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Biomedical subjects

P Upton

Publications and source records attributed to P Upton.

12 recordsLinked to original sources
PubMed2006

School experiences after treatment for a brain tumour.

BACKGROUND: Children surviving a brain tumour face major difficulties including learning problems, lengthy school absences and psychosocial problems, all of which can impact on school functioning. Our aims were to provide information for parents and teachers about the skills and resources of this group. Specifically, we aimed to: describe the special educational needs of these children; document the impact of diagnosis and treatment on school attendance; compare parent and teacher assessments of social, emotional and behavioural difficulties. METHODS: Forty families agreed to participate (response rate = 58.82%). The children (19 males and 21 females) were aged from 6 to 16 years and had completed treatment at least 2 years previously (range = 2 years-12 years 5 months). Questionnaires (Strengths and Difficulties and school experience) were completed by mothers and teachers. RESULTS: Survivors were experiencing a wide range of physical, learning and interpersonal difficulties, according to parent and teacher reports. Almost half the children (n = 19) had ongoing neurological problems that were significant enough to require special help at school. Literacy and numeracy were the most common learning difficulties. Parents also rated brain tumour survivors as having more behavioural and emotional problems than would be expected from population norms. For example, survivors were rated as having more Total Difficulties (t = 6.86, P < 0.001), Emotional Symptoms (t = 8.82, P < 0.001), Hyperactivity (t = 2.25, P = 0.03), Peer Relationship Problems (t = 7.58, P < 0.001) and poorer Pro-social Behaviour (t = -3.34, P = 0.002) than would be expected from population norms. These problems were also seen to be having a significant impact on the child's functioning (t = 3.95, P < 0.001). Teachers rated these problems as less serious than parents. CONCLUSION: These children experience significant problems in school some time after diagnosis and when they are considered medically cured. Closer school-hospital liaison is essential to maximize integration and achievement in these children.

Absenteeism↗
PubMed2005

Development of a measure of the health-related quality of life of children in public care.

OBJECTIVES: To validate PedsQL for children in public care and develop an 'in-care' module. DESIGN AND SETTING: Questionnaire development and validation. Questionnaires were completed in placement. A total of 69 children in public care (aged 8-18 years) and their carers were recruited through routine paediatric assessments, and 662 children not in public care were recruited from local schools. MEASURES: Self- and proxy-report versions of PedsQL generic module and the 'in-care' module. RESULTS: Cronbach's alpha for the generic module ranged from 0.66 to 0.88 and from 0.74 to 0.90 for self- and proxy-report respectively. Lower scores were reported for children in care compared with peers living at home for proxy- and self-report. Proxy- and self-report correlation ranged from 0.43 to 0.60 (P < 0.001). Cronbach's alpha for the in-care module was 0.87 and 0.91 for self- and proxy-report respectively. Proxy- and self-report scores showed significant correlation with generic module scores. The highest correlations were seen with sub-scales measuring Psychosocial Functioning (e.g. Emotional Functioning: Pearson's r = 0.67 and 0.59, P < 0.001 for self- and proxy-report respectively). Proxy- and self-report correlation was 0.45 (P < 0.001). CONCLUSIONS: We found PedsQL generic module and the newly developed 'in-care' module to have excellent internal reliability for self- and proxy-report. Validity was established for both measures and significant correlation found between child and proxy ratings. Although further testing of the measures is recommended, both have potential value in assessing the success of placements and could provide a reliable and valid tool for individual patient analysis in clinical practice and for research with this group.

Activities of Daily Living↗
PubMed2001

A randomised controlled trial of epidural compared with non-epidural analgesia in labour.

