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Biomedical subjects

D James

Publications and source records attributed to D James.

At least 55 records · Page 3Linked to original sources
PubMed2001

The emerging importance of dietary lipids, quantity and quality, in the global disease burden: the potential of aquatic resources.

Achievement of Health-for-All, whereby people everywhere throughout their lives, have the opportunity to reach and maintain the highest attainable level of health is impossible whilst hunger, starvation, and malnutrition remain. Malnutrition covers a broad spectrum of ills, including undernutrition, specific nutrient deficiencies, and overnutrition; and it kills, maims, retards, cripples, blinds, and impairs human development on a truly massive scale worldwide. In the developing world in 1995, of the estimated 10.4 million deaths among children under 5 years of age, protein-energy malnutrition was an associated and causative factor in 5.1 million of these deaths (i.e. 49%). On the other hand, evidence has recently been compiled suggesting that of the more than 10 million cases of cancer that occurred in 1996, an estimated 30-40% (3-4 million every year) are preventable by feasible, appropriate diets, and by physical activity and maintenance of appropriate body weight. Malnutrition affects all age groups across the entire lifespan. From the moment of conception, throughout foetal life, iodine, folate and intrauterine nutrition have a profound influence on development, growth, morbidity, mortality, not only in utero and in early infancy, but on morbidity, physical and mental capacity throughout life. Despite significant improvements in world food supplies, health conditions, and availability of educational and social services, no population escapes malnutrition's grasp. All countries have significant population groups with some form of debilitating malnutrition. Malnutrition worldwide, includes a spectrum of nutrient-related disorders, deficiencies and conditions including the following major public health problems; Intrauterine growth retardation, protein-energy malnutrition, Iodine deficiency disorders, Vitamin A Deficiency, Iron Deficiency Anaemia and Overweight and Obesity (WHO, Website).

Dietary Fats↗
PubMed2001

Monitoring the fetal heart non-invasively: a review of methods.

Doppler ultrasound, ultrasound M-mode analysis, fetal electrocardiography, and fetal magnetocardiography are methods by which the fetal heart can be monitored non-invasively. In this paper, they are evaluated and compared. Customarily, it is solely the fetal heart rate, which is monitored using the Doppler ultrasound technique since it is both simple to use and cheap. However, this method inherently produces an averaged heart rate and therefore cannot give the beat-to-beat variability. Fetal electrocardiography has similar advantages, but in addition offers the potential for monitoring beat-to-beat variability and performing electrocardiogram morphological analysis. Its disadvantage is that its reliability is only 60%, although it is the only technique that offers truly long-term ambulatory monitoring. Ultrasound M-mode analysis allows a estimation of atrial and ventricular coordination, as well as an estimation of PR intervals. Bradycardias, supraventricular tachycardias, extra systoles are readily diagnosed using this method although timing will be inaccurate. Fetal magnetocardiograms can be detected reliably and used for accurate beat-to-beat measurements and morphological analysis. Consequently, they can be used for the classification of arrhythmias and the diagnosis of a long QT syndrome and some congenital heart diseases.

Electrocardiography↗
PubMed2000

Board membership. House of unrepresentatives.

A survey of lay members on PCGs and local health groups in England and Wales found that more than three quarters were over 45. Very few were from an ethnic minority. Almost two-thirds were in paid employment. Almost all were recognised as full members of the board but many felt they were token members. Three-quarters thought PCGs were improving primary healthcare.

Adolescent↗
PubMed2000

Bacteraemia and antibiotic resistance of its pathogens reported in England and Wales between 1990 and 1998: trend analysis.

