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Biomedical subjects

G Foster

Publications and source records attributed to G Foster.

At least 91 records · Page 5Linked to original sources
PubMed1996

Supporting children in need through a community-based orphan visiting programme.

There is an urgent need for programmes to be established to support the growing number of orphans in countries severely affected by AIDS. Most orphans are being cared for by extended families under difficult circumstances. Few descriptions of community-based orphan support programmes exist. We describe one such programme established in Zimbabwe in 1993. Twenty-five volunteers identified 300 orphan households. During one year, volunteers made 1725 home visits and 123 households received an average of $11 in material support or school fees. In 292 orphan households there were 702 orphans, 14.7% of children under 15 years in the area. The rate of parental deaths was increasing with 3.5% of households in the area having a parental death in 1994. Forty-five per cent of caregivers were grandparents and 33% of caregivers were over 60 years. Three per cent of orphans were cared for by adolescent siblings. The poorest orphan households were those in receipt of school fees, with out-of-school children or with an older sibling as caregiver. Community members initiated activities to help orphans. The programme described is targeted, effective and replicable. Community-based organizations such as local churches and women's groups can be mobilized to administer programmes which provide support to the poorest orphan households.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Actinobacillus delphinicola sp. nov., a new member of the family Pasteurellaceae Pohl (1979) 1981 isolated from sea mammals.

We performed phenotypic and phylogenetic studies of a gram-negative, rod-shaped bacterium isolated from cetaceans. The results of a 16S rRNA gene sequence analysis demonstrated that this bacterium represents a previously unknown line of descent in the family Pasteurellaceae. On the basis of the results of our phylogenetic analysis and phenotypic criteria, we propose that this organism should be classified as a new species, Actinobacillus delphinicola sp. nov. The type strain of A. delphinicola sp. nov. is strain NCTC 12870.

Actinobacillus↗
PubMed1996

Parastomal hernia.

Parastomal herniation is a common complication after stoma formation. The incidence can be reduced by using an extraperitoneal technique, limiting the size of the trephine to 1.5-2.0 cm or by strengthening with a mesh. If an intraperitoneal technique is used the intestine should be brought out through the rectus muscle. Generally, the symptoms are easily controlled with a support belt. Various techniques have been advocated for surgical repair. Fascial repair alone should no longer be performed owing to an unacceptably high recurrence rate, but should be combined with a prosthetic mesh. Relocation of the stoma should be performed for primary repairs.

Enterostomy↗
PubMed1996

Low birth weight in urban Harare.

OBJECTIVES: 1. To measure the incidence of low birth weight from all institutional deliveries in a defined catchment area of urban Harare. 2. To estimate the relative proportions of preterm and small for gestational age (SGA). DESIGN: The study was descriptive and was conducted during the last three months of 1986. SETTING: The low risk maternity units in three high density suburbs, Highfield, Glen Norah and Glen View and the referral centre Harare Central Hospital. SUBJECTS: All babies born to women residing in the study areas in the maternity clinics and those transferred to the referral hospital were identified and weighed. MAIN OUTCOME MEASURES: For low birthweight babies gestation was estimated by the Dubowitz method and perinatal outcome was recorded. RESULTS: During the three month study period in 1986, 2,056 babies in total were born; 223 (10.8%) of which were low birthweight. Of these 65 (44%) were preterm and 55 (37%) were SGA. CONCLUSION: The findings show a lower percentage of low birthweight and SGA babies than in many developing countries but higher than the norm for developed countries. The study demonstrates a need for resources to prevent low birthweight delivery and improve care for low birthweight babies.

Female↗
PubMed1995

Accuracy of clinical assessment of deep-vein thrombosis.

The clinical diagnosis of deep-vein thrombosis is generally thought to be unreliable. From experience, we hypothesised that this widely held view might be incorrect. We developed a clinical model and prospectively tested its ability in three tertiary care centres to stratify symptomatic outpatients with suspected deep-vein thrombosis into groups with high, moderate, or low probability groups of deep-vein thrombosis. We evaluated our clinical model in combination with venous ultrasonography to determine the potential for an improved and simplified diagnostic approach in patients with suspected deep-vein thrombosis. All patients were clinically assessed to determine the probability for deep-vein thrombosis before they had ultrasonography and venography. All tests were performed and interpreted by independent observers. In 529 patients, the clinical model predicted prevalence of deep-vein thrombosis in the three categories: 85% in the high pretest probability category, 33% in the moderate, and 5% in the low category. There was no statistical difference in the performance of the model in the three centres. The model demonstrated excellent interobserver reliability (Kappa = 0.85). There were important differences with ultrasonography between the high and low pretest probability groups for both positive predictive values (100% (95% CI, 94-100%) vs (63% [35-85%], respectively). Thus, use of the clinical model combined with ultrasonography would decrease the number of false positive and negative diagnosis if venography were done when the ultrasound result and pretest probability were discordant. The diagnostic process could be simplified by excluding those patients with low pretest probability and normal ultrasound results from serial testing.

