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Biomedical subjects

B Nolan

Publications and source records attributed to B Nolan.

At least 55 records · Page 3Linked to original sources
PubMed1993

Economic incentives, health status and health services utilisation.

The impact on utilisation of differential public entitlements to free health services is analysed, using data for a large sample of Irish households. GP visiting rates are seen to be significantly higher for those on low incomes whose costs are covered by the State than for those who pay for such care, having controlled for other characteristics including health status. The importance of taking differences in health status into account in attempting to distinguish the effects of economic incentives is shown both for GP visits and hospital stays.

Adolescent↗
PubMed1992

Equity in the finance of health care: some international comparisons.

This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues.

Cross-Cultural Comparison↗
PubMed1992

Equity in the delivery of health care: some international comparisons.

This paper presents the results of an eight-country comparative study of equity in the delivery of health care. Equity is taken to mean that persons in equal need of health care should be treated the same, irrespective of their income. Two methods are used to investigate inequity: an index of inequity based on standardized expenditure shares, and a regression-based test. The results suggest that inequity exists in most of the eight countries, but there is no simple one-to-one correspondence between a country's delivery system and the degree to which persons in equal need are treated the same.

Cross-Cultural Comparison↗
PubMed1992

Sleep disturbances in men with asymptomatic human immunodeficiency (HIV) infection.

During the clinical latency phase of human immunodeficiency virus (HIV) disease the central nervous system may be infected and begin to manifest subtle dysfunction. Our early investigations demonstrated persistent alterations in the sleep architecture of HIV-infected asymptomatic men. The major aims of this study were to delineate alterations of sleep architecture in asymptomatic HIV-infected men, to identify and describe sleep behavior complaints and to seek a correlation between objective sleep parameters and subjective complaints of sleep behavior. The study sample consisted of 24 men, 14 HIV-infected and 10 HIV-negative, age-matched controls. The protocol included a comprehensive history and physical, two polysomnograms, urine toxicity, detailed written sleep questionnaire, the Pittsburgh Sleep Quality Index, the Spielberger State-Trait Anxiety Test and the Beck Depression Inventory. Our results indicated that sleep architecture differed from controls in that wakefulness, slow-wave sleep [SWS-stage 3 and 4 nonrapid eye movement (NREM) sleep] and stage rapid eye movement (REM) sleep were more evenly dispersed throughout the night. In particular, SWS was prevalent during the second half of recorded sleep. The observed changes in the NREM/REM cycle could not be explained on the basis of underlying psychopathology. Just as the course of individuals with HIV infection varies, it is expected that sleep abnormalities will vary. Considering the known relationships between NREM stage 3 and 4 and immune system function, it is possible that the observed alterations in the NREM/REM cycle are related to coincident changes in immunologic function. Quantitative measures of NREM sleep, especially SWS and REM sleep, are perhaps of greater significance than relative measures of sleep stages.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Acute ischaemia of the upper limb compared with acute lower limb ischaemia; a 5-year review.

A series of 61 patients with acute upper limb ischaemia treated over a 5-year period is analysed and compared with patients presenting with acute lower limb ischaemia during the same period. The mean age was 74 years with a female to male ratio of 2.2:1. Eighty-two per cent were treated by operation. Three patients died and no survivors required a major or minor limb amputation, in contrast to a 5 per cent major limb amputation rate in patients with acute lower limb ischaemia. Mortality for upper limb ischaemia was 5 per cent compared with a 30 per cent mortality rate in patients with acute lower limb ischaemia in whom cardiopulmonary debility (New York Heart Association score 3-4) was significantly greater.

Acute Disease↗
PubMed1989

Acute ischaemia of the lower limb: the effect of centralizing vascular surgical services on morbidity and mortality.

Surgical audit data for two 5-year periods (1974-78 and 1983-87) have been compared in a Health Board Area to assess the impact of centralization of emergency vascular services on the treatment of the acutely ischaemic lower limb. Patient populations in each period were comparable. Mortality rates remained constant in both periods at approximately 30 per cent. A significant improvement in overall limb salvage was observed (from 54 to 67 per cent, P less than 0.05). Limb salvage in survivors was improved from 80 to 95 per cent (P less than 0.001) and was paralleled by an increase in the number of reconstructive vascular procedures performed. We concluded that the centralization of emergency vascular services has not led to a reduced risk of mortality but has been associated with improved limb salvage.

Acute Disease↗
PubMed1989

Ten-year review of non-ruptured aortic aneurysms.

Between 1978 and 1987, 587 cases of abdominal aortic aneurysm were operated on in the Vascular Unit of the Royal Infirmary of Edinburgh. Over this ten-year period there was a dramatic increase in the number of patients treated. Rupture had occurred in 278 patients. Of the 309 patients with non-ruptured aneurysm 175 were asymptomatic, 84 were symptomatic and 50 were acutely symptomatic. Two hundred and fifty-nine patients underwent elective operation and the 50 acutely symptomatic patients were operated on as emergencies. The overall mortality for the non-ruptured series was 2.9 per cent. The mortality in patients undergoing elective surgery was 1.9 per cent (1.1 per cent in asymptomatic and 3.6 per cent in symptomatic patients) and 4.0 per cent for patients undergoing emergency surgery.