OBJECTIVES: Determination of causes, trends, and antibiotic resistance in reports of bacterial pathogens isolated from blood in England and Wales from 1990 to 1998. DESIGN: Description of bacterial isolates from blood, judged to be clinically significant by microbiology staff, reported to the Communicable Disease Surveillance Centre. SETTING: Microbiology laboratories in England and Wales. SUBJECTS: Patients yielding clinically significant isolates from blood. MAIN OUTCOME MEASURES: Frequency and Poisson regression analyses for trend of reported causes of bacteraemia and proportions of antibiotic resistant isolates. RESULTS: There was an upward trend in total numbers of reports of bacteraemia. The five most cited organisms accounted for over 60% of reports each year. There was a substantial increase in the proportion of reports of Staphylococcus aureus resistant to methicillin, Streptococcus pneumoniae resistance to penicillin and erythromycin, and Enterococcus faecalis and Enterococcus faecium resistance to vancomycin. No increase was seen in resistance of Escherichia coli to gentamicin. CONCLUSIONS: Reports from laboratories provide valuable information on trends and antibiotic resistance in bacteraemia and show a worrying increase in resistance to important antibiotics.

Bacteremia↗
PubMed2000

Nucleotide sequence and genome organisation of cherry mottle leaf virus and its relationship to members of the Trichovirus genus.

The nucleotide sequence of cherry mottle leaf virus (CMLV) was determined and compared to sequences of a number of plant viruses including the type member of the Trichovirus genus (apple chlorotic leafspot virus, ACLSV), and members of the Vitivirus genus including grapevine virus B, (GVB). The CMLV genome was determined to consist of 8003 nt excluding the poly(A) tail at the 3' end of the genome. The overall A + U content of CMLV genomic RNA was 59.1%, which is similar to ACLSV, but significantly different from GVB. Four putative open reading frames were identified (ORFs 1, 2, 3, and 4) encoding proteins of M(r) 215.8 kDa, 47 kDa, 21.6 kDa, and 15.3 kDa, respectively. This differs from ACLSV which has 3 ORFS, and GVB which has 5 ORFs. Protein database searches showed no matches of CMLV ORF4 with ACLSV sequences, but found similarities between ORF4 of CMLV and ORF5 of GVB, suggesting that this may be a nucleic acid-binding protein. CMLV and ACLSV formed a common virus clade in phylogenetic analysis of the coat protein amino acid sequence and except for CMLV's ORF4, these viruses show high levels of similarity throughout the genome. CMLV appears to be a member of the Trichovirus genus.

Amino Acid Sequence↗
PubMed2000

[Effect of the moon on the nocturnal postnuptial migration of the skylark Alauda arvensis L. in France].

Night-migrating skylarks (Alauda arvensis) were captured during four successive autumns in France. The study aimed at detecting a possible influence of the lunar cycle on the nocturnal migration of this species. Though nocturnal postnuptial migration of the skylarks can occur during every phase of the moon, main nocturnal movements occurred when the moon was in its waxing gibbous phase. This phase gives the best conditions for migration because from the very beginning of night, it provides the necessary horizon for individuals to navigate and its light allows the use of topographic cues. In addition it allows the species to benefit from optimal conditions of illumination for almost a week.

Animals↗
PubMed2000

Are routine sensitivity test data suitable for the surveillance of resistance? Resistance rates amongst Escherichia coli from blood and CSF from 1991-1997, as assessed by routine and centralized testing.

