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C Todd

Publications and source records attributed to C Todd.

At least 55 records · Page 3Linked to original sources
PubMed1999

The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey.

OBJECTIVE: Vertebral osteophytes are a characteristic feature of intervertebral disc degeneration. There are, however, few population data concerning the occurrence of and clinico-biological correlates of vertebral osteophytes in both the dorsal and lumbar spine. Our purpose was to determine the frequency and distribution of anterior osteophytes in the thoracic and lumbar spine, and their relationship with both various putative risk factors, including physical activity and obesity, and self-reported back pain. METHODS: Men and women aged 50 years and over were recruited from primary care based registers in 5 UK centers. They were invited to attend for an interviewer administered lifestyle questionnaire, assessment of height and weight, and lateral spinal radiographs. Lateral spinal radiographs were evaluated by a single observer for the presence of osteophytes from T4 to L5 using a semiquantitative score (grade): 0 = none, 1 = doubtful, 2 = mild, 3 = moderate, 4 = severe. Based on these data 2 summary statistics were derived: the maximum osteophyte grade at any vertebral level (MAX), and the sum of the osteophyte grades at the individual vertebral levels (TOT). RESULTS: In total, 681 women, mean age 63.3 years, and 499 men, mean age 63.7 years, were studied; 84% of men and 74% of women had at least one vertebral level with a grade 1 or higher osteophyte. Both the sum of the individual grades (TOT) and the proportion of subjects with MAX > or =2 were greater in men than in women in both the dorsal and lumbar spine, and both increased with age. The pattern of spinal involvement was similar in the sexes, with osteophytes occurring most frequently at T9-10 and L3. Increasing body mass index was associated with more frequent osteophytes at both dorsal and lumbar spine, although the relationship was stronger at the dorsal spine. Heavy physical activity, particularly in young adult life, was associated with osteophytosis in men. Self-reported back pain, both ever and in the past year, was linked with lumbar osteophytes in men. CONCLUSION: The distribution within the spine in our study and the relationship with heavy physical activity points to mechanical factors being important in pathogenesis of vertebral osteophytosis. Prospective studies are needed to explore the types of physical activity that increase susceptibility to vertebral osteophytosis. In men, osteophytes affecting the lumbar spine are associated with back pain.

Aged↗
PubMed1999

Primary care group commissioning of services: the differing priorities of general practitioners and district nurses for palliative care services.

BACKGROUND: General practitioners (GPs) have become more responsible for budget allocation over the years. The 1997 White Paper has signalled major changes in GPs' roles in commissioning. In general, palliative care is ranked as a high priority, and such services are therefore likely to be early candidates for commissioning. AIM: To examine the different commissioning priorities within the primary health care team (PHCT) by ascertaining the views of GPs and district nurses (DNs) concerning their priorities for the future planning of local palliative care services and the adequacy of services as currently provided. METHOD: A postal questionnaire survey was sent to 167 GP principals and 96 registered DNs in the Cambridge area to ascertain ratings of service development priority and service adequacy, for which written comments were received. RESULTS: Replies were received from 141 (84.4%) GPs and 86 (90%) DNs. Both professional groups agreed that the most important service developments were urgent hospice admission for symptom control or terminal care, and Marie Curie nurses. GPs gave greater priority than DNs to specialist doctor home visits and Macmillan nurses. DNs gave greater priority than GPs to Marie Curie nurses, hospital-at-home, non-cancer patients' urgent hospice admission, day care, and hospice outpatients. For each of the eight services where significant differences were found in perceptions of service adequacy, DNs rated the service to be less adequate than GPs. CONCLUSION: The 1997 White Paper, The New NHS, has indicated that the various forms of GP purchasing are to be replaced by primary care groups (PCGs), in which both GPs and DNs are to be involved in commissioning decisions. For many palliative care services, DNs' views of service adequacy and priorities for future development differ significantly from their GP colleagues; resolution of these differences will need to be attained within PCGs. Both professional groups give high priority to the further development of quick-response clinical services, especially urgent hospice admission and Marie Curie nurses.

Community Health Nursing↗
PubMed1998

Care homes. Home truths.

Proposed joint inspectorates of care homes open the way for health input into residential care. An investigation into quality-of-care measures concluded that health professionals should be included in inspectorate teams, particularly in view of the increasing dependency of residents. No association was shown between cost and quality, but higher costs were associated with short-term car provision. When costing residential care, the impact on community and primary healthcare services may need to be taken into account.

