Safety and the place of birth.
Explore the source record for details and available documents.
Attitude of Health Personnel↗
Biomedical subjects
G Young
Publications and source records attributed to G Young.
Diabetes care in general practice: an approach to audit of process and outcome.
As a chronic condition in which the major adverse outcomes only occur after many years, diabetes poses special problems for continuing medical audit. The feasibility of continuous audit of process and outcome in diabetes care has been tested in four general practices with organized diabetes care in Newcastle upon Tyne. For all patients with previously diagnosed non-insulin dependent diabetes, the data already collected according to published protocols were assembled into a single database. The time and resource costs of this exercise, together with measures of process, complications, risk factors, and metabolic outcomes were analysed. Data were successfully collected at minimal cost where structured records were completed. Recommended processes had been completed in a high percentage of patients, adverse patient outcomes were limited, and metabolic output measures not unsatisfactory. Nevertheless, attention has been directed to areas where care could be improved. Continuing diabetes audit in primary health care is feasible and helpful, and can use the same measures as in the hospital setting.
Aged↗
How general practitioners can help subfertile couples.
Explore the source record for details and available documents.
Family Practice↗
Acute-phase proteins in patients with head and neck cancer treated with interleukin 2/interferon alfa.
Circulating acute-phase proteins may mediate adverse reactions in patients receiving biologic response modifiers, including inhibition of immune responsiveness and clinical toxic effects. Nine patients with unresectable head and neck squamous cell carcinoma were prospectively examined for levels of acute-phase proteins during interleukin 2/interferon alfa immunotherapy and for clinical toxic effects. Simultaneous determination of the in vitro immunomodulatory capacity of autologous serum on the induction of lymphokine-activated killer cells was assessed in 4-hour chromium release assays. Of the seven acute-phase proteins analyzed, haptoglobin and C-reactive protein levels were elevated before therapy was started. Toxic events leading to cessation of interleukin 2/interferon alfa therapy had a high correlation with elevated C-reactive protein and lowered C3 component of complement levels. No relationship was noted between serum levels of acute-phase proteins and induction inhibition of lymphokine-activated killer cell cytotoxicity. The role of C-reactive protein and complement degradation products in mediating interleukin 2/interferon alfa toxicity requires further investigation.
Acute-Phase Proteins↗
Mechanical properties of the aneurysmal aorta.
The mechanical properties of the abdominal aorta were investigated non-invasively in 30 patients with aortic aneurysm and 11 with peripheral arterial disease. The distensibility of the aorta was measured using M-mode ultrasonography, permitting non-invasive assessment of the pressure--strain elastic modulus or aortic stiffness, Ep. The median Ep value increased from 4.0 N/cm2 in control subjects in their third decade of life (n = 10) to 10.4 N/cm2 in middle age (n = 11) to 14.0 N/cm2 in the elderly (n = 13). In the presence of a normal diameter, peripheral arterial disease with aortic atherosclerosis had little effect on aortic stiffness, median Ep being 16.0 N/cm2. Aneurysmal dilatation was associated with a significant increase in aortic stiffness, median Ep being 31.3 N/cm2 (P < 0.001). For aortas of normal diameter, Ep was at all ages dependent on mean arterial pressure. In patients with aortic aneurysms there was no clear relationship between Ep and mean arterial pressure or aortic diameter. Of the patients studied, 15 underwent aortic reconstruction; increasing aortic stiffness (log Ep) was associated with a decreased medial elastin content of the aortic biopsy (r = -0.63, P < 0.02). This study demonstrates the marked stiffness or inelasticity of dilated or aneurysmal vessels, part of which is attributable to the loss of elastin.
Adult↗
Abbreviated injury scaling of head injury as a prognostic tool for functional outcome.
