Biomedical subjects
C Gill
Publications and source records attributed to C Gill.
Hello can anyone hear me?
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Five-year incidence and prediction of dementia and cognitive decline in a population sample of women aged 70-79 at baseline.
OBJECTIVE: To determine the incidence of dementia and cognitive decline and their predictors in a population sample. SETTINGS: A rural geographically defined population served by a single health centre. SAMPLE: 75% of the 70-74-year-old, 100% of the 75-79-year-old women registered with the practice. METHOD: Interview the total sample using an augmented version of CAMDEX, including informant interview, and reaction times at baseline and 5 years later. IQ was estimated at baseline only. RESULTS: 365 women were interviewed at baseline, 237 at follow-up. Incidence of dementia of all severities was 3.1% per annum (95% CI, 2.2-4.3). CAMCOG declined by 12.6 points in those who became demented, MMSE by 3 points. Observed, self-reported and informant-reported cognitive difficulty at baseline all predicted later incidence of dementia. The additional use of estimated IQ and reaction times did not increase the efficiency of either cross-sectional detection of dementia or prediction of dementia at 5 years. CONCLUSIONS: The incidence of dementia was in the range reported by other studies; slight cognitive decline was noted in the total population, increasing with age and marked in incident dementia. Of clinical importance was the finding that both the individuals and the informants of those who subsequently demented were aware of decline 5 years earlier. Simple and relatively easily administered cognitive tests were found to be the most efficient method of detection of dementia.
Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers.
BACKGROUND: In the UK EPIC validation studies, the accuracy of several methods was assessed by comparison with to-day weighed records and the biomarkers, 24-hour urine nitrogen (N) and potassium (K), plasma carotenoids and plasma vitamin C. METHODS: Comparisons between methods were made on 156 women, studied over 1 year at 3-monthly intervals at home. On each of four occasions, volunteers completed 4 days of weighed records and provided two 24-hour urine collections and a fasting blood sample. RESULTS: In comparison with the 16 days of weighed records, a food frequency questionnaire (FFQ) yielded higher values mainly due to greater reported consumption of milk and of vegetables. A 24-hour recall was as good as the FFQ in placing individuals in the distribution of habitual diet from weighed records. Results obtained from a 7-day estimated record were closest to those obtained from the weighed record. Correlations between 24-hour urine excretion and dietary N intake from weighed records were high (0.78-0.87) as were those with estimated food diaries (0.60-0.70). Correlations between urine N and the FFQ and 24-hour recall were lower (0.10 to 0.27), but improved by energy adjustment using residuals for N and K which are correlated with total energy intake. Comparisons between dietary estimates and urinary K and serum carotenoids and vitamin C showed broadly similar results. Limited biomarker information amongst 200 UK EPIC participants supported the findings of the validation study. CONCLUSIONS: UK EPIC uses three methods (the 7-day diary, an improved FFQ, and the 24-hour recall) to assess diet. 93% of first food diaries are returned completed by participants. Repeated diaries are the main dietary assessment method for nested case-control analyses.
Interrater reliability of six tests of trunk muscle function and endurance.
Some studies have shown a relationship between trunk muscle strength and low back pain. Measures of trunk muscle strength and endurance, which are feasible in the clinical setting, are needed. The purpose of this study was to determine interrater reliability of six tests of abdominal and trunk extensor muscle strength and endurance. The tests included abdominal and extensor dynamic endurance, hand-held dynamometry of isometric flexion and extension, and abdominal and extensor static endurance. Thirty-nine healthy workers were recruited as subjects. Each was tested by three raters on 3 days within 1 week. Intraclass correlation coefficients (ICC) and the standard error of measurement (SEM) were calculated: abdominal dynamic endurance ICC = .89, SEM = 8 repetitions; extensor dynamic endurance ICC = .78, SEM = 9 repetitions; abdominal isometric force ICC = .25, SEM = 60 N; extensor isometric force ICC = .24, SEM = 68 N; abdominal static endurance ICC = .51, SEM = 35 seconds; extensor static endurance ICC = .59, SEM = 20 seconds. The dynamic endurance tests had acceptable interrater reliability. For the others, reliability was poor and the SEMs were large.
The mobilisation of peripheral blood progenitor cells using chemotherapy, stem cell factor and filgrastim or chemotherapy plus filgrastim alone: a randomised study.
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A study of ovarian cancer patients treated with dose-intensive chemotherapy supported with peripheral blood progenitor cells mobilised by filgrastim and cyclophosphamide.
