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T J Peters

Publications and source records attributed to T J Peters.

At least 163 records · Page 9Linked to original sources
PubMed1998

Development of a questionnaire for measurement of vision-related quality of life.

PURPOSE: To define vision-related quality of life, to outline the development of a vision-specific quality of life instrument and to present the characteristics of a 10-item 'core' questionnaire. METHOD: A standard method included: 1. Generation of relevant issues by individual interviews with 38 visually impaired adults, consultation with 37 professionals and support workers and literature review. 2. Operationalisation, involving 58 ophthalmic patients. 3. Pre-testing, to maximise face validity and content validity, involving 184 individuals with a variety of different visual problems and social backgrounds. 4. Adoption of a modular approach to item selection. 5. Formal piloting in 92 individuals to establish reliability and construct validity. RESULTS: More than 232 items were tested of which 139 were considered suitable for a final question pool or 'parent' questionnaire (the VQOL). From this parent questionnaire individual items or groups of items can be selected. Ten broadly applicable items referring to physical, social and psychological issues were selected for the core questionnaire (the VCM1). The VCM1 has high reliability (alpha = 0.93) and validity. CONCLUSIONS: Any self-reported problem relating to vision may constitute a quality of life issue. A modular approach to item selection may provide the flexibility to investigate vision-related quality of life in a wide range of clinical settings, allowing detailed assessment of specific problems and also cross-study comparisons where appropriate.

Adult↗
PubMed1998

Childhood obesity and adult cardiovascular mortality: a 57-y follow-up study based on the Boyd Orr cohort.

Few studies have examined associations between childhood overweight and adult disease. We examined the relation between BMI measured in childhood and adult all-cause and cardiovascular mortality in a 57-y follow-up of a cohort study based on the Carnegie (Boyd Orr) Survey of Family Diet and Health in prewar Britain (1937-1939). Complete baseline and follow-up data were available for 1165 males and 1234 females who were aged between 2 y and 14 y 9 mo when they were examined. All-cause and cardiovascular mortality were associated with higher childhood BMIs. Compared with those with BMIs between the 25th and 49th centiles, the hazard ratio (95% CI) for all-cause mortality in those above the 75th BMI centile for their age and sex was 1.5 (1.1, 2.2) and for ischemic heart disease it was 2.0 (1.0, 3.9). There was also a suggestion of a nonlinear association with overall mortality; those in the 25-49th centile of the BMI distribution had the lowest mortality rates. The linear associations may be due in part to the tracking of BMI between childhood and adulthood. High BMI in adults is known to be associated with raised blood pressure and abnormal lipid profiles. The relative contributions of adult and childhood overweight to the observed mortality patterns are uncertain. From the public health perspective, strategies aimed at reducing weight in childhood are important but may only affect adult health if such weight reduction persists into adulthood.

Adolescent↗
PubMed1998

Mildly dyskaryotic smear results: does it matter what women know?

BACKGROUND: As of 1992, all women in the UK who have a first mildly dyskaryotic cervical smear are placed under surveillance for 6 months rather than being referred for immediate colposcopy. OBJECTIVES: We aimed to explore the relationship between anxiety and understanding about mild dyskaryotic, and to propose and discuss a method of analysing free text comments written by participants in studies based on structured questionnaires. METHODS: The freely scripted text of 236 women who had completed a questionnaire as part of a randomized controlled trial to assess the impact of an educational package was analysed. Randomization group status was concealed. Texts expressing similar views were grouped together and categorized. A matrix was drawn up to encompass the categories, and the comments were reallocated accordingly. RESULTS: Examination of the free text revealed two dimensions, concern and knowledge. There were no differences with respect to the apparent level of concern between the two randomization groups. However, comments from the intervention group were significantly more likely to have been classified as expressing good or vague knowledge than those from women in the control group. CONCLUSION: Although the educational intervention improved women's knowledge about the meaning of an abnormal smear result, this better knowledge was not correlated with less anxiety about the result. The free text analysis was a useful supplement to the main trial questionnaires. It demonstrated the existence of a range of understanding about cervical dyskaryosis, of anxieties relating to the receipt of such a result and the degree of interest women showed in acquiring further information.