Decision Trees↗
PubMed1995

Orphan prevalence and extended family care in a peri-urban community in Zimbabwe.

An orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included orphans. 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents. Orphan prevalence was highest in a peri-urban rural area (17.2%) and lowest in a middle income medium density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of parental deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less well-educated than non-orphan household heads. The majority of orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation of orphaned children by extended family caregivers. The fact that community coping mechanisms are changing does not imply that extended family methods of caring are about to break down. However, the emergence of orphan households headed by siblings is an indication that the extended family is under stress. Emphasis needs to be placed upon supporting extended families by utilizing existing community-based organizations. Orphan support programmes may need to be established initially in high risk communities such as low-income urban areas and peri-urban rural areas.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Effect of dose adjustment on enalapril-induced cough and the response to inhaled capsaicin.

1. In nine hypertensive patients with enalapril-induced cough the effect of altering the dose of enalapril on subjective cough and the cough response to inhaled capsaicin was examined in a random single-blind balanced cross-over study. They received three doses of enalapril, each for 3 weeks; the dose at entry (mean 10 mg daily); double this dose (mean 20 mg daily); and half this dose (mean 5 mg daily). 2. The cough response to inhaled capsaicin was also measured in two control groups: hypertensive patients on long-term enalapril treatment with no cough (n = 18), and hypertensive patients taking nifedipine (n = 17). 3. In patients with enalapril-induced cough there were significant dose-responses for enalapril as regards severity of cough (P < 0.05) and night time waking by cough (P < 0.05), but not for frequency of cough. Although the cough was less severe (P < 0.02) and caused less night time waking (P < 0.03) on the lowest dose of enalapril (mean 5 mg daily) it did not disappear completely in any patient. 4. The sensitivity to inhaled capsaicin did not differ significantly on the three doses of enalapril. The relative potency of capsaicin on enalapril 20 mg compared with enalapril 5 mg was 1.0 (95% CI 0.4-2.2). The wide confidence limits indicate that an important dose-dependent shift in capsaicin sensitivity is not excluded. 5. The sensitivity to inhaled capsaicin differed significantly between patients with enalapril-induced cough and both control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1995

Cetobacterium ceti gen. nov., sp. nov., a new gram-negative obligate anaerobe from sea mammals.

Phenotypic and phylogenetic studies were performed on a Gram-negative obligately anaerobic rod-shaped bacterium isolated from two sea mammals. 16S rRNA gene sequence analysis demonstrated the bacterium represents a hitherto unknown line of descent peripherally associated to the fusobacteria and low G+C relatives. Based on the result of the phylogenetic analysis and phenotypic criteria, it is proposed that the bacterium should be assigned to a new genus, Cetobacterium ceti gen. nov., sp. nov. The type strain of Cetobacterium ceti sp. nov. is NCFB 3026.

Animals↗
PubMed1995

Novel squalestatins produced by biotransformation.

Microorganisms were screened for the ability to modify the squalene synthase inhibitor squalestatin 1. Biotransformation of 1 by two actinomycetes, S15106 and S15138, yielded three products hydroxylated on the 4,6-dimethyl-oct-2-enoyl side chain either at the 6 position (5) or 7 position (4 two diastereoisomers), and lacking the acetyl ester from the C-1 side chain. Many strains were found to hydrolyse the 4,6-dimethyl-oct-2-enoyl or acetyl esters to yield squalestatins 2 or 3. The 3-methyl ester (6) of 1 was obtained using Fusarium sp. F13945. This fungus also produced a farnesoic acid derivative, possibly in response to inhibition of its squalene synthase by 1. The biotransformation products of 1 all retained potent squalene synthase inhibitory activity.

Actinomycetales↗
PubMed1995

Selecting an appropriate isotopic internal standard for gas chromatography/mass spectrometry analysis of drugs of abuse--pentobarbital example.

Internal standards are commonly used for the quantitative determination of drugs of abuse and their metabolites (drug/metabolite) in biological fluids and tissues by the selective ion monitoring (SIM) gas chromatography/mass spectrometry (GC/MS) procedure. Analogs of drugs/metabolites that are labeled with three or more deuterium atoms (isotopic analog) at appropriate positions are considered to be the most effective internal standards for these applications. Before a specific deuterated analog can be adopted as an internal standard in a GC/MS assay, the mass spectrum of the compound or its derivative must be evaluated along with the corresponding spectrum from the parent drug/metabolite. There should be an adequate number of sufficiently high-mass ions (typically three for the drug/metabolite and two for the isotopic analog) that can be attributed to each analyte, and these ions should be sufficiently free of interference from the other analyte of the pair (cross-contribution). Interferences may be caused by the presence of an isotopic impurity in the deuterated analog (extrinsic factor) or may be due to the ion fragmentation characteristics of the compound (intrinsic factor). The extrinsic factor may be corrected by the manufacturer with different synthetic methods and purification procedures, while the intrinsic factor may be partially or wholly corrected through the use of different chemical derivatives (sample preparation stage) or different ionization (GC/MS assay stage) procedures. In this study, pentobarbital/d5-pentobarbital is used as the exemplar analyte/deuterated analog pair to illustrate the ion selection and evaluation procedures. Full-scan mass spectra were employed for preliminary ion selection. SIM data were then used to calculate the extent, if any, of cross-contributions.(ABSTRACT TRUNCATED AT 250 WORDS)

Gas Chromatography-Mass Spectrometry↗
PubMed1995

Comparison of the accuracy of impedance plethysmography and compression ultrasonography in outpatients with clinically suspected deep vein thrombosis. A two centre paired-design prospective trial.

