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Biomedical subjects

H King

Publications and source records attributed to H King.

At least 37 records · Page 2Linked to original sources
PubMed1998

Epidemiology of glucose intolerance and gestational diabetes in women of childbearing age.

The available data suggest that the frequency of diabetes in pregnancy is highly variable, generally reflecting the underlying pattern of NIDDM in the particular population. Different ethnic groups in the same environmental setting experience widely variable risk. Impaired glucose tolerance is usually more prevalent than diabetes in women of childbearing age. Maternal age, overweight, parity, and family history of diabetes all predispose to gestational diabetes mellitus (GDM). Incidence of GDM is low in the absence of risk factors, suggesting that selective screening programs may be cost-effective. The worldwide epidemic of glucose intolerance predicted by the latest World Health Organization studies will undoubtedly increase the burden of GDM, especially in the developing countries.

Adult↗
PubMed1997

Management of hypercholesterolemia: practice patterns for primary care providers and cardiologists.

This retrospective study, conducted as part of a private practice quality assurance process for patients with coronary artery disease (CAD), compares practice patterns in the LIFEHELP lipid clinic and non-lipid clinic settings at the Heart Institute of St. Petersburg. Quality assurance parameters included documentation of low-density lipoprotein (LDL) cholesterol, initiation of lipid-lowering therapy, and achievement of the Second National Cholesterol Education Program (NCEP II) goal for CAD patients of LDL cholesterol < or =100 mg/dL. A total of 934 patient charts with ICD-9 codes of 410-414 for ischemic heart disease were randomly selected and reviewed by a utilization review nurse. A higher level of documentation and treatment of elevated LDL cholesterol to NCEP II goal in CAD patients was found for those followed in the lipid clinic. Among non-lipid clinic physicians, cardiologists documented and treated elevated LDL cholesterol more frequently than primary care physicians. Women and the elderly subgroups received improved care in the lipid clinic setting. Screening activities and risk-factor management by cardiologists within a lipid clinic, therefore, demonstrated an improved standard of care that came closer to achieving national guidelines in the secondary prevention of CAD.

Age Factors↗
PubMed1997

Vertebral column and spinal cord malformation in children with exstrophy of the cloaca, with emphasis on their functional correlates.

Exstrophy of the cloaca is a dramatic malformation whose embryology is poorly understood. While the management of this disorder has received significant attention in the urology and general surgery literature, the neurologic status of these children has been poorly addressed. In order to better characterize the spinal cord and vertebral column malformations found in children with exstrophy of the cloaca, we undertook a clinical review of 26 consecutive children with exstrophy of the cloaca who had been seen at a single institution over 28 years. The prevalence of vertebral malformations in the 25 children who could be evaluated was 25/25 (100%). Twenty (80%) of the children had at least one vertebral fusion, most frequently at T-7. Twenty-two (88%) of the children had at least one vertebra with deficient posterior elements, and the spinal levels most frequently involved were S-2, S-3, S-4 and S-5. Nine (36%) of the children had at least one vertebra with a narrowed interpedicular distance, most frequently at T-7. Nine (36%) of the children had at least one vertebra with atrophic facet anatomy, most frequently at L-3. The prevalence of myelodysplasia in the 19 children for whom spinal magnetic resonance imaging or intraoperative findings were available was 100%. Of these 19 children, 15 (79%) had myelocystocele, 2 (11%) had a lipomeningocele, 2 (11%) had a meningocele, 2 (11%) had hydromyelia, and 4 (21%) had a tethered cord. These data suggest that spinal cord and vertebral column malformations are very common in children with exstrophy of the cloaca.

Abnormalities, Multiple↗
PubMed1997

Hindshaker, a novel myelin mutant showing hypomyelination preferentially affecting the spinal cord.

