PubMed HealthSearch

Biomedical subjects

P Yuen

Publications and source records attributed to P Yuen.

At least 19 recordsLinked to original sources

Protein C deficiency Hong Kong 1 and 2: hereditary protein C deficiency caused by two mutant alleles, a 5-nucleotide deletion and a missense mutation.

We characterized a mutant protein C gene from an individual with no detectable protein C antigen in blood plasma. Southern blot hybridization analysis with human protein C cDNA demonstrated neither gross deletion nor rearrangement of the gene. Sequencing all the exons and exon-intron boundaries of the gene except the 3' noncoding region showed two mutant alleles. The one, derived from the mother, represents a deletion of 5 nucleotides (nt) (CCCGC) in the end of exon VI (mutation I), predicted to result in the generation of a new stop codon due to a reading frameshift and the premature termination of translation. The other, derived from the father, represents a point mutation (G to A) in exon IX (mutation II), resulting in an amino acid substitution, Gly-376(GGC) to Asp(GAC), in the catalytic domain of the protein. Allele-specific oligonucleotide probe hybridization confirmed the presence of the two mutations. Mutation I would result in a truncated polypeptide of 169 amino acid residues that lacks the heavy chain. Mutation II gives rise to an alteration of a highly conserved amino acid, Gly-376. These data indicate that this patient is a compound heterozygote of the two mutant alleles, each one inherited from each parent. Transient expression assays using COS-7 cells transfected with mutated protein C expression vectors suggested that each of the two mutations leads to the protein C deficiency by causing an impairment of secretion of the respective mutant proteins.

Amino Acid Sequence

Deprivation and general practitioner workload.

OBJECTIVES: To examine general practitioner consultations by demographic and socioeconomic variables and to derive a method of measuring the impact of relative deprivation on general practitioner workload. DESIGN: The study was based on general practitioner consultations reported in the general household surveys of 1983-7, covering a sample of 129,987 individuals in Great Britain. Odds ratios for general practitioner consultations were obtained for selected variables among children (0-15 years), men (16-64), women (16-64), and elderly people (greater than or equal to 65). These were then used to derive deprivation indices specific to electoral wards for use in general practice. SETTING: Great Britain, with particular findings illustrated by English electoral wards and the conurbations of London, Manchester, Merseyside, and the West Midlands. RESULTS: Council tenure increased the likelihood of consultation significantly in all four groups. Odds ratios were raised in children, men, and women with no access to a car. Birth in the New Commonwealth or Pakistan yielded high odds ratios in men, women, and elderly people but not in children. Marginally increased consultation rates were evident in the manual socioeconomic groups in women, elderly people, and children with a single parent mother. The deprivation indices for general practice derived using these odds ratios varied substantially among English electoral wards with, for example, anticipated general practitioner consultations in the electoral ward of Hulme, Manchester, being 24% higher than the average ward in England as a result of local attributes, and consultations in the Cheam South ward of Sutton, London, 11% lower than average. CONCLUSION: This deprivation index for general practice overcomes several shortcomings expressed about the underprivileged area score, which has been adopted in the 1990 contract as a basis for allocating deprivation supplements to general practitioners. The proposed index can be applied nationwide.

Adolescent

Inequalities in health: socioeconomic differences in self-reported morbidity.

Socioeconomic differences in self-reported chronic and acute illness were investigated in men and women using data from the General Household Surveys (1981-4). Logit models were used to investigate the influence of age, socioeconomic group, tenure, access to cars, area of residence and marital status on these measures of morbidity. For both measures local authority tenants, whether male or female, reported the most morbidity as did those with no access to cars. Both males and females reported increasing levels of illness the lower their socioeconomic group but similar patterns were not observed with acute illness. The significance of these present day inequalities is discussed.

Adolescent

Ethnic differences in general practitioner consultations.

OBJECTIVE: To examine the levels of general practitioner consultations among the different ethnic groups resident in Britain. DESIGN: The study was based on the British general household surveys of 1983-5 and included 63,966 people aged 0-64. Odds ratios were derived for consultation by ethnic group by using logistic regression analysis adjusting for age and socioeconomic group. SETTING: The results relate to people living in private households in England, Scotland, and Wales. RESULTS: After adjustment for age and socioeconomic class, consultation among adults aged 16-64 was highest among people of Pakistani origin with odds ratios of 2.82 (95% confidence interval 1.86 to 4.28) for men and 1.85 (1.22 to 2.81) for women. Significantly higher consultations were also seen for men of West Indian and Indian origin (odds ratios 1.65 and 1.53 respectively). Ethnic differences were greatest at ages 45-64, when consultation rates in people of Pakistani, Indian, and West Indian origin were much higher in both sexes compared with white people. CONCLUSIONS: The ethnic composition of inner cities is likely to influence the workload and case mix of general practitioners working in these areas.

Adolescent

Unemployment and patterns of consultation with the general practitioner.

