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Biomedical subjects

J F Mayberry

Publications and source records attributed to J F Mayberry.

At least 91 records · Page 5Linked to original sources
PubMed1995

Colorectal cancer screening in asymptomatic populations.

Colorectal cancer is the second commonest cause of cancer death in the UK. An effective national screening programme is urgently required to reduce the substantial morbidity and mortality from the disease. The success of any screening programme will depend on the screening test detecting early Dukes's A carcinomas and adenomatous polyps. Prognosis is directly related to tumour staging and a proportion of carcinomas are thought to arise from polyps. Two screening methods exist--faecal occult blood testing and sigmoidoscopy. Large trials of faecal occult blood testing show that it detects more early lesions than in patients presenting with symptoms, but whether this reduces mortality is not yet confirmed and lack of sensitivity for cancers and polyps may ultimately limits its usefulness. The role of sigmoidoscopy in screening, particularly flexible sigmoidoscopy, has not been fully investigated. Flexible sigmoidoscopy has a greater sensitivity for distal lesions than stool testing and a randomised controlled trial of its efficacy is planned in Britain. Compliance with screening is essential to ensure its cost effectiveness in both health and economic terms. Large trials of faecal occult blood testing conducted over several years achieved compliance rates in excess of 60%, although in smaller studies these are often much less. Women frequently participate more than men. There are many reasons for non-compliance including lack of appreciation of the concept of asymptomatic illness and fear of the screening tests and cancer itself. Colorectal cancer screening is relatively cheap compared with breast and cervical cancer screening. Provisional cost estimates suggest that the amount spent to detect or prevent cancer by screening is similar to the amount required to treat a symptomatic patient.

Adenoma↗
PubMed1995

South Asian and European colitics show characteristic differences in colonic mucus glycoprotein type and turnover.

South Asians in Britain have a high incidence of ulcerative colitis and a low incidence of colorectal cancer. The pattern of mucus production in 12 South Asian and 16 European colitics and a control group of 19 South Asians was studied. Three types of mucin were identified after organ culture of colonic biopsy specimens with a dual label of [3H]-glucosamine and sodium [35S]-sulphate: type A had a high [35S]:[3H] ratio and high incorporation ([3H] dpm/micrograms DNA > 500); type B had a low ratio and high incorporation; and type C had low incorporation but with either high (C1) or low (C2) ratios. European colitic mucins show a significant reduction in the level of sulphation detected by mucin histochemistry with high iron diamine/Alcian blue staining, together with predominantly type B or C2 mucins (low sulphation). South Asian colitics showed histochemically normal patterns of high sulphation and largely type A and C1 mucins (high sulphation). There was no correlation of mucin type with disease activity index in either ethnic group. The appearance of apparently normal mucin in patients with ulcerative colitis may be a useful marker for the identification of a subgroup at low risk of colorectal cancer.

Asia, Southeastern↗
PubMed1995

Screening for colorectal cancer: reasons for refusal of faecal occult blood testing in a general practice in England.

STUDY OBJECTIVE: To ascertain reasons for non-compliance with faecal occult blood tests in colorectal cancer screening programmes. DESIGN: A standard interview by a trained nurse of a random sample of those who declined screening. SETTING: The Leicestershire town of Market Harborough, where most of the 25,000 population are served by a single general practice of 10 partners. PARTICIPANTS: Altogether 4185 residents aged 51 to 70 years were invited to receive a free faecal occult blood test (Haemoccult). Eighty one subjects from a sample of 351 who wrote declining the offer were interviewed. MAIN RESULTS: Non-compliers were divided into those who did not request a test kit and those who returned an unused kit. In the former group the commonest reasons given were intercurrent illness (39%), fear of further tests and surgery (24%), and feeling well (22%). For those who returned unused kits the commonest reasons were the unpleasantness of the stool collection procedure (65%), feeling well (30%), intercurrent illness (23%), and fear of further tests and surgery (20%). In both groups the main concern of those who did not comply were fear of further diagnostic tests and surgery rather than concern at the lack of effective treatment for cancer. CONCLUSIONS: To increase compliance, education and publicity must explain the concept of asymptomatic illness and allay people's fear of hospital investigation and treatment. The benefits of screening should be particularly emphasised to those who return kits so they may overcome their reservations.