Animals with spontaneous mutations affecting myelin formation have provided useful information about the genetic and cellular mechanisms regulating normal and abnormal myelination. In this paper we describe a novel murine mutation termed hindshaker (hsh), which is inherited in an autosomal recessive manner. Affected mice are characterised by a variable tremor of the hind end which commences at about 2 weeks of age and largely disappears in animals older than 6 weeks. There is hypomyelination affecting predominantly the spinal cord, although the optic nerves and brain are involved to a much lesser degree. The defect of thinly myelinated and naked axons is maximal at 20 days of age and largely resolves with time so that in the adult most axons are myelinated. The myelin structure appears normal and immunostains for the major proteins. Although the distribution of oligodendrocytes in the spinal cord is similar to normal during the period of hypomyelination, there are fewer mature cells. The hsh mutation appears to delay the maturation of oligodendrocytes, particularly in the spinal cord. Additionally, there is a considerable variation in phenotypic expression and in penetrance when the mutation is expressed on different genetic backgrounds, suggesting the hsh locus is subject to the influence of modifying gene(s). Identification of the hsh gene should identify a factor important in the development of oligodendrocytes, particularly those in the spinal cord.

Animals↗
PubMed1996

The WHO national diabetes programme initiative.

Epidemiological studies indicate that diabetes is a highly prevalent disease, with developing countries and minority populations now facing the highest risk. This places a strain on the health authorities, and consequently, has attracted increasing attention from the World Health Organization (WHO). The social and economic burden of diabetes is high, due to the seriousness of the complication of the disease. Many of these complications may be delayed or prevented, offering considerable opportunities for both reduction in costs to the authorities and improvements in quality of life for those affected. Following a resolution on the prevention and control of diabetes, adopted by the Forty-second World Health Assembly in 1989, the WHO diabetes programme prepared guidelines for the development of national diabetes programmes. Goals, targets and supporting materials have also been developed at the regional level by the WHO Regional Offices for Europe and for the Eastern Mediterranean. In 1994, WHO organized a meeting on the implementation of national diabetes programmes at its headquarters in Geneva. There were 70 participants and 32 counties were represented. The purposes of the meeting were to exchange information, motivate, consider evaluation, stimulate new programmes, define educational needs and prepare a written report. WHO plays a major role in the development of national diabetes programmes. In co-operation, WHO Headquarters and Regional Offices can act as clearing houses/information centres for data collection, programme monitoring and evaluation and the exchange of experience and technical information. The national diabetes programme initiative should result in improvements in diabetes control and care worldwide.

Diabetes Mellitus↗
PubMed1995

Family violence. A child-centered, family-focused approach.

Child maltreatment and spousal abuse are complex problems without simple solutions. Pediatricians can play a critical role in the early detection of abuse, carry out an initial assessment, and make appropriate referrals. By taking a family-focused perspective, and considering the social-emotional and economic context in which all family members live, the pediatrician will be more sensitive and alert to both the stressors and strengths within each family. Child maltreatment and spousal abuse affect children directly and indirectly in a variety of domains, including social-interactional, emotional status, self-image, behavior, and learning. A better understanding of these issues will enhance the comprehensiveness of the pediatrician's efforts and provide a better outcome for children and their families.

Adult↗
PubMed1995

Pakistan national diabetes survey: prevalence of glucose intolerance and associated factors in Shikarpur, Sindh Province.

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) and their relationship to age and obesity was estimated in the rural town of Shikarpur in Sindh Province, Pakistan by a population-based survey in 1994. Oral glucose tolerance tests were performed in a stratified random sample of 967 adults (387 men, 580 women) aged 25 years and above. The diagnoses of diabetes and IGT were made on the basis of WHO criteria. The response rate was 71% for men and 80% for women. The prevalence of diabetes was 16.2% (9.0% known, 7.2% newly diagnosed) in men, and 11.7% (6.3% known, 5.3% newly diagnosed) in women. The prevalence rose with age to a peak of 30% and 21% in 65-74 year-old men and women respectively. IGT was detected in 8.2% of men and 14.3% of women. Thus, total glucose intolerance (diabetes and IGT combined) was present in 25% of subjects examined. These results indicate that glucose intolerance in South Asians can no longer be regarded as a problem confined to migrant communities. Of the 72 subjects previously known to have diabetes, none was using insulin treatment, but 57 (79%) took oral hypoglycaemic agents. Central obesity and positive family history were strongly associated with diabetes, as was prevalence of hypertension. The association with central obesity was greater for women than for men, and suggests important, modifiable risk factor(s) related to lifestyle.

Adult↗
PubMed1995

High prevalence of diabetes mellitus and impaired glucose tolerance in the Sultanate of Oman: results of the 1991 national survey.

