Biomedical subjects

K M Dunn

Publications and source records attributed to K M Dunn.

10 recordsLinked to original sources

PubMed2004

Epidemiology and natural history of low back pain.

Low back pain is a common problem affecting most adults at some point during their lifetime. At any one time, around 1 in 5 adults will report symptoms of low back pain, rising to 40% when asked if they have experienced symptoms during the previous month. The majority of people who experience an episode of low back pain will improve over time. However a sizeable proportion experience repeated episodes or recurrences, and some report continuous symptoms for many years. A wide range of factors are linked to both the onset and persistence of low back pain. Some studies have related age and gender to low back pain, but the link overall is equivocal. Work-related factors such as heavy lifting, and socio-demographic factors such as smoking and obesity have been linked with the onset of low back pain. High levels of functional impairment and the presence of pain radiating to the leg have been cited as factors associated with a poor prognosis among primary care consulters with low back pain. Other characteristics associated with both the development and the persistence of low back pain include psychological factors such as depression and anxiety and workplace factors such as job satisfaction. Low back pain places large demands on health, social and welfare systems. Further research is needed to identify practical interventions to reduce this burden from low back pain.

Journal Article↗

PubMed2001

Personalizing retrieval of journal articles for patient care.

We present a system for patient-specific searches on a database of medical journal articles which uses natural language techniques to match search results against patient records. We performed an information retrieval experiment comparing the performance of this system to two strategies, one of which uses extensive medical knowledge, while the other uses the same patient information our system has. The results show that our system is useful in improving recall over the strategy simulating a human specialist, and clearly outperforms the strategy of using the patient record content without intelligent processing.

Algorithms↗

PubMed2000

Surgery for obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea is the periodic reduction (hypopnoea) or cessation (apnoea) of airflow during sleep. The syndrome is associated with loud snoring, disrupted sleep and observed apnoeas. Beside conservative treatments there are a range of 8 broad categories of operative treatments for this condition. Surgical treatments aim to relieve the obstruction by either increasing the surface area OBJECTIVES: Surgery for obstructive sleep apnoea aims to relieve the obstruction by increasing the surface area of the airway, bypassing the pharyngeal airways or removing a lesion. The objective of this review was to assess the effects of any type of surgery for the treatment of obstructive sleep apnoea. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and reference lists of articles. We contacted experts in the field, research dissemination bodies and other Cochrane Review Groups. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing any surgical intervention for obstructive sleep apnoea with other surgical or non-surgical interventions for obstructive sleep apnoea or no intervention. DATA COLLECTION AND ANALYSIS: No completed trials were identified. MAIN RESULTS: No studies fulfilled the inclusion criteria. REVIEWER'S CONCLUSIONS: There is an urgent need for high quality randomised controlled trials to be carried out in the field of surgery for obstructive sleep apnoea. More research should also be undertaken to identify and standardise techniques to determine the site of airways obstructions.

Adult↗

PubMed2000

Interventions for treating calcaneal fractures.

BACKGROUND: Fracture of the calcaneus (os calcis or heel bone) comprises one to two per cent of all fractures. OBJECTIVES: To identify and evaluate randomised trials of treatments for calcaneal fractures. SEARCH STRATEGY: MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register, and the Cochrane Musculoskeletal Injuries Group Trials Register were searched. We checked reference lists of relevant articles and contacted trialists and experts in the field. Date of the most recent search: October 1998. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing interventions for treating patients with calcaneal fractures. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, using a 12 item scale, and extracted data. Wherever appropriate and possible, results were pooled. MAIN RESULTS: Of the six relevant randomised trials identified, four were included, one excluded and one is ongoing. All four included trials had methodological flaws. Three trials, involving 134 patients, compared open reduction and internal fixation with non-operative management of displaced intra-articular fractures. Pooled results showed no apparent difference in residual pain (24/40 versus 24/42; Peto odds ratio 0.90, 95% confidence interval 0.34 to 2.36), but a lower proportion of the operative group was unable to return to the same work (11/45 versus 23/45; Peto odds ratio 0.30, 95% confidence interval 0.13 to 0.71), and was unable to wear the same shoes as before (12/52 versus 24/54; Peto odds ratio 0.37, 95% confidence interval 0.17 to 0.84). One trial, involving 23 patients, evaluated impulse compression therapy. At one year there was a mean difference of 1.40 pain units on a visual analogue score (scale 0-10) (95% confidence interval 0.02 to 2.82) in favour of the treated group. The impulse compression group had greater subtalar movement (mean difference 14.0 degrees, 95% confidence interval 3.2 to 24.6) at three months. On average, patients in the impulse compression group returned to work three months earlier than those in the control group. REVIEWER'S CONCLUSIONS: Randomised trials of management of calcaneal fractures are few, small and generally of poor quality. Even where there is some evidence of benefit of operative compared with non-operative treatment, it remains unclear whether the possible advantages of surgery are worth its risks. Given this it seems best to wait for the results of one large ongoing trial on open reduction and internal fixation against conservative treatment. One very small trial suggests that impulse compression therapy for intra-articular calcaneal fractures may be beneficial. More large-scale, high quality randomised controlled trials are needed to confirm these results, and to test other interventions in the treatment of calcaneal fractures.

