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Biomedical subjects

J Judd

Publications and source records attributed to J Judd.

17 recordsLinked to original sources
PubMed2001

Setting standards in the evaluation of community-based health promotion programmes--a unifying approach.

Community-based health promotion often emphasizes elements of empowerment, participation, multidisciplinary collaboration, capacity building, equity and sustainable development. Such an emphasis may be viewed as being in opposition to equally powerful notions of evidence-based decision making and accountability, and with funders' and government decision-makers' preoccupation with measuring outcomes. These tensions may be fuelled when community practitioners and lay participants feel evaluations are imposed upon them in a manner that fails to appreciate the uniqueness of their community, its programme, and practitioners' skills and experience. This paper attempts to provide an approach that depicts evaluation as being mutually beneficial to both funders/government and practitioners. First, a values stance for health promotion, termed a 'salutogenic' orientation, is proposed as a foundation for the evaluation of community-based health promotion. Secondly, we discuss possible objects of interest, the first component of an evaluation. We then discuss the spirit of the times and its implications for community-based health promotion. Finally, we address the key question of setting standards. A typology of standards is presented. Arbitrary, experiential and utility standards are based on perceived needs and priorities of practitioners, lay participants or professional decision-makers. Historical, scientific and normative standards are driven by empirical, objective data. Propriety and feasibility standards are those wherein the primary concern is for consideration of resources, policies, legislation and administrative factors. The 'model' standards approach is presented as an exemplar of a combined approach that incorporates elements of each of the other standards. We argue that the 'optimal' standard for community-based health promotion depends on the setting and the circumstances. There is no 'magic bullet', 'one-size-fits-all' or 'best' standard. Further, we argue that standards should be set from an inclusive, salutogenic orientation. This approach offers a means of creating a situation in which policy-makers and funders are more supportive of evaluation designs that fit with community realities, and community stakeholders are more capable and consistent in rigorously evaluating community-based health promotion programmes and policies.

Canada↗
PubMed2001

Oolong tea increases metabolic rate and fat oxidation in men.

According to traditional Chinese belief, oolong tea is effective in the control of body weight. Few controlled studies, however, have been conducted to measure the impact of tea on energy expenditure (EE) of humans. A randomized cross-over design was used to compare 24-h EE of 12 men consuming each of four treatments: 1) water, 2) full-strength tea (daily allotment brewed from 15 g of tea), 3) half-strength tea (brewed from 7.5 g tea) and 4) water containing 270 mg caffeine, equivalent to the concentration in the full-strength tea treatment. Subjects refrained from consuming caffeine or flavonoids for 4 d prior to the study. Tea was brewed each morning; beverages were consumed at room temperature as five 300 mL servings. Subjects received each treatment for 3 d; on the third day, EE was measured by indirect calorimetry in a room calorimeter. For the 3 d, subjects consumed a typical American diet. Energy content of the diet was tailored to each subject's needs as determined from a preliminary measure of 24-h EE by calorimetry. Relative to the water treatment, EE was significantly increased 2.9 and 3.4% for the full-strength tea and caffeinated water treatments, respectively. This increase over water alone represented an additional expenditure of 281 and 331 kJ/d for subjects treated with full-strength tea and caffeinated water, respectively. In addition, fat oxidation was significantly higher (12%) when subjects consumed the full-strength tea rather than water.

Absorptiometry, Photon↗
PubMed2000

Field-by-field evaluation of intraoperative transoesophageal echocardiography interpretative skills.

A quality assurance system is essential for the credibility and structured growth of anaesthesiology-based transoesophageal echocardiography (TEE) programmes. We have developed software (Q/A Kappa), involving a 400-line source code, capable of directly reporting kappa correlation coefficient values, using external reviewer interpretations as the 'gold standard', and thereby allowing systematic assessment of the validity of intraoperative echocardiographic interpretation. This paper presents assessment of the validity of 240 intraoperative anaesthesiologists' echocardiographic interpretations, and, in addition, the results of field testing of this prototypical software. Data, derived from consecutive cardiac surgery patients, consisted of standardized two-dimensional transoesophageal echocardiographic, colour flow and Doppler imaging sequences. Intraoperative and off-line 'gold standard' TEE interpretations were compared for 19 fields or variables using the Q/A Kappa program. The kappa correlation coefficients were highly variable and dependent on the examination field, ranging from 0.08 for apical regional wall motion scores to 1.00 for tricuspid regurgitation grade, left atrial measurement, aortic valve anatomy and left ventricular long axis and short axis global function. The correlation coefficients were also operator dependent. These data (480 interpretations) were also manually integrated into the equation required for calculation of values of the variable kappa correlation coefficient. The relationship between Q/A Kappa-derived values and manually calculated values was highly significant (p < 0.001; r = 1.0). The implications and possible explanations of the results for particular examination fields are discussed. This study also demonstrates successful seamless functioning of this software program from data entry, segmentation into tables and valid statistical analysis. These findings suggest that it is practical to provide sophisticated continuous quality improvement TEE data on a routine basis.

