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Biomedical subjects

A Fry

Publications and source records attributed to A Fry.

At least 19 recordsLinked to original sources
PubMed2005

Infections associated with cantaloupe consumption: a public health concern.

Fresh produce is an important part of a healthy diet and is consumed in greater quantity in the United States than ever before. Consumption of cantaloupe has recently been associated with several large outbreaks of infections in North America, highlighting the need for a better understanding of practices and processes that may contribute to contamination. We reviewed all cantaloupe-associated outbreaks that were reported to the Centers for Disease Control and Prevention (CDC) and published in the literature. Twenty-three outbreaks occurred between 1984 and 2002; 1434 people became ill, 42 were hospitalized, and two died in these outbreaks. Aetiological agents in the outbreaks included five serotypes of Salmonella enterica, Campylobacter jejuni, Escherichia coli O157:H7, and norovirus. We reviewed processes contributing to cantaloupe contamination, conditions affecting survival and growth of bacterial pathogens on melons, and potential methods for sanitization. For maximum safety, industry, federal, and international partners must collaborate to ensure that appropriate interventions are in place to minimize the risk of contamination and prevent the growth of pathogens during cantaloupe production, processing, storage, and preparation.

Cucumis melo↗
PubMed2004

Patient satisfaction with two different models of cancer genetic services in south-east Scotland.

There is a need to integrate primary- and secondary-care cancer genetic services, but the most appropriate model of service delivery remains unclear. This study reports patients' expectations of breast cancer genetic services and a comparison of their satisfaction with two service models. In the first model, risk assessment was carried out using mailed family history data. Women estimated as being at high/moderate risk were offered an appointment at the familial breast cancer clinic, and those at low risk were sent a letter of reassurance. In the second model, all women were seen by a genetic nurse specialist, who assessed risk, referred high/moderate-risk women to the above clinic and discharged those at low risk. Over 60% of all women in the study regarded access to breast screening by mammogram and regular check-ups as very important. This underlines the demand for a multidisciplinary service providing both clinical genetic and surgical services. Satisfaction was high with both models of service, although significantly lower among women not at increased cancer risk and thus not offered a clinical check-up and mammography. Increased cancer worry was associated with a greater expressed need for information and for reassurance through follow-up clinical checks and mammography. Better targeting of counselling to the expressed concerns and needs of these women is required to improve the service offered. GPs and patients expressed no clear preference for any specific service location or staffing configuration. The novel community service was less expensive in terms of both staff and patient costs. The potential to decrease health staff/patient contact time and to employ nurse practitioners with both clinical genetic and oncology training should be explored further. The rapidly rising demand for these services suggests that the evaluation of further new models needs to continue to be given priority to guide the development of cancer genetic services.

Adolescent↗
PubMed2003

Referrals of women with a family history of breast cancer from primary care to cancer genetics services in South East Scotland.

As part of a cluster randomised trial to assess an alternative model of cancer genetics services, we gathered data on all referrals from general practitioners (GPs) to cancer genetics services in South East Scotland over a 4-year period. The referral rate per 1000 patients rose by 48% from 0.21 in the 2-year period before the trial to 0.31 during the trial. This increase was much greater in the trial group offered the GP clinic service (64% increase compared to a 38% increase in those referred to the regional service). Thus, the offer of a more local service appeared to have a marked effect on GP management of these women. Referral rates to cancer genetics services from general practices varied widely with higher referral rates from practices with more female partners. There was a negative correlation between referral rates and practice area deprivation scores. However, this was not found during the trial in the group which offered clinics in general practice, the provision of clinic appointments nearer to the homes of more socially deprived women resulting in improved access to women from deprived areas. The interaction with the GP appears to be associated with an inappropriate level of interest in and expectation of the appropriateness of genetic testing. The provision of the clinics within general practice did not result in higher levels of confidence among GPs in managing these women.

Breast Neoplasms↗
PubMed2003

A randomised controlled trial of breast cancer genetics services in South East Scotland: psychological impact.

