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Biomedical subjects

D Nicholls

Publications and source records attributed to D Nicholls.

At least 19 recordsLinked to original sources
PubMed2006

Family-based behavioural treatment of obesity: acceptability and effectiveness in the UK.

OBJECTIVE: To assess the acceptability and impact of family-based behavioural treatment (FBBT) for childhood obesity in a clinical setting in the UK. DESIGN: Pre- and post-treatment assessment for four consecutive treatment groups. SETTING: Treatment groups took place at Great Ormond Street Hospital, London. PATIENTS: Participants were 33 families with obese (BMI >or=98th centile for age and sex) children aged 8-13 years. INTERVENTION: FBBT was delivered over 12 sessions. MAIN OUTCOME MEASURES: Overweight (percentage BMI), self-esteem, mood and eating attitudes were assessed before and after treatment; overweight was re-assessed at 3-month follow-up for those who completed treatment. RESULTS: The FBBT programme materials translated easily to the UK setting and the programme was well-liked by participants. Twenty-seven out of 33 families (82%) completed the sessions. Children lost 8.4% BMI over the time of treatment, and this was maintained at 3-month follow-up. Self-esteem and depression improved significantly and there was no change in food pre-occupation, anorexia or bulimia on the ChEAT. CONCLUSIONS: These results establish that FBBT is feasible and acceptable in a clinical setting in Britain. They indicate that significant loss of overweight can be achieved using the programme without adverse psychological consequences.

Adolescent↗
PubMed2005

Managing obesity in secondary care: a personal practice.

Obesity is becoming a common clinical headache for child health professionals, as the increase in professional and media concern has not been matched by effective clinical solutions. Added to this is considerable confusion about both the definitions of obesity and about which groups of children and adolescents actually require treatment. Little guidance exists for paediatricians and other child health specialists on the assessment and management of child and adolescent obesity. Guidelines produced by the American Academy of Pediatrics (AAP) are useful, but require modification for non-American clinical practice. In the UK, the Royal College of Paediatrics and Child Health has recently issued excellent brief guidance on managing obesity in primary care, as has the Scottish Intercollegiate Guidelines Network.

Adolescent↗
PubMed2004

Validation of the Dutch Eating Behaviour Questionnaire parent version (DEBQ-P) in the Italian population: a screening tool to detect differences in eating behaviour among obese, overweight and normal-weight preadolescents.

OBJECTIVE: To validate the Dutch Eating Behaviour Questionnaire Parent version (DEBQ-P) in the Italian population and investigate the differences in eating behaviour among Italian normal-weight, overweight and obese preadolescents. DESIGN: A cross-sectional validation study. Participants were measured and the approved translation of the questionnaire was administered to their parents. SETTING: : Three school communities in the province of Bergamo, Northern Italy. SUBJECTS: A total of 312 preadolescents (mean age 12.9 y; s.d. 0.8, both sexes) from three secondary schools of the province of Bergamo, Northern Italy, and their parents were invited to participate to the study. Informed written consent was obtained from each subject and their parents. Students were measured and their parents filled in the approved translation of the DEBQ-P. Recruitment was opportunistic and school based. RESULTS: Factor and internal consistency analysis confirmed the factor structure of the DEBQ-P and the high internal consistency of its three scales. Variance analysis showed that eating behaviour of Italian normal-weight, overweight and obese preadolescents differs significantly only in regards to the 'restrained eating' scale (F 19.29, P < 0.001), with overweight and obese scoring higher. CONCLUSIONS: The DEBQ-P can be used for screening projects regarding eating behaviour in the Italian population. The association between restrained eating and weight status was confirmed for both sexes, but the relationship between external eating and emotional overeating and overweight requires further exploration.

Adolescent↗
PubMed2002

Ciclopiroxolamine cream for treating seborrheic dermatitis: a double-blind parallel group comparison.