A national survey of glucose intolerance and cardiovascular disease risk factors in Oman has demonstrated a high prevalence of diabetes (10%) and impaired glucose tolerance (IGT, 13% in females and 8% in males). Prevalence of diabetes rose with age to a maximum of over 30% in both sexes. Prevalence of total glucose intolerance (diabetes and IGT combined) exceeded 50% in the seventh (females) and eighth (males) decade of life.

Adult↗
PubMed1994

Blood pressure, hypertension and other cardiovascular risk factors in six communities in Papua New Guinea, 1985-1986.

Surveys of noncommunicable diseases were performed in six communities in Papua New Guinea during 1985-1986. Results are reported here with respect to blood pressure and associated factors in adults. Mean systolic and diastolic blood pressures were lowest, and hypertension was rarest (less than 2%), in three rural/semirural villages on Karkar Island, Madang Province. Intermediate values for blood pressure and moderate prevalence of hypertension (3-6%) were observed in rural and urban Tolai communities in East New Britain Province. A periurban village in the Eastern Highlands Province displayed the highest mean blood pressures and prevalence of hypertension (12% in men and 5% in women). There was a modest rise in mean systolic blood pressure with age in most groups, but the age-related rise in diastolic pressure was much less pronounced. Other cardiovascular risk factors--body mass index (BMI), and plasma cholesterol, glucose and insulin concentrations--were lowest in the least developed rural villages on Karkar Island and highest in the urban Tolai and periurban highland communities. Both systolic and diastolic blood pressures were significantly (and positively) related to age, male sex, BMI and speaking a non-Austronesian language. It is concluded that there is now a considerable variation in the prevalence of hypertension, and the levels of blood pressure and other cardiovascular risk factors, in different communities in Papua New Guinea.

Adult↗
PubMed1993

Understanding variation in rates of referral among general practitioners: are inappropriate referrals important and would guidelines help to reduce rates?

OBJECTIVES: To determine the extent to which variation in rates of referral among general practitioners may be explained by inappropriate referrals and to estimate the effect of implementing referral guidelines. SETTING: Practices within Cambridge Health Authority and Addenbrooke's Hospital, Cambridge. MAIN OUTCOME MEASURES: Data on practice referral rates from hospital computers, inappropriate referrals as judged by hospital consultants, and inappropriate referrals as judged against referral guidelines which had been developed locally between general practitioners and specialists. Effect of referral guidelines on referral patterns as judged by general practitioners using the guidelines in clinical practice. RESULTS: There was 2.5-fold variation in referral rates among general practices. According to the specialists, 9.6% (95% confidence interval 6.4% to 12.9%) of referrals by general practitioners and 8.9% (2.6% to 15.2%) of referrals from other specialists were judged possibly or definitely inappropriate. Against locally determined referral guidelines 15.9% of referrals by general practitioners were judged possibly inappropriate (11.8% to 20.0%). Elimination of all possibly inappropriate referrals could reduce variation in practice referral rates only from 2.5-fold to 2.1-fold. An estimate of the effect of using referral guidelines for 60 common conditions in routine general practice suggested that application of guidelines would have been unlikely to reduce rates of referral in hospital (95% confidence interval -4.5% to 8.6% of consultations resulting in referral). CONCLUSION: The variation in referral rates among general practitioners in Cambridge could not be explained by inappropriate referrals. Application of referral guidelines would be unlikely to reduce the number of patients referred to hospital.

Decision Making↗
PubMed1993

Prolongation of epidural bupivacaine analgesia with glycerin.

Glycerin has been used as a drug carrier/depot, but never with local anaesthetics. This study was an attempt to use the slow drug release mechanism to prolong the anaesthetic effects of bupivacaine in epidural block. Twenty-seven adults with cancer pain were prospectively selected according to their primary lesions and problems, but their allocation to study groups was randomized. Group I (n = 13), received 5 ml bupivacaine, 0.125% in normal saline via a previous implanted epidural catheter. When the pain returned to its original intensity, the same amount of the same strength anaesthetic dissolved in 50% glycerin was given via the same catheter. Group II (n = 14) received the same solutions, but in the reverse order. Also five patients in each group received plain 50% glycerin prior to administration of the anaesthetic solutions to serve as controls. The pharmacological effects were assessed by the blinded observers. Analgesia produced with glycerin solution was prolonged compared with the saline solution (12.2 vs 7.2 and 11.6 vs 7.4 hr, P < 0.01). The order of giving the solution did not produce any differences. Plan 50% glycerin did not produce analgesic effects. Neither motor blockade nor other adverse effects or complications were observed in either group. It was concluded that 0.125% bupivacaine in 50% glycerin administered epidurally is not neurotoxic. The prolongation of analgesia observed is attributed to the slow release of bupivacaine from the glycerin base which functions as drug depot. In addition to relief of chronic pain, this novel approach may have other clinical applications such as the relief of labour or postoperative pain.

