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Biomedical subjects

P Hatton

Publications and source records attributed to P Hatton.

14 recordsLinked to original sources

Routes of asbestos exposure and the development of mesothelioma in an English region.

OBJECTIVES: To investigate the contribution of exposure to asbestos through different routes in the development of mesothelioma. METHODS: Case-control study. 185 confirmed cases of mesothelioma and 160 controls were identified, when death had occurred between 1979 and 1991 in four health districts in Yorkshire. The surviving relatives were interviewed to ascertain lifetime exposure to asbestos. Adjusted odds ratios (ORs) of exposure to asbestos (through occupational, paraoccupational, and residential routes) were calculated for cases and were compared with controls. RESULTS: Likely or possible occupational exposure to asbestos was more common in cases than in controls (OR 5.6, 95% confidence interval (95% CI) 3.1 to 10.1). After excluding those with likely or possible occupational exposure, likely or possible paraoccupational exposure was more common in cases than controls (OR 5.8, 95% CI 1.8 to 19.2). Only six cases of mesothelioma were identified as being solely exposed to asbestos through their residence, compared with nine controls. The OR for residential exposure to asbestos varied between 1.5 and 6.6, depending on which potential industrial sources were included, but the 95% CIs were so wide that slightly reduced or greatly increased odds comparing cases with controls could not be excluded. CONCLUSION: Study results support previous evidence that occupational and paraoccupational exposure to asbestos is associated with developing mesothelioma. Despite a rigorous search, purely residential exposure seemed to account for only 3% of identified cases. No firm conclusion can be drawn about the risks from residential exposure alone, as many of the study subjects could also have been occupationally or paraoccupationally exposed to asbestos.

Adult

Chronic sinusitis and zinc-containing endodontic obturating pastes.

Several researchers have reported a link between the development of a solitary antral aspergillus sinusitis and the presence of zinc-containing root canal obturating paste within the antrum. If diagnosed correctly, it is generally accepted that this type of sinusitis can be treated effectively using surgical techniques alone. However, previous reports have shown that this is not always the case and may result in prolonged and inappropriate treatment of the condition. It is hoped that the reported case and literature review will assist both dental and medical practitioners in identifying affected patients and in the subsequent instigation of correct treatment regimes.

Adult

Standardized mortality from cervical cancer: a measure of performance?

A retrospective cohort analysis, using data extracted from clinical notes, examined the validity of standardized mortality ratios (SMRs) for cervical cancer as an indicator of the quality of health services by exploring the mortality at five years of patients presenting with cervical cancer, identifying factors associated with survival, and studying the relationship of those factors to SMRs for the disease. The subjects were 1038 women aged 15-64 registered at the Yorkshire Cancer Registry as having invasive cervical cancer between 1979 and 1983. It was found that independent risk factors for mortality within five years of presentation were stage at diagnosis and smoking habit. Method of treatment had an effect that failed to reach statistical significance. Independent risk factors for late stage at presentation were absence of a history of cervical smear and increasing age. Considerable variation remained unexplained in both models. District SMRs were not related to five-year survival, stage at presentation or screening history. SMRs were related to proportions of smokers. It is concluded that SMRs are subject to considerable influence from a range of unidentified factors, as well as identified risk factors. They are too broad an indicator to be a valid measure of health service performance. The health service's ability to reduce case fatality does not outweigh the effects of incidence and severity. Better indicators would be survival to five years of those presenting at stage II or less and distribution of stage at presentation.

Adolescent

The use of the screening technique as a method of rapidly estimating vaccine efficacy.

Using measles notification data for the period December 1st, 1987 to May 31st, 1988, in Leeds, an estimation of measles vaccine efficacy is calculated using the screening technique. This is an equation which allows the rapid estimation of vaccine efficacy and is useful in an outbreak situation in deciding whether the proportion of cases with a vaccination history is still compatible with a good overall vaccine efficacy. No vaccine is 100% effective and the screening technique, which uses readily available data, will quickly indicate whether a more detailed epidemiological investigation is required into vaccine failure.

Child

Measles/mumps/rubella vaccine (MMR): an audit of Leeds health professionals' knowledge of contraindications and intention to vaccinate assessed by postal questionnaire.

An audit of Leeds health professionals' knowledge of valid contraindications to measles/mumps/rubella (MMR) vaccine was undertaken by postal questionnaire, three months after its introduction. The health professional groups were health visitors, clinical medical officers, general practice trainers and general practice vocational trainees. The results indicate that some health professionals would give MMR vaccine to children when it was contraindicated (e.g. to a child receiving chemotherapy or radiotherapy). However, a much greater problem was the number of health professionals stating that they would not vaccinate children with MMR vaccine in clinical situations where there were no valid contraindications to its use. Some health professionals were also applying contraindications to the use of pertussis vaccine to the use of MMR vaccine. The information contained in the Joint Committee on Vaccination and Immunisation handbook Immunisation against infectious disease on contraindications to MMR vaccine use is also reviewed. It is important that false contraindications are not used by health professionals to wrongly deny children the protection provided by MMR vaccine.

Allied Health Personnel

A report of the investigation and control measures instituted after the isolation of toxin-producing Corynebacterium diphtheriae mitis from a child in Leeds.

This report describes the control measures instituted and further investigations undertaken after the isolation of toxin-producing Corynebacterium diphtheriae from a throat swab taken routinely from a nine-year-old boy, recently returned from Pakistan, who had been admitted to hospital in Leeds with hepatitis A infection. Four of his siblings were subsequently shown to have identical Corynebacterium diphtheriae on throat swabbing, except that in one child the organism did not produce toxin. All the children were asymptomatic carriers.

Child

The form and presentation of tuberculosis over a 10-year interval in Leeds.

Over the 10-year period 1973-82 1958 cases of tuberculosis were notified in Leeds (population 728 000). Records were traced for 1673 patients and analysed for age, race, sex, sputum status, site of tuberculosis, route of diagnosis and occupation. These results are presented. The tuberculosis screening service at the Leeds Chest Clinic diagnosed 172 cases of tuberculosis from 13 794 contacts screened and 41 cases from 12 572 newly arrived immigrants representing 10.3% and 2.4% respectively of the cases for whom records could be traced. Of these cases discovered by the tuberculosis screening service 25 were sputum positive. A further 15 cases were diagnosed from 2638 contacts screened by the static Mass Miniature Unit. The cost of the screening service at the Leeds Chest Clinic is estimated to be a minimum of 2000 pounds for every case of tuberculosis diagnosed.

Adolescent