Surveillance of antibiotic resistance can be undertaken by compilation of routine data or by central testing of isolates. Routine results can be obtained cheaply and in sufficient quantities for correlation with population and prescribing denominators but there is concern about their quality. As one of a series of ongoing studies to assess this quality, we compared the proportions of resistance amongst Escherichia coli from patients with bacteraemia or meningitis between 1991 and 1997 (i) as recorded in routine data reported to the PHLS and (ii) as found in tests performed at the PHLS Laboratory of Enteric Pathogens (LEP). These two data sets both showed an overall upward trend in the proportion of isolates resistant to ampicillin, trimethoprim, gentamicin and ciprofloxacin. The average annual percentage increase in resistance was estimated in separate logistic regression models, and 95% confidence intervals (CI) were determined. The annual percentage increases in the proportions of isolates reported resistant were similar in the two data sets for trimethoprim, gentamicin and ciprofloxacin but differed for ampicillin. The upward trends were statistically significant except for gentamicin resistance in the LEP data set, where the 95% CI straddled zero. The proportions of resistant isolates for each antibiotic in the two data sets each year were in poorer agreement than the trends; however, the 95% CI of the difference of proportions resistant between the routine and LEP data sets straddled zero in 4 or 5 of the 7 years studied. Some discrepancies might be explained by geographical bias in the sampling or by differences in definitions of resistance. Thus (i) the proportion of resistant isolates tested at LEP almost always fell within the ranges bounded by the highest and lowest proportions for individual Regional Health Authorities, as recorded in the routine data, and (ii) the fact that LEP consistently recorded less gentamicin resistance but more ciprofloxacin resistance than the routine could be explained by breakpoint differences. We conclude that routine susceptibility data for ampicillin, ciprofloxacin, gentamicin and trimethoprim appear sound for E. coli and might be suitable for correlation with other data, e.g. for prescribing.

Bacteremia↗
PubMed2000

Regional variation in ampicillin and trimethoprim resistance in Escherichia coli in England from 1990 to 1997, in relation to antibacterial prescribing.

Over 200 hospitals in England report resistance data for bacteraemia and meningitis isolates to the Public Health Laboratory Service. We reviewed ampicillin and trimethoprim resistance rates from 1990 to 1997 for Escherichia coli, which is the species reported most frequently from these bacteraemias. Ampicillin resistance was relatively stable over time, but varied between Health Regions. The proportion of ampicillin-resistant E. coli in the East Anglia region remained </=42% in all years except one and that in the South Western region always remained <50%. At the other extreme, the proportions of ampicillin-resistant isolates in the Northern and Trent regions never fell below 59%. The prevalence of resistance to trimethoprim rose over time in most regions; again, however, the prevalence of resistant isolates was lowest in the East Anglia and South Western regions, whereas the highest resistance rates were reported from Mersey, NW Thames, NE Thames and North Western regions. These observations were related to data for community prescribing, which accounts for most ampicillin and trimethoprim use. Prescribing data for ampicillin and trimethoprim from 1987 to 1997 were obtained from the IMS-HEALTH Medical Data Index, and data for all antibacterial drugs between 1995 and 1997 from the Prescription Pricing Authority. Correlations between resistance rates and prescribing of specific antibiotics were weak, although there was some trend for regions with high total prescribing to have higher rates of ampicillin resistance. The South Western region was conspicuous both for low rates of resistance and low prescribing. Several factors may determine the lack of wider and more obvious relationships between resistance and prescribing. In particular, regions may be inappropriately large areas to test the relationship, isolates from bacteraemias may not be representative of those experiencing selection pressure in the community and the resistance data may have been distorted by nosocomial strains, although this seems unlikely with E. coli.

Ampicillin↗
PubMed2000

Susceptibility of gram-positive cocci from 25 UK hospitals to antimicrobial agents including linezolid. The Linezolid Study Group.