Anxiety↗
PubMed1998

Effect of varying the time frame for COOP-WONCA functional health status charts: a nested randomised controlled trial in Bristol, UK.

STUDY OBJECTIVES: To investigate whether changing the stated time frame for COOP-WONCA charts has any effect on responses. Specifically, to assess the effect of attempting to avoid the situation where the time frame crosses the onset of an acute episode. DESIGN: A randomised controlled trial of two time frames, nested within a main trial comparing early discharge with a hospital at home scheme against routine discharge policy. The time frames compared were the standard two weeks (four for the pain chart) and a shorter period of 48 hours for all seven charts. SETTING: Acute hospital wards in Frenchay Healthcare Trust and the Avon Orthopaedic Centre in Bristol. PARTICIPANTS: Patients entered into the main trial, who were medically stable, in need of continued rehabilitative care but suitable for discharge to hospital at home. MAIN RESULTS: A total of 200 patients were randomised, 106 to the shorter time frame, 94 to the standard charts. No clear differences were observed between the two groups for the proportion failing to self complete the charts. For the (seven) chart scores, only pain was statistically significantly different between the time frames (Mann-Whitney p = 0.0085; proportion reporting moderate or severe pain 19% higher in the standard group, 95% confidence intervals 5% to 33%). For both this chart and that for change in health, however, there was evidence of greater differences between the versions of the chart among those admitted more recently (p values for relevant interactions 0.004 and < or = 0.001 respectively). CONCLUSIONS: While the present findings give some support for the wide applicability of the standard version, there is sufficient evidence here to indicate that the time frame may influence the results, particularly for patients with a recent acute episode. In the absence of further data, then, it would seem prudent to consider a shorter time frame for such patients, especially if the aim is to assess current health status or to measure changes over a comparatively short period of time, or both.

Activities of Daily Living↗
PubMed1998

Childhood leg length and adult mortality: follow up of the Carnegie (Boyd Orr) Survey of Diet and Health in Pre-war Britain.

OBJECTIVE: To investigate the relation between childhood height, its components--leg length and trunk length--and mortality in adulthood. DESIGN: Cohort study based on the Carnegie (Boyd Orr) Survey of diet and health in pre-war Britain, 1937-9. SETTING: The 14 centres in England and Scotland that participated in the Carnegie Survey and where children were examined. Scottish centres: Aberdeen, Dundee, West Wemyss, Coaltown of Wemyss, Hopeman, Methlick, Tarves, Barthol Chapel. English Centres: Liverpool, York-shire, Barrow in Furness, Wisbech, Fulham, and Bethnal Green. SUBJECTS: 2990 boys and girls aged between 2 years and 14 years 9 months when they were examined in 1937-9. These children were drawn from 1134 families who underwent a one week assessment of family diet and home circumstances. Of these, 2547 (85%) have been traced and flagged using the NHS Central Register. MAIN OUTCOME MEASURES: Age adjusted overall, coronary heart disease, and cancer mortality in men and women in relation to age and sex specific z scores for height, leg length, and trunk length. All analyses were adjusted for the possible confounding effects of childhood and adult socioeconomic circumstances and childhood diet. RESULTS: Leg length was the component of childhood height most strongly associated with socioeconomic and dietary exposures. There was no significant relation between childhood height and overall mortality. Height-mortality relations were observed in relation to both coronary heart disease (CHD) and cancer. Leg length was the component of height most strongly related to cause specific mortality. In men and women CHD mortality increased with decreasing childhood leg length. Men in the lowest leg length quintile had a relative risk (RR) of 2.5 (95% CI 1.0 to 6.2) compared to those with the longest legs (linear trend p = 0.14). Similarly, women in the lowest leg length quintile had a RR of 3.9 (95% CI 0.8 to 19.0; linear trend p < 0.01). Adjustment for childhood and adult socioeconomic circumstances had little effect on these trends. In men, but not women, those who as children had long legs experienced increased cancer mortality. The significant relations between anthropometry and both CHD and cancer mortality were restricted to those aged < 8 years when measured. CONCLUSIONS: These findings suggest that adverse diet and living conditions in childhood, for which leg length seems to be a particularly sensitive indicator, are associated with increased risk of CHD in adulthood and possibly reduced cancer risk. It is likely that these influences operate after birth, during the first few years of life.

