Care in a midwife managed delivery unit. Study shows interventionist nature of British obstetrics.
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Biomedical subjects
Publications and source records attributed to I G Jones.
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Fife Health Board published its food and health policy in May 1986, introduced a board-wide food and health strategy in 1987, and carried out a comprehensive review of its implementation in 1990. Other health boards currently considering their strategies may benefit by learning from Fife's experience. A number of base-line studies were carried out between 1987 and 1989 before the policy was implemented. Further surveys have monitored progress. Positive features of the programme included the introduction of a comprehensive food and health policy throughout the health board, the establishment of base-line measurements for future outcome evaluation, and the enthusiastic support of a wide range of people. Negative features included some opposition from a number of health service staff to its introduction, lukewarm support from public leaders for its proposed public launch, and a patchy response from the education sector. Although it is still too early to be confident of the success of policy in terms of outcome measures, there is some evidence that the first phase of its introduction may have had some success within the health service. Alternative strategies are now required to tackle some of the areas where the introduction was less successful.
Clinical isolates of Staphylococcus aureus carry various antiseptic and disinfectant resistance determinants (qac genes) on a variety of plasmids. The biochemistry and specificity of these resistance genes in S. aureus is the subject of this report. The qac genes were separated into two families on the basis of resistance profiles and DNA homology. Isotopic and fluorimetric assays demonstrated that the qac genes encode efflux systems that rely on proton motive force.
An audit of all 466 non-insulin-dependent diabetic patients first diagnosed between 1979 and 1981 at a district general hospital in Fife was carried out. This involved the retrospective examination of their medical records and follow up of the patients to 1989 with particular reference to mortality and the development of complications. Throughout the study period the hospital, which has a total catchment population of about 160,000, operated a policy of encouraging all newly diagnosed diabetics to be referred to hospital for assessment and management. One hundred and eighty-nine diabetics (41%) died during the follow-up period. In both sexes they had an excess mortality, compared with the Scottish population of the same sex and age in 1981, of approximately 20% at 40 years of age. This increased to double or above between the ages of 60 and 70. The principal underlying cause of death was attributed to macrovascular disease, including 70 (37%) certified as ischaemic heart disease, 33 (17%) as cerebrovascular disease and 10 (5%) as other diseases of circulation. Thirty-five (8%) diabetics developed macrovascular and 23 (5%) microvascular complications during follow-up. We conclude that non-insulin-dependent diabetics have a high mortality, principally from macrovascular causes. A simple audit of mortality is suitable for measuring their care. General practitioner diabetic mini-clinics for the follow-up of non-insulin-dependent diabetic patients will have smaller numbers of patients to review compared with the traditional follow-up clinics seen in most district general hospitals. These may allow earlier detection and treatment of hypertension and dyslipidaemia.(ABSTRACT TRUNCATED AT 250 WORDS)
The gene specifying the ethidium efflux system of Escherichia coli has been cloned on a 3.2 kbp HindIII fragment and located on a 1.2 kbp fragment within this. Cross-resistance studies indicate that the system has a broad specificity for monovalent cations and the gene shows no hybridisation with similar genes found in Staphylococci.
We report the use of the riboB gene for a gene replacement in the alcC gene of Aspergillus nidulans, and show by "reverse genetics" that the alcC gene is very closely linked to the amdA gene.
An alcohol dehydrogenase was shown to be induced in Aspergillus nidulans by periods of anaerobic stress. This alcohol dehydrogenase was shown to correspond to the previously described cryptic enzyme, alcohol dehydrogenase III (McKnight et al. 1985), by analysis of a mutation in the structural gene of alcohol dehydrogenase III, alcC, created by gene disruption. Survival tests on agar plates showed that this enzyme is required for long-term survival under anaerobic conditions. Northern blot analysis and gene fusion studies showed that the expression of the alcC gene is regulated at both the transcriptional and translational levels. Thus there are mechanisms in this filamentous fungus allowing survival under anaerobic stress that are similar to those described in higher plants.
There are at least three alcohol dehydrogenases in Aspergillus nidulans. ADHIII has no obvious physiological function. We describe here the cloning of the ADHIII gene (alcC), its mapping on linkage group VII by "reverse genetics", and the properties of multicopy transformants tested for their ability to grow on a range of alcohols (butan-1-ol being the best substrate tested for growth). We were unable to detect any obvious alteration in phenotype of a strain carrying a disrupted copy of the ADHIII gene.
Validation of the Fife haematological cancer register data from 1968 to 1981 for patients aged 0 to 24 submitted to the Black Advisory Group demonstrated 'catastrophic' or 'major' errors in 23 (19%) of the 124 records. A case-control study of 43 children with acute lymphoblastic leukaemia aged 0 to 14 at diagnosis in Fife between 1970 and 1985 showed that the Mantel-Haenszel odds ratio (ORMH) was significantly higher for children resident at birth in the post code district KY8 (ORMH = 3.86, 95% confidence interval 1.31-11.36) or who had ever lived in post code districts KY8 (ORMH = 4.00, 95% CI 1.51-10.58) or KY11 (ORMH = 2.35, 95% CI 1.08-5.12). We conclude that routine cancer registration data require extensive validation before they can be used for epidemiological purposes; case-control studies can overcome some of the methodological problems involved in investigating apparent leukaemia clusters; and further environmental investigations are needed in two post code districts of Fife.
We have previously cloned a 3.5 kb fragment from the Staphylococcus aureus multiresistance plasmid pSK1 which carries the qacA determinant responsible for linked resistance to acriflavine (Acr), ethidium bromide (Ebr), quaternary ammonium compounds (Qar), propamidine isethionate (Pir), and diamidinodiphenylamine dihydrochloride (Ddr). This report presents a biochemical and physical analysis of qacA and shows the widespread carriage of this gene on S. aureus resistance plasmids. Tn5 insertion mutagenesis defined the extent of qacA to within 2.40 kb of pSK1 DNA. Examination of the expression of insertion and deletion mutants of the cloned qacA sequences in both maxicells and minicells led to the association of a 50 kDa protein, designated QacA, with the AcrEbrQarPirDdr phenotype. Based on fluorimetric and isotopic assays used to determine the extent of accumulation of ethidium bromide by S. aureus strains harbouring pSK1, we propose that the basis of AcrEbrQarPirDdr in S. aureus is a qacA-mediated efflux system.
A survey of all general practitioners in Fife conducted prior to the introduction of measles-mumps-rubella immunization on a pilot basis in May 1987 showed that 85% considered mumps worth preventing and 94% believed the rubella programme worth augmenting with universal childhood immunization. Ninety seven per cent considered measles worth preventing and 98% were prepared to recommend measles-mumps-rubella immunization to parents instead of measles vaccine. One year after introducing the measles-mumps-rubella vaccine in Fife, 91% of children had been immunized with the combined vaccine or measles vaccine before their second birthday. This compares with the 83% that received measles vaccine before the combined vaccine was introduced. Eighty per cent of preschool children were also immunized with the combined vaccine at school entry in a catch-up exercise. This study demonstrates that there are few major professional barriers to achieving a high uptake of the measles-mumps-rubella vaccine in this area. The vaccine was introduced nationally on 1 October 1988 and its uptake is likely to exceed the current unsatisfactory level achieved with measles vaccine. However, this outcome will largely depend on the commitment of doctors to the programme.
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Speed of injection of bupivacaine was assessed in 73 women who received epidural analgesia in labour. Rapid injection was shown to produce quicker onset of epidural block and more reliable perineal anaesthesia than slow injection, but there was no difference in the final extent of the block.