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Biomedical subjects

D Stephens

Publications and source records attributed to D Stephens.

At least 109 records · Page 6Linked to original sources
PubMed1996

Hearing impairment: special needs of the elderly.

Within this paper we have considered some of the particular disabilities and handicaps commonly experienced by elderly hearing-impaired people as compared with younger individuals. We examined their ratings of their disability and handicap and found that both disability and handicap increased more rapidly with increasing hearing loss in younger than in older patients. We have finally considered the strategies used by older people to cope with hearing loss and found them more likely to withdraw from difficult listening situations or to interrupt the speaker, but less likely to position themselves to hear better.

Aged↗
PubMed1996

Determinants of speech-hearing disability in King-Kopetzky syndrome.

King-Kopetzky syndrome is characterized by auditory disability with a clinically normal hearing threshold. The main reported disability is hearing speech in the presence of background noise. The degrees of speech-hearing disability in patients with King-Kopetzky syndrome have been investigated with the use of the Social Hearing Handicap Index (SHHI), and the relationships between the SHHI scores and a number of physiological, psychoacoustical and psychological factors determined in 109 patients. The significantly higher (worse) SHHI scores in patients with King-Kopetzky syndrome indicate that this group suffer a considerable degree of speech-hearing disability. In our study, the main findings are that some psychological factors, performance of the sentence in noise test and auditory thresholds are significantly correlated with the SHHI scores. We were unable to find any relationships between the SHHI and frequency resolution or EOAEs. In a multiple stepwise regression, somatic anxiety and the performance of the sentence in noise test are the significant predictors of SHHI scores. These two variables appear to be the main determinants of speech-hearing disability in King-Kopetzky syndrome.

Adolescent↗
PubMed1996

Hearing complaints of patients with King-Kopetzky syndrome (obscure auditory dysfunction).

The hearing complaints in patients with King-Kopetzky syndrome were studied by use of the open-ended hearing problem questionnaire. The main findings are that complaints were commonly focused on the categories of 'live speech' and 'electronic speech' difficulties in patients with King-Kopetzky syndrome, particularly the auditory difficulties of speech in noise and group conversation. However, they reported problems with warning signals significantly less frequently than a control 'audiological rehabilitation' group and the patients studied by Barcham and Stephens (1980). In addition, main psychological problems were related to anxiety (e.g. irritability, nervousness and moodiness) in patients with King-Kopetzky syndrome. The open-ended hearing problem questionnaire appears to be a useful tool that can be used to high-light the speech hearing disability encountered by patients with King-Kopetzky syndrome.

Adolescent↗
PubMed1996

Reported benefits and problems experienced with bone-anchored hearing aids.

Within this study we have examined the self-reported benefits and shortcomings experienced by patients fitted with bone-anchored hearing aids using an open-ended approach developed for hearing aid users. Reports were obtained from 39 patients who, between them, listed 165 benefits and 105 shortcomings. Benefits and shortcomings could be sub-divided into four main groups: practical, acoustical, psychological and medical, in that order of frequency. The most commonly reported benefits included hearing better and clearer, ease of use, inconspicuousness, and the fact that it made the individual more confident. The main shortcomings were difficulties with the telephone, wind noise and hearing speech in noise.

Acoustics↗
PubMed1996

Hearing rehabilitation in a psychosocial framework.

This paper is primarily concerned with handicap, which emphasises the psychosocial consequence of hearing loss, its development and a framework for its alleviation. The development of handicap is considered, taking as a starting point the World Health Organization Definitions of disablements and their application to audiology by Stephens and Hétu (1991). This is extended in the light of recent work on the role of significant others and of positive experiences arising from the hearing loss. This approach is then incorporated into an update of the Goldstein/Stephens (1981) management model of audiological rehabilitation which provides a framework applicable in any sociomedical situation.

Adaptation, Psychological↗
PubMed1995

Reported use of strategies by surgeons to prevent transmission of bloodborne diseases.