Aged↗
PubMed1995

Incidence of Crohn's disease in Cardiff over 60 years: 1986-1990 an update.

OBJECTIVE: To report the incidence of Crohn's disease in the city of Cardiff between 1986 and 1990 and relate it to our previous incidence figures which extend over 60 years. METHODS: The incidence of Crohn's disease was examined using hospital diagnostic indices supplemented by records from clinicians and from the Department of Pathology, University Hospital of Wales, Cardiff, UK. In addition, a questionnaire was sent to all family practitioners in Cardiff asking them to identify patients in their practice. RESULTS: Eighty-six new patients were confirmed after reviewing the notes of patients in whom a diagnosis of Crohn's disease was considered. The mean incidence for this quinquennium was 5.9 cases per 10(5) of the population per year (95% confidence interval 4.7-7.3), with the highest age-specific incidence between those aged 15 and 34 years. Colorectal disease was the most common site of disease at the time of diagnosis and this was particularly striking in those aged over 50 years. CONCLUSIONS: The findings are related to our previous studies. The incidence of Crohn's disease has not continued to increase at the rate reported in early 1980s, but remains one of the highest reported in the literature. The colon has become the most commonly affected site, which may reflect an increase in diagnostic awareness.

Adolescent↗
PubMed1994

Survey of the attitude of medical and nursing libraries to information literature for patients with gastrointestinal diseases.

Senior staff in libraries at 281 medical schools, postgraduate institutions, schools of nursing and postgraduate medical centres were approached. They were asked to complete a detailed questionnaire on the availability of patient-orientated information and the nature of access by other health care professionals, patients and the public to their facilities. A total of 252 replies was received (response rate 90%). Medical and nursing schools tended to discriminate against each other's staff. Discrimination against patients was more widespread with less than 30% of libraries open to them. This was reflected in the lack of patient information such as booklets and videos. Less than 10% of libraries provided such information. Libraries in schools of nursing were significantly better in the provision of information about self-help groups. Overall there were limited interest in the provision of any service to patients or the general public.

Attitude↗
PubMed1994

Female fertility, obstetric and gynaecological history in coeliac disease. A case control study.

The purpose of this study was to investigate the incidence of infertility, abortions and perinatal mortality, age at menarche and menopause in coeliac disease (CD). It was a case control study in which patients and controls matched for age and sex were sent questionnaires about their fertility profile and other obstetric and gynaecological problems. All 80 patients and 70 controls replied but only 68 groups could be matched for this study. The mean age of menarche in patients was significantly older at 13.6 years than in controls at 12.7 years. The mean age at menopause in patients and controls were 47.6 and 50.1 years respectively. The study showed the mean number of children born to patients with CD was significantly less at 1.9 (SD +/- 0.9) compared to 2.5 (SD +/- 1.2) in controls. Before diagnosis the mean number of children born to patients was 1.4 and 1.8 in controls. After diagnosis and treatment, patients had 0.5 children (SD +/- 0.9) compared to 0.7 in controls (SD +/- 1.2). It seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten-free diet. Significantly more conceptions amongst women with CD (15%) ended in miscarriage prior to diagnosis than amongst controls (6%). After diagnosis and treatment the rate of miscarriage was similar at 7 and 12% respectively. There were 120 live babies and 7 stillbirths to patients compared with 161 live babies and 1 stillbirth to controls. In conclusion, this study shows that patients with CD are subfertile and have an increased incidence of stillbirths and perinatal deaths.

Adolescent↗
PubMed1994

National industry's interest in colorectal cancer screening programmes.

