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Biomedical subjects

M McColl

Publications and source records attributed to M McColl.

13 recordsLinked to original sources
PubMed1999

Efficacy of an ovine caseous lymphadenitis vaccine formulated using a genetically inactive form of the Corynebacterium pseudotuberculosis phospholipase D.

Caseous lymphadenitis (CLA) is an economically significant disease of sheep caused by the gram-positive bacterium Corynebacterium pseudotuberculosis. CLA vaccines are currently formulated using formalin inactivated culture supernatants that are rich in the C. pseudotuberculosis phospholipase D (PLD) exotoxin. One alternative to chemical detoxification is to inactivate the PLD genetically. This procedure not only provides a means to remove an onerous chemical treatment step but also the opportunity to increase gene expression, therefore improve protein yields. Using site-specific mutagenesis the C. pseudotuberculosis PLD was inactivated by substituting a serine residue at histidine 20 within the enzyme active site. CLA vaccine formulated using genetically inactivated PLD protected 44% of sheep against C. pseudotuberculosis challenge compared with 95% protection offered by the formalin inactivated preparation. Since there was no apparent difference in immune response mounted by vaccinated sheep the reason for this variation in vaccine efficacy remains unclear. Although genetic inactivation can be a convenient means to produce toxoid vaccines its use to develop a new CLA vaccine provided no net benefit over the conventional formulation.

Animals↗
PubMed1998

The effect of a positive T-lymphocytotoxic crossmatch on hepatic allograft survival and rejection.

The influence of crossmatching in liver transplantation is still controversial, and at present, our unit does not alter management according to the result of standard lymphocytotoxicity testing. This study retrospectively assessed outcome of grafts transplanted in the presence of preformed antidonor cytotoxic antibody. One hundred twelve patients undergoing their first orthotopic liver transplantation had results available (mean follow-up: 18 months). Twelve patients had a positive crossmatch and 100 negative. The 1-year graft survival was 58% in the positive crossmatch group, compared with 81% in the negative crossmatch group (P = .02). The 1-year patient survival was 83% in the positive crossmatch group compared with 90% in the negative group (P = .41). Acute cellular rejection occurred in 6 of 7 (86%) grafts surviving more than 7 days in the positive crossmatch group compared with 46 of 88 (52%) grafts in the negative group (P = .09). However, episodes of further acute cellular rejection requiring treatment occurred in 4 of the 6 grafts in the positive crossmatch group but in only 4 of the 46 grafts with a negative crossmatch (P = .0006). The authors conclude that evidence exists in our population that preformed antidonor antibodies adversely affect the outcome of hepatic allografts but not patient survival.

Adult↗
PubMed1996

Uterine Balloon Therapy for the Treatment of Menorrhagia

From June 1994 to December 1995, 116 women (mean age 39 yrs, range 27-50 yrs) who met inclusion and exclusion criteria underwent endometrial ablation with a thermal balloon system. Forty-one (35%) were treated under general and 71 (61%) under neuroleptic anesthesia. Four (3%) treatments were performed under paracervical block only. A 16-cm long, 3-mm diameter catheter with a latex balloon at its tip housing a heating element was inserted into the uterus and filled with sterile 5% dextrose in water solution (mean 10.4 ml, range 2-55 ml). The catheter was connected to a control unit that maintained the temperature at 87 ± 5° C, monitored the pressure, and terminated the treatment after 8 minutes. The starting uterine pressure was 80 to 140 mm Hg in the first 13 women and greater than 140 mm Hg in the rest. Nineteen women were treated for 12 minutes and all others for 8 minutes. Complications were endometritis (3), hematometra (2), and cystitis (1). At 6-month follow-up, after 8 minutes of treatment, persistent menorrhagia was reported by 38% and 12% of patients at less than and greater than 140 mm Hg pressure, respectively. At greater than 140 mm Hg pressure, menorrhagia was reported by 13% of women after 8 and 12 minutes of treatment. In 38 women, amenorrhea or spotting occurred in 29%, hypomenorrhea in 45%, eumenorrhea in 21%, and menorrhagia in 5%. Uterine balloon therapy is a safe and effective treatment for menorrhagia at uterine pressures of 150 to 180 mm Hg and of 8 minutes' duration.

Journal Article↗
PubMed1996

Coping and social support as determinants of quality of life in HIV/AIDS.

