Health records management in transition in the United Kingdom.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to C Thompson.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: To examine associations between children's responses to nutrition and fitness programmes and their baseline levels of cardiovascular risk factors. DESIGN: A randomised controlled trial. SETTING: Primary schools in Perth, Western Australia. PARTICIPANTS: 1147 children aged 10-12 years. INTERVENTIONS: Fitness, fitness+school nutrition, school +home nutrition or home nutrition programmes and a control group. MAIN OUTCOME MEASURES: Blood pressure (BP), cholesterol, nutrient intake, fitness, and body fat. RESULTS: Fall in systolic BP was significantly greater in the higher risk groups with the fitness intervention for boys and the home nutrition intervention for girls. Overall, diastolic BP fell for girls in the fitness intervention with no differences related to cluster membership. Higher risk boys in the fitness intervention showed greater improvement in fitness than the lower risk boys. Fitness improved in girls in the fitness programme but responses did not differ significantly according to cluster membership. Decrease in triceps skinfolds was significantly greater for higher risk boys in the home nutrition group and in higher risk girls except for those receiving the school+home nutrition intervention. Home nutrition programmes were associated with decreased intake of fat and greater intake of fibre in girls in the higher risk group and of sugar in higher risk boys. CONCLUSIONS: The greatest improvement in the higher risk children were associated with fitness and home nutrition programmes. Health education programmes aiming to include higher risk children should focus on these areas.
BACKGROUND: Take Care is a commercially sponsored educational package for the detection and management of depression by all members of the primary health-care team. AIM: This study was designed to evaluate whether the educational package affects the recognition of psychological illness by general practitioners. METHOD: General practitioners working in 13 practices in North West England or Trent Regional Health Authorities took part the evaluation. Patients who scored more than eight on the depression or anxiety component of the Hospital Anxiety and Depression (HAD) scales, and who were thought by their general practitioner to have a totally physical problem or no illness, were deemed to have a psychological illness that had been 'missed' by the doctor. Changes in the proportion of missed cases before and after exposure to Take Care were estimated. RESULTS: When all practices were considered together, the general practitioners missed a depressive illness in 24.1% of patients before Take Care, and 17.1% afterwards; absolute decrease 7.0% [95% confidence interval (CI) -2.0 to -12.0%]. An improvement was seen in most practices (Wilcoxon matched-pair test P < 0.05). The programme was also associated with a small reduction in the overall proportion of episodes of anxiety missed by the doctor (absolute decrease 4.5%; 95% CI -1.0 to -8.0%) a reduction was found in most practices (Wilcoxon matched-pair test P < 0.05). There was no material difference in the diagnostic false-positive rate of the doctors before and after the introduction of the programme. CONCLUSION: Exposure to an educational package for depression was associated with improved recognition of psychological illness by general practitioners.
Unstable angina is generally considered to encompass a spectrum of symptomatic manifestations of ischemic heart disease, intermediate between stable angina and acute myocardial infarction. Approximately 75,000 Canadians are hospitalized yearly with unstable angina. The pathophysiology of unstable angina is still imperfectly understood, but is related to the same pathophysiological factors underlying myocardial infarction and sudden cardiac death. In March 1995 a group of Canadian cardiologists met to review the current understanding of unstable angina and to define a Canadian approach to this common problem. Important issues and questions regarding the diagnosis and management of unstable angina were defined. The objective was to outline approaches to the management of unstable angina that would be appropriate in Canada. Topics discussed included definition, incidence, clinical presentations, pathophysiology, initial diagnostic and risk stratification approaches, acute medical management, role of invasive interventions and long term management.
OBJECTIVE: To describe the rationale and design of the Prospective Reinfarction Outcomes in the Thrombolytic Era Cardizem CD Trial (PROTECT). DESIGN: A multicentre, randomized, double-blind, parallel-group comparison of once daily beta-therapy versus heart rate lowering calcium channel blocker therapy, in the reduction of one-year nonfatal reinfarction and cardiovascular death (combined primary end-point) initiated 24 to 96 h post non-Q wave myocardial infarction. SETTING: One hundred and twenty hospitals across Canada. PATIENTS: Over 7500 women and men aged 21 years or older with enzyme-confirmed non-Q wave infarction and without significant left ventricular systolic dysfunction will be recruited over two years. INTERVENTIONS: Once daily beta-blocker therapy (oral atenolol, 50 to 200 mg) versus once daily calcium channel blocker therapy (oral diltiazem 120 to 360 mg) with follow-up for up to three years. CONCLUSIONS: The PROTECT will be the largest all-Canadian cardiovascular trial to date and will compare two commonly prescribed agents for secondary prophylaxis following non-Q wave infarction. The scientific question addressed by the PROTECT is of major public health importance and the results of the study will directly affect current clinical practice.