The use of Abbreviated Injury Scaling for the head region (HAIS) was evaluated as a prognostic index of functional outcome in 503 consecutive patients with severe injury to the brain who survived initial resuscitation. Although a strong statistical relationship between HAIS and outcome as measured by the Glasgow Outcome Scale was demonstrated, its clinical usefulness is limited. HAIS may be most useful as a classifier for comparative studies of populations and for the evaluation of therapeutic modalities.
Abbreviated Injury Scale↗
Stimulation of coho salmon growth by insulin-like growth factor I.
The effect of insulin-like growth factor I on growth rate of coho salmon (Oncorhynchus kisutch) was examined. Juvenile coho salmon received implants of osmotic minipumps containing recombinant bovine insulin-like growth factor I (rbIGF-I) or saline for a period of 3 to 4 weeks. High doses of rbIGF-I (greater than 0.13 microgram.g-1.d-1) resulted in hypoglycemia and death. In 2-year-old coho salmon, 0.09 microgram.g-1.d-1 rbIGF-I administered for 25 days doubled linear growth rate and increased growth rate in weight by 40%. In rapidly growing, 1-year-old coho salmon, growth rate was not altered by rbIGF-I at 0.01 or 0.05 micrograms.g-1.d-1 for 31 days. In ration-limited fish exhibiting slow growth in the control group, rbIGF-I (0.02 microgram.g-1.d-1) increased linear growth rate by up to threefold and growth rate in weight by up to fourfold. The results indicate that exogenous treatment with mammalian IGF-I can stimulate coho salmon growth under some conditions, and that endogenous IGF-I may be an important factor in regulating growth of teleosts.
Animals↗
Regulation of hepatic growth hormone receptors in coho salmon (Oncorhynchus kisutch).
Factors potentially regulating hepatic growth hormone (GH) receptors in coho salmon (Oncorhynchus kisutch) have been investigated. From December to June of the first year, relative changes in hepatic 125I-sGH binding and 35SO4 incorporation by ceratobranchial cartilage were similar. Stunted salmon, which in seawater have elevated plasma GH yet fail to grow, showed lower hepatic 125I-sGH binding than did normally growing seawater salmon. However, MgCl2 treatment of stunts' membranes to reveal total specific binding of 125I-sGH indicated receptor occupation by endogenous sGH. Total specific 125I-sGH binding was low in seawater stunts and remained low if these fish remained unfed after return to fresh water, but increased approximately twofold upon feeding. Total specific binding in fasted salmon in fresh water showed a trend toward decreased levels by 1 week; by 3 weeks, binding was 40% lower than in fed fish. There was a positive correlation (r = 0.600) between condition factor and total specific binding in fed and fasted salmon in fresh water. Two weeks after hypophysectomy total specific binding was 50% lower than in sham-operated control salmon, indicating pituitary regulation of GH receptors. GH treatment reduced both free and total 125I-sGH binding in salmon examined 24 hr after treatment. Treatment with recombinant bovine insulin-like growth factor I, thyroxine, or cortisol did not affect free 125I-sGH binding. Both the pituitary and nutrition appear to be prime regulators of hepatic GH receptors in coho salmon.
Analysis of Variance↗
Expression of activation antigens, HLA-DR and CD38, on CD8 lymphocytes during HIV-1 infection.
OBJECTIVE: To study the expression of the activation markers human leukocyte antigen (HLA)-DR and CD38 antigen on CD8+ T-lymphocytes in HIV-infected subjects and HIV-negative controls. DESIGN: Two- and three-colour flow-cytometric analysis. METHODS: Fresh peripheral venous blood was obtained from 16 HIV-infected subjects, representing four different stages of HIV disease, and from six HIV-negative controls. Three-colour lymphocyte immunophenotyping was performed using peridinyl chlorophyll-A protein (PerCP)-conjugated anti-CD8 monoclonal antibody (MAb) in combination with anti-HLA-DR (phycoerythrin) and anti-CD38 (fluorescein isothiocyanate) MAb. RESULTS: The relative percentage of the lymphocyte populations thus defined differed between HIV-negative and HIV-positive subjects and between HIV-infected subjects at different clinical stages of disease. Simultaneous expression of HLA-DR and CD38 within the CD8 T-lymphocyte compartment increased from 8% in controls to 49% in asymptomatic HIV-infected subjects (P less than 0.005). Symptomatic patients differed from asymptomatic seropositives by a further increase in the HLA-DR+ CD38+ CD8 subset. In AIDS patients, the HLA-DR+ CD38- CD8 subset decreased (P less than 0.05) and the HLA-DR- CD38+ CD8 subset increased (P less than 0.05), compared with the other HIV disease stage patients. CONCLUSION: There is a stage-associated pattern of HLA-DR and CD38 expression on CD8 T-lymphocytes during HIV infection; specific phenotypic patterns may have functional correlates in the host response to the virus.