OBJECTIVE: To determine how often surgeons use strategies to prevent the transmission of bloodborne diseases and what factors are associated with the use of these strategies. DESIGN: Cross-sectional mail survey. SETTING: Secondary and tertiary care teaching hospitals affiliated with the University of Toronto. PARTICIPANTS: Of 539 active surgical staff and residents who were eligible, 503 (93.3%) responded. OUTCOME MEASURES: Current preventive practices, attitudes toward transmission of bloodborne diseases, perceived risk of infection and willingness to adopt preventive strategies. RESULTS: On average, surgeons reported using double- or triple-gloving in 32.2% of procedures, facial protection (including regular corrective eyewear) in 74.2% and goggles or face shields in 19.4%. Use of strategies to prevent sharp injuries, in addition to barrier precautions, was reported by 259 (51.5%) of the respondents. Factors associated with greater use of preventive strategies included resident position, subspecialty, greater number of years in surgical practice and a high perceived risk. Most of the respondents thought that patients should be routinely screened for HIV antibodies before surgery (68.2% [343/503]), that there was too little research into ways to reduce the risk of transmission of bloodborne diseases (55.3% [278/503]) and that there was too little effort on the part of organizations to reduce the risk of transmission (58.8% [296/503]). The perceived lifetime risk was reported to be moderate or high by 191 (38.0%) of the respondents and low or insignificant by 308 (61.2%). In all, 463 (92.0%) indicated a willingness to change the way they performed surgery to prevent transmission of bloodborne diseases. CONCLUSION: Surgeons expressed varying degrees of concern about the transmission of bloodborne diseases and reported infrequent use of preventive strategies. Efforts to reduce the risk of transmission between patients and surgeons will need to include informing surgeons of their personal risk and the availability of preventive strategies, improving the comfort of barrier precautions and minimizing how preventive strategies interfere with surgery.

Adult↗
PubMed1995

Testing models predicting severity of respiratory syncytial virus infection on the PICNIC RSV database. Pediatric Investigators Collaborative Network on Infections in Canada.

OBJECTIVES: To determine the sensitivity and specificity of published prognostic models to predict morbidity resulting from lower respiratory tract disease caused by respiratory syncytial virus in an independent pediatric population and to assess the accuracy of single risk factors in predicting adverse outcome. DESIGN: All articles obtained from a MEDLINE search that used the terms prognosis or sequelae and respiratory syncytial virus, and from the references of these articles, were reviewed. Studies were included if risk factors and outcomes were defined and if information was available in a database of prospectively enrolled patients with respiratory syncytial virus infections. A probability of adverse outcome was assigned to each patient in the cohort using prognostic models described in the articles. A test was considered positive if the probability of the adverse outcome was 5% or more. PATIENTS: Six hundred eighty-nine patients hospitalized with respiratory syncytial virus in seven tertiary care centers across Canada were prospectively enrolled in the Pediatric Investigators Collaborative Network on Infections in Canada database. MAIN OUTCOME MEASURES: The sensitivity and specificity of single predictors and of models in predicting severe disease were determined. RESULTS: The sensitivity of single predictors varied from 17% to 46%. A model that used age and oxygen saturation at admission in previously well infants had a sensitivity of 98% and a specificity of 47% when predicting intensive care unit admission. Another model that included age at hospitalization, gestational age, presence of an underlying condition, and respiratory syncytial virus subtype used to predict the outcome of a high severity index had a sensitivity of 77% and a specificity of 76%. When the above model was modified by exclusion of viral subgroup, sensitivity increased to 94%, but specificity decreased to 46%. CONCLUSION: Previously described prognostic models were generalizable to an independent study population.

Canada↗
PubMed1995

Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection.

