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Biomedical subjects

A Stewart

Publications and source records attributed to A Stewart.

At least 37 records · Page 2Linked to original sources
PubMed2004

Sex and ethnic differences in 2nd to 4th digit ratio of children.

BACKGROUND: The ratio between the length of the 2nd or index finger and the 4th or ring finger (2D:4D) differs between the sexes, such that males have lower 2D:4D than females, and shows considerable ethnic differences, with low values found in Black populations. It has been suggested that the sex difference in 2D:4D arises early in development and that finger ratio is a correlate of prenatal testosterone and oestrogen. In children, 2D:4D has been reported to be associated with measures of fetal growth, congenital adrenal hyperplasia, developmental psychopathology, autism and Asperger's syndrome. However, little is known of the patterns of sex and ethnic differences in the 2D:4D ratio of children. AIM: To investigate sex and ethnic differences in 2D:4D in Caucasian, Oriental and Black children. STUDY DESIGN: Population survey. METHOD: The 2D:4D ratio was measured from photocopies of the right hand of Berber children from Morocco, Uygur and Han children from the North-West province of China, and children from Jamaica. RESULTS: There were 798 children in the total sample (90 Berbers, 438 Uygurs, 118 Han, and 152 Jamaicans). The 2D:4D ratio was lower in males than in females and this was significant for the overall sample and for the Uygur, Han and Jamaican samples. There were significant ethnic differences in 2D:4D. The Oriental Han had the highest mean 2D:4D, followed by the Caucasian Berbers and Uygurs, with the lowest mean ratios found in the Afro-Caribbean Jamaicans. The sex and ethnic differences were independent of one another with no significant interaction effect. In the overall sample there were no associations between 2D:4D and age and height. CONCLUSIONS: In common with adults, the 2D:4D ratio of children shows sex and ethnic differences with low values found in a Black group. There was no overall association between 2D:4D and age and height suggesting that the sex and ethnic differences in 2D:4D appear early and do not show appreciable change with growth.

Anthropometry↗
PubMed2004

A chronic disease management programme can reduce days in hospital for patients with chronic obstructive pulmonary disease.

BACKGROUND: A steady increase in chronic obstructive pulmonary disease (COPD) admissions was addressed by enhancing primary care to provide intensive chronic disease management. AIM: To compare the effect of a disease management programme, including a COPD management guideline, a patient-specific care plan and collaboration between patients, general practitioners, practice nurses, hospital physicians and nurse specialists with conventional care, on hospital admissions and quality of life. METHODS: One hundred and thirty-five patients with a clinical diagnosis of moderate to severe COPD were identified from hospital admission data and general practice records. General practices were randomized to either conventional care (CON), or the intervention (INT). Pre- and post-study assessment included spirometry, Shuttle Walk Test, Short Form-36, and the Chronic Respiratory Questionnaire (CRQ). Admission data were compared for 12 months prior to and during the trial. RESULTS: For respiratory conditions, mean hospital bed days per patient per year for the INT group were reduced from 2.8 to 1.1, whereas those for the CON group increased from 3.5 to 4.0 (group difference, P = 0.030) The INT group also showed an improvement for two dimensions of the CRQ, fatigue (P = 0.010) and mastery (P = 0.007). CONCLUSIONS: A chronic disease management programme for COPD patients that incorporated a variety of interventions, including pulmonary rehabilitation and implemented by primary care, reduced admissions and hospital bed days. Key elements were patient participation and information sharing among healthcare providers.

Adult↗
PubMed2004

The neurodevelopmental progress of infants less than 33 weeks into adolescence.

BACKGROUND: Several studies have shown an increased incidence of neurodevelopmental impairment in very preterm survivors at school age compared with controls. AIM: To compare findings in the same cohort at 8 years and 15 years. METHODS: A total of 151 of the 224 eligible infants born before 33 weeks of gestation from 1979 to 1982, and who were living in the UK, were assessed at 8 and 15 years. Items common to both assessments were compared to evaluate changes in neurodevelopmental function. The assessment included a structured neurological examination, psychometric tests using the WISC-R (in subjects born in 1981-82), a test of visuomotor integration (Beery), and a school questionnaire. RESULTS: There was a significant increase in the proportion of subjects classified as impaired with disability from 11% at 8 to 22% at 14-15 years of age. The proportion of subjects classified as impaired without disability increased from 16% at 8 to 26% at 14-15 years of age. Full scale IQ decreased from 104 to 95 from childhood to adolescence, and more adolescents (24%) were requiring extra educational provision than they had at the age of 8 years (15%). CONCLUSION: Results indicate that between the ages of 8 and 15 years in this cohort of very preterm survivors there is an apparent deterioration in neurodevelopmental outcome category, cognitive function, and extra educational support. It is not clear whether this represents a genuine deterioration in neurocognitive function or whether it represents the expression of pre-existing cerebral pathology in an increasingly complex environment.

