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Biomedical subjects

D Jolley

Publications and source records attributed to D Jolley.

At least 73 records · Page 4Linked to original sources
PubMed1997

An actual use comparison of condoms meeting Australian and Swiss standards: results of a double-blind crossover trial.

The performance of condoms in actual use has been poorly researched in the past, especially in comparing condoms that met different quality control standards as indicated by laboratory testing. The present study used a double-blind crossover design to compare the performance of 2 types of condoms in actual use; one that met the Australian and International Organization for Standardization (ISO) standards for condom quality and one that met the more stringent Swiss Quality Seal requirements. Ninety-two men recruited from Metropolitan Melbourne completed a self-report diary sheet after each condom was used which assessed the performance of the condom and the conditions under which it was used. From a total of 1917 condom uses, there was an overall breakage risk of 2.7%. The breakage risk ratio (Australian/ISO:Swiss) for all types of use was 1.16 (95% confidence interval 0.68-1.99). When subanalyses by method of entry were performed, the condoms meeting the Swiss standard appeared to fare better than the Australian/ ISO standards for anal sex (RR = 4.84, 95% CI 1.07-21.8, P = 0.022), while the opposite was the case for vaginal sex (RR = 0.74, 95% CI 0.35-1.53, P = 0.41). The result for anal use was statistically significant at the 5% level, despite being based on fewer condom trials than that for vaginal use, but this result needs to be replicated. Although the participants appeared representative of the general male population in Melbourne in the age bracket 18-46 years, there was a significant history of condom usage reported. This may have influenced the risk of breakage.

Adult↗
PubMed1997

An evaluation of educational outreach to general practitioners as part of a statewide cervical screening program.

OBJECTIVES: The purpose of this study was to determine the acceptability, effectiveness, and cost of a face-to-face educational outreach intervention in the context of a program aimed at increasing cervical screening in Victoria, Australia. METHODS: All identified general practitioners in a specified intervention area were offered a visit by a general practitioner educator. Practitioners completed a questionnaire evaluating the acceptability of the visit. Odds ratios for a woman being screened in the 3 months following the visits were determined. RESULTS: Fifty-nine general practitioners (69.4%) accepted the offer of a visit. Most found both the process and the content of the intervention to be acceptable. The intervention and nonintervention regions did not differ either before or after the intervention. In both regions, there was a statistically significant increase in number of Pap tests performed. There was no difference in the change in screening between the two regions. Costs were estimated at Au$34 per general practitioner visited. CONCLUSIONS: This strategy cannot be recommended for widespread use in a cervical screening program.

Adult↗
PubMed1997

Depression in dementia: a study of mood in a community sample and referrals to a community service.

The association between degree of cognitive impairment and severity of depressive symptoms was examined in a randomly selected community-based sample of elderly people and in a sample of patients referred to an old age psychiatry service. Findings contradict previous reports of less cognitive impairment in demented patients with depressive symptoms. We suggest that sample selection bias has contributed to the earlier reports.

Affect↗
PubMed1996

Cancer incidence near municipal solid waste incinerators in Great Britain.

By use of the postcoded database held by the Small Area Health Statistic Unit, cancer incidence of over 14 million people living near 72 municipal solid waste incinerators in Great Britain was examined from 1974-86 (England), 1974-84 (Wales) and 1975-87 (Scotland). Numbers of observed cases were compared with expected numbers calculated from national rates (regionally adjusted) after stratification by a deprivation index based on 1981 census small area statistics. Observed-expected ratios were tested for decline in risk with distance up to 7.5 km. The study was conducted in two stages: the first involved a stratified random sample of 20 incinerators; the second the remaining 52 incinerators. Over the two stages of the study was a statistically significant (P<0.05) decline in risk with distance from incinerators for all cancers combined, stomach, colorectal, liver and lung cancer. Among these cancers in the second stage, the excess from 0 to 1 km ranged from 37% for liver cancer (0.95) excess cases 10(-5) per year to 5% for colorectal cancer. There was evidence of residual confounding near the incinerators, which seems to be a likely explanation of the finding for all cancers, stomach and lung, and also to explain at least part of the excess of liver cancer. For this reason and because of a substantial level of misdiagnosis (mainly secondary tumours) found among registrations and death certificates for liver cancer, further investigation, including histological review of the cases, is to be done to help determine whether or not there is an increase in primary liver cancer in the vicinity of incinerators.