Coping, social support and quality of life (QOL) were examined in 120 HIV+ people (mean age = 37). The sample came from ambulatory clinics and drop-in centres in Toronto: 29% had AIDS, 35% were HIV symptomatic, and 35% were asymptomatic. Information was gathered from self-administered questionnaires. Respondents had good levels of social support and used a variety of coping strategies. Their scores on the behavioural and subjective measures of QOL were somewhat below average. The illness-related measure indicated that their diagnosis had an almost neutral effect on QOL and showed several areas where QOL had been positively affected. Data from male subjects only (n = 107) were analysed using a hierarchical block regression for each QOL measure. Income, emotional social support, and problem-oriented and perception-oriented coping were positively related to QOL. Tangible social support and emotion-oriented coping were negatively related and symptom severity was not related at all. Close friends provided most types of support. Although respondents indicated high levels of satisfaction with support generally, they expressed a need for more emotional support. Unemployment was high despite participants being relatively healthy and well-educated.

Adaptation, Psychological↗
PubMed1996

Association of HLA types A1-B8-DR3 and B27 with rapid and slow progression of HIV disease.

We examined how HLA types A1-B8-DR3 and B27 were related to progression of clinical disease and rate of loss of CD4 lymphocytes in the Edinburgh City Hospital cohort of HIV-positive patients, mainly injection drug users. Patients (n = 692) were prospectively followed from 1985 through March 1994. Accurately estimated seroconversion times were determined retrospectively for a subgroup of 313 (45%). Of 262 patients (39%) who were fully or partially HLA typed, 155 (50%) had known seroconversions. Of 34 patients typed positive for A1-B8-DR3, 29 progressed to CDC stage IV, 22 to AIDS and 20 died. Twelve patients were typed positive for B27; six of these progressed to CDC stage IV, one to AIDS and none died. In a proportional hazards analysis of the 313 patients with known seroconversions, A1-B8-DR3 was significantly associated with covariate-adjusted relative risks of 3.7 (95% CI 1.9-7.2), 3.1 (1.6-6.0) and 1.9 (1.1-3.2) for progression from seroconversion to death, AIDS and CDC stage IV, respectively. Events for B27 were too rare to include B27 in analyses to death and AIDS, but B27 was significantly associated with slower progression to CDC stage IV (0.3, CI 0.1-0.9). Random effects growth curve models were used to estimate individual rates of loss of square root CD4 count and loss of CD4 percentage, for 603 and 617 patients, respectively. A1-B8-DR3 was associated with rapid loss of both markers (p = 0.02 and p = 0.01, respectively); B27 was associated with slow loss of both markers (p = 0.04 and p < 0.005).

Acquired Immunodeficiency Syndrome↗
PubMed1996

Low thrombosis rate seen in blood donors and their relatives with inherited deficiencies of antithrombin and protein C: correlation with type of defect, family history, and absence of the factor V Leiden mutation.

We have previously identified a group of blood donors with inherited deficiencies of either antithrombin (AT) or protein C who appear to have a relatively low thrombosis rate. In the 5 years that have elapsed since initial identification of these individuals, resistance to activated protein C (APC resistance), which is associated with the factor V Leiden gene mutation, has emerged as an important and highly prevalent inherited thrombophilic risk factor. We have followed 28 donors/relatives with deficiency of AT (median age 48 years, range 16-77) and 23 with deficiency of protein C (median age 44 years, range 15-79) over a period of 5 years. During the study period only one individual, who was previously symptomatic, has suffered a thrombotic event which occurred spontaneously whilst on warfarin. We have now excluded coinheritance of APC resistance due to the factor V Leiden mutation in our cohort. Our findings demonstrate that individuals with single inherited thrombophilic defects are not uncommon and are frequently asymptomatic. The absence of the factor V Leiden mutation may in part explain the low thrombosis rate observed, and lends support to the hypothesis that multiple thrombophilic defects may be necessary for the development of thrombosis.

Adolescent↗
PubMed1996

Client follow-up at the Adelaide sexually transmitted disease clinic.

This study investigated the extent to which doctor-client communication is associated with follow-up rates at Clinic 275, an Adelaide sexually transmitted diseases (STD) clinic. At Clinic 275, clients are routinely screened for the major STDs at their first visit. They are then asked to return in one week's time for their results and further treatment if necessary. Over a four-week period in April-May 1994, the clinical consultations between doctors and 100 clients attending for their first visit in an episode of care were observed and recorded. Data from the observation schedules were matched with data collected from interviews, either when clients returned for their follow-up visit (n = 78) or from a telephone interview when they failed to return (n = 20). In addition, 18 clients who failed to return for follow-up (but were not part of the original observation sample) were interviewed. Sociodemographic factors did not affect follow-up rates. Of those who did not return for follow-up, social and environmental reasons were cited by about two-thirds. Reasons given by the remaining clients indicate that failure to return for follow-up was related to discrepancies in doctor-client communication in that they were confused about the need to return to obtain test results. In addition, approximately half could not name the infections for which they had been tested. Changes in clinic practice may prove a more useful method of increasing follow-up rates than seeking to identify the characteristics of noncompliant individuals.

