Informed consent in neonatal randomised trials.
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Humans↗
Biomedical subjects
H Campbell
Publications and source records attributed to H Campbell.
Effect of plasma scale length on multi-MeV proton production by intense laser pulses.
The influence of the plasma density scale length on the production of MeV protons from thin foil targets irradiated at I lambda(2) = 5 x 10(19) W cm(-2) has been studied. With an unperturbed foil, protons with energy >20 MeV were formed in an exponential energy spectrum with a temperature of 2.5+/-0.3 MeV. When a plasma with a scale length of 100 microm was preformed on the back of the foil, the maximum proton energy was reduced to <5 MeV and the beam was essentially destroyed. The experimental results are consistent with an electrostatic accelerating mechanism that requires an ultrashort scale length at the back of the target.
Journal Article↗
The evidence of mtDNA haplogroup F in a European population and its ethnohistoric implications.
Mitochondrial DNA polymorphism was analysed in a sample of 108 Croatians from the Adriatic Island isolate of Hvar. Besides typically European varieties of human maternal lineages, haplogroup F was found in a considerable frequency (8.3%). This haplogroup is most frequent in southeast Asia but has not been reported before in Europe. The genealogical analysis of haplogroup F cases from Hvar suggested founder effect. Subsequent field work was undertaken to sample and analyse 336 persons from three neighbouring islands (Brac, Korcula and Krk) and 379 more persons from all Croatian mainland counties and to determine if haplogroup F is present in the general population. Only one more case was found in one of the mainland cities, with no known ancestors from Hvar Island. The first published phylogenetic analysis of haplogroup F worldwide is presented, applying the median network method, suggesting several scenarios how this maternal lineage may have been added to the Croatian mtDNA pool.
DNA, Mitochondrial↗
Influence of chronic alcohol abuse and ensuing forced abstinence on static subjective accommodation function in humans.
PURPOSE: Acute alcohol ingestion can change accommodation, but the long term effects of sustained alcohol consumption on accommodative function have not been studied in detail. This study was thus undertaken on individuals with a history of alcohol abuse. METHODS: Thirty-seven male individuals aged 25-56 years (average 40 years) from an alcohol rehabilitation centre in Inverness, Scotland, were assessed on admission and after a week of forced abstinence. The results were compared to a paired age-matched set of control male subjects. The static amplitude of accommodation was measured by an RAF rule, and the pupil size measured with a pupil gauge. RESULTS: On admission, the group mean measured amplitude of accommodation was 4.7 +/- 2.2 D (mean +/- SD). These values for the alcoholics were lower than age-matched controls (of 5.9 +/- 2.9 D). The slope of the age-dependent decline in RAF rule accommodation measures was significantly smaller for the alcoholics compared to controls (at 0.215 +/- 0.027 D/year versus 0.332 +/- 0.015 D/year, respectively; p < 0.001), with the younger alcoholics showing a greater impairment. Following abstinence, there was no measurable change in accommodation measured, indicating the lower amplitude in the alcoholics was not attributable to circulatory alcohol levels. The resting pupil diameter in the alcoholics was 4.37 +/- 0.63 mm compared to the controls of 3.97 +/- 0.75 mm, with a higher incidence of small pupils (< or = 3 mm) in the controls. CONCLUSIONS: The results indicate that chronic alcohol use can adversely affect subjective static accommodation, especially in younger alcoholics, as well as cause slight mydriasis.
Accommodation, Ocular↗
Nucleotide excision repair gene XPD polymorphisms and genetic predisposition to melanoma.