The prevalence of antibiotic resistance amongst Gram-positive cocci from 25 UK hospitals was studied over an 8 month period in 1999. A total of 3770 isolates were tested by the sentinel laboratories using the Etest; these bacteria comprised 1000 pneumococci, 1005 Staphylococcus aureus, 769 coagulase-negative staphylococci (CNS) and 996 enterococci. To ensure quality, 10% of the isolates were retested centrally, as were any found to express unusual resistance patterns. The prevalence of penicillin-resistant Streptococcus pneumoniae, vancomycin-resistant enterococci and methicillin-resistant S. aureus (MRSA) varied widely amongst the sentinel laboratories. The resistance rates to methicillin among S. aureus and CNS were 19.2 and 38.9%, respectively, with MRSA rates in individual sentinel sites ranging from 0 to 43%. No glycopeptide resistance was seen in S. aureus, but 6.5% of CNS isolates were teicoplanin resistant and 0.5% were vancomycin resistant. Vancomycin resistance was much more frequent among Enterococcus faecium (24.1%) than E. faecalis (0.5%) (P<0.05), with most resistant isolates carrying vanA. The rate of penicillin resistance in pneumococci was 8.9%, and this resistance was predominantly intermediate (7.9%), with only six hospitals reporting isolates with high level resistance. The prevalence of erythromycin resistance among pneumococci was 12.3%, with the majority of resistant isolates having the macrolide efflux mechanism mediated by mefE. All the organisms tested were susceptible to linezolid with MICs in the range 0.12-4 mg/L. The modal MICs of linezolid were 1 mg/L for CNS and pneumococci, and 2 mg/L for S. aureus and enterococci. Linezolid was the most potent agent tested against Gram-positive cocci, including multiresistant strains, and as such may prove a valuable therapeutic option for the management of Gram-positive infections in hospitals.

Acetamides↗
PubMed2000

How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS)

OBJECTIVES: To assess the impact of rheumatoid arthritis (RA) on function and how this affects major aspects of patients' lives. METHODS: The inception cohort of RA patients was recruited from rheumatology out-patient departments in nine National Health Service (NHS) hospital trusts in England. All consecutive patients with RA of less than 2 yr duration, prior to any second-line (disease-modifying) drug treatment were recruited and followed-up for 5 yr. Standard clinical, laboratory and radiological assessments, and all hospital-based interventions were recorded prospectively at presentation and yearly. The outcome measures were clinical remission and extra-articular features, functional ability [functional grades I-IV and Health Assessment Questionnaire (HAQ)], use of aids, appliances and home adaptations, orthopaedic interventions, and loss of paid work. RESULTS: A total of 732 patients completed 5 yr of follow-up, of whom 84% received second-line drugs. Sixty-nine (9.4%) had marked functional loss at presentation, compared with normal function in 243 (33%), and by 5 yr these numbers had increased in each group, respectively, to 113 (16%) and 296 (40%). Home adaptations and/or wheelchair use by 5 yr were seen in 74 (10%). Work disability was seen in 27% of those in paid employment at onset. One hundred and seventeen (17%) patients underwent orthopaedic surgery for RA, 55 (8%) for major joint replacements. Marked functional loss at 5 yr was more likely in women [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.04-2.5], patients older than 60 yr (OR 1.94, 95% CI 1.3-2.9), and with HAQ > 1.0 at presentation (OR 4.4, 95% CI 2.8-7.0). CONCLUSIONS: Clinical profiles of RA patients treated with conventional drug therapy over 5 yr showed that a small proportion of patients (around 16%) do badly functionally and in terms of life events, whereas around 40% do relatively well. The details and exact figures of cumulative disability are likely to be useful to clinicians, health professionals and patients. The rate of progression and outcome in these patients can be compared against future therapies with any disease-modifying claims.

Adult↗
PubMed2000

Patients' interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction.

OBJECTIVE: To examine whether the association between expected symptoms of acute myocardial infarction and actual symptoms predicted delay in reaching hospital and help seeking behaviour. DESIGN: During hospital convalescence, participants completed a structured interview designed to measure symptom experience and help seeking behaviour following the onset of symptoms of acute myocardial infarction. PATIENTS: 88 patients admitted to hospital with their first myocardial infarction MAIN OUTCOME MEASURES: Delay in reaching hospital from onset of worst symptoms, obtained from ambulance and hospital records. RESULTS: The most common symptoms expected by patients with myocardial infarction were central chest pain (76%), radiating arm or shoulder pain (34%), and collapse (26%). The most common symptoms experienced were sweats or feeling feverish (78%), chest pain (64%), and arm, shoulder, or radiating pain (66%). A mismatch between symptoms experienced and those expected occurred in 58% of patients, and was associated with delay. Patients who experienced a mismatch between expectation and actual symptoms also were more likely to have a third party decide to call for help. CONCLUSIONS: The experience and interpretation of symptoms is an important source of delay and help seeking following onset of myocardial infarction symptoms.

