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Biomedical subjects

J Scott

Publications and source records attributed to J Scott.

At least 199 records · Page 11Linked to original sources
PubMed1997

Estimates of the effectiveness of a whole-cell pertussis vaccine from an outbreak in an immunized population.

Pertussis has re-emerged as a public health problem in Canada in recent years, emphasizing concerns about the effectiveness of the currently licensed whole-cell vaccine. Following a 1994 outbreak in Nova Scotia, we conducted a case-control study of 483 children aged < 10 years to assess vaccine effectiveness. Ninety-three percent of children aged 6 months and above had received three or more doses of vaccine, however, only 78% had received age-appropriate immunization. Among children aged 4 years and more, vaccine effectiveness against laboratory-confirmed pertussis was 57% (95% CI, 23-77%) for age-appropriate immunization (five doses) vs partial or no immunization. Vaccine effectiveness increased with increasing number of doses from 25% (95% CI, -58-65%) for three or more doses to 55% (95% CI, -15-83%) for five doses, compared with 0-2 doses.

Age Factors↗
PubMed1997

Maritime medicine.

This article reviews the emergency care of sick and injured patients on various seafaring vessels in remote areas of the world. It addresses the characteristic problems encountered by those at sea, the logistical difficulties of assessing and treating these patients on the vessel, and the difficulty in arranging and monitoring definitive care.

Case Management↗
PubMed1997

Setting thresholds for MDS (Minimum Data Set) quality indicators for nursing home quality improvement reports.

BACKGROUND: Determining meaningful thresholds to reinforce excellent performance and flag potential problem areas is critical for quality improvement reports. Without thresholds, an organization may interpret its performance as superior to others because it is "better than average" and falsely assume it does not have care problems in certain areas. SETTING THRESHOLDS: The Minimum Data Set (MDS) assessment instrument is mandated for use nationwide in all nursing homes participating in Medicaid or Medicare programs. Since 1993 a research team at the University of Missouri-Columbia has been developing and testing quality indicators (QIs) derived from MDS data as a foundation for quality improvement activities. In July 1996, a cross-section of 13 clinical care personnel from nursing homes participated on an expert panel for threshold setting for QIs derived from MDS assessment data. Panel members individually determined good and poor threshold scores for each QI, reviewed statewide distributions of MDS QIs, and, two weeks later, completed a follow-up Delphi round. Three members of the research team reviewed the results of the expert panel and set the final thresholds. With thresholds established for good and poor scores, MDS QI scores are reported to a sample of Missouri nursing homes using the thresholds. CONCLUSIONS: To ensure that thresholds reflect current practice, threshold setting with another panel of experts will be repeated as needed, but at least biannually. The report format will be revised on the basis of user input, and a statewide study testing different educational support methods for quality improvement using MDS QIs is now underway.

Aged↗
PubMed1997

Quantitative trait loci for cellular defects in glucose and fatty acid metabolism in hypertensive rats.

Coronary heart disease, hypertension, non-insulin-dependent diabetes and obesity are major causes of ill health in industrial societies. Disturbances of carbohydrate and lipid metabolism are a common feature of these disorders. The bases for these disturbances and their roles in disease pathogenesis are poorly understood. The spontaneously hypertensive rat (SHR), a widely used animal model of essential hypertension, has a global defect in insulin action on glucose metabolism and shows reduced catecholamine action on lipolysis in fat cells. In our study we used cellular defects in carbohydrate and lipid metabolism to dissect the genetics of defective insulin and catecholamine action in the SHR strain. In a genome screen for loci linked to insulin and catecholamine action, we identified two quantitative trait loci (QTLs) for defective insulin action, on chromosome 4 and 12. We found that the major (and perhaps only) genetic determinant of defective control of lipolysis in SHR maps to the same region of chromosome 4. These linkage results were ascertained in at least two independent crosses. As the SHR strain manifests many of the defining features of human metabolic Syndrome X, in which hypertension associates with insulin resistance, dyslipidaemia and abdominal obesity, the identification of genes for defective insulin and catecholamine action in SHR may facilitate gene identification in this syndrome and in related human conditions, such as type-2 diabetes and familial combined hyperlipidaemia.

