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Biomedical subjects

B Jacobson

Publications and source records attributed to B Jacobson.

At least 19 recordsLinked to original sources
PubMed1992

Public health in inner London.

One of Sir Bernard Tomlinson's aims in his inquiry into London's health services was to advise the secretary of state for health on the future balance of primary and secondary health care "taking account of the health needs of Londoners." Sir Bernard, however, also made it clear that "we have not seen it as part of our remit to carry out a comprehensive needs assessment for the whole of London," but concluded that the extremes of health need found in London were "unparalleled in the rest of England." Dr Jacobson highlights some of the major determinants of health inequality in inner London and assesses the extent to which the proposed solutions are likely to meet these needs.

Child↗
PubMed1992

Hypertrophy of gonadotropin releasing hormone-containing neurons after castration in the teleost, Haplochromis burtoni.

In the African cichlid fish, Haplochromis burtoni, males are either territorial or nonterritorial. Territorial males suppress reproductive function in the nonterritorial males, and have larger gonads and larger gonadotropin-releasing hormone- (GnRH) containing neurons in the preoptic area (POA). We describe an experiment designed to establish the causal relationship between large GnRH neurons and large testes in these males by determining the feedback effects of gonadal sex steroids on the GnRH neurons. Territorial males were either castrated or sham-operated, 4 weeks after which they were sacrificed. Circulating steroid levels were measured, and the GnRH-containing neurons were visualized by staining sagittal sections of the brains with an antibody to salmon GnRH. The soma areas of antibody-stained neurons were measured with a computer-aided imaging system. Completely castrated males had markedly reduced levels of circulating sex steroids [11-ketotestosterone (11KT) and testosterone (T)], as well as 17 beta-estradiol (E2). POA GnRH neurons in castrates showed a significant increase in mean soma size relative to the intact territorial males. Hence, in mature animals, gonadal steroids act as a brake on the growth of GnRH-containing neurons, and gonadal products are not responsible for the large GnRH neurons characteristic of territorial males.

Animals↗
PubMed1992

Thiamine, riboflavin, and pyridoxine deficiencies in a population of critically ill children.

The unexpected autopsy finding of Wernicke encephalopathy in three children who died after prolonged enteral feeding prompted us to examine the incidence of thiamine deficiency in three high-risk pediatric populations. We also measured riboflavin and pyridoxine activity in the same groups. We used activated enzyme assays (erythrocyte transketolase, glutathione reductase, aspartate aminotransferase) to assess tissue stores of the dependent vitamin cofactors (thiamine (vitamin B1), riboflavin (vitamin B2), and pyridoxine (vitamin B6), respectively). Using our own reference ranges based on data from 80 healthy adults and children, we prospectively investigated the B vitamin status of three groups of children: (1) 27 patients who were fed solely by nasogastric tube for more than 6 months, (2) 80 children admitted to a pediatric intensive care unit for more than 2 weeks, and (3) 6 children receiving intensive chemotherapy. The upper limits for stimulated enzyme activity in control subjects were unaffected by age or gender (16% for transketolase, 63% for glutathione reductase, 123% for aspartate aminotransferase). Using these limits, 10 (12.5%) of 80 patients receiving intensive care and 4 of 6 patients receiving chemotherapy were thiamine deficient. Elevated levels returned to normal after thiamine supplementation. No patients were pyridoxine deficient, but 3 (3.8%) of the 80 patients receiving intensive care and 1 of the 6 patients receiving chemotherapy were also riboflavin deficient. We conclude that unrecognized thiamine deficiency is common in our pediatric intensive care and oncology groups. This potentially fatal but treatable disease can occur in malnourished patients of any age and is probably underdiagnosed among chronically ill children. Our findings may be applicable to other high-risk pediatric groups.

Adolescent↗
PubMed1992

Socio-economic versus obstetric risk factors for drug addiction in offspring.

Two possible risk factors for drug addiction were weighed against each other: (1) perinatal factors associated with obstetric medication at time of birth; and (2) factors associated with familial socio-economic conditions at time of birth. The subjects comprised 200 amphetamine addicts and 200 opiate addicts born in Stockholm 1945-1966. In a matched case control study, addicts were compared to their siblings with regard to possible obstetric risk factors by means of conditional logistic regression controlling for socio-economic level and civil status. Administration of opiates, barbiturates and nitrous oxide to mothers during labour was associated with drug addiction in offspring, hence confirming results from earlier studies. In a cohort study the risk associated with birth at a given hospital and familial socio-economic level was analysed by means of log-linear analysis using 7100 controls from the general population. For amphetamine addicts, a low socio-economic level at time of birth might be of importance for the infant subsequently becoming an addict. This could not be demonstrated for the opiate addicts. An uneven distribution of births among the hospitals, most pronounced for the amphetamine addicts, is in agreement with the hypothesis that obstetric practices may be risk factors for adult drug addiction.

Adolescent↗
PubMed1991

General practitioners' views on quality specifications for "outpatient referrals and care contracts".