OBJECTIVES: To investigate possible short and long term side effects of epidural analgesia, compared with non-epidural analgesia for pain relief in labour. DESIGN: Randomised controlled study, with long term follow up by questionnaire. Analysis by intention-to-treat. SETTING: Busy maternity unit within a district general hospital in England. PARTICIPANTS: Three hundred and sixty nine primigravid women in labour were included (randomised allocation: epidural n = 184, non-epidural n = 185). MAIN OUTCOME MEASURES: Backache at three and twelve months after delivery, instrumental delivery rates and maternal opinion of pain relief in labour. RESULTS: No significant differences were found in the reported incidence of backache between the groups at three months: middle backache [22% vs 20%, chi2 = 0.057, P = 0.81; odds ratio (95% CI) 1.4(0.9-2.3)]; low backache [35% vs 34%, chi2 = 0.009, P = 0.92; odds ratio (95% CI) 1.0(0.6-1.6)]. Nor were there significant differences at 12 months: [middle backache 16% vs 16%, chi2 = 0.013, P = 0.91; odds ratio (95% CI) 1.0(0.5-1.8)]; or low backache [35% vs 27%, chi2 = 1.91, P = 0.17; odds ratio (95% CI) 1.4(0.9-2.3)]. The incidence of instrumental delivery was somewhat higher in the epidural group [30% vs 19%, odds ratio (95% CI) 1.77(1.09-2.86)]. Maternal satisfaction was not significantly different between the groups. CONCLUSIONS: This study provided no evidence to support the suggestion of a direct association between the use of epidural anaesthesia in labour and the incidence of long term backache. Despite a significant proportion of women in each group not receiving their allocated analgesia, a significant difference in terms of instrumental delivery rates remained. Satisfaction in both groups of women was high.

Adult↗
PubMed1995

The occurrence of Mycobacterium bovis infection in cattle in and around an area subject to extensive badger (Meles meles) control.

The occurrence of Mycobacterium bovis infection in cattle herds during the period 1966-92 in two geographically related areas in South-West England is compared. In one area comprising 104 km2 all badgers were systematically destroyed from 1975-81, after which recolonization was allowed; in the other, comprising 116 km2, small scale, statutory badger removal operations were undertaken from 1975 onwards where specific herds were detected with M. bovis infection. In the area with total clearance, no further incidents with M. bovis isolation occurred from 1982-92. Survival analysis and proportional hazards regression indicated that the risk of herds being identified with infection was less once badgers had been cleared from their neighbourhood, whereas it was greater in herds with 50 or more animals, and once cattle in a herd had responded positively to the tuberculin skin test, even though infection with M. bovis was not confirmed subsequently. The study provides further evidence that badgers represent an important reservoir of M. bovis infection for cattle and that badger control is effective in reducing incidents of cattle infection with M. bovis if action is thorough and recolonization is prevented.

Animals↗
PubMed1995

Effect of peptide YY on human renal function.

Peptide YY (PYY) is released from the intestine into the circulation in response to ingestion of food. As PYY/neuropeptide Y (NPY) receptors have recently been identified in the human kidney, we examined the effect of PYY on human renal function. Male subjects (6 per group) received control infusate or PYY at 0.4 or 1.2 pmol.kg-1.min-1 intravenously for 90 min with control periods before and after. Infusion of PYY at the lower dose reproduced normal postprandial plasma concentrations and caused significant decreases in glomerular filtration rate (10% reduction), plasma renin activity (30% reduction), and aldosterone levels while increasing sodium excretion by approximately 30% (all P < 0.01). Infusion of PYY at the higher dose, which reproduced plasma levels seen during a diarrheal illness, resulted in similar changes in renal function and also reduced renal plasma flow by approximately 10% (P < 0.05). Therefore, PYY may be an important mediator of the normal postprandial natriuretic response, and PYY agonists could provide a novel approach to the treatment of patients with sodium overload.

Adult↗
PubMed1995

A review of influenza immunisation in Lothian.

OBJECTIVES: To assess the influence of the Chief Medical Officer's annual guidelines on influenza immunisation and to estimate vaccine uptake particularly of those resident in long-stay residential facilities and of other recommended at-risk groups. DESIGN: Postal questionnaires. SETTING: Lothian, Scotland (population 750,000). SUBJECTS: All consultants caring for patients in long stay National Health Service facilities; a random sample of all general practitioners (GP's) in Lothian; managers/charge nurses of all local authority, private and voluntary long stay facilities in Lothian and continuing care facilities in the National Health Service including adults and children. MAIN OUTCOME MEASURES: Number (%) of general practitioners offering influenza vaccine to at-risk groups as defined in the Chief Medical Officer's guidelines; number (%) of hospital consultants caring for long-stay patients in hospital in Lothian who offer influenza vaccine to the same at-risk groups; percentage of long-stay residents/patients who received influenza vaccine in 1992-3. RESULTS: Seventy nine (75%) GPs said they offered influenza vaccine to all at-risk groups; 15 (14%) GPs said they did not care for patients in long-stay facilities but offered vaccine to the other at-risk groups; 12 (11%) GPs who did have long-stay residents on their list, offered vaccine to some of them only and to all other at-risk groups; 14 (56%) hospital consultants did not offer influenza vaccine to long-stay patients; 10 (40%) immunised only those at risk from chronic medical conditions if their quality of life was good; 1 (4%) consultant offered vaccine to all long-stay patients. In the winter of 1992-3, the mean proportion of residents immunised in private nursing homes was 65%, in residential homes 68.5%, and in long-stay National Health Service wards 4.5%. GPs commented that annual publicity was confusing for the public, vaccine was not available at the right time and there was uncertainty on the efficacy of the vaccine. Hospital consultants were reluctant to immunise patients with a poor quality of life or who were demented and unable to give consent. CONCLUSIONS: A large majority of GPs followed official advice and offered influenza vaccine to long-stay patients and other at risk groups. Hospital consultants offered influenza vaccine only to a small proportion of their long-stay patients, primarily those with a good quality of life.

