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Mark Tomlinson

Publications and source records attributed to Mark Tomlinson.

13 recordsLinked to original sources
PubMed2006

Manifestations of affective disturbance in sub-Saharan Africa: key themes.

BACKGROUND: Affective disorder, once seen as rare in sub-Saharan Africa, is now viewed as more common. There are however challenges in assessing rates of depression, exploring manifestations of depression, and understanding risk factors for depression, especially those related to gender. AIM: To identify key themes and new directions for research on affective disorder in sub-Saharan Africa, with particular reference to gender issues. METHODS: Interpretive review of selected literature, and theoretical analysis. RESULTS: There are gender differences in manifestations and rates of depression in sub-Saharan Africa, and there are forms of presentation (largely somatic, based on interpersonal relationships, or spiritual in nature) which may obscure the detection of depression. Studies are consistent however that when depressive symptoms are sought and are present, these are reasonably easy to elicit. LIMITATIONS: This was not a systematic review, and the substantial grey literature from sub-Saharan Africa was not reviewed. For many countries, there are no data available. CONCLUSIONS: Affective disorder, when properly sought for through both qualitative and quantitative methods, has been found to be common in sub-Saharan Africa. There is a paucity of research on interventions with affective disorder in this region.

Adult↗
PubMed2006

Fatigue in primary biliary cirrhosis is associated with excessive daytime somnolence.

A significant proportion of patients with primary biliary cirrhosis (PBC) suffer from severe fatigue. The aim of this study was to characterize patterns of daytime sleep in patients with PBC (using both objective and subjective assessment approaches) and to study the association between sleep abnormality and fatigue severity. Fatigue severity was assessed in 48 female subjects with PBC (using a disease-specific quality of life instrument (the PBC-40) and a generic fatigue measure (Fatigue Impact Scale [FIS]) as well as 48 case-matched normal controls. All participants also completed the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS, which assesses daytime hypersomnolence). Objective sleep assessment was performed using accelerometry over 7 days. Global sleep quality assessed by the PSQI was significantly lower in the PBC group compared to controls (P < .0001). ESS scores were significantly higher in patients with PBC than controls (P = .0001), suggesting significantly greater daytime somnolence in the patients with PBC. Objective sleep assessment confirmed that subjects with PBC were sleeping on average almost twice as long as controls during the daytime. Both degree of daytime somnolence (ESS) and actual daytime sleep activity (accelerometry) correlated strongly with fatigue severity in the patient group (r2 = 0.5, P < .0001 and r2 = 0.2, P < .01, respectively). In conclusion, Sleep abnormality, in the form of excessive daytime somnolence, is present in a significant proportion of patients with PBC, with the degree of daytime somnolence correlating strongly with the degree of fatigue. Existing agents effective at reducing daytime somnolence (such as modafinil) hold potential for the treatment of fatigue in PBC.

Cognition↗
PubMed2006

Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial.

BACKGROUND: Few patients with amyotrophic lateral sclerosis currently receive non-invasive ventilation (NIV), reflecting clinical uncertainty about the role of this intervention. We aimed to assess the effect of NIV on quality of life and survival in amyotrophic lateral sclerosis in a randomised controlled trial. METHODS: 92 of 102 eligible patients participated. They were assessed every 2 months and randomly assigned to NIV (n=22) or standard care (n=19) when they developed either orthopnoea with maximum inspiratory pressure less than 60% of that predicted or symptomatic hypercapnia. Primary validated quality-of-life outcome measures were the short form 36 mental component summary (MCS) and the sleep apnoea quality-of-life index symptoms domain (sym). Both time maintained above 75% of baseline (T(i)MCS and T(i)sym) and mean improvement (microMCS and microsym) were measured. FINDINGS: NIV improved T(i)MCS, T(i)sym, microMCS, microsym, and survival in all patients and in the subgroup with better bulbar function (n=20). This subgroup showed improvement in several measures of quality of life and a median survival benefit of 205 days (p=0.006) with maintained quality of life for most of this period. NIV improved some quality-of-life indices in those with poor bulbar function, including microsym (p=0.018), but conferred no survival benefit. INTERPRETATION: In patients with amyotrophic lateral sclerosis without severe bulbar dysfunction, NIV improves survival with maintenance of, and improvement in, quality of life. The survival benefit from NIV in this group is much greater than that from currently available neuroprotective therapy. In patients with severe bulbar impairment, NIV improves sleep-related symptoms, but is unlikely to confer a large survival advantage.