Adult↗
PubMed1989

Morbidity and mortality in acute lower limb ischaemia: a 5-year review.

A series of 204 consecutive patients with acute lower limb ischaemia was treated over a 5-year period in a Regional Vascular Unit. The mean age was 70 years, with a range of 41-98 and a female to male ratio of 1:0.94. Eighty-eight percent were treated by operation. Twenty-one had simultaneous vascular reconstructive procedures. Fifty-three patients died within 30 days (mortality rate 26%), and 12 required major amputation. Of these, four died resulting in a limb salvage rate of 95% in the survivors. An analysis of factors affecting outcome has shown increasing age, level of occlusion, recent myocardial infarction, pre-existing peripheral arterial disease and cardiopulmonary functional class to be major determinants of morbidity and mortality.

Adult↗
PubMed1988

Other neurologic diseases with dementia as a sequela.

Less-common causes of dementia are briefly discussed. Disorders covered include Pick's disease, primary progressive aphasia, progressive supranuclear palsy, Huntington's disease, olivopontocerebellar atrophies, closed head injury, dementia pugilistica, and Creutzfeldt-Jakob disease. Pseudodementia is also discussed. These disorders are compared and contrasted with the more common etiologies of dementia that are reviewed in other articles in the issue. Topics covered include treatment, differential diagnosis, clinical features, and pathogenesis.

Aged↗
PubMed1986

Ruptured abdominal aortic aneurysm.

Between 1974 and 1984, 174 patients with ruptured abdominal aneurysms have been treated by three vascular surgeons. The 11-year period showed a dramatic increase in the number of patients presenting with ruptured aneurysms. The overall operative survival, including patients who died before a graft could be inserted, was 67 per cent with improvement from 60 per cent in the first half of the period to 69 per cent in the second. The overall survival rate for the 162 who had a completed graft was 72 per cent. Reference to data from the Lothian area surgical audit showed that there has been a transfer of responsibility from general to vascular surgeons with an increase in the proportion of patients treated by operation. Concentration of care within a single specialized unit appears to have had a favourable effect on survival.

Aged↗
PubMed1985

Hepatic artery aneurysm associated with the mucocutaneous lymph node syndrome.

A case of a 4-year old child with a hepatic artery aneurysm after the mucocutaneous lymph node syndrome is reported. The child had obstructive jaundice and preoperative evaluation did not lead to the correct diagnosis. The aneurysm was resected and the postoperative course was unremarkable. The literature on this entity is reviewed.

Acute Disease↗
PubMed1984

Early childhood pneumonia in Aborigines of Bourke, New South Wales.

We carried out a retrospective survey of all children born in the district of Bourke , New South Wales, over a three-year period to determine the frequency of lobar pneumonia in the first three years of life. Although more non-Aboriginal children (167) than Aboriginal children (103) were born during this period, there was a striking difference between these groups in the frequency of pneumonia. Twenty-six (25.2%) Aboriginal children had one or more episodes of lobar pneumonia, compared with only five (3%) non-Aboriginal children born during the same period. Characteristic features of the disease in the Aboriginal children included a high rate of recurrent pneumonia (35%), frequent involvement of the upper lobe of the right lung (77%), and often a family history of pneumonia in early childhood. Of those with siblings, 39% of the affected infants had siblings who had suffered from pneumonia in early childhood. No perinatal factors which correlated with the subsequent development of lobar pneumonia could be identified. However, a greater proportion of the affected than of the non-affected children lived in substandard housing conditions.

Australia↗
PubMed1982

Budd--Chiari syndrome in a child.

We describe a 14-month-old female who presented with hepatomegaly 1 month after abdominal trauma. Eight years later, radiographic and histologic studies confirmed the diagnosis of Budd--Chiari syndrome with evolution to cirrhosis.

Abdominal Injuries↗
PubMed1979

Tibial defect due to acute haematogenous osteomyelitis: treatment and results in twenty-one children.

The management of twenty-one children with a defect of the tibial shaft due to acute haematogenous osteomyelitis is described. Half the defects were due to removal of the sequestrum before the involucrum had formed. Only four patients, all under ten years of age, had spontaneous regeneration of the shaft. Eleven children had a posterior tibiofibular graft and six had a transfer of the ipsilateral fibular diaphysis. The results of operation were superior to those of spontaneous regeneration. All the grafts united and the children returned home to lead normal lives. Shortening was only a problem when growth plates or adjacent joints had been damaged. We now leave the sequestrum for up to one year after the onset of infection. If the involucrum fails to form we reconstruct the tibia as soon as possible after sequestrectomy.

Acute Disease↗