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Biomedical subjects

J Barlow

Publications and source records attributed to J Barlow.

At least 19 recordsLinked to original sources
PubMed2000

Parent-training programmes for improving maternal psychosocial health.

BACKGROUND: The prevalence of mental health problems in women is 1:3 and such problems tend to be persistent. There is evidence from a range of studies to suggest that a number of factors relating to maternal psychosocial health can have a significant effect on the mother-infant relationship, and that this can have consequences for the psychological health of the child. It is now thought that parenting programmes may have an important role to play in the improvement of maternal psychosocial health. OBJECTIVES: The objective of this review is to address whether group-based parenting programmes are effective in improving maternal psychosocial health including anxiety, depression and self-esteem. SEARCH STRATEGY: A range of biomedical, social science, educational and general reference electronic databases were searched including MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile and the Social Science Citation Index. Other sources of information included the Cochrane Library (SPECTR, CENTRAL), and the National Research Register (NRR). SELECTION CRITERIA: Only randomised controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being either a waiting-list, no-treatment or a placebo control group. Studies had to include at least one group-based parenting programme, and one standardised instrument measuring maternal psychosocial health. DATA COLLECTION AND ANALYSIS: A systematic critical appraisal of all included studies was undertaken using the Journal of the American Medical Association (JAMA) published criteria. The data were summarised using effect sizes but were not combined in a meta-analysis due to the small number of studies within each group and the presence of significant heterogeneity. MAIN RESULTS: A total of 22 studies were included in the review but only 17 provided sufficient data to calculate effect sizes. These 17 studies reported on a total of 59 outcomes including depression, anxiety, stress, self-esteem, social competence, social support, guilt, mood, automatic thoughts, dyadic adjustment, psychiatric morbidity, irrationality, anger and aggression, mood, attitude, personality, and beliefs. Approximately 22% of the outcomes measured suggested significant differences favouring the intervention group. A further 40% showed differences favouring the intervention group but which failed to achieve conventional levels of statistical significance, in some cases due to the small numbers that were used. Approximately 38% of outcomes suggested no evidence of effectiveness. REVIEWER'S CONCLUSIONS: It is suggested that parenting programmes can make a significant contribution to the improvement of psychosocial health in mothers. While the critical appraisal suggests some variability in the quality of the included studies, it is concluded that there is sufficient evidence to support their use with diverse groups of parents. However, it is also suggested that some caution should be exercised before the results are generalised to parents irrespective of the level of pathology present, and that further research is still required.

Anxiety↗
PubMed1999

Abnormal neurophysiology in patients with oesophageal motility disorders.

BACKGROUND: The pathology of oesophageal motility disorders is poorly understood. Oesophageal manometry provides only a descriptive assessment of luminal pressure changes. This study applied the investigative methods of the neurophysiologist to gain insight into the pathophysiology of these disorders. METHODS: Twelve healthy volunteers and 28 patients with oesophageal motility disorders underwent oesophageal manometry and balloon stimulation studies. Cortical evoked potentials (CEPs) in response to electrical stimulation of the oesophagus and oesophageal motor evoked potentials (MEPs) to transcranial magnetic stimulation of the cerebral cortex were recorded. RESULTS: Only two patients had abnormalities with a primary defect in muscle function. Fifteen had abnormal responses to balloon stimulation with normal CEPs and MEPs, suggesting a defect in the intrinsic nerves of the oesophagus. Five with achalasia did not respond to balloon stimulation and had abnormal CEPs and MEPs, suggesting widespread neural defects. The remainder had a variety of abnormal responses suggesting possible defects in receptor sensitivity, central processing or sensory neuropathy. There was no correlation between the manometric diagnosis and abnormal neurophysiology, except in patients with achalasia. CONCLUSION: Neurophysiological testing suggests that oesophageal motility disorders are most commonly due to a variety of neural defects.

Adult↗
PubMed1999

Development of a computer-controlled tensiometer for real-time measurements of tension in tubular organs.