OBJECTIVE: To provide information on disease attributable to respiratory syncytial viral lower respiratory tract infection (RSV LRI) and to quantify the morbidity associated with various risk factors. DESIGN: Prospective cohort study. SUBJECTS: Patients hospitalized with RSV LRIs at seven centers were eligible for study if they were younger than 2 years of age, or hospitalized patients of any age if they had underlying cardiac or pulmonary disease or immunosuppression. MEASUREMENTS AND RESULTS: Enrolled (n = 689) and eligible but not enrolled (n = 191) patients were similar in age, duration of illness and proportion with underlying illness, use of intensive care, and ventilation. Of the enrolled patients, 156 had underlying illness. The isolates from 353 patients were typeable: 102 isolates were subgroup A, 250 were subgroup B, and one isolated grouped with both antisera. The mean hospital stay attributable to respiratory syncytial virus (RSV) was 7 days; 110 patients were admitted to intensive care units, 63 were supported by mechanical ventilation, and 6 patients died. Regression models were developed for the prediction of three outcomes: RSV-associated hospital duration, intensive care unit admission, and ventilation treatment. In addition to previously described risk factors for an increased morbidity, such as underlying illness, hypoxia, prematurity and young age, three other factors were found to be significantly associated with complicated hospitalization: aboriginal race (defined by maternal race), a history of apnea or respiratory arrest during the acute illness before hospitalization, and pulmonary consolidation as shown on the chest radiograph obtained at admission. The RSV subgroup, family income, and day care attendance were not significantly associated with these outcomes. CONCLUSIONS: Hypoxia on admission, a history of apnea or respiratory arrest, and pulmonary consolidation should be considered in the management of children with RSV LRIs. Vaccine trials should target patients with underlying heart or lung disease or of aboriginal race.

Antigens, Viral↗
PubMed1995

Effects of hearing impairment on the patient's family and friends.

A modified version of the Problems Questionnaire was administered to significant others, (SOs) usually spouses, of patients attending audiological rehabilitation clinics. The SOs were asked to list the problems they experienced because of the patient's hearing loss. They were also asked to list the problems the patient was experiencing. In addition the patients were asked to list the problems they experienced and those encountered by their SOs. SO problems concentrated more on difficulties with live speech and psychosocial problems compared with those listed by patients. They also featured more responses indicating dependence. The latter were found particularly among the SOs of male patients whose SOs also emphasised the need to repeat phrases. The SOs of female patients emphasised psychosocial problems.

Adolescent↗
PubMed1995

Assessment of the Vital Signs Quality of Life Questionnaire in three studies on hypertension.

The Vital Signs Quality of Life Questionnaire is a patient survey developed to assess the effects of treatment on 25 variables associated with a sense of well-being and perceptions of general health, mental functioning and social performance. Data collected from this questionnaire in three studies on hypertension were analysed and are presented here. In study 1, low-dose verapamil significantly reduced office and ambulatory diastolic (DBP) and systolic (SBP) blood pressure (P < 0.01) in patients with mild hypertension. In study 2, verapamil and nifedipine significantly and similarly reduced office DBP and SBP in patients with mild to moderate hypertension. In study 3, significantly greater reductions in ambulatory DBP and SBP were observed with verapamil compared with placebo (P < 0.01) in elderly patients with mild to moderate hypertension. Reported adverse experiences were not different from those known to be associated with the study drugs. There was significant improvement in the intensity of quality of life (QOL) variables (P = 0.03) and in the total (sum of frequency and intensity) QOL score (P = 0.02) following treatment in study 1. In study 2, there were no significant changes in QOL scores following treatment with either verapamil or nifedipine. In study 3, QOL scores remained statistically unchanged for both treatment groups; however, there was a trend toward improvement with verapamil and worsening with pacebo. Taken together, the data show no negative effects of verapamil on QOL, even though verapamil demonstrated significant anti-hypertensive effectiveness. The questionnaire displayed a high level reliability, as measured by Cronbach's alpha (0.91 for both frequency and intensity).

Adult↗
PubMed1995

Agreement between professions on ethical decisions: an empirical demonstration.

The decisions of a multidisciplinary competency panel at the Baycrest Centre for Geriatric Care, Toronto, Canada, were studied to try to explain the high level of agreement on individual cases when determining mental capacity. The panel assessed its own judgments on a standardized form developed to capture the process of coming to a capacity determination. Though the relative weights given to decision-making variables varied with discipline, there was agreement on a group of criteria most relevant to capacity. Three alternative explanations are given for these results.

Aged↗
PubMed1995

How should excess admission laboratory test utilization be curtailed? --paediatricians' preferences.