Adult↗
PubMed1999

Androgens regulate bone resorption activity of isolated osteoclasts in vitro.

For many years it has been recognized that sex steroids have profound effects on bone metabolism. The current perception is that estrogen decreases bone resorption and androgen increases bone deposition. To investigate the potential for androgens to directly modulate bone resorption, we have examined avian osteoclast and human and mouse osteoclast-like cells for androgen responsiveness. There was a dose-dependent decrease in resorption activity in response to alpha-dihydrotestosterone (alpha-DHT), beta-DHT, testosterone, or the synthetic androgen RU1881. This decrease was blocked by cotreatment with the specific androgen antagonist hydroxyflutamide. Further examination of avian osteoclasts revealed that the cells exhibited specific and saturable nuclear binding of tritiated RU1881 and that alpha-DHT stimulated the activity of the androgen response element as measured by using a chloramphenicol acetyltransferase reporter plasmid. In addition, avian osteoclasts responded to androgen treatment with elevated production and secretion of transforming growth factor beta, a well documented response to androgen exposure in other cell systems. Treatment with either alpha-DHT or beta-DHT for 24 hours resulted in a significant dose-dependent decrease in secretion of cathepsin B and tartrate-resistant acid phosphatase. This response to beta-DHT, a stereoisomer of alpha-DHT that is inactive in other androgen receptor-dependent systems, supports the hypothesis that the osteoclast androgen receptor has unusual ligand-binding properties. Taken together, these results confirm the presence of functional androgen receptors in these cells and support the conclusion that osteoclasts are able to respond directly to androgens in vitro and thus are potential androgen target cells in vivo.

Acid Phosphatase↗
PubMed1995

Estrogen modulation of osteoclast lysosomal enzyme secretion.

Osteoclast-mediated bone resorption is accomplished by secretion of lysosomal proteases into an acidic extracellular compartment. We have previously demonstrated that avian osteoclasts and human osteoclast-like giant cell tumor cells respond in vitro to treatment with 17 beta-estradiol (17 beta-E2) by decreased bone resorption activity. To better understand the mechanism by which this is accomplished, we have investigated the effects of 17 beta-E2 treatment on lysosomal enzyme production and secretion by isolated avian osteoclasts and multinucleated cells from human giant cell tumors in vitro. Isolated cells were cultured with bone particles in the presence of either vehicle or steroid. The conditioned media and cells were harvested, and the levels of cathepsin B, cathepsin L, beta-glucuronidase, lysozyme, and tartrate-resistant acid phosphatase (TRAP) activities were determined. There was a steroid dose-dependent decrease in secreted levels of these enzymes. Cell-associated levels of cathepsin L, beta-glucuronidase, and lysozyme decreased; whereas cell-associated levels of cathepsin B and TRAP increased. These changes were measurable at 10(-10) M and maximal at 10(-8) M 17 beta-E2. The changes were detectable at 4-18 h of treatment and increased through 24 h of treatment. The response was steroid specific, since the inactive estrogen isomer, 17 alpha-E2, failed to alter the activity levels. Moreover, the effects of 17 beta-E2 were blocked when the cells were treated simultaneously with the estrogen antagonist ICI182-780 in conjunction with 17 beta-E2. Human osteoclast-like cells obtained from giant cell tumors of bone responded similarly to estrogen with respect to cathepsin B, cathepsin L, and TRAP activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Phosphatase↗
PubMed1993

An integrated software system for quality assurance-related kappa coefficient analysis of intraoperative transesophageal echocardiography interpretive skills.

This report describes the development of a quality assurance-oriented integrated software system designed for an anesthesiology-based intraoperative transesophageal echocardiography service. Entry data include patient and operation demographics, two-dimensional echocardiographic, saline-contrast, and color flow/pulsed Doppler assessments of the heart and great vessels, presented in a defined sequence. A statistical analysis component (kappa coefficient analysis) allows for comparison of intraoperative real-time interpretations with laboratory interpretations made by experienced full-time echocardiographers on a field-by-field basis. This provides a means of quantifying expertise in each individual aspect of the patient examination sequence. We believe that such self-appraisal data are essential for delineating the status and tracking the progress of service being provided.

Echocardiography, Transesophageal↗
PubMed1990

Validation and comparison of eight physical activity questionnaires.

Several questionnaires are available for assessing physical activity, but few of these instruments have been validated, particularly with respect to energy balance. Twenty-one healthy men 28-55 years old participating in a free-living, controlled feeding experiment completed eight widely used physical activity questionnaires. These were compared with measured caloric intake and resting energy expenditure during a period of stable body weight. Physical activity indices or daily energy expenditure estimates derived from the questionnaires generally increased with energy intake. The questionnaires were moderately well correlated with each other; interquestionnaire correlation coefficients ranged from 0.09 to 0.81 (median = 0.53). Correlations between the questionnaires and energy intake, which ranged from 0.13 for the Minnesota Leisure Time Activity instrument to 0.49 for the Harvard Alumni questionnaire, were higher than between the questionnaires and nonresting energy expenditure; that is, energy intake minus resting energy expenditure (correlation coefficient range 0.05-0.32). The Five-City Project questionnaire yielded an average estimate of total caloric expenditure that most closely approximated intake (96%). These data indicate that although estimates of individual energy expenditure or physical activity may be less than optimal, most of the questionnaires evaluated provide reasonable group means for these parameters.