Animals↗
PubMed1997

Characterization of endoglin and identification of novel mutations in hereditary hemorrhagic telangiectasia.

To identify mutations that cause hereditary hemorrhagic telangiectasia (HHT, or Rendu-Osler-Weber syndrome), clinical evaluations and genetic studies were performed on 32 families. Linkage studies in four of eight families indicated an endoglin (ENG) gene mutation. ENG sequences of affected members of the four linked families and probands from the 24 small families were screened for mutations, by Southern blot analyses and by cycle sequencing of PCR-amplified DNA. Seven novel mutations were identified in eight families. Two mutations (a termination codon in exon 4 and a large genomic deletion extending 3' of intron 8) did not produce a stable ENG transcript in lymphocytes. Five other mutations (two donor splice-site mutations and three deletions) produce altered mRNAs that are predicted to encode markedly truncated ENG proteins. Mutations in other families are predicted to lie in ENG-regulatory regions or in one of the additional genes that may cause HHT. These data suggest that the molecular mechanism by which ENG mutations cause HHT is haploinsufficiency. Furthermore, because the clinical manifestation of disease in these eight families was similar, we hypothesize that phenotypic variation of HHT is not related to a particular ENG mutation.

Adult↗
PubMed1997

Atovaquone for salvage treatment and suppression of toxoplasmic encephalitis in patients with AIDS. Atovaquone/Toxoplasmic Encephalitis Study Group.

To examine the efficacy of atovaquone as salvage therapy in patients with AIDS-related toxoplasmic encephalitis, 93 patients with AIDS and toxoplasmic encephalitis who were intolerant of standard therapy (pyrimethamine plus sulfadiazine or clindamycin) or for whom such therapy was failing were treated with atovaquone tablets (750 mg four times daily) for 18 weeks. Plasma levels of atovaquone were measured with high-pressure liquid chromatography, and the clinical and radiological responses and survival were compared according to median plasma concentration groups. During the acute-therapy phase (the first 6 weeks), the conditions of 52% and 37% of the patients, respectively, were clinically or radiologically improved; the conditions of 26% and 15% remained clinically or radiologically improved by week 18. Median survival for all patients was 189 days (Kaplan-Meier estimate). A post-hoc analysis revealed a positive relationship between clinical and radiological responses and median atovaquone plasma concentrations. Survival time among patients with high or medium median steady-state plasma concentrations (319 and 289 days) was significantly better than that among those with low plasma concentrations (114 days; P = .003 and P = .006, respectively).

AIDS-Related Opportunistic Infections↗
PubMed1997

Leptin receptor gene variation and obesity: lack of association in a white British male population.

Leptin, a hormone secreted by adipocytes, plays a pivotal role in the control of body weight. Rodents with mutations in the leptin receptor gene develop morbid obesity. It is possible, therefore, that leptin receptor gene mutations contribute to human obesity. To test this possibility, we determined the entire coding sequence of the human leptin receptor cDNA from peripheral blood lymphocytes of 22 morbidly obese patients with body-mass index (BMI) between 35.1 and 60.9 kg/m2. We identified five common DNA sequence variants distributed throughout the coding sequence at codons 109, 223, 343, 656 and 1019, one rare silent mutation at codon 986 and one novel alternatively spliced form of transcript. None of the five common variants, including the three that predict amino acid changes, are null mutations causing morbid obesity, because homozygotes for the variant sequences were also found in lean subjects. Furthermore, the frequency of each variant allele and the distribution of genotypes and haplotypes were similar in 190 obese (BMI >28 kg/m2) and 132 lean (BMI <22 kg/m2) white British males selected from a population-based epidemiological survey. In these subjects, there was no evidence for a significant effect of the common variants on obesity or obesity-related phenotypes. These results suggest that mutations in the leptin receptor gene are not a common cause of human obesity.

Adult↗
PubMed1997

Verifying nursing home care quality using minimum data set quality indicators and other quality measures.

