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Biomedical subjects

I J Perry

Publications and source records attributed to I J Perry.

64 records · Page 4Linked to original sources
PubMed1991

Conflicting views on the measurement of blood pressure in pregnancy.

Current practice with regard to the technique of blood pressure measurement in pregnancy was assessed by means of a self-completed questionnaire sent to all midwives (116) and obstetricians (11) working in a UK District General Hospital obstetric unit. The response rate was 72% (91 respondents). Over half of the respondents (53%) use the fifth phase diastolic end point (contrary to current recommendations). Of the 75 respondents who had access to a large adult cuff 54 (72%) had used it on 'less than two occasions' over the preceding four weeks. Only 10% (9) of respondents reported that they record blood pressure to the nearest 2 mmHg and 23% (22) reported that they round blood pressure readings to the nearest 10 mmHg. There were diverse views on the interpretation of multiple blood pressure recordings. The conclusion is that compliance with current recommendations on blood pressure measurement technique in pregnancy is poor. There is poor agreement among midwives and obstetricians as to how blood pressure should be recorded in pregnancy.

Blood Pressure Determination↗
PubMed1991

An emerging consensus among clinicians on treating mild hypertension but persistent uncertainty as to how blood pressure should be measured.

In 1986 and 1989 the British Hypertension Society published its recommendations on the techniques for the measurement of blood pressure and the level of pressure requiring drug therapy. In order to assess the impact of these recommendations on clinical practice among non-members of the society, we have conducted a survey using a self-reported questionnaire among 196 hospital-based clinicians, and compared our findings with a similar survey conducted in 1979. The response rate to the 1990 survey was 64% (126 respondents). Over one-third (37%) of respondents reported that they usually record the diastolic blood pressure at the fourth Korotkoff phase (muffling of sounds), 52% reported that they use the fifth phase (disappearance of sounds), and 10% reported that they record both the fourth and fifth phase. They also disagreed considerably on a number of other basic issues, including whether blood pressure should be routinely measured in the sitting or lying position, and whether readings should be taken to the nearest 2, 5 or 10 mmHg. A clear majority of clinicians indicated that they would prescribe antihypertensive drugs if the diastolic blood pressure was consistently over 100 mmHg. This represents a marked shift from the opinions expressed in 1979 and is in line with the British Hypertension Society's recommendations. However, many clinicians still measure blood pressure in a manner contrary to the society's guidelines.

Blood Pressure Determination↗
PubMed1989

ACE inhibitors compared with thiazide diuretics as first-step antihypertensive therapy.

While ACE inhibitors are considerably more expensive than thiazide diuretics, they are slightly more effective antihypertensive agents in white patients and have fewer side effects. They can be regarded as suitable first-line therapy in diabetic hypertensives. It is probable that as new drugs in this class are marketed, the price differential will lessen and they will be regarded as acceptable and useful first-line drugs in an increasingly large number of patients.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Parasuicide and suicide in the south-west of Ireland.

BACKGROUND: Suicidal behaviour has become recognised as a major public health problem. AIM: To examine hospital-treated parasuicide and suicide in the Southern and Mid-Western Health Boards. METHODS: Parasuicide data were derived from independent data collection in general and psychiatric hospitals and prisons between 1995 and 1997. The corresponding suicide data were obtained electronically from the Central Statistics Office. RESULTS: Respectively, the annual person-based male, female and total European age-standardised rates were 128.9, 154.3 and 141.3 per 100,000 for parasuicide compared to 22.7, 5.5 and 14.1 per 100,000 for suicide. The parasuicide/suicide ratio varied markedly by age, gender, area and marital status. The majority of suicides were by hanging or drowning whereas drug overdose made up the vast majority of parasuicide acts. Parasuicide was largely a city phenomenon confined to the young of both genders whereas suicide was a significant problem for city and county men, especially young adult men. CONCLUSION: There are striking differences between the patterns of fatal and non-fatal suicidal behaviour in Ireland, which should be considered in prevention initiatives.

Adolescent↗
PubMedDate not supplied

Prevalence and aetiology of leg ulcers in Ireland.

BACKGROUND: The prevalence of leg ulcer disease in Ireland has been poorly documented. AIMS: This study aimed to investigate the aetiology and prevalence of leg ulcers in one health district. METHODS: All patients receiving healthcare for an active leg ulcer in the Mid-Western Health Board (MWHB) region of Ireland (population: 317,069) were identified in a defined two-month period. A cross-sectional survey of all healthcare workers providing care to patients with leg ulceration was carried out. Patients with leg ulcers of uncertain cause were invited for follow-up assessment to establish the underlying cause. RESULTS: There were 389 patients with leg ulcers with a mean (standard deviation [SD]) age of 72.3 (11.1) years. The prevalence was 0.12% but it was 1.03% in patients aged 70 years and over. Women were twice as likely to be affected. Venous disease accounted for 81% of ulcers, and arterial disease for 16.3%, while ulceration due to diabetic neuropathy and rheumatoid vasculitis was unusual. CONCLUSION: Leg ulcers are an important source of morbidity in our ageing population. Effective treatment programmes could diminish the impact of this debilitating disease on the health service.

