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Biomedical subjects

I Jones

Publications and source records attributed to I Jones.

At least 91 records · Page 5Linked to original sources
PubMed1996

Detection of Pityrosporum orbiculare reactive T cells from skin and blood in atopic dermatitis and characterization of their cytokine profiles.

BACKGROUND: Atopic dermatitis (AD) is associated with increased levels of serum IgE, and T-helper (Th) cells are thought to a play role in the pathogenesis. Individuals with AD often develop IgE antibodies against the yeast Pityrosporum orbiculare, a member of the normal cutaneous flora. OBJECTIVE: The role of P. orbiculare in atopic dermatitis was investigated by examining the T-cell reactivity for P. orbiculare. METHODS: Freshly isolated peripheral blood mononuclear cells (PBMC) were isolated from 10 AD patients with serum IgE antibodies against P. orbiculare, and from six healthy controls. The proliferative response after P. orbiculare stimulation, measured by [3H]thymidine incorporation, was examined in the PBMC and in T-cell clones (TCC) obtained from skin and blood of one patient. The cytokine profile of the TCC was determined by enzyme-linked immunosorbent assay (ELISA), radioimmunoassay (RIA) and reverse transcriptase-polymerase chain reaction (RT-PCR) following challenge with either P. orbiculare extract or anti-CD3 antibodies and phytohaemagglutinin. RESULTS: The PBMC response to P. orbiculare was significantly higher in the AD patients than in the control group (P < 0.05). Twenty-nine out of 36 tested TCC derived from one responding patient were reactive for P. orbiculare. The clones were CD2+ and CD4+, except for one CD8+ blood clone. A majority of the TCC derived from lesional skin showed a Th2- or Th2/Th0-like cytokine profile. A co-expression of interleukin-5 (IL-5) mRNA and IL-13 mRNA was detected in five out of six P. orbiculare-reactive clones analysed for their cytokine gene expression with RT-PCR. CONCLUSION: Our data suggest that P. orbiculare can induce a T-cell response in AD patients. The Th2-like profile of P. orbiculare-reactive TCC derived from lesional skin indicates that P. orbiculare may play a role in maintaining IgE-mediated skin inflammation in AD.

Adolescent↗
PubMed1996

Appropriateness of admission and the last 24 hours of hospital care in medical wards in an east London teaching group hospital.

OBJECTIVE: To assess the rates of inappropriateness of admission and last day of care on adult medical wards in an east London hospital, to identify associations with any inappropriateness and to assess what services need to be improved or provided if patients assessed as "inappropriate" are to be more appropriately placed in the future. DESIGN: From the patients' medical notes, nursing notes and ward charts, a trained reviewer with nursing and university qualifications collected concurrent information about each patient's first 24 hours as an in-patient and about the last 24 hours of care preceding discharge. Patients were also interviewed before discharge and 7-10 days after discharge, and their health status and level of satisfaction about the discharge process assessed. SETTING: The three adult medical wards at the Homerton Hospital in Hackney, east London. This hospital is within the St Bartholomew's Hospital Teaching Hospital Group. SUBJECTS: The case-notes of a random sample of 625 adult in-patients were reviewed. END POINTS: Appropriateness of admission and last day of care. MAIN OUTCOME MEASURES: The main instrument used was the Appropriateness Evaluation Protocol (AEP). This is an instrument devised to assess the appropriateness of adult patient admission to, and specific days of care in, acute hospital beds through case-note review against a structured set of criteria. RESULTS: The study presented here reported that 31% of in-patient admissions to adult medical wards in an east London hospital were inappropriate, and also that 66% of the last days of stay were inappropriate. CONCLUSIONS: There is clearly considerable room for improvement in relation to cooperation between service providers in order to maximise efficient bed use. Delays due to waiting for medications from pharmacy, and the combination of more "inappropriate" cases wanting help from social services after discharge with the fact that many of them were still in hospital because they were waiting for these services to be organized, suggest that inappropriateness could be reduced through increased efficiency or increased provision in these areas. The study reported here is unique in its inclusion of patient interview data.