A computer-controlled tensiometer for studying wall tension in tubular organs has been developed. The system consisted of a probe with an inflatable balloon, an impedance planimeter, pressure transducer and amplifier, a pump with RS232 interface and a PC with dedicated software. Circumferential wall tension was computed in real time from pressure and cross-sectional area measurements (tension measurement mode). Wall tension can be maintained on a preset level or be changed as a step or ramp function by a feedback control of the infusion/withdrawal pump (tension control mode). A software regulator adjusted the volume rate (low volume rate when the computed tension was close to the preset value) to minimize overshoot and oscillation. Validation tests were performed and the technique was applied in the human oesophagus. Volume- and tension-controlled balloon distensions elicited secondary peristalsis of increasing intensity that was decreased significantly by the antimuscarinic agent Hyoscine butyl bromide. In tension control mode Hyoscine butyl bromide caused oesophageal relaxation, i.e. CSA to increase and pressure to decay. Furthermore, pronounced pressure relaxation and tension relaxation were observed during volume-controlled distension after administration of Hyoscine butyl bromide.

Computer Systems↗
PubMed1999

Current methods of finish-line exposure by practicing prosthodontists.

PURPOSE: The purpose of this study was to survey members of The American College of Prosthodontists to evaluate current methods of finish-line exposure. In addition, frequency of use of epinephrine compounds and observed side effects were assessed. MATERIALS AND METHODS: A questionnaire was mailed to the 2,436 members of The American College of Prosthodontists. Group differences were evaluated using chi 2 analysis. RESULTS: Completed questionnaires were returned by 1,246 prosthodontists, which is a return rate of 51%. Ninety-eight percent of respondent prosthodontists use retraction cord, and 48% use a double-cord technique. Plain cord is the most commonly used cord (44%), followed by aluminum chloride-impregnated cord (18%), and epinephrine-impregnated cord (14%). Nine hundred one respondents (81%) soak the cord before placing it in the gingival sulcus. The most common medicament for soaking the cords is buffered aluminum chloride (55%). Side effects to epinephrine were reported by 387 respondents (33%), with the most common side effect reported being increased pulse rate, followed by anxiety. Approximately one quarter (24%) of the prosthodontists surveyed had observed side effects to chemical agents other than epinephrine. CONCLUSIONS: Prosthodontists throughout the country use many different techniques and agents to expose finish lines. No statistically significant differences (p > .05) were found between year of specialty training completion groups with respect to retraction cord use. Copper bands are used significantly more frequently (p < .05) in the northwest region of the United States than elsewhere.

Aluminum Chloride↗
PubMed1999

Acoustic detections of singing humpback whales (Megaptera novaeangliae) in the eastern North Pacific during their northbound migration.

Numerous (84) acoustic detections of singing humpback whales were made during a spring (08 March-09 June 1997) research cruise to study sperm whales in the central and eastern North Pacific. Over 15,000 km of track-line was surveyed acoustically using a towed hydrophone array. Additionally, 83 sonobuoys were deployed throughout the study area. Detection rates were greatest in late March, near the Hawaiian Islands, and in early April, northeast of the islands. Only one detection was made after April. Detection rates for sonobuoys were unequal in three equally divided longitudinal regions of the study area. Two high density clusters of detections occurred approximately 1200-2000 km northeast of the Hawaiian Islands and were attributed to a large aggregation of migrating animals. The distribution of these detections corroborates findings of previous studies. It is possible that these animals were maintaining acoustic contact during migration. Two unexpected clusters of singing whales were detected approximately 900 to 1000 km west of central and southern California. The location of these detections may indicate a previously undocumented migration route between an offshore breeding area, such as the Revillagigedo Islands, Mexico, and possible feeding areas in the western North Pacific or Bering Sea.

Acoustics↗
PubMed1999

Prescribing for leg ulcers in general practice, Part 2.

This study, the second of a two-part article, reports the findings of a survey undertaken to establish who selects the product used in the management of leg ulcers, and the factors influencing their decision making. The use of interviews (n = 9) followed by postal questionnaires (n = 197) confirms that the majority of decisions are made by practice nurses and district nurses. The findings suggest that, of the factors considered, patient comfort and compliance are the most important factors influencing product selection. This study also suggests that nurses are not using the best available evidence because of inaccessibility of resources and lack of time to search the literature. Nurses also cited difficulty in discriminating between a biased presentation and reliable research.

Acute Disease↗
PubMed1998

Project Charlie.

Explore the source record for details and available documents.

