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Biomedical subjects

P McCartney

Publications and source records attributed to P McCartney.

At least 19 recordsLinked to original sources
PubMed1995

Can general practice data be used for needs assessment and health care planning in an inner-London district?

BACKGROUND: The development of primary care led commissioning will increase the need for practice-based information on health and morbidity, and the NHS information strategy recommends that routinely collected health and morbidity information held on general practice computer systems should be use to inform local health needs assessment. The aim of this study was to evaluate the quality of information in six computerized practices. METHODS: A comparison was carried out of the recording of registration and social information, health risk factors, medication and record on consultations on the computer and in the manual records for a sample of patients, with an audit of morbidity coding by computer. A comparison was made of computerized disease registers with prescribing for diseases. RESULTS: Computer disease registers identified over 90 percent of diabetic patients on medication, 67 percent of asthmatics, 61 percent of epileptics, and 48 percent of patients with angina. Computer recording of problems was inconsistent; practices which recorded clinical information from every consultation did not have substantially more complete disease registers. Over 90 percent of encounters and prescriptions were computerized, but there was bias in recording consultation problems. Blood pressure, smoking, alcohol, weight and height were recorded for over 50 percent of patients aged 15-74, and computerized for 79 percent (291/370) for height, but only 56 percent (274/488) for the most recent blood pressure recorded. Limited social information was recorded about patients: 45 percent (410/915) had occupation or employment status and 35 percent (230/915) ethnic group; computerized for 26 percent and 18 percent, respectively. CONCLUSIONS: At present, the routine collection of information from practices would not provide reliable information for health care planning. Greater use of information in practices would improve data quality, and practice data could be used to address specific issues, if augmented by additional data, and for practice-based needs assessment.

Adolescent↗
PubMed1986

Improved purification of the pyruvate dehydrogenase complex from Ascaris suum body wall muscle and characterization of PDHa kinase activity.

An improved purification scheme for the isolation of the Ascaris suum pyruvate dehydrogenase complex directly from body wall muscle has been developed which yields a fully activated pyruvate dehydrogenase complex with substantial PDHa kinase activity. The apparent Km for coenzyme A (CoA) is much lower than previously reported and can only be accurately measured in the presence of a CoA-regenerating system. The alpha-pyruvate dehydrogenase subunit of the ascarid complex is unique and its migration on sodium dodecylsulfate polyacrylamide gels is altered after phosphorylation. PDHa kinase activity is inhibited by ADP, thiamine pyrophosphate, and physiological levels of pyruvate and propionate. In contrast, PDHa kinase activity is stimulated by elevated NADH/NAD+ and acetyl CoA/CoA ratios, although it appears that the NADH/NAD+ ratios required for half-maximal stimulation are more than an order of magnitude greater than those reported for mammalian pyruvate dehydrogenase complexes.

Acetyl Coenzyme A↗
PubMed1984

The Whitehall Study: ten year follow-up report on men with impaired glucose tolerance with reference to worsening to diabetes and predictors of death.

Two-hundred and four men with a defined degree of impaired glucose tolerance derived from the Whitehall Survey and its pilot study were enrolled in a therapeutic trial and followed for ten years. For the first five years of the trial approximately half the group received 50 mg phenformin daily and the other half an identical placebo. For the whole ten years of the trial approximately half the group were recommended a diet in which carbohydrate intake was limited to 120 g/day, while the other half was recommended a qualitative limitation of sugar intake. 60 men (29.4%) worsened to diabetes during the follow-up period. The major independent predictor of worsening was the baseline blood glucose level (glucose tolerance). High baseline plasma triglyceride levels and low baseline systolic blood pressure levels were also independent predictors of worsening, though of lower significance (0.01 less than p less than 0.05). Obesity, measured as body mass index, was not a significant risk factor. Thirty-nine men died, with 19 deaths ascribed to coronary heart disease (CHD). Baseline blood pressure significantly predicted both all causes and CHD mortality. All causes mortality rates were higher in the less obese. Allocation to drug or diet therapy did not significantly affect mortality rates or the proportions worsening to diabetes.

Blood Glucose↗
PubMed1983

The Bedford Survey: observations on retina and lens of subjects with impaired glucose tolerance and in controls with normal glucose tolerance.

After the Bedford Survey observations were made upon retina and lens in borderline diabetics (persons with impaired glucose tolerance) and in age and sex matched controls with normal glucose tolerance. Seven years after the Survey, the prevalence of retinal abnormalities ("microaneurysms" and "exudates") was similar in each group. Of 145 initially borderline diabetics examined 10 years after the Survey, 25 had worsened to diabetes. Only two of the total group had "micro-aneurysms" present and the maximum recorded in any eye was three. Lens opacities were of similar frequency in both groups shortly after the Survey and at the seven year follow-up examination. By contrast, 24% of 79 diabetics newly diagnosed during the Survey had "microaneurysms" recorded five years later. These results further justify the diagnostic category of impaired glucose tolerance, which, at least when discovered by population screening, carries no risk of clinically apparent eye disease for at least ten years after ascertainment.