Adult↗
PubMed1996

Promoting breastfeeding: a view of the current position and a proposed agenda for action in Scotland.

The prevalence of breastfeeding in Scotland is the second lowest in Europe. There is good evidence that breastfeeding results in decreased gastrointestinal, and to a lesser extent respiratory infections, in the first year of life, and reduced serious infections in low-birthweight babies. Published evidence for the effectiveness of interventions which seek to promote successful breastfeeding within populations is scanty and of poor quality, although numerous studies have highlighted hospital practices which discourage and undermine breastfeeding. Changing these poor practices has been shown to be achievable and can lead to improved breastfeeding rates. Experience in other industrialized countries such as Canada, Australia and Norway has shown that substantial increases in breastfeeding are achievable through combined government and health service action over a period of one or two decades. We recommend a combination of government and health service action to promote breastfeeding in Scotland including: implementation of the International Code on Marketing of Breastmilk Substitutes; reviews of health professional basic and in-service training in breastfeeding management, maternity leave and allowances, and workplace facilities for breastfeeding mothers; promotion of the Baby Friendly Initiative; development of community support for breastfeeding mothers; routine collection of breastfeeding data to support annual monitoring of breastfeeding rates; and support for research on the effectiveness of strategies which seek to promote breastfeeding.

Adult↗
PubMed1996

Reduced growth hormone secretion improves insulin sensitivity in adolescent girls with type 1 diabetes.

The aims of the present study were to compare nocturnal growth hormone (GH) secretion, insulin requirements and insulin sensitivity on two occasions in six adolescent girls with type 1 diabetes when the GH secretion was reduced one night by an oral dose of 100 mg of pirenzepine at bedtime. The mean nocturnal intravenous insulin infusion required to maintain a normal constant blood glucose concentration between 24:00 and 07:00 was 53% higher during the night on placebo (p = 0.0212). During the night on pirenzepine, the serum GH area under the curve (AUC) was reduced in all patients to a mean concentration which was 50.1% (15-78%) of that during the night without pirenzepine (p = 0.0036). The nocturnal urinary GH excretion was also reduced in all of the investigated patients (p = 0.0229). Insulin sensitivity in the morning, measured by the euglycaemic hyperinsulinaemic glucose clamp, increased significantly from 115 +/- 51 mg m-2 min-1 after the night on placebo to 205 +/- 67 mg m-2 min-1 after the night on pirenzepine (p = 0.0161). No side-effects were observed during the pirenzepine night. Negative correlations were found between the nocturnal serum GH AUC and the insulin-stimulated glucose metabolism (r = -0.65, p = 0.0241) and between the nocturnal urinary GH excretion and the insulin-stimulated glucose metabolism (r = -0.77, p = 0.0054). In conclusion, the present study shows a relation between GH secretion and insulin resistance in adolescent girls with type 1 diabetes. The administration of pirenzepine acutely reduces GH secretion and improves insulin sensitivity.

Administration, Oral↗
PubMed1996

Location, exposure, and conservation of neutralizing and nonneutralizing epitopes on human immunodeficiency virus type 2 SU glycoprotein.

Eleven rat monoclonal antibodies (MAbs) that recognize the SU glycoprotein of human immunodeficiency virus type 2 (HIV-2) ROD were produced and characterized. Binding sites for eight of these MAbs were mapped to epitopes within the Cl, V1/V2, C2, and V3 envelope regions. The three other MAbs defined at least two conformation-dependent, strain-specific epitopes outside Vl/V2, V3, and the CD4-binding site. The MAbs were used to probe the tertiary structure of oligomeric envelope glycoprotein expressed on the surfaces of infected cells. Epitopes at the apices of V2 and V3 were exposed on the native molecule, whereas other epitopes on V1/V2, Cl, and C2 were hidden. The MAbs defined three neutralization targets on exposed domains: two linear epitopes in the V2 and the V3 loops and one conformational epitope outside V1, V2, and V3.