Adolescent↗
PubMed2003

A method for assessment of the shape of the proximal femur and its relationship to osteoporotic hip fracture.

The shape of the proximal femur has been demonstrated to be important in the occurrence of fractures of the femoral neck. Unfortunately, multiple geometric measurements frequently used to describe this shape are highly correlated. A new method, active shape modeling (ASM) has been developed to quantify the morphology of the femur. This describes the shape in terms of orthogonal modes of variation that, consequently, are all independent. To test this method, digitized standard pelvic radiographs were obtained from 26 women who had suffered a hip fracture and compared with images from 24 age-matched controls with no fracture. All subjects also had their bone mineral density (BMD) measured at five sites using dual-energy X-ray absorptiometry. An ASM was developed and principal components analysis used to identify the modes which best described the shape. Discriminant analysis was used to determine which variable, or combination of variables, was best able to discriminate between the groups. ASM alone correctly identified 74% of the individuals and placed them in the appropriate group. Only one of the BMD values (Ward's triangle) achieved a higher value (82%). A combination of Ward's triangle BMD and ASM improved the accuracy to 90%. Geometric variables used in this study were weaker, correctly classifying less than 60% of the study group. Logistic regression showed that after adjustment for age, body mass index, and BMD, the ASM data was still independently associated with hip fracture (odds ratio (OR)=1.83, 95% confidence interval 1.08 to 3.11). The odds ratio was calculated relative to a 10% increase in the probability of belonging to the fracture group. Though these initial results were obtained from a limited data set, this study shows that ASM may be a powerful method to help identify individuals at risk of a hip fracture in the future.

Aged↗
PubMed2003

Bone mineral density in premenopausal women treated for node-positive early breast cancer with 2 years of goserelin or 6 months of cyclophosphamide, methotrexate and 5-fluorouracil (CMF).

The purpose of this study was to compare changes in bone mineral density (BMD) in premenopausal patients with node-positive early breast cancer treated with goserelin (Zoladex) or cyclophosphamide, methotrexate and 5-fluorouracil (CMF). Patients ( n=1640) were randomized to goserelin (3.6 mg every 28 days for 2 years) or CMF (sixx28-day cycles) treatment. In a protocoled sub-study involving 96 patients from eight centers (goserelin: n=53; CMF: n=43), lumbar spine (L2-L4) and femoral neck BMD were assessed by dual X-ray absorptiometry at baseline and then annually for 3 years. At the end of the 2-year goserelin-treatment period, mean BMD losses for goserelin-treated and CMF-treated patients were -10.5% and -6.5% ( P=0.0005) for lumbar spine and -6.4% and -4.5% ( P=0.04) for femoral neck, respectively. At 3 years, partial recovery of BMD was observed in goserelin recipients. In contrast, mean BMD losses for the CMF group indicated persistent BMD loss. No significant differences in BMD were observed between groups at the 3-year assessment of the spine or femoral neck. In the CMF group, based on amenorrhea status at 48 weeks, BMD losses at the lumbar spine were greater for amenorrheic than non-amenorrheic patients. Ovarian suppression resulting in amenorrhea was closely related to BMD loss in both treatment groups. Overall, patients who received CMF did not show recovery of BMD throughout follow-up, whereas partial recovery was observed 1 year after cessation of goserelin therapy, associated with the return of ovarian function in the majority of patients.

Adult↗
PubMed2003

Introduction of the 5-HT3B subunit alters the functional properties of 5-HT3 receptors native to neuroblastoma cells.

