Search PubMed⌕ Search

Biomedical subjects

D J Hunter

Publications and source records attributed to D J Hunter.

At least 217 records · Page 12Linked to original sources
PubMed1995

The impact of lower urinary tract symptoms on general health status and on the use of prostatectomy.

Our objective was to determine the extent to which lower urinary tract symptoms affect the general health status of men and contribute to the decision to undergo surgery. A cross-sectional population survey using postal questionnaires was conducted in the North West Thames health region, followed by a prospective cohort study of men undergoing prostatectomy (North West Thames and Oxford regions). The subjects in the first survey were 221 men aged 55 and over with previously reported mild, moderate or severe urinary symptoms; subjects in the second study were 388 men undergoing prostatectomy. Main outcome measures were self-reported symptom severity, bothersomeness and general health status (Nottingham Health Profile, Part 1). The response rate among eligible responders in the population survey was 85.7%. Increasing symptom severity was associated with worsening NHP scores for energy, emotional reactions, sleep and physical mobility (p < 0.01). Increasing bothersomeness of symptoms was associated with emotional reactions, sleep and pain (p < 0.05). Men undergoing surgery reported worse health status than men in the population with the same severity of symptoms as regards emotional reactions, energy and pain. For a given level of symptom severity, the impact of those symptoms on aspects of a man's general health status may be the determinant of seeking and undergoing surgery. Greater understanding of the factors that affect a man's response to his symptoms is needed in interpreting the decision to seek and accept treatment.

Aged↗
PubMed1995

Contraceptive use and the risk of HIV infection in Nairobi, Kenya.

OBJECTIVES: To determine: (a) the prevalence of human immunodeficiency virus-1 (HIV-1) infection among women attending family planning clinics in Nairobi; and (b) the associations between contraceptive use and HIV infection. METHODS: History, clinical examination and laboratory tests were used to obtain data from 4404 women attending family planning clinics in Nairobi. We conducted a case-control study comparing HIV seropositive and seronegative women with regard to previous and current use of contraception. RESULTS: The overall prevalence of HIV-1 infection was 4.9% (95% C.I. 4.3-5.5). Previous and current use of oral contraceptives (OC), injectable contraceptives and the intrauterine device were not associated with a significant increase in risk, while current users of condoms had a non-significant reduction in risk. OC use was significantly associated with cervical ectopy, but no significant association was evident between ectopy and HIV infection. CONCLUSION: The finding of no significant association between past or current OC use and risk of HIV infection suggests that any independent association that may exist between OC use and HIV risk is not large.

Adolescent↗
PubMed1995

Health status and quality of life of British men with lower urinary tract symptoms: results from the SF-36.

OBJECTIVES: To determine the extent to which urinary symptoms, and resulting bothersomeness interfere with daily activities and affect health status, as measured using the Medical Outcomes Study 36-item short form health survey (SF-36). METHODS: Postal population survey in a British health region of 217 men aged 55 years and over known to have reported mild, moderate, or severe lower urinary tract symptoms. Outcome measures are self-reported urinary symptoms, their bothersomeness, general health status, and quality of life (measured using the SF-36). RESULTS: Response rate among eligible subjects was 84%. Depending on the activity, between 9% and 49% of men with moderate or severe urinary symptoms reported interference with some of their daily activities. Increasing symptom severity was associated with worsening physical role, social functioning, vitality, mental health, and perception of general health, and increasing bothersomeness was associated with worsening of all dimensions of general health status and quality of life. The association between these measures and bothersomeness was stronger than with symptom score. Compared with the general population, men bothered by their symptoms to the extent that they were a medium or a large problem have worse health status for all dimensions except physical functioning. CONCLUSIONS: The SF-36 demonstrates a deterioration in general health status and quality of life with increasing lower urinary tract symptoms and the extent to which those symptoms are bothersome. As such, it provides a generic measure of the burden of ill health arising from these symptoms at a population level. There is, however, considerable individual variation in the way that men respond to their symptoms.

Activities of Daily Living↗
PubMed1995

Rationing health care: the political perspective.