Adult↗
PubMed1989

Hormones regulating lipid and carbohydrate metabolism in premenopausal women: modulation by dietary lipids.

The effect of high- and low-fat diets with different levels of fatty acid unsaturation on plasma hormones involved in lipid metabolism was studied during different phases of the menstrual cycle in 31 premenopausal women. Subjects were divided into two groups and were fed controlled diets containing 39% fat with a ratio of polyunsaturated to saturated fatty acids (P:S) of either 0.3 or 1.0 for four menstrual cycles and then switched to a 19% fat diet with the same P:S for another four cycles. Blood samples were analyzed during both the follicular and luteal phases. A significant direct effect of level of dietary fat was observed on plasma cortisol and dehydroepiandrosterone-sulphate whereas an inverse relationship was seen for plasma insulin. Both plasma insulin and growth hormone levels were higher during the luteal compared with the follicular phase of the menstrual cycle. None of the hormones was affected by the level of unsaturation of dietary fats.

Adult↗
PubMed1988

Intraocular pressure response to topical dexamethasone as a predictor for the development of primary open-angle glaucoma.

In a retrospective study we reviewed the records of 788 subjects who had been corticosteroid tested with 0.1% dexamethasone four times daily to one eye for six weeks. All subjects had normal kinetic visual fields and optic nerve heads in both eyes at the time of testing and were followed up for a minimum of five years. Some subjects had normal baseline intraocular pressures whereas others were considered to have ocular hypertension. Of 276 individuals who were high corticosteroid responders (intraocular pressure greater than 31 mm Hg during dexamethasone administration), 36 (13.0%) developed glaucomatous visual field loss during the follow-up period. Only nine of 261 individuals (3.4%) who were intermediate responders (intraocular pressure 20 to 31 mm Hg during dexamethasone administration) and none of 251 individuals who were low responders (intraocular pressure less than 20 mm Hg during dexamethasone administration) developed glaucomatous visual field loss. However, the ability of the intraocular pressure response to dexamethasone to predict the development of glaucomatous visual field loss was not as good as the predictive power of a multivariate model that included patient age, race, baseline intraocular pressure, baseline outflow facility, baseline cup/disk ratio, and systemic hypertension.

Adult↗
PubMed1988

Relation of changes in amount and type of dietary fat to fecapentaenes in premenopausal women.

Correlation studies suggest that fecal mutagenicity is increased in groups eating high-fat diets, the same groups who are often found to have high colorectal cancer incidence and mortality. The fecapentaenes are the best characterized class of fecal mutagens, but the relationship of dietary fat intake to the excretion of these potent genotoxins is unknown. We studied the effect of changes in amount and type of dietary fat on fecapentaene levels in 31 premenopausal women 20-40 years of age who participated in a controlled feeding study. After a pre-diet free-living period lasting 1 menstrual cycle, women were placed on a high-fat (40% energy from fat) diet for 4 menstrual cycles and then switched to a low-fat (20% energy from fat) diet for an additional 4 menstrual cycles. One-half the subjects were maintained throughout the study at a ratio of polyunsaturated-to-saturated fatty acids (P/S ratio) of 1.0, the other half at 0.3; body weight was constant. All meals during the controlled diet periods were prepared at the Human Study Facility of the Beltsville Human Nutrition Research Center. Fecapentaene and fecapentaene precursor levels were measured in acetone extracts from 3-day pooled stool samples collected during the study. No differences in fecapentaene or precursor levels were observed between the high- and low-fat diets at either P/S ratio. Fecapentaene and precursor levels were higher while on controlled diets than during the pre-diet free-living period, and levels declined again in the post-diet free-living period. We conclude that dietary fat has no significant effect on fecapentaene or precursor levels in acetone extracts of stool in premenopausal women. The effect of other dietary or non-dietary factors on fecapentaenes remains unknown.

Adult↗
PubMed1975

Mechanized blood grouping: a hospital trial using an 8-channel grouping machine.

ABO and Rh (D) groups of 6403 blood samples were assessed on an 8/9-channel autoanalyser in the Serology Department of the London Hospital; the results were independently checked at the Regional Blood Transfusion Centre, Brentwood, using the routine methods for grouping donor blood. Results of this comparative study are given and instances are described in which anomalous results or incorrect groupings occurred; the possible causes are discussed. The 8/9-channel automated blood group analyser is evaluated in terms of routine hospital laboratory practice.

ABO Blood-Group System↗