Amino Acid Sequence↗
PubMed1996

Disturbed anal sphincter function following vaginal delivery.

BACKGROUND: Recently interest in idiopathic (neurogenic) faecal incontinence has swung from denervation of the external anal sphincter to the internal sphincter. AIMS: To evaluate the effects of vaginal delivery on the internal sphincter. SUBJECTS: 1372 mothers were studied antenatally and 1202 were accepted into the study. METHODS: Sphincter pressures were measured antenatally, in the early postnatal period, and six to 10 weeks later in selected patients. RESULTS: 755 of 1202 subjects assessed antenatally were primiparous women and 447 multiparous women. Some 320 previous spontaneous vaginal deliveries (SVD) (mean 59 mm Hg) and 67 previous forceps deliveries (mean 58 mm Hg) had lower resting pressures than 755 primiparous women (mean 66 mm Hg) (p < 0.01). A total of 493 subjects were reassessed postnatally. There were 372 SVDs, 47 vacuum extractions, 20 forceps, and 54 caesarean deliveries. All vaginal deliveries but not caesarean sections dropped their resting anal pressures from antenatal values (p < 0.001). Some 227 first SVDs had a much greater fall than 145 subsequent SVDs. In 162 subjects who had undergone their first vaginal delivery and who were followed up there was some recovery but the resting pressures were still lowered at six to 10 weeks post partum. CONCLUSIONS: The first vaginal delivery causes a permanent lowering of resting anal pressures. The possible reasons for this are discussed.

Adolescent↗
PubMed1996

Does a dedicated discharge coordinator improve the quality of hospital discharge?

OBJECTIVE: To evaluate the effectiveness of the role of a discharge coordinator whose sole responsibility was to plan and coordinate the discharge of patients from medical wards. DESIGN: An intervention study in which the quality of discharge planning was assessed before and after the introduction of a discharge coordinator. Patients were interviewed on the ward before discharge and seven to 10 days after being discharged home. SETTING: The three medical wards at the Homerton Hospital in Hackney, East London. PATIENTS: 600 randomly sampled adult patients admitted to the medical wards of the study hospital, who were resident in the district (but not in institutions), were under the care of physicians (excluding psychiatry), and were discharged home from one of the medical wards. The sampling was conducted in three study phases, over 18 months. INTERVENTIONS: Phase I comprised base line data collection; in phase II data were collected after the introduction of the district discharge planning policy and a discharge form (checklist) for all patients; in phase III data were collected after the introduction of the discharge coordinator. MAIN MEASURES: The quality and out come of discharge planning. Readmission rates, duration of stay, appropriateness of days of care, patients' health and satisfaction, problems after discharge, and receipt of services. RESULTS: The discharge coordinator resulted in an improved discharge planning process, and there was a reduction in problems experienced by patients after discharge, and in perceived need for medical and healthcare services. There was no evidence that the discharge coordinator resulted in a more timely or effective provision of community services after discharge, or that the appropriateness or efficiency of bed use was improved. CONCLUSIONS: The introduction of a discharge coordinator improved the quality of discharge planning, but at additional cost.

Activities of Daily Living↗
PubMed1996

Interleukin 8 in bronchoalveolar lavage of asthmatic and chronic bronchitis patients.