Routine admission casefinding tests are costly and rarely lead to changes in management. Strategies have been proposed to decrease them. However, it is unclear which tests are considered routine at admission. Our objectives were to clarify which tests are considered to be routine and to determine which methods of reducing test utilization are most acceptable. Sixty-five physicians from a paediatric teaching hospital were selected by random stratified sampling. A questionnaire was administered asking about the role of routine tests and preferences for 6 strategies to reduce test ordering. Sixty percent of respondents felt that more casefinding was occurring than should be, and 89% would agree to a trial of test reduction strategies. Just over half the respondents felt that hemoglobin determination and urinalysis were routine admission tests; fewer physicians listed a wide variety of other tests. Physicians who thought that all admissions should be screened were older, graduated earlier, and tended to be community based. Educational strategies to reduce testing were more acceptable than administrative ones. We conclude that many physicians would support the trial implementation of test reduction strategies in childrens' hospitals. Hospitals wishing to reduce excess admission casefinding should implement educational strategies, as physicians prefer these.

Child↗
PubMed1994

Age-related changes in oxygen saturation over the first year of life: a longitudinal study.

Stability of oxygen saturation depends on maturation and function of individual components of the respiratory system. The aim of this study was to record and analyse comprehensive oxygen saturation data in a longitudinal study over the first year of life. Detailed sleep studies were performed on 15 normal infants eight times in the first year of life. The accrued oxygen saturation data were analysed on a computerized oximetry data analysis system. Results show the mean sleep saturation levels trending upwards and stabilizing by 185 days. There was an inverse curvilinear relationship between mean age and median desaturation time and the median number of desaturations at < or = 95, < or = 92 and < or = 90% saturation. The mean cumulative desaturation time < or = 90% in the first 4 months was 11.08 min (range 2.5-36.57 min). This study demonstrates monotonic patterns of increasing saturation and decreasing number and time of desaturations < or = 95% and < or = 90% but a random pattern of desaturations < or = 85% occurs across the first 6 months of life. Cumulative desaturation times over the first 4 months of life were high and could be important to the development of maturity of the respiratory system. After 6 months, all indices of saturation and desaturation point to a stable and mature respiratory system.

Aging↗
PubMed1994

Screening for hearing loss in an at-risk neonatal population using evoked otoacoustic emissions.

The present study examines the performance of a transient evoked otoacoustic emissions hearing screening programme for neonates with risk factors for hearing loss. The programme has run for 5 years, and 772 babies with various risk factors have been screened using the Programmable Otoacoustic Emissions Measurement System (POEMS) designed by the Medical Research Council Institute of Hearing Research. Fourteen cases of significant hearing loss have been detected, with no false negative results. However, a very high false positive rate is reported, especially in babies with a birthweight of less than 1500 g.

Cochlea↗
PubMed1993

Cell-type-specific transactivation of the parathyroid hormone-related protein gene promoter by the human T-cell leukemia virus type I (HTLV-I) tax and HTLV-II tax proteins.

The human T-cell leukemia virus type I (HTLV-I) and HTLV-II Tax proteins are potent transactivators of viral and cellular gene expression. Using deletion mutants, the downstream parathyroid hormone-related protein (PTHrP) promoter is shown to be responsive to both HTLV-I and HTLV-II Tax as well as the AP1/c-jun proto-oncogene. Transactivation of PTHrP by Tax was seen in T cells but not in B-cell lines or fibroblasts. A carboxy terminal Tax deletion mutant was deficient in transactivation of both the PTHrP and IL2R alpha promoters but not the HTLV-I long terminal repeat (LTR). Exogenous provision of NFkB rescued IL2R alpha expression but not the PTHrP promoter. Thus, HTLV-I Tax, HTLV-II Tax, and c-jun transactivate PTHrP and may contribute to the pathogenesis of hypercalcemia in adult T-cell leukemia.

Animals↗
PubMed1993

Some traditional treatments of hearing problems in Brittany and Wales.

The traditions of the healing of deafness associated with the Celtic saints in Brittany and Wales are discussed. Many more have survived in Brittany because of the religious continuity in that country. Three Saints Cadoc (of Welsh origin), Egarec (of Irish origin) and Meriadec (of Breton origin) are associated with such traditions in a number of different locations.

France↗