The politics of rationing are messy and treacherous. As long as rationing remained implicit, politicians were shielded from the impact of decisions about who to treat and who not to treat. Explicit rationing changes all this by making the process of reaching choices more visible. However, implicit rationing may actually be a better way of dealing with difficult and complex issues. There is, nevertheless, scope for improving the process and making it more open and accountable. While efforts to terminate ineffective treatments are welcome and overdue, they are not a substitute for rationing. Finally, while politicians are being called upon to set national priorities and guidelines for rationing care, there is resistance to doing so when the decisions are so context specific and can only be made effectively at a micro level.

Decision Making↗
PubMed1995

Effective practice.

Explore the source record for details and available documents.

Diffusion of Innovation↗
PubMed1995

The validity of recalled weight among younger women.

METHOD: The authors compared recalled weight at age 18 and self-reported current height among 118 participants in the Nurses' Health Study II cohort, aged 25-42 years in 1989, with records from physical examinations conducted at college or nursing school entrance. RESULTS: The correlation between recalled and measured past weight was 0.87 and between reported current height and measured past height was 0.94. Mean body mass index (BMI) values were 21.6 kg/m2 for BMI calculated using recalled weight and 22.1 kg/m2 using weight from medical records; the correlation was 0.84. Participants slightly under-reported weight at age 18 (mean difference = 1.4 kg). CONCLUSION: The validity of recalled weight at 18 years of age and self-reported height as an estimate of height at age 18 appears to be high among women in this cohort.

Adult↗
PubMed1995

Health care sought and received by men with urinary symptoms, and their views on prostatectomy.

BACKGROUND: Urinary symptoms are common among middle aged and elderly men. AIM: A study was undertaken to describe the health care sought by men aged 55 years and over with urinary symptoms, the action taken by general practitioners and urologists, and the men's views on prostatectomy. METHOD: A postal questionnaire was sent to 516 men aged 55 years and over in the North West Thames Regional Health Authority, with previously identified mild, moderate or severe urinary symptoms. RESULTS: The response rate among eligible subjects was 83%. Of 420 respondents 45% had seen their general practitioner for their symptoms. General practitioners had referred 62% of these men to a urologist, reassured 21% and prescribed medication to 17%. The probability of a man seeking medical advice increased with increasing symptom severity. In contrast, the decision to refer was independent of symptom severity. Of the men referred to a urologist, the majority (71%) were offered and accepted surgery. The remainder were reassured (17%), or received a prescription (4%). Eight per cent were offered surgery but declined. When presented with details and information on the risks and benefits of prostatectomy, 22% of men with symptoms would probably or definitely refuse treatment, while a further 47% of men were unsure. CONCLUSION: There are many men who do not seek treatment for urinary symptoms and, of those who do, subsequent referral is not associated with symptom severity. There is scope for improving the referral process through the shared development of guidelines between general practitioners, hospitals and commissioning agencies.

Aged↗
PubMed1994

A prospective study of family history and the risk of colorectal cancer.

BACKGROUND: A family history of colorectal cancer is recognized as a risk factor for the disease. However, as a result of the retrospective design of prior studies, the strength of this association is uncertain, particularly as it is influenced by characteristics of the person at risk and the affected family members. METHODS: We conducted a prospective study of 32,085 men and 87,031 women who had not previously been examined by colonoscopy or sigmoidoscopy and who provided data on first-degree relatives with colorectal cancer, diet, and other risk factors for the disease. During the follow-up period, colorectal cancer was diagnosed in 148 men and 315 women. RESULTS: The age-adjusted relative risk of colorectal cancer for men and women with affected first-degree relatives, as compared with those without a family history of the disease, was 1.72 (95 percent confidence interval, 1.34 to 2.19). The relative risk among study participants with two or more affected first-degree relatives was 2.75 (95 percent confidence interval, 1.34 to 5.63). For participants under the age of 45 years who had one or more affected first-degree relatives, the relative risk was 5.37 (95 percent confidence interval, 1.98 to 14.6), and the risk decreased with increasing age (P for trend, < 0.001). CONCLUSIONS: A family history of colorectal cancer is associated with an increased risk of the disease, especially among younger people.

