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Biomedical subjects

S Halliday

Publications and source records attributed to S Halliday.

16 recordsLinked to original sources
PubMed2006

Data collection from very low birthweight infants in a geographical region: methods, costs, and trends in mortality, admission rates, and resource utilisation over a five-year period.

AIMS: 1. To determine the survival and morbidity of infants at discharge with a birthweight of less than 1500 g in the geographically defined population of East Anglia. 2. To demonstrate a cost-effective method of regional data collection. 3. To determine whether there were any changes in the demand for neonatal care. STUDY DESIGN AND SUBJECTS: A prospective cohort analysis using a single database to collect data on 1244 very low birthweight infants from eight neonatal units in one Region from 1993 to 1997. RESULTS: Estimated ascertainment of VLBW infants to the study was 96%. Over the 5 years survival rates were stable (75-79%). 52% of deaths in infants admitted for neonatal care occurred on day 1, with just 15% of deaths occurring after 28 days of life. Mortality risk significantly decreased with increasing gestational age at birth. Compared to 22-25-week old infants, the mortality risk decreased by 65% for 26-27-week old infants (OR 0.35 95% CI (0.21, 0.59)) and by 92% for 32-39-week old infants (OR 0.08 95% CI (0.03, 0.21)) with intermediate odds ratios of 0.22 (0.12, 0.42) and 0.13 (0.06, 0.28) for the 28-29 and 30-39 weeks gestation, respectively. Higher birthweight, after adjusting for gestation also decreased the mortality risk (OR 0.78 per 100 g difference, 95% CI (0.71, 0.86)). No change was seen in the number of extremely preterm infants admitted for intensive care or resource utilisation, although a significant increase was seen in the number of infants dying in delivery rooms. There was a reduction in the reported incidence of pulmonary interstitial emphysema (10-4%) but no change in the number of ventilation days or the rate of chronic lung disease. The mean maternal age increased from 27.7 years to 28.9 years during the study. Maternal steroid administration increased (30% to 59%) and was associated with a decreased risk of mortality (OR 0.44, 95% CI: 0.31-0.62). CONCLUSIONS: It is possible to collect useful data from the neonatal period at a reasonable cost from a geographically defined population. This information was used for informing clinicians, counselling parents and in the era of managed clinical networks will be useful in guiding the provision of effective health care resources.

Cohort Studies↗
PubMed2005

Outcome at 2 years for very low birthweight infants in a geographical population: risk factors, cost, and impact of congenital anomalies.

AIM: To determine the type and rate of disability at 2 years of age in infants born in the geographically defined population of East Anglia with a birthweight less than 1500 g and to assess the risk factors for disability. STUDY DESIGN: A prospective cohort analysis from all eight neonatal units in East Anglia from 1993-1997 using a single database. METHODS: Local paediatricians assessed children at 2 years using the Health Status Questionnaire and data collection was centrally coordinated. RESULTS: Outcomes for 947 children, 99% of survivors, were available, 74 (7.8%) had severe disability and this was significantly associated with gestational age (p<0.0005), birthweight (p<0.0005) and sex (p=0.046). Major congenital abnormality contributed 27% of all severe disability. The overall cerebral palsy rate was 6.2%, nine children were blind and five had sensorineural hearing loss requiring aids. These children had a high level of use of community services with 19% of the cohort being referred to one or more community service. ELBW infants or those born <30 weeks gestation were 1.5 times and twice as likely to have moderate or severe disability and 2.3 and 5.4 times as likely to have cerebral palsy as those weighing 1000 to 1500 g or >30 weeks gestation. Boys were at higher risk of adverse outcome. CONCLUSIONS: The study was able to define the increased risk associated with being born at lower gestational age or lower birthweight and demonstrates successful ascertainment of outcomes for large local populations at a reasonable cost.

Caregivers↗
PubMed2005

Expression of PrPC on cellular components of sheep blood.

PrP(C), a glycosylphosphatidylinositol-linked glycoprotein, plays a central role in the pathogenesis of transmissible spongiform encephalopathies (TSEs), undergoing a conformational alteration to the disease-associated isoform, commonly designated PrP(Sc). PrP(C) is expressed in many tissues other than the nervous system, although its precise function(s) remains unclear. It has previously been demonstrated that TSEs can be transmitted by blood transfusion in sheep. The aim of this work was to identify which components of blood carried the infection. As an initial step, the distribution of PrP(C) on cellular components of sheep blood was examined to identify potential targets for infection. Cell-surface expression of PrP(C) was found only on peripheral blood mononuclear cells (PBMCs); however, platelets also contained significant amounts of intracellular PrP(C). The level of PrP(C) expressed on the cell surface of PBMCs was influenced by PrP genotype, with the highest levels found in scrapie-susceptible VRQ/VRQ sheep and the lowest levels in scrapie-resistant ARR/ARR sheep. In susceptible sheep, PrP(C) was expressed at varying levels on all major subsets of PBMCs, with the highest levels on the CD21(+) subset of B cells, and PrP expression was upregulated dramatically on CD21(+) B cells in some scrapie-infected sheep.

