epithelial dysplasia. In contrast to the significant increase in the incidence of intra-oral carcinoma, there was no significant change in the annual age standardised incidence of dysplastic lesions over the period. The ratio of malignant to dysplastic diagnoses rose from 2.5:1 to 5.4:1. Only 24 of the dysplastic lesions were known to have subsequently progressed to malignant carcinoma, representing 4.5% of all invasive tumours diagnosed during 1975-89. The results highlight a number of unresolved issues regarding the natural history of intra-oral carcinoma.

Adolescent↗
PubMed1992

Trends in the incidence of histologically diagnosed intra-oral squamous cell carcinoma in Northern Ireland, 1975-89.

Studies in Britain point to a rise in the incidence of intra-oral cancer in the last 20 years, paralleling trends evident in other European countries. Cases of histologically-diagnosed primary intra-oral squamous cell carcinoma have been ascertained by reviewing the records of pathology departments in Northern Ireland. Trends in the incidence of the disease have been determined for the period 1975-89. There has been a significant increase in the incidence among men, rising from 1.78 to 3.14 per 100,000. In women over the same period the incidence rose from 0.87 to 1.19 per 100,000, but this change was not significant. These trends concur with recent findings from other countries.

Adult↗
PubMed1992

Confidence intervals and interval cancers ... needles and haystacks?

The measurement of interval cancer rates will be critical to the successful evaluation of the breast cancer screening programme. The number of interval cancers expected in a district will depend on the population size, the test sensitivity and the background incidence of breast cancer. The present study was undertaken to measure the incidence of breast cancer in Northern Ireland, and to assess the practical problems that might be encountered in ascertaining interval cancers. Given a local yearly incidence of 182/100,000, only 14 interval cancers per year might be expected in Northern Ireland (population 1.5 million). The completeness of the local cancer register would not ensure reliable detection of this relatively small number of tumours. To give larger samples sizes and thus narrow the confidence intervals of measured rates, the results from several smaller regions could be aggregated. Different regions may have different mechanisms of ascertainment and this may make the interpretation of these rates more difficult.

Adult↗
PubMed1992

Colorectal cancer and ischaemic heart disease: an uncommon inheritance!

This study reports the relative risk of death from cancer and from coronary artery disease in 1,811 first-degree relatives of 205 young colorectal cancer probands. The elevation in the risks of death from cancer (eg colon 3.6; rectum 2.0; uterus 1.8; cervix 2.3) is consistent with, though of lower magnitude than previous studies. An unexpected find was a highly significant deficit in coronary deaths. Recently discovered molecular associations between colon cancer and cholesterol metabolism suggest that further family studies of bowel cancer and heart disease in a variety of populations may be worthwhile.

Cause of Death↗
PubMed1992

Do general practitioners facilitate the breast screening programme?

Mammography uptake has been discouragingly low since the introduction of breast cancer screening in Northern Ireland. This questionnaire survey was undertaken to appraise the views of participating general practitioners (GPs) about mammography and the extent to which they followed good practice in facilitating the screening programme. Of 173 GPs, 152 returned a questionnaire. Approximately three-quarters of these GPs believed the screening programme was worthwhile for the eligible women on their list. When sent the prior notification lists from the screening unit, less than half of the GPs always checked the accuracy of patients' addresses. Fifty-five per cent of the GPs said they routinely took opportunities (as they arouse) during normal surgeries to counsel women about mammography and 90% did so in health promotion or well-woman clinics. Despite this, only 56% routinely recorded non-attendance in patients' case notes and less than 20% contacted non-attenders to advocate mammography. Such a pro-active approach was more commonly adopted with women who had not attended when invited for a cervical smear. There was no significant difference in mammography uptake among the women on the lists of GPs with differing views or whose doctors differed in their degree of active commitment to the programme. The results point to a need for the screening unit to evaluate its own advocacy role to GPs and for Health Board to devise effective appraisal strategies for health promotion clinics in primary care.

Attitude of Health Personnel↗