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Biomedical subjects

J Brown

Publications and source records attributed to J Brown.

At least 415 records · Page 23Linked to original sources
PubMed1996

Enlarged blind spots in chorioretinal inflammatory disorders.

PURPOSE: This study was undertaken to better characterize patients with multifocal choroiditis and panuveitis (MCP), punctate inner choroidopathy (PIC), multiple evanescent white dot syndrome (MEWDS), and diffuse subretinal fibrosis syndrome. The specific aim was to determine whether these disorders were different entities or part of a spectrum of diseases with similar features. METHODS: Seventy-nine patients were included in this study. Most of the patients have been followed up prospectively since July 1980 with some found retrospectively. RESULTS: Forty-one patients had MCP, 16 had PIC, 6 had diffuse subretinal fibrosis syndrome, and 16 had MEWDS. Patients with MCP had visual loss and visual field defects caused directly by visible lesions or recurrent inflammation around old lesions. In particular, clustering of lesions around the optic nerve and nasal periphery was seen in patients with MCP and appeared to be related to visual field loss. Patients with PIC also had enlarged blind spot and other field defects explained by fundus lesions. Patients with PIC and MCP did not have recurrent lesions on extended follow-up. Patients with diffuse subretinal fibrosis syndrome represented a subset of patients characterized with lesions in the posterior pole, sever scarring, and visual loss. Patients with MEWDS had the least inflammation with symmetrically distributed lesions. Minimal permanent chorioretinal scarring was seen in patients with MEWDS. Visual field defects improved in most patients with MEWDS and PIC, whereas most patients with MCP and diffuse subretinal fibrosis syndrome did not improve. CONCLUSIONS: Although enlarged blind spots are a feature of all four disorders, other clinical, angiographic, and electroretinographic evidence suggest that these are different entities.

Adolescent↗
PubMed1996

A preliminary investigation into the aetiology of Meares-Irlen syndrome.

A recent double-masked placebo-controlled trial has confirmed that some children experience a reduction in symptoms of eyestrain and headache when they read through individually prescribed coloured filters and has shown that this benefit cannot be solely attributed to a placebo effect. People who are helped by coloured filters in this way have been described as having "Meares-Irlen syndrome'. We investigated the mechanism of this benefit by studying the optometric and visual perceptual characteristics of the children in the double-masked study. This population had normal refractive errors and heterophorias (none of the subjects had strabismus). They demonstrated slightly, but significantly, reduced amplitudes of accommodation and vergence and poor stereo-acuity. However, these factors seemed to be correlates of Meares-Irlen syndrome rather than the underlying cause. Pattern glare, a sensitivity to striped patterns (e.g. lines of text), was prevalent in our sample and was significantly associated with the subjects' symptoms. The spatial contrast sensitivity function was normal.

Adolescent↗
PubMed1996

Injury rates and physiological changes associated with lateral motion training in females.

The purpose of this investigation was to evaluate physiological changes and injury rates associated with lateral motion (slideboard) training. Twenty-five females performed slideboard exercise 3 days per week, 1 hour each session, over a 10 week period. Eleven females served as controls. The subjects were pre and post tested via treadmill exercise to determine VO2peak. Body composition was analyzed by a seven-site skinfold equation. The slideboard subjects (SBS) were evaluated daily for injury incidence. A factorial repeated measures ANOVA (p < 0.05) revealed a significant 14% increase in VO2peak. No significant modifications were shown for body composition. The incidence of injury was 80% for Grade I injuries, 52% for Grade II injuries, 0% for Grade III injuries, and 4% for Grade IV injuries. Thus, the primary injury reports were of a Grade I and Grade II level of severity. The present injuries were largely associated with delayed onset muscle soreness (DOMS) in the medial leg musculature during the first two weeks of training. These results show that during a 10 wk training program lateral motion exercise is an effective mode for improving cardiorespiratory fitness. In addition, the risk of incurring an injury requiring medical attention appears to be quite low. However, untrained women who perform this activity at a frequency, duration, and intensity similar to the present study may experience muscle soreness during the initial period of training.

Adult↗
PubMed1996

The relationship of neuropsychological status and productive outcomes following traumatic brain injury.