Aged↗
PubMed1998

Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS).

Clinically apparent vertebral deformities are associated with reduced survival. The majority of subjects with radiographic vertebral deformity do not, however, come to medical attention. The aim of this study was to determine the association between radiographic vertebral deformity and subsequent mortality. The subjects who took part in the analysis were recruited for participation in a multicentre population-based survey of vertebral osteoporosis in Europe. Men and women aged 50 years and over were invited to attend for an interviewer-administered questionnaire and lateral spinal radiographs. Radiographs were evaluated morphometrically and vertebral deformity defined according to established criteria. The participants have been followed by annual postal questionnaire--the European Prospective Osteoporosis Study (EPOS). Information concerning the vital status of participants was available from 6480 subjects, aged 50-79 years, from 14 of the participating centres. One hundred and eighty-nine deaths (56 women and 133 men) occurred during a total of 14,380 person-years of follow-up (median 2.3 years). In women, after age adjustment, there was a modest excess mortality in those with, compared with those without, vertebral deformity: rate ratio (RR) = 1.9 (95% confidence interval (CI) 1.0,3.4). In men, the excess risk was smaller and non-significant RR = 1.3 (95% CI 0.9,2.0). After further adjusting for smoking, alcohol consumption, previous hip fracture, general health, body mass index and steroid use, the excess risk was reduced and non-significant in both sexes: women, RR = 1.6 (95% CI 0.9,3.0); men RR = 1.2 (95% CI 0.7,1.8). Radiographic vertebral deformity is associated with a modest excess mortality, particularly in women. Part of this excess can be explained by an association with other adverse health and lifestyle factors linked to mortality.

Aged↗
PubMed1998

Up-regulation of p21WAF1 by phorbol ester and calcium in human keratinocytes through a protein kinase C-dependent pathway.

Terminal differentiation in a variety of cell types has been associated with p53-independent up-regulation of p21WAF1 p21WAF1 mRNA and protein are expressed at low levels in normal human skin, but overexpression of p21WAF1 has been observed in differentiating keratinocytes in involved psoriatic epidermis and in human squamous cell carcinoma. In this study we investigated by immunohistochemistry and Western blotting whether calcium and the phorbol ester 12-O-tetradecanoylphorbol-13-acetate, well characterized differentiation signals, induce p21WAF1 in cultured normal human keratinocytes and whether induction of p21WAF1 in this system depends on protein kinase C activation or functional p53. Phorbol ester induced p21WAF1 expression, which was maximal at 4 to 8 h with reduction back to baseline by 24 to 48 h. In contrast, increasing the extracellular Ca2+ concentration from 70 micromol/L to 1.5 mmol/L resulted in upregulation of p21WAF1 expression with a slower time course, with peak induction at 18 to 24 h. No parallel increase in p53 expression was observed in normal human keratinocytes. Up-regulation of p21WAF1 was also observed in response to phorbol ester in HaCaT cells, which carry homozygous and inactivating mutations for p53. Induction of p21WAF1 by phorbol ester and Ca2+ was inhibited by the specific protein kinase C inhibitor Ro 31-8220. The results demonstrate a differential time course of p21WAF1 protein up-regulation in response to phorbol ester and Ca2+, signals that result in keratinocyte differentiation, and suggest that induction of p21WAF1 in differentiating human keratinocytes occurs through protein kinase C-dependent and p53-independent mechanisms.

Blotting, Western↗
PubMed1998

Working with team midwifery: health visitors' views of one team midwifery scheme.

The fragmented nature of maternity services in the UK has led to the introduction of various forms of team midwifery scheme. The aim of such schemes is usually to increase continuity through the provision of antenatal, intrapartum and postnatal care to women by a small team of midwives. Few published studies of this organization of midwifery care exist, and even fewer consider the impact of such schemes on related health professionals. This paper presents the results of an independent survey of health visitors working alongside one team midwifery scheme in the south-east of England. Eighty per cent of the health visitors thought that team midwifery was a good idea in theory; however, just 27% thought it was working well locally and 70% reported that they would like to go back to working in the way they did before the introduction of team midwifery. The survey highlighted the health visitors' concerns in relation to team midwifery locally. Two issues were paramount: firstly a reported deterioration in interdisciplinary communications, and secondly a perceived loss of continuity for the women. Thus team midwifery, as implemented in this locality, may not attain the goals aimed at by the organization of care in this way.