ADP-ribosyl Cyclase↗
Detection of regulatory factors of lymphokine-activated killer cell activity in head and neck cancer patients treated with interleukin-2 and interferon alpha.
Interleukin-2 (IL-2) and interferon-alpha (INF-alpha) are biologic modifiers that have met with limited clinical success in the treatment of human malignancies. We conducted a phase 2 trial of IL-2-IFN-alpha in patients with advanced or unresectable squamous cell carcinoma of the upper aerodigestive tract. Two patients were analyzed sequentially for serum induction phase-blocking factors of lymphokine-activated killer (LAK) cell activity in their therapy. Serum also modulated LAK activity independent of autologous or allogeneic effector cells. Significantly inhibitory serum samples were stable in multiple freezings and thawings. Heat-treating the inhibitory serum, at 56 degrees C for 30 minutes, only partially removed the serum inhibitory capacity. Sequential analysis of p55 and p75, subunits of IL-2 receptors, showed that absence of effector cell lytic activity was associated with markedly decreased fluorescence of the IL-2Rp75 subunit only. No significant alteration of the IL-2Rp55 subunit occurred with therapy. These studies support the theory that lymphocyte and multiple serum factors, developing during IL-2-IFN-alpha therapy, regulate the induction of in vitro LAK activity. Further understanding of these factors may lead to improvements in biologic modifier therapy.
Aged↗
The role of federal waivers in the health policy process.
Federal waiver programs enable states to bypass the requirements of federal programs such as Medicare and Medicaid to experiment with different ways of financing, organizing, and delivering health care. In tracking waiver activity from 1980 to 1990, the authors found that federal involvement with waivers lost momentum during the latter part of the 1980s, while state involvement increased. Three key issues dominate the discussion of waivers: administrative control, the role of the states, and the ability to evaluate demonstration waivers. Examination of the chronology of waiver activity suggests the emergence of a new era, wherein federal control reemerges as a way to counter the increased fragmentation of health policies among states. If this is the case, four areas need to be addressed: (1) balance of political and research objectives; (2) administrative flexibility for states; (3) careful scrutiny of rules; and (4) increased accountability. These recommendations can guide the federal government, with the states as partners, in its attempt to regain momentum in the use of waivers to expand the knowledge base.
Health Policy↗
Side effects of influenza immunization.
Explore the source record for details and available documents.
Acute Disease↗
Governing board structure, business strategy, and performance of acute care hospitals: a contingency perspective.
Contingency theory suggests that for a hospital governing board to be effective in taking on a more active role in strategic management, the board needs to be structured to complement the overall strategy of the organization. A survey study was conducted to examine the strategies of acute care hospitals as related to the structural characteristics of their governing boards. After controlling for organizational size and system membership, results indicated a significant relationship between the governing board structure of 109 acute care hospitals and their overall business strategy. Strategy also accounted for more of the variance in board structure than either organization size or system membership. Finally, the greater the match between board structure and hospital strategy, the stronger the hospitals' financial performance.
Age Factors↗
Home or hospital birth?
Explore the source record for details and available documents.
Attitude of Health Personnel↗
Rigid gas-permeable extended wear: a comparative clinical study.