The nucleotide excision repair pathway has evolved to deal with UV light-induced DNA damage. Individuals with the rare inherited nucleotide excision repair deficiency disease xeroderma pigmentosum have a 1000-fold increased incidence of skin cancer. We are interested in the possibility that more subtle changes in nucleotide excision repair genes, resulting in either a reduced capacity for repair or in altered interactions between repair proteins and components of the cell cycle control machinery, might constitute important genetic risk factors for the development of skin cancer in the general population. To investigate this hypothesis we have compared the frequency of polymorphisms in exons 6, 22 and 23 of the XPD gene in melanoma patients and a control group. For each of these two allele polymorphisms one of the alleles was over-represented in the melanoma group and there was a significant association with melanoma. Importantly, this association did not extend to markers immediately flanking the XPD gene, thus providing evidence that XPD gene polymorphisms might predispose to melanoma in the general population. There is a report that one of the polymorphic XPD alleles (exon 23 Lys), which is over-represented in the melanoma group, has reduced repair proficiency and we discuss the possibility that this is the causal change to the XPD gene that predisposes to melanoma.
Alleles↗
Cost analysis of a hospital-at-home initiative using discrete event simulation.
OBJECTIVES: To examine whether, from a National Health Service (NHS) and local authority social services' viewpoint, a hospital-at-home service was cost saving compared with conventional inpatient care. METHODS: The subjects of this part-retrospective and part-prospective cost analysis were 51 elderly medical and orthopaedic surgical patients assessed at Hillingdon Hospital, West London, as being suitable for hospital-at-home care. Thirty patients received hospital-at-home care, provided for up to 14 days, while 21 patients remained in hospital and received standard inpatient care. All direct costs to the NHS hospital, community health services' provider and social services' department during the initial episode of care and the three months after discharge were collected for each group of patients. Costs and clinical event data were entered in a discrete event simulation model which generated baseline results. Uncertainty surrounding the model's parameters was explored using sensitivity analysis. RESULTS: The baseline simulation performed with 1000 patients in each group showed the mean cost per patient for hospital-at-home care and three-month follow-up to be around three-fifths the mean cost per patient of inpatient care and follow-up. Most of the excess cost in the inpatient group was attributable to the initial period of hospitalisation. Under all assumptions used in the sensitivity analysis, the hospital-at-home service was less costly. CONCLUSIONS: For elderly patients assessed as needing no more than 14 days of hospital care, hospital-at-home care is cost saving to health and social care agencies when compared with conventional inpatient care.
Aged↗
Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health.
UNLABELLED: Pneumococcal disease is a major cause of morbidity and mortality in infants and young children worldwide. New pneumococcal conjugate vaccines include 7 to 11 serotypes, which are the most common cause of paediatric disease in most parts of the world. The efficacy of a 7-valent conjugate vaccine was 97.4% (95% CI, 82.7-99.9) against invasive pneumococcal disease, and 57% (95% CI, 44-67) against otitis media, caused by vaccine serotypes. Evidence shows that the vaccine has the potential to prevent pneumonia. Pneumococcal conjugate vaccination has also been shown to reduce nasopharyngeal carriage of vaccine serotypes (particularly serotypes associated with antibiotic resistance). Thus widespread use of pneumococcal conjugate vaccine could substantially reduce the burden of invasive disease and would have the potential to control the global spread of antibiotic resistance in pneumococci. CONCLUSION: It is important that these highly effective vaccines should be made available to children in the developing countries.
Child, Preschool↗
Pneumococcal vaccination: opinion of general practitioners and hospital doctors in Scotland, 1999-2000.
A cross sectional survey by postal questionnaire was carried out to examine general practitioners' (GPs) and hospital doctors' (HDs) knowledge, attitudes and practice (KAP) with regard to pneumococcal vaccination in primary and hospital care in Scotland. Most GPs and HDs considered patients with chronic medical conditions, as recommended by the Department of Health (DoH), to be candidates for pneumococcal vaccination. Although the DoH does not currently recommend the vaccine for all the elderly, 47% of GPs and 46% of HDs reported that the vaccine should be given to this group. GPs (61-85%) and HDs (48-55%) indicated that they considered the vaccine to be safe and effective. The acceptance of pneumococcal vaccine was much lower than for influenza vaccine however, and 79% of HDs and 17% of GPs had never used the vaccine. Documented policies (with or without set targets) for pneumococcal vaccine existed in only 14% of general practice and 3% of hospital settings. Over 70% of respondents indicated that GPs should take responsibility for pneumococcal vaccination. The main sources of knowledge about pneumococcal vaccines were stated to be discussion with colleagues, review of medical literature, past experience, and the DoH recommendations. A clear immunisation policy and financial support for vaccination were identified as important strategies to improve pneumococcal vaccine coverage. Strategies directed toward these factors could enhance vaccine delivery and coverage of vaccine in high-risk individuals.
