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Biomedical subjects

J Kennedy

Publications and source records attributed to J Kennedy.

At least 73 records · Page 4Linked to original sources
PubMed1999

E test versus agar dilution for antimicrobial susceptibility testing of viridans group streptococci.

Viridans group streptococci (VGS) are commonly isolated from the blood of hospitalized patients. The E test represents a convenient method for determining the MICs for VGS, but for this purpose it has not been well validated against reference methods. In this study, 180 unselected VGS isolates were identified to a species level, and the MICs of penicillin, cefuroxime, cefotaxime, and vancomycin were determined by both agar dilution and the E test. Available data regarding demographic and laboratory variables for each VGS bacteremic episode were collected, the significance of each VGS isolate was assessed, and the associations between and among laboratory and clinical variables were investigated. Among all VGS isolates, 68.3% (median of three runs) were found to be fully susceptible to penicillin by agar dilution. The E test and agar dilution showed average agreements (within +/-1 dilution) of 92.2% for penicillin, 95.7% for cefuroxime 91.3% for cefotaxime, and 86.7% for vancomycin. Agreements over serial E tests and serial agar dilutions were excellent for beta-lactam agents (intraclass correlation coefficients, >0.9) but less impressive for vancomycin. Very major error rates for the E test were </=0.7%, and combined major and minor error rates were within acceptable limits for all antimicrobial agents tested. Lysis-centrifugation culture methods were more often associated with clinically insignificant VGS isolates; otherwise, no associations between clinical and laboratory variables were noted.

Anti-Bacterial Agents↗
PubMed1999

A national profile of primary and secondary household caregivers: estimates from the 1992 and 1993 surveys on income and program participation.

According to the 1992 and 1993 Surveys of Income and Program Participation (SIPP), an estimated 4,538,000 adults in the U.S. serve as primary assistants for one or more household members with disabilities. Another 530,000 serve as secondary assistants. Spouses are the main source of primary ADL and IADL assistance, while adult children and other family members are the main source of secondary assistance. Primary household assistants tend to be older and female, while secondary assistants tend to be younger and male. Primary assistants are more likely than the general adult population to rate their health as fair or poor, describe themselves as work disabled, and be limited in or need assistance with ADLs. Secondary assistants report slightly higher rates of work disability than the general population, but similar rates of ADL limitation and health status. Both assistance groups are more likely than the general adult population to have annual family incomes which fall below the federal poverty line, and working-age (aged 18-64) assistants are much less likely to work full time.

Activities of Daily Living↗
PubMed1999

An evaluation of non-verbal handover.

Verbal handover can have a detrimental effect on nursing documentation. Information provided by verbal handover can be retrospective and task-orientated. Non-verbal handover can save time and ensure documentation is properly updated.

Communication↗
PubMed1999

Dietary supplement use in U.S. Army Special Operations candidates.

We administered a dietary supplement survey to 2,215 males (mean age, 25 years; range, 18-47 years) entering U.S. Army Special Forces and Ranger training schools. The survey contained questions on demographics and health as well as the use of vitamin, mineral, protein, pro-performance, and other cofactor supplements; answers were made on a five-point frequency scale. Eighty-five percent of the men reported past or present use of a supplement, 64% reported current use, and 35% reported daily use. Individuals using a supplement at least occasionally were significantly less likely to smoke (p < 0.05) and more likely to exercise on a daily basis. Recent U.S. Department of Agriculture survey data (1994) reported that 39% of males 20 to 39 years old used a dietary supplement at least occasionally. Our data indicate that the rate of supplement use in this study group was much higher than in the general population of young men. This observation supports the need to study more extensively the use and benefits or potential harm of dietary supplementation by otherwise healthy individuals.

Adolescent↗
PubMed1999

Shoulder dystocia.

Explore the source record for details and available documents.

Delivery, Obstetric↗
PubMed1999

Retinopathy of prematurity in infants < 32 weeks' gestation at birth in New South Wales in 1993 and 1994.

