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Biomedical subjects

P Marsh

Publications and source records attributed to P Marsh.

At least 19 recordsLinked to original sources
PubMed2006

Young people of minority ethnic origin in England and early parenthood: views from young parents and service providers.

The paper explores the phenomenon of early parenthood in minority ethnic communities in England. The data were collected using focus group interviews, in-depth semi-structured interviews and a telephone survey. The sample consisted of 139 participants (41 service providers, 10 grandmothers, 88 young parents). The findings map out the complexity and diversity of experience of early parenthood amongst young people of minority ethnic origin, not least the multiple attachments many experience in relation to their social groups, religious affiliations and the traditional patterns of parenting within their immediate and extended family. Both the young parents and professionals in this study constructed early parenthood in more positive terms than is currently portrayed in the contemporary policy. The findings are analysed and discussed in relation to ethnic identity, social inclusion and exclusion. We explore participants' attempts to counter negative 'deficit' models of early parenthood with reference to perspectives on youth, parenthood and contemporary strategic policy. In conclusion, we suggest an unambiguous focus on the reduction of pregnancy is not a credible message when teenage pregnancy is a social norm for a particular ethnic or cultural group. For young parents of Muslim faith in particular, teenage parenting within marriage is not necessarily considered a 'problem' or seen as a distinctive event. Most participants did not view early parenthood as a barrier to re-establishing career and educational aspirations. A wide diversity of experience amongst young parents is evidenced in the communities studied; this needs to be reflected more comprehensively both in UK policy and in support services.

Adolescent↗
PubMed2002

Primary care teams work harder in deprived areas.

BACKGROUND: The NHS Plan promises an equitable distribution of resources within primary care. To inform the debate on the extent to which resources should be redistributed we examined the association between primary care activity and deprivation. We used the natural experiment of the organization of primary care in Mansfield, Nottinghamshire, where town centre general practices have patients from electoral wards with a range of socio-economic characteristics who are subject to the same degree of supplier-induced demand and variations in data quality. METHODS: We used one year's prospective data for two practices with 20,106 patients from 15 electoral wards. We performed linear regression analysis of directly age-standardized rates for different types of primary care activity and primary care morbidity-specific contacts against Townsend and Index of Multiple Deprivation 2000 scores. RESULTS: There were 44 per cent more out-of-hours contacts in more deprived areas (95 per cent confidence interval (CI) 17-70 per cent), 18 per cent more surgery consultations (95 per cent CI 8-27 per cent), and 28 per cent more same-day consultations (95 per cent CI 12-44 per cent). Routine visits by doctors and contacts by district and practice nurses did not have substantial associations with deprivation. Morbidity-specific contacts for psychological problems and respiratory problems were associated with deprivation but there was no significant association for contacts for low back pain, asthma or menopausal problems. CONCLUSIONS: Different types of primary care activity and contacts for different morbidities had different associations with deprivation. This makes it difficult to recommend a simple list size adjustment; however, increased activity in deprived wards needs to be recognized in resource allocation, service configuration and performance management in primary care.

Adult↗
PubMed2001

Specific detection of DNA and RNA targets using a novel isothermal nucleic acid amplification assay based on the formation of a three-way junction structure.

The formation of DNA three-way junction (3WJ) structures has been utilised to develop a novel isothermal nucleic acid amplification assay (SMART) for the detection of specific DNA or RNA targets. The assay consists of two oligonucleotide probes that hybridise to a specific target sequence and, only then, to each other forming a 3WJ structure. One probe (template for the RNA signal) contains a non-functional single-stranded T7 RNA polymerase promoter sequence. This promoter sequence is made double-stranded (hence functional) by DNA polymerase, allowing T7 RNA polymerase to generate a target-dependent RNA signal which is measured by an enzyme-linked oligosorbent assay (ELOSA). The sequence of the RNA signal is always the same, regardless of the original target sequence. The SMART assay was successfully tested in model systems with several single-stranded synthetic targets, both DNA and RNA. The assay could also detect specific target sequences in both genomic DNA and total RNA from Escherichia coli. It was also possible to generate signal from E.coli samples without prior extraction of nucleic acid, showing that for some targets, sample purification may not be required. The assay is simple to perform and easily adaptable to different targets.

