Search PubMed⌕ Search

Biomedical subjects

J Parry

Publications and source records attributed to J Parry.

At least 19 recordsLinked to original sources
PubMed2006

How safe is safer sex? High levels of HSV-1 and HSV-2 in female sex workers in London.

Female sex workers in Europe have low levels of sexually transmitted infections, attributable to condom use. The aim of this paper is to describe the seroepidemiology of HSV-1 and HSV-2 in female sex workers in London by using a 15-year prospective study of 453 sex workers. The seroprevalence of HSV-1 was 74.4% and independently associated with birth in a 'transitional country' (OR 5.4, 95% CI 1.61-18.20). The seroprevalence of HSV-2 was 60% and declined over time; it was also independently associated with time in sex work (OR 2.12, 95% CI 1.23-3.65) and birth in a 'developing country' (OR 2.95, 95% CI 1.34-6.48). We show that a cohort of sex workers with extensive condom use and little known sexually transmitted infection have high levels of HSV-1 and HSV-2 infection, suggesting that condoms may not be universally protective. Sex workers are candidates for HSV vaccine efficacy or intervention studies.

Adolescent↗
PubMed2006

Predicting the clinical outcome of tetanus: the tetanus severity score.

OBJECTIVES: To create a new tetanus score and compare it with the Phillips and Dakar scores. METHODS: We used prospectively acquired data from consecutive patients admitted to the Hospital for Tropical Diseases, Ho Chi Minh City, to create the Tetanus Severity Score (TSS) with multivariate logistic regression. We compared the new score with Phillips and Dakar scores by means of resubstituted and prospective data, assessing performance in terms of sensitivity, specificity and area under receiver operator characteristic curves. RESULTS: Resubstitution testing yielded a sensitivity of 77% (298/385) and a specificity of 82% (1,183/1,437) for the TSS; 89% (342/385) and 20% (281/1,437) for the Phillips score; and 13% (49/385) and 98% (1,415/1,437) for the Dakar score. The TSS showed greatest discrimination with 0.89 area under the receiver operator characteristic curve (95% CI 0.88-0.90); this was 0.74 for the Dakar score and (95% CI 0.71-0.77) and 0.66 for the Phillips score (95% CI 0.63-0.70; P values <0.001). Prospective testing showed 65% (13/20) sensitivity and 91% (210/230) specificity for the TSS; 80% (16/20) and 51% (118/230) for the Phillips score; and 25% (5/20) and 96% (221/230) for the Dakar score. The TSS achieved the greatest area under TSS of 0.89 (95% CI 0.82-0.96), significantly greater than the Phillips score [0.74 (0.6-0.88), P = 0.049] but not the Dakar score [0.80, (0.71-0.90), P = 0.090]. CONCLUSIONS: The TSS is the first prospectively developed classification scheme for tetanus and should be adopted to aid clinical triage and management and as a basis for clinical research.

Adolescent↗
PubMed2004

Re-organizing services for the management of upper gastrointestinal cancers: patterns of care and problems with change.

The 'Calman-Hine' report (1995) recommended that cancer surgery should be limited to specialist high-volume units. National guidance from the National Health Service (NHS) Executive in 2001 stated that specialist oesophagogastric cancer centres should 'aim to draw patients from catchment areas with a population of 1-2 million.' For pancreatic cancers, the catchment areas should be between 2 and 4 million, reflecting the relatively lower incidence of disease. For the West Midlands region, these recommendations would suggest that four or five centres might be required to provide specialist surgical management for oesophagogastric cancer, and one or two centres for pancreatic disease. We used Hospital Episode Statistics to analyse trends in management patterns for these tumours within the West Midlands during the period 1992-2000. Over 20 different units were involved in the management of oesophagogastric and pancreatic disease, and we were unable to discern any clear and consistent move towards the centralisation of the upper gastrointestinal work in high-volume units since the publication of the Calman-Hine report in 1995. Although the drive for centralisation might be anticipated to increase following the publication of the NHS Executive's guidance, there is a substantial way to go before the provision of surgical services for upper gastrointestinal cancers is limited to a small number of high-volume specialist units.

Cancer Care Facilities↗
PubMed2004

Mechanisms by which area-based regeneration programmes might impact on community health: a case study of the new deal for communities initiative.

STUDY OBJECTIVE: To explore mechanisms by which area-based regeneration initiatives may impact on health. DESIGN: Case study of the New Deal for Communities programme, part of the UK National Strategy for Neighbourhood Renewal. MAIN RESULTS: Health impacts may result from three mechanisms: sociospatial stigma, community participation and the commissioning of projects designed to change the distribution of determinants of health, including access to services and healthy lifestyles. CONCLUSIONS: The present UK National Strategy for Neighbourhood Renewal includes improving health status as one of its key outcome measures. Area-based regeneration schemes such as the New Deal for Communities initiative should, intuitively, bring about health gain through their participatory approach to changing the physical and socio-economic environments. At present, however, the direction and magnitudes of these impacts are not clear.

