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Chris Roberts

Publications and source records attributed to Chris Roberts.

34 records · Page 2Linked to original sources
PubMed2004

National legislation on school smoking restrictions in eight European countries.

OBJECTIVE: To review and compare national legislation addressing smoking at school in eight European countries during the late 1990s. DESIGN: The data are from the EC-funded Control of Adolescent Smoking (CAS) study in eight European countries. The information on national legislation was gathered during the period 1998-1999, through a review of scientific and official documents and interviews with key informants in each country. RESULTS: Four of the participating countries (Austria, French-speaking Belgium, Finland and Norway) had legislation specifically restricting smoking at school, while the remaining countries (Denmark, North Rhein Westphalia region of Germany, Scotland and Wales in the UK) did not have such legislation in place. In those countries with legislation in place, smoking among students aged 15 years and younger was not permitted. The position with regard to teacher smoking varied considerably among countries, but with the exception of Finland, there was no legislation regulating outdoor smoking by teachers during school hours. CONCLUSIONS: The findings suggest that there were inconsistencies within countries in terms of legislation that had been developed and the enforcement, compliance and monitoring practices that were in place. Further work is required to develop and resource such mechanisms, although it may be possible to build on existing practice, such as increasing the involvement of school health services, school inspectorate services or working through health promoting school networks already established in many countries.

Adolescent↗
PubMed2004

The effectiveness of five strategies for the prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic review.

OBJECTIVES: To assess the effectiveness of five gastroprotective strategies for people taking non-steroidal anti-inflammatory drugs (NSAIDs)--H2 receptor antagonists plus non-selective (or cyclo-oxygenase-1) NSAIDs; proton pump inhibitors plus non-selective NSAIDs; misoprostol plus non-selective NSAIDs; COX-2 selective NSAIDs; or COX-2 specific NSAIDs--in reducing serious gastrointestinal complications, symptomatic ulcers, serious cardiovascular or renal disease, and deaths, and improving quality of life. DATA SOURCES: The Cochrane Library, Medline, Embase, Current Controlled Trials, and System for Information on Grey Literature in Europe (SIGLE) were searched to May 2002. Bibliographies and author contacts were used to identify further studies; non-English articles were included. REVIEW METHODS: Trial selection, data extraction, and quality assessment were performed independently, in duplicate. Articles were rejected only if the study was not a randomised controlled trial; did not assess a gastroprotective strategy versus placebo; included exclusively children or healthy volunteers; lasted less than 21 days; or no review outcomes were measured. Quality assessment included allocation concealment and baseline similarity. Random effects meta-analysis, meta-regression and subgrouping were used to pool effects and analyse associations with length of follow up, mean age, and baseline gastrointestinal status. Heterogeneity was examined and sensitivity analyses performed. RESULTS: Of 112 included randomised controlled trials (74 666 participants), five were judged to be at low risk of bias, and 138 deaths and 248 serious gastrointestinal events were reported overall. On comparing gastroprotective strategies versus placebo we found no evidence of effectiveness of H2 receptor antagonists for any primary outcomes (few events reported); proton pump inhibitors may reduce the risk of symptomatic ulcers (relative risk 0.09, 95% confidence interval 0.02 to 0.47); misoprostol reduces the risk of serious gastrointestinal complications (0.57, 0.36 to 0.91) and symptomatic ulcers (0.36, 0.20 to 0.67); COX-2 selectives reduce the risk of symptomatic ulcers (0.41, 0.26 to 0.65) and COX-2 specifics reduce the risk of symptomatic ulcers (0.49, 0.38 to 0.62) and possibly serious gastrointestinal complications (0.55, 0.38 to 0.80). All strategies except COX-2 selectives reduce the risk of endoscopic ulcers (at least 3 mm in diameter). CONCLUSIONS: Misoprostol, COX-2 specific and selective NSAIDs, and probably proton pump inhibitors significantly reduce the risk of symptomatic ulcers, and misoprostol and probably COX-2 specifics significantly reduce the risk of serious gastrointestinal complications, but data quality is low. More data on H2 receptor antagonists and proton pump inhibitors are needed, as is better reporting of rare but important outcomes.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

Does a nurse-led mental health liaison service for older people reduce psychiatric morbidity in acute general medical wards? A randomised controlled trial.

