PubMed Health⌕ Search

Biomedical subjects

Michael Fitzpatrick

Publications and source records attributed to Michael Fitzpatrick.

11 recordsLinked to original sources
PubMed2004

MMR: risk, choice, chance.

The unfolding of the measles, mumps and rubella (MMR) controversy reveals some of the key features of the cultural climate affecting matters of health and illness in contemporary society. A high level of anxiety around issues of health is reflected in a heightened sense of individual vulnerability to environmental dangers (such as atmospheric pollution, electromagnetic fields, bioterrorism) and in a general aversion to risk, particularly in relation to children. This mood has proved responsive to views sceptical, if not hostile, towards science and medicine and associated professionals, particularly in the sphere of immunization. The result is that uptake of MMR vaccination in the UK has fallen, from a peak of 92% in the mid-1990s to a national level of 82% in 2003 (at the age of two); in London uptake is now less than 75%-much less in some areas-causing a significant risk of outbreaks of measles. In the USA too, the proportion of parents opting out of regulations requiring immunization as a condition of school entry has increased significantly in some areas, though these controversies appear to have had little impact so far in continental Europe.

Attitude to Health↗
PubMed2003

Scaling DNAPL migration from the laboratory to the field.

A particular problem with the release of dense nonaqueous phase liquids (DNAPLs) into the environment is identifying where the DNAPL is and if it is still moving. This question is particularly important at sites where thousands of cubic meters of DNAPLs were disposed of. To date, results from laboratory models have not been scaled to predict analogous migration at the larger length and time scales appropriate for sites where large volumes of DNAPLs were released. Modified inspectional analysis is a technique for developing scaling relationships through nondimensionalizing the governing equations. It was applied in this study to scale observations of DNAPL migration in a laboratory model to four hypothetical scenarios in the field where large volumes of DNAPL were released. One scenario was compared to a large DNAPL spill site. The length and time scales of DNAPL movement predicted from our analysis are consistent with those predicted from a numerical model of this site. To our knowledge, this is the first application of modified inspectional analysis for release of DNAPLs in a laboratory model. This methodology may prove useful for scaling results from other laboratory investigations of DNAPL migration to field-scale systems.

Hazardous Waste↗
PubMed2003

Science to services: consumers need "real-world" science.

Over the past decade there has been a revolution in pharmacotherapy for schizophrenia and related disorders. The second generation, or atypical, antipsychotic medications have demonstrated efficacy and generally better side-effect profiles. However, from the perspective of policy makers the higher costs associated with these newer medications leads to tough decisions regarding their continued use in light of an escalating fiscal crisis. For consumers, both persons with the illness and their family caregivers, the budgetary cutbacks leave many scrambling for answers to questions that most treatment (efficacy) studies were never designed to answer. "Should we oppose formulary restrictions on principle alone, or is there scientific data that can be relied on to inform our position?" On a more personal note, many are asking whether or not to switch to one of the newer medications and which medication would be best for them. Unlike CATIE, efficacy studies were never designed to answer such questions. In this article, we start by highlighting how CATIE will fill important gaps in translating the results of efficacy studies to effectiveness in the real world. Both the development of the CATIE methodology and the study design itself reflect what we will refer to as "real-world science": i.e., science that sheds light on effectiveness in vivo and can inform decisions consumers, clinicians, and policy makers are faced with day-to-day. We discuss CATIE in the context of the fiscal crisis hitting MEDICAID programs leading many policy makers to take the more expensive, atypical antipsychotics off the list of medications made available to patients. We argue that studies like CATIE will be highly informative and ultimately vital to policy makers wishing to create mental health policies that will succeed. Throughout, we highlight how CATIE, and real-world science more generally, are vital to consumers striving to find the medication(s) that works best for them. Given the organic research design process, which arguably relies on a fuller range of stakeholders than any study of its kind before, we remain hopeful that CATIE can succeed in generating an unprecedented amount of real-world science that consumers can use.

Consumer Advocacy↗
PubMed2003

Noise-induced hearing loss in snorers and their bed partners.

OBJECTIVE: As habitual snoring affects a large percentage of the population and is associated with various medical and social complications, we examined whether loud snoring is also associated with noise-induced hearing loss for the snorers and/or their bed partners. PATIENT SELECTION: Healthy adults between the ages of 35 and 55 years with subjective symptoms of severe snoring were screened to exclude those with a past history of noise exposure (e.g., factory workers, army personnel), use of ototoxic medications, and previously diagnosed hearing disorder. MAIN OUTCOME MEASURES: Behavioural audiograms and otoacoustic emission testing were used to evaluate the subjects' hearing. RESULTS: Although all of the snorers did not demonstrate consistent hearing loss patterns, all four bed partners of snorers in our study demonstrated a unilateral high-frequency pattern of hearing loss consistent with noise-induced hearing loss. Furthermore, the affected ear in every case was the one that was claimed to be chronically exposed to snoring noise. CONCLUSIONS: The findings suggest that there may be a relationship between snoring and noise-induced hearing loss in the bed partners of chronic snorers. Further investigation of this association may enable the population at risk to identify early hearing loss in order that appropriate management of noise exposure and snoring can be recommended, including preventive measures and medical and surgical therapies.

Adult↗
PubMed2002

Exercise hypercapnia in advanced chronic obstructive pulmonary disease: the role of lung hyperinflation.

In severe chronic obstructive pulmonary disease (COPD), carbon dioxide retention during exercise is highly variable and is poorly predicted by resting pulmonary function and arterial blood gases or by tests of ventilatory control. We reasoned that in patients with compromised gas exchange capabilities, exercise hypercapnia could be explained, in part, by the restrictive consequences of dynamic lung hyperinflation. We studied 20 stable patients with COPD (FEV(1) = 34 +/- 3 percent predicted; mean +/- SEM) with varying gas exchange abnormalities (Pa(O(2)) range, 35 to 84 mm Hg; Pa(CO(2)) range, 31 to 64 mm Hg). During symptom-limited maximum cycle exercise breathing room air, Pa(CO(2)) increased 7 +/- 1 mm Hg (p < 0.05) from rest to peak exercise (range, -6 to 25 mm Hg). We measured the change in Pa(CO(2)) after hyperoxic breathing at rest as an indirect test of ventilation-perfusion abnormalities. The change in Pa(CO(2)) from rest to peak exercise correlated best with the acute change in Pa(CO(2)) during hyperoxia at rest (r(2) = 0.62, p < 0.0005) and with resting arterial oxygen saturation (r(2) = 0.30, p = 0.011). During exercise, the strongest correlates of serial changes in Pa(CO(2)) from rest included concurrent changes in end-expiratory lung volume expressed as a percentage of total lung capacity (partial correlation coefficient [r] = 0.562, p < 0.0005) and oxygen saturation (partial r = 0.816, p < 0.0005). In severe COPD, the propensity to develop carbon dioxide retention during exercise reflects marked ventilatory constraints as a result of lung hyperinflation as well as reduced gas exchange capabilities.

Carbon Dioxide↗