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Biomedical subjects

K McKee

Publications and source records attributed to K McKee.

At least 19 recordsLinked to original sources
PubMed2000

Getting the questions right: an example of loss of validity during transfer of a brief screening approach for depression in the elderly.

Screening for depression in the elderly has been advocated to improve detection and management. This article summarises the trend towards briefer screening instruments, and the integration of mental health screening with other assessments. The study aimed to validate a single question depression screen which has previously shown adequate sensitivity and specificity in a new context: a multi-faceted assessment instrument used by nurse practitioners within a community sample of over 75 year olds. The GMS-AGECAT computerised interview assessment was used as a 'gold standard' to determine the accuracy of the depression question in this new setting. Three hundred and twenty-eight patients were screened by their own nurse practitioners, of whom 100 consenting patients underwent a further interview with a research assistant using the GMS-AGECAT. The prevalence of depression was 30%, the sensitivity of the question was 67%, and its specificity 60% (compared with 88% and 71% previously). Responses indicating disability and loneliness were more closely correlated with depression than the depression screen itself. Relevant factors may include: the derivation of the question, the effect of a different sample, altered reliability when used by multiple interviewers, differing patient expectations, and the wording and context of the question within the multi-faceted screening instrument. Depression screening questions need repeated validation when used in different contexts. Patient and staff expectations may influence how screening instruments are used in practice in a way that may also alter reliability. Further studies are needed to establish the causes of loss of validity when screening approaches are used in new settings.

Aged↗
PubMed2000

Efficacy of potential chemopreventive agents on rat colon aberrant crypt formation and progression.

We assessed the effects of 78 potential chemopreventive agents in the F344 rat using two assays in which the inhibition of carcinogen-induced aberrant crypt foci (ACF) in the colon was the measure of efficacy. In both assays ACF were induced by the carcinogen azoxymethane (AOM) in F344 rats by two sequential weekly injections at a dose of 15 mg/kg. Two weeks after the last AOM injection, animals were evaluated for the number of aberrant crypts detected in methylene blue stained whole mounts of rat colon. In the initiation phase protocol agents were given during the period of AOM administration, whereas in the post-initiation assay the chemopreventive agent was introduced during the last 4 weeks of an 8 week assay, a time when ACF had progressed to multiple crypt clusters. The agents were derived from a priority listing based on reports of chemopreventive activity in the literature and/or efficacy data from in vitro models of carcinogenesis. During the initiation phase carboxyl amidoimidazole, p-chlorphenylacetate, chlorpheniramine maleate, D609, diclofenac, etoperidone, eicosatetraynoic acid, farnesol, ferulic acid, lycopene, meclizine, methionine, phenylhexylisothiocyanate, phenylbutyrate, piroxicam, 9-cis-retinoic acid, S-allylcysteine, taurine, tetracycline and verapamil were strong inhibitors of ACF. During the post-initiation phase aspirin, calcium glucarate, ketoprofen, piroxicam, 9-cis-retinoic acid, retinol and rutin inhibited the outgrowth of ACF into multiple crypt clusters. Based on these data, certain phytochemicals, antihistamines, non-steroidal anti-inflammatory drugs and retinoids show unique preclinical promise for chemoprevention of colon cancer, with the latter two drug classes particularly effective in the post-initiation phase of carcinogenesis.

Animals↗
PubMed1998

The perception of face gender: the role of stimulus structure in recognition and classification.

The perception of face gender was examined in the context of extending "face space" models of human face representations to include the perceptual categories defined by male and female faces. We collected data on the recognizability, gender classifiability (reaction time to classify a face as male/female), attractiveness, and masculinity/femininity of individual male and female faces. Factor analyses applied separately to the data for male and female faces yielded the following results. First, for both male and female faces, the recognizability and gender classifiability of faces were independent--a result inconsistent with the hypothesis that both recognizability and gender classifiability depend on a face's "distance" from the subcategory gender prototype. Instead, caricatured aspects of gender (femininity/masculinity ratings) related to the gender classifiability of the faces. Second, facial attractiveness related inversely to face recognizability for male, but not for female, faces--a result that resolves inconsistencies in previous studies. Third, attractiveness and femininity for female faces were nearly equivalent, but attractiveness and masculinity for male faces were not equivalent. Finally, we applied principal component analysis to the pixel-coded face images with the aim of extracting measures related to the gender classifiability and recognizability of individual faces. We incorporated these model-derived measures into the factor analysis with the human rating and performance measures. This combined analysis indicated that face recognizability is related to the distinctiveness of a face with respect to its gender subcategory prototype. Additionally, the gender classifiability of faces related to at least one caricatured aspect of face gender.