Aged↗
PubMed2006

Obstructive sleep apnoea syndrome: a nurse-led domiciliary service.

AIM: This paper reports a successful transformation of clinical practice from inpatient diagnosis and initiation of treatment for obstructive sleep apnoea syndrome to a nurse-led domiciliary model increasing patient access and choice. BACKGROUND: Obstructive sleep apnoea syndrome is common, affecting globally 2-4% of the adult population. It is characterized by periodic complete or partial collapse of the upper airway, leading to hypoxaemia and sleep fragmentation, resulting in daytime sleepiness and impaired quality of life. It can be treated successfully with nocturnal continuous positive airway pressure. Strategies for diagnosis and initiation of treatment have traditionally been inpatient-based, but limited facilities and increasing demand in many countries have necessitated alternative strategies. METHODS: As an extension to our current inpatient provision, we have established nurse-led domiciliary investigation and treatment. Patients meeting predefined criteria undergo a limited sleep study followed by therapy initiation at home. Confirmation of investigation findings, evaluation of treatment, education and long-term review are carried out in nurse-led clinics. RESULTS: We evaluated outcome in the first 150 patients managed in this way between August 2002 and December 2003. In our highly selected patient group, 79% of those who undertook a trial of treatment continued at 3 months, with average compliance >5 hours per night, a figure which compares favourably with our overall patient population. Statistically significant sustained improvement in sleepiness was seen. Independent predictors of long-term acceptability of continuous positive airway pressure were disease severity and magnitude of improvement in sleepiness. CONCLUSION: A nurse-led service for domiciliary diagnosis, treatment initiation and on-going management of selected patients with obstructive sleep apnoea syndrome is feasible and cost-effective, with outcomes comparable with conventional inpatient services. This approach is applicable in most countries where increasing demand for investigations greatly exceeds the availability of traditional facilities.

Adult↗
PubMed2006

Medical staff guidelines for periviability pregnancy counseling and medical treatment of extremely premature infants.

OBJECTIVES: The goal of this report is to describe the collaborative formation of rational, practical, medical staff guidelines for the counseling and subsequent care of extremely early-gestation pregnancies and premature infants between 22 and 26 weeks. The purposes of the guidelines were to improve knowledge regarding neonatal outcomes, to provide consistency in periviability counseling, and to promote informed, supportive, responsible choices. METHODS: To formulate the guidelines, a 5-step process was conducted; it began with a series of multidisciplinary meetings among maternal-fetal medicine specialists (MFMs), obstetricians, neonatologists, neonatal nurse practitioners, and nurses from both the labor and delivery unit and the NICU at Providence St Vincent Medical Center (Portland, OR). First, our discussions reviewed mortality rates, morbidity rates, and long-term neurodevelopmental outcomes for extremely premature infants. Second, we explored the variations in counseling that pregnant women received, based on providers' individual beliefs and disparate knowledge of neonatal outcomes. Third, we asked participants to complete a survey that focused on the theoretical impending delivery of a premature infant, presenting at each week between 22 and 26 weeks of gestation. Participants indicated their recommendations for NICU care at each gestational age by using a numeric scale. Fourth, the survey results were tabulated and used as a basis for the formation of guidelines related to the recommended obstetric and neonatal care at each week of gestation. MFMs and neonatologists were urged to use these specific guidelines as a framework for counseling pregnant women between 22 and 26 weeks of gestation. Fifth, we surveyed women approximately 3 days after they were counseled by their MFM and neonatologist, to assess comprehension, utility, consistency, and comfort with the periviability counseling. RESULTS: Twenty pregnant women with the possibility of delivery between 22 and 26 weeks of gestation (mean: 24 weeks) received periviability counseling with our consensus medical staff guidelines. The respondents rated the counseling process as highly understandable (80%), useful (95%), consistent (89%), and performed in a comfortable manner (100%). All (100%) of the pregnant women thought they were given enough information to make critical decisions related to the potential level of care of their infant. CONCLUSIONS: Informative, supportive, clear, medical staff guidelines developed to assist in the counseling of women delivering extremely premature infants have been designed and implemented successfully at our hospital. These guidelines form the basis of periviability counseling, which is appreciated by our at-risk pregnant patients. We recommend that all hospitals that provide high-risk obstetric and neonatal intensive care develop similar consensus guidelines based on published outcomes and local provider experience.

Adult↗
PubMed2006

Implementation and case-study results of potentially better practices for collaboration between obstetrics and neonatology to achieve improved perinatal outcomes.