Adult↗
PubMed1994

A prospective study of permanent hair dye use and hematopoietic cancer.

BACKGROUND: Use of permanent hair dye has been suggested as a risk factor for several types of cancer, although epidemiologic data have not generally supported this hypothesis. Retrospective studies have reported a possible association between hair dyes and hematopoietic cancers. PURPOSE: Our purpose was to investigate if permanent hair dye was associated with risks of incident lymphoma, leukemia, and multiple myeloma in the Nurses' Health Study, a prospective cohort study of 99,067 women aged 30-55 years in 1976. METHODS: Questionnaires regarding medical history and other health-related variables were sent to Nurses' Health Study participants every 2 years from 1976 to 1990. The follow-up for mortality in this cohort exceeds 98%. We identified 244 newly diagnosed cases of hematopoietic cancers, confirmed by pathology reports. Permanent hair dye use was ascertained over four cycles of questionnaires from 1976-1982; status of hair dye use established in 1982 was then used for the remainder of the follow-up time (through 1990). Age-specific incidence rates were calculated and used to compute relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: We found no evidence of a positive association between ever use of permanent hair dye and all hematopoietic cancers (age-adjusted RR = 0.9; 95% CI = 0.7-1.2) or specific types (Hodgkin's lymphoma [RR = 0.9; 95% CI = 0.4-2.1], non-Hodgkin's lymphoma [RR = 1.1; 95% CI = 0.8-1.6], multiple myeloma [RR = 0.4; 95% CI = 0.2-0.9], chronic lymphocytic leukemia [RR = 0.6; 95% CI = 0.3-1.5], and other leukemias [RR = 0.8; 95% CI = 0.3-1.9]). Further examination of age at first use, duration, frequency, and time since first use and risk of all hematopoietic cancers or non-Hodgkin's lymphoma (the largest diagnostic group), indicated no material associations. CONCLUSION: In this prospective cohort study, permanent hair dye use is not adversely related to risks of hematopoietic cancers.

Adult↗
PubMed1994

Prospective studies of diet and breast cancer.

To avoid biases due to control selection and the retrospective reporting of diet that may occur in case-control studies, a series of large prospective studies have been started since about 1980 to examine the relationship between fat intake and breast cancer risk. Relative risks for the highest versus lowest categories of energy-adjusted fat intake in the six published studies have all been nonsignificant and close to 1.0: California Seventh-Day Adventists Study (215 cases), relative risk (RR) = 1.21; Nurses' Health Study (1439 cases), RR = 0.90; Canadian Breast Cancer Screening Study (592 cases), RR = 1.30; Iowa Women's Study (408 cases), RR = 1.13; New York State Cohort (359 cases), RR = 1.00; and the Dutch Cohort (471 cases), RR = 1.11. Two additional studies have been reported with fewer than 70 cases and dietary methods less appropriate for studies of this nature; an inverse association was seen in one and a positive association in the other. In studies that included both premenopausal and postmenopausal women, no evidence was seen for a stronger positive association among the older group. In addition, no indication was seen of a threshold for reduced risk below 30% of calories from fat, as has been suggested by some. Although associations with specific types of fat tended to vary somewhat among studies, in none was saturated fat significantly associated with risk of breast cancer. In summary, the evidence from prospective studies strongly suggests that a substantial association does not exist between fat intake by middle-aged women and their risk of breast cancer. A very weak association, an effect of very low fat intake, a greatly delayed effect, and an influence of fat consumption early in life are difficult to exclude. Further follow-up of these and other cohorts will provide additional resolution of these issues.

Animals↗
PubMed1994

International transfers of National Health Service reforms: problems and issues.

