Biomedical subjects
Publications and source records attributed to J McIntosh.
Interviews with a sample of general practitioners in remote areas of Scotland revealed a strong commitment to a wide family counsellor role as well as a wish to use clinical skills more fully. While many urban doctors express similar orientations we believe that rural practitioners feel better able to implement their preferred style of work which combines personal and professional elements.
Seventeen patients with retinal vasculitis, eleven with the peripheral type (Eales' disease) and six with the central type, were investigated to detect the presence of circulating immune complexes (IC) which might then be related to the pathogenesis of their disease. A systemic disease process was identified in six. IC in serum were inferred by the presence of complement (C) activation, rheumatoid factor, Clq or monoclonal rheumatoid factor precipitins, anticomplementary activity, elevated cryoglobulins, inhibition of erythrocyte-antibody (IgG-EA) rosette formation, increased numbers of peripheral blood lymphocytes bearing surface Ig, and spontaneous neutrophil chemotatic activity in plasma. Two or more parameters were positive in thirteen of seventeen patients, with chemotactic activity (69%) and inhibition of EA-rosette formation (59%) being the most frequently positive tests. No immunological differences were detected between the peripheral and central retinal-vasculitis groups. Several IC systems may operate in a give patient.
74 hospital patients with diagnosed but undisclosed malignancy were interviewed and observed to ascertain their awareness of their condition and desire for information about it. While 88% either knew or suspected that they had a malignant tumour at admission to the ward, the great majority of them had no wish to augment that knowledge. The fact that their diagnosis or prognosis was not revealed to them allowed many patients to maintain the hope either that they might not have cancer or that the outlook might be favourable.
The humoral, cellular and neutrophil responses of uraemic patients maintained by haemodialysis were compared with those of renal transplant recipients. Humoral immunity was reduced only in the transplant group. Cell-mediated immunity was abnormal in both groups but more decreased in the transplant group studied particularly within 3 months of transplantation. The neutrophil bactericidal capacities were defective cellular immunity, but fatal infections occurred only in transplant patterns over 40 years of age with combined cellular and neutrophil defects. No single test was predictive of graft survival in uraemic patients. The depressed cellular immune responses in uraemia, of the degree seen in the immunosuppressed transplant recipient, may explain the better prognosis of renal transplants compared with other organ transplants.
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In 1985 the (Byar and Blackard, Urology, Vol. X, 556-561, 1978) data set on bladder cancer became available to researchers. Since then, a number of studies have made use of it. However, none of these has fully utilized all of the data nor have they developed a methodology in which it is possible to estimate models of the number of recurrences and durations that are consistent with each other. The purpose of this research is to determine which, if any, of the two drugs used in the trial, pyridoxine and theotepa, were effective and, by example, illustrate procedures that could be useful in the analysis of other clinical trial data sets. First, the number of recurrences is modeled as a count using the Poisson and negative binomial distributions with covariates. Then Poisson models are tested on the durations. Finally, durations and tumor counts per recurrence are fitted to more general autoregressive Wiebull and negative binomial distributions, respectively. Poisson models for durations are rejected in favor of the more general autoregressive models. The data on durations and tumor counts are shown to be more reliable from an inference point of view than the data on the number of recurrences. The data on durations and tumor counts show quite conclusively that both drugs are effective in treating bladder cancer, a result that differs from what others have found.
The weaning practices of a sample of 65 working class mothers are described. In the majority of cases solid food was introduced relatively early, usually as a problem-solving device. The practice of early weaning gave rise to a great deal of conflict between the mothers and their professional advisers and frequently resulted in serious contamination of the professional-client relationship. Current professional policy and practice in relation to weaning are questioned and certain recommendations discussed. Although there is disagreement among health professionals over the precise stage at which weaning should take place, most agree that infants should not be introduced to solid food under the age of 3-4 months. This view received official endorsement from the Department of Health and Social Security in 1974 and 1980 (Department of Health and Social Security 1974, 1980). Despite this, it would appear that a great many babies are put on solids much earlier than recommended (Shukla et al. 1972, Taitz 1972, Martin & Monk 1982). This paper describes the introduction of solid food in a sample of working class families with particular reference to the factors involved in early weaning.
The frequency and pattern of clinic use by a sample of 60 working class families is described. An attempt is made to explain attendance and non-attendance in terms of the mothers' perceptions of the clinic's functions and relevance and in terms of certain social and organizational barriers. The implications of the findings for clinic use and for the organization and delivery of the service to working class families are discussed.
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