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Biomedical subjects

S Gale

Publications and source records attributed to S Gale.

At least 19 recordsLinked to original sources
PubMed2003

Postpartum mood disorders: a review of clinical and epidemiological factors.

The postpartum period is a time of risk for mood disturbance in women. Postpartum blues occurs commonly, but is self-limited. Postpartum depression occurs in 13% of postpartum women. However, it is estimated that nearly one-half of all cases go undetected. Postpartum psychosis is rare, affecting 1-2 per 1000 women. Postpartum mood disorders can have far-reaching consequences and have been shown to affect the social and psychological development of children. It is critical that healthcare providers understand these disorders and their risk factors to increase detection and to educate women about the risks and treatments of postpartum mood disorders. This review is intended to provide healthcare providers with a better understanding of the descriptive epidemiology, risk factors, and treatments of postpartum mood disorders. The utility of specific screening instruments is also discussed.

Depression, Postpartum↗
PubMed2001

Cataract surgery in a community hospital outreach clinic: patients' costs and satisfaction.

A cataract day surgery service for the population of central Norfolk, UK, was provided by the main ophthalmic department in a district general hospital and in an outreach clinic in a community hospital 40 km distant. The outreach clinic aimed to extend the accessibility of this particular service in a rural area where many patients faced long journeys to the main hospital. Samples of 201 patients attending the main hospital for day cataract surgery and 198 patients attending the outreach clinic for the same procedure were identified. Patients were interviewed and given questionnaire forms to establish their general health before the operation, their arrangements to get to hospital and their satisfaction with the clinic and the care they had received. The sample of patients attending the outreach clinic was slightly older, less affluent and in slightly poorer general health than the patients attending the main hospital. The two samples were similar in terms of visual acuity after the operation, complication rates, satisfaction with the outcome of the operation and subsequent use of health services. The journey to hospital was quicker, more convenient and less costly for the outreach clinic patients than the main hospital patients. The net benefit to patients of the outreach clinic was estimated as pounds sterling 39,000 per annum. Satisfaction with administrative matters, facilities at the two clinics and the care received was high in both samples, but patients were significantly more satisfied with arrangements at the smaller outreach clinic. This evidence suggests that an outreach clinic in a small community hospital can provide cataract day surgery under local anaesthesia as effectively as a district centre, at a reduced social cost and with positive social benefits. Further study of heath service costs is vital, but political pressure to acknowledge patient preferences for more local services is growing.

Aged↗
PubMed2001

Selective modulation of chemokinesis, degranulation, and apoptosis in eosinophils through the PGD2 receptors CRTH2 and DP.

BACKGROUND: PGD(2) is the major prostanoid released by mast cells during an allergic response. Its role in the allergic response, however, remains unclear. OBJECTIVE: Because the accumulation of eosinophils is a feature of allergic reactions, we investigated the role of PGD(2) in the modulation of eosinophil function. METHODS: Circulating human eosinophils were isolated and challenged with PGD(2). The effects of PGD(2) on various eosinophil functions were then analyzed. RESULTS: PGD(2) binds with high affinity preferentially to 2 receptors, DP and chemoattractant receptor-homologous molecule expressed on T(H)2 cells (CRTH2). We show that both DP and CRTH2 are detectable on circulating eosinophils. We demonstrate that PGD(2) (1-10 nmol/L) induces a rapid change in human eosinophil morphology and an increase in chemokinesis and promotes eosinophil degranulation. These effects are induced by the CRTH2-selective agonist 13-14-dihydro-15-keto-PGD(2) (DK-PGD(2)) but not by the DP-selective agonist BW245C. These results suggest a role for CRTH2 in the modulation of eosinophil movement and in triggering the release of cytotoxic proteins. Finally, we demonstrate that BW245C, but not DK-PGD(2), can delay the onset of apoptosis in cultured eosinophils, presumably through interaction with DP. CONCLUSION: These data support the hypothesis that PGD(2) controls eosinophil functions through 2 pharmacologically distinct receptors with independent functions. Blockade of PGD(2)-mediated effects on human eosinophils may reduce the damage caused by these cells during an allergic response, but inhibition of both receptors may be required.

Apoptosis↗
PubMed2000

Deprivation and poor health in rural areas: inequalities hidden by averages.

Poor health and social deprivation scores in 570 wards in East Anglia, UK, were much less associated in rural than in urban areas. The deprivation measure most closely related to poor health in the least accessible rural wards was male unemployment, but use of this measure did not remove the urban-rural gradient of association strength. Neither did replacing wards by smaller enumeration districts as the units of analysis. The differences between urban and rural correlations were removed by restricting the comparison to wards with the same unemployment range and combining pairs of rural wards with similar deprivation values. Apparent differences between rural and urban associations are therefore not due to the choice of deprivation indices or census areas but are artifacts of the greater internal variability, smaller average deprivation range and smaller population size of rural small areas. Deprived people with poor health in rural areas are hidden by favourable averages of health and deprivation measures and do not benefit from resource allocations based on area values.

Cultural Deprivation↗
PubMed1999

Effects of distances to hospital and GP surgery on hospital inpatient episodes, controlling for needs and provision.