Cystic Fibrosis Transmembrane Conductance Regulato↗
PubMed2001

Investigation to evaluate and validate the Leeds in situ device for the study of enamel remineralisation in vivo.

OBJECTIVES: Recently, a novel device to generate dental plaque in situ on a removable human enamel surface was described. The device permitted the recovery of plaque intact and undisturbed on its enamel substrate. The aim of this investigation was to determine the utility and robustness of this model for analysis of the effects of therapeutics on both enamel remineralisation and on the overlying biofilm composition. METHODS: Enamel slices were taken from extracted sound human teeth, sterilised and a 'flat' area ground on each slice. An artificial lesion was formed within this area using acidified gel and the hardness of the enamel within the area of the lesion was determined at five sites using a 'Vickers' indenter. A nylon ring was then attached over the area of the lesion with cyanoacrylate and the excess enamel removed to form the completed device. Two devices were attached to the upper molars of 22 volunteers. Each volunteer was randomly assigned to receive either a fluoride containing (1500 ppm) or a fluoride free dentifrice. The devices were retained for a 4 week period whilst undertaking normal oral hygiene. All procedures were conducted according to GCP. After a 2 week break, the volunteers were fitted with two further devices, given dentifrice of the alternate type and the procedure repeated. Plaque from each device was harvested for microbiological analyses and the enamel subject to microhardness measurement. Then for each device the change in microhardness of the enamel within the lesion over the 4 week period was calculated. RESULTS: There were no significant differences in viable counts of total aerobic bacteria, mutans streptococci or lactobacilli, nor in acidic, aciduric or arginolytic populations in plaque from patients using the two different dentifrices. However, devices subjected to the fluoride containing dentifrice demonstrated a significantly greater increase in microhardness of the enamel (P<0.025). CONCLUSIONS: These results suggest that the novel in situ device is capable of measuring the effect of 1500 ppm fluoride on remineralisation of carious enamel over a 4 week period and is also well suited to determining concomitant effects on plaque ecology.

Adult↗
PubMed2001

Negative staining permits 4.0 A resolution with low-dose electron diffraction of catalase crystals.

Low-dose electron diffraction of thin single crystals of catalase that are negatively stained with the light-atom compound, dipotassium glucose-1,6-diphosphate, reveals Bragg reflections extending to 4.0A (= 0.40 nm). Under the same conditions, negative staining with the traditional heavy-metal salt, ammonium molybdate, also gives diffraction spots extending to 4.0 A. These results establish that negative staining of protein crystals preserves periodic structural information into the high-resolution range, unlike the widely accepted current belief that this methodology can give a resolution limited to only 20-25 A.

Catalase↗
PubMed2001

How useful are sociodemographic characteristics in identifying children at risk of unintentional injury?

The social class gradient in childhood injury mortality is steep and increasing, so there is emphasis on targeting injury prevention on the basis of socioeconomic deprivation, to reduce inequalities in health. This paper examines the relationship between medically attended unintentional injury, sociodemographic characteristics and previous injury. This was a cohort study using the control group from a cluster randomised controlled trial of injury prevention in primary care. The cohort comprised children aged 3-12, months registered with participating practices, whose parents completed the baseline questionnaire (n = 771). 94% were followed for 25 months. Medically attended unintentional injury was ascertained from the primary and secondary care records. Logistic regression analysis examined the relationship between sociodemographic factors, previous injury and the occurrence of future medically attended injuries. Poisson regression examined the relationship between sociodemographic factors, previous injury and the number of future medically attended injuries. The response rate to the questionnaire was 75%. Residence in a deprived ward, lack of access to a car and male sex were associated with at least one medically attended injury. Residence in a deprived ward and young maternal age were associated with hospital admission. Residence in a deprived ward, male sex and non-ownership of a car were independently associated with number of unintentional injuries. Specificity exceeded sensitivity for all factors for medically attended injury and hospital admission. The positive predictive value was low for all factors, especially for hospital admissions. In conclusion, residence in a deprived ward was independently associated with any medically attended injury, with hospital admission and with number of injuries received. However, more than half of those children residing in a deprived ward did not have a medically attended injury and more than 90% did not have a hospital admission. 60% of children who had a medically attended injury and 40% who had a hospital admission do not live in a deprived ward. A combination of a population approach and targeted interventions will achieve the greatest health gain, and is unlikely to widen inequalities in health.