Impedance plethysmography (IPG) and compression ultrasonography (CUS) have been reported to be highly accurate for the diagnosis of deep vein thrombosis (DVT) in symptomatic patients. In many centres CUS has become the method of choice. However, direct comparisons of the accuracy of IPG to CUS have not been performed. To determine the test of choice we performed a two centre prospective comparison of IPG and CUS, with venography, and determined how the size and distribution of thrombi influenced the accuracy of each test. 495 symptomatic outpatients with suspected DVT had evaluable venograms. The prevalence of DVT was 27% (130/495), 84% (109) of which were proximal. The sensitivity of IPG and CUS for proximal vein thrombosis was 77% and 90% respectively (p = .002). The specificity of IPG was 93% whereas the specificity of CUS was 98% (p = 0.04). There were significant differences in accuracy between the two centres as a consequence of differences in the size and location of thrombi The majority of proximal thrombi not detected by IPG and CUS involved less than 5 cm of the distal half of the popliteal vein and most of these thrombi occurred in one centre. Exclusion of these thrombi from the analysis increases the sensitivity of CUS to 99% (86/87) and IPG to 91% (72/79), for proximal thrombi (P = .019). The positive predictive value of CUS was strongly influenced by the number of abnormal venous segments (three sites were examined); 100% (80/80) if two or three sites were abnormal, but only 68% if a single site was involved. We conclude that: 1) CUS is more accurate than the IPG for the diagnosis of DVT in symptomatic outpatients, and this relationship holds true regardless of the size or location of the DVT, 2) the sensitivities of IPG and CUS are much lower for small proximal DVT, and 3) confirmatory venography is warranted if the abnormality with CUS is limited to one venous segment.

Ambulatory Care↗
PubMed1994

Ipsilateral breast tumor recurrence postlumpectomy is predictive of subsequent mortality: results from a randomized trial. Investigators of the Ontario Clinical Oncology Group.

PURPOSE: To determine whether ipsilateral breast tumor recurrence (IBTR) postlumpectomy was independently predictive of distant relapse and mortality in women with node negative breast cancer. METHODS AND MATERIALS: A randomized trial was conducted in Ontario between 1984 and 1989, in which 837 women with node negative disease who had undergone lumpectomy and axillary dissection were randomized to either postoperative radiation (40 Gy in 16 fractions to the whole breast, followed by a boost of 12.5 Gy in five fractions to the primary site), or no further treatment. A Cox proportional hazards regression analysis was performed for the endpoints mortality and distant relapse using the fixed covariates, treatment, age, tumor size, estrogen receptor status, progesterone receptor status, and nuclear grade; and the time dependent variable IBTR. RESULTS: The analysis was based on 799 patients for which all fixed covariate data was available. Median follow-up was 66 months. The cumulative rate of IBTR at 5 years was significantly greater for the no treatment group compared to the radiation group; 30% vs. 8% respectively (p < 0.0001). No difference was detected in overall survival between the treatment groups (p = 0.45). Significant independent predictors for mortality were nuclear grade, high vs. medium or low (relative risk (RR) = 2.28, p = 0.0001); and tumor size > or = 2 cm. vs. < 2 cm. (RR = 1.64, p = 0.01). In addition, IBTR predicted increased mortality (RR = 2.18, p < 0.0006). Similar results were observed for distant relapse. An IBTR within 1 year of surgery was associated with a higher risk of distant relapse and mortality. CONCLUSION: Local breast recurrence following lumpectomy is associated with an increased risk of distant relapse and death.

Breast Neoplasms↗
PubMed1994

Determinants of the demographic impact of HIV-1 in sub-Saharan Africa: the effect of a shorter mean adult incubation period on trends in orphanhood.

Recent evidence suggests that the adult HIV-1 incubation period may be shorter in some sub-Saharan African populations than in Western populations. In this article we use mathematical-model-based simulations to show that, other things being equal, a shorter incubation period can result in smaller but more pronounced HIV-1 epidemics and faster, more acute, changes in demographic features, such as adult mortality, orphanhood and population structure. Empirical studies of orphanhood reveal similar patterns to those found in the simulations, but suggest that migration patterns and structural factors can give rise to greater concentrations of orphans in areas of relatively low HIV-1 prevalence.

Adolescent↗