Recent market-style reforms in the UK National Health Service (NHS) have attracted the attention of health care professionals, managers, and policy-makers from many developing and central and eastern European countries. This article asks how NHS managers and health professionals should react to such international interest. Six key issues have to be considered when introducing market-style reforms into developing and eastern European countries. First, health sector reform should be formulated on the basis of sound research and evidence. We should also take particular care in understanding how efficiency contributes to health policy objectives and the extent to which private management practices are appropriate to the public sector. We should also question the value of international technology transfer and evaluate the experiences of health sector reform in other countries. Last we should look at the way in which health sector reform is formulated and implemented. Here we highlight important questions about the suitability of replicating the UK experience in other countries.

Europe↗
PubMed1994

Regulation of alternative splicing of the fibronectin IIICS domain by cytokines.

The primary fibronectin gene transcript is alternatively spliced in three regions, designated EIIIA, EIIIB and IIICS. While the functions of the EIIIA and EIIIB domains are still to be established, either end of the IIICS domain contains the cell-binding sites CS1 and CS5 recognised by the integrin VLA-4 which is present on mononuclear cells. We have determined the effects of three cytokines upon fibronectin mRNA and IIICS splice variants in four cultured human cell lines using Northern hybridisation and PCR. In the cell line CAKI-2, interleukin 1 beta, Platelet-derived growth factor BB and transforming growth factor beta 1 all increased mRNA splice variants where the CS1 and CS5 regions were removed. This cytokine-induced change would lead to a decrease in the CS1 and CS5 cell binding sites within the extracellular matrix. All the changes in spliceosome function increase use of downstream 3' splice acceptor sites and may represent use of a single common pathway by three different cytokines.

Alternative Splicing↗
PubMed1994

Synthesis of novel N-phosphonoalkyl dipeptide inhibitors of human collagenase.

The synthesis of a series of N-phosphonalkyl dipeptides 6 is described. Syntheses were devised that allowed the preparation of single diastereoisomers and the assignment of stereochemistry. The compounds were evaluated in vitro for their ability to inhibit the degradation of radiolabeled collagen by purified human lung fibroblast collagenase. Several of the compounds were potent collagenase inhibitors and were at least 10-fold more potent than their corresponding N-carboxyalkyl analogues. Activity was lost when the phosphonic acid group P(O)(OH)2 was replaced by the phosphinic acid groups P(O)(H)(OH) and P(O)(Me)(OH). At the P1 position, (R)- or (S)-alkyl groups, especially ethyl and methyl (e.g., 12a,b, 52a,b, and 53a,b), or an (R)-phenethyl moiety (55a) conferred high potency (IC50 values in the range 0.23-0.47 microM). (S)-Stereochemistry was preferred for the P1' isobutyl side chain. Structure-activity relationships were also investigated at the P2' site, and interestingly, compounds with basic side chains, such as the guanidine 57a, were equipotent with more lipophilic compounds, such as 52a. As with other series of collagenase inhibitors, potency was enhanced by introducing bicyclic aromatic P2' substituents. The most potent phosphonic acid of the series was the bicyclic aromatic P2' tryptophan analogue 59a (IC50 0.05 microM).

Animals↗
PubMed1994

Adolescent body mass index and infertility caused by ovulatory disorder.

OBJECTIVE: Our aim was to examine the association between body mass index at age 18 and subsequent primary ovulatory infertility. STUDY DESIGN: A nested case-control study was conducted within a cohort of 116,678 female registered nurses residing in 14 U.S. states. Cases comprised 2527 married nulliparous nurses unable to become pregnant for at least 1 year because of ovulatory disorder; controls comprised 46,718 married parous nurses with no history of infertility. The risk of ovulatory infertility for women at different levels of body mass index at age 18 was compared with that for women whose body mass index at age 18 was 20 to 21.9 (median for the cohort). Logistic regression was used to adjust for age at infertility or first birth, year of birth, age at menarche, physical activity during ages 18 to 22, smoking at ages 15 to 19, ethnicity, alcohol use at ages 18 to 22, use of oral contraceptives before age 22, and diagnosis of diabetes mellitus. RESULTS: Multivariate relative risks for infertility were: 1.2 (body mass index < 16), 1.1 (body mass index 16 to 17.9), 1.0 (body mass index 18 to 19.9), 1.0 (referent body mass index 20 to 21.9), 1.1 (body mass index 22 to 23.9), 1.3 (body mass index 24 to 25.9), 1.7 (body mass index 26 to 27.9), 2.4 (body mass index 28 to 29.9), 2.7 (body mass index 30 to 31.9), and 2.7 (body mass index > or = 32). The relative risks for all categories of body mass index above 23.9 were statistically significantly elevated. Greater body mass index at age 18 was a predictor of ovulatory infertility in women with and without a diagnosis of polycystic ovary syndrome. CONCLUSION: These findings suggest that elevated body mass index at age 18, even at levels lower than those considered to be obese, is a risk factor for subsequent ovulatory infertility.