We have shown that large numbers of haemopoietic progenitor cells are mobilised into the blood after filgrastim [granulocyte colony-stimulating factor (G-CSF)] alone and filgrastim following cyclophosphamide chemotherapy in previously untreated patients with ovarian cancer. These cells may be used to provide safe and effective haemopoietic rescue following dose-intensive chemotherapy. Using filgrastim alone (10 micrograms kg-1), the apheresis harvest contained a median CFU-GM count of 45 x 10(4) kg-1 and 2 x 10(6) kg-1 CD34+ cells. Treatment with filgrastim (5 micrograms kg-1) following cyclophosphamide (3 g m-2) resulted in a harvest containing 66 x 10(4) kg-1 CFU-GM and 2.4 x 10(6) kg-1 CD34+ cells. There was no statistically significant difference between these two mobilising regimens. We have also demonstrated that dose-intensive carboplatin and cyclophosphamide chemotherapy can be delivered safely to patients with ovarian cancer when supported by peripheral blood progenitor cells and filgrastim. Carboplatin (AUC 7.5) and cyclophosphamide (900 mg m-2) given at 3 weekly intervals with progenitor cell and growth factor support was well tolerated in terms of haematological and systemic side-effects. Double the dose intensity of chemotherapy was delivered compared with our standard dose regimen when the treatment was given at 3 weekly intervals. Median dose intensity could be further escalated to 2.33 compared with our standard regimen by decreasing the interval between treatment cycles to 2 weeks. However, at this dose intensity less than a third of patients received their planned treatment on time. All the delays were due to thrombocytopenia.
Defining the minimum level of detectable change for the Roland-Morris questionnaire.
BACKGROUND AND PURPOSE: The Roland-Morris Questionnaire (RMQ) is a self-administered disability measure in which greater levels of disability are reflected by higher numbers on a 24-point scale. The RMQ has been shown to yield reliable measurements, which are valid for inferring the level of disability, and to be sensitive to change over time for groups of patients with low back pain. Little is known about the usefulness of this instrument in aiding decision making regarding individual patients. The purpose of this study was to determine the minimum level of detectable change when the RMQ is applied to individual patients. SUBJECTS: The study sample consisted of 60 outpatients with low back pain. METHODS: The RMQ was administered at the subjects' initial visit and again 4 to 6 weeks later. Conditional standard errors of measurement (CSEMs) were computed for initial and follow-up RMQ scores, and these values were used to estimate the minimum level of detectable change. Results. Minimum levels of detectable change at the 90% confidence level varied from 4 to 5 RMQ points. CONCLUSION AND DISCUSSION: The magnitude of CSEMs is sufficiently small to detect change in patients with initial scores in the central portion of the scale (4-20 RMQ points); however, the magnitude is too large to detect improvement in patients with scores of less than 4 and deterioration in patients who have scores greater than 20.
[Effects of continuous cryotherapy on the surgically traumatized musculoskeletal system. Perioperative Cryotherapy Study Group].
The in-vivo effectiveness of continuous cold pressure therapy was evaluated in 24 patients following elective knee or hip replacement surgery. A cooling of the skin surface down to 8 degrees C resulted in a reduction of the epifascial tissue temperature to 22 degrees C. A significant reduction of subfascial pressure in combination with decreased protein leakage via redovac output were notable. Observing a constant decreased pH-level increased oxygen saturation and reduced drop of base excess were interpreted as signs of reduced enzyme-linked metabolism activity. Clinically these findings were found in correlation to a 50% decrease of postoperative analgetic demands as well as a 20% increased range of motion level.
[Primary biliary cirrhosis--cellular mechanisms and role of enterobacterial antigens].
The nature of primary biliary cirrhosis (PBC) is still unknown. In this study the diagnostic value of the expression of MHC proteins and adhesion molecules in bile duct epithelia, the different amount of inflammatory cells around the bile ductules and the evidence of enterobacterial antigens were tested in liver tissue of patients with PBC, chronic hepatitis B and C, autoimmune hepatitis and cellular or ductopenic liver transplant rejection. There was a significant difference according MHC and adhesion molecules between PBC and rejections at the one and the cases of chronic hepatitis at the other hand. According to inflammatory infiltrate there was no difference. The enterobacterial antigen lipid-A was found more often in centrolobular hepatocytes of PBC/PSC cases but not in the portal bile duct region. The possible pathogenetic role of enterobacterial antigens in the disease are discussed.
Molecular and epidemiological approaches to the etiology of urinary tract tumors in an area with Balkan endemic nephropathy.
Recently, we completed a second biostatistical study of urinary tract tumors (UTT) in areas with Balkan endemic nephropathy (BEN) in the Vratza district, Bulgaria, during the period 1975 to 1991. We confirmed the positive correlation between the incidence of urinary tract tumors (UTT) and BEN demonstrated in our first population-based case control 1977 study. A UTT incidence of 98.9 per 100,000 men and 74.7 per 100,000 women was found in villages most affected by BEN when compared with 11.0 and 6.7 for men and women, respectively, in nonendemic villages. The relative risk (RR) of UTT in BEN villages showed tumors of kidney pelvis and ureters-29 in men and 35 in women and urinary bladder tumors-4 in men and 11 in women. The percentage of food and blood samples containing nephrotoxic and carcinogenic mycotoxin Ochratoxin A (OTA) correlated with the origin of the samples. The most contaminated samples were found in BEN villages and households, and the urinary excretion of OTA was higher in the group of BEN/UTT patients. The UTT DNA's were studied by the 32P-postlabeling method for the presence of OTA-DNA adducts. Some OTA-DNA adducts characteristic for endemic UTT and absent in control nonendemic UTT and nontumorous tissues were described for the first time.
