Crohn's disease and inherited coagulopathy: two case reports.
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Crohn Disease↗
Biomedical subjects
A Worsley
Publications and source records attributed to A Worsley.
Warfarin and epistaxis: should warfarin always be discontinued?
The object of this study was to determine whether warfarin could be safely continued in patients with epistaxis if the International Normalized Ratio (INR) was within the suggested therapeutic range. Twenty patients on warfarin treatment were compared with controls, matched for age and sex. Local measures for the control of epistaxis were undertaken appropriately in all the patients. In the warfarin group 17 patients (85%) did not discontinue warfarin as the INR was within the suggested range. There were no additional bleeding complications or failure of epistaxis control due to continuation of warfarin. There was no significant difference in the mean hospital stay between the warfarin and non-warfarin groups. It is concluded that warfarin can be continued safely in patients with epistaxis, in appropriate circumstances, and that the policy of stopping warfarin routinely in all patients with epistaxis should be reconsidered.
Aged↗
Reported food consumption and dietary habits of New Zealand adolescents.
Six hundred and sixty-seven fifteen year old members of the Dunedin Multidisciplinary Health and Development study cohort completed a self-administered food frequency and dietary habits inventory. The results show that only 14 foods were consumed on a regular basis by more than 80% of the cohort. Statistically significant differences were found between the numbers of boys and girls consuming a variety of foods; generally, more girls consumed fruits and green vegetables and more boys consumed foods rich in fat and sugar. Several differences were observed in the food consumption of three income groups: fewer adolescents in low income families consumed expensive foods such as steak. The implications of these food consumption findings and their associated gender and income differences for nutrition promotion and food policy are discussed.
Adolescent↗
What should you eat? A survey of south Australian women's food consumption norms.
In a random population survey, 418 South Australian women rated the desirability of consumption of 48 common foods, according to their perceived health relevance. Multidimensional scaling of the women's responses yielded three dimensions which accounted for 87% of total variance. The first two dimensions were related to healthiness (low fat, salt and sugar contents) and traditional-artificial nutrient-reduced foods respectively. Younger women rated healthy foods more highly. The mean ratings also formed a unidimensional scale which had high internal reliability (Cronbach's alpha = 0.80). These unidimensional scores were correlated with reported food intakes of a random sample of respondents in the State of Victoria, using mean values for demographic subgroups (r = 0.50). The results suggest that food intake, or alternatively recalls of food intake, may be influenced by such prescriptive norms.
Adult↗
Effects of varying recall periods on reported food intakes.
A 32-item food frequency questionnaire was administered with different time periods over which intake frequencies were to be recalled. In replicate Studies 1 and 2, 154 students were randomly allocated to six recall periods, ranging from the "the past 3 days" through to "the past year" and "usual intake". Perceived "oftenness" of intake was estimated on seven-point ratings. In Study 3, 78 students were randomly allocated to five short recall periods, e.g. last weekend, the past 5 days. In addition to rating "oftenness", they estimated their frequencies of intake numerically. In the first two studies, recall period was related to "oftenness" ratings in three ways. Responses for some foods (mainly snacks) were unaffected by recall period; others (mainly staples) were monotonically related to the requested duration of the recall; and, for a third set of foods, periods greater than one month (including "usual intake") yielded equivalent ratings but these were greater frequencies than those associated with shorter recall periods. In Study 3, marked differences were seen between frequency ratings over "average" durations and those over recent periods of similar duration. Correlations between numerical frequency estimates and "oftenness" ratings were high. The implications of the results for uses of food frequency methodology in nutritional epidemiology are discussed.
Adult↗
Kiwis, food and cholesterol: New Zealand consumers' food concerns and awareness of nutritional guidelines.
New Zealand food shoppers' nutrition and food concerns and attitudes to cholesterol screening were assessed during four consecutive surveys. Over 1000 shoppers were interviewed during each survey, as part of the evaluation of the Heart Food Festival in 1988-89. Over two thirds of the respondents reported that they usually read the ingredients label on food products. Over a third were concerned about the presence of additives in foods (36 per cent), along with fat (27 per cent), salt (18 per cent), sugar (14 per cent) and fibre (5 per cent). Over half indicated that reductions in fat intake would make their diets healthier. One in five reported they were aware of the New Zealand nutrition guidelines. Only one third of respondents could correctly identify the bottom row of the healthy food pyramid. Almost one in eight respondents knew their cholesterol levels and a further two thirds wished to know them. Few differences were observed between the responses of early and late school leavers. In contrast, pronounced differences were associated with gender and the respondents' age groups. The results suggest that awareness of links between nutrition and heart disease is widespread. Educational and empowerment strategies are required to translate such awareness into dietary change.
Cholesterol, Dietary↗
Dietary habits of elderly persons with diabetes.