BACKGROUND: The aim of this study was to compare the efficacy and tolerability of topically applied ciclopiroxolamine cream with that of the corresponding vehicle in patients with seborrheic dermatitis of the face. PATIENTS AND METHODS: The study was conducted as a multicenter prospective, randomized, double-blind parallel group comparison at 14 centers in Australia and New Zealand. 189 patients with clinically diagnosed seborrheic dermatitis participated in the study. Each patient applied ciclopiroxolamine 1% cream or the corresponding vehicle twice daily as a thin film to the affected skin areas and to clinically unaffected skin areas surrounding the lesions for 29 days. RESULTS: The rate of treatment success was significantly higher with ciclopiroxolamine than with vehicle (73.9 vs 53.6%; p = 0.003). Treatment with ciclopiroxolamine reduced the sum score of the clinical signs of seborrheic dermatitis to a greater extent than the vehicle (p </= 0.001). CONCLUSION: This study confirms that topical treatment with ciclopiroxolamine is effective and well tolerated in patients with seborrheic dermatitis.

Adult↗
PubMed2002

Body composition in early onset eating disorders.

BACKGROUND: Body mass index (BMI) or equivalent weight for height indices are the most widely used measures of body composition in early onset and adolescent eating disorders. Although of value as screening instruments the limitation in disease states is their inability to discriminate fat and fat-free components of body weight. OBJECTIVE: To compare height-adjusted fat and fat-free components of body composition in children and young adolescents with different types of eating disorders with those of age matched reference children. DESIGN: Weight, height, triceps and subscapular skinfold thickness were measured in 172 children (aged 7-16 y) with eating disorders receiving specialist treatment. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated using Slaughter's and Deurenberg's equations and normalisation for height. Using data from 157 normal children, representative of the UK 1990 growth reference data, reference curves for FMI and FFMI+/-2 s.d. were derived. Results for patient groups were superimposed on these reference curves. RESULTS: FMI and FFMI were both reduced in eating disorders associated with malnutrition, including anorexia nervosa (AN). AN subjects did not differ from other subjects with comparable degrees of malnutrition. Children with eating disorders of normal weight, such as bulimia nervosa and selective eating, did not differ significantly from reference children in their relative FM and FFM. CONCLUSIONS: FM and FFM merit independent consideration in disorders of malnutrition in children, rather than expressing data as percentage body fat or percentage BMI. The implications of loss of FFM on growth and development merit further investigation.

Adipose Tissue↗
PubMed2001

Takayasu arteritis and atherosclerosis: illustrating the consequences of endothelial damage.

The excess of cardiovascular morbidity associated with chronic vasculitic disease has become a focus of considerable research, particularly regarding the link between endothelial damage and the development of atherosclerosis. We describe a case of Takayasu arteritis treated sub-optimally by today's standards, giving rise to an 11 year history of progressive, stepwise decline associated with cerebrovascular events and leading to early death. Postmortem findings presented a picture of chronic atherosclerotic disease but in a distribution consistent with lesions of Takayasu arteritis.

Aorta↗
PubMed2000

Children into DSM don't go: a comparison of classification systems for eating disorders in childhood and early adolescence.

OBJECTIVE: To evaluate the reliability of diagnostic classification systems for eating disorders when applied to children and young adolescents. METHOD: Eighty-one patients were randomly selected from a population of 226 children (age 7-16) presenting with eating difficulties to a specialist clinic. Diagnoses were assigned according to three classification systems: the 10th edition of the International Classification of Diseases (ICD 10), the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and Great Ormond Street (GOS) criteria. Ratings were performed by two clinicians blind to the diagnosis of the other. RESULTS: Interrater reliability values (kappa) for the three systems were 0.357 (ICD 10), 0.636 (DSM-IV), and 0.879 (GOS). Using DSM criteria, more than 50% of children were classified as eating disorder not otherwise classified (EDNOS) or could not be classified. DISCUSSION: DSM-IV and ICD 10 criteria are of little value in the classification of the eating difficulties of children. The GOS criteria, which were developed for this age range, are more reliable. The classification of eating disorders in childhood needs reevaluation.

