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Biomedical subjects

J Collier

Publications and source records attributed to J Collier.

At least 19 recordsLinked to original sources
PubMed2003

Multimedia versus written information for nocturnal enuresis education: a cluster randomized controlled trial.

OBJECTIVE: This study evaluated the impact of child-focused information provision using a multimedia software package 'All About Nocturnal Enuresis' and written leaflets containing the same information for bedwetting children. DESIGN: A stratified cluster randomized controlled trial with data on 270 children collected longitudinally. SETTING: Fifteen school nurse-led community enuresis clinics in Leicestershire, UK. MAIN OUTCOME MEASURES: The outcome measures were becoming and remaining dry and time to dry, non-attendance and dropout rates. The psychological measures completed by children were the impact of bedwetting and Coopersmith self-esteem scales. Parents completed the maternal tolerance scale. RESULTS: No significant intervention effect was found for any of the outcome measures recorded during treatment, at discharge or six-months post discharge. CONCLUSIONS: Multimedia educational programs and written leaflets are widely used to enable children to learn more about their health-related conditions. However, our result suggests that multimedia is no more effective than traditional materials at effecting health-related behavioural change.

Adolescent↗
PubMed2002

The reproducibility of endometrial volume acquisition and measurement with the VOCAL-imaging program.

OBJECTIVES: To determine the intraobserver reproducibility of volume acquisition and repeatability of endometrial volume measurements using the VOCAL-imaging program (Virtual Organ Computer-aided AnaLysis). METHODS: Ten three-dimensional (3D) ultrasound datasets of the same endometrium were obtained from one patient during one scan session. For every 3D dataset, the endometrial volume was calculated by four different measurement techniques; three rotational methods and one conventional method. A single observer acquired each dataset and conducted all measurements. For the rotational technique, the manual mode was used to trace the myometrial-endometrial border through three different predefined rotations of 30 degrees, 15 degrees and 9 degrees . Endometrial volume was also measured in a conventional manner by scrolling through one of the multiplanar images and outlining the contour in another. Ten consecutive measurements were taken for each of the four measurement techniques so that 40 endometrial volume readings were obtained for each of the 10 3D-ultrasound datasets. RESULTS: Endometrial volume measurements were more reproducible with the rotational technique. Rotational methods employing a rotation step of less than 30 degrees were associated with coefficients of variation below 1% and intraclass correlation coefficients above 0.94. Within each of the 10 different scans, the homogeneity of the variance of measurements was significantly different according to the method of measurement (P = 0.022 to < 0.001). Post-hoc tests revealed that both the conventional and 30 degrees rotational methods resulted in a significantly smaller mean endometrial volume than both the 15 degrees and the 9 degrees rotational methods. CONCLUSIONS: Endometrial volume acquisition is reproducible and endometrial volume measurements are repeatable but they depend upon the technique of volume calculation in so much as rotational methods employing a rotation step of less than 30 degrees are associated with a significantly smaller variance in measurements and a significantly greater mean endometrial volume.

Adult↗
PubMed2002

An investigation of the impact of nocturnal enuresis on children's self-concept.

OBJECTIVE: This study sought to evaluate the relationship between the self-esteem and the self-image of children with nocturnal enuresis and to examine these in relation to various aspects of clinical and demographic variables. Previous studies investigating the self-esteem of bedwetting children have had mixed findings. Some studies report that children with nocturnal enuresis have a lower self-esteem than their non-bedwetting peers, but other studies report that children with nocturnal enuresis perceive themselves similarly to non-bedwetting children. However, what have not been studied to date are the self-perceptions of bedwetting children treated in community clinics. MATERIAL AND METHODS: A total of 114 bedwetting children treated in community clinics provided the sample. School nurses conducted a routine first-visit assessment, collected baseline demographic and social information and invited children to complete the Butler Self-Image Profile and the Coopersmith Self-Esteem Inventory. RESULTS: Age and extent of wetting were not significantly related to self-concept measures. Girls had significantly (p = 0.008) higher scores on positive self-image compared with boys. Children with secondary enuresis also scored higher on positive self-image compared with those with primary nocturnal enuresis (p = 0.02). The Butler self-image scores indicated a number of significant links between positive self-image and enuresis variables, whereas the Coopersmith self-esteem scores generally failed to distinguish between the enuresis variables and closely reflected those of the negative self-image scores. CONCLUSIONS: These findings suggest that amongst children with nocturnal enuresis, the most vulnerable in terms of self-image are male, those with primary enuresis and those with a greater number of wet nights a week.