The identification of a second 5-HT(3) (5-HT(3B)) subunit provides an explanation for 5-HT(3) receptor heterogeneity. We investigated whether introduction of recombinant 5-HT(3B) subunits would alter the functional properties of mouse neuroblastoma 5-HT(3) receptors. RT-PCR analysis revealed that NB41A3 cells contain mRNAs encoding 5-HT(3A) and 5-HT(3B) subunits. 5-HT increased intracellular Ca(2+) concentration ([Ca(2+)](i)) and caused the concentration-dependent activation of inward currents recorded at -60 mV. Both actions of 5-HT were antagonized by ondansetron. The 5-HT concentration-response relationship of NB41A3 cells was indistinguishable from that of the related NG108-15 cell line. The selective 5-HT(3)-receptor agonist mCPBG also elevated [Ca(2+)](i) and activated inward currents. 2-M-5HT was less efficacious than 5-HT as an activator of 5-HT(3) receptors in NB41A3 cells and did not significantly increase [Ca(2+)](i). The 5-HT induced increase in [Ca(2+)](i) did not involve caffeine- or thapsigargin-sensitive intracellular Ca(2+) stores. The introduction of the 5-HT(3B) subunit by transient transfection of NB41A3 cells caused 5-HT to become less potent as an activator of 5-HT(3) receptors and altered the kinetics of 5-HT activated currents so that they resembled currents mediated by 5-HT(3AB) receptors. The 5-HT(3B) subunit also abolished the 5-HT induced [Ca(2+)](i) increase seen in untransfected NB41A3 cells. These data are consistent with the hypothesis that NB41A3 cells predominantly express homomeric 5-HT(3A) receptors that become heteromeric 5-HT(3AB) receptors upon introduction of the recombinant 5-HT(3B) subunit.

Animals↗
PubMed2003

Assessment of the effect upon maternal knowledge of an information leaflet about pain relief in labour.

Pregnant women were randomly assigned to receive, at booking, the usual written information pack either with or without the Obstetric Anaesthetists' Association's (OAA's) leaflet 'Pain Relief in Labour'. At 36 weeks' gestation, a structured interview was conducted at which we assessed the sources of information the women had used and their knowledge of specific aspects of obstetric analgesia and anaesthesia described in the OAA leaflet. The most useful sources of information overall were friends, family, midwives, books and information leaflets (no significant difference between the groups); 72% of all women felt they had received adequate information although 70% said they would have liked to have discussed methods of analgesia with an anaesthetist before delivery. Parturients allocated to receive the leaflet (n = 37) were more knowledgeable than those who received only standard booking information (n = 39) about all analgesic and anaesthetic techniques except for systemic pethidine, although this difference in knowledge only reached statistical significance for extending epidural analgesia for emergency Caesarean section. We conclude that the OAA leaflet improves women's knowledge of analgesic techniques and suggest that all information of this type be formally assessed in this manner; furthermore given the practical difficulties in conducting studies of this type, the latter should be adequately resourced, perhaps by the bodies that issue such leaflets.

Analgesia, Obstetrical↗
PubMed2003

Strain and gender specific effects in the forced swim test: effects of previous stress exposure.

The chronic mild stress (CMS) procedure was developed in rodents to target anhedonia, the core symptom of depressive melancholia. Stress exposure has been shown to induce a variety of physiological, biochemical and behavioral alterations associated with depression, although its anhedonic consequences as indexed by either sucrose intake and preference or thresholds for brain stimulation reward are less reliably observed. In the present study, we assessed the effects of six weeks of CMS on the latter measure in two strains of male and female rats subsequently challenged with an acute psychophysical stressor, forced swimming; their behavior in the swimming cylinder was evaluated on two consecutive days. While brain stimulation reward thresholds and response rates were unchanged by CMS exposure, significant differences in forced swim behaviors were observed between male control and CMS groups. In particular, male Long Evans rats with a history of CMS showed the largest decrease in the duration of active behaviors on the second test day, a pattern less evident in the Sprague-Dawley strain of rats, or in any of the female groups. The results suggest that the effects of depressogenic manipulations are strain and gender dependent, with male Long Evans rats most susceptible, as demonstrated by the selective reduction of struggling behaviors. Inclusion of multiple measures, including the forced swim test, would provide a better understanding of the psychopathological profile engendered by chronic exposure to mild stressors and its genetic specificity.

Animals↗
PubMed2003

Changing practice in residential aged care using participatory methods.