Adolescent↗
PubMed1998

Identification of acute porphyria: evaluation of a commercial screening test for urinary porphobilinogen.

A commercial semi-quantitative kit (Trace) for urinary porphobilinogen (PBG) in which urine is pre-treated with ion-exchange resin and the colour of the Ehrlich-PBG adduct matched against a set of surrogate standards was compared with qualitative screening methods (Watson-Schwartz) in common use. Twenty samples in which PBG had been quantitated were blindly tested by both methods in each of 13 typical user laboratories. For urine samples with raised PBG, 123 out of 129 results were positive when tested with the Trace kit. Using qualitative tests routinely in use in the various laboratories only 45 out of 119 results were unequivocally positive. Sixteen out of 91 results for pigmented urine samples with normal PBG were reported as positive using qualitative screening tests, but only one using the Trace kit. Therefore, the Trace method is far more sensitive and specific than the qualitative screening tests. It is recommended that Watson-Schwartz-type screening tests should be abandoned and, ideally, all urine samples analysed by quantitative methods. However, the Trace method is a convenient alternative which is adequate for the initial screening of symptomatic patients.

Acute Disease↗
PubMed1998

Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement. A prospective, randomized trial.

We conducted a prospective, randomized trial to compare the safety and effectiveness of the A-V Impulse System foot pump with that of low-molecular-weight heparin for reducing the prevalence of deep-vein thrombosis after total hip replacement. Of 290 patients who were to have a primary total hip replacement, 143 were randomized to receive enoxaparin (forty milligrams daily) for seven days after the operation and 147, to use the foot pump for seven days. The primary outcome measure was the prevalence of deep-vein thrombosis, as determined by venography on the sixth, seventh, or eighth postoperative day. Secondary outcome measures included transfusion requirements, intraoperative blood loss, postoperative drainage, blood-loss index, appearance of the site of the wound according to a subjective visual-analog scale, and swelling of the thigh. The patients' compliance with the regimen for use of the foot pump was monitored with an internal timing device, and their acceptance of the device was assessed with a questionnaire. Symptoms consistent with pulmonary embolism were investigated with ventilation-perfusion scanning. The patients were contacted later for detection of symptoms of venous thromboembolism that may have occurred during the first three months after discharge from the hospital. Venography was performed on 274 patients: 136 who used the foot pump and 138 who received enoxaparin. Deep-vein thrombosis was detected in twenty-four (18 per cent) of the patients who used the foot pump compared with eighteen patients (13 per cent) who received enoxaparin (95 per cent confidence interval for the difference in proportions, -3.9 to +13.0 per cent). Thrombosis in the calf was found in seven patients (5 per cent) in the former group compared with six patients (4 per cent) in the latter (95 per cent confidence interval for the difference, -4.2 to +5.8 per cent), and proximal thrombosis was observed in seventeen patients (13 per cent) in the former group compared with twelve patients (9 per cent) in the latter (95 per cent confidence interval for the difference, -3.5 to +11.1 per cent). None of these differences was significant. No patient in either group had major proximal deep-vein thrombosis; all proximal thrombi were isolated entities involving the femoral valve cusp and were of unknown importance. One patient who used the foot pump had a non-fatal pulmonary embolism. One patient who received enoxaparin had a symptomatic deep-vein thrombosis during hospitalization. Two patients (one from each group [0.7 per cent]) were readmitted to the hospital because of a symptomatic deep-vein thrombosis despite normal venographic findings at the time of discharge. There was no difference in the transfusion requirements or the intraoperative blood loss between the two groups. There were more soft-tissue side effects in the patients who received enoxaparin than in those who used the foot pump: there was more bruising of the thigh and oozing of the wound (p < 0.001 for each), postoperative drainage (578 compared with 492 milliliters; p = 0.014), and swelling of the thigh (twenty compared with ten millimeters; p = 0.03). Of 124 patients who used the foot pump and were asked about the acceptability of the device, fourteen (11 per cent) said that it was uncomfortable, twenty-one (17 per cent) reported sleep disturbance, and four (3 per cent) stated that they had stopped using the device. Conversely, ten (8 per cent) found it relaxing. We concluded that the foot pump is a suitable alternative to low-molecular-weight heparin for prophylaxis against thromboembolism after total hip replacement and that it produces fewer soft-tissue side effects. Tolerance of the device is a problem for some patients.