Aneurysm↗
PubMed1982

The ten-year follow-up of the Bedford survey (1962-1972): glucose tolerance and diabetes.

In a 10-year prospective study of 241 people with 'borderline diabetes' (impaired glucose tolerance) identified by screening of the Bedford adult population, 36 (15%) worsened to diabetes and 128 (53%) substantially improved their glucose tolerance. The major predictor of worsening to diabetes was the level of blood glucose at baseline. This was statistically significant (p less than 0.05), independent of other factors, both for deterioration in the first and in the second five years of observation. Body mass index, a measure of adiposity, did not predict worsening to diabetes during the first five years, but was an independent and significant predictor of worsening during the second five years (p less than 0.05). The apparent effect of adiposity was complex, for it was also significantly related to improvement in glucose tolerance during the 10-year follow-up. Persons with impaired glucose tolerance are a heterogeneous group and with present knowledge the ability to predict metabolic deterioration is limited.

Age Factors↗
PubMed1982

The Bedford survey: ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics.

Mortality rates from coronary heart disease and from all causes have been ascertained over ten years in three groups of people participating in the Bedford Survey--newly-diagnosed diabetics, borderline diabetics and control subjects with normal glucose tolerance. Age corrected mortality rates, from all causes and coronary heart disease, were highest in the diabetics and intermediate in the borderline diabetics and in both groups were similar in men and women. When statistical allowance was made for baseline differences in age, blood pressure and obesity, female borderline diabetics still had a significantly increased risk over their controls of death from 'all causes'. Much of the difference appeared to be due to a relative excess of deaths due to coronary heart disease. It is concluded that borderline diabetes (or impaired glucose tolerance) is associated with a relatively greater increase in mortality risk in women than men. During the 10-year follow-up of the Bedford borderline diabetics, coronary heart disease morbidity and mortality rates were similar in men and women. Age at entry to the study was the major independent and significant predictor of mortality from all causes. The level of systolic blood pressure and current cigarette smoking at baseline were statistically significant predictors only of mortality due to coronary heart disease.

Adolescent↗
PubMed1982

Opiate modulation of the pituitary-adrenal axis: effects of stress and circadian rhythm.

The opiate control of the pituitary-adrenal axis has been investigated in normal subjects. The infusion of 1 mg of the met-enkephalin analogue, DAMME, led to a fall in circulating cortisol in spite of a fall in blood pressure. Conversley, 16 mg of the opiate antagonist, naloxone led to brisk and pronounced elevations in plasma ACTH, lipotrophin (LPH) and cortisol. The rise above basal levels was consistent, irrespective of whether the infusion was given at 09.00, 18.00, or 23.00 h; the peak response obtained was significantly less at 23.00 h than at either 09.00 or 18.00 h. Finally, insulin-induced hypoglycaemia (0.15 u/kg) or naloxone (25 mg) produced a similar rise in plasma cortisol which was no different when the two stimuli were combined. It is suggested that there is a constant tonic inhibition of the pituitary-adrenal axis by endogenous opiates throughout 24 h, and that the circadian rhythm of ACTH/LPH secretion is not due to changes in opiate tone. However, disinhibition of this tone is likely to be responsible, at least in part, for the rise in cortisol in response to hypoglycaemic stress.

Adolescent↗
PubMed1981

Hyperglycemia and arterial disease.

Clinical and autopsy evidence support the increased risk of atherosclerotic disease in diabetes mellitus (DM). However, mechanisms other than arterial occlusion may also contribute to clinical syndromes often assumed to be atherosclerotic in origin. There is considerable geographical variability in the frequency of arterial disease in the diabetic. Glucose intolerance short of unequivocal DM is found in some (though not all) populations to carry increased atherosclerotic risk. Morbidity and mortality data suggest that women are particularly vulnerable (as with DM). The Whitehall prospective study of cardiovascular mortality shows that risk does not rise smoothly with increasing degrees of glucose intolerance but that it doubles sharply at the 95th percentile of the 2-h post-glucose blood sugar distribution.

Adult↗
PubMed1978

Prevalence and prognosis of electrocardiographic findings in middle-aged men.

A screening examination including an electrocardiogram (limb leads only) coded by the Minnesota Code, using rigorous quality control was done on 18 403 male civil servants aged 40 to 64. The association of the findings with coronary heart disease has been tested in relation to age trends, symptomatic history, and coronary heart disease mortality rates in the ensuing five years. The results were positive for Q waves, left axis deviation, ST depression, and T wave changes (including minor T wave items as an isolated finding), ventricular conduction defects, and atrial fibrillation; but they were generally unimpressive for increased R amplitude and for lengthening or shortening of the PR interval, QT interval duration, premature beats, and extremes of heart rate. The prognosis of specific electrocardiographic findings discovered at screening is quite different from when they arise in clinical practice. Among the 6 per cent of men in this study with patterns suggesting ischaemia, the subsequent coronary heart disease mortality was little more than 1 per cent per year; and among those who were symptom free it was even less.

Adult↗