Search PubMed⌕ Search

Biomedical subjects

C Hayes

Publications and source records attributed to C Hayes.

At least 73 records · Page 4Linked to original sources
PubMed1998

Impact of epidemic influenza A-like acute respiratory illness in a remote jungle highland population in Irian Jaya, Indonesia.

A suspected epidemic of unknown etiology was investigated in April/May 1996 in the remote jungle highlands of easternmost Indonesia. Trend analysis demonstrates the area-wide occurrence of a major respiratory infection outbreak in November 1995 through February 1996. The monthly mean rate of respiratory infection episodes for the peak outbreak months (2,477 episodes/100,000 persons) was significantly higher (P < .0001) than for the 34 months leading up to the outbreak (109 episodes/100,000 persons). Notable were the high attack rates, particularly among adults: 202 episodes/1,000 persons aged 20-50 years in one community. Excess morbidity attributed to the outbreak was an estimated 4,338 episodes. The overall case-fatality rate was 15.1% of outbreak cases. Laboratory evidence confirmed the circulation of influenza A/Taiwan/1/86-like viruses in the study population, and high hemagglutination inhibition titer responses were indicative of recent infections. Historical documents from neighboring Papua New Guinea highlight the role of influenza A virus in repeated area outbreaks.

Adolescent↗
PubMed1998

Subcutaneous tunnelling of epidural catheters for postoperative analgesia to prevent accidental dislodgement: a randomized controlled trial.

The use of subcutaneous tunnelling to prevent movement of epidural catheters was examined in a prospective controlled trial. There were 113 patients in the standard group and 100 in the tunnelled group. The groups were similar with respect to age, sex and weight. There were 176 thoracic catheters, and 37 lumbar catheters. Mean duration of catheterization in the tunnelled group was 3.5 +/- 1.3 days and in the standard group, 3.1 +/- 1.5 days. In total, 60 catheters moved significantly from their initial position: 17 (28%) moved inwards and 43 (72%) moved outwards. 159 catheters were still functioning at the time of their removal, 76 standard and 83 tunnelled. This represents 67 and 83% of the two groups respectively. Subcutaneous tunnelling was shown to prevent clinically significant inwards (P = 0.043) and outwards (P = 0.0005) movement of epidural catheters and is more likely to result in a functional epidural blockade at the time of catheter removal (P = 0.0084).

Aged↗
PubMed1998

Epidural analgesia: prospective audit of 1062 patients.

A prospective survey of one thousand and sixty-two patients receiving epidural analgesia in surgical wards was undertaken over a two-year period. The duration of infusion ranged from one to fourteen days, with a mode of three days. There were 1131 episodes where a local anaesthetic and opioid mixture was used and 160 where opioids were used alone. Local anaesthetic was not used without opioids. 23% of catheters were removed prematurely because of catheter related problems including accidental dislodgement (13%) and skin site inflammation (5.3%). No epidural abscess or haematoma was identified. In 14% of the total number of episodes there was either no demonstrable block or complications occurred requiring a change of solution: 30% of this group were salvaged following intervention by the Acute Pain Service (APS). The incidence of respiratory depression was 0.24%. There was no case of delayed respiratory depression. Epidural analgesia can be used safely in surgical wards provided that regular review of the patients is undertaken. It must be anticipated however, that up to 20% of patients will not receive adequate analgesia for the first 48 hours postoperatively. The failure rate could be halved if accidental dislodgement of epidural catheters could be eliminated.

Adolescent↗
PubMed1998

Sonic hedgehog is not required for polarising activity in the Doublefoot mutant mouse limb bud.

The mouse mutant Doublefoot (Dbf) shows preaxial polydactyly of all four limbs. We have analysed limb development in this mutant with respect to morphogenesis, gene expression patterns and ectopic polarising activity. The results reveal a gain-of-function mutation at a locus that mediates pattern formation in the developing limb. Shh expression is identical with that of wild-type embryos, i.e. there is no ectopic expression. However, mesenchyme from the anterior aspects of Dbf/+ mutant limb buds, when transplanted to the anterior side of chick wing buds, induces duplication of the distal skeletal elements. Mid-distal mesenchymal transplants from early, but not later, Dbf/+ limb buds are also able to induce duplication. This demonstration of polarising activity in the absence of Shh expression identifies the gene at the Dbf locus as a new genetic component of the Shh signalling pathway, which (at least in its mutated form) is able to activate signal transduction independently of Shh. The mutant gene product is sufficient to fulfil the signalling properties of Shh including upregulation of the direct Shh target genes Ptc and Gli, and induction of the downstream target genes Bmp2, Fgf4 and Hoxd13. The expression domains of all these genes extend from their normal posterior domains into the anterior part of the limb bud without being focused on a discrete ectopic site. These observations dissociate polarising activity from Shh gene expression in the Dbf/+ limb bud. We suggest that the product of the normal Dbf gene is a key active constituent of the polarising region, possibly acting in the extracellular compartment.