OBJECTIVE: To study the incidence and severity of retinopathy of prematurity (ROP) in infants < 32 weeks' gestation. DESIGN: Review of the records maintained in the New South Wales Neonatal Intensive Care Unit Study (NICUS) database on infants admitted to the neonatal intensive care units (NICU) in NSW from 1 January 1993 to 31 December 1994. RESULTS: In the more premature infants, 23-26 weeks' gestation, 65% developed ROP (102 of 157 examined for ROP). Forty-four infants (28%) developed severe ROP (Stage >/= 3 ROP), 19 infants (12.1%) required cryo/laser therapy and one infant (0.6%) in this group had a retinal detachment. One hundred and fifty-seven of 159 surviving infants (98.7%) were examined for ROP. In the infants 27-28 weeks' gestation, 38.3% developed ROP (103 of 269 examined for ROP). Fifteen infants (5.6%) developed severe ROP, seven infants (2. 6%) required cryo/laser therapy for threshold ROP and three infants (1.1%) in this group had a retinal detachment. Two hundred and sixty-nine of 299 surviving infants (90%) were examined for ROP. In the infants 29-31 weeks' gestation, 10.8% developed ROP (48 of 443 examined for ROP). Six infants (1.4%) developed severe ROP, one infant (0.2%) required cryo/laser therapy for threshold ROP and no infant in this group had a retinal detachment. However, only 443 of 681 surviving infants (65.1%) in this group were examined for ROP. Of the four infants with detached retinas, one was a 25 week gestation infant weighing 840 g, two were 27 weeks' gestation weighing 960 and 980 g and one infant was a 28 week gestation infant weighing 620 g. No infant developed Stage 5 ROP. CONCLUSION: In the more mature infants 29-31 weeks' gestation, the rate of ROP is low, although severe ROP still occurs. However, only 65.1% of these infants were examined for ROP and we should be diligent in screening for ROP in the sicker infants in this group. The incidence of severe ROP as well as the rate of cryo/laser therapy in premature infants 23-26 weeks' in NSW has not changed since the increases seen in the early 1990s. Retinal detachment also occurs in the infants 27-28 weeks' gestation and it is important that all these infants are screened for ROP.

Gestational Age↗
PubMed1998

Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiography.

OBJECTIVES: The purpose of this study was to compare quantitative estimates of coronary calcification with traditional coronary risk factors to determine their independent predictive power for the diagnosis of obstructive angiographic coronary artery disease in symptomatic patients. METHODS: Three hundred sixty-eight symptomatic patients underwent coronary angiography and electron beam computed tomography at four different centers between April 1989 and December 1993. A blinded cardiologist interpreted the electron beam computed tomograms. Coronary risk factors were obtained in all 368 patients. Both bivariate and multivariate analyses were used to investigate the relation between risk factors and angiographic disease. RESULTS: One hundred fifty-eight patients (43%) had angiographically obstructive coronary artery disease (>50% luminal stenosis) and 297 (81%) had coronary calcification. At the bivariate level, only male sex and log-transformed coronary calcification were predictive of angiographic disease (p = 0.008, p = 0.001). By multivariate analysis, only male sex and coronary calcification were predictive (p = 0.001, p = 0.001). Sixty-four of the 71 patients without coronary calcification did not have disease, yielding a negative predictive value of 90%. Receiver operating characteristic curve analysis showed that the amount of coronary calcium was a significantly better discriminator of disease than were the other risk factors. CONCLUSIONS: Coronary calcification is a stronger predictor of angiographic coronary artery disease in symptomatic patients undergoing angiography than are standard risk factors.

Aged↗
PubMed1998

Assisted conception in HIV discordant couples: evaluation of semen processing techniques in reducing HIV viral load.

Artificial insemination with motile spermatozoa prepared from HIV-infected men using standard procedures has been employed with many HIV-discordant couples. We have demonstrated that processing semen from HIV positive men can reduce HIV levels, measured as HIV1 RNA copies/ml using nucleic acid based sequence amplification (NASBA), to undetectable levels (less than 400 copies/ml) but not in all samples. We believe that all processed samples should be tested prior to insemination.

Evaluation Studies as Topic↗
PubMed1998

Cognitive neuroscience of attention deficit hyperactivity disorder and hyperkinetic disorder.

Currently, diagnoses of attention deficit hyperactivity disorder (ADHD) and hyperkinetic disorder (HKD) are made on the basis of phenomenology, but information is accumulating from the neurosciences about the biological bases of these disorders. Recent studies addressing the neuropsychology, neuroanatomy, neurochemistry, and molecular biology of ADHD/HKD document abnormalities in well-defined neuroanatomical networks and neurochemical pathways. Magnetic resonance imaging (MRI) studies have shown that some regions of the frontal lobes (anterior superior and inferior) and basal ganglia (caudate nucleus and globus pallidus) are about 10% smaller in ADHD groups than in control groups of children, and molecular genetic studies have shown that diagnosis of ADHD is associated with polymorphisms in some dopamine genes (the dopamine D4 receptor gene and the dopamine transporter gene).

Animals↗
PubMed1998

Production of the antitumor drug epirubicin (4'-epidoxorubicin) and its precursor by a genetically engineered strain of Streptomyces peucetius.

