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Biomedical subjects

A Hart

Publications and source records attributed to A Hart.

At least 37 records · Page 2Linked to original sources
PubMed2001

Effect of acupuncture on nausea of pregnancy: a randomized, controlled trial.

OBJECTIVE: To compare acupuncture with sham (placebo) acupuncture for treatment of nausea of pregnancy. METHODS: In a subject- and observer-masked, randomized, controlled trial in the maternity unit at Exeter Hospital, we gave 55 women between 6 and 10 weeks' gestation genuine, traditional-style acupuncture or sham treatment with a cocktail stick on three or four occasions over 3 weeks. The main outcome measure was nausea score, as determined by subject report on a visual analogue scale in a daily diary. Anxiety and depression also were assessed. RESULTS: Nausea scores decreased from a median of 85.5 (interquartile range 71.25-89.75) to 47.5 (interquartile range 29.25-69.5) in the acupuncture group and from 87.0 (interquartile range 73.0-90.0) to 48.0 (interquartile range 14.0-80.0) in the sham treatment group. There was strong evidence of a time effect (P <.001) but no evidence of a group effect (P =.9) or a group-time interaction (P =.8). Similarly, there was evidence of time effects in scores for anxiety and depression but no group differences. The study had a power of 95% to detect significant differences in nausea scores. CONCLUSION: Acupuncture was as effective in treating nausea of pregnancy as a sham procedure.

Acupuncture Therapy↗
PubMed2001

Randomized controlled trials: the control group dilemma revisited.

In some randomised controlled trials the nature of the therapy means that subjects cannot or should not be blinded. Such studies need careful design. Particular attention needs to be given to the choice of control group and the nature of the informed consent obtained from subjects, because these affect the precise research question being addressed. A survey of published studies was carried to investigate how these issues had been tackled. The paper summarizes key findings from the survey. If the research question is about the specific effect of a therapy sometimes a good case can be made for a second control group which is 'attention-controlled'. There is a need for more detailed justifications of such design decisions in published studies.

Complementary Therapies↗
PubMed2001

Understanding the community perspectives of trachoma: The Gambia as a case study.

Trachoma has justifiably attracted an incredibly large amount of research interest and literature over the last several decades. Perhaps, the area which is least explored is the social aspect of the disease. Most of the major constraints to trachoma control on the global scale appear to be concerned with this aspect of the disease. Recently, a study was conducted in The Gambia with the aim of highlighting the socio-cultural determinants of trachoma. We applied qualitative methods of Focus Group Discussion and Semi-structured interview to explore the local people's concepts of the disease among two traditional ethnic groups, the Jolas and the Manjagos, in five rural communities. Our results show that there appears to be a poor understanding of the chronic nature of the active inflammatory phase of trachoma among the local people. But more importantly, there is a lack of mental connection between this childhood infection and blindness resulting from trichiasis in adults. This probably explains why it is difficult for the people in these communities to see the need for prolonged use of antibiotic eye ointment as required in the treatment of active inflammatory trachoma. Moreover, the local concepts about the cause(s) of the disease tend to compel the people to seek the traditional herbal remedies first, though there is adequate knowledge and experience among them that modern methods of treatment may produce cure, as in the case of corrective lid surgery for trichiasis. This ambivalent attitude of the people to health services appear to be a universal phenomenon in many local communities in Africa, and perhaps hinges on the local people's perspective of the disease, which varies from place to place. We conclude that for any intervention strategy to achieve the set goals of eliminating trachoma in spite of these constraints, community support and participation is essential, and in order to achieve this, the health care provider needs to have a better understanding of the community perspectives of the disease.

Adult↗
PubMed2001

Serum antibodies to group A streptococcal extracellular and cell-associated antigens in Egyptians with post-streptococcal diseases.

We investigated serum antibodies to a comprehensive array of group A streptococcal antigens and superantigens in Egyptian subjects. Antibodies to Streptococcus pyogenes cell-associated proteins and to proteins released by rapidly dividing S. pyogenes were compared in four patient groups with different post-streptococcal diseases and in healthy controls. Enzyme-linked immunosorbent assays showed that total Ig and IgG to extracellular antigens were significantly higher in patients with acute rheumatic fever (ARF) compared to healthy controls, but no differences were found in either total Ig or IgG titres to cell-associated proteins between any of the groups. Western blotting showed that multiple extracellular and cell-associated antigens, covering a wide range of molecular masses, were recognised by all sera, including healthy controls. No evidence was obtained for putative dominant antigens associated with any disease group, although a low molecular mass cell-associated protein (approximately 4 kDa) was clearly recognised by two-thirds of subjects irrespective of disease status. These findings demonstrate that raised serum Ig and IgG titres to extracellular, but not cell-associated, S. pyogenes antigens are a feature of ARF in this population, and suggest that multiple S. pyogenes antigens contribute to this response.