Animals↗
PubMed1998

How dentition status and masticatory function affect nutrient intake.

The authors examined nutrient intake in relation to the number of teeth, denture type and masticatory function among 638 men in the U.S. Department of Veterans Affairs Dental Longitudinal Study. They found that calorie-adjusted nutrient intakes decreased with progressively impaired dentition status, independently of age, smoking status and alcohol use. Intakes of fiber and most vitamins and minerals were inversely correlated with masticatory function. The findings suggest that prevention of tooth loss and prosthodontic replacement of missing teeth could improve diets of older adults.

Adult↗
PubMed1998

The association between alveolar bone loss and pulmonary function: the VA Dental Longitudinal Study.

The effect of oral conditions on medical outcomes is not well understood. The purpose of this epidemiological investigation was to examine whether the risk for chronic obstructive pulmonary disease (COPD) is enhanced among individuals with a history of periodontal disease as assessed by radiographic alveolar bone loss (ABL). Subjects were selected from the VA Dental Longitudinal Study, a long-term study of aging and health in male veterans who were medically healthy at baseline. Subjects are not VA patients. Those subjects with a forced expiratory volume in 1 second (FEV1) less than 65% of predicted volume were categorized as having COPD. ABL was assessed by using full-mouth series periapical films measured by a Schei ruler. Bone loss at each interproximal site was measured in 20% increments, and the mean whole-mouth bone loss score was calculated. Logistic regression analysis was used to determine the independent contribution of bone loss measurement at baseline to the subsequent risk of developing COPD over a 25-year follow-up period. Covariates included measures of smoking, height, age, education, and alcohol consumption. Of the 1,118 medically healthy dentate men at baseline, 261 subsequently developed COPD. We found that ABL status at baseline was an independent risk factor for COPD, with subjects in the worst population quintile of bone loss (mean ABL > 20% per site) found to be at significantly higher risk (OR = 1.8; 95% CI = 1.3, 2.5). The results of this analysis indicate that increased ABL is associated with an increased risk for COPD

Adult↗
PubMed1998

The use of patient based outcome measures in clinical decision making.

OBJECTIVE: Three questions were proposed in this presentation. 1) How can existing quality of life measures be used most effectively now? (2) What additional work is needed in their development or application? (3) Can existing data be used for secondary analyses of 'generic questions' concerning the relationships between oral health and quality of life outcomes? CONCLUSIONS: The availability of existing measures can provide directions for future refinement particularly if existing measures are tested across diverse populations and within the community of practising dentists. Additionally the use of existing data for secondary data analysis of 'generic questions' could provide information which would help to sharpen the instruments. However, if patient based outcome measures are to be used in clinical decision making the clinical community must be involved in the development of instruments which are seen as useful to clinicians. A shift toward health status assessments, in order to be accepted by clinicians, must benefit patients and enhance the clinician's ability to function. For clinicians to embrace this idea it must be clear how they can use this information to design therapeutic interventions. The argument for the use of these measures must be made on practical not theoretical grounds. Therefore it is important to prove to clinicians that measuring health status is useful in improving patient care and that these measures are tools in the service of their patients.

Activities of Daily Living↗
PubMed1997

The standardized prescribing ratio--a new method for comparing prescribing between GPs, controlling for patient age and sex.