Continuity of Patient Care↗
PubMed1998

Iodine-induced hyperthyroidism: occurrence and epidemiology.

We have critically reviewed the available information on iodine-induced hyperthyroidism (IIH) from published sources and other reports as well as the experience of the authors in Tasmania, Zaire, Zimbabwe, and Brazil. Administration of iodine in almost any chemical form may induce an episode of thyrotoxicosis (IIH). This has been observed in epidemic incidence in several countries when iodine has been given as prophylaxis in a variety of vehicles, but the attack rate as recorded has been low. IIH is most commonly encountered in older persons with long standing nodular goiter and in regions of chronic iodine deficiency, but instances in the young have been recorded. It customarily occurs after an incremental rise in mean iodine intake in the course of programs for the prevention of iodine deficiency, or when iodine-containing drugs such as radiocontrast media or amiodarone are administered. The biological basis for IIH appears most often to be mutational events in thyroid cells that lead to autonomy of function. When the mass of cells with such an event becomes sufficient and iodine supply is increased, the subject may become thyrotoxic. These changes may occur in localized foci within the gland or in the process of nodule formation. IIH may also occur with an increase in iodine intake in those whose hyperthyroidism (Graves' disease) is not expressed because of iodine deficiency. The risks of IIH are principally to the elderly who may have heart disease, and to those who live in regions where there is limited access to medical care. More information is needed on the long-term health impact of IIH or "subclinical" IIH, especially in the course of prophylaxis programs with iodized salt or iodinated oil in regions where access to health care is limited.

Age Distribution↗
PubMed1998

Outcome of common mental disorders in Harare, Zimbabwe.

BACKGROUND: Little is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries. METHOD: Two and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n = 199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness. RESULTS: The persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation. CONCLUSIONS: A quarter of cases of CMD were likely to be ill throughout the 12 month follow-up period. Targeting risk groups for poor outcome for interventions and policy interventions to reduce the impact of economic deprivation may provide a way of tackling CMD in primary care in low income countries.

Adult↗
PubMed1998

Why are there so few ethnic minority speech and language therapists?

This report summarises the outcome of a pilot study to investigate the recruitment of ethnic minority students to speech and language therapy, physiotherapy and dietetics courses. The study also sought to identify factors contributing to the low representation of these students on the named courses through interviews and questionnaires to careers advisors, school students and course admissions tutors. Recommendations for changes in practice are made.

Dietetics↗
PubMed1997

Percutaneous angioplasty for infrainguinal graft-related stenoses.

OBJECTIVE: To assess the success of percutaneous transluminal angioplasty (PTA) in treating infrainguinal graft-related stenoses. DESIGN: Retrospective analysis of stenoses undergoing PTA over 6 years. MATERIALS: Fifty-seven stenoses in 42 grafts. METHODS: Site, length and type of stenoses recorded. Follow-up till discharge, graft occlusion or death. RESULTS: PTA was successful in 48/57 stenoses in 36 grafts (G), with a poor result in seven. Further PTA was required in seven stenoses (7 G). One graft occluded at PTA and one stenosis was inaccessible. Overall graft (G) patency (median 13 months) was 82% (1 year patency 84%). Of 48 successful PTAs (37 G), 36 remained patent (28 G), eight (4 G) occluded and four were lost to follow-up (4 G). Fourteen of thirty-six stenoses which remained patent required further intervention (seven PTA, six jump grafts, one vein patch). The four occlusions were associated with small veins (two), multiple stenoses (one) and a PTFE graft which occluded 10 days following PTA. Of the seven PTAs with a poor angiographic result, five remained patent, three after further intervention. CONCLUSION: PTA is the best treatment for localised stenoses. Stenoses > 2 cm or multiple (three or more) stenoses are best treated surgically. Follow-up is essential, as 20% require further intervention.

Angiography↗
PubMed1997

Can general internal medicine be taught in general practice? An evaluation of the University College London model.