The prevalence of depression in a cohort of the very elderly.
In a community study of 1173 very elderly (> or = 77 years) subjects, a screening interview was followed by a CAMDEX diagnostic interview in a subsample of 461. The estimated prevalence of DSM-III-R major depressive disorder in the community sampled was 2.4% (95% CI 0.9%, 4.0%). Using CAMDEX criteria, the prevalence of depressive illness was 3.0% (95% CI 0.7%, 5.3%). 10% of those who had a diagnostic interview were rated as having depressive symptoms of mild or moderate severity. Of these, approximately 1/3 met diagnostic criteria for major depressive disorder. The significance of these findings and the possible need for wider criteria for depression in the elderly are discussed.
Cognitive decline in an elderly population--a two wave study of change.
A sample of 1111 survivors from a population aged 75 years and over completed the Mini-Mental State Examination (MMSE) twice, separated by 28 months on average. There was a mean decline of 1.3 points in MMSE score. With increasing age, mean drop in score also increased. The proportion at each age identified as newly cognitively impaired according to any standard cut-point on MMSE rose markedly. Mean decline was greater in women than men even after adjustment for age. Cognitive change on the MMSE was approximately unimodally and normally distributed. This distribution was a marked contrast to the distribution of MMSE scores themselves, which was skewed due to truncation of scores at the maximum. The decline was not due to the inclusion of individuals with physical impairment. These findings indicate that cognitive decline, like dementia, becomes increasingly common with advancing age, and suggest that dementia may be regarded as one extreme of the continuum of cognitive decline.
Interrater reliability of lumbar accessory motion mobility testing.
BACKGROUND AND PURPOSE: This study examined the interrater agreement, or reliability, of accessory motion mobility testing of the lumbar spine in patients with low back pain. SUBJECTS: Subjects were 18 patients with low back pain referred to the physical therapy outpatient department of a university teaching hospital. METHODS: Six orthopedic physical therapists evaluated the posterior-anterior (P-A) accessory motion mobility at each of six levels, L-1 to the sacral base, on each subject. The mobility was recorded on a nine-point scale, and reproduction of pain was noted. The physical therapists noted any level at which mobility or pain findings were of significance to treat. To evaluate agreement on the identification of spinal levels, therapists were asked to identify one spinous process, which was arbitrarily marked on each subject. Kappa analyses and intraclass correlation coefficients (ICCs) were calculated to evaluate agreement on the level of the marked segment and the mobility at that level, respectively. RESULTS: The ICC for determination of the marked level was R(2,1) = .69 (95% confidence interval = .53-.82). The ICC for mobility findings at the marked level was R(2,1) = .25 (95% confidence interval = 0-.44). A secondary Kappa analysis to determine agreement on treatment decision making demonstrated similarly low levels of agreement. CONCLUSION AND DISCUSSION: There is poor interrater agreement on determination of the segmental level of a marked spinous process. There is poor interrater reliability of P-A accessory mobility testing in the absence of corroborating clinical data. Caution should be exercised when physical therapists make clinical decisions related to the evaluation of motion at a specific spinal level using P-A accessory motion testing.
CAMCOG--a concise neuropsychological test to assist dementia diagnosis: socio-demographic determinants in an elderly population sample.
The CAMCOG, which forms part of the CAMDEX interview (Roth et al., 1986, 1988), is a brief neuropsychological battery designed to assess the range of cognitive functions required for a diagnosis of dementia, and to detect mild degrees of cognitive impairment. It was administered to a population sample of 418 elderly people (aged 77 and above) in their place of residence. The data show that in contrast to the Mini-Mental State Examination, total CAMCOG scores are well distributed and there is no ceiling effect. Examination of the association between CAMCOG scores and socio-demographic variables (age, sex, education and social class) shows that each exerts a significant, and independent, effect upon performance. CAMCOG also includes a number of subscale which assess individual areas of cognitive function. Of the eight major subscales (orientation, language, memory, attention, praxis, calculation, abstract thinking, perception), age was significantly related to all but attention; sex with attention, praxis, calculation and perception; education with language and abstract thinking; and social class with language and perception. In all these analyses, the results were adjusted for the effects of the other socio-demographic variables using analysis of variance. However, education and social class are highly correlated variables and when the association with education is examined without adjusting for social class, attention and praxis are also found to be significantly related to education. Caution must therefore be taken when using the CAMCOG (or any other cognitive test) as a screening test for dementia, using a single, predetermined cutpoint. In general, the combination of brevity and breadth of the CAMCOG, along with its distributional properties, makes it an attractive neuropsychological test for use in the community or the clinic.
Bilingualism and cochlear implants--issues and answers?
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