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Biomedical subjects

J M Simpson

Publications and source records attributed to J M Simpson.

At least 109 records · Page 6Linked to original sources
PubMed1994

Parent and teacher perceptions of child behaviour following cardiac surgery.

To determine if parents whose children had undergone successful cardiac surgery perceived their children any differently from parents of children who had not undergone surgery, we used the Achenbach Child Behaviour Checklist (CBCL) to compare parent and teacher perceptions in these two groups. Subjects included 168 children who had undergone cardiac surgery 4 to 8 years previously and 51 controls. On the behaviour scale of the CBCL, the teacher's mean t scores showed no significant difference between the cardiac and control groups, in contrast to the parents' scores where parents perceived a higher degree of behavioural problems in children who had undergone cardiac surgery. On the social competence scale of the CBCL, the parents scored their children who had undergone cardiac surgery as less socially competent than did the parents of the controls. Teachers' scores showed no difference between groups.

Adolescent↗
PubMed1994

Evaluation of the New South Wales Cancer Council Pap Test Reminder Service.

This study aimed to assess the effect of reminder letters on Pap test rates for women enrolled on the New South Wales Cancer Council Pap Test Reminder Service and to identify predictors of response to the letter. Ten weeks after they had received their reminder letter a questionnaire was sent to 3086 women. It was completed by 1525 (49 per cent) women, of whom 1393 (91 per cent) said they had received their reminder letter. Of these 1393, 48 per cent (95 per cent confidence interval 46 per cent to 51 per cent) reported having a Pap test within 10 weeks of the reminder letter arriving. The proportion of women having a Pap test in response to the reminder letter did not differ by age, region of residence or language spoken at home. Women were less likely to have had a Pap test if they did not know how they were enrolled, were of low socioeconomic status or had some tertiary education. Women on the reminder service have 15-month rescreening rates at least 9 per cent higher than other women in New South Wales; for women aged 50 to 69 in nonmetropolitan areas the increase is estimated at 19 per cent. Reminder services may be a cost-effective way to increase Pap test rescreening rates. Reminder services need accurate records and to follow up changes in address and date of next test.

Adolescent↗
PubMed1994

Who has Pap smears in New South Wales? Patterns of screening across sociodemographic groups.

The aim of this study was to determine whether Pap smear screening at adequate intervals is associated with area of residence, frequency of consultations with a general practitioner, socioeconomic status and non-English-speaking background. A representative 10 per cent sample of women from New South Wales and the Australian Capital Territory, aged 25 to 69 years and registered with the Health Insurance Commission (Medicare) (N = 155,281) was used to obtain age, postcode, frequency of Pap smears and frequency of consultations with general practitioners in the three-year period from February 1985 to January 1988. Census data for each postcode area were used as an indicator of other socio-demographic characteristics. Age-specific screening rates did not vary between Sydney, Newcastle/Wollongong, Canberra, and nonmetropolitan areas. In all age groups, having had a smear was most strongly associated with the frequency with which a woman consulted a general practitioner. Women who visited a general practitioner at least four times a year on average were about twice as likely to have had a recent Pap smear as those who averaged less than one visit per year. Screening rates were lowest among women living in areas with the most non-English-speakers and the lowest socio-economic status. Sociodemographic factors and health service usage patterns influence the proportion of women who are currently being screened. Evaluation of interventions to improve Pap smear screening rates should consider whether the percentage of women screened increases overall, and also whether the imbalances in screening rates between different groups are diminishing.

Adult↗
PubMed1994

Work-site cholesterol screening and dietary intervention: the Staff Healthy Heart Project. Steering Committee.

