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Biomedical subjects

J B Henderson

Publications and source records attributed to J B Henderson.

At least 19 recordsLinked to original sources
PubMed2004

Unexplained swelling symptoms in women (idiopathic oedema) comprise one component of a common polysymptomatic syndrome.

BACKGROUND: Non-menstrually-related swelling symptoms (idiopathic oedema) are common in women. The community prevalence of such symptoms, their association with other symptoms, and their underlying aetiology, are uncertain. AIM: To determine the community prevalence of swelling symptoms and the independent contributions of major risk factors. DESIGN: Comparison of major risk factors in women with and without swelling symptoms. METHODS: We assessed 196 women attending a menopause clinic, 201 women attending a fracture clinic and 201 women attending their general practitioner. Each documented family histories of swelling symptoms and diabetes mellitus, age, height and current weight. Women attending the menopause and fracture clinics also completed Visual Analogue Symptom (VAS) scales documenting the perceived severity of swelling symptoms, and of 20 affective, somatic and functional autonomic symptoms. The independent contributions of risk factors to swelling symptom risk were estimated by logistic regression analysis. RESULTS: Of those attending a fracture clinic or their general practitioner, 28% and 33%, respectively, experienced non-menstrually-related swelling symptoms in the month before interview. Severe (RR 43, 95%CI 16-112, p < 0.001) and moderate (RR 7.8, 95%CI 4-15, p < 0.001) affective symptoms, a family history of swelling symptoms (RR 4.5, 95%CI 2.3-8.8, p < 0.001) and a body mass index (BMI) >or=25 kg/m(2) (RR 4.8, 95%CI 2.5-8.9, p < 0.001) were significantly associated with the presence of mild to severe swelling symptoms (VAS 1-9). The prevalence of swelling symptoms increased from 8% in women with no risk factors to 100% in women with three risk factors, which included severe affective symptoms. DISCUSSION: Affective symptom severity provides the principal independent contribution to swelling symptom risk. BMI >or=25 and a family history of swelling symptoms provide smaller independent contributions. The nature of the mechanisms underlying these associations remains uncertain.

Adolescent↗
PubMed1996

Thyroid function in idiopathic oedema.

BACKGROUND: The role of abnormal thyroid function in the aetiology of idiopathic oedema is unclear. Previous studies of small samples of patients have suggested a high prevalence of latent hypothyroidism and a possible deiodination defect in the conversion of T4 to T3 in this condition. There is a need to clarify the possible significance of abnormal thyroid function in a larger sample of idiopathic oedema patients. OBJECTIVE: The study was undertaken to compare basal thyroid function in idiopathic oedema patients and in an age and sex-matched control group. PATIENTS AND DESIGN: After excluding one idiopathic oedema patient and three control subjects with abnormal thyroid function, basal thyroid function was compared in 44 idiopathic oedema patients and in 44 age and sex-matched controls. MEASUREMENTS: Basal thyroid function was assessed in patient and control groups by measuring serum T4, fT4, T3, fT3 and TSH by standard methods. RESULTS: There were no significant differences in basal thyroid function between patient and control groups except for an elevated mean fT4 concentration in the idiopathic oedema group (P = 0.03). Exclusion of patients and controls taking oestrogen abolished this difference. T4:T3 ratios were similar in patient and control groups. CONCLUSION: Abnormalities of basal thyroid function are uncommon in patients with idiopathic oedema and appear unrelated to the pathogenesis of this disorder. Similar T4:T3 ratios between patient and control groups exclude a deiodination defect in idiopathic oedema.

Adult↗
PubMed1995

The role of diuretics in the aetiology of idiopathic oedema.

The hypothesis that diuretic use and abuse and other purging behaviours cause idiopathic oedema was investigated in 102 patients. Of 91 symptomatic idiopathic oedema patients tested at referral, 16 (17.6%) had diuretic and four (4.4%) laxative in their urine. None had grossly disturbed serum urea and electrolytes. Examination of primary care records from 41 idiopathic oedema patients who denied current diuretic consumption, and denied or were uncertain about past consumption, showed that 20 had not been prescribed diuretics by their general practitioners at any time; a further 18 had not been prescribed diuretics for between seven months and 12 years before referral. The absence of evidence of plasma volume depletion (as judged by similar concentrations of mean serum urea, creatinine, total protein and albumin in patient and age-matched control groups) suggests that neither systematic diuretic and laxative use or abuse, nor episodic overeating and vomiting were responsible for symptoms of idiopathic oedema in our patients. Idiopathic oedema has a strong genetic basis, and correction of major and minor risk factors for this condition leads to substantial amelioration of symptoms in most cases.

