Factors associated with oral health: a multivariate analysis of results from the 1998 Adult Dental Health survey.
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Adolescent↗
Biomedical subjects
M Kelly
Publications and source records attributed to M Kelly.
Nursing inputs to special schools in N. Ireland.
Children attending special schools often have healthcare needs that require ongoing medical and nursing care. Two postal surveys were undertaken of 47 special schools in N. Ireland to determine the type of contact they had with nurses and the functions they fulfilled. Responses were received from 42 school principals and from the 11 Health and Social Service Trusts responsible for nursing services. It was found that nurses were based in nine of 42 schools while the remaining schools depended on a range of different visiting nurses. The nurses were involved in 'hands-on' tasks as well as giving advice and training to school personnel. Further research needs to define more closely the nursing needs of these pupils as well as evaluating the differential benefits of various nursing services to schools and how their inputs can be coordinated with those of other health professionals.
Attitude to Health↗
Continuous intrathecal morphine treatment for chronic pain of nonmalignant etiology: long-term benefits and efficacy.
BACKGROUND: To analyze, prospectively, the long-term effects of continuous intrathecal morphine infusion therapy in 16 patients with chronic nonmalignant pain syndromes. METHODS: Twenty-five patients with severe, chronic, nonmalignant pain that had proven refractory to conservative management were considered candidates for trial of intrathecal spinal morphine. Sixteen patients achieved more than 50% pain relief after a trial period of intrathecal morphine infusion. They were implanted with fully implantable and programmable pumps through which morphine was delivered intrathecally on a continuous basis. These patients were followed prospectively and underwent careful evaluation of their functional and mental status, and pain intensity measurements using standardized techniques before treatment and every 6 months thereafter in the follow-up period. The follow-up period ranged from 13 months to 49 months (mean 29.14 months +/- 12.44 months) for the patients who had implanted morphine pumps. RESULTS: The mean morphine dosage initially administered was 1.11 mg/day (range 0.2--6.5 mg/day); after 6 months, it was 3.1 mg/day (range 0.4--8.75 mg/day). In long-term observation, no patient had a constant dosage history. The patients who received intrathecal morphine for longer than 2 years all showed an increase in morphine dosage to more than 10 mg/day. The best long-term results were seen with deafferentation pain and mixed pain, with 75% and 61% pain reduction (visual analog scale), respectively. Nociceptive pain patients had best pain relief initially (78% pain reduction) but it tended to decrease over the follow-up period to 57% pain reduction at final follow-up. The average pain reduction for all groups after 6 months was 67.5% and at last follow-up, it was 57.5%. Ten patients were satisfied with the delivery system and eleven reported improvement in their quality of life. In two patients, morphine was not able to adequately control the pain without producing undesirable side effects requiring the addition of clonidine to their infusion medication. In this series, 12 patients were considered successes and 4 patients were considered failures. In two patients, the intrathecal opioid therapy was unable to produce satisfactory pain relief and in the other two patients the pumps had to be explanted because of intolerable side effects. CONCLUSIONS: In our experience, the administration of intrathecal opioid medications for nonmalignant pain is justified in carefully selected patients.
Adult↗
Energy level in winter diets of Fallow deer: effect on plasma levels of insulin-like growth factor-I and sex ratio of their offspring.
To determine the effect of dietary energy level in the first winter on subsequent puberty onset, pregnancy, growth, and secretion of progesterone and insulin-like growth factor-I (IGF-I) in Fallow deer, prepubertal deer were fed either a high (H) or a low (L) energy diet in a randomised complete block design. June-born female Fallow deer were fed ad libitum either 12.5MJ/kg DM (H, n=29) or 10MJ/kg DM (L, n=29) in pelleted rations once per day during the winter (approximately 4-10 months of age) preceding puberty. Blood samples were collected twice weekly during the peripubertal period. During the winter feeding period, DM intake was similar for both groups but average daily gain was greater (P<0.05) for deer fed the H versus L diet. Onset of puberty was not affected (P>0.10) by dietary treatment. Concentrations of progesterone in plasma did not differ (P>0.10) between dietary treatments before or after puberty, increasing after puberty in both groups, and reaching maximal levels 8-12 days after the onset of puberty. Concentrations of plasma IGF-I increased (P<0.05) before puberty in both groups reaching maximal levels 3-4 days before the onset of puberty but did not differ (P>0.10) between H and L diets before or after puberty. Of the 28 does fed the H diet that calved, 75% of the calves born were male versus 46% in the L diet (P<0.05). In conclusion, increased plasma IGF-I concentrations were associated with the onset of puberty in Fallow deer regardless of the level of dietary energy intake during the preceding winter. Increased dietary energy during winter does not alter pregnancy rates but does alter sex ratio of calves born.
