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Biomedical subjects

M Spence

Publications and source records attributed to M Spence.

At least 19 recordsLinked to original sources

A comparison of the sampling efficiencies of a range of atmosphere samplers when collecting polymeric diphenylmethane di-isocyanate (MDI) aerosols.

Polymeric diphenylmethane di-isocyanate (PMDI) is a precursor or an intermediate in the manufacture of pure MDI and is used in many industrial applications. Potential health effects of diisocyanates are generally considered to include irritation and respiratory sensitization, dictating the need for low occupational hygiene standards and robust hygiene monitoring methods. A wide range of methods has been developed or adopted for this purpose but questions concerning their ability to accurately sample MDI aerosols in the occupational environment have often been raised. In order to provide such information, studies have been conducted to compare several MDI sampling systems: the Institute of Occupational Medicine (IOM) 25-mm open-faced inhalable dust sampler; the 13-mm Millipore Swinnex Cassette sampler; the 37-mm open-face Millipore cassette; the midget-impinger, the glass tube containing glass wool, and two direct reading paper tape monitors. The program was comprised of two phases, the first being a preliminary comparison of the collection efficiencies of the IOM, 13 mm and midget-impinger at a range of orientations to air flow, aerosol particle sizes, and sampling flow rates, using inert polyethylene glycol aerosols. The second phase compared all samplers operating according to each manufacturer's recommendations and sampling PMDI aerosols at a range of particle sizes and concentrations. All studies were conducted in a wind tunnel. All filter methods performed well in atmospheres containing small particles except impingers that required a filter backup. In general, the variability of all the samplers was high for larger particle size ranges. Direct reading monitors showed low efficiencies.

Aerosols↗

CAM evaluation: what are the research questions?

Much effort is being directed towards the evaluation of CAM therapies. Yet evaluation is often encouraged before truly considering the research questions which need to be asked. Research questions like 'Does this CAM therapy work?' must be clearly distinguished from 'Does this particular CAM treatment work?' and the latter question needs to be replaced by even more specific ones like 'Does it work when administered by therapist X?' and 'Is therapist X effective?'. Suggestions for the study of the therapeutic process and the evaluation of therapist effectiveness are presented.

Complementary Therapies↗

Beating heart coronary artery bypass grafting. A theatre nurse's perspective.

Coronary artery bypass graft (CABG) surgery has been going through a time warp. The development of cardiopulmonary bypass (CPB), together with continuing advances in equipment and refinement of techniques, introduced a high level of safety for CABG operations. Recently, however, with pharmacological and technological advances, surgeons have been able to 'go back in time' and undertake complex CABG surgery without CPB.

Coronary Artery Bypass↗

Effect of postal prompts to patients and general practitioners on the quality of primary care after a coronary event (POST): randomised controlled trial.

OBJECTIVES: To determine whether postal prompts to patients who have survived an acute coronary event and to their general practitioners improve secondary prevention of coronary heart disease. DESIGN: Randomised controlled trial. SETTING: 52 general practices in east London, 44 of which had received facilitation of local guidelines for coronary heart disease. PARTICIPANTS: 328 patients admitted to hospital for myocardial infarction or unstable angina. INTERVENTIONS: Postal prompts sent 2 weeks and 3 months after discharge from hospital. The prompts contained recommendations for lowering the risk of another coronary event, including changes to lifestyle, drug treatment, and making an appointment to discuss these issues with the general practitioner or practice nurse. MAIN OUTCOME MEASURES: Proportion of patients in whom serum cholesterol concentrations were measured; proportion of patients prescribed beta blockers (6 months after discharge); and proportion of patients prescribed cholesterol lowering drugs (1 year after discharge). RESULTS: Prescribing of beta bockers (odds ratio 1.7, 95% confidence interval 0.8 to 3.0, P>0.05) and cholesterol lowering drugs (1.7, 0. 8 to 3.4, P>0.05) did not differ between intervention and control groups. A higher proportion of patients in the intervention group (64%) than in the control group (38%) had their serum cholesterol concentrations measured (2.9, 1.5 to 5.5, P<0.001). Secondary outcomes were significantly improved for consultations for coronary heart disease, the recording of risk factors, and advice given. There were no significant differences in patients' self reported changes to lifestyle or to the belief that it is possible to modify the risk of another coronary event. CONCLUSIONS: Postal prompts to patients who had had acute coronary events and to their general practitioners in a locality where guidelines for coronary heart disease had been disseminated did not improve prescribing of effective drugs for secondary prevention or self reported changes to lifestyle. The prompts did increase consultation rates related to coronary heart disease and the recording of risk factors in the practices. Effective secondary prevention of coronary heart disease requires more than postal prompts and the dissemination of guidelines.

