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Biomedical subjects

P Townsend

Publications and source records attributed to P Townsend.

At least 19 recordsLinked to original sources
PubMed1994

Widening inequality of health in northern England, 1981-91.

OBJECTIVE: To identify relative and absolute changes in mortality in the Northern region of England between 1981 and 1991. DESIGN: 1981 and 1991 census data were used to rank 678 wards on an index of material deprivation composed of four variables (unemployment, car ownership, housing tenure, household overcrowding). Standardised mortality ratios (all causes) were calculated for various periods between 1981 and 1991 and for different age categories. SETTING: Counties of Cleveland, Cumbria, Durham, Northumberland, and Tyne and Wear. RESULTS: During 1981-91 mortality differentials widened between the most affluent and deprived fifths of wards in all age categories under 75 years. The decline in the relative position of the poorest areas was particularly great, and there was no narrowing of inequalities across the remainder of the socioeconomic spectrum. In absolute terms, there were improvements in mortality in all age categories in the most affluent areas. In the poorest areas improvements in the 55-64 age group were balanced by increased mortality among men aged 15-44, a slight rise among women aged 65-74, and static rates among men aged 45-54. CONCLUSIONS: These results re-emphasise the case for linking mortality patterns with material conditions rather than individual behaviour.

Adolescent↗
PubMed1994

Long term bradycardia by electrical pacing: a new method for studying heart rate reduction.

OBJECTIVE: The aim was to develop a method of inducing bradycardia on a chronic basis by electrical pacing and to study its effect upon myocardial capillarity in pigs. METHODS: Farm pigs were instrumented with Medtronic dual chamber telemetric pacemakers and two leads, either both atrial or one atrial and one ventricular. Bradycardia was achieved by linking pacing stimuli to endogenous atrial or ventricular events for the different electrode positions respectively, and monitored postoperatively for 4-5 weeks by implanted telemetric ECG devices. Myocardial capillary supply (lectin staining) and myocyte cross sectional areas were then estimated in sections of the left ventricle. RESULTS: Heart rates were reduced by 40-50 beats.min-1 at operation from a resting rate of 110(SEM 3) beats.min-1 in eight animals and bradycardia maintained upon recovery from anaesthesia for up to five weeks, with no obvious limitations for the animals. After this time, heart rates measured under anaesthesia were found to remain low for up to 2 h after pacing had been switched off. There was no evidence of myocyte hypertrophy, yet mean capillary density.mm-2 was significantly increased by pacing, from 1470(50) to 1734(82), p < 0.02. CONCLUSIONS: It is possible to produce primary heart rate reduction in the pig by a novel means of pacing on a chronic basis, leading to increased myocardial capillary supply without myocyte hypertrophy. This method can provide a basis for future investigations of the beneficial effects of heart rate reduction in the vascularly compromised heart.

Animals↗
PubMed1992

Control of cyclic AMP levels in primary cultures of human tracheal smooth muscle cells.