There is national and international interest in increasing the community-based component of undergraduate medical education, but more research is needed on its potential, practicability and effectiveness. The objective of the study was to examine the feasibility and efficacy of general practitioners teaching basic clinical skills to first year clinical medical students in the community. The structure and methods of evaluation of the programme are described. Evaluation tools included semistructured interviews of general practitioner tutors; student questionnaires; assessment of student performance; and costs of the programme. The great majority of the students found the programme enjoyable (81 out of 81, 100%) and educational (79 out of 81, 97%). Students' performance in the end of rotation Objective Structured Clinical Examination suggested that clinical skills are acquired at least as well in the community as in the hospital. Tutors identified the personal benefits of this teaching as development of their own clinical skills and the stimulation of teaching. The programme has been successfully expanded from 24 students to 230 students annually and has demonstrated that community-based teaching can usefully contribute to undergraduate medical education in the area of clinical skills teaching. Key practical issues for schools contemplating similar initiatives are presented.

Adult↗
PubMed1997

Common mental disorders in primary care in Harare, Zimbabwe: associations and risk factors.

BACKGROUND: This study aimed to investigate the associations for common mental disorders (CMD) among primary care attenders in Harare. METHOD: This was an unmatched case-control study of attenders at primary health clinics, general practitioner surgeries and traditional medical practitioner clinics; 199 cases with CMD as identified by an indigenously developed case-finding questionnaire, and 197 controls (non-cases), were interviewed using measures of sociodemographic data, disability, care-giver diagnoses and treatment, explanatory models, life events and alcohol use. RESULTS: CMD was associated with female gender (P = 0.04) and older age (P = 0.02). After adjustment for age, gender and site of recruitment, CMD was significantly associated with chronicity of illness; number of presenting complaints; beliefs in "thinking too much" and witchcraft as a causal model; economic impoverishment; infertility; recent unemployment; an unhappy childhood for females; disability; and consultations with traditional medical practitioners and religious priests. CONCLUSIONS: Mental disorders are associated with female gender, disability, economic deprivation, and indigenous labels of distress states.

Age Factors↗
PubMed1997

The nursing record as a research tool to identify nursing interventions.

This paper describes a study which was designed to test the feasibility of using retrospective case note abstraction of data from nursing records to identify the nursing interventions given to two groups of patients: those who had suffered a myocardial infarction and those who had sustained a fractured neck of femur. The aim of the study was to assess whether the data obtained from the records were an accurate reflection of the nursing care given to patients. This was done by comparing what was recorded in the notes for specific areas of care with what the nursing staff said they did. The specific areas of care for patients suffering a myocardial infarction were: pain, mobility, anxiety, patient education. The specific areas of care for patients sustaining a fractured femur were: pressure areas, pain, nutrition, mobility and rehabilitation, information and teaching. Data were collected in three ways: using a retrospective data abstraction tool to examine the case notes of a particular patient; interviewing a nurse who had looked after the same patient; interviewing a senior ward nurse to obtain information about ward policies and practices to obtain a profile of the care usually given to these groups of patients. In this paper we present some of our findings and discuss the methodological and logistical problems of using this method.

Feasibility Studies↗
PubMed1997

Overexpression of protein kinase C-alpha and -beta isozymes by stromal dendritic cells in basal and squamous cell carcinoma.

Protein kinase C (PKC) isoenzymes transduce signals from cell surface receptors and thereby regulate important cellular functions in skin including keratinocyte growth and differentiation. Overexpression of individual PKC isoenzymes results in aberrant cell growth and in certain instances tumorigenicity. PKC is implicated in tumour promotion in mouse skin. Abnormal expression of PKC has been reported in several human cancers. We have, therefore, investigated expression of PKC-alpha and -beta in basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) by immunohistochemistry. Sections were stained with specific antibodies to PKC-alpha, PKC-beta, CD1a, T cells, B cells and dermal dendritic cells (factor XIIIa), using an immunoperoxidase technique. PKC-alpha and PKC-beta were not detected in tumour cells in BCCs or SCCs. In SCCs, PKC-beta immunostaining revealed positively stained inflammatory and dendritic cells scattered through the stroma; PKC-alpha immunostaining was essentially negative. In contrast, in BCCs, PKC-alpha+ and PKC-beta+ dendritic and spindle-shaped cells were observed in the stroma, immediately adjacent to the tumour islands. Double-labelling experiments showed that a proportion (approximately 20%) of PKC-beta+ dendritic cells also expressed factor XIIIa. BCCs depend on stroma for growth; PKC regulates expression of type IV collagenase and stromelysin III and interactions between tumour and stroma may be important in determining tumour invasion and metastasis. Therefore, overexpression of PKC-alpha and -beta by stromal dendritic cells in BCCs suggests that PKC activation may be involved in stromal/tumour interactions in these tumours.