This study compared the psychological impact of two models of breast cancer genetics services in South East Scotland. One hundred and seventy general practices were randomised to refer patients to the existing standard regional service or the novel community-based service. Participants completed postal questionnaires at baseline (n=373), 4 weeks (n=276) and 6 months (n=263) to assess perceived risk of breast cancer, subjective and objective understanding of genetics and screening issues, general psychological distress, cancer worry and health behaviours. For participants in both arms of the trial, there were improvements in subjective and objective understanding up to 4 weeks which were generally sustained up to 6 months. However, improvements in subjective understanding for the women at low risk of breast cancer (i.e. not at significantly increased risk) in the standard service arm did not reach statistical significance. Cancer worry was significantly reduced at 6 months for participants in both arms of the trial. The two models of cancer genetics services tested were generally comparable in terms of the participants' psychological outcomes. Therefore, decisions regarding the implementation of the novel community-based service should be based on the resources required and client satisfaction with the service.

Adolescent↗
PubMed2001

Cancer risk perceptions and distress among women attending a familial ovarian cancer clinic.

Of 230 women referred to a familial ovarian cancer clinic, 196 (85%) completed a questionnaire before they attended. The data collected included pre-counselling risk perceptions and an assessment of distress. Respondents were more likely to underestimate (44%) than overestimate (19%) their risk. Those with a family history of breast and ovarian cancer (HBOC) were particularly likely to underestimate their ovarian cancer risk. The variables assessed in this study - sociodemographic, family history, distress, anxiety proneness, coping style and beliefs about health control - explained little of the observed variation in accuracy of risk perception. On the General Health Questionnaire (GHQ-30) 30% of the sample obtained scores above the cut-off (>/= 6) recommended for screening for 'case-level' psychological distress. Women exhibiting case-level distress were more likely to overestimate their risk (OR = 2.3). On univariate analysis low internal locus of control was associated with 'case-level' distress (P = 0.008). On multiple regression the best predictors of 'caseness' were high-trait anxiety, being a graduate and inaccurate risk perception. There was no difference in the level of distress shown by women with HBOC vs. those with a history of ovarian cancer only. Implications of these findings for the counselling needs of the women are discussed. The effectiveness of the clinic in improving the accuracy of risk perceptions and relieving distress is being assessed.

Adult↗
PubMed2001

Deciding about prophylactic oophorectomy: what is important to women at increased risk of ovarian cancer?

BACKGROUND: Little is known about the factors that women at increased risk of ovarian cancer consider to be important when deciding about prophylactic oophorectomy, surgery to remove the ovaries before they develop cancer. METHODS: Women who had undergone prophylactic oophorectomy (surgical group; n = 30) were compared with women who remained on the ovarian screening program (nonsurgical group; n = 28) on their importance ratings for a number of relevant decision-making factors. RESULTS: The most important decision-making factor across all subjects was reducing risk of ovarian cancer, but the single best predictor of group membership was the importance attributed to reducing cancer worry. Women who rated this factor as more important were more likely to be in the surgical group. No women identified the increased risk of heart disease and osteoporosis as issues for consideration. CONCLUSIONS: The desire to reduce cancer worry is likely to be the most important factor in a woman's decision to proceed to prophylactic oophorectomy. In view of the current imprecision in risk estimates given to women considering this option, cancer worry may override a more rational consideration of the costs and benefits of surgery.

Adult↗
PubMed2001

A family history of breast cancer: women's experiences from a theoretical perspective.

Individuals at increased risk of developing breast cancer due to their family history of the disease face a number of uncertainties. Personal cancer risk estimates are imprecise and current methods for early detection or prevention are not 100% effective. It is therefore not surprising that adverse psychosocial outcomes have been described within this population. Research attempting to predict the incidence of distress and dysfunction in individuals at increased risk of cancer has been largely a-theoretical and has overlooked a number of potentially important predictive variables. In particular, the influence of personal experience of cancer through involvement with affected relatives has been neglected. There are strong theoretical grounds for hypothesising that dimensions of personal experience may influence response to cancer risk. This paper discusses the potential impact of personal experience on risk perception, illness representations and decision-making. Systematic research in this area may improve predictions of outcome of cancer genetic counselling and inform the clinical process.

Breast Neoplasms↗
PubMed2001

Women at risk of ovarian cancer: attitudes towards and expectations of the familial ovarian cancer clinic.