Journal Article↗
Social cognitive correlates of sexual experience and condom use among 13- through 15-year-old adolescents.
PURPOSE: To examine the role of self-efficacy, outcome expectancies, and perception of peer attitudes in the delay of onset of sexual activity among 13- through 15-year-old adolescents. We also explored the role of self-efficacy, outcome expectancies, and perception of friends' condom use behavior in explaining the use of condoms among sexually active adolescents. METHODS: This study was part of a larger cross-sectional study to evaluate personal characteristics and maternal factors associated with early initiation of sexual intercourse. Mothers and adolescents were recruited from a community-based organization that offered afterschool and summer programs for youth. Enrollment was limited to adolescents aged 13-15 years and their mothers. Mothers and adolescents completed separate interviews. For adolescents, the interviews included the assessment of the variables in the present study. Each interview lasted about 60 min and was conducted by a trained interviewer. Data were analyzed using descriptive statistics and regression analysis. The average age of the 405 adolescent participants was 13.86 years, and approximately 30% of them had engaged in sexual intercourse. Slightly more than half (56%) of participants were male, and 82% were African-American. RESULTS: Participants who were less likely to believe that their friends favored intercourse for adolescents and who held more favorable attitudes about the personal benefits of abstaining from sex were less likely to have initiated sexual intercourse. Among sexually active adolescents, those who expressed confidence in putting on a condom, and in being able to refuse sex with a sexual partner, and who expressed more favorable outcome expectancies associated with using a condom were more likely to use condoms consistently. CONCLUSIONS: Human immunodeficiency virus and pregnancy prevention programs should emphasize peer influences in both the initiation of sexual intercourse and the use of safer sex practices among sexually active adolescents, as well as personal attitudes about consequences to self and confidence in negotiating safer sex practices with one's partner.
Acquired Immunodeficiency Syndrome↗
Absent p53 immunohistochemical staining in a pituitary carcinoma.
BACKGROUND: Carcinomatous transformation of pituitary adenomas is uncommon, and is generally accompanied by nuclear accumulation of p53 protein. Pituitary carcinoma lacking accumulation of p53 protein is very rare, only two such cases being previously reported. METHODS: A patient presented with visual disturbance and cranial nerve palsies and was found to have a suprasellar mass. He underwent both transphenoidal and transfrontal excision of a nonfunctioning pituitary adenoma which recurred several times. The third recurrence was accompanied by multiple dural-based metastases. Despite aggressive surgical management, he continued to develop additional intracranial lesions and died two years after the discovery of metastatic disease. Specimens from 1984, 1995, 1997 and 1998 were available for histological and immunocytochemical analysis. Antibodies recognizing the pituitary hormones (ACTH, PRL, GH, FSH, LH and TSH), as well as cytokeratin, epithelial membrane antigen (EMA), glial fibrillary acidic protein (GFAP) and chromogranin A were applied to investigate the lineage of the neoplasm. Antisera specific for Ki-67 (MIB-1) and p53 protein were also applied to further delineate the biology of the tumour. RESULTS: Although cytokeratin and chromogranin A were detected in neoplastic cells. no expression of pituitary hormones was demonstrable, indicative of a nonfunctioning, null-cell pituitary adenoma. Nuclear pleomorphism and mitotic activity increased with subsequent resections. Abnormal accumulation of p53 protein was not observed, neither in early resections nor in the metastatic deposits. CONCLUSIONS: Failure to demonstrate p53 protein accumulation does not ensure a favourable outcome for pituitary adenoma. Accordingly, pituitary carcinoma may occur in the absence of p53 accumulation. The factors which underlie aggressive behaviour of pituitary neoplasms are uncertain but are under investigation.
Adenoma↗
Antimalarial, antiviral, and antitoxoplasmosis norsesterterpene peroxide acids from the Red Sea sponge Diacarnus erythraeanus.
