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Biomedical subjects

J Cleland

Publications and source records attributed to J Cleland.

At least 19 recordsLinked to original sources
PubMed2006

Sexual behavior and perceived risk of HIV/AIDS among young migrant factory workers in Nepal.

PURPOSE: To analyze the sexual behavior, perceived risk of contracting STIs and HIV/AIDS, and protective behaviors of migrant workers aged 14-19 years in carpet and garment factories in the Kathmandu Valley, Nepal. A common assumption in Nepal is that young migrant workers experience an increase in vulnerability. Moving away from the social controls of family and community, they become exposed to a mixed-gender environment and therefore might initiate sex earlier or have more casual encounters than might otherwise be the case. METHODS: The analysis is based on a representative sample survey of 1050 factory workers. Information was also obtained from 23 in-depth case histories. Both bivarite and multivariate techniques were applied to identify the factors associated with involvement in risky sexual behavior. RESULTS: Despite religious and cultural restrictions, one in five boys and one in eight unmarried girls reported experience of sexual intercourse. Early sexual experimentation, multiple partners, and low and irregular use of condoms are not uncommon. Instances of sexual exploitation by factory owners or managers were documented but were rare. Most nonregular sex partners were described as friends from the same factory or community. Despite high-risk behavior, relatively few young people considered themselves to be at risk of getting STIs or HIV/AIDS. Information on the possible consequences of unsafe sex is inadequate. CONCLUSION: Programs aimed at promotion of safer sex practices and life skill training that facilitates communication and utilization of sexual health services should target vulnerable migrant young people.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Migrant men: a priority for HIV control in Pakistan?

OBJECTIVES: To assess sexual risk behaviour and prevalence of treatable sexually transmitted infections (STI) in migrant male workers in Lahore, Pakistan. METHODS: Behavioural interviews were conducted on a representative sample of 590 migrant men aged 20-49 years. Biological samples were collected from a subsample of 190 and tested for chlamydia, gonorrhoea, and syphilis. RESULTS: Over half (55%) of single men were sexually experienced and 36% of married men reported premarital sex. The median ages at first intercourse and first marriage were 21 years and 28 years, respectively. In the total sample (including virgins), 13% reported any female non-marital partner in the past 12 months, 7% contact with a female sex worker, and 2% sex with a man. Only 10% reported using a condom during most recent contact with a sex worker. STI symptoms in the past 3 months were reported by 8% of men. Laboratory tests disclosed that STI prevalence was 3.2%. CONCLUSIONS: If and when HIV infection spreads among sex workers in Lahore, the reported behaviour of migrant men suggests that they may act as a conduit for further transmission to the general population. Condom promotion focused on the sex trade is likely to be the most effective way of reducing this risk.

Adult↗
PubMed2006

Management of COPD in primary care in north-east Scotland.

INTRODUCTION: We wished to obtain a snapshot of current service provision and how this could best be developed approximately one year on from the introduction of the National Institute for Clinical Excellence (NICE) guidelines for the management of chronic obstructive pulmonary disease (COPD) and the inclusion of COPD care in the New GMS Contract Quality and Outcomes Framework (QOF). METHODOLOGY: A questionnaire-based survey sent to every general practice (n = 84) in Grampian. RESULTS: Responses were received from 75 of 84 practices (89%). Questionnaires were returned by both general practitioners (GPs) and practice nurses in 45 practices (54%). All responding practices reported that they had COPD registers. 60/75 (80%) of practices reported having a dedicated COPD clinic; 70/75 (93%) had a spirometer. Areas identified for service development were: quality assuring training in COPD care and spirometry; expanding pulmonary rehabilitation provision (86%), delivering this service locally (54%) and in primary care (75%); standardising referral, assessment and communication about provision of home oxygen; training in pulse oximetry (71%). CONCLUSION: This data has important implications for the validity of the quality indicators (QOF) under the new GMS contract. Our respondents identified areas where the new GMS contract QOF could be improved, as well as providing useful suggestions for service development. Respondents recognised that not all clinical services can be effectively delivered by general practice with data supporting the development of intermediate care services for people with COPD.

Humans↗
PubMed2004

Differences between patients with a preserved and a depressed left ventricular function: a report from the EuroHeart Failure Survey.

