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Biomedical subjects

L Michell

Publications and source records attributed to L Michell.

9 recordsLinked to original sources
PubMed2005

Factors that influence special care nursery admissions to a district hospital in South-western Sydney.

OBJECTIVES: To explore the socio-demographic factors and maternal characteristics that influence special care nursery (SCN) admission for infants of more than 34 weeks' gestation. Particularly, this paper aims (i) to estimate the incidence of SCN admission by various mothers' socio-demographic factors; and (ii) to investigate the relationship between SCN admission and mothers' socio-demographic and obstetric and gynaecological factors. METHODS: This was a cohort study of 10,148 pregnant women who accessed the birthing unit within a public district hospital in south-western Sydney in New South Wales, between 1998 and 2001. The main outcome measure was risk factors for SCN admission. RESULTS: The incidence of SCN admission was 11.7%. Multivariate analysis revealed that the risk factors for SCN admission were diabetes, gestational diabetes, high parity, pregnancy induced hypertension, living in suburbs with low education and occupation index, and no private health insurance status. CONCLUSIONS: The results from this large population-based study suggest that, apart from clinical/medical factors, admission to a special care nursery at a District Hospital was significantly affected by maternal insurance status and level of education and occupation.

Adult↗
PubMed2000

Ten years of liver transplantation at Groote Schuur Hospital.

INTRODUCTION: Liver transplantation has evolved from an experimental procedure to being the treatment of choice for many patients with end-stage liver disease, and is performed on a routine basis in most major centres throughout the world. However, certain situations peculiar to developing countries have a major impact on liver transplant programmes in these countries. We present the results of the liver transplant programme in Cape Town. PATIENTS AND METHODS: All patients undergoing orthotopic liver transplantation at Groote Schuur Hospital and Red Cross War Memorial Children's Hospital were included in this report. Standard surgical techniques were used for procuring the donor liver, the recipient hepatectomy and the subsequent implantation of the liver. All patients received standardised peri-operative management; in particular, the immunosuppressive protocol consisted of cyclosporin, steroids and azathioprine. Since October 1988, 83 patients have undergone 89 orthotopic liver transplants. There were 44 adults and 39 children, the age range being from 6 months to 56 years. The commonest indications for hepatic transplantation in adults included cryptogenic cirrhosis, auto-immune hepatitis and primary sclerosing cholangitis. In children biliary atresia was the commonest cause of liver failure. RESULTS: Of the 81 patients transplanted, 50 are alive and well with follow-up ranging from 2 months to 9.5 years. The cumulative graft survival rate was 72% at 1 year and 61% at 5 years. Six patients have undergone re-transplantation and 4 patients have had combined liver/kidney transplants. De novo hepatitis due to hepatitis B virus (HBV) has occurred in 8 patients following transplantation. Subsequent investigation has shown that 5 of the donors of these livers were hepatitis B core antibody (HBcAb)-positive, while information on the remaining 3 was not available. Tuberculosis (TB) has been a significant problem in 4 patients, with 2 deaths precipitated by anti-TB drug-induced hepatitis. Post-transplant lymphoproliferative disorder was also responsible for significant postoperative morbidity. CONCLUSION: Orthotopic liver transplantation has been established at Groote Schuur Hospital as the treatment of choice for selected patients with chronic end-stage liver disease. However, hepatitis B and TB appear to present a problem. The particularly high prevalence of HBV carrier status in our donor population may necessitate the use of living donors in the future.

Adolescent↗
PubMed1997

Girls, pecking order and smoking.

Against a background of growing concern about the failure to reduce cigarette smoking amongst young people, particularly girls, this paper attempts to unravel the complex interrelationships between smoking, peer group structure and gender. We were particularly intrigued to explore a recent hypothesis in the literature that suggests that girls who smoke, far from lacking self-esteem, are more self-confident and socially skilled than their non-smoking peers. Sociometric and qualitative analyses revealed that smoking behaviour was indeed shaped by gender, and that the psychosocial processes involved in smoking uptake may be different for boys and than for girls. Peer group structure, consistently described by young people as hierarchical, was closely related to smoking behaviour. Girls at the top of the social pecking order who projected an image of high self-esteem were identified as most likely to smoke, while only a small minority of girls fitted the stereotype of the young female smoker who has poor social skills and low self-esteem. Boys of high social status were less vulnerable, since sport and a desire to be fit to some extent protected them. Our findings raise fundamental questions about the meaning of self-esteem in relation to smoking uptake, arguing instead for an exploration of the term "self-worth". They suggest the need for health education programmes which are sensitive both to gender and to peer group structures.