The interest of the largest 200 British industries in developing and financing colorectal screening services for employees was determined. A standard questionnaire asked if the company would advertise screening supply names of employees to local hospitals and finance faecal occult blood testing. The reasons for rejection were noted. Eighty-six companies returned the questionnaire (43% response rate) of which 78 firms (39% of the total mailed) were prepared to advertise screening programmes at the workplace. A quarter of the companies were prepared to both advertise and release employee details. Companies willing to participate employed significantly more people (mean of 17,000 employees) than those rejecting screening (mean of 6100 employees, Mann-Whitney U test = 7, P < 0.05). Fifty-nine industries would consider financing screening, although only five made a definite decision to do so. All companies rejecting (36/36) were concerned about releasing employee information to hospitals. If screening does reduce mortality and community programmes are developed industry could and is prepared to advertise such programmes. If a partnership between hospitals and industry is developed, concerns about employee confidentiality needs to be addressed.

Advertising↗
PubMed1994

A nationwide survey of liver biopsy--is there a need to increase resources, manpower and training?

A postal questionnaire survey was conducted to establish the pattern of current practice of liver biopsy, to estimate the frequency of adverse events and their possible associations, and to compare respondents' personal preferences with what they offer patients. Three hundred and sixty-four members of the British Society of Gastroenterology (BSG) were questioned. There were 296 returns, of which 278 were appropriate, giving an overall response rate of 81.3%. Over the previous 2 years complications were reported in 80 patients who required blood transfusion, 11 who needed laparotomy (including 1 for pain), 13 with septicemic shock, 29 who had peritonitis, and 1 with a subphrenic collection; 53 had pulmonary complications (hemoptysis, pneumothorax and 1 hemothorax), and there were 19 deaths. The overall complication rate was 5.6 per 1,000, and the mortality rate 5.2 per 10,000. The complication rate gradually decreased with increasing number of biopsies performed until the number reached 20 per month, after which there was a significant increase in complications (chi 2 = 42.98, p < 0.001). Although 50% of the respondents were themselves prepared to have a liver biopsy on a day case basis, only 11% do it routinely on patients, and 72% do not offer it at all (chi 2 = 76.8, p < 0.001). There were no differences in complication and death rates between the above groups, but those who do occasional (< 50%) day case biopsies have a significantly higher complication rate (chi 2 = 24.3, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle↗
PubMed1993

Disinterest in local self-help groups amongst patients with inflammatory bowel disease in Leicester.

An invitation to attend the inaugural meeting of a self-help group and a questionnaire were sent to 2084 patients with inflammatory bowel disease (IBD). Twelve months later 180 patients who had joined the group (n = 90) and a similar number who had not, were sent a second questionnaire seeking why they had or had not, and what functions the group had managed to fulfill. 254 (13%) responded and 138 (7%) joined. Patients with Crohn's disease chi 2 = 5.43, P = 0.02) and women (chi 2 = 3.80, P < 0.05) were more likely to join. These differences were not seen amongst the Asians who responded to the questionnaire (chi 2 = 0.01, ns) who were much less likely to respond (chi 2 = 15.1, P < 0.0001). Responders wanted the group to provide an information service (85%) to give an opportunity to discuss problems with other patients (77%) and to promote the needs of people with IBD to the local community. 88% (n = 159) responded to the second questionnaire, including 83 from joiners and 76 from non-joiners. Forty-seven (57% of joiners) had attended meetings. Answers indicated the group provided useful general information (99%), mutual support (66%), information on medical research (70%) and an opportunity to meet (60%). Amongst non-joiners, 81% (n = 62) thought such a group might be useful. Reasons for not joining included: too busy (40%), too far away (23%), managing without support (28%) and reluctance to broadcast their illness (20%).

Asia↗
PubMed1993

Smoking and ulcerative colitis: a community study.

Smoking habits of patients with ulcerative colitis, diagnosed in the City of Cardiff between the 1st of January 1978 and the 31st of December 1987 were examined. There was a significant deficit of current smokers, an excess of life-long non-smokers and ex-smokers compared with the general population. Men who had previously smoked presented with colitis later than life long non-smokers (mean age difference 16.1 years). The proportion of ex-smokers in this group of patients with colitis was more than twice that expected in the general population. The interval between cessation of smoking and subsequent onset of colitis in ex-smokers was relatively short and in more than half of them occurred within 8 years. There was no significant difference in the frequency of colectomy or the extent of disease among smokers, ex-smokers or life-long non-smokers with ulcerative colitis.