Adolescent↗
PubMed2001

Zanamivir: an alternative translation.

This paper offers an alternative view to that given elsewhere regarding the value of zanamivir as an agent for treating patients who develop influenza symptoms. The position taken here has developed as a result of an analysis of the data that was undertaken by the journal Drug and Therapeutics Bulletin.

Antiviral Agents↗
PubMed2001

Parental information needs in chronic renal failure and diabetes mellitus.

UNLABELLED: The information needs of parents of children with end stage renal failure (ESRF) or with insulin dependent diabetes mellitus (IDDM) were assessed by questionnaires over a 2-year period. Questionnaires were posted on seven occasions at 4-monthly intervals and were sent to both mothers and fathers. Most information needs were reported to be for detailed test results, for new information about the condition and about the child's future social development. Questions responsible for the three highest scores were concerned with the future: the child's fertility; their social, career and marriage prospects; and the hope for a new improved treatment. For the IDDM mothers, scores were significantly different depending on age of the child (P = 0.02). Change in treatment mode had no significant effect on the information needs of parents of children with ESRF (P = 0.81). Occupation was significantly associated with the mean general information needs scores for parents, with occupations of a lower socioeconomic status associated with higher information needs scores. There were no significant differences between the reported mean general information needs scores of parents of children with ESRF and of parents of children with IDDM (P = 0.69) or between mothers and fathers mean general information needs scores (P = 0.58). CONCLUSION: Multidisciplinary team members need to tailor information to the needs of the individual families and be sensitive to socioeconomic factors and communication issues.

Adaptation, Psychological↗
PubMed2001

Bedwetting, behaviour and self-esteem: a review of the literature.

AIM: The aim of this review was to examine the empirical evidence on the impact of bedwetting and its treatment on a child's self-esteem and behaviour. INCLUSION CRITERIA: The inclusion criteria for this review were empirical studies conducted on children, aged 5-16 years old, with primary nocturnal enuresis using measures of self-esteem or behaviour. Studies utilizing psychological measurement scales completed by children were the main focus although those that used scales completed by parents were also included. SEARCH STRATEGIES: The electronic databases from 1981 to 1999 were searched, and hand searching of the literature dating back to 1973 was conducted using the reference lists of key papers. RESEARCH FINDINGS: Fifteen empirical studies matched the inclusion criteria. There was only one randomised-controlled trial and the rest of the studies were cohort, case-control or cross-sectional design. Evidence of sample bias predominantly due to the use hospital-based and/or 'volunteer' subjects was found in five studies. A further five studies used birth cohort data, which excludes important variables such as the impact of treatment. Four studies used single parent-reported measures, which may under or over-estimate the problem. No large cohort studies were available which compare the self-esteem of bedwetting children with matched controls. The most interesting line of enquiry is pursued by studies looking at whether self-esteem improves with successful treatment. However, the use of self-selected subject groups does not make the current evidence convincing and more work is required to determine outcomes for all children. There is empirical evidence for increased behavioural problems in bedwetting children. Studies conducted on younger children report less behavioural problems with more reported in studies conducted on older children with complex wetting disorders. This may point towards wetting being the primary problem, but more work is needed, as causation in any direction is difficult to ascertain from the literature.