Analysis of Variance↗
PubMed1997

An international validation of the interaction with disabled persons scale.

The Interaction with Disabled Persons Scale (IDP) was devised to measure attitudes in terms of discomfort reported about social interaction with people with disabilities. The Scale has been used in Australia for ten years. This article reports results of an international validation project that was designed to determine whether psychometric characteristics and norms emerging for Australian groups apply elsewhere. A methodological proforma was developed to maximize uniformity of data collection across nine countries: Australia, Canada, Croatia, England, Germany, Hong Kong, Poland, Scotland and the United States. In most countries the Scale was administered in English; however it also was translated into Germany, Polish, French and Croat. Results indicate that across countries mean scores fell within ten points, similar moderate to high levels of item homogeneity occurred and level of prior contact with people with disabilities emerged as the strongest predictor of IDP scores. It was concluded that the IDP Scale is a valid measure that is able to discriminate between respondents within the countries included in the study.

Adult↗
PubMed1994

Essential amino acid reference profile affects the evaluation of enteral feeding products.

The chemical score is a measure of the predicted metabolic usefulness of a protein in a food based on the comparison (ratio or percentage) of the concentrations of the essential amino acids (EAAs) to a "profile" assumed to reflect the true needs of the body. The score for the limiting EAA is taken to represent the value of the food. Such a chemical score is particularly useful for therapeutic diets where bioassay (such as nitrogen-balance studies) in a large number of patients may be unethical or impractical. Although a major limitation to the chemical-score method previously was scarcity and/or imprecision of data about EAA concentrations in foods, this situation has been mitigated by modern analytic methods. The validity of a chemical score is also exquisitely sensitive to the EAA profile used for comparison. Chemical scores published for a variety of enteral and parenteral feeding products implied a low (approximately 50%) protein value. These computations were based on the EAA profile of egg protein. This pattern is sufficient, in most cases, for body needs, but it may be far more than is necessary. Recently published profiles, based on measurements in human beings of actual protein and EAA requirements, point to a more realistic chemical-score computation. These profiles accommodate age and lifestyle factors and provide greater flexibility in the formulation of therapeutic diets.

Adolescent↗
PubMed1994

Staff nurses' work satisfaction in psychogeriatric wards.

This paper begins by reviewing the small number of studies of staff nurses' work satisfaction. Subsequently, an examination is made of the differences in work satisfaction between staff nurses and other grades of nursing staff in psychogeriatric wards in National Health Service hospitals in Scotland. These data are part of a larger study into work satisfaction and the quality of care in these settings. Significant differences in satisfaction at work are identified between the staff nurse group and the other grades taken as a whole. Analysis of the components of job satisfaction suggests that these differences arise from: first, the experience of the work itself; second, the quality of the supervision which takes place; and third, the assessment of hospital policies, such as the transfer of staff to other wards.

Adult↗
PubMed1993

Measuring the quality of care in psychogeriatric wards.

This paper discusses the way in which quality of care has been measured and in particular draws attention to the vagueness of concepts such as autonomy, individuality and dignity. In our research we have put forward a number of indicators for the quality of care received by patients and, in addition, we have constructed a method by which they can be measured, through the use of standardized observation schedules. This paper therefore describes our indicators and the data collection process followed. This aspect of our work is part of a larger study into work satisfaction and quality of care in psychogeriatric wards in Scotland. Ultimately, the data will allow us to identify factors affecting high and low levels of job satisfaction as well as factors influencing good and bad quality of care. Further, we will be able to examine any association between work satisfaction and the quality of care delivered to patients. The results of this research are due to be published shortly.

Activities of Daily Living↗
PubMed1992

Quantitation of eosinophil Major Basic Protein cytotoxicity to rodent respiratory epithelium.

Eosinophil Major Basic Protein (MBP) may be a potent effector in damaging airway epithelium and inducing acute (2-3 h) hyperresponsiveness to agonists in primates. Accordingly, interactions between human eosinophil MBP and guinea-pig airway epithelium were quantitated biochemically. MBP was extracted from human eosinophils and purified by size-exclusion HPLC. This resulted in a single protein band on electrophoresis, which cross-reacted with antisera raised to peptides derived from the predicted sequence of human MBP. This human MBP caused modest, but statistically significant, damage to respiratory epithelium (16.4% increase in efflux of 51Cr from guinea-pig tracheal rings) after 3 h of incubation with 10(-4) M concentration, but not with lower concentrations. These data demonstrates that MBP cytotoxicity to intact epithelium can be rapidly measured in vitro, and suggests that rodent airway epithelium may be relatively resistant to the cytotoxic effects of MBP.

