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Biomedical subjects

J McIntyre

Publications and source records attributed to J McIntyre.

At least 55 records · Page 3Linked to original sources
PubMed1998

Monitoring utilisation, quality & effectiveness of free antenatal care in an informal settlement in Gauteng.

The aim of this study was to monitor utilisation, quality and effectiveness of free antenatal care from a review of clinic records. Starting randomly, 197 clinic records from four clinics were reviewed. Antenatal care was initiated at the end of the second trimester or in the third trimester, in an inadequate quantity (64% had made less than three visits). Teenagers were significantly more likely to attend only once than the older age groups (Chi-square = 12.5, df = 6, p = 0.05). Standard tasks such as age, weight, blood pressure, foetal heart monitoring, estimated gestational age and urine test results were recorded correctly. However, the effectiveness of care was difficult to assess due to incomplete records and the lack of blood test results. It was concluded that the provision of a free antenatal care service does not automatically increase utilisation; timing and quantity of care obtained were inadequate; and improvements in record keeping are essential for assessing the quality and effectiveness of care.

Adolescent↗
PubMed1998

Ethical holistic thinking and practice for community health workers and nurses.

If we take on board the assumption that social realities are perceived through filters of experience, social position, personality and emotion, then we accept that 'facts' can be differently construed or constructed Compassion cannot be taught as a competency, but we can be made aware through reflexive thinking that the closest we can ever get to a shared truth is through listening to and understanding the other. This paper is a modest attempt to provide some tools for community health workers and nurses who are concerned about the quality of their practice and wish to find creative solutions.

Community Health Nursing↗
PubMed1997

Maintenance of somite borders in mice requires the Delta homologue DII1.

During vertebrate embryonic development, the paraxial mesoderm is subdivided into metameric subunits called somites. The arrangement and cranio-caudal polarity of the somites governs the metamerism of all somite-derived tissues and spinal ganglia. Little is known about the molecular mechanisms underlying somite formation, segment polarity, maintenance of segment borders, and the interdependency of these processes. The mouse Delta homologue Dll1, a member of the DSL gene family, is expressed in the presomitic mesoderm and posterior halves of somites. Here we report that, in Dll1-deficient mouse embryos, a primary metameric pattern is established in mesoderm, and cytodifferentiation is apparently normal, but the segments have no cranio-caudal polarity, and no epithelial somites form. Caudal sclerotome halves do not condense, and the pattern of spinal ganglia and nerves is perturbed, indicating loss of segment polarity. Myoblasts span segment borders, demonstrating that these borders are not maintained. These results show that Dll1 is involved in compartmentalization of somites, that dermomyotome and sclerotome differentiation are independent of formation of epithelia and subdivision of somites in cranial and caudal halves, and that compartmentalization is essential for the maintenance of segment borders in paraxial mesoderm-derived structures.

Animals↗
PubMed1997

Viewer-centered frame of reference for pointing to memorized targets in three-dimensional space.

Pointing to a remembered visual target involves the transformation of binocular visual information into an appropriate motor output. Errors generated during pointing tasks may indicate the reference frames used by the CNS for the transformation and storage of the target position. Previous studies have proposed eye-, shoulder-, or hand-centered reference frames for various pointing tasks, depending on visual conditions. We asked subjects to perform pointing movements to remembered three-dimensional targets after a fixed memory delay. Pointing movements were executed under dim lighting conditions, allowing vision of the fingertip against a uniform black background. Subjects performed repeated movements to targets distributed uniformly within a small (radius 25 mm) workspace volume. In separate blocks of trials, subjects pointed to different workspace regions that varied in terms of distance and direction from the head and shoulder. Additional blocks were performed that differed in terms of starting position, effector hand, head rotation, and memory delay duration. Final pointing positions were quantified in terms of the constant and variable errors in three dimensions. The orientation of these errors was examined as a function of workspace location to identify the underlying reference frames. Subjects produced anisotropic patterns of variable error, with greater variability for endpoint distances from the body. The major axes of the variable-error tolerance ellipsoids pointed toward the eyes of the subject, independent of workspace region, effector hand (left or right), initial hand position, and head rotations. Constant errors were less consistent across subjects, but also tended to point toward the head and body. Both overshoots and undershoots of the target position were observed. Increasing the duration of the memory delay period increased the size but did not alter the orientation of the variable-error ellipsoids. Variability of the endpoint positions increased equally in all three Cartesian directions as the memory delay increased from 0.5 to 8.0 s. The anisotropy of variable errors indicates a viewer-centered reference frame for pointing to remembered visual targets with vision of the finger. The anisotropy of pointing variability stems from variability in egocentric binocular cues as opposed to reliance on allocentric visual references or to specific approximations in the sensorimotor transformation. Nevertheless, observed increases in variability with longer memory delays indicate that the short-term storage of the target position does not simply mirror the retinal and ocular sensory signals of the visually acquired target location. Thus spatial memory is carried out in an internal representation that is viewer-centered but that may be isotropic with respect to Cartesian space.