Cross-Sectional Studies↗
Serotypes/groups distribution and antimicrobial resistance of invasive pneumococcal isolates: implications for vaccine strategies.
Based on the invasive pneumococcal isolates referred to reference laboratories in Scotland in 1988-99, we identified the distribution of serotypes/groups and their antimicrobial resistance patterns in order to evaluate the coverage of polysaccharide and the new pneumococcal conjugate vaccines. A total of 5659 invasive isolates were included. Of these, 5124 (90.5%) were blood isolates, 308 (5.5%) were CSF isolates, 143 (2.5%) were blood and CSF and 84 (1.5%) were other normally sterile isolates. The most prevalent 11 serotypes/groups were 14, 9, 19, 6, 23, 1, 3, 4, 7, 8 and 18, in numerical order. These accounted for 84% of total serotypes/groups. The serotypes/groups included in the 23 and 14-valent polysaccharide vaccines accounted for 96% and 88% of all isolates. Both vaccines accounted for 98% of penicillin non-susceptible and 100% of erythromycin non-susceptible isolates. The 7, 9, and 11-valent conjugate vaccines covered 61, 68 and 80% of invasive isolates respectively. The coverage of these vaccines was substantially higher in youngest age group with 84, 86 and 93% of invasive isolates in children < 2 years included in the 7, 9 and 11-valent conjugate vaccines compared with 58, 64 and 77% in adults > or = 65 years of age. The serotype/group distribution of invasive isolates in Scotland varied from year to year over the period 1993-9. The coverage of the 23-valent vaccine remained above 95% in each year but the coverage of the 7, 9 and 11-valent conjugate vaccines showed more marked fluctuation with coverage as low as 53, 60 and 75% in some years. Continued surveillance of invasive pneumococcal isolates is required to inform the development of appropriate vaccine strategies to prevent pneumococcal disease in Scotland.
Adolescent↗
Lead levels in domestic water supplies and neural tube defects in Glasgow.
OBJECTIVE: To study the association between "pregnancy" prevalence (affected births and terminations) of neural tube defects in postcode districts of Glasgow and lead concentrations in domestic water. SETTING: Postcode districts of Glasgow supplied by water from the Loch Katrine reservoir. DESIGN: An ecological study. Lead concentrations from 1911 randomly selected domestic water samples were obtained from the Glasgow 93 lead study. Neural tube defects (affected births and terminations) were identified from the Glasgow register of congenital anomalies for the period 1983-95 for each postcode district in the study population. Correlations were sought between lead concentrations and pregnancy prevalence of neural tube defects/1000 live births in postcode districts. RESULTS: No correlation was found between domestic water lead concentrations > 10 microg/litre and pregnancy prevalence of neural tube defects within postcode districts. Areas of Glasgow previously with high domestic water lead concentrations did not have a higher prevalence of neural tube defects. Houses with the lowest domestic water lead concentrations were in Carstairs deprivation categories 1 (least deprived), 6, and 7 (most deprived). The highest pregnancy prevalence of neural tube defects was found in the most deprived areas. CONCLUSION: Deprivation is a risk factor for neural tube defects and might have been a confounding factor in previous studies looking at the association between such defects and domestic water lead concentrations. This study does not support the hypothesis that levels of lead > 10 microg/litre in domestic water supplies are associated with a higher pregnancy prevalence of neural tube defects. The reasons behind the decline in pregnancy prevalence of neural tube defects seen in the past two decades remain unexplained.
