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Biomedical subjects

L Carpenter

Publications and source records attributed to L Carpenter.

At least 55 records · Page 3Linked to original sources
PubMed1992

A case-control study of benign ovarian tumours.

STUDY OBJECTIVE: The aim was to investigate the association between reproductive, contraceptive, and menstrual factors and risk of benign ovarian tumours. DESIGN AND SETTING: This was a case-control study carried out in six London Hospitals. An interviewer administered questionnaire was used. SUBJECTS: 62 women with a benign epithelial ovarian neoplasm, 37 women with a functional ovarian cyst, and 20 women with a dermoid cyst presenting between 1983 and 1985, together with 132 controls, took part in the study. MAIN RESULTS: On average, women with a benign epithelial ovarian neoplasm were older than those with a functional ovarian cyst, who in turn were older than those with a dermoid cyst. Nulliparity and infertility were associated with an increased risk, and multiparity with a reduced risk, of benign epithelial ovarian neoplasms. Infertility and pelvic inflammatory disease were associated with increased risks of functional and dermoid cysts. Recent use of oral contraceptives was associated with a reduced risk of all three tumour types. CONCLUSIONS: The findings suggest that the aetiology of ovarian cysts and benign epithelial ovarian neoplasms may differ. The aetiology of benign and malignant epithelial ovarian neoplasms may be similar, however, since some risk factors are shared.

Adolescent↗
PubMed1992

Cohort study of human immunodeficiency virus infection in patients with tuberculosis in Nairobi, Kenya. Analysis of early (6-month) mortality.

Retrospective studies suggest that the mortality rate from HIV-1-associated tuberculosis is greater than that from tuberculosis alone, but it is not clear if this is due to failure of antituberculosis treatment or to the complications of HIV-1 infection. We have carried out a prospective cohort study of patients with tuberculosis in Nairobi, Kenya, to compare mortality rates, risk factors, and causes of death in HIV-1 positive and HIV-1 negative patients. One hundred seven HIV-1 positive and 174 HIV-1 negative patients with tuberculosis attending two tuberculosis treatment centers in Nairobi were enrolled and followed monthly. Mortality was significantly higher in HIV-1 positive than in HIV-1 negative patients within 6 months of the start of antituberculosis treatment after adjustment for age, sex, and education (rate ratio = 3.8; 95% confidence interval, 1.7 to 8.1; p less than 0.001). Most of the excess mortality occurred after the first month of treatment and was due to nontuberculous infections. Predictors for mortality differed greatly between HIV-1 positive and HIV-1 negative patients. Mortality was greater in HIV-1 positive patients treated with a "standard" regimen for tuberculosis than in HIV-1 positive patients receiving a "short-course" regimen (p = 0.08 when adjusted for all independent risk factors). Tuberculosis control programs in developing countries need to implement "short-course" regimens and train health workers to recognize and treat nontuberculous infections to maintain their effectiveness in the face of the HIV epidemic.

AIDS-Related Opportunistic Infections↗
PubMed1991

Further evaluation of a mutagen-attenuated Rift Valley fever vaccine in sheep.

A previous study demonstrated that a mutagen-attenuated Rift Valley fever virus (RVFV) vaccine, RVF MP-12, was immunogenic and non-abortogenic when ewes, 90-110 days pregnant, were inoculated with 5 x 10(5) plaque-forming units (p.f.u.) of the virus strain. The ewes delivered live, healthy lambs that had no neutralizing antibody to RVFV until after they had ingested colostrum. To assess further the safety and protective capability of this candidate vaccine, six pregnant ewes were inoculated with 5 x 10(3) p.f.u. of RVF MP-12 and challenged with 5 x 10(5) p.f.u. of virulent ZH-501 strain of RVFV 30 days later. No viraemia was detected after vaccination or challenge and all six ewes delivered live, healthy lambs. Those lambs tested before their nursing did not have neutralizing antibody to RVFV but quickly acquired antibody titres of 1:320 to greater than or equal to 1:10,240 after ingesting colostrum. To test the safety of the RVF MP-12 immunogen in neonates, lambs less than or equal to 7 days old, born to unvaccinated ewes, were inoculated with 5 x 10(5) p.f.u. of RVF MP-12. With the exception of brief pyrexia in 18 of 26 lambs, and a transient low-titred viraemia in 16 of 26 lambs after inoculation, no untoward effects were observed. Serum-neutralizing antibody to RVFV was detected 5-7 days after inoculation. Lambs vaccinated with either 5 x 10(5) or 5 x 10(3) p.f.u. of RVF MP-12 were protected against virulent RVFV challenge at 14 days postvaccination.