Adult↗
PubMed1993

Mortality in patients with ulcerative colitis in Leicestershire, 1972-1989. An epidemiological study.

The mortality in 1014 patients with ulcerative proctocolitis diagnosed while resident in Leicestershire identified in a population-based study from 1972 to 1989 was assessed. Ninety-two Europeans and one South Asian died. The standardized mortality ratio (SMR) in South Asians was 26 (95% confidence interval 0-147). In Europeans the overall mortality was not increased, the SMR was 93 (95% confidence interval 75-114). The SMR did not differ between established disease extents, but was highest in those patients in whom the extent was undefined (SMR = 237, 95% confidence interval 130-397). Comparison of SMRs and survival curves showed no difference in mortality in patients diagnosed from 1972 to 1980 and from 1981 to 1989. Mortality was similar in patients who had colectomy and those who had not (SMR = 130, 95% confidence interval 71-219, chi 2(1) = 1.2, NS). Mortality did not change during the study. These findings should be made available to patients and their families.

Adult↗
PubMed1993

Incidence of abdominal tuberculosis in Bangladeshi migrants in east London.

A retrospective epidemiological study of abdominal tuberculosis in a defined population in the London Borough of Tower Hamlets was conducted between January 1985 and 31 December 1989. The total population of 163,900 included a mean of 20,732 Bangladeshis. Of the 13 cases diagnosed 8 were Bangladeshi, with equal involvement of the peritoneum and intestine. The crude incidence in the Bangladeshi community was 7.7 cases/10(5)/year, which was significantly higher than that in Europeans (0.3 cases/10(5)/year, chi 2 with Yate's correction = 14.0 P < 0.001). The highest age-specific incidence was amongst those aged 16-20 years and 41-45 years. Most patients had a laparotomy or peritoneal biopsy to confirm the diagnosis. The response to therapy was good. Only 62% of cases were notified. This study confirms the importance of tuberculosis in the differential diagnosis of abdominal symptoms in Bangladeshi patients.

Adolescent↗
PubMed1993

Prevalence and family risk of ulcerative colitis and Crohn's disease: an epidemiological study among Europeans and south Asians in Leicestershire.

The family history of patients identified during incidence studies in Leicestershire were investigated and the prevalence and comparative risks calculated; 1254 patients aged 15 to 80 years were sent a questionnaire about their family history. All cases with a positive family history were reviewed and confirmed cases included in the study. In Europeans the standardised prevalence of Crohn's disease was 75.8/10(5) and that of ulcerative colitis 90.8/10(5). The prevalence of Crohn's disease among South Asians was 33.2/10(5) and that of ulcerative colitis 135/10(5). The prevalence of Crohn's disease in Europeans was significantly greater than that in Hindus (chi 2 = 16, p < 0.001), while the prevalence of ulcerative colitis was significantly lower in Europeans than Hindus (chi 2 = 27, p < 0.001) and Sikhs (chi 2 = 4.4, p < 0.05). The comparative risk of developing ulcerative colitis in first degree relatives of Europeans patients with ulcerative colitis was increased by approximately 15, but the risk of Crohn's disease was not increased. The comparative risk of developing Crohn's disease among first degree relatives of patients with Crohn's disease was increased by up to 35, the comparative risk of ulcerative colitis was approximately 3. The risk among relatives of South Asian patients with Crohn's disease was not increased, but the risk of ulcerative colitis to relatives of patients with ulcerative colitis was. This study supports the view that Crohn's disease and ulcerative colitis arise in people with a genetic predisposition and exposed to some, as yet unknown, environmental factor.

Adolescent↗
PubMed1993

The renaissance of abdominal tuberculosis.