Health Education↗
PubMed1998

Systematic review of the school entry medical examination.

AIMS: To summarise and critically evaluate research conducted in the UK between 1962 and 1996, on the effectiveness and efficiency of the school entry medical (SEM) examination. METHODS: An electronic search of a large number of databases, in conjunction with a search of reference lists, and sources in the grey literature produced a total of 64 studies. RESULTS: Only one overview and 16 primary studies met the review's broad inclusion criteria. The results showed significant differences in the identification and referral of new and ongoing problems not only between the routine and selective SEM but also within the two types of SEM examination. There were also large differences in the numbers of children selected for SEM examination. No study included in the review defined either the methods or the criteria used to identify children as screen positive. No study provided follow up of children after referral to estimate the positive predictive value or yield of the screening, or follow up of the whole cohort to identify false negative cases. CONCLUSION: Data on the effectiveness and efficiency of both the routine and selective SEM examination in accurately identifying children with new or ongoing health problems are not available at the present time. The studies reviewed here demonstrate the fragility of the evidence on which the school entry medical is based, and call into question the ethical basis of this programme.

Child, Preschool↗
PubMed1998

Evidence for a lipid specific effect in nutrient induced human proximal gastric relaxation.

BACKGROUND/AIM: The presence of lipid in the upper gut is able to modify gastrointestinal motor performance, but its influence on the relaxation of the human stomach, which is known to modify gastric emptying, remains incompletely understood. The relaxation of the proximal stomach in response to various lipid concentrations was therefore studied in healthy volunteers. Since the observed effects could be mediated through osmolality or energy sensitive pathways, the effects of equicaloric and equiosmolar non-lipid solutions were also determined. METHODS: The tone of the proximal stomach was measured during stepwise inflation of a non-compliant bag sited in the proximal stomach, both before and after a test meal was delivered intragastrically. Iso-osmolar lipid emulsions were diluted in iso-osmolar saline at concentrations of 1.25, 2.5, 5, 10, and 20%. NaCl solutions at osmolalities of 300, 600, 1200 and 2400 mmol/kg and glucose solutions of 836 and 3344 kJ/l were also given. RESULTS: All lipid meals of 2.5% or greater concentration induced a reduction in gastric tone in a non-dose-dependent manner, responses to 5% lipid (median (range) 74 (62-92)%) being similar to those to 20% lipid (80 (55-83)%; p > 0.05). No relaxation was elicited by isocaloric glucose. NaCl only consistently caused relaxation at 2400 mmol/kg. CONCLUSION: Lipid meals reduce human proximal gastric tone by a lipid specific mechanism, independently of their energy content or osmolality.

Adult↗
PubMed1998

Responses to support groups for family caregivers in schizophrenia: who benefits from what?

With increasing focus on community-based mental health services, family caregivers require and deserve professional support. The aim of the paper is to provide information useful to mental health professionals planning to run support groups for family caregivers in chronic mental illness. The data presented here combine qualitative information with quantitative information. From 36 group members who were caring for a relative with schizophrenia, eight were selected with extreme positions on four intake dimensions: (i) length of time since patient's diagnosis; (ii) amount of carer-patient contact; (iii) level of psychological distress; and (iv) level of rejecting attitudes to the patient. Differences in the responses of these individuals to the group meetings, as shown by their comments on both short and long-term effects, suggest how meetings, as shown by their comments on both short and long-term effects, suggest how groups might be selected and structured for maximum effectiveness. While all carers wanted better mental health rehabilitation services, accurate information regarding their relatives' illness and respect from mental health professionals, their length of experience as carers fundamentally affected their responsiveness to the discussion topics.

Aged↗
PubMed1997

Estrogen affects development of alveolar structures in whole-organ culture of mouse mammary glands.

In order to determine if estrogen affects lobulo-alveolar development, and to determine if whole organ culture of mouse mammary glands is an appropriate model of estrogen effects on mammary development, mouse mammary glands were cultured in the presence or absence of phenol red and estrogen. Lobulo-alveolar development did not occur in vitro when phenol red was eliminated from culture medium. Lobulo-alveolar development was stimulated by 17 beta-estradiol in a dose dependent manner over a physiological range. These results support the hypothesis that estrogen plays a critical role in alveolar development in the mammary gland. In this report an in vitro model of mammary development is identified in which the effects of estrogen are morphologically described and quantified.