Accidents↗
PubMed2001

Screening of a HUVEC cDNA library with transplant-associated coronary artery disease sera identifies RPL7 as a candidate autoantigen associated with this disease.

A HUVEC cDNA library was screened with sera from two patients who had developed transplant-associated coronary artery disease (TxCAD) following cardiac transplantation. A total of six positive clones were isolated from a primary screen of 40 000 genes. Subsequent DNA sequence analysis identified these to be lysyl tRNA synthetase, ribosomal protein L7, ribosomal protein L9, beta transducin and TANK. Another gene whose product could not be identified showed homology to a human cDNA clone (DKFZp566M063) derived from fetal kidney. Full-length constructs of selected genes were expressed as his-tag recombinant fusion proteins and used to screen a wider patient base by ELISA to determine prevalence and association with TxCAD. Of these ribosomal protein L7 showed the highest prevalence (55.6%) with TxCAD sera compared to 10% non-CAD.

Adult↗
PubMed2001

Do self reported safety behaviours predict childhood unintentional injuries?

OBJECTIVE: The aim of this study was to investigate the validity of self reported safety behaviours as a proxy for injuries in unintentional injuries research. SETTING: The study population comprised parents and guardians of children aged 3-12 months in 18 general practices throughout Nottingham (n = 764) who responded to a questionnaire on safety practices. METHOD: Injury data were collected by searching the primary and secondary care records of each child in the study. Safety behaviour was measured by computing a safety practices score from self reported safety practices for each respondent to a postal baseline questionnaire survey of safety behaviours. The score was used to classify families into low, medium, and high risk of injury occurrence. Two further scores were calculated, firstly for those safety practices which required obtaining an item of safety equipment, and secondly those safety practices requiring behavioural change without cost implications. RESULTS: High risk families were no more likely than low risk families to sustain an injury (odds ratio (OR) 1.08; 95% confidence interval 0.65 to 1.79). Medium risk families were also no more likely than low risk families to have a medically attended injury (OR 1.09; 0.73 to 1.61) suggesting no association between safety score and future medically attended injury. Similarly, compared to low risk families, medium risk (OR 0.93; 0.33 to 2.61) and high risk (OR 0.46; 0.08 to 2.43) families were no more likely to have a child admitted to hospital with an injury. There was no correlation between the total number of injuries sustained during the study period and the baseline safety practices score (Spearman's rho = 0.004; p = 0.917). Subgroup analyses for safety behaviours requiring passive and active safety measures did not reveal significant associations with injury outcomes. CONCLUSION: Self reported safety behaviours do not appear to be good predictors of childhood unintentional injuries. Further research is required to ascertain valid proxy outcome measures for injury research.

Attitude to Health↗
PubMed2001

Do safety practices differ between responders and non-responders to a safety questionnaire?