During the last decade, abdominal tuberculosis (TB) has experienced a renaissance. The number of cases diagnosed in Western European and North American countries has dramatically increased. The reasons for this are multiple and include the appearance of AIDS as a significant disorder and the increased morbidity of peoples across the world with the migration of many people from areas of high incidence of TB to the West. Recent epidemiological work is reviewed, and its relationship to these changes considered. The distribution of disease along the gastrointestinal tract and in the mesentery is discussed. The frequency of involvement at various sites and the clinical symptoms caused by the disease are reviewed. The need to diagnose abdominal TB in the 1990s is considered in detail in areas where the disease had previously been thought rare.

Developing Countries↗
PubMed1993

Proctitis and proctosigmoiditis--a need to identify the extent of disease in epidemiological surveys.

Proctitis and proctosigmoiditis may be distinct clinical entities. The lesions are restricted to the rectum or extend proximally to involve the sigmoid colon, respectively. Barium enema examination should be normal proximal to the rectum and sigmoid colon. Histology is used merely to confirm the disease process. We provide evidence drawn from a large epidemiological database that significantly more patients with proctitis than proctosigmoiditis followed over a mean period of 11 years became asymptomatic or had their diagnosis revised to a non-inflammatory bowel disease condition (p < 0.05). The 2 groups were well-matched for age, sex, duration of disease and received similar medical treatment. Future epidemiological studies and therapeutic trials should make a distinction between proctitis and proctosigmoiditis.

Female↗
PubMed1993

Gastric and colorectal cancer in patients attending mission hospitals in rural areas of South-east Asia.

25 missionaries working in Taiwan, Thailand, Indonesia and the Philippines completed questionnaires regarding their clinical practice during the year 1980. Data were collected on the numbers of both gastric and colorectal cancers diagnosed. More than 90,000 out-patients were reviewed, and over 25,000 in-patients treated. In total, 76 gastric and 118 colorectal carcinomas were seen. Surgery and radiology were available at 88% of hospitals, but histology at only 53%. In both Indonesia and the Philippines, the relative risk of developing colorectal compared with gastric cancer was 3.3 (95% confidence limits 1.8-6.2 and 1.4-8.5, respectively). In Thailand and Taiwan, these tumours occurred with similar frequencies. Thailand, Indonesia and the Philippines had similar numbers of gastric neoplasms, but Taiwan a significantly higher number than the other countries (z > or = 4.4, p < 0.0001). Thailand had lower numbers of colorectal tumours than the Philippines, (z = 2.2, p < 0.05), Taiwan (z = 3.4, p < 0.001) and Indonesia (p = 5.0, p < 0.0001). Local dietary factors probably play an important role in the development of these tumours.

Christianity↗
PubMed1993

High risk of coeliac disease in Punjabis. Epidemiological study in the south Asian and European populations of Leicestershire.

The purpose of this study was to measure the incidence of coeliac disease in different ethnic communities and investigate the hypothesis that the incidence is decreasing in most European countries and the role incomplete retrieval of data may play. In a retrospective study of histologically confirmed cases of coeliac disease between 1975 and 1989 in the City of Leicester, 106 patients with coeliac disease were identified. Of these 86 were European and 20 Asian. The overall incidence of coeliac disease in Europeans was 2.5/10(5)/year (95% CI 2-3.2), in Gujaratis 0.9/10(5)/year (95% CI 0.4-1.8), and in Punjabis 6.9 (95% CI 3.2-12.3). These differences were independent of religious belief. The relative risk to Punjabis compared with Europeans is 2.9 (95% CI 1.5-5.3; chi 2 = 12.5, p < 0.01) and to Gujaratis 8.1 (95% CI 3-22.4; chi 2 = 25; p < 0.001). Gujaratis were at 0.4 risk of Europeans (90% CI 0.2-0.8; chi 2 = 6.7; p < 0.01). The incidence in the urban populations of Leicester was 6/10(5)/year (95% CI 1.3-1.9) which was significantly lower than the 3.2/10(5)/year (95% CI 2.7-3.8; chi 2 = 5.6; p < 0.001) in surrounding rural areas. This study shows that the incidence of coeliac disease in Punjabis (Sikhs, Hindus and Muslims) is 8 times higher than in Gujaratis (Hindus and Muslims) and 4 times higher than in Europeans in Leicester.

Adult↗