Adolescent↗
PubMed2001

Effect of HLA class II genotype on T helper lymphocyte responses and viral control in hepatitis C virus infection.

Hepatitis C virus (HCV) infection is very common worldwide, but has a broad range of outcomes. A minority of patients are able to clear infection spontaneously, and this is thought to be due to the emergence and maintenance of effective cell-mediated immunity, particularly CD4+ T lymphocyte responses. Furthermore, genetic studies have indicated that HLA class II genotype strongly influences the outcome of infection. We have therefore investigated the influence of the protective HLA class II haplotype (DQB1*0301, which is in tight linkage disequilibrium with DRB1*1101) on the CD4+ T lymphocyte responses to HCV. We observe a strong association between this genotype and maintenance of a multispecific CD4+ T helper response. The effect on T helper responses was also maintained after combination interferon-alpha/ribavirin therapy, although the latter influenced the pattern of viral antigens to which patients responded. This is the first disease in which an association of HLA genotype with clinical outcome has been linked to an alteration of the immunological phenotype. The selection of protective peptides in those with the favourable HLA class II genotype may point in the direction of suitable vaccine candidates.

Adult↗
PubMed2001

Parental perceptions of comfort during mechanical ventilation.

There are no reports of the parental perceptions of comfort during the mechanical ventilation of children. We have assessed the quality of sedation in 28 mechanically ventilated children and compared these results to an overall parental assessment of comfort, obtained by postal questionnaire. There was no correlation between the parental assessment of comfort and the paediatric intensive care unit (PICU) staff satisfaction with the level of sedation. Parental assessment of comfort was positively correlated with the duration of ventilation, whilst PICU staff satisfaction was positively correlated with the age of the child. Parents appear to become more satisfied with the degree of comfort of their children as the duration of mechanical ventilation increases, which is an effect that may have an important bearing on communication between parents and health professionals. Our results also suggest that the commonly used sedation regime of midazolam and morphine is less effective in younger children.

Adolescent↗
PubMed2001

The child with a non-blanching rash: how likely is meningococcal disease?

AIMS: To examine a number of simple clinical features and investigations in children with a non-blanching rash to see which predict meningococcal infection. METHODS: A total of 233 infants and children up to 15 years of age presenting with a non-blanching rash were studied over a period of 12 months. Clinical features and laboratory investigations were recorded at presentation. The ability of each to predict meningococcal infection was examined. RESULTS: Eleven per cent had proven meningococcal infection. Children with meningococcal infection were more likely to be ill, pyrexial (>38.5 degrees C), have purpura, and a capillary refill time of more than two seconds than non-meningococcal children. Five children with meningococcal disease had an axillary temperature below 37.5 degrees C. No child with a rash confined to the distribution of the superior vena cava had meningococcal infection. Investigations were less helpful, although children with meningococcal infection were more likely to have an abnormal neutrophil count and a prolonged international normalised ratio. No child with a C reactive protein of less than 6 mg/l had meningococcal infection. CONCLUSIONS: Most children with meningococcal infection are ill, have a purpuric rash, a fever, and delayed capillary refill. They should be admitted to hospital and treated without delay. Children with a non-blanching rash confined to the distribution of the superior vena cava are very unlikely to have meningococcal infection. Measurement of C reactive protein may be helpful-no child with a normal value had meningococcal infection. Lack of fever at the time of assessment does not exclude meningococcal disease.

Adolescent↗
PubMed2001

Combination therapy with interferon-alpha and ribavirin for hepatitis C: practical treatment issues.