A new norsesterterpene acid, named muqubilone (1), along with the known sigmosceptrellin-B and muqubilin were isolated from the Red Sea sponge Diacarnus erythraeanus. The structure determination of 1 was based primarily on 1D and 2D NMR analyses. Sigmosceptrellin-B exhibits significant in vitro antimalarial activity against Plasmodium falciparum (D6 and W2 clones) with IC(50) values of 1200 and 3400 ng/mL, respectively. Muqubilin and 1 show in vitro antiviral activity against herpes simplex type 1 (HSV-1) with ED(50) values of 7.5 and 30 microg/mL, respectively. Muqubilin and sigmosceptrellin-B display potent in vitro activity against Toxoplasma gondii at a concentration of 0.1 microM without significant toxicity.
Animals↗
Gelliusterols A--D, new acetylenic sterols from a sponge, Gellius species.
New acetylenic sterols, gelliusterol A (1, 26,27-bisnorcholest-5-en-23-yn-3 beta,7 alpha-diol), its corresponding 7-ketone, gelliusterol B (2, 26,27-bisnorcholest-5-en-23-yn-3 beta-ol-7-one), and gelliusterols C (4, cholest-5-en-23-yn-3 beta,7-one) and D (5, cholest-5-en-23-yn-3 beta,25-diol-7-one), were isolated from an unidentified species of sponge, Gellius sp. The structures of the steroids were established from spectroscopic data.
Animals↗
Cytotoxic cyclic norterpene peroxides from a Red Sea sponge Diacarnus erythraenus.
Investigation of the lipophilic extract of the Red Sea sponge Diacarnus erythraenus revealed one new norsesterterpene cyclic peroxide, aikupikoxide A (1), three new norditerpene cyclic peroxides, aikupikoxide B-D (2-4), and the known norterpene peroxides muqubilin and nuapapuin A methyl ester. In addition, a new sesquiterpene, O-methyl guaianediol, was isolated. Their structures were determined by means of spectroscopic methods. The cytotoxic activities for the isolated compounds have been reported.
Animals↗
Clinical and microbiological follow-up of an outbreak of Yersinia pseudotuberculosis serotype Ib.
Yersinia pseudotuberculosis, a food-borne pathogen, causes infection that commonly presents as gastroenteritis and mesenteric lymphadenitis. Post-infectious complications include erythema nodosum, reactive arthritis and, less commonly, uveitis and nephritis. Six serotypes of Y. pseudotuberculosis have been identified, and post-infectious complications have been identified following infection with some, but not all, serotypes. The first recognized outbreak of Y. pseudotuberculosis serotype lb occurred in British Columbia in November 1998. We documented the incidence of post-infectious complications and the effect of antibiotic use on the clinical course. Four months after the outbreak, a standardized questionnaire asking about symptoms and antibiotic use was administered by telephone to laboratory-confirmed cases. Stool samples were collected to examine for chronic carriage of Y. pseudotuberculosis and 59 of 74 eligible cases participated. The most common post-infectious symptoms were rash (8/59) and joint pain (7/59). Microbiological analysis, at follow-up, revealed 0/36 stools positive for Y. pseudotuberculosis. Seventy-eight percent of cases had taken antibiotics during their acute illness. There was no significant difference in the frequency of post-infectious symptoms between cases who had or had not taken antibiotics. The post-infectious pathogenicity of Y. pseudotuberculosis serotype lb is lower than that documented for other serotypes. Antibiotic use did not significantly alter the reported clinical course of illness.
Adolescent↗
Long-term followup of newborns with myelodysplasia and normal urodynamic findings: Is followup necessary?
PURPOSE: A subset of newborns with myelodysplasia have normal bladder function on urodynamic assessment. We analyzed long-term followup in this population to determine the necessity for subsequent urological surveillance. MATERIALS AND METHODS: We retrospectively analyzed the records of 25 of 204 newborns (12%) with myelodysplasia in whom neurourological evaluation was normal after surgical repair of the spinal defect. Initial assessment included complete urodynamic study, renal ultrasound, urinalysis and urine culture. These patients were reevaluated every 3 months until age 3 years, semiannually until age 6 years and yearly thereafter. The longest followup was 18.6 years. RESULTS: Of the 25 newborns 22 had myelomeningocele and 3 had meningocele. During a mean followup of 9.1 years urodynamics subsequently showed neurourological deterioration in 8 children (32%). No changes in urodynamics were observed in any patient older than 6 years. All children with neurourological deterioration underwent magnetic resonance imaging, which confirmed a tethered spinal cord that was then surgically corrected. After the untethering procedure 2 patients (25%) regained normal voiding function, whereas in 6 (75%) mild or moderate neurogenic bladder dysfunction persisted. CONCLUSIONS: Newborns with myelodysplasia and initially normal urodynamic studies are at risk for neurological deterioration secondary to spinal cord tethering, especially during the first 6 years of life. Close followup of these children is important for the early diagnosis and timely surgical correction of tethered spinal cord, and for the prevention of progressive urinary tract deterioration.