Adult↗
PubMedDate not supplied

Perception of the risks of smoking in the general population and among general practitioners in Ireland.

BACKGROUND: Data on perception of smoking risk amongst the Irish population are sparse. AIMS: To study the accuracy and determinants of the perceived risk of premature death due to smoking in the general population and amongst general practitioners (GPs). METHODS: Telephone surveys of a representative sample of Irish adults (1,247) and GPs (171; 85% response rate) asked participants to estimate how many of 1,000 20-year-old life-long smokers would die from smoking-related disease before the age of 70 and to identify the main cause of death from a list of seven causes: smoking, road traffic accidents, accidents at work, AIDS, homicide, illicit drugs and alcohol misuse. RESULTS: In the population and GP samples, perception of the risk of smoking-related death was similar (median 200 and 150 deaths per 1,000 smokers respectively, epidemiological estimates 250/1000). Only 43% of the population identified smoking as the most important cause of death compared with 87% of GPs. Current smoking status, younger age, female gender, lower educational attainment and lower income were associated with failure to identify smoking as the main cause of death. CONCLUSION: Despite decades of health promotion, the general public underestimates the relative importance of smoking as a cause of death.

Adult↗
PubMedDate not supplied

Established cardiovascular disease and CVD risk factors in a primary care population of middle-aged Irish men and women.

Contemporary Irish data on the prevalence of major cardiovascular disease (CVD) risk factors are sparse. The primary aims of this study were (1) to estimate the prevalence of major cardiovascular disease risk factors, including Type 2 Diabetes Mellitus, in the general population of men and women between the ages of 50 and 69 years; and (2) to estimate the proportion of individuals in this age group at high absolute risk of cardiovascular disease events on the basis of pre-existing cardiovascular disease or as defined by the Framingham equation. Participants were drawn from the practice lists of 17 general practices in Cork and Kerry using stratified random sampling. A total of 1018 people attended for screening (490 men, 48%) from 1473 who were invited, a response rate of 69.1%. Cardiovascular disease risk factors and glucose intolerance are common in the population of men and women aged between 50 and 69 years. Almost half the participants were overweight and a further quarter met current international criteria for obesity, one of the highest recorded prevalence rates for obesity in a European population sample. Forty per cent of the population reported minimal levels of physical activity and 19% were current cigarette smokers. Approximately half the sample had blood pressure readings consistent with international criteria for the diagnosis of hypertension, but only 38% of these individuals were known to be hypertensive. Eighty per cent of the population sample had a cholesterol concentration in excess of 5 mmol/l. Almost 4% of the population had Type 2 Diabetes Mellitus, of whom 30% were previously undiagnosed. A total of 137 participants (13.5%) had a history or ECG findings consistent with established cardiovascular disease. Of the remaining 881 individuals in the primary prevention population, a total of 20 high-risk individuals (19 male) had a risk of a coronary heart disease event > or = 30% over ten years according to the Framingham risk equation, giving an overall population prevalence of 2.0% (95% CI 1.3 - 3.0). At a risk level > or = 20% over ten years, an additional 91 individuals (8.9%) were identified. Thus a total of 24.4% of the population were at risk either through pre-existing CVD (13.5%) or an estimated 10-year risk exceeding 20% according to the Framingham risk equation (10.9%). Thus a substantial proportion of middle-aged men are at high risk of CVD. The findings emphasise the scale of the CVD epidemic in Ireland and the need for ongoing monitoring of risk factors at the population level and the need to develop preventive strategies at both the clinical and societal level.

Aged↗
PubMedDate not supplied

Prevalence and lifestyle determinants of the metabolic syndrome.

Participants with the metabolic syndrome are at risk of developing type 2 diabetes and coronary heart disease. The aim of this study was to determine the role of lifestyle risk factors in the development of the metabolic syndrome with particular reference to physical activity, smoking and alcohol consumption. We performed a cross sectional study of the prevalence of CVD risk factors and glucose intolerance, including type 2 diabetes involving a group of 1473 men and women were sampled from 17 general practice lists in the South of Ireland. A total of 1018 attended for screening, giving a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and provided fasting blood samples for analysis of glucose, insulin and lipids. The metabolic syndrome was defined according to the current WHO criteria. The prevalence of the metabolic syndrome was 21.0% (95% C.I. 18.7% to 24.1%). In multivariate analyses with the metabolic syndrome as the dependent variable we observed a significant, independent inverse association with physical activity level (OR = 0.60; 95% CI, 0.39-0.90 for medium and OR = 0.51; 95% CI, 0.28-0.93) for high level of activity relative to the low level of activity group). Ex-drinkers had a higher prevalence of the syndrome in multivariate analysis relative to occasional drinkers, (OR = 2.38; 95% CI, 1.08-5.26). Prevalence of the metabolic syndrome was not significantly associated with current alcohol consumption or with smoking status. These data highlight the importance of physical inactivity in the aetiology of the metabolic syndrome.

Aged↗