Ictal radial and horizontal neglect.
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Attention↗
Biomedical subjects
C A Boyle
Publications and source records attributed to C A Boyle.
Auditing clinical teaching in oral surgery: the use of a student log book.
Objective assessments of clinical teaching are difficult; in oral surgery students must acquire a wide range of clinical and operative skills before qualifying as independent dental practitioners. A student log book system was introduced in Manchester University to monitor student progress and assess the efficacy of clinical instruction in oral and maxillofacial surgery following the introduction of the new 5-year BDS curriculum. Initial appraisal of third- and fourth year students undertaking 10-week clinical attachments revealed generally high levels of attendance (greater than 80%), and reasonable clinical experience (over 80% of students acquiring regular experience of dentoalveolar surgery and extractions). However, individual variation in both attendance and achievement was wide, and a persistent 8% of students did not appear to gain any practical experience. Students achieving less than the average course performance marks were thus easily identified and measures initiated to identify and correct their difficulties. Log book assessment also facilitated effective audit of teaching staff, clinical sessions and overall course delivery. The use of student log books to record clinical performance is recommended as a versatile aid to clinical teaching practice.
Documentation↗
Pneumonia with pleural effusion due to Legionella pneumophila serogroup Lansing 3.
We describe a case of pneumonia with pleural effusion due to Legionella pneumophila serogroup Lansing 3 in a human immunodeficiency virus-infected person. The 55-year-old man had been treated with immunosuppressive agents for hypersensitivity pneumonitis.
AIDS-Related Opportunistic Infections↗
The relationship between maternal education and mental retardation in 10-year-old children.
We conducted a case-control study of mental retardation (MR) in which case children (aged 10 years) were identified from existing records at multiple sources, primarily the public school systems. Control children were drawn from a roster of public school students not receiving special education services. We found that maternal educational level at the time of delivery was strongly and inversely related to a form of MR not accompanied by other serious neurologic conditions. For this isolated form of MR, maternal educational level was by far the most important predictor from among seven sociodemographic variables examined. There was a significant race-education interaction that indicated a steeper gradient in risk among white mothers than among black mothers. Relative to children of white mothers with 12 years of education, all children of black mothers, except those whose mothers had 16 or more years of education, were at increased risk. The results may be useful as a guide for selecting high-risk groups as candidates for early childhood intervention programs.
Adult↗
The accuracy of hospital records and death certificates for acute myocardial infarction.
BACKGROUND: In Australia information on the incidence of acute myocardial infarction (AMI) is available from routinely collected morbidity and mortality data. Given that these data are used for monitoring AMI it is important to assess their quality. AIMS: This paper examines the accuracy of the hospital records and death certificates. METHODS: Morbidity and mortality data were compared with the Newcastle heart disease register which is part of the WHO MONICA Project for 1986-1991 and sensitivity and positive predictive values calculated. RESULTS: For non-fatal AMI the hospital diagnostic coding had sensitivity of 78.9% (95% confidence interval [CI] 77.1%-80.7%), and positive predictive value of 65.6% (95% CI 63.7%-67.4%). Sensitivity was higher for men than for women and decreased with increasing age. Sensitivity was higher in those with no history of either AMI or other ischaemic heart disease (IHD), higher in current smokers than ex-smokers or never smokers, and lower in those with a self-reported history of high blood pressure. Sensitivity also varied among hospitals. Positive predictive value varied only with hospital. Both sensitivity and positive predictive value were high for death certificate data--89.9% (95% CI 88.4%-91.3%) and 96.0% (95% CI 95.1%-97.0%), respectively. CONCLUSIONS: Although the mortality data appear to be quite accurate, the hospital data alone are not accurate enough to be used to estimate rates or trends of heart attacks. Additional data are required in order to determine numbers of non-fatal AMIs accurately.
Adult↗
Leisure-time physical activity and other health behaviours: are they related?
Data on the associations between leisure-time physical activity and other health behaviours are conflicting. The National Heart Foundation 1989 Risk Factor Prevalence Survey data were analysed to examine the associations between leisure-time physical activity and other life-style health behaviours in a national representative sample with adjustment for potential confounders. Multivariate stepwise logistic regression analysis using data from 9054 respondents aged 20 to 69 years showed that participation in leisure-time physical activity, even when it was not vigorous, was weakly associated with not smoking, following a special diet and moderate consumption of alcohol; it was inversely associated with obesity. These weak associations could influence health practices at a population level if, as has been hypothesised, the adoption of leisure activity promotes the adoption of other good health practices. Confirmation of earlier findings of cross-sectional associations between activity and other positive health practices justifies future prospective or experimental studies to determine the behavioural response to adoption of leisure-time physical activity.