OBJECTIVES: The Staff Healthy Heart Project was established to run a work-site cholesterol screening project and a randomized controlled trial of dietary interventions. METHODS: Screening was offered to all staff at six Australian hospitals. Participants with blood cholesterol of 5.2 mmol/L (200 mg/dL) or above were randomly allocated to receive screening only (control group), a self-help package, or a nutrition course. Participants were seen 3 and 6 months after intervention to measure blood cholesterol and dietary changes. RESULTS: Eighty percent of available staff (n = 2638) were screened. Of those eligible, 67% (n = 683) entered the trial. Follow-up measures of blood cholesterol and dietary intake were obtained for 63% and 38% of trial participants, respectively. A reduction in reported dietary fat was found for all groups, but there were no significant differences between groups. Reported dietary fiber rose by 0.6 g/MJ/day for those in the nutrition course. There were no changes in total blood or high-density lipoprotein cholesterol. CONCLUSIONS: Cholesterol reduction was not demonstrated, but this result is difficult to interpret given the poor ongoing participation rates. Strategies to improve ongoing participation in work-site projects are needed to achieve adequate assessment of dietary interventions used in cholesterol screening.

Adolescent↗
PubMed1994

Environmental factors in childhood IDDM. A population-based, case-control study.

OBJECTIVE: To identify environmental factors involved in the etiology of insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: An estimated 90% of all incident cases of IDDM in patients 0-14 years of age in New South Wales, Australia, were ascertained over 18 months. For each IDDM patient, two age- and sex-matched control subjects were randomly selected from the population. Past environmental exposures were determined with a questionnaire completed by the parents. Response rates were 92% for the IDDM patients (217 of 235) and 55% for the control subjects (258 of 470). The relative risk associated with each exposure was estimated with the odds ratio (OR) adjusted for confounding factors using multiple logistic regression. RESULTS: The introduction of cow's milk-based infant formula into the diet before 3 months of age was associated with an increased risk (OR 1.52, 95% confidence interval [CI] 1.04-2.24). Exclusive breast-feeding for > or = 3 months was associated with a protective effect (OR 0.66, 95% CI 0.45-0.97). High dietary intake of cow's milk protein in the 12 months before the onset of diabetic symptoms was also associated with an increased risk (OR 1.84, 95% CI 1.12-3.00). A recent infection (during the 3 months before onset of diabetic symptoms) was more common in the patients than the control subjects (OR 2.92, 95% CI 1.96-4.35), as was day care attendance before the age of 3 (OR 1.73, 95% CI 1.00-3.00). When two age-groups, defined by the median age at onset of diabetes, were compared, the associations with early infant-feeding were stronger among the younger group (< 9.2 years), and associations with recent diet and recent infection were stronger among the older group (> or = 9.2 years). CONCLUSIONS: These results indicate an increased risk of IDDM associated with early dietary exposure to cow's milk-containing formula, short duration of exclusive breast-feeding, high intake of cow's milk protein in the recent diet, recent infection, and early attendance at day care.

Adolescent↗
PubMed1994

Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls.

There have been numerous studies that implicate cigarette smoking as a risk factor for the development of back pain or disc disease. The purpose of this article is to review patients who underwent surgery for cervical or lumbar radiculopathy and to investigate the relationship between cigarette smoking and development of surgical disc disease. A cigarette smoking study of 205 surgical patients with lumbar and cervical disc diseases was done, with the surgical patients compared to 205 age-sex-matched inpatient controls during 1987-1988. This study was conducted at the Pennsylvania Hospital in Philadelphia, Pennsylvania. There were 163 patients with lumbar disc disease and 42 patients with cervical disc disease. The ratio of men to women was 1.5:1 for lumbar disc and 2.5:1 for cervical disc disease. Smoking history (current and ex-smokers) was strikingly increased in both prolapsed lumbar intervertebral disc (56% vs. 37% of controls, p = 0.00029) and cervical disc disease (64.3% vs. 37% of controls, p = 0.0025). Calculated relative risks for smokers were 2.2 for lumbar disc and 2.9 for cervical disc diseases. This association between cigarette smoking and disc disease was more significant when comparing between current smokers versus nonsmokers (p = 0.000011 for lumbar disc disease, and p = 0.00064 for cervical disc disease). Relative risks for current smokers were 3.0 for lumbar disc and 3.9 for cervical disc diseases. This correlation was significant for both males (p = 0.000068 for lumbar disc disease, p = 0.043 for cervical disc disease) and females (p = 0.018 for lumbar disc disease, p = 0.006 for cervical disc disease).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Thoracic disc herniation. Re-evaluation of the posterior approach using a modified costotransversectomy.