Adolescent↗
PubMed1998

A pilot study of needs assessment in acute psychiatric inpatients.

The needs of acute psychiatric patients have been less studied than those of long-term patients. A pilot study of needs assessment using the MRC Needs for Care Assessment Schedule is reported in 35 consecutive acute inpatients who had been in hospital for 1 month or more. Unmet clinical needs included treatment of drug side effects and dangerous and socially embarrassing behaviour. Unmet social needs were widespread and included household shopping, cooking meals, occupation and money management. Although the MRC Needs for Care Assessment was found unsuitable for assessing needs in very acutely ill patients whose mental status was rapidly changing, we did find it a useful instrument in more stable acute patients, both on an individual basis and for identifying service underprovision.

Acute Disease↗
PubMed1998

Transcription pattern of a FIM homologue in Impatiens during floral development and reversion.

Flowering and reversion in Impatiens are characterised by gradual transitions of organ identity and constitute a unique system for the molecular and physiological study of floral organogenesis. The authors have isolated an Impatiens homologue of the FIM gene of Antirrhinum (UFO in Arabidopsis), Imp-FIM, and analysed its expression in three states of the terminal meristem: vegetative, floral, and reverted. In floral meristems, Imp-FIM transcription is associated with petal identity, as in Antirrhinum and Arabidopsis, but this is achieved through a novel transcription pattern, characterised by a high level of transcript within petal primordia. This novel transcription pattern could contribute to the more diffuse boundaries between organ types in Impatiens. In vegetative meristems, Imp-FIM is expressed in the axils of leaf primordia which are arranged in a spiral. A similar pattern is observed in reverted meristems in which leaf primordia are initiated in a whorled arrangement. This result indicates that the maintenance of floral phyllotaxis is not associated with a specific pattern of Imp-FIM transcription. Transcription of Imp-FIM in a non-reverting line is no different from that in the reverting line. Therefore, the lack of floral commitment in the reverting line does not seem to be responsible for Imp-FIM transcription within petals. The novel transcription pattern in petals, together with features of Impatiens that are reminiscent of fim and ufo mutant phenotypes suggest an evolutionary divergence for Imp-FIM regulation in this species.

Amino Acid Sequence↗
PubMed1997

A study of general practitioners' skin surgery in Canterbury.

AIMS: To evaluate skin surgery done by general practitioners in Christchurch. METHODS: Twenty-eight general practitioners performing regular skin surgery were studied. Their clinical accuracy and completeness of excision was analysed. Skin lesions referred for specialist treatment were also studied. RESULTS: Three hundred and three lesions were sent to the laboratory for analysis by participating practitioners. Sixty-one malignancies were present comprising 29 basal cell carcinomas, 28 squamous cell carcinomas, three malignant melanomas and one cutaneous lymphoma. Nineteen of the 61 malignant lesions were incompletely excised. Twenty eight further lesions were referred to specialists for treatment. CONCLUSIONS: General practitioners in Canterbury perform more skin surgery and remove more malignant lesions than their British counterparts. Although the adequacy of their skin surgery is better than other groups studied overseas there is considerable room for improvement.

Basal Cell Carcinoma↗
PubMed1997

The development of Ca2+ channel responses and their coupling to exocytosis in cultured cerebellar granule cells.