The dietary habits and nutrient intakes of a group of 151 persons with diabetes were compared with those of a group without diabetes in a random postal survey of 3,000 individuals aged 65 years and older residing in Adelaide, South Australia. A semiquantitative food frequency questionnaire was used. The response rate was 77%. Only 64% of individuals with diabetes reported following a diabetic diet at the time of the survey, and only 6% were consuming a high-carbohydrate, low-fat diet (greater than or equal to 50% energy intake from carbohydrate and less than or equal to 30% from fat). The dietary habits of elderly persons with diabetes suggested an awareness of the need to limit simple sugars; however, adherence to the latest recommendations concerning dietary fat and fiber was poor. Individuals with diabetes had lower intakes of refined carbohydrate but were just as likely as those without diabetes to eat high-fat foods, and they ate eggs and cheese more frequently. Those with diabetes were no more likely than those without diabetes to consume the recommended complex-carbohydrate and fiber-rich foods. The extent of adherence to current dietary recommendations for the management of diabetes was found to be independent of sex, age, occupational status, educational attainment, marital status, living arrangements (alone vs with a spouse), and source of income.
Aged↗
Sociodemographic determinants in Australia of the intake of food and nutrients implicated in cancer aetiology.
In recent years, there has been a growing awareness of the role that diet can play in the promotion, retardation or amelioration of the cancer process. This has led to the development of dietary guidelines for cancer prevention by health authorities in several Western societies. However, there is still limited information about the sociodemographic determinants of intake of foods and nutrients of interest in many of these countries. A study of the dietary intake of a random sample of residents of the State of Victoria in Australia showed that women, those in the older age groups and in the higher occupational ranks, had diets more in line with current recommendations for cancer prevention--the most marked differences being between men and women. However, the sociodemographic differences were relatively small compared with the low rate of overall compliance with the guidelines.
Adolescent↗
Assessment of the validity of a food frequency questionnaire as a measure of food use by comparison with direct observation of domestic food stores.
The aim of this study was to assess the validity as a measure of food use of a 90-item semi-quantitative food frequency questionnaire which had been used in a study of food consumption patterns and health among 3,000 people aged 65 years and over selected at random from the electoral rolls of Adelaide, South Australia. In 1986, 18 months after the original survey, 200 randomly selected participants were invited to take part in the present study. The food frequency questionnaire was administered by mail, and results were compared with a direct observation of the foods that 40 subjects had in their home. The kappa statistic indicated good agreement (in all cases greater than that expected due to chance) between the reported use of individual foods in the questionnaire and the observed presence or absence of those foods in the subject's home. Correlation coefficients between scores generated from the questionnaire for consumption from specific food groups and those derived from direct observation of domestic food stores ranged from 0.42 to 0.86. These data indicate that a simple self-administered dietary questionnaire can provide a valid measure of food use patterns in elderly people.
Aged↗
The weight control practices of 15 year old New Zealanders.
More than 800 15 year old members of the Dunedin Multidisciplinary Health and Development study cohort completed a questionnaire designed to provide descriptive data concerning the weight control behaviours of this sample of New Zealand adolescents. The results showed that approximately 75% of the adolescents were within acceptable body mass index ranges. However 68% of the girls (but only 19% of the boys) wanted to weigh less than their present weight. Generally, girls were more concerned about their body weight than boys: 26% of girls weighed themselves fortnightly or more often, compared with 12% of boys; 45% of girls reported that they were trying to lose weight at present, compared with 9.5% of boys. The main methods of weight reduction included weight reduction diets (21% of girls, 4% of boys in the previous year); exercise such as jogging, walking, swimming and cycling (60% of girls, 34% of boys); and participation in dieting and fitness clubs (35% of girls, 16% of boys). In addition, 20% of girls reported using techniques such as slimming tablets (3%), cigarette smoking (5%) and self-induced vomiting (5%) to control weight. The results show that weight control is a major preoccupation of many girls and some boys. Results are discussed in relation to differential social influences on the sexes, and health consequences.
Adolescent↗
Laypersons' evaluation of health: an exploratory study of an Australian population.
The importance of 33 aspects of health was evaluated by 677 people as part of a postal random population survey conducted in Adelaide, South Australia. Principal factors analysis suggested that the respondents' evaluations could be represented along four dimensions to do with: the avoidance of illness; feeling healthy; healthy lifestyle; and disease prevention activities. Generally, women, persons in older age groups, and persons in lower social status and education groups evaluated health more highly than others. These and other findings suggest that health evaluations depend upon illness experience and social roles. These findings have implications for health education, mass communication and medical practice.
Adult↗
Comparison of erythroid progenitor cell growth in vitro in polycythemia vera and chronic myelogenous leukemia: only polycythemia vera has endogenous colonies.
The ability of erythroid cultures to distinguish among myeloproliferative disorders was examined. We studied 14 patients with polycythemia vera (PV), 11 with chronic myelogenous leukemia (CML), four with non-PV erythrocytosis, two with agnogenic myeloid metaplasia, as well as three normal fetuses and greater than 25 normal adults. Endogenous, i.e. grew without added erythropoietin, bone marrow CFU-E-derived colonies were observed in all but one PV patient. However, endogenous blood BFU-E-derived bursts were observed in only eight of 14 PV patients. Endogenous erythroid colonies were not seen in cultures from any normal adults or fetuses, or patients with CML, erythrocytosis, or myeloid metaplasia. In PV, relative HbF synthesis was always greater in cultures without erythropoietin, while in cultures from all other patients relative HbF synthesis was similar to that observed in cultures from normal individuals. We conclude that PV and CML are distinguishable in culture since CML patients do not have endogenous growth. Most important, endogenous bone marrow CFU-E-derived colonies are the only consistently unique observation in patients with PV, and endogenous CFU-E- and BFU-E-derived colonies and bursts are not uniformly observed in PV blood cultures. In-vitro studies of erythropoiesis to confirm the diagnosis of PV, therefore, require marrow when endogenous colonies and bursts are absent from blood cultures.