A 12-month clinical trial involving 88 subjects was undertaken to compare the clinical performance of rigid gas-permeable contact lens extended wear (EWRGP) with that of RGP daily wear (DWRGP) lenses and soft lens extended wear (SLEW) with medium water content lenses. Withdrawals from the EWRGP group tended to result from lens-related problems, whereas the SLEW withdrawals generally resulted from adverse effects on corneal physiology. Changes in spherical refractive error during the 1-year study were small (less than 1.00 D) and similar for both gas-permeable lens-wearing groups. Most of the SLEW group (58%) showed an increase in myopia and the mean increase was 0.38 D, which represented a significant difference from the EWRGP group. The EWRGP group showed a mean flattening in corneal curvature of 0.11 and 0.15 mm in the flattest and steepest corneal meridians, respectively. A positive correlation was noted between change in corneal curvature and baseline corneal astigmatism, which suggests corneal molding as a result of lid pressure as the most likely cause. The DWRGP and SLEW groups showed small, nonsignificant changes in corneal curvature. Most of the EWRGP subjects (69%) who completed the study showed increased corneal distortion. This compares with 30 and 17% with the DWRGP and SLEW groups, respectively. Likely corneal edema was a major contributory factor. For most of the slitlamp variables monitored, there were no significant differences between the groups. However, microcystic changes were detected in both EWRGP (35%) and SLEW subjects but not in the DWRGP group. Corneal staining was noted in all groups but was more prevalent among the EWRGP group. The findings of this study are discussed in relation to the clinical management of RGP extended wear.
Adolescent↗
Rethinking antenatal care.
Explore the source record for details and available documents.
Community Health Services↗
Circulating C1q-binding macromolecules and their relationship to radiographic characteristics of laryngeal cancer.
Circulating macromolecules capable of binding the first component of complement (C1qBM) may represent subcellular components of tissue/tumor debris generated from rapidly proliferating invasive disease. Thirty-eight patients were randomly selected from 74 untreated patients with laryngeal cancer on the basis of disease stage and C1qBM levels. C1qBM levels were correlated with computed tomographic evidence of tumor necrosis and/or thyroid cartilage destruction. Results show that patients with stage III/IV disease with tissue necrosis and/or cartilage invasion had demonstrably higher C1qBM levels than did individuals with similarly staged disease with no evidence of these radiographically defined characteristics (120 +/- 81 micrograms/mL vs 18 +/- 15 micrograms/mL); the strongest association was reflected by the area of necrosis within regional lymph metastases. Elevated C1qBM level in patients with stage III/IV laryngeal cancer thus reflects highly aggressive disease, which is less responsive to therapeutic intervention.
Biomarkers, Tumor↗
Psychosocial adjustment and physical growth in children with imperforate anus or abdominal wall defects.
Pediatric surgeons have the unique responsibility of performing surgical procedures that will enable their patients to function normally throughout a lifetime. Good anatomic results may not ensure that this goal will be achieved. Using a battery of psychological testing instruments, we evaluated the academic achievement and psychosocial status of 56 children (mean age, 10.6 years) with imperforate anus (IA) and abdominal wall defects (AWDs). Physical growth was assessed by measurement of standard anthropometric parameters, and a parent questionnaire was used to define clinical status. As a group, the children presented with average intellectual ability. Achievement in both reading and math was in the normal range. In 12.5% of the children a reading learning disability was noted and 10.7% had a disability in math. On the basis of parental assessments, 25% of the children demonstrated externalizing behavior disorders (eg, conduct problems) and 29% displayed internalizing symptomatology (eg. withdrawal, anxiety). Social competency deficits were described in 23% of the children. Data obtained from the teachers were consistent with the parental assessments. No major differences between the IA and AWD patients in academic achievement, psychosocial status, or physical growth were discovered. Routine screening of these children for learning disabilities and behavior problems is recommended.
Abdominal Muscles↗