Aged↗
PubMed1993

Adequacy of general anesthesia for cesarean section.

To assess the adequacy of the general anesthesia commonly employed for Cesarean section, we used isolated forearm technique to study 30 parturients (physical status ASA I/II, aged 17-35 yr) scheduled for nonemergent abdominal delivery. Anesthesia was induced with intravenous thiopental (3 mg/kg, 250 mg maximum) and succinylcholine (1.5 mg/kg), and then proceeded with a mixture of 50% N2O, 50% O2, and 0.5% halothane at a flow of 5 L/min and end-tidal CO2 at 40 mm Hg. Paralysis was maintained with a 0.1% succinylcholine infusion. When eyelash reflex disappeared, patients received taped instruction via headphones at 1-min intervals for 10 min. The tapes instructed patients to flex fingers if they were able to hear, to make a fist or squeeze the investigator's hand if they felt pain, to remember six target words, and to respond with specific physical signals during later interviews. Three sets of tapes assigned at random were used in the study. For signs of inadequate anesthesia, other variables such as eye centering, pupil size, sweating, and lacrimation were concomitantly monitored at the time of induction, laryngoscopy/intubation, and skin incision, and then at 1-min intervals for 10 min. Brain activity was also monitored by means of computerized aperiodic analysis of electroencephalogram Lifescan). Patients were interviewed in the postanesthesia recovery room and again 24 h later. At the time of skin incision, 96.7% of patients (29/30) signaled awareness by flexing fingers, 86.7% (26/30) exhibited lacrimation, and 80% (24/30) made a fist or squeezed the investigator's hand, indicating pain perception.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. WHO Ad Hoc Diabetes Reporting Group.

OBJECTIVE: To assemble standardized estimates of abnormal glucose tolerance in adults in diverse communities worldwide and provide guidelines for the derivation of comparable estimates in future epidemiological studies. RESEARCH DESIGN AND METHODS: The project was limited to population-based investigations that had used current WHO criteria for diagnosis and classification of abnormal glucose tolerance. Raw data were obtained by WHO from surveys conducted during 1976-1991 of over 150,000 persons from 75 communities in 32 countries. Data within the truncated age range of 30-64 yr were adjusted to the standard world population of Segi. Age-specific prevalences also are reported for selected populations. RESULTS: Within the chosen age range, diabetes was absent or rare (< 3%) in some traditional communities in developing countries. In European populations, age-standardized prevalence varied from 3 to 10%. Some Arab, migrant Asian Indian, Chinese, and Hispanic American populations were at higher risk with prevalences of 14-20%. The highest prevalences were found in the Nauruans (41%) and the Pima/Papago Indians (50%). Age-standardized prevalence of IGT was low (< 3%) in some Chinese, traditional American Indian, and Pacific island populations. Moderate (3-10%) or high (11-20%) prevalences of IGT were observed in many populations worldwide. The highest estimates for prevalence of IGT were seen in female Muslim Asian Indians in Tanzania (32%) and in urban male Micronesians in Kiribati (28%). Prevalence of diabetes rose with age in all populations in which age-specific data were examined. This trend was most pronounced in those at moderate to high risk. The ratio of prevalence of diabetes in men versus women varied markedly between populations with little discernable trend, although IGT was generally more common in women. In most communities, at least 20% of diabetes cases were unknown before the survey, and in many communities, > 50% were previously undiagnosed. In both Chinese and Indian migrant populations, relative prevalence was high when compared with indigenous communities. CONCLUSIONS: Diabetes in adults is now a global health problem, and populations of developing countries, minority groups, and disadvantaged communities in industrialized countries now face the greatest risk.

Adult↗