Community Health Services↗
PubMed2004

Hepatitis A virus and injecting drug misuse in Aberdeen, Scotland: a case-control study.

To describe an epidemiological investigation of an outbreak of hepatitis A virus (HAV) infection among injecting drug users in Aberdeen, Scotland. A case-control study to determine whether transmission was facilitated by poor personal hygiene or through sharing injecting equipment. Cases were more likely to report not washing their hands after using the toilet [odds ratio (OR) = 12.9, 95% confidence interval (CI) = 1.58-105.89] or before preparing food (OR = 4.0, 95% CI = 1.01-15.8), and less likely to have washed their hands prior to preparing drugs (OR = 10.67, 95% CI = 2.14-53.07). Cases were also more likely to report recipient sharing of needles/syringes (OR = 8.27, 95% CI = 1.68-40.57), and to have had injecting contact with someone who was jaundiced (OR = 29.4, 95% CI = 3.18-271.44). The results indicate that the lack of hygiene within the context of individuals gathering to prepare and inject drugs provides ample opportunity for the transmission of HAV. Although the promotion of good hygiene and the avoidance of sharing injecting equipment are important measures in preventing HAV transmission, they are unlikely to effect major behavioural change. Such measures should, therefore, be reinforced by routinely offering HAV vaccine to injectors.

Adolescent↗
PubMed2003

How evidence based are recruitment strategies to randomized controlled trials in primary care? Experience from seven studies.

BACKGROUND: Failure to recruit adequate numbers of participants represents a major barrier to the completion of randomized controlled trials in primary care and is associated with substantial opportunity costs. However, uncertainty exists regarding the relative effectiveness of different methods to promote recruitment. OBJECTIVES: The purpose of this study was to estimate the proportion of strategies used to promote patient recruitment to randomized controlled trials in primary care that are evidence based. METHODS: Investigators from seven primary care-based clinical trials of dyspepsia management aiming to recruit a total of 6070 patients participated. Following a survey of trial organization, a Delphi technique was used to reach consensus on levels of evidence on the effectiveness of interventions or organizational characteristics in influencing recruitment. The main outcome measures were the proportions of interventions or organizational characteristics for influencing patient recruitment that are based upon randomized controlled trials, on convincing non-experimental evidence or meeting neither of these criteria. RESULTS: Out of a total of 56 interventions used across the trials, 35 (63%) were judged as evidence based. Out of a total of 29 organizational characteristics possessed by the trials, five (17%) were judged as evidence based. Across the seven dyspepsia trials, the presence of 'favourable' organizational characteristics appeared to be important contributors towards successful recruitment. CONCLUSIONS: A wide range of interventions and organizational characteristics with the potential to promote recruitment were used or possessed by seven primary care trials. Many were not evidence based. Our experience suggests that organizational characteristics could be more influential in trial recruitment than the use of specific interventions. Given the costs of primary care-based trials, researchers need more rigorous evidence to inform recruitment strategies.

Dyspepsia↗
PubMed2002

Quality of life, taste, olfactory and oral function following high-dose chemotherapy and allogeneic hematopoietic cell transplantation.

Multiple oral complaints develop following high-dose chemo/radiotherapy and hematopoietic cell transplantation (HCT) which can influence quality of life. The purpose of this investigation was to assess quality of life, oral function, taste and smell in a cohort of patients following HCT. A general quality of life survey (the European Organization for Research and Treatment of Cancer (EORTC)) Quality of Life (QOL) questionnaire (QLQ-C30), with an added oral symptom and function scale and assessment of taste and smell was administered to a consecutive series of patients at day 90-100 post HCT. General QOL was impacted by fatigue, affecting physical, social emotional and cognitive function. While oral function scales appeared to be little affected at day 90-100 post HCT, abnormalities of taste were reported. Reports of changes in taste and smell appeared to parallel each other and changes remained at the time of the survey post-HCT. Change in taste appeared to be closely associated with dry mouth. Patients appeared to have difficulty in differentiating sour and bitter, which had been more affected than salt and sweet taste. Females appeared to report greater changes in taste than males. Increased smell sensitivity and taste change resulted in changes in food preparation in some cases, as did reported increase in sensitivity to sour and bitter taste. Acute complications are well known to affect QOL during the early period following HCT, but little assessment of long-term changes in oral QOL and taste has been conducted following transplant. The EORTC QLQ C-30 questionnaire with the oral addendum provides a measure of the quality of life and oral function, and may provide useful outcome measures for assessment of oral care prevention and management in HCT patients.

