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Biomedical subjects

R Shepherd

Publications and source records attributed to R Shepherd.

At least 55 records · Page 3Linked to original sources
PubMed1995

Perceived behavioural control, unrealistic optimism and dietary change: an exploratory study.

In the context of five dietary changes conducive to reductions in fat consumption, a short questionnaire was constructed to examine the applicability of the theory of planned behaviour and to assess the presence of the phenomenon of "unrealistic optimism". An extension to the theory of planned behaviour was also included, in the form of a "self-identity" measure assessing identification with concern about the health consequences of diet. The questionnaire was completed by 612 members of the general public at three different locations in the U.K. The findings indicate some support for the applicability of the theory of planned behaviour, with the measure of "self-identity" producing some additional independent effects. Evidence of unrealistic optimism concerning diet-related health risks was found, with greater optimism being significantly related to lower relative consumption estimates of "unhealthy" foods. The findings are discussed in the context of implications for health promotion.

Adolescent↗
PubMed1995

The influence of dietary advice on nutrient intake during pregnancy.

To assess the effect of an antenatal nutrition programme designed specifically for the local population, questionnaires on nutrition knowledge, attitudes to healthier eating and 4 d diet diaries were completed by women attending routine antenatal clinics. Women who received the nutrition education programme were allocated into an Intervention Education Group whilst those women who did not were allocated into a Routine Education Group. The results showed that knowledge about nutrition was significantly higher in the intervention group. However, no significant differences were detected between the two groups for attitude variables or nutrient intake. It is concluded, therefore, that the most-widely-read form of nutrition advice for pregnant women may have some impact on nutrition knowledge but has little effect on nutrient intake during pregnancy.

Adolescent↗
PubMed1995

Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort.

STUDY OBJECTIVE: Awareness of bronchiectasis on the part of clinicians has been low in recent years, although it was previously well recognized. We believe that bronchiectasis is underdiagnosed, and that current literature is skewed toward the esoteric etiologies of bronchiectasis. DESIGN: We reviewed the clinical, radiologic, microbiologic, and physiologic findings in 123 well-studied patients with proved bronchiectasis. SETTING: The University of Texas Health Center at Tyler Hospital and Clinics. MEASUREMENTS AND RESULTS: There were 38 men and 85 women with a mean (+/- SD) age of 57.2 +/- 16.7 years; 55% were lifetime nonsmokers. Diagnosis was confirmed with CTs of the chest in 56%, by bronchogram in 28%, and surgery with the remainder. Seventy percent of patients gave a history of an antecedent potentially causative event for the bronchiectasis, usually pneumonia. Symptoms of bronchiectasis included chronic cough with the production of purulent sputum, hemoptysis, recurrent fever, and pleurisy. The finding of crackles on chest examination was the rule (70%) with wheezing present in 34% of the group. Pulmonary function studies documented airway obstruction to be present in 54% of the lifetime nonsmokers. The chest radiographs were abnormal in 91.3%, showing fibrotic stranding and infiltrates. A variety of pathologic microbial flora, particularly Pseudomonas aeruginosa and other opportunistic organisms, were isolated from the sputum. Patients who had smoked had much the same picture as nonsmokers, although they had a greater degree of airway obstruction. CONCLUSIONS: A characteristic clinical picture of bronchiectasis emerges after review and evaluation of these data. Knowledge of this picture should allow ready recognition of the disease.

Adult↗
PubMed1995

Education and audit can improve the identification of excessive drinkers among medical inpatients.

This study investigated the effect of education and audit on the identification and management of medical inpatients with excessive alcohol consumptions by use of a cross-sectional survey of medical and nursing notes, compared with historical controls. We report the proportion of medical and nursing notes containing qualitative and quantitative drinking histories, the use of the CAGE questionnaire, and notification of alcohol consumption in discharge summaries. A total of 1,979 out of 2,680 (74%) notes of eligible patients were examined. The number of medical notes containing quantitative alcohol histories rose from 175/792 (22%) among historical controls, to 242/690 (35%) after training of junior medical and nursing staff, and to 241/497 (48%) after feedback of results in a clinical audit meeting. The number of medical notes with no recorded alcohol history changed from 309/792 (39%) to 287/690 (42%) to 152/497 (31%), respectively (chi 2 for trend = 97.2, p < 0.0001). The number of nursing notes containing quantified alcohol histories rose from 31/792 (4%) among historical controls, to 123/690 (18%) after training, and to 237/497 (48%) after feedback of results in a clinical audit meeting. The number of nursing notes with no recorded alcohol history fell from 309/792 (90%), to 512/690 (74%), to 205/497 (41%) respectively (chi 2 for trend = 353.7, p < 0.0001). The proportion of patients found to be drinking excessively rose from 40/792 (5.1%) to 57/690 (8.3%) to 45/497 (9.1%) (chi 2 for trend = 8.25, p = 0.004). There was little worthwhile improvement in use of the CAGE questionnaire and in discharge summaries. Education and audit are effective ways of improving the identification of excessive drinkers by both junior doctors and nurses alike. Other aspects of management are less responsive.

Alcoholism↗
PubMed1994

Public perceptions of the potential hazards associated with food production and food consumption: an empirical study.

Although public perceptions of food-related hazards receive much media comment and debate, the research literature on such perceptions is sparse and piecemeal. In the reported study, 216 people completed a questionnaire relating to their perceptions of the "risk characteristics" of potential hazards associated with various aspects of food production and food consumption. Responses were examined via principal-components analysis to obtain a structural representation of risk perception of the kind provided by Fischhoff, Slovic, and their colleagues in their seminal psychometric work. A three-component solution accounting for 87% of the variance was obtained, with the dimensions labeled as "severity," "unknown," and "number of people exposed." The findings also yielded information pointing to evidence of the phenomenon of unrealistic optimism. We conclude that our findings offer a useful base upon which further in-depth research integrating different perspectives on risk perception with respect to food-related hazards may be developed.