Animals↗
PubMed1991

Psychosocial and physiological correlates of male gender role stress among employed adults.

Previous research has identified male gender role stress (MGRS) as a construct that leads men, as a function of traditional socialization processes, to appraise certain situations in ways that produce psychosocial and physiological distress. Because the initial research was based on college undergraduates, the current study explored the relationship of MGRS to psychosocial and physiological risk factors for cardiovascular disease among employed adults. As predicted, men obtained significantly higher scores than women on a measure, the MGRS Scale, developed to assess this construct. Women with elevated MGRS Scale scores, however, experienced undesirable outcomes much the same as their male counterparts. Specifically, MGRS Scale scores were significantly associated with Type A behavior, hostility, personal loss, life dissatisfaction, and elevated systolic and diastolic blood pressure. The authors discuss possible environmental contributors to the development and maintenance of MGRS, including organizational factors associated with male-dominated work environments.

Adolescent↗
PubMed1991

Clinical significance of reversed vegetative subtypes of recurrent major depression.

The significance of reversed vegetative forms of atypical depression (AD) was investigated in a sample of 211 outpatients with recurrent major depression. Consistent with several earlier reports, AD patients were younger, had fewer typical symptoms of melancholia, and responded slower to imipramine and psychotherapy treatment given according to protocol. There were few differences between reversed vegetative AD patients with reactive and nonreactive moods; both subforms of AD responded well to monoamine oxidase inhibitor when crossed over after initial protocol treatment failed.

Adult↗
PubMed1990

Health related selection and death rates in the United Kingdom Atomic Energy Authority workforce.

Follow up data on 37,355 employees of the United Kingdom Atomic Energy Authority (UKAEA) for the period 1946-79 were analysed to investigate the extent to which selection for work on the basis of health affected subsequent death rates. Causes of death were grouped into two broad categories for analysis: all cancers and all other causes of death. Evidence for an effect of selection of healthy individuals into the workforce was sought primarily by examining standardised mortality ratios (SMRs) by period since recruitment. SMRs for both categories were particularly low during the first two years after recruitment (SMR = 69, 95% confidence interval (CI) 48-97 for all cancers; SMR = 55, 95% CI 44-69 for all other causes of death). SMRs for all cancers did not increase significantly with period since recruitment (chi 2 for trend = 0.4, p = 0.53) but did increase for causes of death other than cancer (chi 2 for trend = 11.1, p = 0.001). Although adjustment for social class strengthened the association between death from causes other than cancer and period since recruitment (chi 2 for trend = 18.8, p less than 0.001), simultaneous adjustment for all confounding factors considered (age at death, sex, calendar period of death, geographical location of the workforce, and social class) produced results broadly similar to those obtained from the unadjusted analyses for both cause of death categories. SMRs remained low even after 25 years of follow up (SMR = 84, 95% CI 69-101 for all cancers; SMR = 81, 95% CI 72-91 for all other causes of death). The persistently low SMRs observed in this workforce are unlikely to be due to the selection of healthy individuals at the time of recruitment but may be due to differences in sociodemographic and lifestyle characteristics. The effect on mortality of selection of individuals out of the workforce due to ill health was also examined. SMRs were particularly high for both categories in the first two years after termination of employment in individuals who left before normal retirement age (SMR = 167, 95% CI 131-211 for all cancers; SMR = 149, 95% CI 128-173 for all other causes of death). In comparison, death rates for the subsequent three years after termination of employment were lower (SMR = 89, 95% CI 67-115 for all cancers, SMR = 99, 95% CI 85-115 for all other causes of death). The persistently low SMRs observed in this workforce are unlikely to be due to the selection of healthy individuals at the time of recruitment but may be due to differences in sociodemographic and lifestyle characteristics. The effect on mortality of selection of individuals out of the workforce due to ill health was also examined. SMRs were particularly high for both categories in the first two years after termination of employment in individuals who left before normal retirement age (SMR = 167, 95% CI 131-211 for all cancers; SMR 149,95% CI 128-173 for all other causes of death). In comparison, death rates for the subsequent three years after termination of employment were lower (SMR = 89, 95% CI 67-115 for all cancers SMR = 99, 95% CI 85-115 for all other causes of death). Apart from this initial fall, there was little evidence of a systematic increase or decrease in mortality with increasing period was not significantly associated with durationof employment for either cause of death category either before or after adjustment for confounding factors. Whereas selection of individuals into or out of the workforce on the basis of health affects the way in which death rates change with time, other factors such as sociodemographic characteristics or health related behaviour determine the general level of mortality in the longer run. The persistently low SMRs observed in this workforce throughout the follow up period suggest that selection on the latter factors are likely to have had a considerable effect on death rates in the UKAEA workforce.