Adult↗
A randomised controlled trial of a dietary advice program for relatives of heart attack victims.
OBJECTIVE: To compare two interventions for reducing dietary fat intake in first degree relatives of recent heart attack victims. DESIGN: A randomised controlled trial comparing a low cost mail-out advice program; referral to a general practitioner (GP); and no intervention (control group). PARTICIPANTS: Adult children or siblings, aged less than 70 years, of survivors of definite or suspected heart attack who had been admitted to hospitals in the Lower Hunter Region of New South Wales. MAIN OUTCOME MEASURES: Dietary fat intake (evaluated with a validated short questionnaire) and measurement of blood cholesterol levels at six months. RESULTS: Of the 342 relatives who participated (36% of those invited), 109, 120 and 113, respectively, were randomly assigned to receive a mail-out intervention, advice from their GP or to be part of a control group. The six-month follow-up questionnaire was completed by only 59% of those in the mail-out intervention group compared with 71% of the GP group and 77% of the control group. Younger participants, cigarette smokers and children (compared with siblings) were less likely to return a follow-up questionnaire. The mail-out group showed a statistically significant 20% reduction in self-reported dietary fat intake, but this was not seen in either the GP group or the controls. The low response rate meant the study had insufficient power to detect hypothesised changes in blood cholesterol. CONCLUSION: Because of the poor response rate and possible biases from a differential response to follow-up, we conclude that this low intensity intervention for relatives of people with recent heart attack produces only a modest improvement in reported dietary fat intake. Alternative strategies may be more effective in reducing the risk of heart disease.
Adult↗
Prevalence of depression among electrical workers.
To address the possible association between electric and magnetic field exposure and depression, we analyzed data from the Vietnam Experience Study. In order to compare the risk of diagnosed depression, depressive symptoms, and elevations in personality scales indicative of depression, we classified employed participants as electrical workers (N = 183) and nonelectrical workers (N = 3,861) and compared their scores on the Diagnostic Interview Survey (DIS) and the Minnesota Multiphasic Personality Inventory (MMPI). Electrical workers in the aggregate showed little evidence of increased risk, with the possible exception of an increase in elevated MMPI depression scores among short-term workers. Data on electricians yielded indications of increased risk for several markers of depression. Despite the limited number of electrical workers, uncertainty regarding exposure, and our inability to address other workplace exposures, these results suggest that electrical workers in general are not at increased risk for depression. However, our results encourage further evaluation of depression among electricians.
Adult↗
Contribution of developmental disabilities to childhood mortality in the United States: a multiple-cause-of-death analysis.
Although developmental disabilities are among the major chronic health problems affecting children in the United States, the contribution of developmental disabilities to childhood mortality is unknown. To investigate the magnitude of this contribution, multiple cause-of-death data were examined for US children, aged 1-19 years, for 1980 and 1983-1989. The following conditions were included as developmental disabilities: autism, attention deficit disorder, learning disorders, mental retardation, cerebral palsy, epilepsy, muscular dystrophy, blindness and deafness. Based on underlying cause only, it was found that developmental disabilities were the fifth leading cause of nontraumatic death for children between 1 and 14 years of age and the third leading cause of non-traumatic death for children between 15 and 19 years. When a multiple cause approach was used to define developmental disability-related deaths (i.e. when contributing as well as underlying cause was considered), the number of such deaths nearly doubled. On the basis of both underlying- and multiple-cause analyses, cerebral palsy was the developmental disability most frequently cited as a cause of death. Mental retardation ranked second according to the multiple-cause approach but only fourth according to the underlying-cause approach. The least frequent causes of death (autism, attention deficit disorder, learning disorders, blindness, and deafness) were the ones most likely to be coded as contributing rather than underlying causes. Developmental disability-related mortality rates were highest among children aged 1-4 and 15-19 years, highest among blacks and lowest among racial groups other than blacks and whites, and higher among males than females. Although results of multiple-cause-of-death analyses more accurately reflect the proportion of deaths related to developmental disabilities, even this approach may underestimate the degree to which mortality is associated with a developmental disability.
Adolescent↗
Prevalence and health impact of developmental disabilities in US children.