Interleukin 8 (IL-8) is a chemoattractant cytokine having a distinct target specificity for the neutrophil. However, it was also found to be active on primed eosinophils. IL-8 was measured by enzyme immunoassay in the bronchoalveolar lavage fluid (BALF) of 9 control subjects, 19 asthmatics and 36 chronic bronchitis patients. Its levels were correlated with neutrophil and eosinophil counts as well as levels of myeloperoxidase (MPO) and eosinophil cationic protein in the BALF. Asthmatic and chronic bronchitis patients had elevated levels of IL-8 in comparison with normal subjects. There was no correlation between the severity of asthma or chronic bronchitis and IL-8 levels. In asthmatic subjects there was a correlation between IL-8 and MPO levels (p < 0.0001, Spearman test). There was no significant correlation between eosinophils and IL-8. In chronic bronchitis there was a correlation between IL-8 and MPO levels as well as between IL-8 and neutrophil counts (p < 0.004 and p < 0.0152, respectively, Spearman test). IL-8 is involved in neutrophilic inflammation in asthma and chronic bronchitis, but differences in the IL-8 regulation of neutrophils were observed in both diseases.

Adolescent↗
PubMed1996

Screening for psychiatric morbidity in subjects presenting with chronic fatigue syndrome.

BACKGROUND: There is a need for a valid self-rating questionnaire to screen for psychiatric morbidity in patients with chronic fatigue syndrome (CFS). This study had the aim of assessing the utility and validity of two commonly used measures. METHOD: Scores obtained on the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) were compared with various diagnostic and severity ratings obtained via a validating clinical interview, the Schedules for the Clinical Assessment of Neuropsychiatry (SCAN) in 95 consecutively referred subjects at a medical out-patient clinic who fulfilled standard criteria for CFS, and 48 healthy controls. Outcome measures were validating coefficients and receiver operating characteristics (ROC) for different thresholds and scoring on GHQ and BDI and index of definition (ID) as measured by SCAN; and Pearson and point by serial correlation coefficients for different diagnostic groups derived via SCAN and defined according to ICD-10 and DSM-III-R. RESULTS: GHQ and BDI perform poorly as screeners of psychiatric morbidity in CFS subjects when compared with various SCAN derived ratings although results for controls are comparable with other studies. CONCLUSIONS: Neither the GHQ nor BDI alone can be recommended as screeners for psychiatric morbidity in CFS subjects.

Fatigue Syndrome, Chronic↗
PubMed1996

Fibronectin as a predictor of preeclampsia: a pilot study.

The measurement of serum fibronectin levels in women carrying a singleton pregnancy at between 25-30 weeks' gestation has allowed the separation of those women who will remain normotensive from those who develop preeclampsia in this pilot study. The fibronectin assays were performed using nephelometry. It is recognized that some severe cases of preeclampsia will have already declared themselves clinically by 28 weeks' gestation, but if a screening test is to be limited by cost to a single test event, then this pilot study suggests the 28-week gestation time to be the most suitable. Further studies are being undertaken to test this hypothesis and to adequately assess the test's reliability, predictability and its cost-effectiveness.

Adolescent↗
PubMed1995

Validity and reliability of the twenty-eight-joint count for the assessment of rheumatoid arthritis activity.

OBJECTIVE: To investigate the validity of the 28-joint count for assessment of joint involvement in patients with rheumatoid arthritis (RA). METHODS: Joint involvement as determined by the 28- and the 66/68-joint count was compared using data from 735 prospectively studied RA patients. RESULTS: The joints included in the 28-joint count were more commonly involved than other joints, and findings from the 28-joint count correlated highly with those from the 66/68-joint count in all analyses. CONCLUSION: The 28-joint count is a reliable and valid measure for joint assessment. It is easier to perform than the 66/68-joint count, and it addresses the joints that are critically involved.

Arthritis, Rheumatoid↗
PubMed1995

Attachment of an oligopeptide epitope to the C-terminus of recombinant SIV gp160 facilitates the construction of SMAA complexes while preserving CD4 binding.

A small 14 amino acid oligopeptide tag (termed SV5-Pk) was fused onto the carboxy-terminus of simian immunodeficiency virus gp160 expressed from a recombinant baculovirus. The presence of the Pk tag had no obvious effect on the expression and glycosylation of gp160 and did not interfere either with CD4 binding or with cleavage at its maturation site by the protease furin. The presence of the Pk tag did, however, facilitate the simplified purification of full-length gp160 and its incorporation into immunogenic solid matrix-antibody-antigen (SMAA) complexes.