Adult↗
PubMed1997

The epidemiology of incomplete abortion in South Africa. National Incomplete Abortion Reference Group.

OBJECTIVE: To describe the epidemiology of incomplete abortion (spontaneous miscarriage and illegally induced) in South Africa. DESIGN: Multicentre, prospective, descriptive study. SETTING: Fifty-six public hospitals in nine provinces (a stratified, random sample of all hospitals treating gynaecological emergencies). PATIENTS: All women of gestation under 22 weeks who presented with incomplete abortion during the 2-week study period. MAIN OUTCOME MEASURES: Incidence of, morbidity associated with and mortality from incomplete abortion. MAIN RESULTS: An estimated 44686 (95% CI 35633-53709) women per year were admitted to South Africa's public hospitals with incomplete abortion. An estimated 425 (95% CI 78-735) women die in public hospitals from complications of abortion. Fifteen per cent (95% CI 13-18) of patients have severe morbidity while a further 19% (95% CI 16-22) have moderate morbidity, as assessed by categories designed for the study which largely reflect infection. There were marked inter-provincial differences and inter-age group differences in trimester of presentation and proportion of patients with appreciable morbidity. CONCLUSIONS: Incomplete abortions and, in particular, unsafe abortions are an important cause of mortality and morbidity in South Africa. The methods used in this study underestimate the true incidence for reasons that are discussed. A high priority should be given to the prevention of unsafe abortion.

Abortion, Incomplete↗
PubMed1997

Management of incomplete abortions at South African public hospitals. National Incomplete Abortion Study Reference Group.

OBJECTIVE: The objective of this report was to review and describe the management of incomplete abortion by public sector hospitals. DESIGN: A descriptive study in which data were collected prospectively from routine hospital records on all women admitted with incomplete abortion to a stratified random sample of hospitals between 14 and 28 September 1994. SETTING: Public sector hospitals in South Africa. PATIENTS: Women with incomplete abortions. MAIN OUTCOME MEASURES: Length of hospital stay, details of medical management, details of surgical management, determinants of the above. MAIN RESULTS: Data were collected on 803 patients from the 56 participating hospitals. Of these, 767 (95.9%) were in hospital for 1 day or more, and 753 (95.3%) women underwent evacuation of the uterus. Sharp curettage was the method employed in 726 (96.9%) and general anaesthesia was used for 601 (68%) of the women requiring uterine evacuation. Antibiotics were prescribed for 396 (49.5%) and blood transfusions were administered to 125 (17%) women. Statistical analysis showed length of stay to be longer in small hospitals (under 500 beds) and when the medical condition was more severe. Antibiotic usage and blood transfusion were more common with increasing severity and a low haemoglobin level on admission. However, some inappropriate management was identified with regard to both. MAIN CONCLUSIONS: It is suggested that uncomplicated incomplete abortion can be more effectively and safely managed using the manual vacuum aspiration technique with sedation/analgesia as an outpatient procedure. Attention should be directed at the introduction of this management routine at all types of hospital and to the ensuring of appropriate management of women with complicated abortion.

Abortion, Incomplete↗
PubMed1996

Physical and kinetic characterization of recombinant human cholesteryl ester transfer protein.