OBJECTIVE: Data from the 1988 National Health Interview Survey--Child Health Supplement were used to examine the prevalence of selected developmental disabilities and their impact among children ages 0 through 17 years. DESIGN: The following conditions, identified through a structured in-person interview with a parent or other adult household member, were examined: deafness or trouble hearing, blindness, epilepsy or seizures, stammering and stuttering, other speech defects, cerebral palsy, delay in growth or development, learning disabilities, and emotional or behavioral problems. The impact was defined by measures of perceived health status, school performance and attendance, and health care utilization. RESULTS: Seventeen percent of children in the United States were reported to have ever had a developmental disability. The prevalence of the individual disabilities ranged from 0.2% for cerebral palsy to 6.5% for learning disabilities. These conditions taken together had a substantial impact on the health and educational functioning of affected children: 1.5 times more doctor visits, 3.5 times more hospital-days, twice the number of school-days lost, and a 2.5-fold increase in the likelihood of repeating a grade in school compared with children without these conditions. The extent of this impact was much greater among children with multiple disabilities or with either cerebral palsy, epilepsy or seizures, delays in growth and development, or emotional or behavioral problems. The impact on school performance was most pronounced for children reported to have learning disabilities. CONCLUSIONS: Future research efforts should be focused on ways to reduce the impact of these developmental disabilities on quality of life.
Absenteeism↗
Can the increasing weight of Australians be explained by the decreasing prevalence of cigarette smoking?
In Australia there has been a recent increase in the body mass index (BMI) of the population and a decrease in smoking prevalence. Data from the three risk factor prevalence surveys conducted by the National Heart Foundation of Australia in 1980, 1983 and 1989 were analysed to determine if the increase in BMI could be explained by the decrease in smoking. For men in all age groups and for women aged 50 years or over, there were parallel increases in mean BMI for current smokers, ex-smokers and never smokers. For women under 50 years, the pattern of increasing BMI over time was less clear. Mean BMI increased over time within each five-year age group and in age 'cohorts' and the pattern was independent of smoking status. For men and for both groups of women there were similar changes in mean BMI over time for most categories of employment status, education and physical activity. Thus the increase in body weight cannot be explained by the decrease in smoking rate, or by the other factors investigated in this paper.
Adult↗
Smoking control in restaurants: the effectiveness of self-regulation in Australia.
OBJECTIVES: The provision of smoke-free areas in restaurants has been a controversial issue; the restaurant industry largely opts for a self-regulation approach. This study aimed to examine the effectiveness of self-regulation as a strategy in meeting the industry's and customers' perceived needs. METHODS: Restaurateur and customer perspectives on the provision of smoke-free areas in restaurants were examined by survey among 365 restaurateurs and 1327 customers in New South Wales, Australia. RESULTS: Less than 2% of restaurants were totally smoke-free; 22% provided some smoke-free areas. Customers were much more likely than owners to think that smoke-free areas should be provided. Owners appeared to be unaware of customers' views about smoke-free areas in restaurants. CONCLUSIONS: Little evidence was found to support the effectiveness of the self-regulation policy adopted by the restaurant industry. Characteristics of restaurants and owners associated with the provision of smoke-free areas are presented and implications of the findings are discussed.
Attitude↗
Solar protection behaviours: a study of beachgoers.
This study explored the prevalence and predictors of solar protection behaviour in a community sample of beachgoers. A total of 670 participants was randomly selected from six beaches in the Newcastle district. The solar protection behaviour of each participant was assessed by direct observation and interview. A subsample was also asked to complete a written questionnaire to assess attitudes to solar protection use, knowledge of skin cancer and awareness of recommended solar protection behaviours. Forty-five per cent of the beachgoers in this sample were using a high level of solar protection, and a substantial proportion (16 per cent) of the sample was not using any kind of solar protection. Sunscreen with SPF 15+ was applied to at least one body region by 69 per cent of the sample, 17 per cent of the sample were wearing a recommended hat, 15.1 per cent were using shade, and 3.4 per cent were wearing a recommended style of shirt at the time of observation. Chi-square analyses of the data for under-15-year-olds indicated that a significantly greater proportion of 0- to 9-year-olds were well protected compared to 11- to 14-year-olds, but there was no difference in use of protection by boys and girls under 15 years of age. Stepwise regression analysis of the adult sample (15 years and over) showed that the predictors of overall level of solar protection were marital status and frequency of skin self-examination in the past 12 months. The practical implications of these findings for future community-based skin cancer prevention programs are discussed.
