Injury prevention in the Republic of Ireland.
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Accidents, Traffic↗
Biomedical subjects
P Fitzpatrick
Publications and source records attributed to P Fitzpatrick.
Prostate cancer: how aware is the public?
OBJECTIVE: To assess the public awareness of prostate cancer and willingness to seek medical attention for urinary symptoms, and to determine associated factors. SUBJECTS AND METHODS: A community survey was conducted using a questionnaire administered by the interviewer to 280 randomly selected Irish men aged 40-69 years. RESULTS: A quarter of the men had not heard of prostate cancer; factors associated with having heard were nonmanual social class, living with a female partner and a history of treatment for urinary disease. Eighty per cent said they would be willing to attend a GP if they had urinary symptoms; associated factors were living with a female partner, having heard of prostate cancer and having seen a GP more than once in the preceding year. Just over half deemed attendance to be urgent/important; associated factors were having heard of prostate cancer, living with a female partner and having a relative with cancer. Having a General Medical Services card (a means-tested medical card entitling the holder to free medical services) was negatively associated. Lower social class was negatively associated with routine questioning by a GP about urinary symptoms. CONCLUSIONS: There is a marked social-class gradient in knowledge and willingness to seek medical advice. In the absence of population screening, earlier clinical presentation with prostate cancer is essential if prognosis is to be improved; there is an evident need to improve prostate cancer awareness, particularly in the lower social classes, if this goal is to be achieved.
Adult↗
Inertial eigenvalues, rod density, and rod diameter in length perception by dynamic touch.
Four experiments addressed the relevance of the eigenvalues Ik of the inertia tensor for perceiving length by dynamic touch. Experiments 1-2 focused on the consequences of limiting variation in the minimum eigenvalue I3. Both revealed that perceived length is a function of Ik. Whether the contribution of I3 is detected, however, depends on the range of values that characterize a particular object set. Experiments 3-4 considered the relationship between an independent index of a rod's diameter, which does not affect Ik, and actual manipulation of a rod's diameter, which does affect Ik. Whereas the former appeared as satisfaction of implicit instructions to alter reports of perceived length, the latter entailed actual differences in perceived length in accordance with Ik. Results are discussed with respect to the links among actual length, perceived length, and Ik, as well as, in particular, how these links guarantee that perceived length is in the range of actual lengths.
Adult↗
Improved precision of newborn screening for congenital adrenal hyperplasia using weight-adjusted criteria for 17-hydroxyprogesterone levels.
OBJECTIVE: To evaluate the efficacy and efficiency of weight-adjusted threshold levels for 17-hydroxyprogesterone (17-OHP) in screening newborn infants for 21 hydroxylase deficiency-congenital adrenal hyperplasia (21-OH-D-CAH). DESIGN: Analysis of the number of false-positive reports and diagnoses in infants, of 21-OH-D-CAH with the use of two strategies. Before October 1993, separate criteria for definite abnormal 17-OHP levels were established and implemented for 41,846 infants on the basis of birth weight: either less than 2200 gm (17-OHP level, 90 ng/ml) or 2200 gm or more (40 ng/ml). To reduce the burden of follow-up testing in low birth weight infants, criteria for definite abnormal 17-OHP results were statistically determined for four, rather than two, birth weight divisions: 1299 gm or less (17-OHP level > or = 165 ng/ml), 1300 to 1600 gm (> or = 135 ng/ml), 1700 to 2200 gm (> or = 90 ng/ml), and more than 2200 gm (> or = 40 ng/ml). These criteria were applied to the next 149,684 infants screened, and rates of false-positive test results and of false-positive diagnoses of 21-OH-D-CAH were compared. RESULTS: Before implementation of four-tiered weight-adjusted 17-OHP criteria, 205 definite abnormal reports yielded four confirmed cases of 21-OH-D-CAH (positive predictive value = 2%; incidence of 21-OH-D-CAH = 1 in 10,461). With the revised criteria, 61 of 149,684 infants had definite abnormal results and 14 cases of 21-OH-D-CAH were confirmed (positive predictive value, 20%; incidence of 21-OH-D-CAH, 1 in 10,692). No undetected severe cases of 21-OH-D-CAH have been subsequently reported. CONCLUSIONS: Weight-adjusted criteria for 17-OHP levels in screening for 21 -OH-D-CAH markedly reduced the number of false-positive results requiring immediate follow-up testing, particularly among low birth weight infants. Increased specificity afforded by these criteria was not accompanied by diminished sensitivity in detecting severe cases. Long-term follow-up of this screened cohort will determine whether the goals of newborn screening for 21-OH-D-CAH are adequately and efficiently fulfilled by this approach.