Adolescent↗
PubMed1994

Reproducibility and validity of a self-administered physical activity questionnaire.

BACKGROUND: The reproducibility and validity of self-administered questionnaires on physical activity and inactivity were examined in a random (representative) sample of the Nurses' Health Study II cohort and a random sample of African-American women in that cohort. METHODS: Repeat questionnaires were administered 2 years apart. Past-week activity recalls and 7-day activity diaries were the referent methods; these instruments were sent to participants four times over a 1-year period. RESULTS: The 2-year test-retest correlation for activity was 0.59 for the representative sample (n = 147) and 0.39 for the African-American sample (n = 84). Correlations between activity reported on recalls and that reported on questionnaire were 0.79 and 0.83 for the representative and African-American samples, respectively. Correlations between activity reported in diaries and that reported on questionnaire were 0.62 and 0.59, respectively. Test-retest coefficients for inactivity were 0.52 and 0.55, respectively. Correlations between inactivity reported in diaries and that reported on questionnaire were 0.41 and 0.44, respectively. CONCLUSION: The simple, short questionnaires on activity and inactivity used in the Nurses' Health Study II are reasonably valid measures for epidemiological research.

Adult↗
PubMed1994

Sexual behavior, sexually transmitted diseases, male circumcision and risk of HIV infection among women in Nairobi, Kenya.

OBJECTIVE: To study risk factors for HIV infection among women in Nairobi, Kenya, as the epidemic moves beyond high-risk groups. DESIGN: A cross-sectional case-control study among women attending two peri-urban family planning clinics. METHODS: A total of 4404 women were enrolled after giving written informed consent. Information on risk factors was obtained by interview using a structured questionnaire. Blood was taken for HIV and syphilis testing, and genital specimens for gonorrhea and trichomoniasis screening. RESULTS: Two hundred and sixteen women (4.9%; 95% confidence interval, 4.3-5.5) were HIV-1-positive. Although risk of HIV was significantly increased among unmarried women and among women with multiple sex partners, most seropositive women were married and reported only a single sex partner in the last year. Women with a history or current evidence of sexually transmitted disease were at significantly increased risk; however, the prevalence of these exposures was low. Women whose husband or usual sex partner was uncircumcised had a threefold increase in risk of HIV, and this risk was present in almost all strata of potential confounding factors. Only 5.2% of women reported ever having used a condom. CONCLUSIONS: These data suggest that, among women who are not in high-risk groups, risk of HIV infection is largely determined by their male partner's behavior and circumcision status. Interventions designed to change male sexual behavior are urgently needed.

Adolescent↗
PubMed1994

The market and health sector reform.

A new international orthodoxy has developed on health sector reform. The dominant theme of the orthodoxy is the alleged benefits of market style reforms for health development. This is shaping changes formulated, and being implemented, in the British NHS and other European health services (including Central and Eastern Europe), Latin America and a number of developing health systems in Africa and Asia. Sets out a ten-point description of the orthodoxy. Contends that the orthodoxy is showing distinct signs of restricting the analysis and development of health management and planning. This is a matter for considerable concern as the adoption of market-style reforms can generate unforeseen and, in some cases, negative consequences. There is clearly a need for strengthening management research and development as a basis for effective health sector reform.

Consumer Behavior↗