Calcaneus↗

PubMed2000

Has endometrial ablation replaced hysterectomy for the treatment of dysfunctional uterine bleeding? National figures.

OBJECTIVES: To describe trends in the use of endometrial ablation and hysterectomy for the treatment of dysfunctional uterine bleeding. DESIGN: Analysis of hospital admissions data. SETTING: National Health Service Hospitals in England. POPULATION: Women who underwent a hysterectomy or endometrial ablation for dysfunctional uterine bleeding between 1989 and 1996. MAIN OUTCOME MEASURES: Annual operation rates and standardised operation ratios for England and for the National Health Service Regions within it, and proportion of operations for dysfunctional uterine bleeding that were endometrial ablations or hysterectomies. RESULTS: There was an initial rise in operation rates for endometrial ablation until 1992/3, since when the rates have fallen. Hysterectomy rates have remained relatively steady since the introduction of endometrial ablation. The total operation rates for dysfunctional uterine bleeding initially increased but have tended to fall since 1992/3. The ratio of hysterectomy to endometrial ablation for dysfunctional uterine bleeding troughed at 3:1 in 1992/3, but by 1995/6 had increased to 4:1. CONCLUSIONS: Rather than replacing hysterectomy in the treatment of dysfunctional uterine bleeding, endometrial ablation appears to have added an alternative operative technique. This led to an increase in the total number of operations for this condition, perhaps by lowering the threshold for intervention.

Catheter Ablation↗

PubMed1999

Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional population survey.

STUDY OBJECTIVE: To investigate the association of sexual problems with social, physical, and psychological problems. DESIGN: An anonymous postal questionnaire survey. SETTING: Four general practices in England. PARTICIPANTS: 789 men and 979 women responding to a questionnaire sent to a stratified random sample of the adult general population (n = 4000). MAIN RESULTS: Strong physical, social, and psychological associations were found with sexual problems. In men, erectile problems and premature ejaculation were associated with increasing age. Erectile problems were most strongly associated with prostate trouble, with an age adjusted odds ratio of 2.6 (95% confidence intervals 1.4, 4.7), but hypertension and diabetes were also associated. Premature ejaculation was predominantly associated with anxiety (age adjusted odds ratio 3.1 (95% confidence intervals 1.7, 5.6)). In women, the predominant association with arousal, orgasmic, and enjoyment problems was martial difficulties, all with odds ratios greater than five. All female sexual problems were associated with anxiety and depression. Vaginal dryness was found to increase with age, whereas dyspareunia decreased with age. CONCLUSIONS: This study indicates that sexual problems cluster with self reported physical problems in men, and with psychological and social problems in women. This has potentially important consequences for the planning of treatment for sexual problems, and implies that effective therapy could have a broad impact on health in the adult population.

Adolescent↗

PubMed1998

An integrated algal sulphate reducing high rate ponding process for the treatment of acid mine drainage wastewaters.