AIMS: Due to a lack of clinical trials, scientific evidence regarding the management of patients with chronic heart failure and preserved left ventricular function (PLVF) is scarce. The EuroHeart Failure Survey provided information on the characteristics, treatment and outcomes of patients with PLVF as compared to patients with a left ventricular systolic dysfunction (LVSD). METHODS AND RESULTS: We performed a secondary analysis using data from the EuroHeart Failure Survey, only including patients with a measurement of LV function (n = 6806). We selected two groups: patients with LVSD (54%) and patients with a PLVF (46%). Patients with a PLVF were, on average, 4 years older and more often women (55% vs. 29%, respectively, p < 0.001) as compared to LVSD patients, and were more likely to have hypertension (59% vs. 50%, p < 0.001) and atrial fibrillation (25% vs. 23%, p = 0.01). PLVF patients received less cardiovascular medication compared to PLVF patients, with the exception of calcium antagonists. Multivariate analysis revealed that LVSD was an independent predictor for mortality, while no differences in treatment effect on mortality between the two groups was observed. A sensitivity analysis, using different thresholds to separate patients with and without LVSD revealed comparable findings. CONCLUSIONS: In the EuroHeart Failure Survey, a high percentage of heart failure patients had PLVF. Although major clinical differences were seen between the groups, morbidity and mortality was high in both groups.

Aged↗
PubMed2004

Monitoring sexual behaviour in general populations: a synthesis of lessons of the past decade.

This supplement contains selected papers from a workshop on the measurement of sexual behaviour in the era of HIV/AIDS held at the London School of Hygiene and Tropical Medicine in September 2003. The focus was on low and middle income countries, where the majority of HIV infections occur. The motive for holding such a meeting is easy to discern. As the AIDS pandemic continues to spread and as prevention programmes are scaling up, the need to monitor trends in sexual risk behaviours becomes ever more pressing. Behavioural data are an essential complement to biological evidence of changes in HIV prevalence or incidence. Biological evidence, though indispensable, is by itself insufficient for policy and programme guidance. AIDS control programmes need to be based on monitoring of not only trends in infections but also of trends in those behaviours that underlie epidemic curtailment or further spread.

Acquired Immunodeficiency Syndrome↗
PubMed2003

The EuroHeart Failure Survey programme--a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment.

BACKGROUND: National surveys suggest that treatment of heart failure in daily practice differs from guidelines and is characterized by underuse of recommended medications. Accordingly, the Euro Heart Failure Survey was conducted to ascertain how patients hospitalized for heart failure are managed in Europe and if national variations occur in the treatment of this condition. METHODS: The survey screened discharge summaries of 11304 patients over a 6-week period in 115 hospitals from 24 countries belonging to the ESC to study their medical treatment. RESULTS: Diuretics (mainly loop diuretics) were prescribed in 86.9% followed by ACE inhibitors (61.8%), beta-blockers (36.9%), cardiac glycosides (35.7%), nitrates (32.1%), calcium channel blockers (21.2%) and spironolactone (20.5%). 44.6% of the population used four or more different drugs. Only 17.2% were under the combination of diuretic, ACE inhibitors and beta-blockers. Important local variations were found in the rate of prescription of ACE inhibitors and particularly beta-blockers. Daily dosage of ACE inhibitors and particularly of beta-blockers was on average below the recommended target dose. Modelling-analysis of the prescription of treatments indicated that the aetiology of heart failure, age, co-morbid factors and type of hospital ward influenced the rate of prescription. Age <70 years, male gender and ischaemic aetiology were associated with an increased odds ratio for receiving an ACE inhibitor. Prescription of ACE inhibitors was also greater in diabetic patients and in patients with low ejection fraction (<40%) and lower in patients with renal dysfunction. The odds ratio for receiving a beta-blocker was reduced in patients >70 years, in patients with respiratory disease and increased in cardiology wards, in ischaemic heart failure and in male subjects. Prescription of cardiac glycosides was significantly increased in patients with supraventricular tachycardia/atrial fibrillation. Finally, the rate of prescription of antithrombotic agents was increased in the presence of supraventricular arrhythmia, ischaemic heart disease, male subjects but was decreased in patients over 70. CONCLUSION: Our results suggest that the prescription of recommended medications including ACE inhibitors and beta-blockers remains limited and that the daily dosage remains low, particularly for beta-blockers. The survey also identifies several important factors including age, gender, type of hospital ward, co morbid factors which influence the prescription of heart failure medication at discharge.

Adrenergic beta-Antagonists↗
PubMed2002

Infertility in Shanghai: prevalence, treatment seeking and impact.