Antibodies, Bacterial↗
PubMed2001

Rapid receptor-clustering assay to detect uropathogenic and diarrheal Escherichia coli isolates bearing adhesins of the Dr family.

Infections caused by Escherichia coli isolates expressing adhesins of the Dr family are associated with diarrhea and urinary tract infections, and these E. coli strains recognize the complement regulatory protein decay-accelerating factor (DAF) as their receptor. Clustering of the DAF receptor at the sites of bacterial adherence to epithelial cells is proposed as an alternative to PCR assay for rapid detection of Dr-positive E. coli.

Adhesins, Escherichia coli↗
PubMed2001

Survey of adverse events following acupuncture (SAFA): a prospective study of 32,000 consultations.

Acupuncture is increasingly used, so it is important to establish whether its benefits outweigh its risks. Numerous case reports of adverse events show that acupuncture is not free of risk, but accurate data from prospective investigations is scarce. A prospective survey was undertaken using intensive event monitoring. Forms were developed for reporting minor events each month and significant events as they occurred. The sample size was calculated to identify any adverse events that occurred more frequently than once in 10,000 consultations. Acupuncturists were recruited from two professional organisations in the UK. Seventy-eight acupuncturists, all doctors or physiotherapists, reported a total of 2178 events occurring in 31,822 consultations, an incidence of 684 per 10,000 consultations. The most common minor adverse events were bleeding, needling pain, and aggravation of symptoms; aggravation was followed by resolution of symptoms in 70% of cases. There were 43 significant minor adverse events reported, a rate of 14 per 10,000, of which 13 (30%) interfered with daily activities. One patient suffered a seizure (probably reflex anoxic) during acupuncture, but no adverse event was classified as serious. Avoidable events included forgotten patients, needles left in patients, cellulitis and moxa burns. In conclusion, the incidence of adverse events following acupuncture performed by doctors and physiotherapists can be classified as minimal; some avoidable events do occur. Acupuncture seems, in skilled hands, one of the safer forms of medical intervention.

Acupuncture Therapy↗
PubMed2000

Single blind, randomised trial of efficacy and acceptability of oral picolax versus self administered phosphate enema in bowel preparation for flexible sigmoidoscopy screening.

OBJECTIVE: To compare the acceptability and efficacy of two methods of self administered bowel preparation for flexible sigmoidoscopy screening: a single phosphate enema and a single sachet of Picolax. DESIGN: Single blind, randomised trial. SETTING: Endoscopy units of two general hospitals. PARTICIPANTS: 1442 men and women aged 55-64 years who had agreed to be screened by flexible sigmoidoscopy. MAIN OUTCOME MESURESs: Attendance rates, compliance with allocated preparations, adverse effects, quality of bowel preparation, procedure time, and yield of neoplasia. RESULTS: Compliance with the enema was higher than with the Picolax (608 (84%) v 566 (79%); difference 6%, 95% confidence interval 2% to 10%). Almost half of those who refused Picolax used an enema at home. Wind, incontinence, and sleep disturbance were more frequent in the Picolax group than the enema group; bottom soreness was more frequent in the enema group. Around 30% (187) found the diet restriction required by Picolax difficult; 78% (471) found the enema easy to administer. The quality of preparation was better with the enema; the proportion of procedures complete to the descending colon was greater and the mean duration of the procedure was shorter. There was no significant difference in polyp detection rates. CONCLUSION: A single phosphate enema self administered around one hour before leaving home is a more acceptable and effective method of preparing the distal bowel for flexible sigmoidoscopy than Picolax.

Administration, Oral↗
PubMed2000

Psychosocial influences on older adults' interest in participating in bowel cancer screening.

BACKGROUND: As part of a multicenter, randomized controlled trial of the efficacy of flexible sigmoidoscopy for the prevention of bowel cancer, an investigation of the predictors of screening interest was carried out in a subsample of older adults. METHOD: The aim of the study was to establish the predictive power of the Health Belief Model (HBM) and to evaluate the contribution of HBM elements in mediating the effect of other demographic and health variables which have been found to be associated with screening interest and participation. A total of 5,099 participants were sent a postal questionnaire which examined screening interest, attitudes toward screen ing (benefits and barriers), perceived bowel cancer risk, bowel cancer worry, bowel symptoms, health status, state anxiety, and optimism. A total of 3,648 questionnaires were returned completed, giving a response rate of 71.5%. RESULTS: The results showed that threat, barriers, and benefits explained 47% of the variance in interest. Demographic and health variables were also associated with screening interest, although most of their effect was mediated by the HBM constructs. DISCUSSION: This community study in older adults showed a high level of interest in participating in screening. The large sample size provided the opportunity to test the value of the HBM model and to examine mediation of demographic and health variables. The HBM proved to be a good model of screening interest. These results further our understanding of the decision processes in participating in cancer screening and point to directions to increase the level of participation in community samples.