Incidence↗
PubMed1996

The first hit: circumstances surrounding initiation into injecting.

Initiation into injecting is a crucial event for continued reproduction of an injecting drug using (IDU) population and for exposure to blood-borne viruses, but little is known about how this happens. Three hundred young injectors were interviewed in Melbourne by peer workers within the first few years of beginning to inject, about the circumstances surrounding their initiation. Most had indications of social disruption, including having left school early, unemployment, family disruption, homelessness and incarceration. First drug injected was most often amphetamines (average age 16 years), most having already used amphetamines by a different route of administration, but with a steady movement thereafter to heroin as the drug of choice. The most common scenario was one in which injecting was unplanned but the person was active in bringing about the initiation. Most identified a significant other who initiated them (few of whom were dealers), and over half had subsequently initiated others into injecting, on average 0.6 per year; after 5 years 237 young injectors had initiated at least 420 others. Those who initiated multiple others were more likely to be unemployed, to inject multiple drugs and to have dealt. Modelling injecting as a communicable phenomenon, where appropriate, may help estimate population dynamics among IDUs. Peer education programmes are likely to be the most effective harm reduction approach among new injectors.

Adolescent↗
PubMed1995

Declining risk for HIV among injecting drug users in Kathmandu, Nepal: the impact of a harm-reduction programme.

OBJECTIVE: To measure changes in self-reported risk behaviour for HIV infections and HIV seroprevalence among injecting drug user (IDU) clients of an outreach harm-reduction programme in Kathmandu, Nepal. METHODS: The Lifesaving and Lifegiving Society (LALS) of Kathmandu began providing sterile injecting equipment and education to Nepalese IDU in 1991. A sample of these IDU were interviewed and tested for HIV each year from 1991 through 1994. RESULTS: Indicators of unsafe injecting fell, as knowledge of HIV rose more in 1994 for those who had been in touch with LALS for longer. Indicators of unsafe sex did not change. HIV seroprevalence remained low, 1.6% in 1991 and 0% in 1994. CONCLUSION: We conclude that programmes for the prevention of HIV spread among IDU are possible and effective in Asia, and are urgently needed.

Adult↗
PubMed1995

The effect of regular sunscreen use on vitamin D levels in an Australian population. Results of a randomized controlled trial.

BACKGROUND AND DESIGN: Studies published have suggested a possibility that regular use of sunscreen to prevent skin cancer may put the population, particularly elderly people, at risk of vitamin D deficiency. We aimed to determine whether regular use of sunscreens in the normal adult population, as recommended by public health authorities for the prevention of skin cancer, may put individuals at risk of vitamin D deficiency. A randomized double-blind control trial of the daily use of a broad-spectrum sunscreen (sun protection factor [SPF] 17) vs placebo cream over a summer period in Australia was conducted in 113 people aged 40 years and over, with sampling stratified by age. All participants had at least one solar keratosis. Serum samples taken at the beginning and at the end of the study were analyzed for 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3. RESULTS: Mean levels of 25-hydroxyvitamin D3 rose significantly by the same amount in both groups over the period of the study (placebo, +12.8 mmol/L; sunscreen, +11.8 mmol/L). Mean levels of 1,25-dihydroxyvitamin D3 increased significantly in the placebo group only (placebo, +10.8 pmol/L; sunscreen, +1.3 pmol/L), but for no subject in either group was the level of 1,25-dihydroxyvitamin D3 outside the reference range either at the start or at the end of the study. There were no significant differences by age, sex, and skin type in the change in 25-hydroxyvitamin D3 or 1,25-dihydroxyvitamin D3 over the study period. CONCLUSIONS: No person, including those aged 70 years and over, developed any vitamin D levels outside the normal reference range during the period of the study. The data suggest that over an Australian summer sufficient sunlight is received, probably through both the sunscreen itself and the lack of total skin cover at all times, to allow adequate vitamin D production in people who are recommended to use sunscreens regularly. More work is required to elucidate the relationship between 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3, particularly during the different seasons of the year.