Adult↗
PubMed2001

Volumes of cancer surgery for breast, colorectal and ovarian cancer 1992-97: Is there evidence of increasing sub-specialization by surgeons?

The 'Calman-Hine Report' (1995) recommended that cancer surgery should be limited to 'high-volume' consultants. Through an analysis of 5 years of Hospital Episode Statistics for the West Midlands region (1992-1997), we have investigated whether there is evidence of increasing numbers of patients with breast, colorectal or ovarian cancer being treated by high throughput, i.e. sub-specialist surgeons, who carry out more than a threshold level of primary cancer resections annually. The proportion of cases treated by the high-volume breast, colorectal and ovarian cancer surgeons increased annually during the 5 years. The absolute number of consultant firms who undertook breast cancer resections reduced during the 5 years; but the number doing colorectal and ovarian surgery increased. Throughout the 5 years, half of the ovarian cancer resections were carried out by consultant firms who did very few procedures - less than 5 of these procedures annually. The relatively high case-load, the elective nature of breast cancer surgery and an early policy change have undoubtedly facilitated the move towards sub-specialization. The weaker trends for colorectal and ovarian cancer surgery suggest continued monitoring is required to ensure that there is a reduction in the proportion of people treated by surgeons who undertake few cancer resections annually.

Breast Neoplasms↗
PubMed2001

A report of an outbreak of Shigellosis in a primary school in Staffordshire.

This paper describes the management of an outbreak of Shigellosis, reported in the national media, in a village school in Staffordshire. The issues encountered by the outbreak team during the management of this incident have re-affirmed the need for public and environmental health departments to work closely with educational bodies to develop clear and consistent action plans for the management of communicable disease outbreaks. The management of communicable disease in schools, the workplace and other settings should be addressed, possibly as a component of local health improvement plans.

Child↗
PubMed2001

Investigation of mineral waters and soft drinks in relation to dental erosion.

A range of still and sparkling mineral waters were assessed for their erosive potential together with comparator soft drinks using in vitro dissolution assays with extracted human teeth and powdered hydroxyapatite. Dissolution levels with all of the mineral waters were very low and for several still waters were undetectable. Sparkling mineral waters showed slightly greater dissolution than still waters, but levels remained low and were of the order of one hundred times less than the comparator soft drinks. De-gassing of a sparkling mineral water reduced its dissolution, but the total levels were still relatively low suggesting that carbonation of drinks may not be an important factor per se in respect of erosive potential. The complex and heterogeneous mineral compositions of mineral waters could influence the dissolution equilibrium of apatite in enamel and controlled addition of several ions to ultrapure deionized water was investigated. Calcium ions led to the greatest reduction in hydroxyapatite dissolution, but their effects were moderated by other ions including magnesium and sulphate. Thus, mineral waters appear to offer a safe alternative to more erosive acidic beverages and their complex mineral ion compositions may positively influence any dissolution processes at the tooth surface.

Apatites↗
PubMed2001

Creutzfeldt-Jakob syndrome presenting as epilepsia partialis continua.

Creutzfeldt-Jakob disease (CJD) is an uncommon rapidly progressive neurological disorder which can have protean clinical presentations. We report an autopsy-proven case of CJD presenting initially as epilepsia partialis continua but then developing the typical clinical features of CJD over several weeks. CJD should be considered in the differential diagnosis of new onset epilepsia partialis continua in adults.

Aged↗
PubMed2001

Identifying 'non-medical' datasets to monitor community health and well-being.

BACKGROUND: The aim of the study was to identify 'non-medical' datasets holding routinely collected information that might be used to measure and monitor the wider determinants of community health and well-being. METHODS: An expert panel discussion, involving public health and environmental health academics and professionals with expertise in a variety of backgrounds (including environmental health, housing, transport, community safety, public health, primary and secondary care), and interrogation of the Office for National Statistics database were carried out for the West Midlands region. The aim was to identify routinely collected 'non-medical' datasets containing information on the following factors: physical environment, crime, housing and homelessness, social services, socio-economic environment including employment, lifestyles, education, leisure and culture, transport and accidents. RESULTS: Fifty-six datasets were identified. Although 43 (77 per cent) were collected at least annually, few (17; 30 per cent) held data that were disaggregated and routinely available at the sub-local authority level. CONCLUSIONS: This study has identified a number of datasets that hold information relevant to health. However, no single dataset is likely to provide information on all dimensions of health and the determinants of health, and local agencies should consider carefully the strengths and weaknesses of each. Through the development of inter-sectoral working and multi-agency involvement at the local level there is now considerable scope to improve the quality of many of these datasets and to promote their use in the measurement and monitoring of community health.

Accidents↗