1. [3H]-adenosine 3':5'-cyclic monophosphate ([3H]-cyclic AMP) responses were studied in primary cultures of human tracheal smooth muscle cells derived from explants of human trachealis muscle and in short term cultures of acutely dissociated trachealis cells. 2. Isoprenaline induced concentration-dependent [3H]-cyclic AMP formation with an EC50 of 0.2 microM. The response to 10 microM isoprenaline reached a maximum after 5-10 min stimulation and remained stable for periods of up to 1 h. After 10 min stimulation, 1 microM isoprenaline produced a 9.5 fold increase over basal [3H]-cyclic AMP levels. The response to isoprenaline was inhibited by ICI 118551 (10 nM), (apparent KA 1.9 x 10(9) M-1) indicating the probable involvement of a beta 2-adrenoceptor in this response in human cultured tracheal smooth muscle cells. However, with 50 nM ICI 118551 there was a reduction in the maximum response to isoprenaline. Prostaglandin E2 also produced concentration-dependent [3H]-cyclic AMP formation (EC50 0.7 microM, response to 1 microM PGE2 6.4 fold over basal). 3. Forskolin (1 nM - 100 microM) induced concentration-dependent [3H]-cyclic AMP formation in these cells. A 1.6 fold (over basal) response was also observed following stimulation with NaF (10 mM). 4. The nonselective phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine (IBMX) (0.1 mM) and the type IV, cyclic AMP selective, phosphodiesterase inhibitor rolipram (0.1 mM) both elevated basal [3H]-cyclic AMP levels by 1.8 and 1.5 fold respectively. IBMX (1-100 microM) and low concentrations of rolipram (< 10 microM), also potentiated the response to 1 microM isoprenaline. Inhibitors of the type III phosphodiesterase isoenzyme (SK&F 94120 and SK&F 94836) were without effect upon basal or isoprenaline-stimulated cyclic AMP responses in these cells.5. Carbachol (1 nM-I 00 microM) produced concentration-dependent inhibition of the [3H]-cyclic AMP response to 1 microM isoprenaline in human cultured tracheal smooth muscle cells (IC50 0.24 JM). Carbachol(1 JM) inhibited the [3H]-cyclic AMP response to 1 JM isoprenaline by 60%. This effect of carbachol was itself inhibited by atropine (50 nM) (KA 2.3 x 109 M-') indicating the involvement of a muscarinic receptor.6. These results show that primary cultures of human tracheal smooth muscle cells demonstrate cyclic AMP responses to direct receptor stimulation, adenylyl cyclase activation and inhibition with nonselective and type IV-selective cyclic AMP phosphodiesterase isoenzyme inhibitors, and that the cyclic AMP response to isoprenaline can be inhibited by muscarinic receptor stimulation.

1-Methyl-3-isobutylxanthine↗
PubMed1992

Tumour necrosis factor alpha secretion in leporine endotoxaemia: role of the liver and effects of hepatic ischaemia.

A leporine model to investigate tumour necrosis factor alpha (TNF alpha) secretion after peripheral vein or mesenteric vein lipopolysaccharide injection was devised. Mesenteric vein injection provoked lower arterial concentrations after 90 minutes (median (range), 2.81, (0.75-11.96) ng/ml) than peripheral vein injection (7.00 (4.27-14.95) ng/ml (p less than 0.05)). Mesenteric vein injection after 10 minutes' warm hepatic ischaemia, which impairs hepatic clearance, provoked higher median arterial TNF alpha values at 90 minutes (7.98 (2.85-21.48) ng/ml) than in normal animals (p less than 0.05). Portal vein endotoxaemia induced less TNF alpha production than systemic endotoxaemia unless hepatic clearance was impaired, thus the major source of TNF alpha in systemic endotoxaemia is probably extrahepatic.

Animals↗
PubMed1991

Bad news: delivery, dialogue, and dilemmas.

The narrative from a real patient encounter is used to illustrate the powerful effect that delivering bad news can have on both patient and physician. The meaning of bad news to the patient may be quite different than the medical or the personal meaning to the physician. Differences in perception must be explored and understood before the common ground necessary for joint decision making is established. Initial patient responses can be divided into three categories: (1) basic psychophysiologic (fight-flight or conservation-withdrawal), (2) cognitive, and (3) affective. Responses vary considerably depending on the meaning of the diagnosis to the patient, the degree of immediate threat, and the patient's previous experience with illness. Desired outcomes of the initial meeting include (1) minimizing aloneness and isolation for both patient and physician; (2) achieving a common perception of the problem; (3) giving information tailored to the immediate needs of the patient; (4) addressing immediate medical needs, including the risk of suicide; (5) responding to immediate discomforts; and (6) ensuring a basic plan for follow-up. Though all clinicians deliver bad news, few have had formal training or open exploration of the profound potential impact of the experience.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Free and total lidocaine levels in cardiac surgical patients.