OBJECTIVE: The objective of this study was to make improvements in communication and collaboration between neonatal and obstetric specialties. Five NICUs from the Vermont Oxford Network's Evidence-Based Quality Improvement Collaborative in Neonatal and Perinatal Medicine tested potentially better practices that overlap obstetric and NICU care. METHODS: One area of practice improvement was the management of the pregnancy at the margin of viability. Another included the use of team training and video simulation to improve team performance during high-risk deliveries using aviation-based communication techniques. Another focus of the collaborative was the creation of a multicenter database to measure combined perinatal and neonatal outcomes. RESULTS: The principle outcomes are increased patient satisfaction with teamwork between neonatology and obstetric services and improved team response times for emergent deliveries and the increased use of team communication skills during video simulations of high-risk deliveries. CONCLUSIONS: Implementing these potentially better practices can result in improved communication and collaboration related to perinatal and neonatal care.

Communication↗
PubMed2006

Attitudes of obstetric and pediatric health care providers toward resuscitation of infants who are born at the margins of viability.

OBJECTIVES: The objective of this study was to determine the attitudes of a variety of health care providers toward the recommendations that should be made to parents regarding the resuscitation of infants who are born at the margins of viability. METHODS: A written questionnaire was distributed to the medical and nursing staff at 4 tertiary perinatal centers. For each of 5 weekly gestational age intervals from 22 weeks to 26 weeks, 6 days, the health care providers were asked to describe on a scale from 1 to 5 whether they would strongly discourage through strongly encourage resuscitation. They also were queried regarding their comfort with counseling regarding these issues. The attitudes of various groups of providers were compared across weekly intervals. RESULTS: A total of 204 physicians and 539 nurses completed the survey. The majority would strongly discourage, either discourage or strongly discourage, be neutral or recommend, recommend or strongly recommend, and strongly recommend resuscitation during the 23rd, 24th, 25th, 26th, and 27th weeks of gestation, respectively. Obstetric caregivers were slightly less likely than pediatric caregivers to strongly discourage resuscitation from 22 weeks to 22 weeks, 6 days and 23 weeks to 23 weeks, 6 days. There were no significant differences in the recommendations of obstetricians and pediatricians. Pediatric nurses were more likely to strongly recommend resuscitation from 26 weeks to 26 weeks, 6 days and more likely either to discourage or to strongly discourage resuscitation from 23 weeks to 23 weeks, 6 days and to strongly discourage resuscitation from the 22 weeks to 22 weeks, 6 days than their obstetric counterparts. Obstetric nurses were slightly less likely than obstetricians to strongly recommend resuscitation at 26 weeks to 26 weeks, 6 days and less likely to strongly discourage resuscitation from 22 weeks to 22 weeks, 6 days. CONCLUSIONS: The caregivers' recommendations seem to be based logically on the current literature regarding survival and morbidity that is experienced by infants who are born at the threshold of viability. Although there are minor differences, there was a relatively consistent approach among professional groups.

Attitude of Health Personnel↗
PubMed2005

Maternal iron deficiency anemia affects postpartum emotions and cognition.

The aim of this study was to determine whether iron deficiency anemia (IDA) in mothers alters their maternal cognitive and behavioral performance, the mother-infant interaction, and the infant's development. This article focuses on the relation between IDA and cognition as well as behavioral affect in the young mothers. This prospective, randomized, controlled, intervention trial was conducted in South Africa among 3 groups of mothers: nonanemic controls and anemic mothers receiving either placebo (10 microg folate and 25 mg vitamin C) or daily iron (125 mg FeS0(4), 10 microg folate, 25 mg vitamin C). Mothers of full-term normal birth weight babies were followed from 10 wk to 9 mo postpartum (n = 81). Maternal hematologic and iron status, socioeconomic, cognitive, and emotional status, mother-infant interaction, and the development of the infants were assessed at 10 wk and 9 mo postpartum. Behavioral and cognitive variables at baseline did not differ between iron-deficient anemic mothers and nonanemic mothers. However, iron treatment resulted in a 25% improvement (P < 0.05) in previously iron-deficient mothers' depression and stress scales as well as in the Raven's Progressive Matrices test. Anemic mothers administered placebo did not improve in behavioral measures. Multivariate analysis showed a strong association between iron status variables (hemoglobin, mean corpuscular volume, and transferrin saturation) and cognitive variables (Digit Symbol) as well as behavioral variables (anxiety, stress, depression). This study demonstrates that there is a strong relation between iron status and depression, stress, and cognitive functioning in poor African mothers during the postpartum period. There are likely ramifications of this poorer "functioning" on mother-child interactions and infant development, but the constraints around this relation will have to be defined in larger studies.