A fermentation method that bypasses the low-yielding semisynthesis of epirubicin (4'-epidoxorubicin) and 4'-epidaunorubicin, important cancer chemotherapy drugs, has been developed for Streptomyces peucetius. This bacterium normally produces the anthracycline antibiotics, doxorubicin and daunorubicin; the 4'-epimeric anthracyclines are formed by introducing the heterologous Streptomyces avermitilis avrE or Saccharopolyspora eryBIV genes into an S. peucetius dnmV mutant blocked in the biosynthesis of daunosamine, the deoxysugar component of these antibiotics. Product yields were enhanced considerably by replacing the chromosomal copy of dnmV with avrE and by introducing further mutations that can increase daunorubicin and doxorubicin yields in the wild-type strain. This method demonstrates that valuable hybrid antibiotics can be made by combinatorial biosynthesis with bacterial deoxysugar biosynthesis genes.

Antibiotics, Antineoplastic↗
PubMed1998

Retinopathy of prematurity in infants <29 weeks' gestation at birth in New South Wales from 1986-92.

OBJECTIVE: To study the effect of increased survival of infants <29 weeks' gestation on the incidence and severity of retinopathy of prematurity (ROP). METHODOLOGY: Review of prospective records from 1986 to 1992 kept in the New South Wales (NSW) NICUS database on infants admitted to the neonatal intensive care units (NICU) in NSW. The survival rate and the incidence and severity of ROP on all infants <29 weeks' gestation admitted to the NICUs in NSW from 1 July 1986 to 31 December 1987 were compared to a similar group of infants admitted from 1 January 1992 to 31 December 1992. RESULTS: There was a significant difference in the survival rate of infants admitted between the two periods (235 of 376, 62.5% survival vs 255 of 336, 75.9% survival, respectively, P<0.0001). The odds ratio for survival adjusted for gestational age in the second period was 1.76 [1.24, 2.48 (95% confidence interval), P<0.002]. There was a slight increase in ROP in the second period (79 of 172 examined, 45.9% ROP vs 133 of 238 examined, 55.8% ROP, respectively). There was a rise in the number of infants with Stage 3 ROP in the second time period (14 of 172 examined, 8.1% ROP vs 41 of 238 examined, 17.2% ROP, respectively). However, fewer infants had detached retinas or > or = Stage 4 ROP in the second group [7 of 172, (4.1 %) vs 3 of 238, (1.3%), respectively]. This may be a reflection of the increase in the use of cryo- or laser therapy for Stage 3 ROP with 'plus' disease [2 of 172 examined, (1.2%) vs 18 of 238 examined, (7.6%), respectively]. CONCLUSIONS: With the increase in survival of the very preterm infant in recent years, there has been an increase in severe ROP (> or = Stage 3) in NSW. Despite the increased survival of the highest at-risk group (24- to 26-week gestation infants), there have been fewer cases of retinal detachment. There was also a rise in the number of infants receiving cryo- or laser therapy intervention.

Gestational Age↗
PubMed1998

Feasibility of named antenatal HIV screening in an inner city population.

The object of this study was to assess the resource use, feasibility, uptake and consumers' perspective of introducing routine named human immunodeficiency virus (HIV) testing into an inner city hospital antenatal clinic (St Thomas Hospital, part of Guy's and St Thomas Hospital Trust). Following the introduction of a new service offering routine named HIV testing at booking appointments, the length of the appointments were recorded over a three-month period and compared with appointment lengths in the previously existing service. Women being offered routine named HIV testing were asked to complete a questionnaire before and after their appointment to assess knowledge, attitudes and acceptability of HIV testing. Subjects were three-hundred-and-eighty-one pregnant women attending the antenatal clinic for their booking appointment. There was no significant difference in the length of the booking appointments following the introduction of offering routine named HIV testing. One-hundred-and-fifty-eight women (42%) consented to testing with no positive results detected. There was a significant rise in the uptake of the test over the three-month period. No other variables (demographics, perceived risk, having read the leaflet) were predictive of uptake. Anxiety scores were significantly less after the booking appointment. Routine named HIV testing was feasibly introduced into a hospital antenatal clinic with minimum resource implications. Further study is needed to monitor the ongoing uptake rate and identification of HIV-positive women before a decision can be made as to the long-term benefit of this new service. Women considered it acceptable to be offered the HIV test and were less anxious after their appointments.

Adult↗
PubMed1998

Women's knowledge and attitudes, and the acceptability of voluntary antenatal HIV testing.