A lidocaine bolus of 2 mg/kg has been shown to decrease the incidence of ventricular fibrillation in cardiac surgical patients during reperfusion following aortic cross-clamp release (CCR). In an effort to extend this effect into the immediate postoperative period, many centers routinely administer a prophylactic lidocaine infusion for the first 12 to 24 hours after surgery. Sequential total serum lidocaine levels were measured over 6 hours in 28 adult cardiac surgical patients without liver, kidney, or respiratory disease, and free serum lidocaine levels were measured in 15 of these patients. In addition, pharmacokinetic data were collected and analyzed in 8 of these patients. Each patient received a lidocaine bolus of 1.5 mg/kg and an infusion at 2 mg/min immediately before CCR. Serum levels were determined just before CCR, and at 10, 20, 30, 60, 120, 240, and 480 minutes after CCR. More than 50% of patients had subtherapeutic total serum lidocaine levels from 20 to 120 minutes after CCR, but free lidocaine levels remained within the therapeutic range. No patient showed malignant ventricular dysrhythmias during the study. The results suggest that (1) it may be misleading to estimate free lidocaine concentration based on total lidocaine levels; and (2) free drug is the moiety responsible for lidocaine's antiarrhythmic effect.

Adrenergic beta-Antagonists↗
PubMed1990

Individual or social responsibility for premature death? Current controversies in the British debate about health.

This article uses the current controversies in the British debate about health to illustrate the need to theorize, and therefore critically evaluate, the links between medicine and health policies, including health care policies. The medical model of health is deeply embedded in institutional practices in many countries, and while this model has attracted deserved criticism in recent years, an alternative social model, or one that incorporates indispensable aspects of the medical model, has attracted much less attention and requires sustained development. Comparative study of patterns of inequality in health, and especially of the correlation between material deprivation and premature mortality, necessarily reveals causal determinants of both health and ill-health in populations and invites ambitious programs to develop a social model.

Delivery of Health Care↗
PubMed1990

Widening inequalities of health in Britain: a rejoinder to Rudolph Klein.

Since the publication in 1980 of the Black Report, Inequalities in Health, critics have attempted to challenge its finding that for nearly all adult male and female age groups in Britain, inequalities in mortality between occupational class groups have widened during recent decades. This article seeks to refute one of the critics, using data published during the 1980s, and goes on to point out that if, as the Black Report also argued, material deprivation is the predominant scientific explanation for inequalities in mortality, then it is widening living standards between classes that we must examine to understand the trend.

Adult↗
PubMed1989

Leuprolide acetate in the treatment of refractory or persistent epithelial ovarian cancer.

Leuprolide acetate (Lupron, TAP Pharmaceuticals, North Chicago), a gonadotropin-releasing hormone analogue, was administered subcutaneously at a 1-mg dose for a minimum of 8 weeks to 23 patients with refractory epithelial ovarian cancer. Eighteen of these patients were evaluable. There were no complete responses. Four patients (17%) had a partial response, with a median duration of 52 weeks. Three of six patients with grade 1 carcinomas had a partial response and two had stabilized disease. There was only one response among 15 patients with grade 2 or 3 disease. Therapy was well tolerated, with three patients complaining of hot flashes and two of mild pedal edema. Leuprolide acetate thus shows evidence of antitumor activity against refractory grade 1 epithelial adenocarcinoma of the ovary. Further trials with larger numbers of patients should be conducted.

Adult↗
PubMed1986

Why are the many poor?

In this article the author restates the same arguments put forward in the first Fabian Tract of 1884 entitled Why Are the Many Poor? Today, mass poverty is still the central problem facing the British nation and all nations. The only long-term remedy is to restrict the power and wealth of the rich, to dismantle the present structures of social privilege, and to build social institutions based on fair allocation of wealth and on social equality. The public debate of one hundred years ago on the connections between poverty and wealth is revived in this article.