OBJECTIVES: To develop a method for comparing the proportion of patients on any drug or group of drugs for individual GP patient panels in Ireland, taking account of the age and sex structure of the panel. DESIGN: Calculations based on prescribing data for the fourth-quarter of 1995 supplied by the Irish General Medical Services Payments Board for the Eastern Health Board area.Setting-Five hundred and fifty Irish general practices serving 355,000 persons entitled to free medical care under the General Medical Services Scheme in the Eastern Health Board area (28% of the population). MAIN OUTCOME MEASURES: Weightings for number of persons prescribed each of four drug groups, and all drugs combined, for 22 age/sex groupings, leading to a single age/sex adjusted prescribing index-the standardized prescribing ratio (SPR) for each GPs practice population. RESULTS: The SPRs showed a large amount of variation from the average figure of 100 for practices of 1000 or more patients for all drugs and for each of the four drug groups studied: all drugs 54-125, antibiotics 52-165, H(2) antagonists/proton pump inhibitors 38-197, antidepressants 13-213 and thyroxine 33-175. Practices with above average SPRs for all drugs, antibiotics and H(2) antagonists/proton pump inhibitors were significantly larger than those with below-average SPRs. Practices with below average SPRs for thyroxine were significantly larger than those with above-average SPRs. CONCLUSIONS: The SPR provides a useful age/sex adjusted method of comparing prescribing between GPs and it can be applied to any drug or group of drugs.

Journal Article↗
PubMed1997

In vivo measurement of regional brain metabolic response to hyperventilation using magnetic resonance: proton echo planar spectroscopic imaging (PEPSI).

A new rapid spectroscopic imaging technique with improved sensitivity and lipid suppression, referred to as Proton Echo Planar Spectroscopic Imaging (PEPSI), has been developed to measure the 2-dimensional distribution of brain lactate increases during hyperventilation on a conventional clinical scanner equipped with a head surface coil phased array. PEPSI images (nominal voxel size: 1.125 cm3) in five healthy subjects from an axial section approximately 20 mm inferior to the intercommissural line were obtained during an 8.5-min baseline period of normocapnia and during the final 8.5 min of a 10-min period of capnometry-controlled hyperventilation (end-tidal PCO2 of 20 mmHg). The lactate/N-acetyl aspartate signal increased significantly from baseline during hyperventilation for the insular cortex, temporal cortex, and occipital regions of both the right and left hemisphere, but not in the basal ganglia. Regional or hemispheric right-to-left differences were not found. The study extends previous work using single-voxel MR spectroscopy to dynamically study hyperventilation effects on brain metabolism.

Adult↗
PubMed1997

Pattern management: a tool for improving blood glucose control with exercise.

Pattern management can help the person with type 1 diabetes to understand glycemic response to activity, make reasonable management decisions, and evaluate the effectiveness of adjustments to exercise. Insulin adjustments and carbohydrate supplementation can be used independently or in conjunction to maintain target-range blood glucose levels during activity. To achieve success, the patient must be encouraged to gather data through self-monitoring of blood glucose and diligent recordkeeping, analyze information collected, make careful adjustments, and assess outcomes.

Adult↗
PubMed1997

National survey of MRSA: Ireland, 1995.

The objective of this survey was to obtain an indication of the size of the methicillin-resistant Staphylococcus aureus (MRSA) problem in Ireland prior to introducing national MRSA control guidelines. A survey of all microbiology laboratories in Ireland was carried out over two weeks in Spring 1995. For patients from whom MRSA was isolated during the study period standard demographic and clinical data were requested and period prevalence/1000 discharges was calculated. All 45 microbiology laboratories surveyed responded. MRSA was isolated from 448 patients during the two-week period. The period prevalence of MRSA was 16.5/1000 discharges. Males aged > or = 65 had the highest rate (50/1000 discharges). Half of all isolates were from patients in surgical or medical wards, but 4% were from community-based sources such as GPs, nursing homes and hospices. Thirty-two percent of MRSA patients were infected rather than colonized. MRSA is clearly a significant problem in Ireland. While it is largely a hospital problem at present, the increasing trend towards day procedures and shorter hospital stay means that infection will increase in the community.

Adolescent↗
PubMed1997

Inoculation of plasmids expressing the dengue-2 envelope gene elicit neutralizing antibodies in mice.

To develop a nucleic acid vaccine against dengue type-2 virus, the PreM and 92% of the envelope (E) genes were cloned into different eukaryotic plasmid expression vectors (pkCMVint Polyli and pVR1012). The resultant plasmid constructs (pD2ME and P1012D2ME) properly expressed the truncated E protein in vitro as evidenced by the expected protein size on SDS-PAGE and the ability of the protein to be recognized by monoclonal antibodies directed against conformational epitopes. Three-week-old BALB/c mice were given intradermal inoculations of each construct. Plasmid expression vectors without dengue genes were used as controls. One hundred percent of the mice that received the pD2ME and p1012D2ME constructs developed anti-dengue antibodies. These antibodies were shown to neutralize dengue type-2 virus in vitro. This is the first demonstration of the use of nucleic acid inoculation in the development of potential dengue virus. vaccines.