OBJECTIVE: To assess pregnant women's knowledge of, and attitudes towards, antenatal HIV testing, and its acceptability to them. SETTING: Antenatal clinic at Guy's Hospital, London, six community antenatal clinics and a midwifery group practice. POPULATION: Eight hundred and forty-three women attending the antenatal clinics. METHOD: The women received a leaflet explaining HIV testing, and completed a questionnaire before and after their booking appointment. This included an assessment of their knowledge of, and attitudes towards HIV testing, and its acceptability. RESULTS: Seven hundred and eighty-nine women (94%) completed questionnaires. Fifty-one percent (n = 405) were Caucasian, 25% (n = 195) African, 11% (n = 86) West Indian and 13% (n = 100) were from other ethnic groups. Fifty-eight percent received the HIV information leaflet, of whom 86% had read it. Knowledge relating to HIV was good, the median knowledge score being 6 out of a possible 8, but it was less in non-Caucasian women and those with lower educational qualifications. Knowledge was not related to uptake of testing. Thirty-five percent of women accepted the offer of an HIV test, rates being higher in hospital clinics (41%) than in the midwifery group practice (10%) and the community clinics (30%). Women more likely to accept the offer of an HIV test were non-Caucasian (P = 0.0443), those who had thought about the HIV test before this pregnancy (P = 0.0298) and those seeing one particular midwife (P = 0.0003). Most women (67%) thought that all pregnant women should be offered the HIV test and then make their own decision. Overall, 64% women did not change their original pre-discussion decision on testing for HIV. Thirty-six percent of women changed their decision from 'yes' to 'no' or 'don't know' after seeing the midwife. Women attending the community clinics (P = 0.003) and those who had been tested before (P = 0.0451) were more likely to change their decision. CONCLUSION: This study, in a multiethnic population, has shown that knowledge regarding HIV is good but does not increase the uptake of testing. Women prefer to be offered the HIV test and make their own choice regarding whether to accept it.

Africa↗
PubMed1998

Urinary antibody level and survival in bacteriuric institutionalized older subjects.

OBJECTIVE: In a previous study, elevated urine antibody levels in institutionalized subjects with asymptomatic bacteriuria were associated with decreased survival. This study was undertaken to confirm the previous observation in a prospective study in a larger cohort and to explore selected other variables that may be associated with survival. DESIGN: A prospective, 24-month, observational cohort study. SETTING: Three large nursing homes in Winnipeg, Manitoba. PARTICIPANTS: Permanent residents were identified by initial screening urine cultures and subjects with bacteriuria were enrolled. The median age of subjects was 76 years, 51% were women, and the median duration of residence before enrollment was 26 months. Subjects were highly functionally impaired. MEASUREMENTS: Monthly urine specimens were collected for culture, leukocyte count, and urine antibody. Serum specimens for antibody to uropathogens and IL6 were obtained at enrollment and every 6 months. Anthroporphometric tests of nutritional status and functional and mental status were also measured every 6 months. Residents were stratified as having elevated or not elevated urine antibody, based on the initial urine specimen. The mean urine antibody for all of each subject's specimens was also calculated, and subjects were stratified as low, intermediate, or elevated urine antibody. Outcomes measured included mortality, infection and antibiotic use, and functional, mental, and nutritional decline. RESULTS: Ninety-eight bacteriuric subjects were enrolled in the study; 34 (35%) had elevated urine antibody and 64 (65%) had not elevated urine antibody. The two groups did not differ in demographic features, co-morbidities, functional status, medication use, or infecting organisms. Survival was significantly (P < .001) poorer in the group with elevated urine antibody. At 24 months, 35% of subjects with an elevated urine antibody were alive compared with 75% with a low urine antibody level. This survival difference was consistent when the two groups were stratified by sex, institution, and presence of a chronic indwelling catheter. Subjects with elevated urine antibody had no evidence for accelerated functional or nutritional decline during the study period compared with the group with low urine antibody. These subjects did, however, have an increased incidence of episodes of symptomatic urinary infection and infections at non-urinary sites. CONCLUSIONS: Older, bacteriuric, institutionalized subjects with elevated urine antibody had decreased survival rates compared with subjects with lower urine antibody levels. There is no clinical evidence to support accelerated decline caused by chronic infection to explain this observation. Urine antibody may be a marker for immune dysregulation, which precedes death in older impaired subjects.

Aged↗
PubMed1998

Disability theory and public policy: implications for critical gerontology.

Current gerontological theories and aging policy often fail to acknowledge the social and economic consequences of disability in later life, while disability theories and policies tend to focus only on the employment impacts of disability in younger populations. This article attempts to apply a critical gerontology framework to aging and disability issues. The authors review theoretical models of the disablement process, and note the primacy of environmental factors. The production and distribution of disability are assessed, using both social epidemiology and political economy insights. The authors examine the linkage of disability and work impedance and the consequences in disability programming, giving special consideration to inherent age, gender, and racial biases. Some of the historical antecedents of disability stigma in aging populations are also identified. The article concludes by suggesting that analysts and policymakers who wish to address the tremendous social and economic inequities that accompany aging and disability should look to the principles put forth by the independent living movement and to recent work on the moral economy of interdependency over the life course.

Age Factors↗