OBJECTIVE: To determine the clinical effectiveness of a nurse-led mental health liaison service in managing mental health problems in older physically ill inpatients. DESIGN: Randomised controlled trial. SETTING: Four general medical wards in a district general hospital in a northern UK town. PARTICIPANTS: 153 medically ill older people (aged 65 or over) who scored above the threshold for depression and/or cognitive impairment on a brief screening instrument (4-item geriatric depression scale and 6-item orientation-memory-concentration test): 77 were randomised to a nurse-led intervention and 76 to usual care. Included in the analysis were 120 participants who completed 6-8 week follow-up assessments. INTERVENTION: Multi-faceted intervention led by a mental health liaison nurse. MAIN OUTCOME MEASURES: Scores on the Health of the Nation Outcome Scale 65+, the geriatric depression scale, and the Standardised Mini-Mental State Examination. RESULTS: No significant differences were found between groups on the total Health of the Nation Outcome Scale 65+ scores (11.5 versus 11.5, adjusted mean difference -0.04, 95% CI-1.4 to 1.3, P = 0.96) nor on the Standardised Mini-Mental State Examination (20.3 versus 21.8, adjusted mean difference -0.4, 95% CI-2.1 to 1.3, P = 0.63). Subjects randomised to the intervention arm had significantly lower Geriatric Depression Scale scores at 6-8 week follow-up than those receiving usual care (12.2 versus 14.0, adjusted mean difference -2.0, 95% CI-4.0 to -0.1, P = 0.043). CONCLUSIONS: Nurse-led mental health liaison services which accept all screened cases from acute medical wards are unlikely to be effective in reducing general psychiatric morbidity. Services which focus on the prevention of delirium and target particular patient groups or disorders such as depression are more likely to be effective.

Aged↗
PubMed2004

Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients.

OBJECTIVE: To investigate the criterion validity of the four-item Geriatric Depression Scale (GDS4) and the six-item Orientation-Memory-Concentration-test (OMC) against longer widely used screening instruments. METHOD: Participants were 153 patients (aged 65 or over) admitted to four acute medical wards of a northern UK town. The validity of the GDS4 was determined using the 30-item geriatric depression scale (GDS30) as the comparator; the validity of the OMC was determined using the standardised mini-mental state examination (MMSE) as the comparator. For both screens, the area under receiver operating characteristic (ROC) curve was calculated in addition to the number of true and false positives and the sensitivity and specificity for various cut-off points. RESULTS: The area under ROC curve was 0.80 for the GDS4 and 0.90 for the OMC. Using a cut-off of 0/1, the GDS4 correctly classified 78.2% of participants, using the GDS30 as the standard. This cut-off gave a sensitivity of 90.1% and specificity of 55.3%. With a cut-off of 1/2 the GDS4 correctly classified 76.8% of participants and had sensitivity and specificity of 78% and 74.5% respectively. The GDS4 and GDS30 were highly correlated (rho=0.63, p < 0.0005). A cut-off of 10/11 on the OMC gave optimum performance. With this cut-off, it correctly classified 85.9% of participants, and had 85.6% sensitivity and 86.8% specificity. There was a significant correlation between the OMC and the SMMSE (rho = -0.827, p < 0.0005). CONCLUSION: The GDS4 and OMC appear to be useful instruments for screening for depression and cognitive impairment among older medical inpatients.

Aged↗
PubMed2004

National and school policies on restrictions of teacher smoking: a multilevel analysis of student exposure to teacher smoking in seven European countries.

The paper examines the association between restrictions on teacher tobacco smoking at school and student exposure to teachers who smoke during school hours. The data are taken from a European Commission-funded study 'Control of Adolescent Smoking' (the CAS study) in seven European countries. Multilevel modelling analyses were applied to investigate associations between national legislation concerning tobacco smoking in school, local school smoking restrictions and students' exposure to teachers who smoke at school. The analyses integrate data from three levels: national (types of policy and how restrictive they are), school (survey among teachers, n = 455) and student (survey among 15-year-old students, n = 10890). The results suggest that both national- and school-level policies on restriction of smoking among teachers are associated with a decreased probability of students reporting that they are exposed to teachers who smoke indoors, but an increased probability of being exposed to teachers smoking outdoors.

Adolescent↗
PubMed2004

Consistent presence of two normally distributed sperm subpopulations within normozoospermic human semen: a kinematic study.