Neuropsychological assessment is a standard component of traumatic brain injury rehabilitation programmes; however, the relationship between neuropsychological test scores and functional abilities is not clear. The current study compared serial neuropsychological test data with functional outcomes for 152 subjects. Outcome was operationally defined for three activity settings (home, school, work) with six levels of productivity for each. Productivity was defined as one's ability to function at increasing levels of independence. Demographic and caseload variables were analysed utilizing correlation and stepwise multiple regression analyses. Significant relationships to outcome were found between certain neuropsychological test scores, and certain demographic variables. Positive outcomes were related in part to patient's speed of information processing, memory skills, and simultaneous processing abilities. Also related to positive outcomes were mechanism of injury, level of insurance funding, premorbid educational level, and negative history of substance abuse. The activity setting influenced outcome such that it appeared to be most difficult to return to work, suggesting the necessity of adequate vocational assistance. However, cognitive and demographic variables accounted for less than 30% of the total variance in outcome. Therefore, brain injury rehabilitation must be multifaceted.

Activities of Daily Living↗
PubMed1996

Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample.

OBJECTIVE: To examine teacher-reported prevalence rates for attention-deficit hyperactivity disorder (ADHD) based on DSM-III-R and DSM-IV in the same population. METHOD: Teachers completed questionnaires in which they rated all their students on all DSM-III-R and DSM-IV symptoms for disruptive behavior disorders except for seven conduct disorder symptoms but including seven symptoms screening for anxiety or depression. This constituted all children in kindergarten through fifth grade in a middle Tennessee county during the 1993-1994 academic year (16 schools, 398 teachers, and 8,258 children). Also included were questions about the children's diagnosis of ADHD, treatment with stimulants, and the presence of behavior or academic problems. RESULTS: The prevalence rates were 7.3% for ADHD (DSM-III-R); 11.4% for ADHD, total (TOT); 5.4% for ADHD, inattentive type (AD); 2.4% for ADHD, hyperactive-impulsive type (HI); and 3.6% for ADHD, combined type (CT). Factor analysis identified five factors: opposition/defiance-conduct, inattention, hyperactivity/impulsivity, anxiety/depression, and stealing-truancy. The rates of problems differed mostly between ADHD-AD and ADHD-HI (40% versus 80%) for behavior and (75% versus 23%) for academics. Few (15% to 40%) had an ADHD diagnosis or stimulant treatment (21% to 32%). CONCLUSION: DSM-IV criteria are likely to increase the prevalence of this disorder in comparison with DSM-III-R rates, but they may better characterize its heterogeneity.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Recombination patterns around the breakpoints of a balanced 1;11 autosomal translocation associated with major mental illness.

The frequency and extent of pairing failure around human translocations are unknown. We have examined the pattern of recombination around the breakpoints of a balanced autosomal translocation t(1;11) (q43;q21) associated with major mental illness. DNA was available from 17 carriers and 10 non-translocation carriers with meioses involving four generations. The derivative 1 and 11 chromosomes were also isolated in somatic cell hybrids and used to confirm phase. We have genotyped pedigree members using 20 polymorphic markers within 10 cM on either side of both chromosome 1 and 11 breakpoints. We find no significant reduction of recombination in the vicinity of either breakpoint. However we estimate that there are insufficient meioses even in this large family to make a meaningful interpretation and suggest that sperm typing alone can answer these interesting questions.

Chromosome Mapping↗
PubMed1996

Attention deficit hyperactivity disorder: perceptions, practice and politics.

Some of the issues related to the doubts and complexities involved in the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) are reviewed. While some writers claim that it is clear that all children presenting with ADHD should be treated by pharmacological means, there are associated risks and politics. However, in the absence of well established and research-supported alternative understandings of the aetiology and treatment of the disorder, many practitioners feel unable to offer a useful service. Resulting frustrations have led some parents to form their own support networks, which make strong demands for increased services. More creative and innovative therapeutic interventions focusing on the broader impact of ADHD must be developed to deal with this disorder.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Meningococcal disease in urban south western Sydney, 1990-1994.