OBJECTIVE: To compare reported safety practices between responders and non-responders to a safety survey. DESIGN: Cross sectional survey at baseline compared with safety practices reported at subsequent child health surveillance checks. SUBJECTS: Parents of children aged 3-12 months registered with practices participating in a controlled trial of injury prevention in primary care that did, and did not, respond to the baseline survey and who subsequently attended child health surveillance checks. RESULTS: No difference in safety practices was found between responders and non-responders to the survey at the 6-9 month check. Responders were more likely to report owning a stair gate (odds ratio (OR) 2.75, 95% confidence interval (CI) 1.82 to 4.16) and socket covers (OR 2.16, 95% CI 1.53 to 3.04) at the 12-15 month check, and owning socket covers (OR 2.19, 95% CI 1.34 to 3.61) at the 18-24 month check. Responders were more likely to report greater than the median number of safety practices at the 18 month check. CONCLUSIONS: Non-responders to a safety survey appear to be less likely to report owning several items of safety equipment than responders. Further work is needed to confirm these findings. Extrapolating the results of safety surveys to the population as a whole may lead to over estimation of safety equipment possession.

Attitude to Health↗
PubMed2001

Small intestine large granular lymphoma in a horse.

A 12-year-old Appaloosa gelding was referred to the Texas Veterinary Medical Center with a history of chronic diarrhea and weight loss. At necropsy, numerous oval, craterlike ulcers were observed throughout the small intestine. Histologically, these lesions were composed of a neoplastic proliferation of round cells with intracytoplasmic phosphotungstic acid-hematoxylin-positive granules. The tumor cells stained positively for the CD3 antigen and negatively for a B-cell marker. A diagnosis of large granular lymphoma was based on the morphologic and immunohistochemical characteristics of the neoplasm. The postmortem presentation of this case depicted unusual multifocal, ulcerative lymphomatous lesions throughout the small intestine without involvement of the regional lymph nodes. The histologic and ultrastructural morphology of the neoplastic lymphocytes was similar to that in previously reported cases of abdominal equine large granular lymphomas, but in this case the neoplasm was restricted to the small intestine.

Animals↗
PubMed2000

Near miss and minor injury information--can it be used to plan and evaluate injury prevention programmes?

AIM: To assess the usefulness of collecting information on near miss and minor injuries for use in planning and evaluating injury prevention programmes for children aged under 5 years in the home environment. METHOD: The research was set within the context of a controlled intervention study based in 36 general practices across Nottingham. All parents of children aged between 3 and 12 months who had completed the intervention study questionnaire (n = 1594) were used as the sampling frame for the diary study. A diary, developed specifically for the main intervention study, was administered to a systematically assigned sample of 434 parents. Information provided by the Home Accident Surveillance System on 252 randomly selected children, of the same age and sex, who had attended an accident and emergency department, was used to compare the circumstances surrounding near miss and minor injuries with those of medically attended injuries. The children whose parents had completed a diary were followed over a two year time period. The children who had had a medically attended injury were identified from a search of the child's general practice records and the Queens Medical Centre accident and emergency records. The definition of a near miss used in the study was: A near miss incident is something your child does or that happened to your child which could have resulted in him/her being hurt, but fortunately it did not. RESULTS: Overall two hundred and thirty one (53%) diaries were completed and returned. Three hundred and fifty incidents were recorded of which 207 were near misses and 143 minor injuries. The circumstances surrounding near miss and minor injuries, although not identical when compared to medically attended injuries, were very similar. The relationship between the occurrence of near miss, minor injuries and future medically attended injuries appeared weak, for all categories the negative predictive value was higher than the positive predictive value. CONCLUSION: Although the circumstances surrounding all the incident categories were similar, the numbers were too small to see whether specific injury mechanisms predict future injuries of the same type. It appeared that near miss and minor injuries are of limited use in predicting medically attended injuries, however this hypothesis needs to be tested on a much larger sample.

Accident Prevention↗
PubMed2000

Light atom derivatives of structure-preserving sugars are unconventional negative stains.