Aged↗
PubMed1998

Running a randomised controlled trial in a service setting: a progress report.

This paper will give a progress report on a randomised controlled trial which is currently underway in the Bristol area. Some of the key influencing literature will be summarised, followed by an overview of the study design. The paper will also highlight some of the methodological and practical advantages and disadvantages afforded by the service setting of the study.

Child, Preschool↗
PubMed1998

A randomized controlled trial and economic evaluation of counselling in primary care.

BACKGROUND: Counselling in primary care settings remains largely unevaluated. Such evaluation has been strongly recommended. AIM: To determine the relative effectiveness and cost-effectiveness of generic counselling and usual general practitioner (GP) care for patients with minor mental health problems. METHOD: A randomized controlled trial and health economic evaluation were carried out in nine general practices. Access to generic counselling (brief counselling, generally involving up to six 50-minute sessions) was compared with usual GP care. A total of 162 patients aged 16 years and over with diverse mental health problems (excluding phobic conditions and psychoses) were randomized. The Hospital Anxiety and Depression (HAD) scale, COOP/WONCA (World Organization of Family Doctors) functional health assessment charts, and the delighted-terrible faces scale were used to assess outcome four months after randomization. RESULTS: The two groups were similar at baseline. There were significant improvements in both groups between randomization and follow-up for most outcome measures, but no significant differences between the study arms. The 95% confidence limits were narrow and excluded clinically significant effects. Under various assumptions concerning the cost of secondary care referrals and of counselling time, no clear cost advantage was associated with either intervention. CONCLUSIONS: This pragmatic trial demonstrates no difference in functional or mental health outcome at four months between subjects offered access to counselling and those given usual care by their GP. There is no clear difference in the cost-effectiveness of the two interventions. Purchasers should take account of these findings in allocating resources within primary care.

Adult↗
PubMed1998

Skeletal muscle ribonuclease activities in chronically ethanol-treated rats.

Alcoholic myopathy occurs in up to two thirds of alcohol misusers and is characterized by selective atrophy of type II (anaerobic, fast-twitch) fibers; type I (aerobic, slow twitch) fibers are relatively unaffected. Both clinical and animal studies have indicated that skeletal muscle RNA content is reduced in response to ethanol exposure, and contributes to impaired protein synthesis. We hypothesized that the reduction in muscle RNA may be due to raised ribonuclease (RNase) activities that enhance RNA catabolism. To test this hypothesis, we measured the total tissue and plasma RNase activities as well as the activities of general (RNase A) and specific or "restriction" RNases (T1L, T2L) in ethanol-treated rats. Chronically treated rats were fed a nutritionally complete liquid diet with 35% of calories as ethanol. Weight-matched controls were pair-fed with isocaloric glucose. Rats were killed at time-points up to 6 weeks. For comparative purposes, the effect of acute (24 hr) starvation was also analyzed in a second group of rats relative to a group of control rats allowed free access to food and water over 24 hr. Results showed that the type II fiber-predominant plantaris muscle exhibited a significant increase in total RNase, RNase A and RNase T1L activities (increases ranged from +59% to +196%; P-values between 0.025 and 0.01) concomitant with large falls in RNA and protein content. In contrast, none of the RNase activities measured in the type I fiber-predominant soleus muscles were significantly affected; compositional changes were also smaller in the soleus. This effect was independent of reduced nutrition. In conclusion, the raised total RNase, RNase A and RNase T1L activities may contribute to the type II fiber-specific reduction in total RNA in chronically ethanol-treated rats. In turn, this may contribute to the alterations in cellular protein metabolism seen under these treatments.

Alcoholism↗
PubMed1997

The International Continence Society "Benign Prostatic Hyperplasia" Study: international differences in lower urinary tract symptoms and related bother.