Animals↗
PubMed1992

Clinical and laboratory observations following oral or intramuscular administration of a live attenuated hepatitis A vaccine candidate.

Clinical observations made after immunising volunteers with a live attenuated hepatitis A vaccine are described. The candidate vaccine was prepared with the HM175 strain of hepatitis A virus and shown to be safe, immunogenic and efficacious in experimental animals. When the candidate vaccine was tested by oral administration in humans at increasing doses--10(4), 10(5), 10(6) and 10(7) median tissue culture infective doses (TCID50)--an antibody response was not observed at any dose. Volunteers who received similar doses by the intramuscular route developed antibody to hepatitis A three weeks after immunization with 10(6) or 10(7) TCID50. The antibody response was sustained for the 12 weeks of the observation period. All volunteers remained healthy with normal results from liver tests throughout the monitoring period. Further clinical observations of this product are in progress.

Administration, Oral↗
PubMed1991

Effects of diet and phenotype on adipose cellularity and 5'-deiodinase activity of liver and brown adipose tissue of diabetic SHR/N-cp rats.

1. Groups of lean and obese male SHR/N-cp rats were fed isoenergetic diets containing 54% carbohydrate as cornstarch (CS) or sucrose (SU) plus other nutrients from 5 weeks of age, and measures of adiposity, thyroxine 5' deiodinase (T4-5'DI) activity, and tissue and plasma triiodothyronine (T3) content determined at 9.5 months of age. 2. Body weights (BW) of obese greater than lean, and were greater when fed the SU than CS diet in both phenotypes. Phenotype effects (obese greater than lean) were present for fat pad weights and adipose cellularity in most primary adipose tissue depots, and diet effects (SU greater than CS) were present for epididymal and retroperitoneal depots in both phenotypes. 3. Interscapular brown adipose tissue (IBAT) and IBAT:BW ratios of obese greater than lean, and diet effects (SU greater than CS) were present for lean but not obese rats. Liver T4-5'DI activity and plasma and tissue T3 of lean greater than obese, while IBAT 5'DI activity of obese greater than lean in the CS diet. 4. These results indicate that obesity occurs in the SHR/N-cp rat as the result of hypertrophy and hyperplasia of adipose tissue, and that isoenergetic substitution of simple for complex carbohydrate exaggerates fat accretion in lean but not obese rats. Moreover, the obesity occurs in spite of greater mass, cellularity, and T4-5'DI activity of IBAT, consistent with a thermogenic defect in the obese phenotype of this strain.

Adipose Tissue↗
PubMed1991

Viral haemorrhagic fever in Sweden: experiences from management of a case.

The first recognized case in Scandinavia with potential man to man transmission of viral haemorrhagic fever occurred in Linköping, Sweden, in January 1990. Following a visit to Kenya a 21-year-old male student suffered a very severe illness including extremely prolonged high grade fever, rash, disseminated intravascular coagulation with thrombocytopenia and severe bleedings. This necessitated one month of intensive care support including respirator treatment. The patient was discharged after 2 1/2 months in good condition, with a partial femoral nerve paresis. About 100 medical personnel were exposed to aerosol or blood before a strict containment regimen was established. No secondary cases occurred.

Adult↗
PubMed1990

Eosinophil-eicosanoid interactions: inhibition of eosinophil chemotaxis in vivo by a LTD4-receptor antagonist.

Chemotaxis of guinea-pig eosinophils in vivo has been studied in the guinea-pig conjunctiva. Guinea-pig eosinophils were labelled with 111In oxine and injected i.v. into recipient animals. Circulating radioactivity remained constant over a period of 4 h but dropped transiently in response to a bolus injection (1 nmol) of platelet activating factor (PAF), suggesting that the 111In-labelled eosinophils had retained their responsiveness to PAF. Leukotriene D4 (LTD4, 1 nmol/eye) and PAF (10 nmol/eye), but not histamine (5 nmol/eye), induced a significant 2.5-fold increase in conjunctival radioactivity, a measure of eosinophil chemotaxis in vivo, after 17 h. Antigen challenge (250 micrograms/eye) in ovalbumin-sensitized animals produced larger responses (8-fold increases) at the same time point. A specific LTD4 receptor antagonist MK-571 (10 micrograms/eye) completely inhibited in vivo chemotactic responses to LTD4, and partially inhibited (54%) the responses to ovalbumin (observations subsequently confirmed by histological studies). As eosinophils may play an important role in allergic diseases, the results with MK-571 indicate that selective and potent LTD4 receptor antagonists may provide a novel therapy for allergic conjunctivitis, rhinitis and asthma.

