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Biomedical subjects

J Meara

Publications and source records attributed to J Meara.

At least 19 recordsLinked to original sources
PubMed2004

Chemical, biological, radiological and nuclear terrorism: an introduction for occupational physicians.

BACKGROUND: Chemical, biological, radiological and nuclear terrorism poses considerable threat throughout the world. AIM: To provide occupational physicians with an understanding of this threat and its main forms and what action can be taken to counter this threat. METHODS: Presenters at a conference on chemical, biological, radiological and nuclear terrorism were asked to contribute their evidence-based opinions in order to produce a review article. RESULTS: This paper presents a summary of the different forms of chemical, biological, radiological and nuclear terrorism and the effective counter-measures and also provides a review of current scientific literature. CONCLUSION: The threat of chemical, biological, radiological and nuclear terrorism is present throughout the world and is one that occupational physicians should be aware of, as well as the action that can be taken to counter it.

Anthrax↗
PubMed1999

Use of the GDS-15 geriatric depression scale as a screening instrument for depressive symptomatology in patients with Parkinson's disease and their carers in the community.

OBJECTIVES: To assess the level of depressive symptomatology in a community based group of patients with Parkinson's disease (PD) and their carers and to investigate the patient characteristics that might predict carer distress. METHODS: The GDS-15 geriatric depression scale was used to measure self-rated depressive symptoms in a group of 132 subjects with clinically probable PD randomly selected from a community-based disease register. Disease severity was assessed by the Webster scale and cognitive function by the CAMCOG test. Carers of the patients, who in this study were all spouses, were also asked to complete the GDS-15. RESULTS: A total of 64% of our group of patients and 34% of carers scored within the 'depressed' range on the GDS-15. Patients with high levels of depressive symptoms tended to have more severe disease, disease of longer duration and more impaired cognitive function. The GDS score of the carer was best predicted by the GDS score of the patient being cared for. Less than 10% of patients and carers were being treated with antidepressant medication. CONCLUSIONS: This community-based study confirms the high level of depressive symptoms in PD suggested by hospital- and clinic-based studies. Depression in patients appears to be related to disease severity and cognitive impairment. An important determinant of carer distress and mood disorder, as reflected by the GDS score, appears to be the level of depression expressed by the patient being cared for. Despite high levels of depressive symptoms in both patients and carers, very few subjects were in receipt of antidepressant drug therapy.

Aged↗
PubMed1999

The detection of dementia and cognitive impairment in a community population of elderly people with Parkinson's disease by use of the CAMCOG neuropsychological test.

AIM: To assess cognitive function in elderly subjects with clinically probable Parkinson's disease (PD). METHODS: A community sample of 126 patients with probable PD completed the CAMCOG, which is the cognitive section of the Cambridge Examination for Mental Disorders, and the Mini-Mental State Examination (MMSE). The performance of the CAMCOG and the MMSE in detecting dementia in this subject group was compared with the results of applying the DSM-IV criteria for dementia to this population. RESULTS: A total of 44% of the group met DSM-IV criteria for dementia, which is higher than most previous prevalence figures for dementia in PD. The CAMCOG was more sensitive than the MMSE in detecting cognitive impairment and more specific than the MMSE in detecting dementia as defined by DSM-IV criteria. Poorer performance on the CAMCOG was related to gender, social class and age (P<0.05). Among subjects with PD, those with dementia, as defined by DSM-IV criteria, were significantly older, had greater depressive symptomatology and had greater motor deficits. A greater proportion of the group with dementia were living in residential care (P<0.05). CONCLUSION: The CAMCOG appears to be a useful screening instrument for dementia and cognitive impairment in PD. Furthermore, it may prove helpful in detecting those with PD who may be at risk of developing dementia and in longitudinal studies of cognitive function in PD.

Aged↗
PubMed1999

Accuracy of diagnosis in patients with presumed Parkinson's disease.