A consecutive series of 23 thoracic disc herniations in 21 patients treated between 1980 and 1988 were reviewed. All patients were decompressed through a posterolateral approach (costotransversectomy or transpedicular). Pain and weakness were the most common presenting symptoms. Twenty-one thoracic disc herniations in 19 patients were available for long-term follow-up, averaging 58.1 months. Sixteen patients had an excellent or good result. Three patients had a fair result. There were no poor results. All six patients with significant preoperative lower extremity weakness improved. Pain was relieved in 16 patients and reduced in three. There were no significant neurologic complications associated with the procedure. Posterolateral decompression for thoracic disc herniation remains a viable alternative without the inherent risk and morbidity of the transthoracic approach.

Diskectomy↗
PubMed1993

Evaluation of two school smoking education programmes under normal classroom conditions.

OBJECTIVES: To assess the effectiveness of two school based smoking education projects in delaying onset of smoking behaviour and in improving health knowledge, beliefs, and values. DESIGN: Cluster randomised controlled trial of two projects taught under normal classroom conditions. Schools were allocated to one of four groups to receive the family smoking education project (FSE); the smoking and me project (SAM); both projects in sequence (FSE/SAM); or no intervention at all. SETTING: 39 schools in Wales and England matched for size and catchment profile. SUBJECTS: All first year pupils in the schools were included and were assessed on three occasions (4538 before teaching (1988), 3930 immediately after teaching (1989), 3786 at one year follow up (1990)). MAIN OUTCOME MEASURES: Self reported smoking behaviour (backed by saliva sample) and change in relevant health knowledge, beliefs, and values. RESULTS: No consistent significant differences in smoking behaviour, health knowledge, beliefs, or values were found between the four groups. For never smokers at baseline the rate of remaining never smokers in 1990 was 74% (594/804) in the control group, 65% (455/704) in the FSE group, 70% (440/625) in the SAM group, and 69% (549/791) in the FSE/SAM group (chi 2adj = 6.1, df = 3, p = 0.1). Knowledge about effects of smoking rose in all groups from a mean score of 5.4 in 1988 to 6.4 in 1989 and 6.5 in 1990. CONCLUSIONS: More comprehensive interventions than school health education alone will be needed to reduce teenage smoking. Other measures including further restrictions on access to cigarettes and on the promotion of tobacco products need to be considered. Further research will be needed to develop effective school based health education projects, which should be formally field tested under normal conditions before widespread dissemination.

Child↗
PubMed1993

What do students find attractive about the practice of medicine? A pattern of stability over time.

There is little consensus about the stability or instability of medical students career preferences during their time in college. These two studies found little change in their perception of the attractiveness of aspects of medical work which may be related to their final career choice. In the first study three successive cohorts of students in a London medical school completed questionnaires about the attractiveness of various medical job-attributes. Each cohort was tested twice such that the pattern of testing covered the entire course. Only data from students who were present at both test sessions were used for the longitudinal study. Comparisons with students in other London schools indicated that the study groups were representative of all London medical students. The second study was cross-sectional comparing final year data from 1983 and 1991 at three London medical schools. The first study results suggest that students enter medical school with values and opinions about their work which remain, on the whole, unchanged until they leave. There were significant decreases in the attractiveness of four attributes, but none became significantly more attractive. The second study revealed little change, five attributes were significantly less attractive 8 years later. In both studies most of the changes related to organisational rather than patient-related attributes. This may reflect greater realism about doctors' work. Comparison of final years students' data with published data from the mid-seventies confirms the overall stability of these values. It is suggested that specialists could use this information to highlight the desirable aspects of their work and so 'sell' their discipline to students and newly qualified doctors.

Career Choice↗
PubMed1993

Are elderly people at risk of falling taught how to get up again?