Although glucose and certain other sugars are known to greatly reduce distortion and denaturation of proteins during drying, use of this monosaccharide as an experimental negative stain does not permit imaging of lattice periodicities in test specimens of thin catalase crystals. However, the potassium and sodium salts of several forms of monophosphorylated glucose (200 mM), diphosphorylated glucose, monosulfated glucose, maltose-1-phosphate, and trehalose-6-phosphate, all dry into a glassy layer and scatter transmitted electrons sufficiently to show the 86 A major periods in catalase crystals. Glucose-6-phosphate provides sufficient image contrast at concentrations from 2 mM (=0.067%) to 500 mM (= 16.8%). Underfocusing increases visualization of the periodic lattice, indicating a large contribution of phase contrast to these images. Upon exposure to the electron beam, thicker regions of derivatized saccharides or pure glucose develop bubbling; this redistribution of dried stain largely can be precluded by imaging with low-dose exposures. Power spectra of images of catalase crystals contained within 200 mM disodium glucose-6-phosphate show that periodic information can be recorded to 21 A; some individual features of dipotassium glucose-6-phosphate distribution within the protein lattice have a measured width of around 5 A. The experimental results demonstrate that structure-preserving mono- and di-saccharides also serve successfully as negative stains after they are coupled to light atom scatterers.

Animals↗
PubMed2000

School nursing: costs and potential benefits.

BACKGROUND: Previous reports that variations in school nursing resources across the UK had no relationship to deprivation; controversy about the changing role of the school nursing service. OBJECTIVES: To measure the resources allocated to school nursing, determine whether the variations can be explained by deprivation, and assess whether the allocation of school nursing time to a range of tasks is in line with current evidence and perceptions of changing needs. STUDY DESIGN: Quantitative economic analysis; qualitative descriptive study. SETTING: Detailed study of four English districts with diverse characteristics; staffing and service questionnaire and telephone survey of 62 districts. MAIN MEASURES: Staff resources and their salaries; measures of population and deprivation; activity statistics. RESULTS: There were wide variations in the cost of the school nursing service, but in contrast to previous reports 24% of the variance was explained by deprivation. There were no clear associations with any other social or educational variables. The greatest allocation of time was in routine screening and surveillance tasks. Relatively little time was allocated to other activities such as health promotion, support of special needs or unwell children, or teenage clinics. The expenditure on school nursing is only loosely related to deprivation and the results of this study offer guidance on what districts should spend to achieve equity of provision. CONCLUSIONS: The current allocation of resources to school nursing in between districts comparisons is not equitable and the use of school nursing time is out of step with current evidence of need and effectiveness.

Adolescent↗
PubMed2000

How well do socio-demographic characteristics explain variation in childhood safety practices?

BACKGROUND: Unintentional injury is the leading cause of death in children older than 1 year. Deaths from accidents have a steeper class gradient than any other fatal condition and this inequality is widening. There are few published data on the relationship between safety practices and sociodemographic characteristics, hence this study has been undertaken to examine this relationship. METHODS: The study population comprised all parents and guardians of children aged 3-12 months in 36 practices throughout Nottingham (n = 2,152). A postal questionnaire was used to survey current childcare safety practices (from which safe practices scores were derived), together with socio-demographic variables and known risk factors for childhood unintentional injury. RESULTS: Unsafe childcare practices were common. Socioeconomically disadvantaged families had more unsafe practices than more affluent families, but few parents undertook safe practices all the time. The child's age (p<0.01), ethnicity (p<0.01) and living in non-owner-occupied accommodation (p<0.01) were independently associated with the safe practices score. Multivariate regression modelling showed that these risk factors explained only 11 per cent of the variation in the safety practices score. Socio-economic factors explained more of the variation in possession and use of items of safety equipment (13 per cent) than the variation in safety behaviours with no cost implications (3 per cent). CONCLUSIONS: Most of the variation in the number of safety practices is not explained by socio-demographic characteristics and further work is required to examine other possible determinants of safe practice.

Accidents, Home↗
PubMed2000

Mathematical analysis of growth and interaction dynamics of streptomycetes and a bacteriophage in soil.