Combination therapy with ribavirin and interferon (IFN)-alpha for 6 to 12 months is currently the treatment of choice for chronic hepatitis C infection. The overall sustained response rate to treatment, defined as loss of hepatitis C virus (HCV) from serum 6 months after completion of treatment, is 40%. The indications for treatment are serum HCV RNA positivity, abnormal serum transaminases and the presence of portal fibrosis and/or moderate/severe inflammation. Response rates are lower in genotype 1 than in genotype 2 or 3 and in the presence of a high viral load. Anaemia is the most common adverse event and is due to ribavirin; neuropsychiatric adverse effects due to IFNalpha lead to premature cessation of therapy in 10 to 20% of patients. The current recommended dose of interferon is 3MU given subcutaneously 3 times a week. However, it is likely that longer-acting pegylated interferons, which may be more effective and can be administered once weekly, will in the future replace currently used IFNalpha.

Antiviral Agents↗
PubMed2000

Norm values for the Generic Children's Quality of Life Measure (GCQ) from a large school-based sample.

This study aimed to assess the quality of life of a population sample of schoolchildren. The Generic Children's Quality of Life Measure (GCQ) has been developed to allow comparison between chronically ill children and the general child population. The measure assesses how the child views his or her life and also how they would like it to be. Quality of life is measured as the discrepancy between the two viewpoints. This large community-based survey aimed to establish GCQ norm values for children aged 6-14 years. The children were from a sample of schools stratified by geographical location and social need: rural affluent, rural low affluence, urban affluent and urban low affluence. 720 completed questionnaires were analysed. The scores were normally distributed with a wide range. The GCQ showed an acceptable reliability with a Cronbach's alpha of 0.75. The quality of life score was not correlated with age (r = -0.02, p = 0.64) nor with the deprivation score of the area in which the children lived (r = -0.026, p = 0.49). There were no significant differences between the scores by gender (p = 0.22) nor by rural/urban location (p = 0.60). Normative values were established. The GCQ is suitable for using with children over a large age range (6-14 years) without the scores being confounded by the age, gender, affluence or geographical location.

Adolescent↗
PubMed2000

Autonomy and process closure as the basis for functionality

Most accounts of functionality are based in etiology, either design or selection. In this paper I give an account of function as serving autonomy, which is the closure of self-maintaining processes, including those interacting with the environment. Autonomy is inherently dynamic, being based entirely on interacting processes, whose organization constitutes the integrity of the autonomous system. The etiological account focuses on external factors, either intentions in design or outcomes in selection. It ignores any but idiosyncratic organizational requirements within the biological entity and in its interactions with its environment, even though these may play a central role in the functionality of the trait in question. In particular, there is no simple relation between adaptation on the etiological account and adaptability, a higher order emergent trait that plays a central role in behavior and the evolutionary and developmental genesis of intelligence. I propose redefining adaptiveness in terms of autonomy. The definition naturally extends to adaptability and focuses on the organizational character of adaptiveness, forcing attention on this central biological characteristic, which is easily ignored in the etiological account. The result is a much richer account of both adaptation and selection.

Journal Article↗
PubMed2000

Haemodynamic, renal sodium handling, and neurohormonal effects of acute administration of low dose losartan, an angiotensin II receptor antagonist, in preascitic cirrhosis.

BACKGROUND: The renin-angiotensin system may be implicated in the subtle sodium handling abnormality in preascitic cirrhosis. AIMS: To assess the role of angiotensin II in sodium homoeostasis in preascitic cirrhosis, using losartan, its receptor antagonist. PATIENTS: Nine male, preascitic cirrhotic patients, and six age matched, healthy male controls. METHODS: A dose response study using 2.5, 5, 7.5, and 10 mg of losartan was performed on a daily 200 mmol sodium intake, followed by repeat studies with the optimal dose, 7.5 mg of losartan, to determine its effects on systemic and renal haemodynamics, renal sodium handling, and neurohumoral factors. RESULTS: Preascitic cirrhotic patients had significantly reduced baseline urinary sodium excretion compared with controls (154 (8) versus 191 (12) mmol/day, p<0.05), associated with significantly reduced systemic angiotensin II levels (6.0 (1.7) versus 39.5 (10.0) pmol/l, p=0.002). Losartan 7.5 mg normalised renal sodium handling in the preascitic cirrhotic patients (202 (12) mmol/day, p=0.05 versus baseline), without any change in systemic or renal haemodynamics, but with significantly increased systemic angiotensin II levels (7.8 (2.3) pmol/l, p=0.05 versus baseline). Losartan had no effect on renal sodium handling in controls. CONCLUSIONS: In preascitic cirrhotic patients, the subtle renal sodium retention, paradoxically associated with low systemic neurohumoral factor levels, is improved with low dose losartan, suggesting the involvement of angiotensin II via its direct action on the renal tubule.