PURPOSE: We investigated the international differences in the reporting of lower urinary tract symptoms and related bother in patients with symptoms suggestive of bladder outlet obstruction. MATERIALS AND METHODS: Multiple logistic regression analysis was used to evaluate international differences in the reporting of lower urinary tract symptoms and related bother in 1,271 patients from 12 countries who participated in the International Continence Society "benign prostatic hyperplasia" study. RESULTS: Country of origin was significantly associated with the prevalence of a large number of lower urinary tract symptoms (10 of 20), even after adjusting for potentially confounding variables, including physical and socio-demographic factors. Country of origin was also significantly associated with the reporting of bother but for a much smaller number of symptoms (2). CONCLUSIONS: In different countries lower urinary tract symptoms may be reported to different extents. Therefore, the results of studies in particular countries may not be generally applicable to other countries. It is likely that symptom scores will conceal this variation, necessitating consideration of individual symptoms (as in the International Continence Society "benign prostatic hyperplasia" study) or the development of country specific scoring systems. An alternative would be to focus on bother, which appeared to be much less sensitive to international differences.

Aged↗
PubMed1997

Time-course of iron overload and biochemical, histopathological and ultrastructural evidence of pancreatic damage in hypotransferrinaemic mice.

1. The time course of iron overload of the pancreas in hypotransferrinaemic mice maintained on a standard rodent diet was compared with biochemical and histological markers of tissue damage. 2. Pancreatic iron levels increased linearly from weaning till 9 months of age [73.3 nmol/mg of tissue (SEM 9.9; n = 5) compared with 0.9 nmol/mg of tissue (SEM 0.1; n = 4) in age-matched controls] then decreased linearly till at least 18 months of age. 3. Investigation of tissue distribution of newly absorbed radioiron suggested that significant redistribution of iron from liver to pancreas (rather than direct dietary iron sources) must be invoked to explain the rate of pancreatic iron loading in hypotransferrinaemic mice. 4. Pancreatic epithelial cells first showed altered morphology at 9 months of age. At 12 months of age, the pancreatic epithelium had developed a micronodular appearance, with large numbers of acini replaced by atrophic, degenerated acinar cells. Increased collagen fibre deposition was evident by trichrome staining and by electron microscopy. Biochemical markers of pancreatitis (serum lipase, tissue pancreatitis-associated protein mRNA) were elevated before 9 months of age, whereas the levels of pancreatic amylase mRNA declined from 9 months of age. 5. The data suggest that iron loading of hypotransferrinaemic mouse pancreas proceeds up to a threshold level at 9 months of age followed by a progressive atrophy of secretory epithelium. The hypotransferrinaemic mouse pancreas is a useful model system for investigation of parenchymal cell damage by iron.

Acute-Phase Proteins↗
PubMed1997

Iron metabolism in transgenic mice with hypoplastic anaemia due to incomplete deficiency of erythropoietin.

Iron overload is a serious complication of many forms of anaemia, arising in part from mechanisms associated with compensatory increases in erythropoiesis. To investigate other mechanisms by which anaemia itself may perturb iron metabolism, without the confounding effects of compensatory erythropoiesis, we studied transgenic mice with a partially disabling insertion in the erythropoietin gene, which manifested as incomplete erythropoietin deficiency. Mice were studied aged 7-8 weeks. Haemoglobin concentrations were 6.6 +/- 0.8 g/dl in mice homozygous for the modified erythropoietin gene, 12.9 +/- 2.2 g/dl in heterozygous mice and 14.1 +/- 1.0 g/dl in controls. Homozygous mice showed significant hepatic iron loading (2-fold increase in liver non-haem iron, compared with heterozygous mice and normal controls, with iron staining principally in the periportal hepatocytes). Absorption studies using 59Fe showed increased uptake from the lumen of an in vivo isolated duodenal segment in homozygous mice, although at this point in time overall transfer of radioiron to the circulation and other tissues (mucosal transfer) was not different from controls. These observations demonstrate that anaemia can lead to hepatic iron loading even in the absence of increased erythropoiesis, and are consistent with the possibility that anaemic hypoxia can enhance mucosal iron uptake by the duodenal enterocyte.

Absorption↗