Adult↗
PubMed2005

Mother-infant interactions and infant development are altered by maternal iron deficiency anemia.

The aim of this study was to determine whether iron deficiency anemia (IDA) in young South African mothers alters mother-infant interactions and the infant's development. The study was a prospective, randomized, controlled intervention trial with 3 groups of mothers: nonanemic controls and anemic mothers administered either placebo (25 mg ascorbic acid and 10 microg folate) or daily iron treatment (125 mg FeSO(4) plus ascorbate and folate). Mothers of full-term, normal birth weight infants (n = 81) were followed from 10 wk to 9 mo postpartum. Maternal iron status, socioeconomic level, mother-infant interaction [Parent/Caregiver Involvement Scale (PCIS scale)], and infant development (Griffiths scale) were assessed. At baseline, anemic mothers tended (P < 0.10) to be less responsive to, and more controlling of, their infants. Infants of anemic mothers were developmentally delayed at 10 wk in hand-eye movement and overall quotient. Despite normalization of maternal iron status with supplementation in some mothers, the developmental delays were not diminished at 9 mo. At 9 mo, anemic mothers were significantly more "negative" towards their babies, engaged less in goal setting, and were less "responsive" than control mothers. In contrast, the behavior of anemic mothers given iron treatment toward their children was similar to that of the control mothers on all 11 scales of the PCIS. In conclusion, IDA altered mother-child interactions at both 10 wk and 9 mo postpartum. Additionally, infants whose mothers were anemic in the early postpartum scored worse on developmental tests at 10 wk and 9 mo of age.

Anemia, Iron-Deficiency↗
PubMed2002

Impact of a mother-infant intervention in an indigent peri-urban South African context: pilot study.

BACKGROUND: A high rate of maternal depression and associated disturbance in the mother-infant relationship has been found in an indigent peri-urban South African community, Khayelitsha. The question arises whether a community-based intervention could be beneficial. AIMS: To train community workers to deliver an intervention to mothers and infants in Khayelitsha, and to compare mothers and infants receiving this intervention with a sample receiving no such intervention. METHOD: Four Khayelitsha women were trained in a mother-infant intervention, which they delivered to 32 women recruited in late pregnancy. At 6 months post-partum, maternal mood, the mother-infant relationship and infant growth were assessed. The findings were compared with a matched group of 32 mothers and infants. RESULTS: There was no reliable impact of the intervention on maternal mood. However, compared with the comparison sample, the quality of mother-infant engagement was significantly more positive for those who had received the intervention. CONCLUSIONS: The pilot study produced preliminary evidence of a benefit of a community-based mother-infant intervention delivered by trained, but otherwise unqualified, community workers, sufficient to warrant a formal controlled evaluation of this treatment.

Adult↗
PubMedDate not supplied

Identification and collection of quality indicators for perinatal care.

We describe the development of a database of quality indicators and outcomes for perinatal care as part of a multi-institutional collaborative quality improvement project, Neonatal Intensive Care Quality 2002. Important principles of developing such a database are also discussed including eligibility criteria that identify high-risk patients without burdening data collectors, clinically important and well-defined measures, development of systems within each hospital to ensure identification of all eligible patients, use of data collectors with knowledge of perinatal care, appropriate design of paper and electronic data-collection tools, multiple pilot tests, and periodic feedback of data to participating hospitals.

Adult↗
PubMedDate not supplied

The mother-infant relationship and infant attachment in a South African peri-urban settlement.

A sample of 147 mother-infant dyads was recruited from a peri-urban settlement outside Cape Town and seen at 2- and 18-months postpartum. At 18 months, 61.9% of the infants were rated as securely attached (B); 4.1% as avoidant (A); 8.2% as resistant (C); and 25.8% disorganized (D). Postpartum depression at 2 months, and indices of poor parenting at both 2 and 18 months, were associated with insecure infant attachment. The critical 2-month predictor variables for insecure infant attachment were maternal intrusiveness and maternal remoteness, and early maternal depression. When concurrent maternal sensitivity was considered, the quality of the early mother-infant relationship remained important, but maternal depression was no longer predictive. Cross-cultural differences and consistencies in the development of attachment are discussed.

Adult↗