Familial ovarian cancer clinics are a recent development and little is known about the characteristics of women who attend. One hundred and ninety-seven women with a family history of ovarian cancer completed a questionnaire prior to their initial attendance at the Familial Ovarian Cancer Clinic in Edinburgh. Issues relating to screening procedures were the most commonly cited barriers to attendance, with a proportion finding gynaecological examination embarrassing (17.0%) or uncomfortable (18.0%). Expectations of the clinic were high in terms of access to resources and information. The vast majority of women would prefer to have regular screening (94.7%) and genetic testing (93.2%) if it were available. Attitudes to prophylactic surgery and chemoprevention were more diverse, but would be considered by 54.3% and 43.9% of respondents respectively. Although the current screening procedure for ovarian cancer is of unproven efficacy, a high proportion of women believed in its ability to reduce mortality (77.9%) and to detect tumours at an early stage (65.8%). There was a trend for women to believe this more strongly at follow-up. This study highlights the need to make women more aware of the limitations of current ovarian cancer screening techniques, particularly where the alternative management strategy of prophylactic surgery might otherwise be dismissed.

Adult↗
PubMed2001

'The experience of community mental health case management provided from an acute in-patient psychiatric unit'.

In Australia, case management is the cornerstone of mental health service delivery for seriously ill clients living in the community. In this study, case management was provided from an acute, inpatient psychiatric unit; a model thought to be unique. Findings from this qualitative study explicated the experience of case management from client and case manager (CM) perspectives. They note the nature, purpose, processes and outcomes of case management within that context. Findings were positive, suggesting clients and CM's develop a therapeutic alliance through which interventions are implemented and which result in clients experiencing personal (re) integration and enhanced well-being. These findings are discussed and they suggest an alternative model of service delivery well regarded by both clients and CM's.

Activities of Daily Living↗
PubMed1999

The role of community mental health nurses in educating clients and families about schizophrenia.

The aim of the study was to investigate the role of community mental health nurses in educating clients and families about schizophrenia. A random sample of community mental health nurses was surveyed using a postal questionnaire. Results showed that most nurses did not use a specific approach for education. Families were educated when clients were admitted to hospital and clients were included when they regained the ability to process information. All nurses provided practical advice to families coping with clients' unpredictable behaviours. The client's home was mostly used for education. Clients and families were often in denial of the illness. Time constraints restricted the nurses' role of providing education. Nurses reported that psycho-educational theories or models were not incorporated into their basic professional education. Nurses require the necessary knowledge, skills and confidence to competently perform this role.

Attitude of Health Personnel↗
PubMed1999

GPs' views on their role in cancer genetics services and current practice.

BACKGROUND: Increasing demand for cancer genetics services has necessitated an urgent review of how these services are organized and, in particular, identification of an effective role for primary care. OBJECTIVES: We aimed to assess the views of GPs on their role in cancer genetics services and their confidence in performing that role; to assess their understanding of cancer genetics, current practice and referral behaviour; and to identify needs for information and training to enable GPs to play an effective role in these services. METHOD: A cross-sectional questionnaire survey of GPs was conducted through general practices in SE Scotland; 397 (response rate 59.3%) GPs returned a completed questionnaire. Outcome measures were: responders' perceptions of their role in cancer genetics services; confidence within that role; understanding of cancer genetics; current practice regarding patients presenting with concerns about their family history of cancer; and perceived information and training needs. RESULTS: GPs identified their role to be: taking a family history; making appropriate referrals to specialist services; providing emotional support; teaching breast self-examination; and discussing need for screening. Lack of confidence within this role was reflected in low levels of understanding of cancer genetics and in inappropriate referral practices. Concerns were expressed about the increasingly specialist role demanded of primary care. A desire for referral guidelines and community genetics clinics was identified. CONCLUSIONS: GPs readily identify a role for themselves in cancer genetics services, but admit to a lack of confidence in this area, calling for clear referral guidelines and specialist community support. Current inappropriate referral to specialist services results from a lack of confidence in estimating cancer risk, highlighting the need for the development of clear referral criteria. Given the rapidly increasing demand for cancer genetics services and the vital role of primary care, it is important to identify a model of these services that facilitates effective involvement of GPs without further increasing their workload.

Attitude of Health Personnel↗
PubMed1998

Sleep abnormalities demonstrated by home polysomnography in teenagers with chronic fatigue syndrome.

To provide objective information about sleep physiology in young people with chronic fatigue syndrome (CFS), home polysomnography (PSG) was performed on 18 teenagers, aged 11-17 years, in whom CFS had been diagnosed according to internationally accepted criteria. The results were compared with those for healthy controls matched individually for gender and age. Compared with controls, CFS subjects showed significantly higher levels of sleep disruption by both brief and longer awakenings. Disruption of sleep in this way could at least contribute to the daytime symptoms of young people with CFS. The underlying cause of the disruption needs to be considered in each individual case. Further research is required to clarify the relative contribution of this neurobiological aspect of CFS in young people.