Adult↗
PubMed1989

Respiratory symptoms as predictors of 27 year mortality in a representative sample of British adults.

OBJECTIVE: To examine associations between reported respiratory symptoms (as elicited by questionnaire) and subsequent mortality. DESIGN: Prospective cohort study. SETTING: 92 General practices in Great Britain. PARTICIPANTS: A nationally representative sample of 1532 British men and women aged between 40 and 64. MAIN OUTCOME MEASURES: Mortality from all causes, cardiovascular disease, lung cancer, and chronic bronchitis. RESULTS: Subjects were interviewed in 1958 regarding various respiratory symptoms (including cough, phlegm, breathlessness, and wheeze) by using a questionnaire which formed the basis of the Medical Research Council's questionnaire on respiratory symptoms. By the end of 1985, 889 deaths had been reported, including 51 in men due to chronic bronchitis. After adjustment for differences in age and smoking habits death rates from chronic bronchitis in men who reported symptoms were greater than those in men who did not for each of the symptoms examined. The adjusted mortality ratios were 3.4 (95% confidence interval 1.8 to 6.5) for morning cough, 3.7 (2.0 to 6.9) for morning phlegm, 6.4 (3.0 to 13.8) for breathlessness when walking on the level, and 10.5 (4.4 to 24.6) for wheeze most days or nights. Mortality ratios were also significantly raised for four episodic symptoms not usually included in more recent respiratory symptom questionnaires--namely, occasional wheeze (mortality ratio 6.0; 95% confidence interval, 2.4 to 15.1), weather affects chest (5.7; 3.1 to 10.3), breathing different in summer (4.9; 2.8 to 8.6), and cold usually goes to chest (3.7; 2.0 to 6.8). The excess mortality associated with these symptoms remained significant after further adjustment for breathlessness or phlegm. Ratios for all cause mortality in men and women were also significantly raised for most respiratory symptoms, death rates being some 20-50% higher in people reporting symptoms after adjustment for age, sex, and smoking. Breathlessness was the only symptom significantly associated with excess mortality from cardiovascular disease (mortality ratio 1.4 (95% confidence interval 1.0 to 1.9) for breathlessness when walking on the level). Ratios were generally around unity and not significant for mortality due to lung cancer. CONCLUSIONS: The results suggest that episodic symptoms, which often do not appear in standard respiratory questionnaires, predict subsequent mortality from chronic obstructive airways disease. This supports the hypothesis that reversible airflow obstruction may be a precursor of progressive and irreversible decline in ventilatory function.

Adult↗
PubMed1989

UCH/RNID single channel extracochlear implant: results in thirty profoundly deafened adults.

The University College Hospital/Royal National Institute for the Deaf (UCH/RNID) Cochlear Implant Programme has now given single channel extracochlear implants to forty profoundly deafened adults. Audiological, psychophysical, speech perceptual and subjective results for the first thirty cases are described. The main findings can be summarised as follows: 1. Users of the single channel extracochlear implant gained considerable improvements in their lipreading and communication ability, as assessed by both objective testing and by the patients' own reports. All acquired useful awareness of environmental sounds and an improvement in their quality of life; some also showed improvements in their own speech. A small number were capable of some open-set speech discrimination without lipreading. 2. Extracochlear implantation was not found to destroy residual hearing, although it did cause slight deterioration in hearing thresholds in some cases. 3. Our results so far suggest that patients deafened by meningitis are likely to obtain less benefit from a single channel cochlear implant than those deafened by other causes. Better results were also achieved by younger, more recently deafened patients and those who were good lipreaders. Despite the emergence of these trends we have not yet found a reliable way to predict benefit from an implant on the basis of preoperative variables. 4. Self-reported measures of the benefits of the implant correlated well with the objective test results, but also revealed important information that was not available from the objective tests. In particular, they showed that the improvement in lipreading provided by the implant was reduced in noisy conditions.

Acoustic Stimulation↗
PubMed1988

Mortality of employees of the Atomic Weapons Establishment, 1951-82.