Using single-cell imaging, we investigated developmental changes in the modulation of KCl-evoked Ca2+ entry by various voltage-dependent Ca2+ channels and the coupling of these channels to exocytosis in cultured cerebellar granule neurons. A component of the KCl-evoked Ca2+ elevation sensitive to nifedipine and localized at cell somata, decreases with culture age. A component blocked by 200 nM omega-Agatoxin-IVA increases with age and whilst localized primarily at the cell somata, also becomes evident at the neurites. The change in activity between nifedipine-sensitive Ca2+ channels and omega-Agatoxin-IVA-sensitive Ca2+ channels occurs at 13 days in vitro at cell somata. A component of Ca2+ entry insensitive to nifedipine and 200 nM omega-Agatoxin-IVA is localized primarily at the neurites and is apparent at all ages. Single-cell imaging of exocytosis using FM1-43 destaining indicates that the residual, but not the nifedipine- or omega-Agatoxin-IVA-sensitive components of Ca2+ entry, modulates exocytosis. However cells cultured for 20-26 days develop a component of Ca2+ entry at the neurites which is sensitive to 200 nM omega-Agatoxin-IVA and omega-Conotoxin-MVIIC and which partially controls release. Immunolocalization studies reveal that binding sites for omega-Conotoxin-GVIA are present throughout development, even though this toxin does not inhibit KCl-evoked [Ca2+]c elevations or exocytosis. 300 nM omega-Agatoxin-IVA labels both somata and, at later developmental stages, neurites, consistent with the functional studies.

Animals↗
PubMed1997

The induction and maintenance of flowering in Impatiens.

The mechanisms that establish the floral meristem are now becoming clearer, but the way in which flowering is maintained is less well understood. Impatiens balsamina provides a unique opportunity to address this question because reversion to vegetative growth can be obtained in a predictable way by transferring plants from inductive to non-inductive conditions. Following increasing amounts of induction, reversion takes place at progressively later stages of flower development. Partial flower induction and defoliation experiments show that a floral signal is produced in the cotyledon in response to inductive conditions and that this signal progressively diminishes after transfer to non-inductive conditions, during reversion. Therefore reversion in Impatiens is most likely due to the failure of leaves to become permanent sources of inductive signal in addition to the lack of meristem commitment to flowering. Analysis of the expression of the Impatiens homologues of the meristem identity genes floricaula and squamosa indicates that a change in floricaula transcription is not associated with the establishment or maintenance of the floral meristem in this species. Squamosa transcription is associated with floral development and petal initiation, and is maintained in existing petal or petaloid primordia even after the meristem has reverted. However, it is not expressed in the reverted meristem, in which leaves are initiated in whorled phyllotaxis and without axillary meristems, both characteristics usually associated with the floral meristem. These observations show that squamosa expression is not needed for the maintenance of these floral characters. The requirement for the production of the floral signal in the leaf during the process of flower development may reflect an additional function separate to that of squamosa activation; alternatively the signal may be required to ensure continued transcriptional activation in the meristem.

Amino Acid Sequence↗
PubMed1996

The incidence of deep venous thrombosis after laparoscopic cholecystectomy.

OBJECTIVE: To determine the incidence of deep venous thrombosis (DVT) after laparoscopic cholecystectomy. DESIGN: Prospective cross-sectional analysis, with a one-month follow-up, conducted in 1994. SETTING: University teaching hospital. SUBJECTS: 20 patients undergoing elective or urgent laparoscopic cholecystectomy, consecutively recruited. INTERVENTIONS: Patients received thromboprophylaxis according to the normal practice of the attending surgeon and underwent laparoscopic cholecystectomy. A venous duplex scan was performed before the operation and on Day 1, 7 and 30 after the operation. MAIN OUTCOME MEASURE: The presence of postoperative DVT. RESULTS: All patients were given graduated compression stockings to wear and 16 received electrical stimulation of the calf during the operation. Only 16 patients received pharmacological thromboprophylaxis before the operation, but all patients received this after the operation. The median duration of pneumoperitoneum was 80 minutes (40-160 minutes). Eleven of 19 patients completing all the required scans developed venous thrombosis (incidence, 55%); in three the thromboses involved major axial veins. In one patient the Day 7 and Day 30 scans were not performed, but the Day 1 scan was negative. Seven of the 11 thromboses were detected on the Day 1 scan. None of the DVTs were suspected clinically. CONCLUSIONS: This extremely high incidence of venous thrombosis correlates with the haemodynamic changes which occur in the venous system during pneumoperitoneum. Laparoscopic cholecystectomy should not be considered a procedure with a low risk of DVT, and further studies are needed to determine optimal DVT prophylaxis for laparoscopic surgery.

Adult↗