It is recommended that patients at risk of falling should be taught how to get up from the floor. Clinical experience suggests, however, that this is rarely done. A stratified random sample of members of the special interest group of physiotherapists working with elderly people in England and Wales (PT: n = 50) and all members of the corresponding occupational therapy group (OT: n = 41) were surveyed to ascertain whether or not this impression was justified. The response rate was 80% with 67 usable replies (74%, PT: n = 38, OT: n = 29). Replying to an open-ended question about their usual management of instability and tendency to fall, only four physiotherapists (11%) and six occupational therapists (21%) indicated that would they teach such elderly people how to get up from the floor.

Accidental Falls↗
PubMed1993

Androgen regulation of circulating insulin-like growth factor-I during puberty in male hypogonadal mice.

This study aimed at determining the relationship of sex steroids, particularly in the perinatal period, to the pubertal insulin-like growth factor-I (IGF-I) surge in male mice. We used hypogonadal (hpg) mice, which have a major deletion in the gonadotrophin-releasing hormone (GnRH) gene, in order to have a model lacking all GnRH-induced gonadotrophin and sex steroid secretion throughout pre- and postnatal life. Cross-sectional data on body weights and weights of testes, seminal vesicles, kidneys, liver and spleen from 9 to 77 days of age were obtained in male hpg, heterozygous (Hz) and homozygous normal (N/N) littermates (n = 75-78/group). These data did not reveal any difference between Hz and N/N mice. Hpg mice had decreased body weights which by 70-77 days of age were approximately 18% less than normal controls. Testes and seminal vesicles of hpg mice did not demonstrate any significant postnatal growth. Relative to body weight, kidney weights were also markedly reduced in hpg mice (P < 0.0001), deviating significantly from normal by 28-35 days of age, reflecting the impact of androgen deficiency on a non-reproductive organ. From the cross-sectional data it was concluded that puberty commenced soon after weaning (21 days) in the male and that maturity was achieved within 4-5 weeks. Longitudinal study showed that, compared with normal controls, untreated hpg mice had an exaggerated pubertal IGF-I surge (P < 0.005) which peaked in mid-puberty.(ABSTRACT TRUNCATED AT 250 WORDS)

Androgens↗
PubMed1993

Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives.

OBJECTIVES: This study reports an efficacy trial of four work-site health promotion programs. It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies. METHODS: Twenty-eight work sites were randomly allocated to a health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives intervention. Participants were assessed before the intervention and at 3, 6, and 12 months. RESULTS: Compared with the average of the health risk assessment and risk factor education conditions, there were significantly higher validated continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions. The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition. On average among all groups, there was a short-term increase in aerobic capacity followed by a return to baseline levels. CONCLUSIONS: Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and, if implemented routinely, can have a significant public health impact.

Adult↗
PubMed1993

The results of operations on the lumbar spine in patients who have diabetes mellitus.

The results for sixty-two patients who had had a diagnosis of diabetes mellitus and lumbar disc disease or spinal stenosis and had been managed with a posterior decompressive procedure were compared, in a retrospective study, with those for sixty-two age and sex-matched non-diabetic (control) patients who had had similar operative procedures. Forty-four of the sixty-two diabetic patients and fifty-five of the non-diabetic patients were available for long-term follow-up (mean, five and seven years, respectively). Among the diabetic patients, there were high rates of postoperative infection and prolonged hospitalization compared with the rates for the control group. The long-term result was excellent or good for seventeen (39 per cent) of the forty-four patients who had diabetes mellitus and for fifty-two (95 per cent) of the fifty-five non-diabetic patients. The poor results in the diabetic patients may have been related to coexisting diabetic neuropathy, to the associated microvascular disease that affects the spinal nerve roots in diabetic patients, or to the failure of the nerve roots of these patients to recover after decompressive procedures.

Adult↗
PubMed1993

Pupillary abnormalities in type I diabetes occurring during adolescence. Comparisons with cardiovascular reflexes.