Attitude to Health↗
PubMed2000

Fli-1 is required for murine vascular and megakaryocytic development and is hemizygously deleted in patients with thrombocytopenia.

The ETS gene Fli-1 is involved in the induction of erythroleukemia in mice by Friend murine leukemia virus and Ewings sarcoma in children. Mice with a targeted null mutation in the Fli-1 locus die at day 11.5 of embryogenesis with loss of vascular integrity leading to bleeding within the vascular plexus of the cerebral meninges and specific downregulation of Tek/Tie-2, the receptor for angiopoietin-1. We also show that dysmegakaryopoiesis in Fli-1 null embryos resembles that frequently seen in patients with terminal deletions of 11q (Jacobsen or Paris-Trousseau Syndrome). We map the megakaryocytic defects in 14 Jacobsen patients to a minimal region on 11q that includes the Fli-1 gene and suggest that dysmegakaryopoiesis in these patients may be caused by hemizygous loss of Fli-1.

Animals↗
PubMed2000

A blinded investigation into the accuracy of reflexology charts.

OBJECTIVES: Reflexology is an increasingly popular complementary therapy in which parts of the body are deemed to be represented on the soles of the feet. The aim of this study was to investigate whether this representation can be used as a valid method of diagnosis. METHODS: Three experienced reflexologists took part in this study. Eighteen adults with one or more of six specified conditions were identified from primary care records. Two reflexologists, who were blinded to the patients' conditions and monitored, then examined each patient's feet and rated the probability that each of the six conditions was present. RESULTS: There is little evidence that the distribution of ratings vary with the status of the condition. Receiver operating curves suggest that this diagnostic method is very poor at distinguishing between the presence and absence of conditions. Inter-rater reliability (kappa) scores were very low, providing no evidence of agreement between the examiners. CONCLUSION: Despite certain limitations to the data provided by this study, the results do not suggest that reflexology techniques are a valid method of diagnosis.

Adult↗
PubMed2000

The treatment of 'acquired tonsillar herniation' in pseudotumour cerebri.

Acquired tonsillar herniation and syrinx formation are recognized complications of a lumboperitoneal shunt used to treat conditions of increased CSF volume. Treatment of this complication is by ventriculoperitoneal shunt or foramen magnum decompression. We describe the first case of acquired tonsillar herniation in a pseudotumour cerebri (following lumboperitoneal shunt insertion) that responded partly to ventriculoperitoneal shunt insertion and more completely to foramen magnum decompression. Our case demonstrates that a ventriculoperitoneal shunt is not always sufficient in treating this complication and reversing visual deterioration. Foramen magnum decompression may therefore be a sight saving procedure in pseudotumour cerebri with acquired tonsillar herniation and may be important in understanding the pathogenesis of conditions of increased CSF volume.

Adult↗
PubMed2000

Controversial attachments: the indirect treatment of fostered and adopted children via Parent Co-Therapy.

Fostered and adopted children often show a large array of psychosocial problems and are conceptualized as having attachment disorders. It can be necessary to engage such children in direct mental health treatment, in addition to interventions set up to deal with their problems through agencies such as Education and Social Services. In order to protect children from a multitude of treating professionals, thereby potentially further weakening the emerging parental attachments, a model is proposed of indirect treatment of children, with the adoptive parents as co-therapists. This elevates the status of parents and is controversial in child mental health work as it challenges traditional hierarchies. We refer to this model, based on a single case study, as Parent Co-Therapy (PCT). It is proposed that this may be a suitable treatment model for fostered and adopted children, particularly in the early years of placement. The model has the potential to strengthen the children's attachments to the parents and vice versa, with a concomitant reduction in symptomatology.

Adoption↗
PubMed2000

Are acupuncture points tender? A blinded study of Spleen 6.

OBJECTIVES: To explore the methodology for investigating the tenderness of acupuncture points, with particular reference to the hypothesis that the point Spleen 6 (SP6) is more tender in women than in men. DESIGN: Single-blind, observational study with volunteers. SETTING: University of Exeter, U.K. SUBJECTS: Student volunteers, 13 male and 13 female. OUTCOME MEASURES: Pressure thresholds at SP6, a control acupuncture point Stomach 36, and two nonacupuncture control sites in each leg were measured weekly for 4 weeks. RESULTS: No statistically significant differences were found between the pressure thresholds of SP6 in women and those in men. CONCLUSION: The present study provides no strong evidence to support the hypothesis that the acupuncture point SP6 is more tender in women and in men. Recommendations for further investigations are discussed.

Acupuncture Points↗