Analysis of Variance↗
PubMed1993

Current attitudes and future influences on meat consumption in the U.K.

A survey of 1018 U.K. residents was conducted using the basic structure of the theory of reasoned action along with scenarios of possible future events investigating meat-eating and vegetarianism. Over a quarter (28%) of the sample considered themselves to be reducing meat consumption although a comparison of present and retrospective meat consumption indicated that less than a quarter of this group had cut down on a variety of meats in their diets over the past year. The attitudes related to present meat consumption were healthiness, taste, value for money and, to some extent, ethical issues. Healthiness, taste and concerns over additives were related to changes in meat consumption over the preceding year. Beliefs about the healthiness of meat were also related to reported changes in meat-eating behaviour when "something that could possibly happen in the future" was described. Future events found to affect people's estimated meat-eating were the availability of polyunsaturated meat and meat produced with strict safety guarantees, the former change being dependent on a constant price. Reductions in the fat content of meat or claims extolling the nutritional benefits of eating meat were not related to predicted future meat-eating.

Animals↗
PubMed1993

Onset, natural history and outcome in idiopathic adult motor neuron disease.

Cases of adult-onset idiopathic motor neuron disease (MND) identified from January 1970 through December 1986 were studied in a defined area of California. The patients were followed prospectively throughout the illness in 99% of cases. Among 708 cases aged 25-74 years at onset, the most common type (86%) was typical, sporadic amyotrophic lateral sclerosis (SporALS). The risk of bulbar onset and shorter survival times increased with age in both men and women. About 4%, mainly younger men, experienced unusually long courses with milder paralysis, but could not be identified early in the illness. They probably represent one extreme of the ALS spectrum rather than a distinct subtype. Familial ALS (FamALS) was diagnosed in 7%. It developed earlier in life but ran a slightly longer course, which suggests a different disease process. Overall there was a statistically significant predominance of males, especially in 17 cases (2%) of progressive muscular atrophy (PMA). There were 26 cases (4%) classified as primary lateral sclerosis (PLS). Progressive bulbar palsy was not found; that diagnosis usually denotes merely the bulbar onset of ALS.

Adult↗
PubMed1993

Serum immunoglobulin G directed against porcine trypsin in the serum of cystic fibrosis children receiving porcine pancreatic enzyme supplements.

Cystic fibrosis (CF) patients require pancreatic enzyme replacement therapy to correct pancreatic insufficiency. These enzymes are derived from porcine pancreas and are known to be antigenic. To determine the possible clinical consequences, a specific ELISA was developed to detect IgG antibody directed against porcine trypsin (PTAb) in the sera of CF patients. The assay was used to evaluate the occurrence of PTAb in a cross sectional study of 103 CF patients in relation to the introduction of porcine enzyme therapy, clinical status and genotype. Antibodies against porcine trypsin were detected in the sera of 63% of patients unrelated to the age of commencement or the duration of enzyme therapy. No differences were observed in the clinical status of CF patients who had developed PTAb (n = 65) and those who had no detectable PTAb (n = 38) as determined from: the current prescribed dose of porcine pancreatic enzyme capsules; Z scores for height and weight; and respiratory function tests. It is suggested that the PTAb commonly found in the sera of CF patients are of doubtful clinical significance but the prospect of PTAb contributing to immune complex disease should be examined further.

Adolescent↗
PubMed1992

Application of Fishbein and Ajzen's expectancy-value model to understanding fat intake.

A questionnaire on attitudes towards the consumption of food types (specified by verbal labels) which contribute highly to fat in the diet was completed by 240 subjects who were quota sampled for sex, age and social class. The person's attitude toward consumption was found to be a good predictor of reported consumption. Differences in responses were found between groups of subjects who were classified by sex, age and social class. In general, females, the lower age groups and the higher social class subjects were found to have lower consumption and more negative attitudes towards the food types included. Individual belief-evaluation products on taste and healthiness of the foods were more closely related to attitudes towards consumption than were other beliefs (e.g. on convenience and price).

Adolescent↗
PubMed1991

Evaluation of growth and changes in body composition following neonatal diagnosis of cystic fibrosis.

Early deficits in nutritional status that might require specific treatment and early response to nutritional therapy were studied longitudinally in 25 infants with cystic fibrosis (CF) diagnosed by neonatal screening, using anthropometric and research body composition methodology, and evaluation of pancreatic function. At the time of confirmed diagnosis (mean 5.4 weeks), body mass, length, total body fat (TBF), and total body potassium (TBK) were all significantly reduced. Following diagnosis and commencement of therapy there was a normalization of weight, length, and TBK by 6-12 months of age, indicating catch-up growth. But in some individuals the response was incomplete, and as a group, mean total body fat remained significantly lower than normal at 1 year of age. Seven of 25 (28%) were pancreatic sufficient at diagnosis, and all but one had evidence of declining pancreatic function requiring the institution of pancreatic enzyme therapy during the next 1-9 months. The median age of commencement of enzyme therapy was 10 weeks (range 5 weeks to 11 months). These longitudinal assessments emphasize the dynamic changes occurring in absorptive function, body composition, and nutritional status following neonatal diagnosis of cystic fibrosis and may reflect previously described abnormalities of energy metabolism in this age group. Abnormal body composition is evident in most CF infants following diagnosis by neonatal screening but pancreatic damage may still be evolving. We suggest that early active nutritional therapy and surveillance for changes in pancreatic function are warranted in CF infants diagnosed by neonatal screening.

Body Composition↗