Animals↗
PubMed2003

Decision-making at the end-of-life and the incompetent patient: a comparative approach.

In contrast to the situation in the Netherlands and Belgium, the legislatures in both England & Wales and Germany have not recognised that active euthanasia may be lawful in any circumstance. Nevertheless, the courts in both jurisdictions have held that passive euthanasia, that is the withdrawal or withholding of life-prolonging treatment, is perfectly lawful; indeed it will often constitute good medical practice. This article adopts a comparative approach to assessing the manner in which decisions to withdraw or withhold life-prolonging treatment are made in relation to previously competent patients without a legally effective advance directive or a proxy decision-maker, considering the approaches adopted by the courts in England & Wales and Germany: the best interests and 'presumed will' approaches respectively. Due to the inherent drawbacks associated with each approach it is concluded that the best way forward would be for both jurisdictions to adopt a mixed approach, allowing the autonomy model to temper the best interests approach, recognising that the patient is an individual rather than simply an object of concern.

Decision Making↗
PubMed1998

Isolation and characterization of adociavirin, a novel HIV-inhibitory protein from the sponge Adocia sp.

Aqueous extracts of the New Zealand sponge Adocia sp. (Haplosclerida) displayed potent anticytopathic activity in CEM-SS cells infected with HIV-1. Protein fractions of the extract bound both to the viral coat protein gp120 and to the cellular receptor CD4, but not to other tested proteins. The purified active protein, named adociavirin, was characterized by isoelectric focusing, amino acid analysis, MALDI-TOF mass spectrometry and N-terminal sequencing. Adociavirin, a disulfide-linked homodimer with a native molecular weight of 37 kDa, was active against diverse strains and isolates of HIV-1, as well as HIV-2, with EC50 values ranging from 0.4 nM to > 400 nM. The anti-HIV potency of adociavirin appears dependent on host cell type, with macrophage cultures being the most sensitive and peripheral blood lymphocytes the most resistant.

Amino Acid Sequence↗
PubMed1998

Psychological interventions in self-injurious behaviour. Working with people with a learning disability.

BACKGROUND: Psychological approaches to working with people with learning disabilities who self-injury have developed over the past 30 years. METHOD: The major literature is reviewed and an ecological framework is described which emphasises the importance of environmental, interpersonal and intrapersonal dynamics to understanding the multi-factorial nature of self-injury. Case examples are given. RESULTS: Self-injury is seen as essentially communicative and functionally adaptive; it is the person's best attempt to deal with abusive, neglecting or traumatic environments or events. CONCLUSIONS: The persistence of self-injurious behaviour once established, requires an interdisciplinary approach which addresses comprehensively the variety of factors which have contributed to the development and maintenance of self-injury.

Behavior Therapy↗
PubMed1987

Successful management of daytime enuresis using alarm procedures: a randomly controlled trial.

Forty four children with daytime wetting were included in a randomly controlled trial of two alarm devices, a contingent one that sounded when wetting occurred and a non-contingent one that went off from time to time unrelated to wetting events. A quota allocation system ensured comparability between treatment groups. Two thirds responded to an alarm by becoming dry. The non-contingent alarm produced as good a response as the contingent one and is recommended for routine use in children with diurnal enuresis. Twenty three per cent of those who responded to treatment relapsed up to two years after completion of the trial.

Adolescent↗
PubMed1981

Growth of immigrant children in the centre of Glasgow.

One hundred and ninety six Asian, 89 African, 96 Chinese and 98 Scottish children from 173 families were studied to assess growth in relation to country of birth, time of parental residence in Scotland, child order in family, social class, living conditions and dietary factors. The growth measurements (standardised height, weight and bone age) differed between ethnic groups. The Africans were the tallest and Scottish the shortest. In all immigrant groups, children born in Scotland were on average, taller and more advanced in bone age than those born in their country of origin. In this study, there was no demonstrable effect on growth of social class or of living conditions. Dietary variable showed a lack of coherent effects on growth.

Adolescent↗
PubMedDate not supplied

Staff stress and satisfaction in small staffed houses in the community: 1.

In this article, the first of two parts, the sources of stress and satisfaction experienced by nursing and social service staff working in group homes with young people with severe learning disabilities are investigated. It focuses on the stresses and satisfactions arising out of the performance of the direct care role for staff working in ordinary housing in the community.

Adolescent↗
PubMedDate not supplied

Staff stress and satisfaction in small staffed houses in the community: 2.

The first part of this article focused on the stresses and satisfactions arising out of the performance of the direct care role for staff working in three houses in the community for young people with severe learning disabilities and challenging behaviour. This article focuses on the experience of home/work conflict by staff and the impact of organisational issues in relation to staff-staff and staff-management communication, the processes for decision making and standard setting, operational policies and rotating shifts and their effects on the morale and stress levels of staff.

Burnout, Professional↗