Adult↗
PubMed1991

Ranitidine suppresses aluminium absorption in man.

1. Intragastric pH monitoring was performed before and after the single-blind administration of ranitidine or placebo (saline) in eight healthy subjects and four patients with end-stage renal disease who were on regular haemodialysis. 2. The subjects were studied on two occasions and were given aluminum hydroxide (1185 mg) orally 90 min after the administration of ranitidine or saline. 3. Plasma aluminum concentrations and, in normal men, urinary excretion of aluminum were monitored before and after the oral aluminum load. 4. Intragastric pH increased significantly with ranitidine but not with placebo (P less than 0.001). Urinary aluminum excretion increased significantly after the administration of aluminum hydroxide during the placebo phase (P less than 0.001) but not during the ranitidine phase. Plasma aluminium concentrations were higher in the patients with renal failure than in the normal subjects (P less than 0.05), but were unchanged in both groups after the oral aluminium load. 5. This study shows that gastric pH is an important factor in the modulation of aluminum absorption in man, and indicates that reducing gastric acid secretion with ranitidine may reduce the toxicity of orally administered aluminium compounds.

Adult↗
PubMed1990

Asian osteomalacia is determined by dietary factors when exposure to ultraviolet radiation is restricted: a risk factor model.

Twenty-seven previously osteomalacic and 77 normal Asian women participated in a seven-day survey of dietary intake and daylight outdoor exposure. Individual levels of daylight outdoor exposure discriminated poorly between normal and osteomalacic women. The presence of osteomalacia was strongly related to varying degrees of vegetarianism. Lactovegetarianism (no meat, fish or egg consumption) was associated with significantly greater osteomalacic risk than ovolactovegetarianism (no meat or fish consumption). Unlike Asian rickets, high-extraction wheat cereal as chapatti was not a significant risk factor for osteomalacia in Asian women and dietary fibre was a less important risk factor than absent dietary meat, fish or egg. When exposure to ultraviolet radiation is limited, Asian osteomalacia (and Asian rickets) are determined by dietary factors.

Adolescent↗
PubMed1988

Changes in the incidence of acute appendicitis in Glasgow Asian and white children between 1971 and 1985.

Between 1971 and 1985 there was a significant rise in the annual hospital discharge rate for acute appendicitis in Glasgow Asian boys aged 10-19.9 years. A smaller and statistically insignificant rise occurred in Asian girls of 10-19.9 years; discharge rates for younger Asian boys and girls did not change significantly. In keeping with national trends, discharge rates for acute appendicitis in all Glasgow children fell significantly between 1971-85. The divergent trend in older Asian children may reflect dietary adaptation which is most marked in older Asian boys.

Acute Disease↗
PubMed1987

The importance of limited exposure to ultraviolet radiation and dietary factors in the aetiology of Asian rickets: a risk-factor model.

Regional variation in the prevalence of Asian rickets was examined in Coventry, Bradford and Glasgow. Records of 152 weeks of daylight outdoor exposure were obtained from 104 Glasgow Asian children, 53 of whom had been treated for rickets. Records of seven-day weighed dietary intake were obtained from 84 Asian children, 43 of whom had been treated for rickets. There was a marked north-south gradient in the prevalence of Asian rickets. In all cases of severe rickets with deformity the child was vegetarian. Severe rickets was associated with lower intake of meat, higher intake of chapati and lower daylight outdoor exposure values than in normal children. Multivariate analysis employing a combination of these variables provided good separation between rachitic and normal groups. A risk-factor model is proposed which suggests that regional variation in the prevalence of rickets among Asian communities in Britain is mainly determined by the effects of latitude and the nature of the urban environment on available ultraviolet radiation. Where UV radiation is restricted, individual propensity to rickets within a given Asian community is mainly determined by dietary factors.

Adolescent↗
PubMed1985

Prevention of rickets in Asian children: assessment of the Glasgow campaign.