A total of 22,552 workers employed by the Atomic Weapons Establishment between 1951 and 1982 were followed up for an average of 18.6 years. Of the 3115 who died, 865 (28%) died of cancer. Mortality was 23% lower than the national average for all causes of death and 18% lower for cancer. These low rates were consistent with the findings in other workforces in the nuclear industry and reflect, at least in part, the selection of healthy people to work in the industry and the disproportionate recruitment of people from the higher social classes. At some time during their employment 9389 (42%) of the workers were monitored for exposure to radiation, the average cumulative whole body exposure to external radiation being 7.8 mSv. Their mortality was generally similar to that of other employees, even when exposures were lagged by 10 years. The rate ratio after a 10 year lag in workers with a radiation record compared with other workers was 1.01 (95% confidence interval 0.92 to 1.10) for all causes of death and 1.06 (0.89 to 1.27) for all malignant neoplasms. The only significant differences were for prostatic cancer (rate ratio 2.23; 95% confidence interval 1.13 to 4.40) and for cancers of ill defined and secondary sites (rate ratio 2.37; 1.23 to 4.56). Cancers of lymphatic and haemopoietic tissues were notable for their low occurrence in the study population, with only four deaths from leukaemia and two from multiple myeloma in workers with a radiation record, 9.16 and 3.55 deaths respectively being expected on the basis of national rates. Among workers who had a radiation record 3742 (40%) were also monitored for possible internal exposure to plutonium, 3044 (32%) to uranium, 1562 (17%) to tritium, 638 (7%) to polonium, and 281 (3%) to actinium. In these workers mortality from malignant neoplasms as a whole was not increased, but after a 10 year lag death rates from prostatic and renal cancers were generally more than twice the national average, these excesses arising in a small group of workers monitored for exposure to multiple radionuclides. Though mortality from lung cancer in workers monitored for exposure to plutonium was below the national average, it was some two thirds higher than in other radiation workers, the excess being of borderline statistical significance. Mortality from malignant neoplasms as a whole showed a weak and non-significant increasing trend with increasing level of cumulative whole body exposure to external radiation. When the exposures were lagged by 10 years the trend became stronger and significant, the estimated increase in relative risk per 10 mSv being 7.6% (95% confidence interval 0.4% to 15.3%). This trend was confined almost entirely to workers who were also monitored for exposure to radionuclides (p<0.001), the main contributions coming from lung cancer and prostatic cancer. Exposures of the lung and prostate from internal sources of radiation were not quantified, except for the contribution from tritium. It was therefore not possible to assess the extent to which the associations were due to internally deposited radionuclides rather than external exposure. The finding for prostatic cancer taken in conjunction with the results of other studies suggest a specific occupational hazard in a small group of workers in the nuclear industry who had comparatively high exposures to external radiation and who were also monitored for internal exposure to multiple radionuclides. Research is needed to discover whether any of the radionuclides and other substances concerned are concentrated in the prostate. The occurrence of lung cancer in this workforce requires further investigation taking into account smoking habits and tissue doses from inhaled radionuclides.

Cardiovascular Diseases↗
PubMed1988

Medicaid eligibility for persons in nursing homes.

Presented in this article is an overview of Medicaid policies affecting persons in nursing homes and other institutions that provide long-term care--the criteria they must meet to qualify for Medicaid and the costs of care paid by the Medicaid program and by Medicaid recipients themselves. Underlying these complex policies, and creating sometimes peculiar consequences, is the fact that the population served in institutions and the nature of the benefit are different from the Medicaid program in general, although many of the rules affecting eligibility are the same.

Aged↗
PubMed1987

Childhood leukaemia in the West Berkshire and Basingstoke and North Hampshire District Health Authorities in relation to nuclear establishments in the vicinity.