To assess the level of treatment seeking and impact on marriage of infertility among newly married couples of Shanghai, China, a total of 7872 newly married couples, enrolled between 1987 and 1988, were followed-up for 5 years. The prevalence of infertility (no fertile conception after 24 months of unprotected intercourse) was found to be 5.1%. Couples' age at marriage, education, prior induced abortion, miscarriage, use of IUD or hormonal contraceptives and medical problems of both partners were associated significantly with infertility. About 57% of infertile couples sought infertility treatment and subsequently had a higher probability of childbirth (42%) than non-seekers (28%). Husband's education, induced abortion and both partner's previous medical problems were associated significantly with infertility treatment seeking. Moreover, infertile couples were 2.2 times more likely to divorce than their counterparts (95% CI 1.52-3.18). We conclude that infertility in Shanghai is modest, but a substantial number of infertile couples would not like to seek infertility treatment. Further research is needed on this subject.

Adult↗
PubMed2001

Repeat heart valve surgery: risk factors for operative mortality.

BACKGROUND: Patients undergoing repeat heart valve operations are a diverse population. We assessed risk factors for operative mortality in patients undergoing a first heart valve reoperation. METHODS: A retrospective review of hospital records was performed for 671 patients who underwent first repeat heart valve operations between 1969 and 1998. Univariable and multivariable analyses were performed. RESULTS: Operative mortality was 8.6%. Mortality fell each decade to 4.8% in the most recent period (adjusted chi(2) for linear trend P <.0005). Mortality increased from 3.0% for reoperation for a failed repair or reoperation at a new valve site to 10.6% for prosthetic valve dysfunction or periprosthetic leak and to 29.4% for endocarditis or valve thrombosis. Concomitant coronary artery bypass grafting was associated with a mortality of 15.4% compared with 8.2% when it was not required. Mortality for aortic valve replacement was 6.4%, mitral valve replacement 7.4%, aortic and mitral valve replacement 11.5%, tricuspid valve replacement 25.6%, periprosthetic leak repair 9.1%, and isolated valve repair 2.2%. Among 336 patients requiring replacement of prosthetic valves, mortality was 26.1% for replacement of a mechanical valve compared with 8.6% for replacement of a tissue valve (P <.0005). Multivariable analyses identified year of reoperation, age, coronary artery bypass grafting, indication, and replacement of a mechanical valve rather than a tissue valve as significant explanatory variables for operative mortality. CONCLUSIONS: Heart valve reoperations can be performed with an acceptable operative mortality. However, we have identified several categories of patients in whom reoperation carries an increased risk.

Aortic Valve↗
PubMed2001

Health-care seeking and expenditure by young Indian mothers in the public and private sectors.

A total of 421 young married mothers in Karnataka State, India, were followed up at monthly intervals for 1 year. Results are presented on self-reported morbidity, treatment-seeking behaviour and health expenditures. A total of 911 completed illness episodes were reported, of which 58% resulted in consultations with practitioners, mostly working in the private sector. Amongst those who did consult physicians, an average of 1.76 visits was made per episode. The average cost per visit was 46 Rupees and 38 Rupees, for private and public-sector consultations respectively. The overall mean annual expenditure on treatment and associated costs for the entire sample was 172 Rupees, of which 104 Rupees was spent on private-sector treatment. Poorer women reported significantly more days of morbidity than richer women but spent significantly less per 100 days of illness.

Cross-Sectional Studies↗
PubMed2001

Surveys on sexual health: recent developments and future directions.

The increasingly widespread adoption of the term sexual health reflects a move away from the medicalisation of this specialty. The focus has shifted from clinical practice to lifestyle and behaviour; from clinician to client, and from treatment to prevention. This article discusses these themes, identifying their implications for sexual health research. Recent times have seen, for example, a growing number of studies combining biological and behavioural measures conducted by interdisciplinary teams able to combine biomedical measurements of morbidity with insights into the subjective interpretations of symptoms and consequences. Considerable progress has been made, too, in mounting community based studies, and much has been achieved in gaining compliance and refining sampling methods. Integrated sexual health services, encompassing more than contraceptive or prophylactic service provision, have provided the impetus to investigation of the costs and benefits of coordinated family planning and genitourinary medicine services. Despite its broader focus, there remain opportunities for sexual health research to expand its remit. Studies to date may have focused too narrowly on pathological, to the neglect of health enhancing, consequences of sexual behaviour.

Adolescent↗
PubMed2001

The contribution of reproductive ill-health to the overall burden of perceived illness among women in southern India.