Adult↗
PubMed1994

The closure of residential homes: what happens to residents.

A controlled, prospective study is described which demonstrates changes in behaviour and mortality in the residents of two residential homes which were closed. The 59 residents were dispersed to 19 different establishments. Thirteen general practitioners (GPs) received sick elderly people on their lists after relocation. There were delays and other difficulties in communication between GPs. Restlessness, as measured by the Crichton Geriatric Behavioural Rating Scale, was increased soon after moving but no differences in behaviour or dependency between patients and control subjects were demonstrable after 1 year. Although moving in itself did not increase mortality, residents with poor mobility and dressing skills had a high death rate. This pattern of closure with widespread dispersal of residents is likely to become more common after the introduction of the NHS and Community Care Acts. It is associated with psychiatric morbidity which may be preventable by better organization. Medical involvement in the move was minimal, and the special responsibility of medical care of patients living in residential homes should be recognized.

Activities of Daily Living↗
PubMed1993

Reduction of solar keratoses by regular sunscreen use.

BACKGROUND: The incidence of and mortality from skin cancer are increasing in many countries. In view of the added concern about ozone depletion, many organizations are promoting the regular use of sunscreens to prevent skin cancer, despite the absence of evidence that these products have this effect. Solar (actinic) keratosis is a precursor of squamous-cell carcinoma of the skin. METHODS: We conducted a randomized, controlled trial of the effect on solar keratoses of daily use of a broad-spectrum sunscreen cream with a sun-protection factor of 17 in 588 people 40 years of age or older in Australia during one summer (September 1991 to March 1992). The subjects applied either a sunscreen cream or the base cream minus the active ingredients of the sunscreen to the head, neck, forearms, and hands. RESULTS: The mean number of solar keratoses increased by 1.0 per subject in the base-cream group and decreased by 0.6 in the sunscreen group (difference, 1.53; 95 percent confidence interval, 0.81 to 2.25). The sunscreen group had fewer new lesions (rate ratio, 0.62; 95 percent confidence interval, 0.54 to 0.71) and more remissions (odds ratio, 1.53; 95 percent confidence interval, 1.29 to 1.80) than the base-cream group. There was a dose-response relation: the amount of sunscreen cream used was related to both the development of new lesions and the remission of existing ones. CONCLUSIONS: Regular use of sunscreens prevents the development of solar keratoses and, by implication, possibly reduces the risk of skin cancer in the long-term.

Adult↗
PubMed1993

Formyl peptide receptor chimeras define domains involved in ligand binding.

We have begun to study the structural requirements for the binding of formyl peptides to their specific receptors. As an initial approach, we constructed C5a-formyl peptide receptor chimeras. Unique (and identical) restriction sites were introduced within the transmembrane domains of these receptors that allowed for the exchange of specific areas. Four types of chimeric receptors were generated. 1) The C5a receptor was progressively substituted by the formyl peptide receptor. 2) The formyl peptide receptor was progressively substituted by the C5a receptor. 3) Specific domains of the C5a receptor were substituted by the corresponding domain of the formyl peptide receptor. 4) Specific domains of the formyl peptide receptor were replaced by the same corresponding domain of the C5a receptor. Wild type and chimeric receptors were transfected into COS 7 cells and their ability to bind formyl peptide determined, taking into account efficiency of transfection and expression of chimeric protein. Based on these results, a ligand binding model is presented in which the second, third, and fourth extracellular (and/or their transmembrane) domains together with the first transmembrane domain form a ligand binding pocket for formyl peptides. It is proposed that the amino-terminal domain plays a role by presumably providing a "lid" to the pocket. The carboxyl-terminal cytoplasmic tail appears to modulate ligand binding by regulating receptor affinity.

Base Sequence↗
PubMed1993

Atypical and malignant meningiomas: importance of micronecrosis as a prognostic indicator.