Adolescent↗
Correlation of bone marrow colony growth in the myelodysplastic syndromes with the FAB classification and the Bournemouth score.
Erythroid and myeloid colonies were grown from the bone marrow of 81 patients with myelodysplasia and the median number of colonies correlated with the FAB classification and Bournemouth score. CFU-GM were increased in CMML compared to RAEB and RAEBt. BFU-E were higher in RA than in the other FAB subgroups. Patients with a high Bournemouth score had poorer CFU-GM and BFU-E growth than those with a low score.
Anemia, Refractory↗
Treatment of chronic myelomonocytic leukemia with low dose etoposide.
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Aged↗
Early childhood development: a comparative study of beliefs held by adolescents, medical students and mothers.
This study examined beliefs about the normal development of preschool children held by adolescents, medical students and mothers. A consistent pattern was identified, with adolescents estimating that young children can do the least, medical students' estimations lying between those of adolescents and mothers, and mothers estimating that the children can do the most. In addition, medical students were found to change their beliefs during the time that they participated in their paediatric teaching programme. It is suggested that paediatricians and other child health professionals take into account the varying beliefs held by different groups in the community when providing advice or teaching about early child development.
Adolescent↗
Dietary supplement use in a randomly selected group of elderly Australians. Results from a large nutrition and health survey.
The prevalence of dietary supplementation and its relationship to health and dietary habits was investigated in a random mail survey of 2,195 people aged 65 years and over in Adelaide, South Australia. Subjects were selected from the electoral rolls in an urban area, and 77% returned completed survey instruments. Thirty-five percent of men and 46% of women reported taking some form of supplement at least once a week regularly throughout the year (these are defined as "regular" supplementers). The most popular supplements (in descending order of popularity for the total group) were: unprocessed bran, wheatgerm, vitamin C, and multivitamins or minerals. Thirteen percent of men and 15% of women reported the use of supplements on an occasional basis (once every few months or "now and then")--these are defined as "irregular" or "occasional" supplementers. Supplement users did not differ from non-supplementers in their use of medical facilities or in the number of bouts of minor illness they had experienced in the preceding year. Regular supplement users had more favorable dietary habits and higher intakes of several vitamins, minerals, trace elements and fiber than either non-supplementers or occasional supplementers.
Aged↗
Bone marrow transplantation for severe aplastic anaemia using cyclosporin: long-term follow-up.
Between 1980 and 1986 we transplanted 49 patients from genotypically identical sibling donors for severe aplastic anaemia (SAA). Patients were predominantly adults, median age 22 years (3-47). Forty-six were multiply transfused prior to referral. The median pre-transplant disease duration was 4 months (1-72). Pre-transplant conditioning was with cyclophosphamide (CY) 200 mg/kg. Cyclosporin A (CSA) was given from 1 day before the transplant and continued for 9-12 months. Eight of 48 evaluable patients did not achieve initial engraftment (early graft failure). Six of these episodes occurred in the eight cases transplanted more than 1 year after diagnosis, four of whom died. Thirteen of 44 (30%) evaluable patients (with stable engraftment after one or two transplants) had grade III-IV acute graft-versus-host disease (GVHD). Only three of 35 patients surviving more than 100 days with sustained engraftment developed generalized chronic GVHD; two died. An additional 10 patients developed localized chronic GVHD, which was very mild, transient and related to CSA withdrawal. Four long-term survivors are known to have autologous marrow function. All survivors have Karnofsky scores of greater than 90%. We conclude that the use of CSA after bone marrow transplantation for SAA is associated with good long-term survival and minimal on-going chronic GVHD. Early graft failure was frequent when transplantation was delayed beyond 1 year from diagnosis.
Anemia, Aplastic↗
The Victorian Nutrition Survey--intakes and sources of dietary fats and cholesterol in the Victorian population.
A random State-wide nutrition survey of the population of Victoria that was carried out in late 1985 demonstrated that the total fat and saturated fat intake of Australians had changed little since studies that were carried out in the 1970s. However, since that time, there has been a considerable increase in the contribution of polyunsaturated fats with a consequent improvement in the polyunsaturated-to-saturated fatty-acid ratio in the diet. The survey was carried out by means of a postal technique and a semiquantified food-frequency questionnaire which allows for the characterization of usual dietary intake in individuals. The survey served to highlight the value of collecting nutrient, food and food-habits data in the same individuals and demonstrated that relatively cost-effective surveys of this type make feasible the regular continuing surveillance of the usual nutrient intakes of large numbers of individuals.
Adult↗