OBJECTIVE: To investigate women's perceptions of the overall burden of illness among a sample of women in southern India. METHODS: A community-based sample of 421 young married women in a subdistrict about 70 kilometres from Bangalore, Karnataka State, India, were interviewed monthly for one year. At each visit, information on the symptoms of all forms of illness they had experienced was elicited with the aid of a checklist. Details were obtained on the durations of episodes of illness and on health-seeking behaviour and costs. The symptoms were subsequently coded in accordance with the International Classification of Diseases (ICD-10). FINDINGS: Reproductive ill-health accounted for half of all illness-days and for 31% of total curative health expenditure. The 1990 Global Burden of Disease study estimated that 27.4% of disability-adjusted life years (DALYs) lost in Indian women aged 15-44 years were attributable to reproductive ill-health. CONCLUSIONS: Our study indicates that this dimension of morbidity, when measured in terms of women's subjective experiences, makes a larger contribution to the burden of illness than that suggested by the DALY approach. This lends justification to the high priority attached to reproductive ill-health in India.

Adolescent↗
PubMed2001

The role of MCH and family planning services in HIV/STD control: is integration the answer?

During the mid 1990s, high HIV and sexually transmitted disease (STD) prevalence led to calls for the integration of effective services with maternal and child health and family planning (MCH/FP) programs. There are advantages and disadvantages to integration, but little evidence existed to assess the practicalities of implementing this policy. Analysis of policy development for integration was conducted in Ghana, Kenya, South Africa, and Zambia. Semi-structured interviews were conducted with policy-makers at national, provincial and district levels and a survey of facilities was undertaken to identify gaps between policy intent and implementation. Significant advances had been made at the national level to formulate policies to integrate reproductive health and primary health care. However, barriers to implementation included entrenched HIV/STD and MCH/FP vertical programs; diverse demands on district managers and providers, such as on-going institutional reform; and conflicting objectives of international donors. Policy-makers need to address conflicting objectives between the needs for vertical accountability and the reality of providing integrated services. More careful consideration of implementation is required at earlier stages of policy design. Increased consultation with those who are to implement and provide integrated services is recommended.

Child↗
PubMed2000

Links between premarital sexual behaviour and extramarital intercourse: a multi-site analysis.

OBJECTIVES: Data from Côte d'Ivoire, Tanzania, Lusaka and Thailand were used to explore the relationship between premarital and extramarital sexual activity in men. DESIGN: Analysis was performed on data collected in the Global Programme on AIDS/WHO programme of stratified probability sample surveys of sexual behaviour of men and women aged 15 to at least 49 years interviewed face to face in 1989/1990. This analysis was restricted to male respondents currently married or in a regular partnership for at least a year. METHODS: Predictors of extramarital intercourse (EMI) in the preceding year were assessed using crude and adjusted odds ratios (OR), and 95% confidence intervals were calculated for a set of behavioural and sociodemographic variables that were believed a priori to be associated with EMI. RESULTS: Bivariate analysis showed that younger age at sexual debut, marriage to someone other than the debut partner and a higher number of sex partners before first marriage were significantly associated with enhanced probability of EMI in the past year in all sites. The adjusted OR indicated that in Côte d'lvoire and Tanzania the age at debut and in Tanzania and Thailand the number of sex partners before marriage were significantly associated with EMI in the past year. CONCLUSION: Characteristics of premarital conduct such as age at sexual debut, length of acquaintance with debut partner and number of premarital partners were significantly associated with EMI in men later in life. This continuity in sexual conduct over the life course was open to several competing interpretations, but sexual socialization in adolescence was likely to be at least a contributory factor.

Adolescent↗
PubMed2000

Angiography of fluoresceinated anti-vascular endothelial growth factor antibody and dextrans in experimental choroidal neovascularization.