Twenty-eight patients with a diagnosis of either atypical or malignant meningioma, according to the World Health Organisation (WHO) classification, were followed up to relate histopathological features with times to recurrence and death. Five year disease-free survival was 41% with a median disease free survival of 27 months. Micronecrosis was the only histopathological feature associated with increased risk of recurrence (rate ratio, 3.73: 95% confidence interval 1.03-13.6). At 36 months, 32% of patients with micronecrosis were alive compared with 71% of patients without micronecrosis. Brain invasion was not associated with disease-free survival. After recurrence, median survival was 7 months and was not correlated with any histopathological feature. The prevalence of micronecrosis was estimated from random samples of benign, atypical and malignant meningiomas to be 8%, 42% and 71% respectively. The relevance of these findings and the current WHO classification is discussed.

Adult↗
PubMed1992

Incidence of cancers of the larynx and lung near incinerators of waste solvents and oils in Great Britain.

The Small Area Health Statistics Unit (SAHSU) is a new independent facility for the investigation of disease near industrial installations in the UK. SAHSU analysed the incidence of cancers of the larynx and lung near the incinerator of waste solvents and oils at Charnock Richard, Coppull, Lancashire (which operated between 1972 and 1980) and nine other similar incinerators in Great Britain, after reports of a cluster of cases of cancer of the larynx near the Charnock Richard site. Postcoded cancer registration data were available for 1974-84 in England and Wales and 1975-87 in Scotland. Lag periods of 5 and 10 years were used between start-up (or first registration) of the incinerators and cancer incidence. Standardised observed/expected (O/E) ratios were assessed within 3 km and 3-10 km of each site and then aggregated over all sites. Expected values were based on national rates (regionally adjusted) with and without stratification by Carstairs' index, a measure of the socioeconomic profile of areas that uses census data for enumeration districts. Data were also assessed over a range of circles up to 10 km to test for trend in O/E ratios with distance. For Charnock Richard, none of the O/E ratios within 3 km or from 3-10 km differed significantly from unity, for either cancer or lag period. In the analysis of all sites with stratification by Carstairs' index, none of these O/E ratios differed significantly from unity for the two cancers. There was no evidence of decreasing risk with distance from the sites of either cancer. We conclude that the apparent cluster of cases of cancer of the larynx reported near Charnock Richard was unlikely to be due to its former incinerator.

Cluster Analysis↗
PubMed1992

Visualizing age-period-cohort trend surfaces: a synoptic approach.

Mortality data from 1950 to 1986 in Australia have been used to exemplify a method of displaying trends by age and cohort in populations over time. The visual summary or synoptic method illustrated here is similar to a topographic map with age and calendar time as its ordinates. This method is complementary to conventional analyses of age-period-cohort data which lack a summary graphic view other than that provided by the trend in age-standardized rates or a three dimensional perspective plot. Mortality from ischaemic heart disease (IHD), lung cancer and motor vehicle accidents are used as examples of the method and illustrate its utility when dealing with different forms of mortality trend e.g. cross-sectional cohort, and mixed trends.

Age Factors↗
PubMed1992

Effects of follicle-stimulating hormone on inhibin release by different testicular compartments in the adult ram.

The aim of this study was to determine the bidirectional release of immunoreactive inhibin-alpha (irINH-alpha) by different testicular compartments in the adult ram and to assess the effects of FSH on the distribution of inhibin in the testis. Immunoreactive INH-alpha was measured by RIA in fluid samples collected concurrently from the three testicular compartments--the seminiferous tubules, the interstitium, and the vascular system--through catheters inserted surgically into the rete testis, testicular lymphatic duct system, and spermatic veins, respectively. Overall, the concentration of irINH-alpha in rete testis fluid was 25 times the level in testicular lymph and over 500 times the concentration in peripheral blood. The pattern of irINH-alpha concentration in rete testis fluid was inversely related to that in testicular lymph, but i.v. administration of FSH had a decoupling effect on this relationship by depressing inhibin concentration in testicular lymph without affecting inhibin levels in rete testis fluid. Nevertheless, increased flow of testicular lymph more than compensated for the transient fall in irINH-alpha concentration so that, overall, the total output of inhibin via the testicular lymphatic duct system (and the vascular system) increased significantly. No persistent or significant changes were observed in the flow rate of rete testis fluid or concentration of irINH-alpha in the fluid after administration of FSH. The time frame for the response of the testis to FSH is indicative of the involvement of a mediator. Electrophoretic analysis of serially collected testicular lymph samples consistently revealed an FSH-induced release of a series of proteins in the M(r) range of 30,000-32,000.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Chemoprophylaxis against malaria in Papua New Guinea: a trial of amodiaquine and a combination of dapsone and pyrimethamine.