Cholesteryl ester transfer protein (CETP) mediates the exchange of triglycerides (TGs), cholesteryl esters (CEs) and phospholipids (PLs) between lipoproteins in the plasma. In order to better understand the lipid transfer process, we have used recombinant human CETP expressed in cultured mammalian cells, purified to homogeneity by immunoaffinity chromatography. Purified recombinant CETP had a weight-average relative molecular mass (MW) of 69561, determined by sedimentation equilibrium, and a specific absorption coefficient of 0.83 litre.g-1.cm-1. The corresponding hydrodynamic diameter (Dh) of the protein, determined by dynamic light scattering, was 14 nm, which is nearly twice the expected value for a spheroidal protein of this molecular mass. These data suggest that CETP has a non-spheroidal shape in solution. The secondary structure of CETP was estimated by CD to contain 32% alpha-helix, 35% beta-sheet, 17% turn and 16% random coil. Like the natural protein from plasma, the recombinant protein consisted of several glycoforms that could be only partially deglycosylated using N-glycosidase F. Organic extraction of CETP followed by TLC showed that CE, unesterified cholesterol (UC), PL, TG and fatty acids (FA) were associated with the pure protein. Quantitative analyses verified that each mol of CETP contained 1.0 mol of cholesterol, 0.5 mol of TG and 1.3 mol of PL. CETP mediated the transfer of CE, TG, PL, and UC between lipoproteins, or between protein-free liposomes. In dual-label transfer experiments, the transfer rates for CE or TG from HDL to LDL were found to be proportional to the initial concentrations of the respective ligands in the donor HDL particles. Kinetic analysis of CE transfer was consistent with a carrier mechanism, having a Km of 700 nM for LDL particles and of 2000 nM for HDL particles, and a kcat of 2 s-1. The Km values were thus in the low range of the normal physiological concentration for each substrate. The carrier mechanism was verified independently for CE, TG, PL and UC in 'half-reaction' experiments.

Animals↗
PubMed1996

The control of stable postures in the multijoint arm.

The stiffness that is measured at the hand of a multijoint arm emerges from the combined effects of the elastic properties of the muscles and joints, the geometry of the linkages and muscle attachments, and the neural control circuits that act on the arm. The effective stiffness of a nonlinear linkage such as a two-joint arm depends on the force acting on the system as well as the intrinsic stiffness of the actuators. This paper presents an analysis of the factors that affect limb stiffness, including the effects of external forces. Three potential strategies for controlling the stability of the limb are proposed and demonstrated by computer simulations. The predictions from the simulations are then compared experimentally with measured stiffness values for human subjects working against an external force. These experiments were directed toward understanding what strategies are used by the CNS to control limb stiffness and stability. The experimental evidence showed that human subjects must increase the stiffness at the joints in order to maintain limb stability in the presence of applied external forces at the hand. In the process we identified a precise role for muscles which span two or more joints in the control of over all limb stiffness. A local strategy may be used to achieve limb stability, in which the muscle stiffness increases with muscle force. Multijoint muscles are shown to provide mechanical couplings which are necessary for the maintenance of stability. By utilizing these muscles, the neuro-musculo-skeletal system can control a global property of the system (stability) with a passive local strategy.

Adult↗
PubMed1996

Children's emotional and behavioral reactions following the disclosure of extrafamilial sexual abuse: initial effects.

Despite a dramatic increase of the empirical literature on child sexual abuse, very few investigations have examined the initial effects of extrafamilial sexual abuse (ESA). The present study evaluated the emotional and behavioral adjustment of 41 children (mean age 10 years, range 5.4 to 15.5 years) within the first 3 months following the disclosure of ESA. Children's functioning was compared to that of a nonclinical comparison group of 43 children, matched on child's age, gender, and family constellation. Child functioning was assessed using a combination of child-report, primary caregiver-report (i.e., parent), and teacher-report measures. Results revealed that sexually abused children, in comparison to nonabused children, suffered deleterious and clinically significant effects. Standard multiple regressions found that the children's perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symptomatology of depression, social efficacy, and general and abuse-related fears. As well, child's gender predicted the level of general fearfulness. None of the other demographic or abuse-related variables were related to children's functioning. These results underscore the need for multidimensional and multisource assessment of children who experience ESA, and point to the clinical importance of addressing the abuse-related attributions of these children.

Adolescent↗
PubMed1996

Secondary traumatization in parents following the disclosure of extrafamilial child sexual abuse: initial effects.

Disclosure or discovery of extrafamilial sexual abuse (ESA) has the potential to traumatize the entire family system. Little controlled research has examined the initial reactions of parents to this type of trauma. The present study evaluated the adjustment of 93 parents (63 mothers and 30 fathers) within 3 months of the disclosure of ESA. Parents' functioning was compared to that of a nonclinical comparison group of 136 parents (74 mothers, 62 fathers). Parent adjustment was assessed using self-report measures of psychological distress, parent competence, family functioning, marital functioning, life stressors, and environmental support. Results revealed that mothers of sexually abused children, in comparison to mothers of nonabused children, experienced greater overall emotional distress, poorer family functioning, and lower satisfaction in their parenting role. Fathers of sexually abused children also experienced greater overall emotional distress relative to comparison fathers but their level of distress remained below that of mothers. Standard and hierarchical multiple regressions on maternal self-reports revealed that mothers' satisfaction with their parenting role and their perceived level of environmental support predicted their emotional functioning. Abuse-related variables did not contribute to the prediction of emotional functioning. These results emphasize the need to expand our focus beyond the child victims to the traumatized families and to normalize the potential for all close family members to be vulnerable to experience adjustment difficulties following ESA.