Age and sex adjusted inpatient episode ratios were calculated from hospital records over a two year period for 555 census wards in Cambridgeshire, Norfolk and Suffolk, UK. Hospital episodes were divided into acute, psychiatric and geriatric specialties, and elective and emergency acute admissions were distinguished. Variations in inpatient episode ratios between wards were compared with census indicators of the 'needs' of local populations for inpatient services, measures of the local provision of hospital and other related services, and measures of the distance to the nearest general practitioner surgery and the distance to the nearest hospital. Hospital episodes were found to be strongly related to both distance measures, but the associations were partially explained by a tendency for the health status of local populations (measured by the needs indicators) to be worst in urban areas close to health services. Including needs and provision variables together with the distance variables explained most of the variations in age and sex adjusted inpatient ratios for small areas. Needs were the most important determinants of emergency acute and psychiatric inpatient rates, but service provision was more important for elective acute and geriatric inpatients. Controlling for needs and provision, distance to hospital produced 17% reduction in acute episodes, 37% reduction in psychiatric episodes and 23% reduction in geriatric episodes over the range of distances observed. Distance to nearest GP surgery reduced elective acute episodes by up to 15% after controlling for confounders. These results demonstrate that the NHS is falling short of its aim to provide fair access to services irrespective of geography, and new policies will be required if geographical inequities are to be reduced.

England↗
PubMed1999

Mortality, long-term illness and deprivation in rural and metropolitan wards of England and Wales.

The relationships between mortality, limiting long-term illness and indicators of social deprivation were investigated using regression analysis on data for rural wards, metropolitan wards and the remaining wards in England and Wales. Regional differences were controlled. In rural wards, people had better health than average and slightly better health than would be expected from their deprivation scores. Average levels of health in rural areas were only weakly related to deprivation, which was partly but not fully due to the restricted range of average deprivation values in rural wards. In metropolitan areas, relatively poor levels of health were largely explained by social deprivation, but people in Inner London were healthier than might be expected from measures of deprivation. The relationship between health and social deprivation is therefore not uniform over England and Wales, but varies between geographical types of area. One consequence is that resource allocation on the basis of social deprivation would put the populations of rural areas and Inner London at an advantage.

Adolescent↗
PubMed1999

Autism and autistic behavior in Joubert syndrome.

To determine whether individuals with Joubert syndrome exhibit features of autism as defined by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), we examined 11 children with Joubert syndrome using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule-Generic. Three children met DSM-IV criteria for autistic disorder and one for pervasive developmental disorder not otherwise specified. The other seven all demonstrated at least one DSM-IV symptom of autism, but did not meet criteria for a pervasive developmental disorder. Both total number of DSM-IV symptoms and number of social symptoms distinguished the autism and nonautism subgroups. In contrast, the two subgroups displayed similar levels of communication impairments and repetitive or stereotyped behavior. The key to diagnosing autism in Joubert syndrome is to focus on social behaviors, particularly milestones typically achieved very early in life (eg, attending to human voices, showing objects of interest, enjoyment of social interactions). Implications for the role of the cerebellum in nonmotor behavior and for clinical management of Joubert syndrome also are discussed.

Adolescent↗
PubMed1996

Factors associated with home advantage in English and Scottish soccer matches.

Using the results from the end-of-season (1992-93) league tables, overall home advantage was confirmed in the eight major divisions of the English and Scottish football leagues. The degree of home advantage was found to vary significantly across the divisions. Furthermore, these divisional differences in home advantage were found to be significantly associated with the mean attendance of each division. In an attempt to understand these findings, every occurrence of two influential events (either a sending-off or penalty scored) reported in a national Sunday newspaper was recorded. The overall frequency of both sendings-off and penalties scored favoured the home side, but again this was not constant across the divisions. In divisions with large crowds, the percentage of home sendings-off was relatively small (30%), compared with no difference (50%) in divisions with smaller crowds. Similarly, the percentage of penalties scored by home sides in divisions with the largest crowds was large ( > 70%), in contrast to little or no advantage in divisions with smaller crowds. Two possible explanations for these findings were proposed. Either larger crowds were able to provoke the away player into more reckless behaviour (real fouls), or influence the referee into believing that the away player had committed more fouls (perceived fouls).

England↗
PubMed1996

Unemployment rate as an updatable health needs indicator for small areas.

BACKGROUND: The objective of the study was to compare updatable unemployment rates with the unemployment rate and composite deprivation indices from the 1991 Census as health needs indicators for small areas. METHODS: Townsend, Carstairs and Jarman indices and male unemployment rates were calculated from the 1991 Census, for 275 wards of the former East Anglian health region with unchanged boundaries between 1981 and 1991. Male unemployment rates were also derived from April 1991 unemployment benefit claimant figures, using both Office of Population Censuses and Surveys mid-year estimates of population and estimates derived from Family Health Services Authority patient registers as the denominator. Ward values were compared using Pearson product moment correlation. RESULTS: All three unemployment measures were closely related to each other and all were broadly as effective in predicting ward variations in mortality and long-term illness in 1991 as the compound deprivation indices of Jarman. Townsend and Carstairs. CONCLUSION: Updatable unemployment rates were as suitable as the composite indices as an indicator of relative health needs for small areas in the year of the Census and might be expected to be superior in inter-censal years.