Aldosterone↗
PubMed1997

Improving outpatient clinic efficiency using computer simulation.

To assess and plan alterations in outpatient clinic structure, produces a computer simulation of an outpatient clinic based on detailed time and role measurements from the authors' clinic. The stimulation which used an object-oriented design method is able to indicate the impact of changes in clinic structure using patient and doctor waiting times in clinic as endpoint measures. The effects of changes in clinic size, consultation time, patient mix, appointment scheduling and non-attendance were examined. We found that patient waiting time could be shortened considerably by using an optimizing appointment scheduler to determine appointment intervals. Clinic mix influences patient waiting time, which was shorter with a 1 in 4 ratio of new to follow-up patients. In mixed clinics, new patients appointments are optimally spread throughout the clinic to reduce patient waiting time. In all new or all follow-up clinics, waiting time is improved if the appointment interval reflects the consultation time. Computer modelling can help in optimizing clinic management so improving the delivery of care in outpatient services.

Appointments and Schedules↗
PubMed1997

Cranial nerve modulation of human cortical swallowing motor pathways.

Animal data indicate that cortical swallowing pathways can be modulated by cranial nerve afferent stimulation. We therefore studied the effects of human trigeminal and vagal nerve excitation on the corticofugal pathways to the oropharynx and esophagus, using electromagnetic stimulation. Unilateral stimulation of either the trigeminal or vagus nerve evoked two distinct reflex electromyographic responses in the pharynx and esophagus, an early response (latency range 19-30 ms) and a late response (latency range 42-72 ms). In the mylohyoid muscles, however, only a single response was seen (latency range 36-64 ms). Cortical stimulation also evoked electromyographic responses in the mylohyoid muscles, pharynx, and esophagus, with latencies of 8.5 +/- 0.3, 9.3 +/- 0.3, and 10.1 +/- 0.4 ms, respectively. When either trigeminal or vagus nerve stimulation preceded cortical stimulation, the cortically evoked responses were facilitated, with maximal effects at interstimulation intervals of 30-200 ms for pharynx and esophagus (P < 0.02) and at interstimulation intervals of 50-100 ms for mylohyoid muscles (P < 0.05). Our results demonstrate that stimulation of human cranial nerve afferent fibers facilitates cortical swallowing motor pathways.

Adult↗
PubMed1997

Effect of cholecystokinin-A receptor blockade on lipid-induced gastric relaxation in humans.

The purpose of this study was to assess the role of endogenous cholecystokinin (CCK) in regulating fat-induced changes in human gastric relaxation. Proximal gastric pressure-volume relationships were determined in 12 healthy volunteers during a series of gastric distensions, both fasting and after intragastric instillation of 250 ml of 10% Intralipid. All subjects were studied twice, in a randomized, double-blind study, during intravenous infusion of either loxiglumide (CCK-A antagonist) or saline. For each distension, intragastric pressure and compliance were determined together with perception intensity. During saline infusion, Intralipid reduced intragastric pressure (prelipid, 11.7 +/- 0.8; postlipid, 9.7 +/- 0.6 mmHg; P = 0.002) and increased compliance (pressure-volume slope values: prelipid, 87.6 +/- 9.7; postlipid, 47.2 +/- 7; P < 0.01). Loxiglumide infusion during fasting exerted no effect on either intragastric pressure or compliance. After lipid, however, loxiglumide abolished the expected postlipid reduction in intragastric pressure (prelipid, 12.1 +/- 0.7; postlipid, 11.5 +/- 0.8 mmHg; P = 0.4) but did not consistently abolish the postlipid increase in compliance. Loxiglumide exerted no effect on the cumulative perception score or on the volume at perception threshold, although it prevented the fat-induced reduction in pressure at perception threshold [control: prelipid, 15.4 +/- 1.1; postlipid, 10.7 +/- 0.5 (P < 0.05); loxiglumide: prelipid, 13.8 +/- 1.5; postlipid, 12.2 +/- 0.9 (P > 0.05)]. Endogenous CCK or CCK-A receptors therefore play a role in the fat-induced reduction of intragastric pressure and might also modulate gastric perception after lipid.

Adult↗