Adaptation, Psychological↗
PubMed1996

Seroepidemiology of HTLV-I in relation to that of HIV-1 in the Gauteng region, South Africa, using dried blood spots on filter papers.

The seroprevalence of human T-lymphotropic virus type I (HTLV-I), in relation to that of human immunodeficiency virus type I (HIV-1), was determined in a comparative unlinked anonymous antenatal and neonatal (for indirect measurement of maternal antibodies) serosurvey in the Gauteng region of South Africa, using dried blood spots (DBS) and modified particle agglutination assays. Samples were confirmed to be antibody positive by western blot. A total of 2582 DBS collected during 1993 and 1994 from subjects of African, European and coloured origin were tested. Ten were confirmed as positive for HTLV-I and 128 for HIV-1. No antibodies to HTLV-I or HIV-1 were demonstrated in the 221 women of European and coloured origin who were screened. The HTLV-I seroprevalence rate in subjects of African origin appeared to increase from 0% in 1993 to 0.49% in 1994, while HIV-1 seroprevalence rates of 5.2% and 5.4% were recorded for 1993 and 1994 respectively. No significant differences in HTLV-I and HIV-1 seroprevalence rates were noted for the two areas investigated. These results indicate that HTLV-I should be included in infection control programs, and provide baseline data for monitoring the possible spread of HTLV-I in the heterosexual population in this region.

Black People↗
PubMed1996

Assessing a support and learning network for palliative care workers in a country area of South Australia.

Palliative care might be described as a movement within the healthcare systems of many countries which has a strong voluntary backing in the wider community. Much of the developments in Australia have taken place in the metropolitan areas with 'cinderella' services attempting to make provision in rural and remote parts of the country. This paper describes and reviews an action research project designed to provide a support and learning network for palliative care workers in a country area of South Australia, using the telephone and interactive video conference facilities for communication purposes. The lessons of the project have applicability for other healthcare providers in rural and remote parts of Australia.

Education, Continuing↗
PubMed1996

Comparing efficacy and tolerability of ibuprofen and paracetamol in fever.

The purpose of this study was to compare antipyretic activity and evaluate tolerability of ibuprofen and paracetamol suspension in the treatment of febrile children. It was designed as a double blind, parallel group, multiple dose study comparing ibuprofen (20 mg/kg/24 hours) with paracetamol (50 mg/kg/24 hours) given at six hourly intervals for a maximum of 12 doses. Children on paediatric wards between the ages of 0.2 and 12 years, with fever as defined by an axillary temperature > or = 37.5 degrees C, were included. The main outcome measures were: change in axillary temperature; palatability of medication; changes in irritability and clinical condition; overall efficacy at the end of treatment; and number and nature of adverse events. The mean temperature change from baseline at four hours was -1.8 degrees C and -1.6 degrees C in ibuprofen and paracetamol groups respectively. In both groups: median palatability score was 'no reaction'; median irritability score at end point was 'not irritable'; median score for change in clinical condition was 'improved'; and median score for overall efficacy was 'good effect'. The proportion of patients experiencing adverse events was similar in both groups, the majority of events having doubtful or no relationship to therapy and being mild in severity. In conclusion, ibuprofen suspension was as effective and well tolerated as paracetamol in treatment of fever in young children.

Acetaminophen↗
PubMed1996

Metabolic rate in febrile infants.

An open circuit indirect calorimeter was used to measure resting energy expenditure in febrile infants. Twelve infants admitted to hospital with fever (axillary temperature 37.5 degrees C) were studied on admission and then again at the same time of day and in similar environmental conditions after the fever had resolved. Mean age of the infants was 0.31 years (range 0.12-0.54) and the mean body weight 6.59 kg (range 4.50-8.88 kg). On average the infants' axillary temperatures were +2.1 degrees C higher when they were febrile. Overall the mean difference in oxygen consumption (VO2), carbon dioxide production (VCO2), and resting energy expenditure (REE) between the febrile and afebrile measurements was not statistically significant. Of eight infants with a greater REE when febrile, five were diagnosed as having viral illness and three had bacterial meningitis. Of the four with a lower REE when febrile, two had viral illness and two had bacterial infection (one chest infection and one meningitis). In conclusion, there was no consistent alteration of REE during a fever in infants 1 to 6 months of age. In particular, age and type of infection were not predictors of whether REE would increase or decrease during the illness.

Bacterial Infections↗