Sperm motion analysis was performed using computer-aided semen analysis (CASA) on nine normozoospermic human ejaculates following six fractionation schemes that included Percoll discontinuous gradient centrifugation, swim-up, hyper and hypo-osmotic stress in which 4600-13 400 tracks were analysed (depending on the scheme). In addition, the effect of ageing for 2 h in seminal plasma or re-addition of seminal plasma, on the kinematic properties was investigated. Analysis following sorting of the swimming velocity at 5 microm/sec intervals revealed the presence of two discrete normally distributed subpopulations selected on the basis of path velocity (VAP): these subpopulations were also present in the track speed (VCL) and progressive velocity (VSL) distributions. The validity of the two subpopulations was examined using a two-component normal mixture model and found to be highly statistically significant (p < 0.00001). The basis for the subpopulations was independent from the possession of midpiece vesicles or hyperactivation. Swim-up produced subpopulations of sperm that were significantly different from those obtained by Percoll separation. Compared with sperm in seminal plasma, swim-up and Percoll separation significantly increased the level of hyperactivated sperm at 2 h. Hyperactivation was inhibited by the re-addition of seminal plasma. Swim-up enhanced the proportion of sperm in the fast VAP subpopulation (independently of the level of hyperactivation) and whilst this altered distribution was maintained following the addition of homologous seminal plasma the mean velocity of the fast fraction was significantly decreased. Both swim-up and Percoll separation significantly increased the mean velocity of the fast subpopulation but the increase was greater with swim-up. This analysis highlights a way in which subpopulations may be detected and analysed. The procedure revealed fundamental differences in the kinematic properties of sperm processed by different methods that are used in assisted reproductive technology and showed that these were independent of hyperactivation.

Biomechanical Phenomena↗
PubMed2004

Competence in the musculoskeletal system: assessing the progression of knowledge through an undergraduate medical course.

BACKGROUND: Professional bodies have expressed concerns that medical students lack appropriate knowledge in musculoskeletal medicine despite its high prevalence of use within the community. Changes in curriculum and teaching strategies may be contributing factors to this. There is little evidence to evaluate the degree to which these concerns are justified. OBJECTIVES: To design and evaluate an assessment procedure that tests the progress of medical students in achieving a core level of knowledge in musculoskeletal medicine during the course. PARTICIPANTS AND SETTING: A stratified sample of 136 volunteer students from all 5 years of the medical course at Sheffield University. METHODS: The progress test concept was adapted to provide a cross-sectional view of student knowledge gain during each year of the course. A test was devised which aimed to provide an assessment of competence set at the standard required of the newly qualified doctor in understanding basic and clinical sciences relevant to musculoskeletal medicine. The test was blueprinted against internal and external guidelines. It comprised 40 multiple-choice and extended matching questions administered by computer. Six musculoskeletal practitioners set the standard using a modified Angoff procedure. RESULTS: Test reliability was 0.6 (Cronbach's alpha). Mean scores of students increased from 41% in Year 1 to 84% by the final year. Data suggest that, from a baseline score in Year 1, there is a disparate experience of learning in Year 2 that evens out in Year 3, with knowledge progression becoming more consistent thereafter. All final year participants scored above the standard predicted by the Angoff procedure. CONCLUSIONS: This short computer-based test was a feasible method of estimating student knowledge acquisition in musculoskeletal medicine across the undergraduate curriculum. Tested students appear to have acquired a satisfactory knowledge base by the end of the course. Knowledge gain seemed relatively independent of specialty-specific clinical training. Proposals from specialty bodies to include long periods of disciplinary teaching may be unnecessary.

Computers↗
PubMed2004

Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders.

PURPOSE: To review the effectiveness of cognitive behaviour therapy (CBT) as a treatment for anxiety disorders of childhood and adolescence. METHOD: Studies were included if they treated young people (under 19 yrs) with diagnosed anxiety disorder (excluding trials solely treating phobia, PTSD or OCD), had a no-treatment control group, and used diagnosis as an outcome variable. A search of the literature, incorporating electronic databases, hand search and expert consultation, yielded 10 randomized controlled trials that were appropriate for inclusion. RESULTS: The outcome of interest was remission of anxiety disorder. Employing conservative criteria, the remission rate in the CBT groups (56.5%) was higher than that in the control groups (34.8%). The pooled odds ratio was 3.3 (CI = 1.9-5.6), suggesting that CBT has a significant effect. CONCLUSIONS: CBT is useful for the treatment of anxiety in children over the age of 6 years. However, we still know little about the treatment of younger children or about the comparative efficacy of alternative treatments. Most of the trials were efficacy trials, and have limited generalizability. Reporting of many aspects of the trials was weak.