17-alpha-Hydroxyprogesterone↗
National survey of MRSA: Ireland, 1995.
The objective of this survey was to obtain an indication of the size of the methicillin-resistant Staphylococcus aureus (MRSA) problem in Ireland prior to introducing national MRSA control guidelines. A survey of all microbiology laboratories in Ireland was carried out over two weeks in Spring 1995. For patients from whom MRSA was isolated during the study period standard demographic and clinical data were requested and period prevalence/1000 discharges was calculated. All 45 microbiology laboratories surveyed responded. MRSA was isolated from 448 patients during the two-week period. The period prevalence of MRSA was 16.5/1000 discharges. Males aged > or = 65 had the highest rate (50/1000 discharges). Half of all isolates were from patients in surgical or medical wards, but 4% were from community-based sources such as GPs, nursing homes and hospices. Thirty-two percent of MRSA patients were infected rather than colonized. MRSA is clearly a significant problem in Ireland. While it is largely a hospital problem at present, the increasing trend towards day procedures and shorter hospital stay means that infection will increase in the community.
Adolescent↗
Changing the infection control paradigm from off-line to real time: the experience at Millard Fillmore Health System.
In 1993, several departments at Millard Fillmore Health System joined efforts to initiate a new approach to infection control. The main emphasis of this program is to move infection control to a real-time mode to manage patient outcomes daily. The principal objective was to decrease the number of nosocomial infections by 10%, with a particular emphasis on surgical-site infections. Besides real-time surveillance, we are critically evaluating several aspects of the management of nosocomial infections. High-level computer support has been the frame-work upon which this program was built. We have microcomputers that are linked directly to microbiology, pharmacy, billing, and admissions, downloading data several times daily. An expert software system merges all of the data, and from this we can target patients for real-time interventions. The computer system allows all inpatients to be screened for either infection control or antibiotic management interventions on a daily basis, with minimal time being spent on data collection and maximal efforts devoted to interventions at the bedside. Additionally, the infection management program will assist in maintaining the extraordinarily low expenditures on antimicrobial agents. During 1993, the Millard Fillmore Health System spent $924,884 on antibiotics, an amount approximately 50% that of comparably sized hospitals.
Anti-Bacterial Agents↗
Community mothers' programme: extension to the travelling community in Ireland.
STUDY OBJECTIVE: To see whether the community mothers' programme, using lay volunteer mothers to deliver a childhood development programme, could be extended successfully to the travelling community in Ireland. DESIGN: This was a prospective study of the travelling community; comparisons were made with results of a previous randomised trial of settled mothers. SETTING: A regional health authority in Ireland. PARTICIPANTS: These comprised 39 traveller and 127 settled intervention mother/ infant pairs (randomised controlled trial (RCT) intervention); settled community mothers; 105 settled control pairs (RCT control). All mothers received standard support; traveller and RCT intervention groups also received the services of a community mother. MAIN RESULTS: The travellers' sociodemographic profile differed significantly from the other groups. At the end of the study, traveller and intervention children were exposed to more cognitive games and nursery rhymes. There were significant differences in the proportions who received all three shots of their primary immunisation schedule before 12 months of age and who received "three in one" vaccination, with traveller children doing least well. The diet of traveller children surpassed that of RCT controls in all food groups except fruit; they were less likely to begin cows' milk before 26 weeks of age. Traveller mothers' diet was superior to that of RCT control and similar to RCT intervention mothers. Traveller and RCT intervention mothers were less likely to feel tired, feel miserable, and want to stay indoors than RCT control mothers. CONCLUSIONS: The results of the community mothers' programme in the travelling community are encouraging; poor immunisation uptake remains a challenge.
Accidents↗
Determinants of breastfeeding in Salisbury and Durham.
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Attitude to Health↗
Attitudes to and use of baby walkers in Dublin.
OBJECTIVES: To identify the rate of baby walker use, parental attitudes, and associated injuries. DESIGN: Parents of babies attending clinics for developmental assessment were surveyed by self administered questionnaire about their use, attitudes, and history of injuries associated with walkers. SETTING: Dublin, Ireland. SUBJECTS: Parents of 158 babies. RESULTS: Fifty five per cent of the sample used a walker. The main reasons for doing so included babies' enjoyment of them and the fact that the walker was used for an older sibling. Although none of the users listed safety concerns as a reason to stop using the walker, non-users (45%) did so; 12.5% of the users had at least one walker related injury. CONCLUSIONS: Parents of babies who use a walker perceive them as beneficial. However these babies are placed at unnecessary risk. It behoves all health professionals and child carers to alert parents to these dangers and the sale of walkers should be reviewed.