Appointments and Schedules↗
PubMed1992

Disability and depression: some etiological considerations.

Although the literature on this subject is fraught with ambiguity, it appears that there is a higher incidence of depression in people with disabilities than in the general population. The etiology of the disorder is by no means clear but several of the explanations which exist for depression in general, appear particularly suited when considering the disabled population. In this article, theoretical origins of the relationship between depression and disability are explored under two broad headings: Biological Factors and Psychosocial Factors. Clinical interventions and social-ecological implications pertinent to the various etiologies are discussed in relation to facilitating psychosocial adjustment and preventing serious depression. Problems of definition and methodology are noted and the importance of focusing attention on this high-risk population is stressed.

Adaptation, Psychological↗
PubMed1992

Social support intervention after stroke: results of a randomized trial.

The purpose of this study was to determine if social support intervention would improve the support experienced by stroke survivors and if improvement would result in better psychosocial outcome. Subjects were drawn from a community-based sample that had received rehabilitation services in the hospital and at home. The study was a randomized trial (n = 48 experimental group, n = 40 control group), and measures were taken at entry into the study, immediately after intervention (or, at a comparable time for the control group), and again 3 months later. No significant differences were found between groups either on social support measures or psychosocial outcomes. Secondary analyses showed that significant changes in support had been experienced within the sample as a whole in relation to the subjects' gender, living situation, marital status, and employment status. Findings are discussed in terms of methodologic and programmatic concerns, and recommendations are made for further research with this potentially valuable intervention.

Adaptation, Psychological↗
PubMed1990

The Canadian occupational performance measure: an outcome measure for occupational therapy.

The Canadian Association of Occupational Therapists, in collaboration with Health and Welfare Canada have developed and published a conceptual model for occupational therapy, the Occupational Performance model. This paper describes the development of an outcome measure, The Canadian Occupational Performance Measure (COPM), which is designed to be used with these guidelines for client-centred clinical practice. The COPM is an outcome measure designed for use by occupational therapists to assess client outcomes in the areas of self-care, productivity and leisure. Using a semi-structured interview, the COPM is a five step process which measures individual, client-identified problem areas in daily function. Two scores, for performance and satisfaction with performance are obtained. This paper describes the rationale and development of the COPM as well as information about its use for therapists.

Canada↗
PubMed1987

Social support and psychosocial dysfunction after stroke: buffering effects in a community sample.

This study examined the effect of social support as a mediator between stressful life events experienced by stroke survivors and outcome measured by psychosocial dysfunction. Eighty-five stroke survivors were interviewed at home two to 24 months after discharge from active rehabilitation. The sample was selected for a high number of stressful life events in the recent past, placing subjects at risk for psychosocial dysfunction. Eight components of social support were measured to determine the magnitude of their influence on adjustment. A new instrument, the Social Support Inventory for Stroke Survivors, was designed for this purpose. The General Health Questionnaire, used to measure psychosocial symptomatology, showed that 27% of the sample suffered psychosocial dysfunction. Multiple regression analysis explained 14.5% of total variance as due to social support and functional status. Risk analysis, using the odds ratio, indicated that an especially strong protective effect was produced by community social support.

Adaptation, Psychological↗
PubMed1985

Community occupational therapists and volunteers: a survey of utilization and satisfaction.

Current estimates lead us to believe that approximately 16% of the population works in some capacity on a volunteer basis. In spite of the size of this valuable human resource, occupational therapists often remark that they are unable to find suitable volunteers to assist with patient-related activities. The present study is an attempt to explore this topic, looking specifically at how community occupational therapists use volunteers, and how satisfied they are with the services provided. A descriptive survey was carried out in two parts: a questionnaire was distributed to all therapists associated with Community Occupational Therapy Associates (COTA) in Toronto; and, a structured interview was conducted with a sample of therapists who indicated they were dissatisfied with volunteer services. The survey revealed three problems: non-availability of appropriate volunteers to do specific patient-related activities; poor communication between therapists and volunteers; and general negative feelings about the reliability and accountability of volunteers. Based on identified problems and in consultation with the literature, a program was set up at COTA to enhance the effective utilization of volunteers within the agency.

Analysis of Variance↗