Adolescent↗
PubMed2004

Sex hormone patterns and serum retinol concentrations in adolescent girls.

OBJECTIVE: To describe the pattern and relation of sex serum hormones and retinol concentrations over 1 menstrual cycle in adolescent girls living in a resource-poor setting. STUDY DESIGN: Venous blood samples were collected on alternate days of the cycle, and estrogen, progesterone, luteinizing hormone (LH), follicle stimulating hormone and serum retinol were measured. A linear random effects model was used to examine the relationship between sex hormones and serum retinol. RESULTS: Twenty-eight girls were studied. During the follicular phase, serum retinol was associated negatively with progesterone and positively with LH. In the luteal phase, serum retinol was positively associated with estrogen. Serum retinol increased in the follicular phase but not the luteal phase. Sex hormone and serum retinol concentrations showed marked individual and day-to-day variability. Two girls maintained serum retinol concentrations > 0.7 mumol/L throughout the cycle. Six remained at < 0.7 mumol/L, which indicated subclinical deficiency. CONCLUSION: This study indicated that in adolescent girls, sex hormone patterns correlate significantly with serum retinol, and in vitamin A-deficient girls this could be important for reproductive function.

Adolescent↗
PubMed2003

Managing the learning environment in undergraduate medical education: the Sheffield approach.

This paper describes one possible model for e-learning in undergraduate medical education with an emphasis on supporting and managing curriculum development. The University of Sheffield School of Medicine is undergoing a major revision of is undergraduate medical curriculum, prompted by requirements of the professional regulatory body, the General Medical Council (GMC), and the Quality Assurance Agency for Higher Education (QAA). A computer-based system was developed to provide more efficient administration of the current course and more effective delivery of educational materials to students. The Sheffield Networked Learning Environment (NLE) has been developed in collaboration with other medical schools. A new 'revised' curriculum, due to start in 2003, will be intensively supported by an NLE which has been extensively tested and modified through pilot studies in the current curriculum.

Curriculum↗
PubMed2002

A gene-expression signature as a predictor of survival in breast cancer.

BACKGROUND: A more accurate means of prognostication in breast cancer will improve the selection of patients for adjuvant systemic therapy. METHODS: Using microarray analysis to evaluate our previously established 70-gene prognosis profile, we classified a series of 295 consecutive patients with primary breast carcinomas as having a gene-expression signature associated with either a poor prognosis or a good prognosis. All patients had stage I or II breast cancer and were younger than 53 years old; 151 had lymph-node-negative disease, and 144 had lymph-node-positive disease. We evaluated the predictive power of the prognosis profile using univariable and multivariable statistical analyses. RESULTS: Among the 295 patients, 180 had a poor-prognosis signature and 115 had a good-prognosis signature, and the mean (+/-SE) overall 10-year survival rates were 54.6+/-4.4 percent and 94.5+/-2.6 percent, respectively. At 10 years, the probability of remaining free of distant metastases was 50.6+/-4.5 percent in the group with a poor-prognosis signature and 85.2+/-4.3 percent in the group with a good-prognosis signature. The estimated hazard ratio for distant metastases in the group with a poor-prognosis signature, as compared with the group with the good-prognosis signature, was 5.1 (95 percent confidence interval, 2.9 to 9.0; P<0.001). This ratio remained significant when the groups were analyzed according to lymph-node status. Multivariable Cox regression analysis showed that the prognosis profile was a strong independent factor in predicting disease outcome. CONCLUSIONS: The gene-expression profile we studied is a more powerful predictor of the outcome of disease in young patients with breast cancer than standard systems based on clinical and histologic criteria.

Adult↗
PubMed2002

Gene expression profiling predicts clinical outcome of breast cancer.