Adolescent↗
PubMed1998

Spirituality, communication and mental health nursing: the tacit interdiction.

Spirituality was embedded in the underpinnings of nursing when care of the sick was a 'good work' in the medieval monastic Christian tradition and human beings were recognized as spiritual beings. Contemporary mental health nursing practice is slow to recognize the value of the spiritual. This paper explores the nature of spirituality and communication about spirituality in mental health nursing practice. Philosophical, biological, psychiatric and psychological arguments antithetical to spirituality are explored. Effective mental health nursing practice incorporates conceptual frameworks and skills that reflect universal spiritual wisdom by means of various therapeutic modalities.

Communication↗
PubMed1996

Temporal discounting in choice between delayed rewards: the role of age and income.

This study examined the effects of age and income temporal discounting (i.e. the decrease in the subjective value of a reward as the delay to its receipt increases). The value of delayed hypothetical monetary rewards was discounted at similar rates by adults of different ages but similar income levels, but at different rates by adults of similar age but different income levels. Specifically, lower income older adults showed a greater degree of temporal discounting than did either upper income older adults or upper income younger adults, but there were no age differences in discounting between the upper income groups. Comparison of these findings with those of a previous study (Green, Fry, & Myerson, 1994) suggests that impulsivity in decision making declines rapidly in young adulthood, reaching stable levels in the 30s. Further, age and income appear to interact in determining the impulsivity of decision making by adults.

Adult↗
PubMed1995

Energy-rich phosphates in slow and fast human skeletal muscle.

We investigated the relationship between energy-rich phosphate content and muscle fiber-type composition in human skeletal muscle using a combination of 31P-nuclear magnetic resonance spectroscopy (NMR), histochemical, and biochemical analyses of muscle biopsies. Localized 31P spectra were collected simultaneously from the predominantly slow-twitch soleus muscle and the mixed (fast-twitch and slow-twitch) medial and lateral gastrocnemius muscles, using B1-insensitive Hadamard Spectroscopic Imaging. Biopsy samples were taken from the soleus and lateral gastrocnemius muscles before NMR investigation and analyzed for fiber type composition and succinic dehydrogenase (SDH) activity. Fiber-type composition was determined based both on myofibrillar actomyosin ATPase activity combined with cross-sectional area and on myosin heavy-chain composition. Localized spectroscopy demonstrated a significantly (P < 0.001) higher P(i)/phosphocreatine ratio in the soleus muscle (0.15 +/- 0.01) compared with the medial (0.12 +/- 0.01) and lateral (0.10 +/- 0.0) gastrocnemius. However, in vitro analysis of muscle biopsies showed only a moderate relationship between the basal phosphate content and myofibrillar actomyosin ATPase-based fiber-type composition and SDH activity, respectively.

Adolescent↗
PubMed1994

Allelic differences in TCR gamma-chains alter gamma delta T cell antigen reactivity.

Mouse gamma delta T cell hybridomas from various strains that express a TCR-V gamma 1/V delta 6 respond weakly to an autologous Ag and more strongly to a short segment of the mycobacterial heat shock protein-60 (HSP-60). However, V gamma 1/V delta 6 hybridomas derived from AKR mice show greatly reduced or absent responses to these stimuli. To determine whether the lack of response in these AKR hybridomas is caused by polymorphisms found in the expressed AKR gamma and TCR-delta genes or, instead, stems from other genes in AKR, we crossed an AKR mouse with a responder mouse, C57BL/10 (B10), and prepared hybridomas from F1 progeny. Expression of an AKR V gamma 1-J gamma 4-C gamma 4 gene correlated with nonresponsiveness, whereas expression of a B10 V gamma 1-J gamma 4-C gamma 4 gene in most hybridomas ensured responses to both self Ag and the HSP-60 peptide. An allelic difference in the expressed V gamma 6 gene was irrelevant to these responses. Moreover, transfection of a functional B10 V gamma 1-J gamma 4-C gamma 4 gene into an F1 hybridoma variant that had lost the AKR version of this gene restored responses. The allelic gamma gene products differ at nine amino acids in the V region, and three amino acids in the C region. In addition, the AKR C gamma 4 region contains a 16-amino acid insertion. We propose that amino acid differences among those encoded by the AKR V gamma 1-J gamma 4-C gamma 4 gene are responsible for the lack of response, and reduce the ability of the TCR-gamma delta to bind the relevant Ag.

Alleles↗