We observed the infection cycle of the temperate actinophage KC301 in relation to the growth of its host Streptomyces lividans TK24 in sterile soil microcosms. Despite a large increase in phage population following germination of host spores, there was no observable impact on host population numbers as measured by direct plate counts. The only change in the host population following infection was the establishment of a small subpopulation of KC301 lysogens. The interaction of S. lividans and KC301 in soil was analyzed with a population-dynamic mathematical model to determine the underlying mechanisms of this low susceptibility to phage attack relative to aquatic environments. This analysis suggests that the soil environment is a highly significant component of the phage-host interaction, an idea consistent with earlier observations on the importance of the environment in determining host growth and phage-host dynamics. Our results demonstrate that the accepted phage-host interaction and host life cycle, as determined from agar plate studies and liquid culture, is sufficient for quantitative agreement with observations in soil, using soil-determined rates. There are four significant effects of the soil environment: (i) newly germinated spores are more susceptible to phage lysis than are hyphae of developed mycelia, (ii) substrate mycelia in mature colonies adsorb about 98% of the total phage protecting susceptible young hyphae from infection, (iii) the burst size of KC301 is large in soil (>150, 90% confidence) relative to that observed in liquid culture (120, standard error of the mean [SEM], 6), and (iv) there is no measurable impact on the host in terms of reduced growth by the phage. We hypothesize that spatial heterogeneity is the principal cause of these effects and is the primary determinant in bacterial escape of phage lysis in soil.

Bacteriophages↗
PubMed2000

Effect of topical administration of epidermal growth factor on healing of corneal epithelial defects in horses.

UNLABELLED: OBJECTIVE-To characterize healing of corneal epithelial defects in horses and to evaluate the ability of epidermal growth factor (EGF) to modulate rate of corneal epithelial healing in horses. SAMPLE POPULATION: 20 eyes in 12 adult horses. PROCEDURE: Corneal epithelial wounds were created by mechanically debriding the limbus. Corneal healing was recorded for 3 treatment groups: 50 microg of EGF/ml (n = 5 eyes), 5 microg of EGF/ml (7), and PBS solution (8). Corneal healing was recorded once daily after instillation of fluorescein stain by use of photography and calculating the area of the wound, using imaging software. RESULTS: After corneal debridement, re-epithelialization was rapid and progressed in a linear fashion for the first 5 to 7 days after surgery in all groups. After that period, rates of healing decreased. A profound increase in the degree of inflammation, neovascularization, melanosis, and scarring was observed in eyes treated with the high dose of EGF (50 microg/ml), but there was not a statistical difference in mean healing time or in mean decrease in radius during the linear phase between the control and either EGF treatment groups. However, for all 8 horses in which both eyes were debrided, the first eye healed significantly faster than the second eye, regardless of treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Beneficial effects of topical administration of a high dose of EGF for acceleration of healing of corneal defects in eyes of horses are outweighed by the intensity of the associated inflammatory response.

Administration, Topical↗
PubMed2000

How much does self-reported health status, measured by the SF-36, vary between electoral wards with different Jarman and Townsend scores?

BACKGROUND: The best way for practices to determine the health status of patients living in areas with different socioeconomic characteristics is unclear. AIMS: To see how much SF-36 health status varies between electoral wards, how much of this variation can be explained by census-derived Jarman and Townsend scores, and compare the performance of census scores with direct socioeconomic information. METHOD: A postal questionnaire survey of 3000 randomly selected 18 to 75-year-olds residing in 15 electoral wards and registered with two urban practices. RESULTS: The response rate was 73%. Only two of the eight SF-36 domains were significantly associated with Jarman scores, whereas seven domains were associated with the Townsend score. Of the four socioeconomic variables derived directly from the survey, unemployment showed the weakest association, housing tenure was associated with seven domains, and car ownership and low income were associated with all eight. Income explained between 47% to 71% of the variation across the eight domains. CONCLUSION: The most accurate predictions about health status were made from direct socioeconomic information. Nonetheless, the association between Townsend score and health status was strong enough to be of practical importance. This study cautions against assuming the Jarman score of a population has a clear relationship with its health status.

Adolescent↗