Animals↗
PubMed1997

Ten-year survival of Down syndrome births.

OBJECTIVE: To determine the survival status of children with Down syndrome (DS), and to document factors influencing survival. DESIGN: Follow-up study of cases identified from the Dublin European Register of Congenital Anomalies and Twins (EUROCAT) Register. Follow-up was attempted for each case until death or 1992 or until the date last known to be alive. SETTING: Eastern Health Board, Dublin. SUBJECTS: In all, 389 DS children, born between 1 January 1980 and 31 December 1989 were followed up. RESULTS: Survival rates of 88% at one year and 82% at 10 years were found. There was a non-significant improvement in survival between the cohort born in 1980-1984 and that born in 1985-1989. Congenital heart defects reduced survival to 72% and complete atrio-ventricular canal defects (CAVD) had the poorest prognosis (58% survival at 10 years). Cases with CAVD showed a trend towards improved survival when surgically treated. Maternal age mother's county of residence, sex of infant, season of birth and presence of additional non-cardiac congenital anomalies had no impact on survival. CONCLUSIONS: Four out of five DS children now survive at least 10 years. Adequate educational and health service provision needs to be made for them, especially those with congenital heart defects. The need for studies which compare survival and quality of life in DS children with CAVD who undergo cardiac surgery versus those who do not, taking account of various selection factors, is identified.

Child↗
PubMed1997

Neuropathic pain in the perioperative period.

The presence of neuropathic pain in the postoperative period may be associated with unnecessary suffering, particularly if the diagnosis is not made and treatment modalities chosen are ineffective. It is likely that inadequate management of acute pain may set the scene for progression to a chronic pain state. The underlying neurobiological mechanisms whereby short-term stimuli may lead to long-term plasticity and structural changes in the nociceptive pathways are now being unraveled. The possibility arises that acute, intensive intervention may avoid or significantly reduce the development of these changes and subsequent chronic pain. Early diagnosis and treatment becomes a priority. There is a need for further research in this area to determine whether or not such theoretical potential can be turned to therapeutic advantage.

Acute Disease↗
PubMed1997

Cultural diversity in Australian medical education.

The present study sought to explore the relevance of cultural dimensions and cultural diversity among overseas and local medical students. The main comparison among the fourth year medical students studied was between Asian origin and Anglophone background students. The measures used included cultural variation, reasons for studying medicine, learning approaches and strategies, patient interaction confidence, and medical practices anxieties. Results indicated cultural differences between the two groups, and relationships between cultural variables and, in particular, reasons for studying medicine, learning approaches and strategies, and patient interaction confidence. Results were interpreted according to Hofstede's (1980, 1986) theory of cultural dimensions as they may apply in the educational setting.

Anxiety↗
PubMed1996

Case-control study of periconceptional folic acid supplementation and oral clefts.

There is consistent evidence that the risk of neural tube defects is decreased by periconceptional supplementation with folic acid. A similar protective effect has been postulated for oral clefts. A case-control study was conducted in greater metropolitan Boston; Massachusetts; Philadelphia, Pennsylvania; and southeastern Ontario, Canada, from 1988 through 1991 to test the hypothesis that folic acid supplementation during the periconceptional period reduces the risk of oral clefts. Crude and multivariate-adjusted relative risks were calculated for all oral clefts (n = 303), cleft palate (n = 108), and cleft lip with or without cleft palate (n = 195). Controls (n = 1,167) were liveborn or stillborn infants less than age 6 months who had various congenital anomalies other than oral clefts, neural tube defects, or other "midline defects." Adjusted relative risks and 95 percent confidence intervals for daily folic acid supplementation during the periconceptional period were: oral clefts, 1.1 (95% confidence interval (CI) 0.8-1.7), cleft palate, 0.9 (95% CI 0.5-1.6), and cleft lip with or without cleft palate, 1.3 (95% CI 0.8-2.1). These findings do not support a protective association between the periconceptional use of folic acid supplements and the risk of oral clefts.

Case-Control Studies↗