Aged↗
PubMed2000

Patient perceptions of day surgery.

Having an operation is always a cause for some anxiety, and probably fear for most people. Being told that you don't need to stay in hospital, and that your surgery can be done as a day case with no need for even a one night stay would probably be a comfort. The thought that it will be all over on one day, and that you can go home to your own bed, makes the prospect less daunting. Indeed research has shown that patients prefer day surgery for these and other reasons. Because day surgery means more patients treated at less cost than inpatient surgery, the Government is encouraging the expansion of day surgery services and Trusts are responding. Treating more patients more quickly has got to be good news for the many thousands of patients on waiting lists, but having your operation as a day case should not mean production line treatment. Caring for the personal and meeting individual needs is equally applicable to day case patients as it is to inpatients. This study presents an exploration of some of the actual and potential problems which need to be addressed if day surgery is to become part of the 'first class service' the Government has promised.

Ambulatory Surgical Procedures↗
PubMed2000

Pressure monitoring of the femoral nerve during total hip replacement: an explanation for iatropathic palsy.

Pressure changes around the femoral nerve were monitored throughout 10 consecutive primary total hip replacements to identify any surgical steps that might raise pressure around the nerve and be implicated in iatropathic palsy. The only notable variable was the patient himself/herself. The only step that consistently raised pressure around the nerve, sometimes to alarming levels, was use of a retractor sited on the anterior lip of the acetabulum. Pressure changes were modest in patients with an endomorphic body type suggesting relative protection from this injury by a thicker soft cushion.

Arthroplasty, Replacement, Hip↗
PubMed1999

Prediction of survival for preterm births by weight and gestational age: retrospective population based study.

OBJECTIVE: To produce current data on survival of preterm infants. DESIGN: Retrospective population based study. SETTING: Trent health region. SUBJECTS: All European and Asian live births, stillbirths, and late fetal losses from 22 to 32 weeks' gestation, excluding those with major congenital malformations, in women resident in the Trent health region between 1 January 1994 and 31 December 1997. MAIN OUTCOME MEASURES: Birth weight and gestational age specific survival for both European and Asian infants (a) known to be alive at the onset of labour, and (b) admitted for neonatal care. RESULTS: 738 deaths occurred in 3760 infants born between 22 and 32 weeks' gestation during the study period, giving an overall survival rate of 80.4%. The survival rate for the 3489 (92.8%) infants admitted for neonatal care was 86.6%. For European infants known to be alive at the onset of labour, significant variations in gestation specific survival by birth weight emerged from 24 weeks' gestation: survival ranged from 9% (95% confidence interval 7% to 13%) for infants of birth weight 250-499 g to 21% (16% to 28%) for those of 1000-1249 g. At 27 weeks' gestation, survival ranged from 55% (49% to 61%) for infants of birth weight 500-749 g (below the 10th centile) to 80% (76% to 85%) for those of 1250-1499 g. Infants who were large for dates (>/=27 weeks' gestation) had a slightly reduced, but not significant, predicted survival. Similar survival rates were observed for Asian infants. The odds ratio for the survival of infants from a multiple birth compared with singleton infants was 1.4 (1.1 to 1.8). Survival graphs for infants admitted for neonatal care are presented by sex. CONCLUSION: Easy to use birth weight and gestational age specific predicted survival graphs for preterm infants facilitate decision making for clinicians and parents. It is important that these graphs are representative, are produced for a geographically defined population, and are not biased towards the outcomes of particular centres. Such graphs, produced in two stages, allow for the changing pattern of survival of infants from the start of the intrapartum period to immediately after admission for neonatal care.

Asia↗