Biomedical subjects

M Campbell-Brown

Publications and source records attributed to M Campbell-Brown.

12 recordsLinked to original sources

PubMed2001

High-meat, low-carbohydrate diet in pregnancy: relation to adult blood pressure in the offspring.

To examine the hypothesis that a high-animal protein, low-carbohydrate diet in pregnancy is associated with raised blood pressure in the adult offspring, we performed a follow-up study of 626 men and women in Motherwell, Scotland, whose mothers' food intake had been recorded during pregnancy. The mothers had taken part in a dietary intervention in which they were advised to eat 1 lb (0.45 kg) of red meat per day and to avoid carbohydrate-rich foods during pregnancy. The offspring were followed up at age 27 to 30 years, and their systolic and diastolic blood pressures were measured. Women who reported greater consumption of meat and fish in the second half of pregnancy had offspring with higher systolic blood pressure in adult life (regression coefficient, 0.19 mm Hg per portion per week; 95% confidence interval, 0.04 to 0.35; P=0.02). High maternal consumption of fish, but not meat, was associated with higher diastolic blood pressure in the offspring (regression coefficient, 1.00 mm Hg per portion per week; 95% confidence interval, 0.18 to 1.82; P=0.02). These associations were independent of maternal blood pressure, body size, and smoking habits during pregnancy. Although we cannot exclude confounding by maternal saturated fat or salt intake, the findings support those of a study in Aberdeen showing higher blood pressure in men and women whose mothers had eaten a high-animal protein, low-carbohydrate diet in late pregnancy. These associations may reflect the metabolic stress imposed on the mother by an unbalanced diet in which high intakes of essential amino acids are not accompanied by the nutrients required to utilize them.

Adult↗

PubMed2001

Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management.

OBJECTIVES: To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women's understanding of the reasons for their attendance at the hospital clinics, and clinic outcome. DESIGN: Questionnaire survey, with partial review of case notes after 8 months. SETTING: Three hospital gynaecology clinics in Glasgow and Edinburgh. PARTICIPANTS: 952 women completed the questionnaire, and the first 665 were reviewed. OUTCOME MEASURES: Reason for referral, women's reported menstrual problems and reason for clinic attendance, diagnosis, and treatment. RESULTS: Only 38% (95% confidence interval 34% to 41%) of women reported excessive menstrual loss as a severe problem. However 60% (57-63%) gave it as reason for attending a clinic, and 76% (73-79%) of general practitioners gave it as reason for referral. Reason for referral was significantly biased towards bleeding (McNemar odds ratio 4.01, 3.0 to 5.3, P<0.001) and against pain (0.54, 0.4 to 0.7, P<0.001). Dysfunctional uterine bleeding was diagnosed in 37% (31-42%) of the 259 women who gave as reason for attendance something other than bleeding. Women who were economically disadvantaged differed in prevalence of the main diagnoses and were more likely to fail to reattend. Hysterectomy was associated with referral for bleeding (relative risk 4.9, 1.6 to 15.6, P<0.001) but not with the patient stating bleeding as the reason for clinic attendance. CONCLUSIONS: Intolerance of the volume of their bleeding is not a key feature among women attending clinics for bleeding problems. Broad menstrual complaint tends to be reframed as excessive bleeding at referral and during management. This may result in women receiving inappropriate care. Conceptualisation and assessment of menorrhagia requires reconsideration.

Adult↗

PubMed1999

Endometrial apoptosis in patients with dysfunctional uterine bleeding.

AIMS: To assess glandular apoptosis in the zona functionalis of proliferative phase endometrium in normal individuals and in patients with dysfunctional uterine bleeding (DUB). METHODS AND RESULTS: Routinely processed, haematoxylin and eosin-stained endometrial biopsies were assessed in 26 patients with symptomatic menstrual abnormality, mainly menorrhagia, and in 24 controls. All biopsies were in the proliferative phase and had been reported as within normal limits and consistent with the menstrual cycle dates provided. Apoptotic and mitotic figures were counted in a minimum of 100 transversely sectioned endometrial glands in all cases. In 16 biopsies (12 DUB and four controls) apoptosis was further assessed using the in situ terminal deoxynucleotidyl-transferase-mediated 2'-deoxyuridine-5'-triphosphate (dUTP) nick-end labelling (TUNEL) method. Apoptotic figures were identified in most control biopsies averaging 5.6/100 glands, and were significantly increased in biopsies from patients with DUB averaging 13.9/100 glands. There was no difference in mitotic figure counts. Apoptoses tended to be clustered within adjacent glands in both groups and individual glands exhibited both mitotic and apoptotic activity. Application of the TUNEL method gave broad agreement with morphological assessment although approximately 20-25% of typical apoptotic figures were not labelled. CONCLUSIONS: Endometrial glandular apoptosis is present in most normal proliferative phase biopsies and appears increased in some cases of DUB. The significance of this finding is not known but increased apoptosis may serve as a morphological marker of abnormal endometrial development in otherwise normal biopsy specimens.