Adult↗
Eigenvalues of the inertia tensor and exteroception by the "muscular sense".
Muscle spindles and Golgi tendon organs constitute the receptor foundation to the "muscle sense." Muscle sensitivity has long been assumed relevant to the non-visual perception of the positions and motions of the body's segments and of the properties of hand-held objects. Dynamic touch is the label given to the particular kind of tactile exteroperception that involves a non-spatial input from muscles and tendons. When a hand-held object is wielded, hefted, carried and so on, the hand movements, together with the physical properties of the object, produce torques and angular motions that change in time with the movement. There is, however, an unchanging quantity that relates the variable torques and angular motions, namely, the object's inertia for rotation about a fixed point in the wrist. Our research revealed that the non-visual perception of the length of a wielded object by dynamic touch is a function of muscular sensitivity to the principal moments or eigenvalues of the inertia tensor. Across four experiments, variations in object length were accompanied by variations in width, spatial and material heterogeneity, the relation of the tensorial components to mass, and geometric shape. Subjects had no foreknowledge of the variations in object dimensions. Perceived lengths of occluded objects were reported by adjusting a visible marker so that its position corresponded to the position of the felt end of the object. In each experiment, perceived length was closely related to actual length and uniquely constrained by the major and minor eigenvalues of the inertia tensor. The present results, in conjunction with previous research, suggest that the inertia tensor provides the domains for two sets of functions realized by the "muscular sense," one consisting of the principal moments of inertia or eigenvalues, which map on to perceived object magnitudes (e.g. length, weight), and one consisting of the principal directions or eigenvectors, which map on to perceived relations between hand and object (e.g. position of grasp). The significance of information-perception specificity over cognitive mechanisms is underlined and perspectives on dynamic touch and its underlying muscular sensitivity, including a general tensorial analysis, are discussed.
Adult↗
Intravenous thrombolytic therapy in myocardial infarction: an analytical review.
The properties and physiological effects of three currently FDA-approved thrombolytic agents, streptokinase (SK), tissue plasminogen activator (tPA), and anisoylated plasminogen activator complex (APSAC) are reviewed. All thrombolytic agents have been shown to reduce mortality postmyocardial infarction (MI). Comparative trials have failed to demonstrate a difference between the effects of tPA, SK, and APSAC on mortality. In addition, no consistent difference between the three agents on ejection fraction (EF) has been found despite a superior reperfusion rate with tPA at 90 min. Furthermore, reinfarction and interventional procedure rates were significantly higher after thrombolytic treatment, and the incidence of total strokes was higher with tPA than SK in some comparative studies. Based on analysis of the published megatrials, SK is a more cost-effective thrombolytic agent for patients with acute MI than tPA or APSAC.
Anistreplase↗
Tensorial basis to the constancy of perceived object extent over variations of dynamic touch.
Subjects wielded occluded rods, with or without attached masses, and reported the distances reachable with their distal tips. Experiments 1-3 compared wielding about the wrist, the elbow, and the shoulder. Experiments 4 and 5 compared free wielding, using the whole arm, with wielding only about the wrist. The two comparisons, respectively, were of spatial and temporal variations in the rod's rotational inertia. Perceived extent was found to be constant in both comparisons. This constancy was tied to the inertia tensor Iij defined about a point that remains a fixed distance from the object during wielding--an invariant of the spatially and temporally dependent patterning of mechanical energy impressed upon the tissues of the body. Discussion focused on the reciprocal action and perception capabilities of multisegmented limbs, the tensorial relations in the neurobiology of dynamic touch, and the strategy of understanding perceptual constancy through invariants.
Adult↗
Commentary: development of perception-action systems and general principles of pattern formation.