Animals↗
PubMed1989

Human lactoferrin supplementation of infant formulas increases thymidine incorporation into the DNA of rat crypt cells.

Lactoferrin has been identified as the factor in human colostrum that accounts for the increased incorporation of thymidine into DNA in a rat crypt enterocyte bioassay. Commercially available infant formulas used in the refeeding of infants who have severe dietary intolerance associated with mucosal atrophy were tested in this bioassay. In contrast to human milk, no stimulation was observed with these formulas in the assay. All formulas inhibited basal thymidine incorporation. The degree of inhibition of the basal assay progressed from 14% with cow's-milk formula to 30% with soy-based formulas to 45% with hydrolyzed casein formulas. When the formulas were supplemented with lactoferrin to match the level of that in human milk, the result was a 35% relative increase in thymidine incorporation into DNA. The quantitative level of response was primarily influenced by the baseline inhibitions associated with the specific formulas. The most profound effect was observed with the hydrolyzed casein formula, when lactoferrin supplementation reversed the baseline inhibition but did not result in a response greater than that seen in control basal bioassays. The supplementation of infant formulas with lactoferrin improved the thymidine incorporation in rat crypt enterocytes; a response equivalent to that of human milk, however, would require a redesign of other formula components to reduce basal inhibition.

Animals↗
PubMed1979

Pneumocystis carinii infection of the lung: radiologic and pathologic correlation.

The incidence of Pneumocystis carinii infection of the lung was determined in 100 consecutive autopsies on patients with hematologic malignancies and in a control group of 50 patients with acute myocardial infarction and chronic obstructive pulmonary disease. Thirteen instances of infection were found in the study group and one instance in the control group. Of the 14 patients with P. carinii infection, five were classified as uncomplicated P. carinii pneumonia with typical host response and five had no evidence of any host response to the presence of the organisms. Four cases were impossible to assess because of complicating bacterial, viral, or fungal pneumonia. The five patients with the typical histologic response to the presence of P. carinii organisms all showed diffuse pulmonary densities on the chest radiographs in accordance with the classic descriptions of P. carinii pneumonia. The five without any evidence of host response to the presence of P. carinii organisms showed no evidence of parenchymal disease on chest radiographs. The finding of P. carinii organisms in the lung is not necessarily an indication of clinically significant disease and, from this study, it seems that chest radiography is of considerable importance in determining the significance of such infestation.

Diagnosis, Differential↗
PubMedDate not supplied

Nurse midwives' attitudes toward abortion performance and related procedures.

In 1990 a symposium was held by the American College of Obstetricians and Gynecologists and the National Abortion Federation to address the national shortage of physician abortion providers. One symposium recommendation was that nurse-midwives be trained to perform first-trimester legal abortions under physician supervision. A national mail survey was conducted to determine the attitudes of nurse-midwives toward performing abortion and related procedures. One-half of the nurse-midwives who were members of the American College of Nurse-Midwives as of October 1991 were polled, and 1,208 questionnaires (71.1%) were returned, resulting in a sample representative of the general membership and students. Seventy-nine percent of respondents would not support federal and state efforts to limit access to abortion, 52% would or possibly would vote in a secret ballot to permit the performance of abortion by certified nurse-midwives; 24% would, or possibly would, incorporate abortion procedures into their practice; and 19% would, or possibly would, perform abortions in an abortion clinic. The lowest level of support to permit the certified nurse-midwife practice of abortion came from the midwest (31%) and southeast (41%) and the greatest from the west coast (65%). Supporters for the nurse-midwife performance of abortion were more likely to have practiced well-woman gynecology and provided abortion-related services such as abortion referrals, pre- and postabortion workups and the treatment of abortion-related complications. They were more likely to have inserted intrauterine contraceptive devices and laminaria, and to have performed circumcision. Opinions about the performance of abortion were not related to age, education, or student status. The majority of nurse-midwives (91%) would be willing to refer a woman to another provider for an abortion, prescribe RU 486 (57%), and perform dilation and curettage for spontaneous abortion (56%). The American College of Nurse-Midwives membership reported many different reasons for support of and opposition to professional involvement with abortion. Further research suggestions for institutional policy and individual practice are offered.

Abortion, Legal↗