Acid mine drainage pollution may be associated with large water volume flows and exceptionally long periods of time over which the drainage may require treatment. While the use and role of sulphate reducing bacteria has been demonstrated in active treatment systems for acid mine drainage remediation, reactor size requirement and the cost and availability of the carbon and electron donor source are factors which constrain process development. Little attention has focussed on the use of waste stabilisation ponding processes for acid mine drainage treatment. Wastewater ponding is a mature technology for the treatment of large water volumes and its use as a basis for appropriate reactor design for acid mine drainage treatment is described including high rates of sulphate reduction and the precipitation of metal sulphides. Together with the co-disposal of organic wastes, algal biomass is generated as an independent carbon source for SRB production. Treatment of tannery effluent in a custom-designed high rate algal ponding process, and its use as a carbon source in the generation and precipitation of metal sulphides, has been demonstrated through piloting to the implementation of a full-scale process. The treatment of both mine drainage and zinc refinery wastewaters are reported. A complementary role for microalgal production in the generation of alkalinity and bioadsorptive removal of metals has been utilised and an Integrated 'Algal Sulphate Reducing Ponding Process for the Treatment of Acidic and Metal Wastewaters' (ASPAM) has been described.

Acids↗

PubMed1998

Sexual problems: a study of the prevalence and need for health care in the general population.

BACKGROUND: There has been little research carried out on the prevalence and types of sexual dysfunction in the general population, although the indications are that such problems are relatively common. Most common sexual problems are potentially treatable. However GPs have estimated the prevalence of sexual problems to be far lower than survey estimates. OBJECTIVE: To provide an estimate of the prevalence of sexual problems in the general population, and assess the use of and need for professional help for such problems. METHODS: We used an anonymous postal questionnaire survey. The study was set in four general practices in England*, and the study population was a stratified random sample of the adult general population (n = 4000). The subjects were 789 men and 979 women who responded to the questionnaire. The main outcome measures were the presence and type of current sexual problems in men and women, and the provision and use of treatments for sexual problems. RESULTS: A response rate of 44% was obtained. The median age of the responders was 50 years. A third of men (34%) and two-fifths of women (41 %) reported having a current sexual problem. The most common problems were erectile dysfunction (n = 170) and premature ejaculation (n = 88) in men; in women the most widely reported problems were vaginal dryness (n = 186) and infrequent orgasm (n = 166). In men, the proportion of responders reporting sexual problems increased with age, but there was no similar trend in women. Of those responders who reported a sexual problem, 52% said that they would like to receive professional help for this problem, but only one in ten of these people (n = 50) had received such help. CONCLUSION: Among responders there was a high level of reported sexual problems. The most frequently reported problems (vaginal dryness, erectile problems) may be amenable to physical treatment in practice, and yet few had sought or received help. However, many said that they would like to receive help. These figures suggest that there may be an important burden of potentially reversible sexual problems in the general population.

Adolescent↗

PubMed1991

Examining predictors of sex guilt in multiethnic samples of women.

Previous research has shown that attitudes, including sex guilt, may influence the nature and type of sexual practices in which a person engages. This study examined the relationship of socioeconomic status (SES), ethnicity, and religiosity to sex guilt and aspects of sexual permissiveness that relate to sexual attitudes. Subjects were random samples of 126 African American women and 122 white American women in Los Angeles County. They were interviewed face-to-face and completed the Mosher Forced Choice Sex Guilt subscale. Results indicated that while the association between church attendance and sex guilt was stronger for white than for black women, no significant differences in sex guilt across attendance levels was found for black women. Overall, contrary to previous reports, black women had higher levels of sex guilt than their white peers. The importance of understanding factors including SES and religiosity as they relate to African American and white American women's sexual attitudes and behaviors is discussed.

Adolescent↗

PubMedDate not supplied

Satisfaction in the sex life of a general population sample.

A questionnaire asking about satisfaction and problems in the sex lives of respondents and their partners was sent to 4,000 adults registered with general practices in England. A quarter of respondents said that they were dissatisfied with their sex lives, men more so than women, particularly with the frequency of intercourse. Respondents were more likely to be dissatisfied with their sex life if they perceived their partner to have a sexual problem. Respondents who were dissatisfied were more likely to report that their partner was dissatisfied with their sex life. The benefits of treating sexual problems have wide implications for both partners in a relationship.

Adolescent↗