Cross-Cultural Comparison↗
PubMed1986

Potentiation of lymphocyte responses by monoclonal antibodies to the ganglioside GD3.

Previous studies have shown that the ganglioside GD3 is expressed in high concentrations on melanoma cells and that monoclonal antibodies (MAbs) against GD3 may induce partial remissions in tumor growth in patients with melanoma. The present studies indicated that incubation of interleukin 2 (IL2) dependent murine natural killer cells with several MAbs against the ganglioside GD3 potentiated the proliferative response to IL2. There was no effect on cell division in the absence of added IL2. Similarly the mitogenic response of human blood lymphocytes to phytohemagglutinin (PHA) or the T3 antigen was enhanced by coculture with these MAbs. This was noted when the MAbs to GD3 were added either before or up to 48 h after addition of PHA or MAb to T3. Kinetic analysis revealed that the potentiation of the PHA induced mitogenic response followed the expected response to PHA suggesting that the MAbs amplified normal activation pathways. These effects were also seen wih MAb to GD3 and the T10 structure on T-cells but not with MAbs to the transferrin receptor or isotype MAb controls. Studies on T-cell subsets suggested that the enhanced PHA responses were confined mainly to the T8 subset and responses of the T4 subset were not enhanced. Flow cytometric analysis revealed low levels of GD3 expression on blood lymphocytes which increased during culture with PHA. IL2 receptor (Tac epitope) expression did not show close correlation with the enhanced lymphocyte responses and the mechanism of the potentiation remains uncertain. These studies raise questions concerning the role of gangliosides in T-cell activation and whether these in vitro effects of MAbs to GD3 may account in part for their antitumor effects in patients with melanoma.

Antibodies, Monoclonal↗
PubMed1985

Inequalities in health in the city of Bristol: a preliminary review of statistical evidence.

This article compares statistical indicators of health with those of material and social deprivation for 28 wards of the city of Bristol, England. Four general indicators of health were examined-a combined rate per 1,000 live births of stillbirths and infant deaths; deaths of persons aged 15 to 64 per 1,000 of that age; deaths of persons aged 65 and over per 10,000 of that age, and numbers of babies born after 40 weeks gestation weighing less than 2,800 (and 2,500) grams per 1,000 births having that period of gestation. Measures of average and cumulative rank were used to augment tests of the significance of correlations between different indicators. The degree of rank consistency was high, and several wards at the top and the bottom of the rankings were clearly distinct on all indicators. Five indicators of deprivation were also examined-the percentages of: 1) households with fewer rooms than persons; 2) households lacking a car; 3) economically active persons seeking work; 4) children aged 5 to 15 who receive school meals free; and 5) households experiencing disconnection of electricity in the previous 12 months. Again the consistency of ranking according to the five indicators was high, with marked differences on all five indicators between the highest and lowest ranking wards. Between 1971 and 1981 some forms of deprivation increased in nearly all wards. According to some criteria, deprivation increased more in wards already most deprived in 1971 than in those least deprived. Finally, a strong association between the two sets of indicators was found. On the data available to health and planning authorities poor health is significantly correlated with deprivation. There are therefore implications for new forms of joint policy-making on the part of different departments of local and central government.

Adolescent↗
PubMed1984

Physeal, metaphyseal, and diaphyseal injuries of the lower extremities in children with myelomeningocele.

A study of 16 patients with myelomeningocele who sustained 37 fractures revealed that children with diaphyseal and metaphyseal fractures presented with local warmth, redness, swelling, and increased general body temperature, leukocytosis, and sedimentation rate. These fractures were the result of a single stress or trauma and healed uneventfully by splinting for approximately 4 weeks. In physeal injuries, which probably resulted from repetitive stresses, the systemic response was less pronounced. These injuries had to be immobilized more rigidly in plaster casts for a minimum of 8 weeks.

Adolescent↗