Adult↗

PubMed1999

GnRH analogue in everyday gynecology: is it possible to rationalize its use?

BACKGROUND: The study was an audit of patients who attended the Menstrual Disorders Clinic at Glasgow Royal Infirmary over a five year period, and received gonadotrophin-releasing hormone analog (GnRHa). We aimed to identify the clinical indications for the use of GnRHa, and the effect of the latter in terms of symptom resolution and ultimate outcome. We aim to use this information to formulate a strategy for the use of GnRHa by targeting this expensive therapy to those situations where maximum benefit will be achieved. METHODS: A retrospective case review analysis of 201 patients. RESULTS: Thirty-eight percent of women presented with pelvic pain, 33% with disordered menstruation and 26% with premenstrual symptomatology. Overall, 74% of patients reported a beneficial effect of GnRHa. In the non-cyclical pelvic pain group, those patients with adhesions constituted a much greater proportion of those who did not derive benefit from GnRHa than those who did (43% vs. 16%; p<0.05; data not shown). In those patients with disordered menses, there was no difference between the diagnosis in those who did or did not derive benefit from GnRHa. Also with the exception of endometrial preparation prior to ablation and in the correction of anemia, the ultimate outcome was no different in the two groups. Of the patients with premenstrual symptomatology, the greatest proportion of those deriving benefit from GnRHa (41%) ultimately had an operative resolution. CONCLUSIONS: Our results enable us to use GnRHa as a first line in those clinical situations where maximum benefit will be achieved, either in terms of symptom resolution or as a tool to identify the most appropriate therapeutic option. We can therefore rationalize our prescribing both to the benefit of the patient and to our budget.

Adult↗

PubMed1992

Scottish gynaecologists: their views on hormone replacement therapy.

In a postal questionnaire Scottish gynaecologists were asked their views on the use of Hormone Replacement Therapy (HRT). They were almost unanimous in support of HRT, but varied in the circumstances in which they would recommend it and in the length of time they would prescribe it. The need for designated Menopause Clinics was seen to be limited, with most smaller Units preferring the present practice of menopausal patients being seen at general Gynaecology Clinics. Most of those replying thought that General Practitioners (GPs) should continue to be the main providers of the therapy but 89 (77%) felt that Well Women/Family Planning Clinic (WW/FPC) doctors could be an alternative source. Several problems associated with the use of the therapy were indicated. These included uncertainties about the risks of long term use and the management of unscheduled vaginal bleeding, but there was also concern over the administrative and prescribing costs if the therapy is to be widely used as prophylactic medication.

Attitude of Health Personnel↗

PubMed1987

Is screening for bacteriuria in pregnancy worth while?

A total of 4470 pregnant women were screened for bacteriuria by the dipslide method and significant growth found in 226 (5.1%). In 198 cases the urine was re-examined, in 119 by using suprapubic aspiration or catheterisation (62 (52%) samples contained bacteria) and in 79 by using midstream urine samples (26 (33%) samples contained greater than 10(8) colony forming units/1), showing the maximum prevalence of confirmed bacteriuria to be 2.6%. Overt urinary tract infection developed later in four of 80 patients with proved bacteriuria who had been given antibiotics, in one of eight untreated patients with bacteriuria, in one of 110 patients with unconfirmed bacteriuria, and in one of 226 non-bacteriuric controls. A history of urinary tract infection was given by 18% of controls and 42% of women with confirmed bacteriuria. Screening for bacteriuria and treatment with antibiotics to prevent later overt infection is expensive. Whether it is worth while and cost effective depends largely on the prevalence of bacteriuria in the local population and the proportion who develop overt infection. The screening and treatment programme reported here appeared to prevent only six cases of overt infection.

Anti-Bacterial Agents↗

PubMed1987

Single-dose treatment of bacteriuria in pregnancy.

Comparison of the results of single-dose treatment of urinary tract infection in women is confused by differences between published series in the duration of follow-up and in the diagnosis of infection. Pregnancy allows prolonged follow-up in a motivated population, but increases the possibility of false positive diagnosis of infection from midstream urines due to increased vulvovaginal contamination. Suprapubic aspiration (SPA) is safe in pregnancy and accurately confirms the presence or absence of bacteria in the bladder urine. Bacteriuria was diagnosed by SPA in 86 pregnant women. Thirty-seven of these were treated with a single dose of 3 g cephalexin and 49 with 3 days of cephalexin 1 g or of a combined preparation of pivmecillinam-pivampicillin. Both single-dose and 3-day treatments prevented further bacteriuria in 65% of the patients for the remainder of their pregnancies. This is similar to the results achieved with 10-day treatment. If extended trials confirm that single-dose treatment is as effective as conventional treatment with the same drug, then single-dose treatment has the advantages in pregnancy of minimal medication, good patient compliance and lack of side-effects.

Amdinocillin↗

PubMed1985

Zinc and copper in Asian pregnancies--is there evidence for a nutritional deficiency?