In March 1979 the Greater Glasgow Health Board launched a campaign to reduce the high prevalence of rickets in Asian children in the city. A precampaign survey had shown that voluntary low dose vitamin D supplementation would reduce the prevalence of rickets in Asian children. A survey carried out two and three years after the launch of the official campaign also showed a reduction in the prevalence of rickets in children taking low dose supplements equivalent to about 2.5 micrograms (100 IU) vitamin D daily. There was a considerable reduction in the total prevalence of rickets in this survey compared with the precampaign survey. Hospital discharges of Asian children with rickets declined rapidly after the start of the campaign.

Adolescent↗
PubMed1984

The evaluation of new services: possibilities for preventing congenital toxoplasmosis.

We examine the resource implications of two potential health services aimed at preventing congenital toxoplasmosis: a screening service involving serological surveillance for toxoplasma infection in pregnant women and its prophylactic treatment; and a health education campaign to help pregnant women avoid acquiring toxoplasma infection, through advice about special precautions regarding hygiene. Measuring the costs and benefits of prevention is complicated by uncertainty of the incidence of congenital toxoplasmosis in the United Kingdom, the extent of its harmful manifestations--mental and visual handicap--and the effectiveness of preventive measures. Hence an important aspect of this study is that it exemplifies the use of 'sensitivity analysis' as an aid to evaluation in the absence of hard data. We find that a screening service would seem unlikely to save resources, but that a health education campaign would seem much more likely to do so and further assessment of its potential effectiveness would be valuable.

Blindness↗
PubMed1984

Co-ordinating prevention.

A major reason why the balance between pronouncements on prevention and action is tipped so much towards the former is that, in most countries, responsibility for prevention is fragmented and vaguely defined. If an effective and efficient national prevention policy is to come about, then it is important that overall responsibility be placed in the hands of a single agency, and for that agency to recognise that priorities in prevention must be a function of costs as well as benefits. The first task of such an agency will be to sort out the fundamental objectives of public policy by clarifying what is meant by prevention and specifying the rationale for government intervention and hence the sorts of prevention which should be the responsibility of the public sector. Given this, national expenditure on prevention from any source which contributes to government prevention strategy can be identified and expressed in the form of a programme budget showing the proportions of total prevention expenditure going to each of the defined programme areas (environment, occupational health and safety, screening, health promotion, etc.). This framework gives a broad overview of the existing situation and by forcing consideration of benefit valuation in any decision to alter the balance of expenditure between programmes, ought to lead to a more rational prevention strategy than would result from a focus on individual programmes in isolation. Moreover, through an emphasis on costs and benefits, the overseers of prevention policy will be better placed to consider the relative efficiency of existing policies--since all share the common objective of reducing future morbidity and mortality. Finally, consideration will also need to be given to issues of equity. The approach described, illustrated by the case of the United Kingdom, will, if adopted, increase the likelihood that a rational and sensible national prevention policy will emerge.

Budgets↗
PubMed1983

Smoking cessation in patients with cardiopulmonary disease: an initial study.

Thirty-five smokers, all with current, long-standing, cardiovascular or pulmonary disease, were randomly assigned to either health motivation treatment, or to aversive smoking. The former included self-management skills, a film model, verbal commitment, and discussion of the costs and benefits of smoking and abstinence. The latter included normally paced (every 30 sec.) aversive smoking, relaxation training, role playing high risk situations, and discussion of maladaptive thought patterns. Strong differences between the conditions in abstinence rate and reduction from baseline did not emerge; however, the data generally favored the health motivation condition both in attrition rates and in outcome immediately posttreatment and at six month follow-up. Negative mood states were found to be related to minimal reduction in smoking; and consistent mood dysphoria at pre and posttreatment predicted relapse at three month follow-up.

Affect↗
PubMed1983

Controlled hypotensive anesthesia to reduce blood loss in radical cystectomy for bladder cancer.