Adrenergic beta-Antagonists↗

Why do we continue to take unnecessary smears?

A questionnaire survey of all general practices and family planning doctors in Manchester Health Authority was undertaken to determine why many more smears are taken in primary care than are scheduled by the screening programme. An 82% response rate was obtained. The indications for additional smear tests most frequently cited by responders were postcoital (88%), postmenopausal (84%), or intermenstrual bleeding (55%); genital warts (87%); and multiple sexual partners (52%). Forty-six per cent think that a woman should have a repeat test within one year of her first ever test. We discuss why these are not valid indications for additional smear tests.

England↗

Exon and intron variants in the human tryptophan 2,3-dioxygenase gene: potential association with Tourette syndrome, substance abuse and other disorders.

Defects in serotonin metabolism, and abnormalities in both blood serotonin and tryptophan levels, have been reported in many psychiatric disorders. Tryptophan 2,3-dioxygenase (TDO2) is the rate limiting enzyme for the breakdown of tryptophan to N-formyl kenurenine. Functional variants of this gene could account for the observed simultaneous increases or decreases of both serotonin and tryptophan in various disorders. We have identified four different polymorphisms of the human TDO2 gene. Association studies show a significant association of one or more of these polymorphisms and Tourette syndrome (TS), attention deficit hyperactivity disorder (ADHD) and drug dependence. The intron 6G-->T variant was significantly associated with platelet serotonin levels. Only the association with TS was significant with a Bonferroni correction (p = 0.005). Our purpose here is not to claim these associations are proven, but rather to report preliminary results and show that easily testable polymorphisms are available. We hope to encourage additional research into the potential role the TDO2 gene in these and other psychiatric disorders.

Electrophoresis, Polyacrylamide Gel↗

Do clinical guidelines introduced with practice based education improve care of asthmatic and diabetic patients? A randomised controlled trial in general practices in east London.

OBJECTIVE: To determine whether locally developed guidelines on asthma and diabetes disseminated through practice based education improve quality of care in non-training, inner city general practices. DESIGN: Randomised controlled trial with each practice receiving one set of guidelines but providing data on the management of both conditions. SUBJECTS: 24 inner city, non-training general practices. SETTING: East London. MAIN OUTCOME MEASURES: Recording of key variables in patient records (asthma: peak flow rate, review of inhaler technique, review of asthma symptoms, prophylaxis, occupation, and smoking habit; diabetes: blood glucose concentration, glycaemic control, funduscopy, feet examination, weight, and smoking habit); size of practice disease registers; prescribing in asthma; and use of structured consultation "prompts." RESULTS: In practices receiving diabetes guidelines, significant improvements in recording were seen for all seven diabetes variables. Both groups of practices showed improved recording of review of inhaler technique, smoking habit, and review of asthma symptoms. In practices receiving asthma guidelines, further improvement was seen only in recording of review of inhaler technique and quality of prescribing in asthma. Sizes of disease registers were unchanged. The use of structured prompts was associated with improved recording of four of seven variables on diabetes and all six variables on asthma. CONCLUSIONS: Local guidelines disseminated via practice based education improve the management of diabetes and possibly of asthma in inner city, non-training practices. The use of simple prompts may enhance this improvement.