Female↗
Evidence based medicine in practice: lessons from a Scottish clinical genetics project.
OBJECTIVE: To establish national clinical guidelines and integrated care pathways for five conditions (tuberous sclerosis (TS), Huntington's disease (HD), myotonic dystrophy (MD), neurofibromatosis type 1 (NF1), and Marfan syndrome (MS)) and audit their use in Scotland. DESIGN: Systematic review of published reports followed by consensus conferences to prepare clinical guidelines and integrated care pathways. Structured review of medical records before and after introduction of integrated care pathways to document changes in practice. Survey of staff views on procedures adopted. SETTING: All four clinical genetics centres in Scotland. RESULTS: Project resulted in reduced variation in practice across centres, improved data recording in medical records, and improved communication with other professional groups. A very poor evidence base for management of patients with the conditions studied was found. CONCLUSIONS: A collaborative structure for undertaking clinical research would improve the evidence base for current practice. National discussion of the boundaries of responsibility of care for the long term management of patients with these disorders is required. The integrated care pathway approach shows promise as a means of facilitating the development of audit within clinical genetics services.
Evidence-Based Medicine↗
Trend analysis of socioeconomic differentials in deaths from injury in childhood in Scotland, 1981-95.
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Adolescent↗
Potential interventions for the prevention of childhood pneumonia in developing countries: improving nutrition.
Acute respiratory infections are the leading cause of childhood death in developing countries. Current efforts at mortality control focus on case management and immunization, but other preventive strategies may have a broader and more sustainable effect. This review, commissioned by the World Health Organization, examines the relations between pneumonia and nutritional factors and estimates the potential effect of nutritional interventions. Low birth weight, malnutrition (as assessed through anthropometry), and lack of breast-feeding appear to be important risk factors for childhood pneumonia, and nutritional interventions may have a sizeable effect in reducing deaths from pneumonia. For all regions except Latin America, interventions to prevent malnutrition and low birth weight look more promising than does breast-feeding promotion. In Latin America, breast-feeding promotion would have an effect similar to that of improving birth weights, whereas interventions to prevent malnutrition are likely to have less of an effect. These findings emphasize the need for tailoring interventions to specific national and even local conditions.
Breast Feeding↗
GPs' views on their role in cancer genetics services and current practice.
BACKGROUND: Increasing demand for cancer genetics services has necessitated an urgent review of how these services are organized and, in particular, identification of an effective role for primary care. OBJECTIVES: We aimed to assess the views of GPs on their role in cancer genetics services and their confidence in performing that role; to assess their understanding of cancer genetics, current practice and referral behaviour; and to identify needs for information and training to enable GPs to play an effective role in these services. METHOD: A cross-sectional questionnaire survey of GPs was conducted through general practices in SE Scotland; 397 (response rate 59.3%) GPs returned a completed questionnaire. Outcome measures were: responders' perceptions of their role in cancer genetics services; confidence within that role; understanding of cancer genetics; current practice regarding patients presenting with concerns about their family history of cancer; and perceived information and training needs. RESULTS: GPs identified their role to be: taking a family history; making appropriate referrals to specialist services; providing emotional support; teaching breast self-examination; and discussing need for screening. Lack of confidence within this role was reflected in low levels of understanding of cancer genetics and in inappropriate referral practices. Concerns were expressed about the increasingly specialist role demanded of primary care. A desire for referral guidelines and community genetics clinics was identified. CONCLUSIONS: GPs readily identify a role for themselves in cancer genetics services, but admit to a lack of confidence in this area, calling for clear referral guidelines and specialist community support. Current inappropriate referral to specialist services results from a lack of confidence in estimating cancer risk, highlighting the need for the development of clear referral criteria. Given the rapidly increasing demand for cancer genetics services and the vital role of primary care, it is important to identify a model of these services that facilitates effective involvement of GPs without further increasing their workload.