OBJECTIVE: To evaluate computerized infrared pupillometry for the assessment of autonomic neuropathy in adolescents with type I diabetes. RESEARCH DESIGN AND METHODS: We measured resting pupil diameters and pupillary light reflexes in 142 adolescents with type I diabetes (72 boys and 70 girls, 10.4-19.8 yr of age, duration of diabetes 0.7-18.3 yr) and in 75 nondiabetic control subjects (29 boys, 46 girls, 11.3-19.8 yr of age). All study participants were assessed using four standard cardiovascular tests: maximum-minimum heart rate during deep breathing (mean of three cycles); heart-rate change during a Valsalva maneuver (Valsalva ratio, mean of three maneuvers); lying-to-standing heart-rate change (30:15 ratio); and lying-to-standing BP change. RESULTS: Mean resting pupil diameters were significantly smaller in the diabetic group: 6.28 +/- 0.06 vs. 6.77 +/- 0.11 mm, P < 0.0001); and significantly smaller with greater duration of diabetes (r = -0.29, P = 0.0006) and higher levels of GHb (r = -0.24, P = 0.004). Patients with retinopathy grade 30 or more (Wisconsin 191 grading) had significantly smaller resting pupil diameters: 5.9 +/- 0.16 vs. 6.4 +/- 0.12 mm, P = 0.008). The phasic light reflex as determined by reflex amplitude and maximum constriction velocity was significantly reduced in the diabetic group: 2.27 +/- 0.03 vs. 2.44 +/- 0.04 mm, P = 0.0009; and 6.68 +/- 0.12 vs. 7.24 +/- 0.16 mm/s, P = 0.007). Reduced reflex amplitude was related to a longer postpubertal duration of diabetes (r = -0.18, P = 0.04). We found no association between pupillary and cardiovascular tests. CONCLUSIONS: Infrared computerized pupillometry demonstrates subclinical diabetic autonomic neuropathy as early as adolescence. Its presence seems to be related to longer duration of diabetes and unfavorable metabolic control.

Adolescent↗
PubMed1993

Internal fixation of the thoracic and lumbar spine using Roy-Camille plates.

Thirty patients underwent fixation of the thoracic and lumbar spine from 1986 to 1990 using the Roy-Camille pedicular screw fixation system. The spine was stabilized for a variety of pathologic entities including fracture, tumor, spondylolisthesis, postlaminectomy instability, and pseudarthrosis. All but one patient obtained solid fusion based on radiographic and clinical criteria with an average follow up of 19.5 months. All patients reported subjective improvement in preoperative pain levels. There were no neurologic complications associated with the surgical procedure. Roy-Camille plate fixation appears to offer a stable surgical construct in the treatment of thoracic and lumbar spine instability.

Adolescent↗
PubMed1992

Diversity of blood pressure recording during pregnancy: implications for the hypertensive disorders.

OBJECTIVE: To determine the number and type of methods used to measure blood pressure (BP) in pregnant women. DESIGN: Questionnaires were distributed to obstetricians and midwives concerning: method of recording BP (arm used, subject position, Korotkoff sounds recorded); accuracy of recording BP (cuff size, sphygmomanometer calibration); and definitions of hypertension in pregnancy. PARTICIPANTS: Obstetricians (academic, staff and private) in Sydney; members of the New South Wales Midwives' Association. MAIN RESULTS: Responses were received from 85 obstetricians (55% of those surveyed) and 173 midwives (43%); the overall response rate was 46%. Almost 80% of respondents agreed that diastolic BP above 90 mmHg constituted hypertension during pregnancy but at least six different methods were used to obtain BP readings, with a potentially large variability in the BP so obtained. Forty-five per cent of obstetricians and 72% of midwives stated that they always used a large cuff when necessary. Few had had their sphygmomanometer calibrated within the previous two years. CONCLUSIONS: There is considerable variability in the way BP is recorded in pregnant women. Hypertension in pregnancy may therefore be over or under diagnosed according to the method employed and there is an urgent need for international consensus on how to measure BP accurately in pregnancy.

Blood Pressure↗