Adult↗

Home visitation services for at-risk pregnant and postpartum women: a randomized trial.

A randomized trial tested the psychosocial efficacy of a home visitation model for women at risk of out-of-home placement of their newborns. After an average of ten months of exposure, the experimental group reported significantly increased social support, greater access to services, and decreased psychological distress. Implications of the findings for interventions with at-risk families are discussed.

Adolescent↗

Psychosocial characteristics of pregnant women with and without a history of substance abuse.

This study was undertaken to identify the psychosocial characteristics and service needs of pregnant women with substance abuse histories. Two hundred and twenty-five pregnant women defined as having high-risk pregnancies for psychosocial reasons were interviewed using a structured questionnaire when they presented for prenatal care at a large urban clinic. Women who admitted to problems with substance abuse were compared to those who denied a history of substance abuse. Women with an admitted history of substance abuse were significantly older, had more children, were more likely to live on their own or in an institutional setting, and more frequently reported that they currently smoked cigarettes. In addition, women with substance abuse problems delayed prenatal care an average of one month longer. Other differences between the two groups, as well as the implications of the findings for social work practice in health care settings, are discussed.

Adult↗

Clinical experience with penicillin skin testing in a large inner-city STD clinic.

OBJECTIVE: To establish (1) the prevalence of positive penicillin skin tests among outpatients with well-defined but variable history of penicillin allergy and (2) the reproducibility, safety, and negative predictive value of skin testing with benzylpenicilloyl polylysine (PPL) and a minor-determinant mixture (MDM). DESIGN: Serial consenting outpatients with current indications for penicillin therapy were skin-tested in duplicate with PPL and MDM. Subjects with negative skin tests (93% of those positive by history and 95% of those negative by history) received therapeutic courses of benzylpenicillin (81%) or ampicillin (19%). Negative predictive value of skin testing was established by 72-hour follow-up for adverse reactions to drug. SETTING/PATIENTS: A total of 5063 consecutive, qualifying outpatients in a Baltimore, Md, sexually transmitted disease (STD) clinic. The study group was young (73% between 20 and 40 years old), 66% male, and 90% black; 25% had history of atopy. Follow-up was 94% complete. RESULTS: Positive skin tests were observed in 7.1% of 776 individuals with previous history of penicillin allergy and in 1.7% of 4287 subjects negative by history (P << .001). Previous history of anaphylaxis or urticaria was associated with significantly higher rates of positive skin tests of 17.3% and 12.4%, respectively (P<<.001). Only 4% with history of exanthem had positive skin tests (P = .03). The coefficient of variation for duplicate skin tests was 11%. Time intervals since last penicillin treatment did not influence the rate of positive skin tests. Adverse reactions to skin tests occurred in 13 (1.2% of patients positive by history; 9.4% of those with positive skin tests). A mild anaphylactic reaction occurred in one individual whose preliminary scratch testing was inadvertently omitted; systemic pruritus or urticaria occurred in 11 subjects; one had a large local reaction. After penicillin administration to individuals with negative skin tests, acute allergic reactions occurred in 0.5% of subjects negative by history compared with 2.9% of subjects positive by history (chi 2 = 33.3; P = .0001). Reactions were generally mild and self-limited; only two cases of mild anaphylactic reaction occurred, both in patients with history of severe IgE-mediated reaction. CONCLUSIONS: Skin testing with both major and minor penicillin determinants is safe using current recommendations, and both reagents are necessary for maximizing the identification of sensitized subjects. Routine penicillin skin testing can facilitate the safe use of penicillin in 90% of individuals with a previous history of penicillin allergy.

Adult↗

Evolution of the human immunodeficiency virus epidemic among patients attending sexually transmitted disease clinics: a decade of experience.