BACKGROUND: Residential aged care staff play a significant role in the day-to-day lives of residents yet are faced with many barriers to providing care that promotes resident wellbeing. APPROACH: Action research is a useful approach for clarifying issues, identifying education and training needs, and identifying, and in some cases overcoming, organizational barriers to change. The Well for Life project aimed to enhance the social and physical health and well being of residents of aged care settings by empowering the staff of facilities to make change. The project had a particular focus on nutrition and physical activity. This paper reports on the action research group process undertaken during Phase I of the Well for Life project. Five residential aged care settings participated in the action research process facilitated by project staff independent of the facilities. The action plan and outcomes from one of these settings is used to illustrate the process and outcomes. FINDINGS: The main findings of the project indicate that using a process that encourages staff involvement in identification of issues and actions can facilitate change in the practice of resident care. The action research groups identified specific gaps in knowledge and skill leading to targeted education that addressed areas of need. The importance of presenting information and learning opportunities for staff in a variety of formats was also recognized, as was the importance of organizational context, management support and empowerment of staff to make change.

Aged↗
PubMed2003

Agreement between written and video questions for comparing asthma symptoms in ISAAC.

Phase One of the International Study of Asthma and Allergies in Childhood (ISAAC) has reported the prevalence of asthma, rhinitis and eczema symptoms in children. In 99 centres from 40 countries, a total of just under 317,000 13-14-yr-old children also completed a video questionnaire, showing the symptoms and signs of asthma. This first video sequence has been compared to the ISAAC written question asking about current wheezing to explore variations in agreement and the contribution of each questionnaire to wheezing prevalence between centres, by region and language groups. In general, responses to the video questionnaire gave a lower prevalence than the siritten questionnaire and responses were closely correlated. The overall proportion of agreement was high, mean 0.89. but unbalanced, with good negative agreement but poor positive agreement. Chance corrected agreement using Cohen's kappa coefficient, was generally low, with onl 20 centres with kappa >0.4. The contribution of each questionnaire to wheezing prevalence also varied between centres and suggests that written questions about wheezing are variably understood and interpreted by 13-14 yr olds. International comparisons of wheezing and its audiovisual presentation suggest that adolescents interpret a written question about wheezing differently from its audiovisual presentation and that this interpretation shows variation between centres. This relationship and the interpretation of both written and audiovisual presentation of symptoms requires further study in order to better predict asthma.

Adolescent↗
PubMed2003

Association of transforming growth factor beta-1 single nucleotide polymorphisms with radiation-induced damage to normal tissues in breast cancer patients.

PURPOSE: To investigate whether transforming growth factor beta-1 (TGFbeta1) single nucleotide polymorphisms were associated with the susceptibility of breast cancer patients to severe radiation-induced normal tissue damage. MATERIALS AND METHODS: PCR-RFLP assays were performed for TGFbeta1 gene polymorphisms on DNA obtained from 103 breast cancer patients who received radiotherapy. The G-800A, C-509T, T+869C and G+915C polymorphic sites were examined, and genotype and allele frequencies of two subgroups of patients were calculated and compared. RESULTS: The less prevalent -509T and +869C alleles were significantly associated with a subgroup of patients who developed severe radiation-induced normal tissue fibrosis (n=15) when compared with those who did not (n=88) (odds ratio=3.4, p=0.0036, and 2.37, p=0.035, respectively). Furthermore, patients with the -509TT or +869CC genotypes were between seven and 15 times more likely to develop severe fibrosis. CONCLUSIONS: These findings imply a role for the -509T and +869C alleles in the pathobiological mechanisms underlying susceptibility to radiation-induced fibrosis. Their predictive value would be limited to patients who are -509TT or +869CC, but if "fibrosis-associated" polymorphic sites in other genes could be identified, it may be possible to detect fibrosis prone individuals before radiotherapy with greater certainty.

Alleles↗
PubMed2002

Goserelin versus cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy in premenopausal patients with node-positive breast cancer: The Zoladex Early Breast Cancer Research Association Study.