The relation between unemployment and consultations with the general practitioner was investigated among 13,275 economically active men aged 18-64 by using the British general household surveys. Men who were unemployed but seeking work consulted with doctors significantly more (odds ratio 1.83; 95% confidence interval 1.61 to 2.09) than those in employment, the highest consultation rate being among those who had been out of work for five years or more (odds ratio 2.12; 95% confidence interval 1.12 to 3.78). The high consultation rates persisted even after adjustment for self reported longstanding illness (odds ratio 1.53; 95% confidence interval 1.34 to 1.76). These findings suggest that in areas with high unemployment general practitioner workload is likely to be high.

Adolescent

Single mothers: their health and health service use.

STUDY OBJECTIVE: The aim of the study was to investigate differences in reported health and health service use in single mothers. DESIGN: The study was a survey of data derived from the General Household Surveys conducted by the Office of Population Censuses and Surveys (OPCS). SETTING: The OPCS data are derived from samples of households throughout Great Britain. PARTICIPANTS: OPCS data for 1983 and 1984 were used, comprising approximately 60,000 individuals, of whom 793 were single mothers. MEASUREMENTS AND MAIN RESULTS: Five different health outcomes were examined, two on perceived morbidity and three on the use of health services. The chief determinants of health and health services use among single mothers were housing tenure, employment status and the age of the youngest child. Single mother status did not consistently contribute to self reported morbidity and uptake of care when adjusted for other social variables, but there was a difference between categories of single mother, with those who were separated/divorced and those who were widowed reporting more acute illness than those who were married. CONCLUSION: The findings suggest that single mothers do not form a homogeneous group and that, if special consideration is to be given to them when planning and allocating health service resources, this needs to be taken into account in the context of other socioeconomic factors.

Adolescent

Four documented cases of eosinophilic meningoencephalitis due to Angiostrongylus cantonensis in Hong Kong.

4 cases of eosinophilic meningoencephalitis in Hong Kong are described. The major clinical features of the patients, who were 2-60 years old, were low grade fever, headache, mild meningeal signs, right facial palsy or hemiplegia. Eosinophilia in the peripheral blood and eosinophilic pleocytosis were prominent. Computerized tomography scans of brain showed a small area of attenuation with surrounding hypodense area; the lesion was resolved 1-2 months after admission to hospital. Electroencephalograms revealed abnormally slow dysrhythmia. Sections of a nematode observed in the brain of a patient who died were identified as those of young adult Angiostrongylus cantonensis. High ELISA titres against the crude antigens of this nematode were also noted in the serum of 3 patients. The disease is probably under-recognized in Hong Kong.

Adult

Socioeconomic differentials in the uptake of medical care in Great Britain.

Socioeconomic differentials in the uptake of medical care in men were investigated using data from the General Household Survey (1974-76 and 1979-80). Hospitalisation, attendance at out patient clinics, and consultation with doctors were higher in local authority tenants than in owner occupiers. Men belonging to the manual socioeconomic groups also used services and consulted doctors more often than those in the non-manual groups. Hospitalisation among men was highest among manual workers living in local authority properties without access to car(s) (OR 1.92). Highest attendance at outpatient clinics (OR 1.60) was seen among local authority tenants in urban areas belonging to manual groups. However, consultation with doctors was highest among urban manual workers living in local authority properties but with access to car(s) (OR 1.72). The implications of these findings for resource allocation are discussed.

Health Services

A plasminogen activator from benign ovarian cystadenoma: partial purification and characterization.

A plasminogen activator has been partially purified from benign serous cystadenomas by a combination of Sephadex G-200 gel filtration, CM-Sephadex ion exchange, Concanavalin A-Sepharose and arginine-Sepharose affinity chromatographies. Its apparent size was very large and could not penetrate Sepharose 6B or 5% SDS polyacrylamide gel. It hydrolyzed plasminogen in a manner similar to that of urokinase in terms of their apparent Michaelis constants, although a one-minute lag period had to be allowed for this activation before the hydrolysis of plasminogen. It was very sensitive to reducing agent such that 5 mM dithiothreitol could completely destroy its activity. The activator crossreacted with anti-uterine plasminogen activator IgG, but did not react with anti-urokinase at all. It also bound fibrin well. In the absence of plasminogen, the activator was devoid of amidolytic activity towards S-2251, S-2302 and S-2288 but had a small but measurable activity against S-2444.

Chromatography, Affinity

Purpura fulminans in a Chinese boy with congenital protein C deficiency.

Severe and recurrent purpura fulminans developed in a Chinese boy at one day of age. Results of coagulation studies performed on the patient during attacks were compatible with the diagnosis of disseminated intravascular coagulation. Subsequent investigations have revealed that the patient is homozygous and that his parents are heterozygous for protein C deficiency. Cryoprecipitate and fresh frozen plasma induced a remission, and administration of warfarin has been successful in preventing recurrence of attacks for as long as 8 months without infusion of any plasma components. None of the family members who are heterozygous for protein C deficiency have had thrombotic episodes.

Combined Modality Therapy