Researchers, providers and government agencies have devoted time and resources to the development of a set of Quality Indicators derived from Minimum Data Set (MDS) data. Little effort has been directed toward verifying that Quality Indicators derived from MDS data accurately measure nursing home quality. Researchers at the University of Missouri-Columbia have independently verified the accuracy of QI derived from MDS data using four different methods; 1) structured participative observation, 2) QI Observation Scoring Instrument, 3) Independent Observable Indicators of Quality Instrument, and 4) survey citations. Our team was able to determine that QIs derived from MDS data did differentiate nursing homes of good quality from those of poorer quality.

Data Collection↗
PubMed1997

Managing chronically ill older people in the midst of the health care revolution.

The health care revolution is challenging nursing to change, as are the rapidly changing population demographics. The aging of America underlines a need for the health care revolution to address continuum-based care requirements, particularly of the chronically ill older population. They and their families are stressed with the current fragmentation of the health care system. Continuum-based care for the chronically ill is critical in altering the trajectory of health care consumption, and case management is central to it. A model of nurse case management is presented as an emerging solution.

Aged↗
PubMed1997

A randomized trial of group outpatient visits for chronically ill older HMO members: the Cooperative Health Care Clinic.

OBJECTIVE: To compare the impact of group outpatient visits to traditional "physician-patient dyad" care among older chronically ill HMO members on health services utilization and cost, self-reported health status, and patient and physician satisfaction. DESIGN: A 1-year randomized trial. SETTING: A group model HMO in the Denver Metropolitan area. PARTICIPANTS: Three hundred twenty-one members aged 65 and older, randomized to a group visit intervention (n = 160) or to usual care (n = 161). INTERVENTION: Patients with high health services utilization and one or more chronic conditions had monthly group visits with their primary care physician and nurse. Visits included health education, prevention measures, opportunities for socialization, mutual support, and for one-to-one consultations with their physician, where necessary. MEASUREMENTS: Health services utilization and associated cost, health status, and patient and physician satisfaction. RESULTS: Outcome measures obtained after a 1-year follow-up period showed that group participants had fewer emergency room visits (P = .009), visits to subspecialists (P = .028), and repeat hospital admissions per patient (P = .051). Group participants made more visits (P = .021) and calls (P = .038) to nurses than control group patients and fewer calls to physicians (P = .019). In addition, a greater percentage of group participants received influenza and pneumonia vaccinations (P < .001). Group participants had greater overall satisfaction with care (P = .019), and participating physicians reported higher levels of satisfaction with the groups than with individual care. No differences were observed between groups on self-reported health and functional status. Cost of care per member per month was $14.79 less for the group participants. CONCLUSIONS: Group visits for chronically ill patients reduce repeat hospital admissions and emergency care use, reduce cost of care, deliver certain preventive services more effectively, and increase patient and physician satisfaction.

Aged↗
PubMed1997

Partial remission in depressive disorders.

Although the concept of partial or incomplete remission from depression has been noted in the literature for many decades, it is only recently that a precise definition of partial remission has been formulated (1). This paper reviews publications relating to this concept, in terms of prevalence, clinical characteristics and implications for prognosis. There have been too few studies to allow conclusive evidence to be presented, but partial remission may affect one third of subjects treated for depression, and may increase the risk of further depressive relapse and adversely affect social and work performance. This paper highlights the need to increase awareness of this concept among clinicians so that residual symptoms may be aggressively treated, and also comments on the need for researchers to consider this important group in all treatment and outcome studies.

Antidepressive Agents↗
PubMed1997

Teaching as a tool.

Explore the source record for details and available documents.

Education, Dental↗
PubMed1997

Individual risk factors for early repetition of deliberate self-harm.

This study investigated individual factors associated with repetition of deliberate self-harm (DSH) within three months of a first-ever episode. Individuals from an 'at risk' population who repeated DSH (N = 25) were compared with a socio-demographically matched group of 'at risk' individuals who did not engage in a further episode of DSH (N = 18). In comparison with the 'single DSH' individuals, those in the 'repeated DSH' group demonstrated significantly higher levels of depression and hopelessness, were significantly less skilled at problem solving, were significantly less likely to report the availability of a confidante and significantly more likely to identify that the reason for their DSH was to communicate their desperation. The implications of these findings for risk assessment and interventions are noted.

Adaptation, Psychological↗
PubMed1997

Defects of insulin action on fatty acid and carbohydrate metabolism in familial combined hyperlipidemia.