PURPOSE: Current adjuvant therapies have improved survival for premenopausal patients with breast cancer but may have short-term toxic effects and long-term effects associated with premature menopause. PATIENTS AND METHODS: The Zoladex Early Breast Cancer Research Association study assessed the efficacy and tolerability of goserelin (3.6 mg every 28 days for 2 years; n = 817) versus cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy (six 28-day cycles; n = 823) for adjuvant treatment in premenopausal patients with node-positive breast cancer. RESULTS: Analysis was performed when 684 events had been achieved, and the median follow-up was 6 years. A significant interaction between treatment and estrogen receptor (ER) status was found (P =.0016). In ER-positive patients (approximately 74%), goserelin was equivalent to CMF for disease-free survival (DFS) (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.84 to 1.20). In ER-negative patients, goserelin was inferior to CMF for DFS (HR, 1.76; 95% CI, 1.27 to 2.44). Amenorrhea occurred in more than 95% of goserelin patients by 6 months versus 58.6% of CMF patients. Menses returned in most goserelin patients after therapy stopped, whereas amenorrhea was generally permanent in CMF patients (22.6% v 76.9% amenorrheic at 3 years). Chemotherapy-related side effects such as nausea/vomiting, alopecia, and infection were higher with CMF than with goserelin during CMF treatment. Side effects related to estrogen suppression were initially higher with goserelin, but when goserelin treatment stopped, reduced to a level below that observed in the CMF group. CONCLUSION: Goserelin offers an effective, well-tolerated alternative to CMF in premenopausal patients with ER-positive and node-positive early breast cancer.

Amenorrhea↗
PubMed2002

The genome sequence of Schizosaccharomyces pombe.

We have sequenced and annotated the genome of fission yeast (Schizosaccharomyces pombe), which contains the smallest number of protein-coding genes yet recorded for a eukaryote: 4,824. The centromeres are between 35 and 110 kilobases (kb) and contain related repeats including a highly conserved 1.8-kb element. Regions upstream of genes are longer than in budding yeast (Saccharomyces cerevisiae), possibly reflecting more-extended control regions. Some 43% of the genes contain introns, of which there are 4,730. Fifty genes have significant similarity with human disease genes; half of these are cancer related. We identify highly conserved genes important for eukaryotic cell organization including those required for the cytoskeleton, compartmentation, cell-cycle control, proteolysis, protein phosphorylation and RNA splicing. These genes may have originated with the appearance of eukaryotic life. Few similarly conserved genes that are important for multicellular organization were identified, suggesting that the transition from prokaryotes to eukaryotes required more new genes than did the transition from unicellular to multicellular organization.

Base Sequence↗
PubMed2002

Correcting calf girth discriminates the incidence of falling but not bone mass by broadband ultrasound attenuation in elderly female subjects.

Calf circumference has been cited as an independent risk factor for hip fracture. Correcting this measured girth for subcutaneous adipose tissue or fluid accumulation provides a more valid estimate of lean tissue, but has not been reported in elderly populations. Two hundred eighty-eight randomly selected female volunteers, aged >or=70 years, were assessed by quantitative ultrasound (QUS) and clinical risk factors as part of a larger screening study for hip fracture risk. This involved measuring broadband ultrasound attenuation (BUA) and administering a structured risk factor questionnaire that included estimated daily skeletal loading (time standing or walking). Body mass index (BMI) was estimated using current body mass and height at age 25 years. Calf girth was measured using a standard anthropometric tape, the medial calf skinfold (a vertical fold at the point of maximum calf girth) was measured, and corrected calf girth (CCG) was calculated by subtracting the skinfold (in centimeters) multiplied by pi from calf girth. Subjects were aged 76.9 +/- 5.0 years, had BMIs of 24.3 +/- 3.9 kg/m(2), and spent an average of 5.5 +/- 2.0 h on their feet each day. Age, current body mass, BMI calf girth, and CCG all correlated with BUA (p < 0.01). CCG correlated with hours on the feet (p < 0.05), whereas calf girth did not (p > 0.05). Dividing the sample into tertiles by these correlates of BUA and predicting BUA using stepwise regression revealed different predictors for each tertile. Of the total sample, 93 had fallen in the last 12 months, whereas 195 had not. Independent t-tests showed these groups to be similar in age, BMI, and calf girth (p > 0.05), but fallers spent less time on their feet each day, and had smaller CCG (p < 0.05). This suggests that larger calf muscles may be protective against falling-possibly as a result of enhanced stability or greater neuromuscular control.

Accidental Falls↗
PubMed2002

Bilateral hypoglossal nerve injury following the use of the laryngeal mask airway.

A healthy 54-year-old man undergoing elective knee arthroscopy developed bilateral hypoglossal nerve palsy, lasting 6 weeks following the use of a laryngeal mask airway. He suffered impairment of speech and difficulty in swallowing, the latter resulting in almost 7 kg loss of weight within 2 weeks of surgery. We discuss the possible aetiology of the injury and review the literature describing injuries to the hypoglossal nerve.

Cranial Nerve Injuries↗