OBJECTIVES: to study the diagnostic accuracy for parkinsonism and Parkinson's disease in a community-based sample of subjects on anti-parkinsonian medication. METHODS: computerized prescribing records in general practice were used to create a community-based disease register for Parkinson's disease. Subjects were examined to establish the likely diagnosis using recommended clinical diagnostic criteria. RESULTS: of 402 cases, parkinsonism was confirmed in 74% and clinically probable Parkinson's disease in 53%. The commonest causes of misdiagnosis were essential tremor, Alzheimer's disease and vascular pseudo-parkinsonism. Over one-quarter of subjects did not benefit from anti-parkinsonian medication. CONCLUSIONS: there is difficulty in diagnosing parkinsonism and Parkinson's disease in elderly subjects and we suggest early referral of those suspected of having parkinsonism for specialist assessment.

Adult↗
PubMed1999

Measuring the impact of Parkinson's disease with the Parkinson's Disease Quality of Life questionnaire.

OBJECTIVES: To assess the validity of the Parkinson's Disease Quality of Life (PDQL) questionnaire, a patient-specific multi-dimensional quality of life measure, in a community-based sample of patients with Parkinson's disease (PI)) using standardized measures of disease severity, depressive symptomatology and cognitive function. DESIGN: A group of 194 patients with probable PD were randomly selected from a community-based register and were invited to self-complete the 37-item PDQL. Disease severity was measured by the disease-specific Webster scale, cognition by the CAMCOG neuropsychological test and depressive symptomatology by the self-report 15-item GDS-15 geriatric depression scale. RESULTS: A total of 136 patients returned completed PDQL questionnaires. Significant differences (P < 0.05) emerged between the pooled PDQL score of patients grouped on the basis of disease severity. Depressive symptoms and cognition were also associated with poorer perceived quality of life as measured by the PDQL. CONCLUSIONS: The results of this study are indicative of the validity of the PDQL as an important additional measurement which reflects the impact of PD from the patient perspective. It shows poorer quality of life to be associated with increasing age, disease severity more severe depressive symptomatology and impaired cognitive functioning. However, the responsiveness of this instrument in the evaluation of care in PD remains to be determined.

Aged↗
PubMed1989

Alcohol, cigarette smoking and breast cancer.

The results of two case-control studies of breast cancer which included questions on exposure to tobacco and alcohol are reported. One study included 998 hospital cases and a like number of matched hospital controls while the other included 118 cases identified during mammographic screening and a like number of matched normal screenees. Both studies used the same questionnaires and the same methods to obtain information. The results with regard to cigarette smoking differed between the two studies. The hospital-based study showed a decreased risk of breast cancer with increasing amounts smoked (relative risk for 15 or more cigarettes per day was 0.82, 95% confidence interval 0.60-1.13) while the screening study showed an increased risk (relative risk for 15 or more cigarettes per day was 2.90, 95% confidence interval 1.16-7.25). Evidence is presented that both results may be attributable to bias in the selection of cases and controls. It is concluded that reliable results on the relationship between smoking and breast cancer are only likely to come from population-based studies. These studies, in general, have found no relationship. Neither study produced any hint of an association between alcohol consumption and breast cancer. From this, it appears that bias in subject selection may not be such a significant factor in interpretation of studies of alcohol and breast cancer as it is in studies of smoking and the disease. A number of other difficulties in the interpretation of studies of alcohol and breast cancer are considered, including the great variation in the amount of alcohol consumed. It is concluded that the assertion that alcohol is a risk factor for breast cancer remains unproven.

Adult↗
PubMed1988

Use of hospital beds: a cohort study of admissions to a provincial teaching hospital.

An instrument was developed to study the use of hospital beds and discharge arrangements of a cohort of 847 admissions to the John Radcliffe Hospital, Oxford, for a three week period during February-March 1986. For only 38% of bed days were patients considered to have medical, nursing, or life support reasons for requiring a provincial teaching hospital bed. The requirements for a bed in the hospital decreased with the patient's age and length of stay in hospital. For only a tenth of patients was the general practitioner concerned in discussions with hospital staff about the patient's discharge and less than one third of patients had been given more than 24 hours' notice of discharge. Several features might increase the proportion of bed days that are occupied by patients with positive reasons for being in hospital. Among these are an increased frequency of ward rounds by consultants, or delegating discharge decisions by consultants to other staff; providing diagnostic related protocols for planning the length of stay in hospital; planned discharges; and providing liaison nurses to help with communication with primary care staff.

Bed Occupancy↗