In 92 Hindu Asians, 59% of them vegetarian, and 51 Europeans longitudinal measurements were made during pregnancy of the zinc and copper concentrations in plasma and hair together with urinary zinc excretion, as indices of their zinc and copper status. Maternal diets were assessed once at booking. Zinc intakes ranged from 3.1 to 16.9 mg/day, with average intakes least in vegetarian Hindus and most in Europeans. Average copper intakes ranged between 1.48 and 1.80 mg/day and were similar in the three patient groups. Both ethnic groups showed the pregnancy-associated fall in the plasma concentration of zinc and rise in that of copper but throughout the study Hindus had statistically significant lower levels of zinc and higher levels of copper than Europeans. Urinary zinc excretion was not only significantly lower throughout the study in Hindus than in Europeans but the increase in excretion which occurred after 20 weeks gestation was smaller. There were no ethnic differences in the zinc content of hair. Urinary zinc excretion correlated with both plasma zinc levels and dietary zinc. Mean birthweight in the Hindus was 2912 g and 34% of infants were below the 10th centile, using the Aberdeen standards, compared with 6% of the European babies (mean birthweight 3349 g). No association was found between crude or adjusted birthweight and any of the measures of zinc or copper status in either ethnic group. The Hindus had an apparently lower average zinc status than the Europeans, but there was no evidence that this had acted as a nutritional constraint and was the cause of their slower rate of intrauterine growth.

Adult↗

PubMed1985

Diet during pregnancy in an Asian community in Britain--energy, protein, zinc, copper, fibre and calcium.

Dietary intake of 813 pregnant Harrow Asians of mainly Gujarati descent was compared with the intake of 54 pregnant Europeans living in the same area. The diet of the Europeans had more protein and zinc but less fibre and fat that that of the Harrow Asians. The average rate of weight gain and the energy intakes were similar in both groups. Hindu non-vegetarians and Muslim non-vegetarians differed somewhat, because the Hindus, who are more recent converts to meat-eating, have diets with a lactovegetarian basis to which small amounts of meat have been added. Among the Hindu vegetarians, those who ate eggs and cheese had higher protein and zinc intakes, but otherwise Hindu vegetarians can be regarded as a fairly homogeneous group. Although the protein and zinc intakes of the Asians, particularly the vegetarians, were lower than those of the Europeans, there was no evidence of adverse consequences to the mother and fetus.

Adult↗

PubMed1984

Factors affecting birthweights in Hindus, Moslems and Europeans.

The birthweights of 664 Hindu and 132 Moslem babies were compared with those of 486 European babies born at the same hospital. The mean birthweight of the Europeans was 3362 g, compared with 3146 g for the Moslems and 2960 g for the Hindus. The Asian women were smaller than the European and tended to have a shorter length of gestation. Forty-four per cent of the Asians and 46% of the European mothers were of social classes I and II; 28% of the Europeans and 2% of the Asians smoked. There were no significant differences between Asians and Europeans in the effects of maternal size, parity, gestational age and fetal sex on birthweight. After adjustment for these variables and for cigarette smoking there was no significant difference in birthweight between the Moslems and the Europeans, but the mean birthweight of the Hindus was about 190 g lighter than that of the Europeans. Hindus from East Africa had lighter babies than those from India.

Asia↗

PubMed1983

Bacteriuria in pregnancy treated with a single dose of cephalexin.

Of 87 women in whom bacteriuria was diagnosed on dip slides at between 9 and 22 weeks gestation only 51 (59%) had true bacteriuria in urine obtained by suprapubic aspiration. A single oral dose of cephalexin (3 g) was given to 37 of these patients, 10 were Indian and none of them had recurrence of infection after treatment, whereas 11 of the 27 (41%) 'indigenous' women again had bacteriuria within 2 weeks of treatment. None of the other 26 patients had recurrent bacteriuria in the pregnancy studied. Success of treatment was not related to renal concentrating ability nor, apart from ethnic group, were there other significant differences between successes and failures. Although single-dose treatment seems to be less effective in pregnancy than in the non-pregnant patients, it is an acceptable method of treatment provided that all treated patients are followed closely to detect those who do not respond and require further therapy.

Bacteriuria↗

PubMed1982

Effects of prenatal nutritional supplementation on the placenta: report of a randomized controlled trial.

Protein and nucleic acid content, and RNase levels were measured in placentas collected at birth in a randomized controlled trial of prenatal nutritional supplementation in New York City. These biochemical indices were explored to understand better the effects of nutritional supplementation. (With high-protein supplements, gross measures had shown no improvement in outcome at birth and adverse effects on fetal growth, prematurity, and newborn survival; with balanced protein-calorie supplements, there was a nonsignificant rise in birth weight and longer gestation.) The biochemical indices were in general somewhat weakly related to fetal growth measures. Significant effects of nutritional treatment on the indices were minimal, and added no information that could account for gross effects observed in the fetus.

Birth Weight↗