Attitude of Health Personnel↗
Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. WHO Integrated Management of Childhood Illness (IMCI) Referral Care Project.
Simplified guidelines for the emergency care of children have been developed to improve the triage and rapid initiation of appropriate emergency treatments for children presenting to hospitals in developing countries. The guidelines are part of the effort to improve referral level paediatric care within the World Health Organisation/Unicef strategy integrated management of childhood illness (IMCI), based on evidence of significant deficiencies in triage and emergency care. Existing emergency guidelines have been modified according to resource limitations and significant differences in the epidemiology of severe paediatric illness and preventable death in developing countries with raised infant and child mortality rates. In these settings, it is important to address the emergency management of diarrhoea with severe dehydration, severe malaria, severe malnutrition, and severe bacterial pneumonia, and to focus attention on sick infants younger than 2 months of age. The triage assessment relies on a few clinical signs, which can be readily taught so that it can be used by health workers with limited clinical background. The assessment has been designed so that it can be carried out quickly if negative, making it functional for triaging children in queues.
Case Management↗
Genetic epidemiological studies of eastern Adriatic Island isolates, Croatia: objective and strategies.
In this paper, the authors discuss why isolate island populations represent a particularly helpful model for genetic epidemiological studies. A thorough previous anthropological research carried out in Eastern Adriatic island isolates, Croatia, in terms of ethnohistory, geography and current demography is reviewed. The major results of the studies of population genetic structure of those populations, including model-bound and model-free approaches, the analyses of serogenetic polymorphisms and most recent studies using HLA class II, VNTR and STR DNA polymorphisms, are briefly presented. The organization of health care on the islands is analyzed and some relevant details of specific medical problems and some autochtonous diseases in these island populations is noted. The authors present in outline four illustrative examples of research opportunities which are afforded by the unique circumstances found in these isolate communities. These relate to hereditary dwarfism on Krk island, Mal de Meleda on Mljet island, extreme inbreeding on Susak island and population genetics of cancer on the islands of Brac, Hvar, Korcula, Vis and Lastovo. Finally, the authors develop objectives and strategies for a long-term genetic epidemiological research of these populations and suggest that such a programme of investigation would further our understanding of the causes of (rare) diseases which are uniquely important to these communities but also of common diseases which are important contributors to the burden of disease both in these islands and throughout the world.
Croatia↗
Cancer incidence in eastern Adriatic isolates, Croatia: examples from the islands of Krk, Cres, Losinj, Rab and Pag.
As an extension of previous research this study investigates the incidence of cancer in five genetic isolate island populations of the Eastern Adriatic, Croatia. Thorough anthropological research over the past three decades has established some of those populations as outstanding examples of genetic isolates. A previous study which found higher cancer incidence in 5 Eastern Adriatic islands than in a control population supported a hypothesis that among the founders of these populations there were genetic variants (especially with recessive inheritance) responsible for genetic susceptibility to certain types of cancer. This study sought to investigate cancer incidence in 5 further island populations. All cancer cases in five island populations (Krk, Cres, Losinj, Rab and Pag) over the 20-year period (1971 to 1990) was extracted from the data of the Croatian Cancer Registry. The mainland populations of Istrian and Primorsko-Goranska County, characterized by similar environmental factors but an outbred genetic structure, represented a control population. After standardization by by sex and age, cancer incidence was higher in the island populations than in the control population in both sexes. The cancer sites primarily responsible for the excess incidence were prostate, stomach and pancreatic cancer in males, and ovarian, breast, stomach, bowel, and brain cancer in females. The reasons for the increased cancer incidence are uncertain and may be due to different environmental exposure between the two populations. However, it is possible that genetic isolation and inbreeding are important factors. Further investigations of cancer in these isolate populations are warranted to explore these findings further.
Adult↗
Integrated care pathways.
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Clinical Protocols↗