OBJECTIVE: To ascertain general practitioners' views about which quality specifications should be included in contracts for hospital care. DESIGN: In depth interview study and postal survey. SETTING: General practitioners in City and Hackney Health District. SUBJECTS: Fourteen doctors were interviewed in depth; 77 of 131 doctors (59%) returned postal questionnaires. MAIN OUTCOME MEASURE: Rating of listed quality specifications. RESULTS: The most popular items which doctors thought should be included in contracts by April 1991 related to the availability of patients' notes in outpatient clinics, respect shown to general practitioners in telephone communications with hospital doctors, supply of medicines after discharge, patient management plans for general practitioners, the earlier arrival of discharge slips, the type of hospital doctor to see new outpatients, and the unnecessary duplication of investigations. CONCLUSIONS: A high premium was attached by general practitioners to effective organisation, effective communication between primary and secondary sources of care, and effective communication with patients.

Attitude of Health Personnel↗
PubMed1991

Cigarette advertising policy and coverage of smoking and health in British women's magazines.

A survey of cigarette advertising and coverage of health aspects of smoking in 86 British magazines with a large female readership was done in 1989. The findings were compared with the results of a 1985 survey which had led to the introduction of new voluntary restrictions in 1986 on cigarette advertising in magazines. Although there was a decrease in the proportion of magazines accepting cigarette advertising (64% to 42%), the new restrictions failed to cover the most popular magazines, so that an estimated collective readership of 7 million women aged 15-24 years were still exposed to cigarette advertising. Revenue from cigarette advertising by women's magazines increased by 10% in real terms between 1985 and 1988. There was a small decrease in the coverage given to health aspects of smoking; a third of magazines were willing to use pictures of people smoking in their editorial pages. The findings show that the voluntary restrictions introduced in the UK in 1986 have had a small effect on cigarette advertising and have failed to achieve their aim of protecting young women.

Adolescent↗
PubMed1991

The Nation's Health: when epidemiology meets ethics and politics.

The main conclusions of The Nation's Health: a Strategy for the 1990s-a 10 year review of public health in the UK-are presented. The interrelation between the epidemiological, ethical and political dimensions encountered in the preparation and publication of the report are discussed. An initial appraisal of the impact of the report on public health awareness and policy is presented.

Epidemiology↗
PubMed1990

Opiate addiction in adult offspring through possible imprinting after obstetric treatment.

OBJECTIVE: To test the hypothesis that opiate addiction in adults might stem partly from an imprinting process during birth when certain drugs are given to the mother. DESIGN: Retrospective study by logistic regression of opiate addicts with siblings as controls. SETTING: Stockholm, Sweden. SUBJECTS: 200 Opiate addicts born in Stockholm during 1945-66, comprising 41 identified during interviews of probands for an earlier study; 75 patients whose death from opiate addiction had been confirmed during 1978-88; and 84 accepted for the methadone programme. 262 Siblings (controls) born in Stockholm during the same period, 24 of whom were excluded for drug addiction or being brought up outside the family. Birth records were unavailable for eight, leaving 230 siblings and 139 corresponding probands. MAIN OUTCOME MEASURES: Administration of opiates, barbiturates, and nitrous oxide (for greater than 1 h) to mothers of all subjects during labour within 10 hours before birth as a risk factor for adult opiate addiction. RESULTS: In subjects who had subsequently become addicts a significant proportion of mothers had received opiates or barbiturates, or both, compared with unmatched siblings (25% v 16%, chi 2 = 5.83, df = 1, p = 0.02), and these mothers had received nitrous oxide for longer and more often. After controlling for hospital of birth, order of birth, duration of labour, presentation other than vertex, surgical intervention, asphyxia, meconium stained amniotic fluid, and birth weight the relative risk for offspring subsequently becoming an adult opiate addict increased with the number of administrations of any of the three drugs. When the addicts were matched with their own siblings the estimated relative risk was 4.7 (95% confidence interval 1.8 to 12.4, p for trend = 0.002) for three administrations compared with when no drug was given. CONCLUSIONS: The results are compatible with the imprinting hypothesis. Therefore, for obstetric pain relief methods are preferable that do not permit substantial passage of drugs through the placenta.

Analgesia, Obstetrical↗
PubMed1990

The clinical role of transoesophageal echocardiography.

The role of transoesophageal echocardiography (TEE) was evaluated in a consecutive series of 100 procedures performed in 86 patients (age 17-81, mean 56 years). All patients had prior transthoracic echocardiography (TTE). TEE was performed with a 5 MHz phased array transoesophageal transducer with pulsed wave Doppler and colour flow mapping capability. Forty-four per cent of patients received intravenous sedation and 36% received antibiotic prophylaxis. There were no complications of TEE. The TTE and TEE findings were compared. In patients referred for possible cardiac source of embolism, left atrial thrombi were detected in 8/27 TEE studies but in none of 27 TTE studies. In 12 patients with prosthetic valve dysfunction TEE distinguished prosthetic from periprosthetic regurgitation in 9/12 studies compared to 3/12 with TTE. In 11 patients with suspected aortic dissection TEE correctly detected dissection in all seven cases in which the diagnosis was subsequently confirmed, whereas TTE showed only equivocal findings in two cases. Vegetations were detected by TEE in 4/5 studies in patients with proven native valve endocarditis and by TTE in 2/5. No vegetations were detected by TTE or TEE in five studies in patients with proven prosthetic valve endocarditis. Compared with other investigations there were no false positive TEE studies and one possible false negative study. We conclude that TEE is a safe procedure which often provides additional clinical information to transthoracic echocardiography.

Adolescent↗