Adult↗
PubMed1999

Genetic epidemiological study of schizophrenia in Palau, Micronesia: prevalence and familiality.

We are studying the genetic etiology of schizophrenia in the Republic of Palau, a remote island nation in Micronesia that has been geographically and ethnically isolated for approximately 2,000 years. The first epidemiological phase sought to estimate the lifetime prevalence of schizophrenia and evaluate the familiality of the illness based on complete ascertainment of cases and families segregating schizophrenia. A total of 160 strictly defined cases of schizophrenia were ascertained in a population of 13,750 adults who were 15 years of age and older. The lifetime prevalence of strictly defined schizophrenia in Palau was 1.99% overall and 2.77% in males vs. 1.24% in females. This greater than 2:1 male-to-female risk ratio for schizophrenia was accompanied by an earlier mean age of onset for males (23.3 years) than for females (27.5 years). These 160 cases of strict schizophrenia represent 59 separate families each identified by a single common founder. Eleven of these families have 5 to 14 cases and represent nearly half of the strict schizophrenia cases in Palau. Although schizophrenia is clearly aggregating in these 11 families, cases are distributed sparsely throughout the large sibships. In the entire sample of 160 cases of strict schizophrenia, there were only 11 sib-pairs and 2 sib-trios. When a family was defined to include third-degree relatives, only 11 cases (6.9%) were nonfamilial. The majority of the ascertained cases can be linked together into extended pedigrees with complex multilineal inheritance patterns. These intricately interconnected families may pose challenges for traditional linkage techniques. However, these Palauan families represent a valuable resource for studying the genetic etiology of schizophrenia because there may be fewer susceptibility genes for schizophrenia in this genetic isolate than in the heterogeneous populations that are common throughout the world today.

Adolescent↗
PubMed1999

Culture-specific views of child maltreatment and parenting styles in a Pacific-Island community.

OBJECTIVE: Providing culturally sensitive definitions of child abuse is difficult as perceptions of what constitutes abuse can vary around the world. This study was undertaken to assess how teachers in the Republic of Palau perceived the severity of potentially abusive incidents and what types of recommendations, if any, they would have for situations judged as severely abusive. Attitudes about child rearing practices were also evaluated. METHODS: Teachers (n = 141 ) were given: (1) a questionnaire consisting of 25 vignettes describing parent/child interactions that were potentially abusive and asked to rate the severity of abuse and recommended interventions for each vignette; and (2) a 40-item parenting styles questionnaires to evaluate attitudes about child-rearing practices. RESULTS: Teachers identified and recommended interventions for more severe forms of abuse at rates similar to other international samples. For less severe parental misconduct, teachers were reluctant to involve nonfamily and outside agencies. Sexual abuse was rated as the most serious type of abuse and when identified, intervention was highly recommended. Some traditional Palauan parenting practices that might be considered maltreatment by other cultures were not considered abusive. For parenting styles, older individuals were more likely to use guilt induction and less likely to use methods of acceptance. Aggressive parenting styles were negatively correlated with all forms of abuse, suggesting that teachers who used aggressive disciplinary styles were less likely to perceive abusive situations as harmful. CONCLUSIONS: These results indicate that cultural values and practices play important roles in shaping the definition and interpretation of child maltreatment.

Adult↗