Since human immunodeficiency virus (HIV) is predominantly sexually transmitted, serologic surveys for HIV infection in sexually transmitted disease (STD) clinics provide sentinel observations regarding HIV epidemiology. Over the past decade, 17,207 systematically collected sera from patients attending Baltimore STD clinics were analyzed. From 1979 through 1989, HIV seroprevalence rose from 0.23% to 5.35%, increasing significantly in both men and women (P less than .001). Due to a marked increase in HIV infection among women during the mid-1980s, the male-to-female ratio of HIV infection declined from 16:1 in 1979-1982 to 1.0 in 1988-1989. HIV seroprevalence increased significantly (P less than .001) in all age groups, with the greatest increase among teenagers, rising from 0.18% in 1979-1983 to 2.1% in 1987-1989 (P less than .001). Although HIV seroprevalence was higher among whites than blacks during the early 1980s, it increased in blacks subsequently (P less than .001), eventually resulting in a greater rate among black than white clinic patients (P less than .01). These data reflect the evolution of the HIV epidemic in US inner cities. HIV prevalence has increased greater than 20-fold, with recent increases being most marked among women, teenagers, and blacks. Additional resources will undoubtedly be required to support further intensive behavioral and educational programs targeted at adolescents and inner-city minorities.

Adolescent↗

Pregnancy in premature ovarian failure after therapy with oral contraceptives despite resistance to previous human menopausal gonadotropin therapy.

We report the case of a 35-year-old woman with premature ovarian failure that was documented at 29 years of age, who wanted to conceive. Although she failed to respond to high doses of menotropin therapy, she ovulated and conceived after she took an oral contraceptive. The oral contraceptive was used to reduce the elevated level of gonadotropins in an effort to restore receptors to the luteinizing hormone and follicle-stimulating hormone, which theoretically may have been down-regulated.

Adult↗

Reproducibility of the diagnosis of cervicitis in pregnancy.

Cervicitis has been associated with several infections of the female genital tract. Criteria have been established for making the diagnosis of cervicitis in gynecologic populations but there are no well-established criteria for diagnosing cervicitis in obstetrical populations. Because of the association of the cervicitis and sexually transmitted diseases, and because of the association of sexually transmitted diseases and adverse pregnancy outcome, the present study was undertaken in an attempt to establish criteria for the diagnosis of cervicitis in pregnancy. We also attempted to determine the reproducibility of that diagnosis with respect to intra- and interobserver variability. We concluded that intraobserver variability is improved after specific training has been completed and that interobserver variability may be reduced to an acceptable level. On a public health scale, this may allow for identification of a population at high risk for adverse pregnancy outcome when sophisticated microbiologic techniques are unavailable.

Adolescent↗

Trichomonas vaginalis: electrophoretic analysis and heterogeneity among isolates due to high-molecular-weight trichomonad proteins.

The protein composition of Trichomonas vaginalis isolates was evaluated using one-dimensional and two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis and fluorography. At least two hundred intrinsically labeled and about 30 major extrinsically labeled proteins of molecular weights less than 120,000 were resolved by isoelectric focusing and electrophoresis. In general, long-term grown and fresh isolates of T. vaginalis gave similar fluorograms of the readily detectable proteins. Only a minor variance in a distinct protein was noted among three of the four fresh isolated tested. Labeling with [35S]methionine or 3H-amino acids gave almost identical profiles, ensuring the efficient radiolabeling of trichomonad proteins that dominate quantitatively. Comparative analysis of radioactivity profiles of one-dimensional gels emphasizing the region of high-molecular-weight proteins known to reside in low copy number revealed the presence or absence of the internally synthesized proteins from surfaces of T. vaginalis isolates. Finally, immunoblotting of two-dimensional gels demonstrated the highly immunogenic nature of proteins corresponding to quantitatively dominant molecular weight regions of intrinsically labeled proteins.

Animals↗