Explore the source record for details and available documents.
Pneumococci are a leading cause of severe bacterial disease in infants and children world wide. A possible means of protecting infants in the first few months of life is immunisation of the mother during pregnancy. We prospectively assessed pneumococcal immunisation of pregnant women to determine the amount of pneumococcal antibody transmitted to the infants in serum and milk and the half-life of the passively acquired antibody. Healthy pregnant women in Dhaka, Bangladesh, were randomised to receive pneumococcal or meningococcal vaccine with routine prenatal tetanus immunisation at 30-34 weeks of gestation. Serum and breast milk specimens from the mothers and sera from infants were collected up to 22 weeks of age and assayed for specific serum IgG, IgG1, and IgG2 and for milk IgA antibodies to pneumococcal serotypes 6B and 19F. 55 mothers and 56 infants were followed from birth to five months. Women who received pneumococcal vaccine had geometric mean antibody increases of 2.6 and 3.4 to types 6B and 19F, respectively. The mean infant/maternal antibody ratios were 0.56 and 0.59 (range 0.11-1.46) for these serotypes. Infant cord antibody titres correlated with maternal titres. Infant/maternal IgG ratios correlated with the interval between immunisation and birth and were higher for specific IgG1 than for IgG2. Infants of pneumococcal vaccine recipients had geometric mean antibody concentrations of 6.8 and 7.5 micrograms/mL to serotypes 6B and 19F in cord blood; in cord blood and in all subsequent serum specimens the concentrations were 2-3 fold higher than in control infants. The median half-life of passive antibody was about 35 days; at five months of age 63-71% of infants of pneumococcal vaccine recipients had antibody concentrations greater than 0.15 micrograms/mL. Breast milk IgA antibodies for pneumococcal serotype 19F, but not for type 6B, were significantly higher in vaccine recipients up to five months after delivery. If maternal pneumococcal polysaccharide antibodies do not interfere with active immunisation of the infant with new glycoprotein conjugate pneumococcal vaccines, passive-active immunisation of infants can be a feasible strategy for developing regions.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Mitochondrial function in muscle in vivo can be quantitatively evaluated using 31-phosphorus nuclear magnetic resonance. In resting muscle, the concentrations of ions (e.g. H+, Na+) and two of the major bioenergetic components (inorganic phosphate and creatine) are determined by regulated transcellular transport processes. During recovery after exercise the kinetics and control of mitochondrial ATP synthesis can be established. During exercise the relative contributions to ATP synthesis of phosphocreatine (using creatine kinase), anaerobic glycogenolysis and oxidative phosphorylation are dissected and have been shown to change with time. The consequences of mitochondrial lesions and dysfunctions on these processes have been summarised.
Explore the source record for details and available documents.
Recent studies have proposed that tumor necrosis factor alpha (TNF-alpha) and ionizing radiation induce apoptosis by activating hydrolysis of sphingomyelin to ceramide. Bcl-2 and a related gene, Bcl-X, inhibit several forms of apoptosis. Herein, we report that internucleosomal DNA fragmentation, characteristic of apoptosis and induced by ionizing radiation, is accompanied by concomitant decreases in Bcl-2 and Bcl-X mRNA levels in HL-60 and U-937 human leukemia cells. Apoptotic DNA fragmentation after exposure to TNF-alpha and C2-ceramide was also associated with down-regulation of Bcl-2 mRNA in HL-60 and U-937 cells, while Bcl-X mRNA production was unaffected. These results suggest that modulation of Bcl-2 gene expression may be a target for ceramide-mediated apoptosis following exposure to ionizing radiation and TNF-alpha. Changes in Bcl-2 expression may be the basis for the interactive killing observed between radiation and TNF-alpha in some human and tumor cells.