Animals↗
PubMed1995

General practitioners' background knowledge of their patients.

The aim of the study was to describe the background knowledge of their patients used by general practitioners in decision making in the consultation. Tape-recorded interviews with 22 general practitioners randomly selected from one FHSA, concerning 198 consultations, were used. General practitioners were asked to describe their background knowledge of the first ten patients seen that day, and to describe how their management decisions were influenced by this information. The interviews were analysed from transcripts. All except one doctor appeared to identify patients as 'copers' or 'non-copers'. Decisions which appeared to be linked with coping were: (1) expecting them to have a physical illness; (2) offering reassurance, expecting that to be effective; (3) deciding that there was no need to take action; (4) allowing the patient to decide on some aspect of management. Decisions linked with not coping were: (1) to look for a psychological diagnosis; (2) to offer reassurance, but expecting that not to be effective; (3) to examine or refer because of the doctor's perception of the patient's expectations. General practitioners also appeared to make decisions based on their perception of their patients' social support. If there was thought to be adequate support, or no social stress, the doctors decided (1) to look for a physical diagnosis; (2) to leave some decisions to the patient; (3) not to involve outside agencies in management; and (4) to ignore those areas of the patient's life which were thought not to be a problem. If doctors believed that there were problems with support, they seemed to try to give more of their time, and to refer or investigate more.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1995

Continued prescribing of inappropriate drugs in general practice.

Seven general practitioners used various methods to identify patients in their practices whom they had inherited and whose medication they regarded as inappropriate in the light of current knowledge. Information was collected in each case about the drug concerned, the patient, the original prescriber, and the reason for continued prescribing. Each patient was also interviewed. Altogether, 25 different drugs were prescribed for 40 patients: in 16 the inappropriate drug was one acting on the brain, in 13 an antihypertensive, in seven it was given for heart disease and in three, for asthma. The influence of the original prescriber, and the patient's dependence on the drug, helped to explain its continued use. Almost half the patients said that they might consider changing their medication. The study underlines the importance of reviewing long-term medication and offers a method of scrutinizing repeat prescribing in general practice. Community pharmacists could help in this process.

Adult↗
PubMed1995

Diagnostic value of blood cytokine concentrations in acute pneumonia.

BACKGROUND: The role of cytokines in the pathogenesis of pneumonia is still poorly understood. In a previous study the diagnostic value of measuring blood concentrations of interleukin 6 and interferon gamma was established. In the present study the value of blood concentrations of interleukin 8, granulocyte-colony stimulating factor, and lactoferrin as markers of bacteraemic pneumonia is evaluated. METHODS: The circulating concentrations of interleukin 8 (IL-8), granulocyte-colony stimulating factor (G-CSF), and lactoferrin were measured in 14 patients with bacteraemic pneumococcal pneumonia and 49 patients with atypical pneumonia or influenza A infection using enzyme immunoassays. RESULTS: Serum G-CSF concentrations were higher in the group with bacteraemic pneumococcal pneumonia, and G-CSF values correlated with the white blood cell count and levels of C-reactive protein (CRP). The levels of IL-8 were higher in the group with bacteraemic pneumococcal pneumonia than the groups with Chlamydia pneumonia, Legionella pneumonia, or influenza A infection, but there was no difference when compared with the group with Mycoplasma pneumonia. A white blood cell count of > 15 x 10(9)/l was highly suggestive of bacteraemic pneumonia. The concentrations of lactoferrin were raised in all groups except those with influenza A infection, but no difference was found between the different aetiological groups. A correlation was found between lactoferrin and white blood cell counts. CONCLUSIONS: Serum G-CSF and IL-8 concentrations are potential markers of bacteraemic pneumonia.

Acute Disease↗