Adolescent↗
PubMed1995

Prepubertal testosterone treatment of female rats: defeminization of behavioral and endocrine function in adulthood.

This study assessed the capacity of testosterone (T) administered well after the neonatal "critical" period to permanently sexually differentiate reproductive function. Females received T filled or empty Silastic capsules during days 15-30 of age and vaginal cyclicity, ovarian weight and appearance, lordosis and proceptive behaviors, mounting behavior, and the gonadotropin response to estrogen and progesterone were measured in adulthood. T-treated females (plasma levels of 0.66 ng T/ml) showed constant vaginal estrus from the day of vaginal opening and small, polyfollicular ovaries. Proceptive behaviors were dramatically reduced whether or not the ovaries were present after day 15 of age, but lordosis behavior was not affected. Exposure to T for 5-6 h was ineffective. Compared to controls, T-treated females had dramatically reduced plasma FSH and LH surges. No effects were observed on mounting behavior, phallus size, or body weights. These results suggest that androgen at approximately male levels can act on neural substrates well beyond the neonatal period to permanently defeminize endocrine and behavioral function in the female rat.

Aging↗
PubMed1994

Day of injury CT scan as an index to pre-injury brain morphology.

This study compared the ventricle-to-brain ratio (VBR) of the day-of-injury (DOI) computerized tomogram (CT) in traumatic brain-injured (TBI) patients with post-injury (2 months or greater) magnetic resonance (MR) VBRs in the same patients and in medical control subjects. The DOI VBR did not differ significantly from the medical controls, but both (DOI and medical control VBR) differed significantly from post-injury VBR. Additionally, a case study is presented wherein MR imaging studies were obtained prior to TBI so that a direct comparison of pre-injury to DOI to post-injury changes could be made. In this case the pre-injury and DOI VBRs were within approximately 9% of each other. In contrast, the post-injury VBR demonstrated over a 100% increase in comparison to either the pre-injury or DOI scan. This case and another case are illustrated using three-dimensional image analysis to represent ventricular change over time. These cases, along with the similarity of the DOI VBR with the medical controls, suggests that the DOI VBR can be utilized as an estimate or index of pre-injury ventricle/brain morphology. This will permit the use of DOI CT data for within-subject designs in TBI research that examines the course of degenerative changes over time.

Adolescent↗
PubMed1991

Peri-operative drug prescribing pattern and manufacturers' guidelines. An audit.

Many patients admitted for surgery are receiving regular drug therapy. Adverse effects may occur, either as a result of these drugs being stopped suddenly or because staff are unaware of significant interactions between certain drugs and anaesthetic agents or techniques. This study aimed to find out how regular drug medication is actually given in the peri-operative period. In addition, pharmaceutical companies were contacted and asked for information about the effects of sudden withdrawal of their products and potential interactions with anaesthetic agents. We found that many drugs were omitted peri-operatively with potentially significant effects. Pharmaceutical companies do not seem to appreciate the importance of this problem and not all of them give clear recommendations relevant to practising anaesthetists.

Anesthesia↗
PubMed1990

Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning.

Acardiac twinning affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 pregnancies overall. The presence of an acadiac twin requires the normal (or "pump") twin to provide circulation for itself, as well as the acardiac sibling. In many cases the acardiac twin is almost equal to the normal twin. The principal perinatal problems associated with acardiac twinning are pump-twin congestive heart failure, maternal hydramnios, and preterm delivery. We reviewed the perinatal courses of 49 acardiac twin pregnancies to identify factors prognostic of favorable outcome. The overall perinatal mortality was 55%, primarily associated with prematurity. Mean (+/- SD) gestational age at delivery was 29 +/- 7.3 weeks, with a mean (+/- SD) normal twin weight of 1378 +/- 1047 gm. The acardiac weight averaged 651 +/- 571 gm. However, the occurrence of hydramnios, the occurrence of preterm labor, and perinatal outcome were strongly related to the ratio of the acardiac and pump-twin's weight. The mean overall ratio of the twin weights was 52% +/- 42%. However, the mean weight ratio for patients delivered before 34 weeks was 60% versus 29% (p less than 0.04). Preterm delivery was strongly associated with the development of hydramnios and congestive heart failure in the pump twin (p less than 0.01). If the twin-weight ratio was above 70% (25% of cases), the incidence of preterm delivery was 90%; hydramnios, 40%; and pump-twin congestive heart failure, 30% compared with 75%, 30%, and 10%, respectively, when the ratio was less (p less than 0.05). Regression of the weight of the acardiac twin against its longest dimension (L) resulted in this equation for prediction of acardiac weight: Weight (grams) = 1.2 L2-1.7L; r = 0.79, p less than 0.01. These data suggest that estimation of the relative weights in acardiac twins provides prognostic information regarding outcome. Poor outcome occurs with congestive heart failure and hydramnios in the normal twin. Use of the above data may assist in counseling patients and determining optimal management.

Adult↗