A placebo-controlled chemoprophylaxis trial was carried out in 1980 in 318 semi-immune school children in the Madang area of Papua New Guinea, where there was a high prevalence of strains of Plasmodium falciparum resistant to 4-aminoquinolines. Since prophylaxis with amodiaquine at 5 mg/kg weekly had failed, amodiaquine at a dose of 10mg/kg weekly and Maloprim (half a tablet or one tablet depending on body weight, which gave ranges of dapsone of 1.7-3.3mg/kg and pyrimethamine 0.2-0.4 mg/kg) weekly were tried. Neither regimen was completely successful in preventing parasitaemia, though after 13 weeks of prophylaxis the slide positivity rate was 16% for the amodiaquine group and 2% for the Maloprim group, which was in each case significantly lower than the normal baseline rate in the controls of 42%. Amodiaquine was completely successful in suppressing Plasmodium vivax infections. Breakthrough parasitaemia occurred, with either P. falciparum or P. vivax, in 5% of subjects on Maloprim at some time during the 13-week period of prophylaxis. Significantly more children in both the amodiaquine and Maloprim groups than in the placebo group showed a reduction in spleen size. All groups showed an unexplained fall in haemoglobin level over the study period but the fall was significantly less in both the prophylaxis groups. There was no adverse effect on white cell counts by either drug regimen. Chemoprophylaxis as a component of an integrated malaria control program should not be overlooked, provided that compliance can be maintained. However, in this particular case the principal purpose of the study had been to evaluate the proposed chemoprophylactic regimens in school children before embarking on an intervention study in young children. As a result of this study it was decided not to go ahead with the chemoprophylactic intervention in young children but to adopt an approach based on early presumptive treatment.

Antimalarials↗
PubMed1991

Prognosis of depression in the elderly.

Fifty-six consecutively admitted elderly (65 and over) patients with depression were assessed on mental, physical and social states. They were followed up and assessed at home one year later. A group of 24 depressed in-patients aged under 65 years admitted to the same ward during the same period was also assessed. Outcome was different for the two groups, with 68% of the elderly 'well' at one year, against 50% of the younger group. The younger group were more likely to have 'poor' outcome (41%) than the elderly (16%). However, there were more deaths than expected, particularly in the elderly. These findings differ from some previous studies, and indicate an excellent prognosis for depression in the elderly. Outcome in younger patients is less good.

Adult↗
PubMed1990

Slow euthanasia? The deaths of psychogeriatric patients.

Psychogeriatric services reach out to people who are suffering from psychiatric disorders which may persist until death and may bring forward death. It has been suggested that these services should aim at avoiding admitting patients for hospital care whose lives may be ended by the upset of admission or prolonged by inappropriate nursing and medical interventions. A review of the characteristics of patients dying during one year while under the care of a psychogeriatric service showed that one in three died as a psychogeriatric inpatient, the remainder dying at home or as inpatients in a general hospital. Those dying as psychogeriatric inpatients differed in their clinical and social characteristics from those dying elsewhere and it seemed unlikely that they could have been cared for humanely without the resources of the hospital ward. Psychogeriatric practice has many similarities to the work of hospices with other terminally ill patients, but the duration of the terminal illness and the needs arising from it are often more prolonged. Probably the management of dying among psychogeriatric patients will be improved if lessons learnt from other hospice practices are adopted.

Aged↗