BACKGROUND: There has been a sustained increase in incidence of meningococcal disease throughout Australia since 1987. In south western Sydney the incidence is higher than the national rate and a cluster of cases occurred in 1991 resulting in a widespread vaccination programme. AIMS: To investigate the clinical demographics of patients with meningococcal disease treated in south western Sydney, and to differentiate meningococcal strains to understand better the epidemiology in this urban setting. In addition, to investigate whether delays in diagnosis of meningococcal disease and institution of appropriate treatment were occurring. METHODS: Retrospective classification of notified cases as meningitis, septicaemia, meningitis/septicaemia, and other syndromes. Clinical information recorded to establish patterns of disease, delays in diagnosis and appropriate treatment, and outcome. Microbiological classification of organisms isolated by serogroup, serotype and subtype. RESULTS: Meningococcal disease primarily affects young children in winter months in south western Sydney, with a secondary peak of incidence in the 15-20 year old age group. 20.7% presented with meningitis only, 22.4% with septicaemia only, and 53.4% with meningitis/septicaemia. There was a delay in diagnosis and institution of appropriate treatment of more than two hours in 21/58 (36.2%) patients including three of the six who died. No patient had received a parenteral antibiotic prior to coming to hospital -18.9% had received an oral antibiotic. The use of antibiotics before diagnostic lumbar puncture decreased the number of positive CSF cultures. However, in all but one patient with negative cultures there was other microbiological evidence of meningococcal disease. The mortality rate was highest (30.8%) in patients with septicaemia only, 6.5% in patients with meningitis/septicaemia and 0% in patients with meningitis only. Serogroup C was the predominant organism in all age groups. The predominant serotype was 2b (80% of serogroup C isolates). Subtypes were more variable but P1.2 occurred in 66.7% of serogroup C strains. CONCLUSIONS: There is a need for more education in our Health Area to improve the time taken to diagnose and institute appropriate treatment. The predominance of serogroup C is unusual in urban Australia where national data show serogroup B organisms predominate. Meningococci of phenotype C:2b:P1.2 have continued to cause disease in our Health Area for the past five years. This phenotype is uncommon in other areas of Australia.

Adolescent↗
PubMed1996

Assessment of medication compliance in alcoholics through UV light detection of a riboflavin tracer.

Compliance with the medication regimen in treatment trials for alcoholism appears to be a key determinant of treatment outcome. However, there is no consensus as to the best method to assess medication compliance. This study examines the feasibility of using ultraviolet light detection of a urinary riboflavin tracer to determine compliance with medication therapy. Six sets of urine specimens (with n ranging from 15 to 38) were rated independently by two judges. Test-retest reliability was high: 90 and 95% agreement for two judges. Inter-rater reliability ranged from 73 to 95% agreement between judges (mean = 88%), with correspondence kappa values ranging from 0.46 to 0.85 (mean = 0.69). Diaries, capsule counts, and spectrofluorimetric data were used to validate judges' ratings in four trials, including one in which subjects were alcohol-dependent participants in one of three pharmacotherapy trials. Rating accuracy was influenced by dosage, time interval between ingestion and urine collection, and previous dosing. Overall, ratings tended to be accurate, with incorrect judgments limited to specimens with low concentrations of urinary riboflavin. The results indicate that ultraviolet light detection of urinary riboflavin is a useful method for the assessment of patient compliance with medication regimens, including compliance of patients assigned to receive placebo in clinical trials of medications for alcoholism treatment.

Alcoholism↗
PubMed1996

Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics.

OBJECTIVE: The aim of this study was to test the hypothesis that, because of abnormalities in serotonergic neurotransmission that may underlie craving and impulsive behavior, fluoxetine treatment differentially affects drinking among type B alcoholics, who are characterized by high levels of both premorbid vulnerability and alcohol-related problems. METHODS: Using a k-means clustering procedure, alcohol-dependent subjects from a placebo-controlled trial of fluoxetine were grouped into low-risk/severity (type A: n = 60) and high-risk/ severity (type B: n = 35) groups. Multivariate analysis of covariance (with pretreatment measures as covariates) evaluated the effects of Alcoholic Subtype, Medication Group, Treatment Completion, and their interactions on measures of drinking, both during the 12-week treatment period and a 6-month follow-up period. RESULTS: Although there were no main effects of Alcoholic Subtype or Medication Group, subjects who completed the treatment trial showed significantly better drinking-related outcomes. There was also an interaction of Alcoholic Subtype by Medication Group during treatment. Among type B subjects, fluoxetine treatment resulted in poorer drinking-related outcomes than placebo treatment. Among type A subjects, there was no effect of Medication Group. This interactive effect did not persist during the 6-month follow-up period. CONCLUSIONS: Alcoholic subtypes identified by cluster analysis seem to be differentially responsive to the effects of fluoxetine treatment on drinking-related outcomes. Serotonergic abnormalities previously identified among a subgroup of alcoholics who are also characterized by impulsivity and severity of alcohol dependence may help to explain the differential medication effect. Based on these findings, it is recommended that, in the absence of a comorbid mood or anxiety disorder, fluoxetine not be used to maintain abstinence or reduce drinking in high-risk/severity alcoholics.

Adult↗
PubMed1996

Occupational stress among senior police officers.

From a survey of over 500 senior UK police officers completing the occupational stress inventory, it was observed that those serving in England and Wales exhibited the highest job stress related to structure and climate, co-worker relationships and their managerial role. There were no inter-regional differences on the individual difference variables, Type A behaviour, locus of control, or on physical health measures. Superintendents in Scotland used coping methods least frequently including domestic/home support, time management and social support, the latter strategy being most used by Northern Ireland officers. Findings relating job stress to job satisfaction were inconsistent with other police populations. Results are discussed in the context of organizational reform in the police service.