Aged↗
PubMed1995

A review of influenza immunisation in Lothian.

OBJECTIVES: To assess the influence of the Chief Medical Officer's annual guidelines on influenza immunisation and to estimate vaccine uptake particularly of those resident in long-stay residential facilities and of other recommended at-risk groups. DESIGN: Postal questionnaires. SETTING: Lothian, Scotland (population 750,000). SUBJECTS: All consultants caring for patients in long stay National Health Service facilities; a random sample of all general practitioners (GP's) in Lothian; managers/charge nurses of all local authority, private and voluntary long stay facilities in Lothian and continuing care facilities in the National Health Service including adults and children. MAIN OUTCOME MEASURES: Number (%) of general practitioners offering influenza vaccine to at-risk groups as defined in the Chief Medical Officer's guidelines; number (%) of hospital consultants caring for long-stay patients in hospital in Lothian who offer influenza vaccine to the same at-risk groups; percentage of long-stay residents/patients who received influenza vaccine in 1992-3. RESULTS: Seventy nine (75%) GPs said they offered influenza vaccine to all at-risk groups; 15 (14%) GPs said they did not care for patients in long-stay facilities but offered vaccine to the other at-risk groups; 12 (11%) GPs who did have long-stay residents on their list, offered vaccine to some of them only and to all other at-risk groups; 14 (56%) hospital consultants did not offer influenza vaccine to long-stay patients; 10 (40%) immunised only those at risk from chronic medical conditions if their quality of life was good; 1 (4%) consultant offered vaccine to all long-stay patients. In the winter of 1992-3, the mean proportion of residents immunised in private nursing homes was 65%, in residential homes 68.5%, and in long-stay National Health Service wards 4.5%. GPs commented that annual publicity was confusing for the public, vaccine was not available at the right time and there was uncertainty on the efficacy of the vaccine. Hospital consultants were reluctant to immunise patients with a poor quality of life or who were demented and unable to give consent. CONCLUSIONS: A large majority of GPs followed official advice and offered influenza vaccine to long-stay patients and other at risk groups. Hospital consultants offered influenza vaccine only to a small proportion of their long-stay patients, primarily those with a good quality of life.

Adult↗
PubMed1990

Apolipoprotein localization in the human bile duct and gallbladder.

Apolipoproteins AI, AII and B were identified in the normal and pathological human bile duct and the gallbladder epithelium using an avidin-biotin immunoperoxidase technique. Small intestine and stomach sections served as positive and negative controls respectively. Staining was focal for apolipoproteins AI and AII, and continuous for apolipoprotein B. In addition to homogenous and granular cytoplasmic staining, foamy cytoplasmic staining, particularly for apolipoproteins AI and AII, was observed around lipid droplets in cells containing much lipid. No correlation between a particular pathological condition of the gallbladder (acute cholecystitis, mucocele, chronic cholecystitis, cholesterolosis) and staining pattern or intensity of staining was found for any of the apolipoproteins, although both apolipoproteins AI and AII stained more intensely than apolipoprotein B in each group. Positive staining was also found for all apolipoproteins in epithelial cells which had invaded the underlying connective tissue (gallbladder carcinoma), suggesting that the epithelial cells are capable of synthesizing apolipoproteins de novo. In this latter case, apolipoprotein B stained more intensely than for either AI or AII, and significantly (p less than 0.05) more strongly than that found in the other pathological groups. The identification of apolipoproteins in the gallbladder epithelium raises the interesting question of their origin and functional role.

Apolipoproteins↗
PubMed1989

House officers' workload--little changes in 20 years.

Studies undertaken in the late 1960s and early 1970s identified areas of the junior hospital doctors' workload that merited attention. Some 20 years later the same key areas continue to raise criticism from house officers in Edinburgh.

Humans↗