OBJECTIVE: To determine if anti-vascular endothelial growth factor antibody and a range of dextrans with varying diffusion radii and molecular weights are permeable through experimental choroidal neovascularization (CNV). METHODS: Choroidal neovascularization was induced in 10 cynomolgus monkey retinas by means of argon laser injury. Digital fundus fluorescein angiograms were performed with fluorescein sodium, fluoresceinated IgG antibodies (anti-vascular endothelial growth factor and a control antibody), and fluoresceinated dextrans with molecular weights of 4, 20, 40, 70 and 150 kd. The 40- and 70-kd dextrans straddle the effective diffusion radius of IgG. For each reagent, early and late angiograms were performed in a standardized fashion, with follow-up images obtained to monitor residual fluorescence. RESULTS: Perfusion of retinal vessels and choroidal vasculature was seen with all reagents. Fluorescein and 4- and 20-kd dextran leaked rapidly from the CNV within the first minute. Angiography with the use of 40-kd dextran and fluoresceinated antibody, either anti-vascular endothelial growth factor or control IgG, showed fluorescence within the CNV that increased during the first 1 to 5 hours, with mild leakage from the CNV. By 24 hours, fluorescence in the CNV was minimal, although in some cases persistent fluorescence in the surrounding tissue was evident up to 2 weeks. The 70-kd dextran showed fluorescence within the CNV and leakage in 1 of 3 eyes. The 150-kd dextran showed fluorescence within the CNV but did not demonstrate leakage. CONCLUSIONS: Fluoresceinated antibodies and dextran with smaller effective diffusion radii showed CNV perfusion and leakage. Dextrans with larger effective diffusion radii (70 kd and 150 kd) perfused into CNV but did not show leakage consistently. CLINICAL RELEVANCE: Determining the permeablity of antibodies and molecules of similar size through CNV can help ascertain the feasibility of using intravenously administered antibodies against angiogenic growth factors as a future treatment for choroidal neovascularization.

Animals↗
PubMed2000

Low doses vs. high doses of the angiotensin converting-enzyme inhibitor lisinopril in chronic heart failure: a cost-effectiveness analysis based on the Assessment of Treatment with Lisinopril and Survival (ATLAS) study. The ATLAS Study Group.

OBJECTIVE: A cost-effectiveness analysis of high and low doses of the angiotensin-converting enzyme (ACE) inhibitor lisinopril in the treatment of chronic heart failure. METHODS: A cost-effectiveness analysis using data from a randomized controlled trial, ATLAS, where 3164 patients with chronic heart failure were allocated to a high-dose (daily target dose 32.5-35 mg) or low-dose strategy (daily target dose 2.5-5.0 mg) of lisinopril. Differential costs were based on resource use data collected in the trial costed using UK unit costs. Cost-effectiveness analysis related differential costs to differential life-years during a 4-year trial follow-up. RESULTS: The mean total number of hospital in-patient days per patient was 18. 5 in the high dose group and 22.5 in the low dose group. Over the whole duration of the trial, the mean (S.D.) daily dose of lisinopril in the high-dose group was 22.5 mg (15.7 mg) compared to 3.2 mg (2.5 mg) in the low-dose group. The mean difference in cost per patient was pound sterling 397 lower in the high-dose group [95% CI (high-dose-low-dose) - pound sterling 1263 to pound sterling 436]. Mean life-years per patient were 0.085 years higher in the high-dose group [95% CI (high-dose-low-dose) -0.0074 to 0.1706). Based on mean costs and life-years, high-dose therapy dominates low-dose (less costly and more effective). Allowing for uncertainty in mean costs and life-years, the probability of high-dose therapy being less costly than low dose was 82%. If a decision maker is willing to pay at least pound sterling 3600 per life-year gained, the probability of high-dose being more cost-effective was 92%. CONCLUSIONS: The ATLAS Study showed that the treatment of heart failure with high-doses of lisinopril has a high probability of being more cost-effective than low-dose therapy.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2000

Pulmonary artery pressure measurement during exercise testing in patients with suspected pulmonary hypertension.

It is recognized that exercise produces abnormally large increases in pulmonary artery pressure in patients with pulmonary vascular disease as a consequence of a variety of disorders, but the relationship between pressure and cardiopulmonary exercise performance is poorly understood. This lack of understanding is due (in part) to difficulty making measurements of pulmonary haemodynamics using conventional fluid filled catheters. This article seeks to improve understanding by comparing variables measured during formal exercise testing with simultaneous measurements of pulmonary artery pressure using a micro-manometer tipped catheter. Ten patients with suspected pulmonary hypertension were studied using a micromanometer tipped pulmonary artery catheter, during cardiopulmonary exercise testing. Ventilatory equivalents for oxygen and carbon dioxide correlated with the pulmonary artery pressure measured on exercise, but oxygen pulse and oxygen uptake did not. Ventilatory equivalents, noninvasively measured during exercise, may merit further study as potential surrogates of pulmonary artery pressure and hence be useful in identifying individuals at risk of developing pulmonary hypertension.

Adult↗