Our commentary on this special issue devoted to Developmental Biodynamics: Brain, Body, and Behavior Connections is divided into 3 main sections. The first section is an overview of the individual contributions. 5 major themes are identified: (1) inappropriateness of computational treatments of development and the need for more biologically and physically relevant treatments; (2) significance of tailoring muscular to nonmuscular forces in developing movement coordination; (3) importance of spontaneous movements as exploratory and formative mechanisms; (4) influences of action capabilities on the development of perception capabilities, and vice versa; (5) applications of methods and techniques of nonlinear dynamics to developmental processes. In the second section, we provide a synopsis of current ways of thinking about prototypical developmental processes, namely, pattern formation and pattern differentiation, in various classes of physical and biological systems. It is suggested that efforts to understand the progressive formation and differentiation of patterns in terms of very general principles provide a valuable resource of concepts and methods for students of child development. In the third section, hypotheses about the development of perception-action systems are generated from juxtaposing the themes and conjectures of this special issue with general principles of pattern formation. The hypotheses suggest the possibility of a pattern formation or dynamics approach to child development as an alternative to the conventional approaches emphasizing maturation (nativist), specific learning experiences (empiricist), cognitive stages (Piagetian), and strategies of encoding and retrieval (information processing).
Child Development↗
Haptic probing: perceiving the length of a probe and the distance of a surface probed.
Knowing about the properties of objects by wielding them and knowing about the distances of surfaces by striking them with objects as probes are examples of dynamic or effortful touch. Six experiments focused on the invariant mechanical parameters that couple the time-varying states (displacements, velocities) of hand-held rods to the time-varying torques and forces imposed upon them by wielding and probing. There were three major conclusions. First, when a probe is wielded without contact, perceived probe length is a function of the probe's rotational inertia; however, with contact, perceived probe length is affected by the rotational inertia and the distance of the point of contact from the probe's center of percussion. Second, when a surface is struck with a probe, perceived surface distance is affected by the probe's rotational inertia and the angle of inclination of the probe at contact. Third, under seemingly identical conditions of probing, either probe length or surface distance can be perceived selectively without confusion. Results were discussed in terms of haptic information, haptic attention, and the dynamics of probing.
Adult↗
A management approach to incompletely excised basal cell carcinomas of skin.
There were 187 incompletely resected basal cell carcinomas (BCC) of skin referred to the Princess Margaret Hospital between 1970 and 1985. Median age at presentation was 62 years. The commonest location of these lesions was in the head and neck region (93%). One hundred twenty lesions were immediately treated: 119 were irradiated and 1 was excised. The remaining 67 lesions were managed expectantly. Follow-up time for the entire population ranged from 1 month to 17 years, with a median time of 2.7 years. The 5-year probability of remaining relapse-free in the group immediately treated was 91% versus 61% if managed expectantly (p = 0.0001). If only lateral margins were positive, the crude probability of local failure was 3/18 (17%), versus 9/27 (33%) if the deep margins were involved (p = 0.2). Once relapse occurred in the group of lesions treated expectantly, 17/20 (85%) of these relapses were salvaged by either radiation or surgery. The 10-year actuarial probability of local control for the lesions immediately treated and observed were similar: 92% and 90%, respectively (p = 0.5). An economic analysis revealed that immediate radiation treatment saved the health system only $223.00 per patient. Since there is no difference in the ultimate local control between these two approaches, and these elderly patients may be spared the morbidity of unnecessary treatments, it is suggested that a policy of observation may be adopted for basal cell carcinomas of skin which have been incompletely excised.
Actuarial Analysis↗
Effects of methylphenidate on stimulus evaluation and response processes: evidence from performance and event-related potentials.
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Adult↗
Stimulant treatment for adolescents with attention deficit disorder.
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Adult↗
Intraocular lymphoma: report of three cases and review of the literature.
Three cases of intraocular lymphoma are presented. One patient had only ocular involvement, one had involvement of the eye and central nervous system, and in the third patient, ocular lymphoma developed 1 year after the diagnosis of a systemic lymphoma. One patient died before treatment could be initiated, but the other two patients responded well to local radiotherapy. Only one patient who received radiation to both eyes and the whole brain, followed by systemic chemotherapy, remains alive 4 years after diagnosis. Eighty-seven cases of intraocular lymphoma reported in the literature are reviewed. Only 16.7% of cases involved the eyes alone without central nervous system or systemic disease. In more than one-half of the cases (59.7%), the eye was the primary site of involvement. Craniotomy or enucleation was required for diagnosis in 52.7% of patients, and diagnosis frequently followed a significant period of delay during which time patients were treated unsuccessfully for uveitis or iritis. Death for most patients was due to progressive central nervous system involvement. Therefore, we recommend combined modality therapy with radiation to the whole brain and both eyes, followed by systemic chemotherapy with or without intrathecal medications.
Adult↗