Basal Cell Carcinoma↗
PubMed1997

How common is medical training in palliative care? A postal survey of general practitioners.

BACKGROUND: General practitioners (GPs) have a central role in palliative care, yet research continues to reveal room for improvement in symptom control at home. There is a need to evaluate how well-prepared GPs are for this task of caring for the dying at home. AIM: To evaluate the training in palliative care GPs have received throughout their careers. METHOD: Postal survey of 450 randomly selected East Anglian GP principals, investigating training in five areas of palliative care (pain control, control of other symptoms, communication skills, bereavement care, use of syringe driver), as clinical students, junior hospital doctors, GP trainees (registrars), and GP principals. RESULTS: A response rate of 86.7% was obtained. While GPs were clinical students, training was uncommon, (32% reported no training in pain control, and 58% no training in bereavement care), although there has been a significant increase in more recent years. Training as junior doctors was particularly uncommon (over 70% report no training in communication skills or bereavement care); there was some evidence of an increase in more recent years. During the GP trainee year, training was much more common. For GP principals, most areas had been covered, although over 20% reported no training in communication skills and bereavement care. During the community-based years as trainee and principal, training was significantly more common than during the hospital-based years of training as clinical student and junior doctor. CONCLUSIONS: There is a continuing need for medical education in palliative care. Particular attention should be paid to the basic medical education of clinical students and the training of junior doctors, especially regarding communication skills and bereavement care.

Adult↗
PubMed1996

Unresponsiveness of human epidermal melanocytes to melanocyte-stimulating hormone and its association with red hair.

There is increasing evidence that pro-opiomelanocortin-derived peptides have a role in controlling human skin pigmentation. In vitro, human epidermal melanocytes respond to melanocyte-stimulating hormone (MSH) with increases in melanogenesis and cell dendricity. However, in the present study, not all melanocyte cultures exhibited these changes and 24% were totally unresponsive to MSH. This unresponsiveness was limited to melanocytes from white Europeans but was particularly prevalent in cultures from individuals with red hair. Cyclic AMP, the second messenger of the melanocyte-associated MSH (MC-1) receptor, induced melanocyte dendricity, even in those cultures which were morphologically unresponsive to MSH. The cyclic nucleotide also increased melanogenesis in the cultures that responded melanogenically to MSH but its effect was reduced in those cultures that were unresponsive to MSH. Thus, while the morphological data support the hypothesis that unresponsiveness is mediated at the MSH receptor, intracellular events may also be important in determining melanogenic unresponsiveness to MSH.

Adult↗
PubMed1996

Tyrosinase may protect human melanocytes from the cytotoxic effects of the superoxide anion.

Reactive oxygen species (ROS) are potentially cytotoxic and several mechanisms have evolved to protect against their damaging effects. In melanocytes, tyrosinase may have such a rôle by utilising the superoxide anion (O2-) in the production of melanin. In the present study, we have examined the cytotoxic effects of O2- and hydrogen peroxide (H2O2) in human melanocytes both before and following the activation of tyrosinase. Xanthine oxidase (XO, 5-150 mU.ml-1) and glucose oxidase (GO, 0.1-20 mU.ml-1) were used to generate the O2- and H2O2 respectively, and the cytotoxic effects assessed by measuring cell survival using the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium (MTT) assay. 3 h later, dose-related decreases in melanocyte survival were seen. Similar experiments with keratinocytes and fibroblasts showed that these cells were more resistant to the cytotoxic effects of O2- than were the melanocytes. The effect of increasing tyrosinase activity was examined by growing the melanocytes in the presence of an analogue of melanocyte-stimulating hormone (MSH) Nle4DPhe7 alpha-MSH (10(-8) M), for 48 h. This increased tyrosinase activity, melanin content, the ability to trap O2- and the resistance of the melanocytes to the cytotoxic effects of this ROS, but failed to alter their susceptibility to the damaging effects of H2O2.Nle4DPhe7 alpha-MSH had no effect on the resistance of keratinocytes and fibroblasts to either O2- or H2O2. After 3 h, XO, as opposed to GO, also increased the melanin content of human melanocytes; this effect was not accompanied by an increase in tyrosinase activity. The present results suggest that tyrosinase may utilise O2- to produce melanin and that this process may protect melanocytes from the potentially damaging effects of this ROS.

Cell Survival↗