During the years 1972-85, 89 children aged 0-14 were registered with leukaemia in the West Berkshire and Basingstoke and North Hampshire District Health Authorities. Two nuclear establishments are located within the health authorities, and a third is situated nearby. Fifty of the 143 electoral wards in the two district health authorities lie wholly within, or have at least half their area lying within, a circle of radius 10 km around the establishments. In those 50 electoral wards 41 children aged 0-14 were registered with leukaemia, 28.6 registrations being expected on the basis of leukaemia registration rates in England and Wales (incidence ratio = 1.4, p less than 0.05). This excess was confined to children aged 0-4, among whom there were 29 registrations of leukaemia, 14.4 being expected (incidence ratio = 2.0, p less than 0.001). In the remaining 93 electoral wards there was a small and non-significant increase in the number of registrations of leukaemia at age 0-14 (48 observed, 40.8 expected; incidence ratio = 1.2). There was no obvious trend in the incidence of childhood leukaemia over the 14 years and the overall occurrence of the malignancy in the 143 electoral wards was consistent with a random distribution. In the surrounding Oxford and Wessex Regional Health Authorities the number of registrations of leukaemia at age 0-14 was virtually identical with that expected on the basis of registration rates in England and Wales (362 observed, 372.5 expected; incidence ratio = 1.0). These data indicate that in the two district health authorities studied there was an excess incidence of childhood leukaemia during 1972-85 in the vicinity of the nuclear establishments. In the West Berkshire and Basingstoke and North Hampshire District Health Authorities an average of 60,000 children aged 0-14 lived within a 10 km radius of a nuclear establishment each year. The normal expectation of leukaemia in these children was two cases a year, whereas the recorded incidence was three cases per year, representing one extra case of leukaemia each year among these 60,000 children.

Adolescent↗
PubMed1986

Effects of sodium cyanate in mice bearing B16 melanoma.

Sodium cyanate injected IP at a dose level of 200 or 250 mg/kg caused a 90% or greater inhibition of the incorporation of [3H]thymidine into DNA of B16 melanoma transplanted SC in mice. Despite the inhibitory effect of sodium cyanate on precursor incorporation into DNA, no significant effect on host survival was observed when sodium cyanate was administered as a single agent in the diet, in drinking water, or by IP injection to mice that had received IP transplants of B16 melanoma. The action of melphalan and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) in prolonging the survival time of melanoma-bearing mice was not enhanced by combined treatment with sodium cyanate. However, combined injections of sodium cyanate and 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) increased the survival of tumor-bearing mice significantly more than injections of BCNU alone at a lower dose than the maximum tolerated one. These data and other studies suggest that B16 melanoma may be less responsive to the action of sodium cyanate than are murine leukemic cells or rat hepatomas.

Animals↗
PubMed1981

Empathic perceptions of nursing students: self-reported and actual ability.

Clearly, one of the goals of nursing education is to enhance the empathic functioning of nursing students. In this study we examined one major component of empathic functioning--accuracy of empathic perceptions--in both undergraduate (n = 66) and graduate nursing students (n = 50) We predicted that actual ability (Kagan's Affective Sensitivity Scale) and self-perceived ability would vary as a positive function of educational level. The results supported the first prediction, even when the effects of the subjects' age and amount of prior nursing experience were controlled. Self-perceived ability, however, was not reliably related to educational level, although it did relate to actual ability. Compared with students in other "helping" professions, the students in this study appeared relatively empathic. Finally, students' perceptions of their difficulty in detecting and handling other particular feeling states suggest that nursing needs to take a more "affect-specific" approach to empathic functioning.

Adult↗
PubMed1980

Relationship between pre-operative anxiety and post-operative state.

Janis (1958) has proposed a curvilinear relationship pre-operative anxiety and post-operative emotional state. While other hypotheses share the prediction of a poor outcome for patients with pre-operative high anxiety, Janis' theory is unique in predicting a poor outcome for those with low anxiety. Subsequent research has failed to confirm Janis' hypotheses, perhaps because the designs have been insensitive to the predictions for low anxiety patients. The current study tests the hypothesis more directly and finds some support for a linear relationship between pre-operative anxiety and post-operative negative affect, with no support for Janis' curvilinear hypothesis. On the whole, pre-operative anxiety was a poor predictor of other measures of recovery but, on one measure, patients with low anxiety showed a slower recovery than those with moderate anxiety, i.e. supporting the prediction of a poor outcome for low anxiety patients. The implications of these results for pre-operative preparation of surgical patients and the development of theories of anxiety are discussed.

Adult↗
PubMed1980

A controlled trial of oxypertine in tardive dyskinesia.

A study was undertaken to investigate the effects of oxypertine in treating tardive dyskinesia. The design was double-blind, placebo-controlled, between-patient, in 28 patients from whom previous medication was withdrawn, with 14 patients in each group. Treatment was for 4 weeks. Although more oxypertine patients improved than placebo, i.e. 71.4 vs. 50%, the results did not reach statistically significant difference. A further study is planned to increase the overall number of patients in the study, and to lengthen treatment periods.

Adolescent↗