Breast cancer patients with the same stage of disease can have markedly different treatment responses and overall outcome. The strongest predictors for metastases (for example, lymph node status and histological grade) fail to classify accurately breast tumours according to their clinical behaviour. Chemotherapy or hormonal therapy reduces the risk of distant metastases by approximately one-third; however, 70-80% of patients receiving this treatment would have survived without it. None of the signatures of breast cancer gene expression reported to date allow for patient-tailored therapy strategies. Here we used DNA microarray analysis on primary breast tumours of 117 young patients, and applied supervised classification to identify a gene expression signature strongly predictive of a short interval to distant metastases ('poor prognosis' signature) in patients without tumour cells in local lymph nodes at diagnosis (lymph node negative). In addition, we established a signature that identifies tumours of BRCA1 carriers. The poor prognosis signature consists of genes regulating cell cycle, invasion, metastasis and angiogenesis. This gene expression profile will outperform all currently used clinical parameters in predicting disease outcome. Our findings provide a strategy to select patients who would benefit from adjuvant therapy.

Adult↗
PubMed2002

A pragmatic randomised controlled trial of a prompt and reminder card in the care of people with epilepsy.

BACKGROUND: The quality of epilepsy care has often been noted to be poor and fragmentary. Most people with epilepsy are solely under the care of their general practitioner (GP). Many patients report medication side-effects and poor seizure control. Most GPs accept responsibility for epilepsy care; however, many report problems with knowledge of epilepsy and nearly all support guidance on epilepsy management. AIM: To determine whether a GP-completed prompt and reminder card is effective in improving the quality of epilepsy care when used opportunistically. DESIGN OF STUDY: Primary care-based pragmatic cluster-randomised controlled trial. SETTING: People with active epilepsy (n = 1275) from 82 practices. METHOD: Practices were randomly categorised as 'control', 'doctor-held card' (card in patient records), or 'patient-held card' practices. RESULTS: Compared with control practices, recording of seizure frequency was significantly increased in doctor-held card practices (57.4% versus 42.8%, P = 0.003) but not in patient-held card practices (44.6% versus 42.8%). No differences were found in the proportion of seizure-free patients (doctor-held card [56.0%] versus control [51.5%]; patient-held card [58.1%] versus control [51.5%]) or in the proportion on monotherapy. Patients in both intervention groups reported more medication-related side-effects and patients in doctor-held card practices were less satisfied with information provision about epilepsy. Participating GPs found the card useful. The doctor-held card was retrieved and completed more often than the patient-held card. CONCLUSIONS: A doctor-held prompt and reminder card is effective in improving the recording of key clinical information for people with epilepsy, is felt to be useful by GPs, and is completed more often than a patient-held card. However it does not improve outcomes and may result in less patient-centred care.

Attitude of Health Personnel↗
PubMedDate not supplied

Expression of bFGF, VEGF and c-met and their correlation with microvessel density and progression in prostate carcinoma.

BACKGROUND: Previously, we found angiogenesis measured as microvessel density (MVD) to be associated with both pathological stage and clinical outcome after radical prostatectomy (RP). In addition, we have shown that Vascular Endothelial Growth Factor (VEGF) is one of the important inducers of angiogenesis in prostate cancer (PC). The aim of this study was to investigate the expression of additional angiogenic factors, namely basic Fibroblast Growth Factor (hFGF) and the c-met receptor of Hepatocyte Growth Factor/Scatter Factor (HGF/SF) in PC. MATERIALS AND METHODS: Ninety-eight paraffin-embedded RP specimens and 20 adjacent normal prostatic tissues were evaluated for factor VIII staining and microvessel counting. Expression of VEGF (n=55), bFGF (n=65) and c-met (n=66) was studied by immunohistochemistry. Results were correlated with pathological grade and stage, MVD and clinical outcome. RESULTS: While adjacent benign tissue in RP specimens generally showed low MVD, VEGF-, bFGF- and c-met-expression, this was different in PC. All angiogenesis inducers were associated with stage while c-met as well as VEGF expression were associated with grade. Tumor progression was associated with grade and MVD. There was a clear correlation between VEGF and c-met expression and MVD. CONCLUSION: VEGF and c-met expression increase with tumor stage and grade, while bFGF expression increases only with tumor stage. In addition to VEGF, c-met seems to be important and clinically relevant to the induction of angiogenesis in PC. Both VEGF and c-met appear to influence tumor progression, mainly through their effect on MVD.

Factor VIII↗