Female↗
Reinflating the wheel: tissue expansion using an air-filled expander.
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Air↗
Ambulatory estimates of maximal aerobic power from foot -ground contact times and heart rates in running humans.
Seeking to develop a simple ambulatory test of maximal aerobic power (VO(2 max)), we hypothesized that the ratio of inverse foot-ground contact time (1/t(c)) to heart rate (HR) during steady-speed running would accurately predict VO(2 max). Given the direct relationship between 1/t(c) and mass-specific O(2) uptake during running, the ratio 1/t(c). HR should reflect mass-specific O(2) pulse and, in turn, aerobic power. We divided 36 volunteers into matched experimental and validation groups. VO(2 max) was determined by a treadmill test to volitional fatigue. Ambulatory monitors on the shoe and chest recorded foot-ground contact time (t(c)) and steady-state HR, respectively, at a series of submaximal running speeds. In the experimental group, aerobic fitness index (1/t(c). HR) was nearly constant across running speed and correlated with VO(2 max) (r = 0.90). The regression equation derived from data from the experimental group predicted VO(2 max) from the 1/t(c). HR values in the validation group within 8.3% and 4.7 ml O(2) x kg(-1) x min(-1) (r = 0.84) of measured values. We conclude that simultaneous measurements of foot-ground constant times and heart rates during level running at a freely chosen constant speed can provide accurate estimates of maximal aerobic power.
Acceleration↗
Analysis of DEXI/Dexi refines the organization of the mouse 7C and human 15q11-->q13 imprinting clusters.
Identification of imprinted genes in the Prader-Willi/Angelman syndrome deletion region is complicated by the presence of large flanking repeats. While inactive copies of DEXI are located within the repeats, we have now localized the active DEXI gene to 15q11-->q13 outside the PWS/AS deletion and Dexi to mouse chromosome 16, suggesting complex evolution of this genomic region in both species.
Angelman Syndrome↗
The working practices of the police in relation to mentally disordered offenders and diversion services.
A research study was undertaken to examine the working practices of four bridewells in Hampshire in relation to mentally disordered offenders (MDOs) and diversion services. A consecutive sample of individuals detained in cells and not identified by the police as having a mental disorder were screened for the presence of mental disorder and their suitability for diversion. Custody and detention staff were observed and interviewed to elicit their views and working practices in relation to MDOs. The findings revealed that in bridewells with diversion schemes an average of about 7% of detained individuals had mental disorders who were suitable for diversion but were not detected by the police. In the bridewell without a diversion scheme the figure was 14%. Conversely, many individuals without a formal mental disorder were inappropriately referred to diversion schemes. The effectiveness of screening processes by custody staff was variable. Facilities in the bridewells were not suitable for containing disturbed individuals. Delays in obtaining mental health assessments caused considerable concern for police officers and prolonged the discomfort of vulnerable individuals. Further preparation and training of custody staff is needed to improve screening procedures. Reception and detention facilities for mentally disordered individuals should be reviewed and response times for approved social workers (ASWs) and psychiatrists would benefit from improvement.
Adult↗
On becoming a doctor.
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Attitude of Health Personnel↗
Diagnostic quiz #47. Case no. 2. Idiopathic external or internal resorption.
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Aged↗
Difficulty in removing suprapubic urinary catheters in home based patients: a comparative descriptive study.
The aim of the study was to monitor difficulties being experienced by community nurses when removing suprapubic catheters in 94 patients living in two area health services in Sydney. The study identified one catheter brand (Simpla) that was associated with more pain and bleeding for patients, and increased difficulties in removal for the nurses. It was found that muscle relaxant medications taken by patients contributed significantly in ease of catheter removal. In over 50% of all-silicone catheters surveyed, there was evidence of hysteresis leading to balloon cuffing on deflation. This phenomenon could be associated with increased trauma to the suprapubic cystostomy tract on catheter removal. A review of the risks and benefits associated with all-silicone catheters used for suprapubic insertion is recommended.
Adolescent↗