Adaptation, Psychological↗
PubMed1996

Prognosis in lung cancer: physicians' opinions compared with outcome and a predictive model.

BACKGROUND: Although the study of prognostic factors in small cell lung cancer has reached the stage where they are used to guide treatment, fewer data are available for non-small cell lung cancer. Although correct management decisions in non-small cell lung cancer depend upon a prognostic assessment by the supervising doctor, there has never been any measurement of the accuracy of physicians' assessments. METHODS: A group of consecutive patients with non-small cell lung cancer was studied and the predictions of their physicians as to how long they would survive (in months) was compared with their actual survival. A prognostic index was also developed using features recorded at the patients' initial presentation. RESULTS: Two hundred and seven consecutive patients diagnosed and managed as non-small cell lung cancer, who did not receive curative treatment for their condition, were studied. Of the 196 patients whose date of death was known, physicians correctly predicted, to within one month, the survival of only 19 patients (10%). However, almost 59% of patients (115/196) had their survival predicted to within three months and 71% (139/196) to within four months of their actual survival. Using Cox's regression model, the sex of the patient, the activity score, the presence of malaise, hoarseness and distant metastases at presentation, and lymphocyte count, serum albumin, sodium and alkaline phosphatase levels were all identified as useful prognostic factors. Three groups of patients, distinct in terms of their survival, were identified by the use of these items. When the prediction of survival made by the physician was included as a prognostic factor in the original model, it was shown to differentiate further between the group with a poor prognosis and the other two groups in terms of survival. CONCLUSIONS: Physicians were highly specific in identifying patients who would live less than three months. However, they had a tendency to overestimate survival in these patients, failing to identify almost half the patients who actually died within this time. Both the physicians and the prognostic factor model gave similar performances in that they were more successful in identifying patients who had a short time to survive than those who had a moderate or good prognosis. Physicians appear to use information not identified in the prognostic factor analysis to reach their conclusions.

Adult↗
PubMed1996

Expandable metal stents for non-malignant bronchial obstruction.

An expandable metal stent was inserted to relieve bronchial obstruction following lobectomy for localised squamous carcinoma which had not been relieved by bronchoplasty with a Goretex flap. This resulted in substantial improvement in lung function and exercise tolerance for nine months, following which severe inflammation around the stents required residual pneumonectomy.

Airway Obstruction↗
PubMed1996

Amino acid profiles and muscle protein composition in rats with a reduced renal mass in the fed state.

In severe chronic renal failure (CRF) with associated metabolic acidosis, abnormalities in protein metabolism and amino acid (AA) profiles in the fed state are well described. To evaluate the effect of early uraemia and the influence of acid-base status on protein metabolism and AA profiles, three groups of pair-fed rats were studied: group I - rats with 1+ 1/2 nephrectomy; group II - rats with 1+ 1/2 nephrectomy receiving NaHCO3 supplementation, and group III - sham-operated rats with NaHCO3 supplementation. After 4 weeks, serum creatinine values were similar in groups I and II (111 +/- 5 and 119 +/- 4 mumol/l) and higher than in group III (51 +/- 5 mumol/l, p < 0.0001); HCO-3 was reduced only in group I (22.4 +/- 0.8 mmol/l) compared to group II (28.3 +/- 0.6 mmol/l, p < 0.001) and group III (28.2 +/- 1.3 mmol/l, p < 0.001). In the uraemic animals (groups I and II) arterial AA profiles showed increased levels of phenylalanine, glycine, glutamate, proline and alanine. The marked increase of threonine in group I was corrected by NaHCO3 supplementation in group II. The total nonessential AA were higher both in group I (1,832 +/- 53 mumol/l, p < 0.05) and group II (1,788 +/- 103 mumol/l, p < 0.05) than in group III (1,542 +/- 54 mumol/l). These results are similar to those described in the fed state of uraemic patients. Intracellular AA changes were detected, especially in group II namely increased glycine and a decrease in threonine and serine levels. No signs of malnutrition or changes in alkali-soluble protein (ASP) or ASP/DNA ratio in liver and muscle were observed. These results show that AA abnormalities in the fed state occur early in the course of CRF, and that the marked increase of threonine is corrected by NaHCO3 supplementation. These data suggest that either an impaired utilization of the ingested proteins might occur before the appearance of major alterations in endogenous protein metabolism or acid-base status might alter AA metabolic rate per se.

Acid-Base Equilibrium↗