Adolescent↗
PubMed1997

Loud, sad or bad: young people's perceptions of peer groups and smoking.

This paper suggests that most 13 year olds and many 11 year olds have a clear and detailed grasp of their own social map, recognize the pecking order which is established amongst their peers and are aware of the different levels of risk-taking behaviour, including smoking, adopted by different peer groups in their school year. Thirty six 11 year olds and 40 13 year olds took part in the study. Their remarkably consistent views about which pupils adopt or reject smoking are closely related to their perceptions of their social map. Their accounts differentiate top girls, top boys, middle pupils, low-status pupils, trouble-makers and loners, associating smoking behaviour consistently with three of the five groups--the top girls, the low-status pupils and the trouble makers. Top boys, although sharing many of the characteristics of top girls, have an added protection factor--their keen interest in football and physical fitness. From their descriptions, it is apparent that different groups of pupils smoke for different reasons which are related to pecking order and group membership. The implications of these young people's views for health education programmes to prevent smoking and other risk-taking behaviours are far reaching.

Adolescent↗
PubMed1992

Smoking: a special need?

The smoking behaviour of 665 children aged 12-15 years with special educational needs was compared with that of a control group of 842 children in mainstream education. Each child was interviewed using a structured questionnaire and reported smoking behaviour was validated against scores on a carbon monoxide monitor. We identified as the most at risk group children with emotional and behavioural disorders. They had the highest smoking rates and were the heaviest smokers. In contrast, children with learning difficulties had slightly lower smoking rates than those of the control. There were significant associations between the children's smoking behaviour and the smoking behaviour of siblings and 'other adults' in the household, belonging to single parent families, low self-esteem and large friendship groups. The reported smoking rates of the families of both groups of special needs children was found to be considerably higher than that in the control group or in the general population.

Achievement↗
PubMed1992

Orthotopic liver transplantation at Groote Schuur Hospital.

We present data on 10 patients (5 men and 5 women, aged 21-56 yrs) with end-stage liver disease or tumour who underwent orthotopic liver transplantation at Groote Schuur Hospital between October 1988 and June 1991. Standard surgical techniques were used for procuring the donor liver, the recipient hepatectomy and the implantation of the liver. The venovenous bypass method was used in all but 2 patients. Postoperative immunosuppression was usually achieved with cyclosporin, azathioprine and low-dose steroids. Six patients were treated with prophylactic OKT3. Rejection episodes were treated with bolus doses of intravenous steroids. The indications for liver transplantation included chronic active hepatitis progressing to cirrhosis (5), biliary cirrhosis in association with inflammatory bowel disease (1), sclerosing cholangitis (2), alpha 1-antitrypsin deficiency (1), and tumour (1). All patients with chronic liver disease had experienced at least one complication, examples of which included encephalopathy, bacterial peritonitis, ascites, variceal bleeding and septicaemia. Serious postoperative complications included acute rejection of the transplanted liver, renal and liver failure that responded to intensive care support and medical management. One patient died on the 11th postoperative day with complications of bleeding oesophageal ulcer, shock and fungaemia. The remaining patients are alive and well 1-31 months after transplantation.

Adult↗
PubMed1991

Anti-smoking policies and practice in Scottish Health Boards: progress 1985-89. Scottish Tobacco Group.

1. The anti-smoking policies in practice of Scottish Health Boards (HBs) were surveyed in 1989, and the results compared to those of a previous survey in 1985. 2. There has been reasonable to good progress in production of a HB policy document; in smoke-free HB committee meetings; in smoke-free public offices, hospital offices, canteens, hospital outpatient areas, community clinics, health centre waiting rooms and offices: in prohibiting sale of cigarettes on NHS premises; in provision of smoking cessation services; in liaison with other organisations; and in initiatives on National No-Smoking Day. 3. On the other hand progress has been poor in providing a smoke-free environment in acute, maternity and longstay wards, and especially poor in hospital ward sitting up areas. There has been disappointingly little progress in the education of nurses and only minor improvement in that for paramedical and lay staff.

Health Education↗