Adolescent↗
Proxy respondents and the validity of occupational and other exposure data. The Selected Cancers Cooperative Study Group.
As part of a multicenter cancer case-control study conducted in 1984-1988, a proxy interview was attempted for all cases who were initially interviewed for the study but who died during the 4-year data collection period. To assess the validity of using wives, other relatives, or other informants to obtain information about a subject, the authors compared occupational and other exposure data obtained from 270 male cancer cases and their proxy respondents. The primary focus of the case-control study was on Vietnam military service and exposure to phenoxy herbicides, but cases and their proxy respondents were also asked about occupational and other exposures relevant to the cancers. The accuracy of reporting for specific occupational exposures (e.g., asbestos and formaldehyde) and specific occupations (e.g., dry cleaning and meat packing or processing) was poor, although the latter improved somewhat when only case-spouse pairs were examined. Similarly, there was poor sensitivity in the reporting of herbicide exposure information in farming and other related occupations. In contrast, the reporting of certain demographic characteristics, childhood history characteristics, and use of alcohol and cigarettes was relatively good, and was even better when only case-spouse pairs were examined. The poor quality of proxy information for detailed exposure information suggests the need for careful use and interpretation of proxy information in epidemiologic studies.
Adult↗
Self-reported health status of Vietnam veterans in relation to perceived exposure to herbicides and combat.
The authors examined how the self-reported health of 7,924 US Army Vietnam veterans in 1985-1986 related to the men's perceived exposure to herbicides and combat in Vietnam. The results showed strong, positive associations between the extent of reported herbicide exposure (classified as a four-level ordinal index) and all 21 health outcomes studied, with clear "dose-response" relations in most instances. In contrast, only chloracne and psychological symptoms, including a symptom pattern consistent with posttraumatic stress disorder, were found to be strongly related to the amount of reported combat exposure (classified as a four-level ordinal index). The multiple herbicide/outcome associations seem implausible because of their nonspecificity and because of collateral biologic evidence suggesting the absence of widespread exposure to dioxin-containing herbicides among US Army combat units. These associations may have resulted from long-term stress reactions that produced somatization, hypochondriasis, and increased utilization of medical care among some Vietnam veterans. The available data suggest, however, that the association between reported combat exposure and psychological symptoms consistent with posttraumatic stress disorder may be causal.
Germany↗
The relation of computer-based measures of sperm morphology and motility to male infertility.
We investigated the relation between various sperm characteristics, including morphometric parameters, and impaired fertility among 596 men who participated in a national study. Semen was collected and processed by using a standardized protocol, and sperm measurements were made using a computer-aided sperm analysis instrument. We defined infertility in two ways: (1) the inability to father a child after trying for a year or longer, and (2) the number of children fathered. We found that all measures of sperm motion were decreased among men with impaired fertility. After adjustment for the other motion parameters and various potential confounders, however, only the percentage of progressive cells was associated with infertility. One morphometric parameter, the mean length/width ratio, was consistently associated with both measures of infertility, even after adjustment for potential covariates. This measure was also strongly associated with infertility among various subgroups defined by poor sperm concentration, motility, and morphology. The sperm length/width ratio appears to be an important correlate of infertility in males.
Adult↗
Changes in oxygen saturation using two different sedation techniques.
Pulse oximetry was used to assess the degree of hypoxia observed in patients receiving simple midazolam sedation for removal of lower third molars and compared to that seen in patients receiving a combination sedation technique using nalbuphine and midazolam. Results showed that the degree of hypoxia experienced by patients receiving the combination technique was significantly more profound in both incidence and depth than that seen in the group receiving midazolam alone (p less than 0.05).
Procedural Sedation↗
Non-Hodgkin's lymphoma in a cohort of Vietnam veterans.
We examined the incidence of non-Hodgkin's lymphoma (NHL) in a cohort of 18,313 United States Army veterans from the Vietnam era. Diagnoses were confirmed through a review of hospital records. Among veterans who had died after discharge or who had participated in a telephone interview (8,170 Vietnam veterans and 7,564 non-Vietnam veterans), seven Vietnam veterans and one non-Vietnam veteran had developed non-Hodgkin's lymphoma (p = 0.07). As none of the NHL cases had military job titles which suggest that they were occupationally exposed to herbicides while in Vietnam, the reasons for the excess are unclear.
2,4,5-Trichlorophenoxyacetic Acid↗