Controlled intraoperative hypotension has been reported to reduce blood loss in major cancer operations. We did a retrospective evaluation on the effects of induced controlled hypotensive anesthesia using enflurane or trimethaphan compared to standard normotensive anesthesia in 37 consecutive patients who were undergoing single stage radical cystectomy with pelvic lymphadenectomy and bilateral ureteroileal cutaneous urinary diversion. Group 1 contained 16 patients who received induced hypotensive anesthesia and group 2 contained 21 patients who received normotensive anesthesia. Average age, pathological stage, and hematocrit values preoperatively and 5 days postoperatively were not significantly different. The average blood loss in group 1 was 821 plus or minus 78 cc and in group 2 it was 1,740 plus or minus 132 cc, a difference of 919 cc (p less than 0.001). Concomitantly, total blood replacement was significantly different. The hypotensive group required an average of 1.38 plus or minus 0.25 units or 700 plus or minus 100 cc and the normotensive group averaged 3.25 plus or minus 0.45 units or 1,600 plus or minus 225 cc (p less than 0.05). In addition, only 69 per cent of the hypotensive group required blood replacement compared to 90 per cent of the normotensive group. Our data demonstrate that controlled hypotensive anesthesia markedly reduces blood loss for radical bladder cancer surgery.

Anesthesia↗
PubMed1982

An economic appraisal of the benefits of screening for open spina bifida.

Appraisal of the costs and benefits of public sector programmes is an essential part of planning the optimal allocation of society's resources. This paper reports a study of the potential benefits to be derived if the UK National Health Services (NHS) were to introduce a mass-screening programme for the prenatal detection of fetuses affected by open spina bifida. These benefits are compared with the costs of a screening programme as estimated in the Report [1] by the Working Group on Screening for Neural Tube Defects of the Department of Health and Social Security (DHSS), A satisfactory screening test for open spina bifida has been developed in recent years, but routine prenatal screening has not yet become generally available. The paper therefore considers first the inferences that may be drawn about the efficiency and desirability of implementing a national screening programme from comparison of its costs and benefits. A brief description of screening and its likely impact is followed by a discussion of previous attempts at measuring the benefits of a screening programme and it is argued that these evaluations have adopted an approach which is rather unsatisfactory from the standpoint of economic methodology. A more appropriate conceptual approach to measuring the benefits of a screening programme is outlined and, after discussing the resolution of the theoretical and practical problems encountered in applying it, estimates of the benefits are calculated. The findings are compared first with those of previous studies which are shown to have under-estimated the benefits and secondly with the costs of a screening programme which almost certainly are lower than the benefits. It is therefore concluded that a screening programme would constitute an efficient use of NHS resources. Details of the data and their sources are appended.

Adolescent↗
PubMed1982

Measuring the benefits of screening for open neural tube defects.

Evaluation of the costs and benefits of public sector programmes is necessary to plan the optimum uses for society's resources. Here the benefits of screening for open neural tube defects are examined, and the most appropriate methodological approach to their valuation is discussed in the context of the possible provision by the National Health Service of a routine prenatal screening programme. It is argued that, in measuring the benefits of screening, previous evaluations have adopted an approach that is rather unsatisfactory from the standpoint of economic methodology. An attempt is therefore made here to show the effect that adopting a more appropriate approach would have on the estimated value of the benefit of routine screening. The effect is found to be a substantial increase in its estimated value.

Cost-Benefit Analysis↗
PubMed1981

Vowel height and the perception of consonant nasality.

By means of an articulatory synthesizer, the perception of the oral-nasal distinction in consonants was explored experimentally. This distinction was chosen because it is achieved by a very simple articulatory maneuver and because it is phonologically relevant in virtually every language. Lowering the velum in equal increments provided continua of CV syllables varying in size of velopharyngeal port which were divided perceptually into /d/ and /n/ categories by American English listeners. To test the hypothesis that the coarticulation of these nasal consonants with lower (more open) vowels requires a larger area of velopharyngeal coupling to give a nasal consonant precept, three oral-nasal continua incorporating the vowels /i/, /delta/, and /alpha/, respectively, were presented for identification. The results were compared with those of A. S. House and K. N. Stevens [J. Speech Hear. Disord. 21, 218-232 (1956)] and A. S. House [J. Speech Hear. Disord. 22, 190-204 (1957)] obtained with steady-state vowels and consonantal murmurs and with those of M. H. L. Hecker [J. Acoust. Soc. Am. 34, 179-188 (1962)]. Three conclusions emerged. First, the relationship between vowel height and the amount of velopharyngeal coupling needed for a nasal precept occurs in conditions where subjects are required to make linguistically relevant judgments. Second, the relationship can arise in conditions where vocalic coarticulation is present. Third, the relationship is not confined to vowels but can also be observed in the case of dynamically articulated consonants. One of the continua was also used for discrimination experiments, which yielded the classical pattern of high discriminability at the category boundary.

Humans↗