Familial combined hyperlipidemia (FCHL) is a common cause of premature myocardial infarction, but its metabolic basis is unknown. Insulin resistance has been suggested in some patients by the presence of fasting hyperinsulinemia. We studied insulin action on carbohydrate and fatty acid metabolism in FCHL patients and healthy control subjects by a two-step euglycemic, hyperinsulinemic clamp. During low-dose insulin infusion, steady-state nonesterified fatty acids (NEFAs) were higher in patients than in control subjects (0.36 mmol/L [95% confidence limits, 0.19, 0.53] versus 0.19 mmol/L [0.10, 0.28]; P = .05). The ratio of steady-state to basal NEFAs was increased by 88% in patients compared with control subjects (P = .005). During high-dose insulin infusion, insulin sensitivity for peripheral glucose disposal was reduced by 60% in FCHL patients compared with control subjects (P = .03). Hepatic glucose production at baseline and during the clamp was similar in the two groups. In multiple regression analysis, increased upper-body fat in the patient group accounted for the impairment of insulin-mediated glucose disposal but did not influence the defect in insulin-mediated NEFA suppression in the FCHL patients. This defect in fatty acid metabolism may be a primary defect in FCHL that contributes to abnormalities in the secretion and composition of lipoproteins in this disorder. Direct study of this defect may facilitate genetic analysis of this disorder.

Adult↗
PubMed1997

Acute and one-year outcome of a randomised controlled trial of brief cognitive therapy for major depressive disorder in primary care.

BACKGROUND: The consensus statement on the treatment of depression (Paykel & Priest, 1992) advocates the use of cognitive therapy techniques as an adjunct to medication. METHOD: This paper describes a randomised controlled trial of brief cognitive therapy (BCT) plus 'treatment as usual' versus treatment as usual in the management of 48 patients with major depressive disorder presenting in primary care. RESULTS: At the end of the acute phase, significantly more subjects (P < 0.05) met recovery criteria in the intervention group (n = 15) compared with the control group (n = 8). When initial neuroticism scores were controlled for, reductions in Beck Depression Inventory and Hamilton Rating Scale for Depression scores favoured the BCT group throughout the 12 months of follow-up. CONCLUSIONS: BCT may be beneficial, but given the time constraints, therapists need to be more rather than less skilled in cognitive therapy. This, plus methodological limitations, leads us to advise caution before applying this approach more widely in primary care.

Acute Disease↗
PubMed1997

Alterations in parathyroid dynamics in lithium-treated subjects.

Chronic lithium (Li) therapy, used extensively in the treatment of bipolar affective disorders, is one of psychiatry's most effective treatments. The data on the effects of Li on baseline PTH and calcium (Ca) levels are conflicting. A clear resetting of the PTH set-point to the right was documented in vitro; however, the effect of Li on the Ca-PTH axis has not been rigorously studied in vivo. In this study, we used a Ca and citrate infusion protocol to fully characterize PTH dynamics in seven female patients, 40 +/- 11 yr old, on chronic Li therapy for 5.23 +/- 4.0 yr, compared with seven controls, 41 +/- 16 yr old (mean +/- SD). Baseline ionized Ca (Cai) and intact PTH levels were 5.2 +/- 0.06 mg/dL and 38.4 +/- 5.7 pg/mL in the Li group and 4.9 +/- 0.06 mg/dL and 21.2 +/- 5.0 pg/mL in the controls, (mean +/- SEM) P = 0.008 and 0.042, respectively. We defined an inverse sigmoidal curve between Cai and the intact biologically active PTH molecule (iPTH) for the two study groups and demonstrated a significant shift in the iPTH set-point to the right in the Li-treated patients, compared with controls. The set-point was 5.08 +/- 0.04 for the former group and 4.88 +/- 0.04 mg/dL for the latter, P = 0.004. Patients on Li had significantly higher Cai levels during citrate and Ca infusions, P = 0.0008 and 0.012, respectively; however, iPTH levels were not significantly different between the two study groups during either infusion. The shift in the iPTH set-point to the right in the Li-treated patients and the similar iPTH levels, despite higher serum Cai levels during both infusions, establish the presence of a clear alteration in PTH dynamics in patients on chronic Li therapy.

Adult↗