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Biomedical subjects

J Stevenson

Publications and source records attributed to J Stevenson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Subjective health complaints in adolescence. A cross-national comparison of prevalence and dimensionality.

BACKGROUND: The purpose of this work was to study the prevalence and dimensionality of subjective health complaints in a cross-national population of adolescents. METHODS: The analyses were based on data from a WHO cross-national survey, Health Behaviour in School-aged Children (HBSC). The study included a representative sample of 11, 13 and 15-year-old adolescents from Finland, Norway, Poland and Scotland. Data were collected in 1993-1994 and the total sample included 20,324 adolescents. Subjective health complaints were measured by the HBSC Symptom Checklist (HBSC-SCL), including headaches, abdominal pain, backache, feeling low, irritability, nervousness, sleeping difficulties and dizziness. Descriptive analyses, MANOVA and structural equation modelling (EQS) were conducted. RESULTS: Patterns of reporting were consistent for all four countries. A large number of students reported a high level of symptoms. The reporting of most symptoms increased with age. Girls reported significantly more symptoms than boys and the gender differences also increased with age. Structural equation modelling suggests a model of two correlated factors, which can be labelled psychological and somatic. CONCLUSION: The findings of this study indicate that students report a high level of subjective health complaints already at the age of 11 years. The reporting of most symptoms increases with age and more so for girls than for boys. The finding of two dimensions that differ qualitatively, suggests that these dimensions may have different etiologies.

Adolescent↗
PubMed2001

A case ascertainment study of septic discitis: clinical, microbiological and radiological features.

We studied the spectrum of septic discitis presenting to two busy district general hospitals over 2.5 years (November 1996 to April 1999), surveying the case notes of all patients attending Royal Bournemouth and Poole Hospitals with probable septic discitis on magnetic resonance imaging (MRI). Twenty-two cases of septic discitis were identified, suggesting an annual incidence of 2/100 000/year. Seventy-three percent of patients were aged > or =65 years. In 91% of patients, back pain was the presenting symptom, with neurological signs evident in 45% of patients. Fever >37.5 degrees C was present in 68% of patients, and a marked elevation of erythrocyte sedimentation rate (ESR) in 91%. Diagnosis was originally by MRI in 86% of patients, with plain radiographs not diagnostic of discitis in the early stages of the infection. Staphylococcus aureus was the commonest pathogen (41%), but in 18% of patients, no organism was identified. The major predisposing factors to septic discitis were invasive procedures (41%), underlying cancer (25%) and diabetes (18%). Pre-existing degenerative spinal disease was found in 50% of patients. Four patients whose causative organism was not isolated had a poorer outcome: one death and three with increased morbidity. Our estimated incidence rate (2/100 000/year) is higher than that in previous studies and may be due to a higher detection rate with MRI and/or a genuine increase in the number of cases. Septic discitis should be considered in any patient who has severe localized pain at any spinal level, especially if accompanied by fever and elevated ESR, or in the immunosuppressed.

Adult↗
PubMed2001

Genes and environment in asthma: a study of 4 year old twins.

BACKGROUND: Although the genetic and environmental factors of asthma have been investigated in adolescence and adulthood, no previous studies have focused on the early development of asthma. AIMS: To test, in a large sample of 4 year old twins, the hypotheses derived from the literature on adolescents and adults that genetic influences are substantial and shared environmental influences are modest. METHODS: The sample consisted of 4910 twin pairs who were born in England and Wales in 1994 and 1995. Data on asthma status were obtained from the twins' parents by postal questionnaire. RESULTS: Univariate parameter estimates derived from model fitting were 68% heritability, 13% shared environment, and 19% non-shared environment. CONCLUSIONS: Our findings suggest that asthma is highly heritable in 4 year olds, whereas shared environmental influences are not statistically significant.

Analysis of Variance↗
PubMed2001

Subcutaneous emphysema of upper limb.

A case is reported of subcutaneous emphysema involving upper limb resulting from a trivial laceration to the elbow. Gas in the soft tissues after the injury can be caused by infection with a gas forming organism or by a variety of non-infective causes. It is hypothesised that this minor skin wound has acted like a ball-valve mechanism leading to air being trapped in the soft tissue.

Aged↗
PubMed2001

Association between behaviour at age 3 years and adult criminality.

BACKGROUND: The continuity in antisocial behaviour into adulthood from middle childhood is well established but it is not clear whether this is also true of the pre-school period. AIMS: To determine whether pre-school behaviour problems increase the risk of later criminal convictions and add to risk associated with family and social circumstances. METHOD: The records of adult convictions were traced for a general population sample (n=828) initially assessed at age 3 years. RESULTS: The risk of having any adult conviction was related to soiling, daytime enuresis, activity level and management difficulties, and that of having an adult violent offence to recent-onset daytime enuresis, management difficulties and temper tantrums. The only other predictors of later convictions were the child's gender and social competence at age 3 years. CONCLUSIONS: The presence of specific behaviour problems in the pre-school period places the child at increased risk of being convicted of an adult offence. Family and social circumstances at age 3 years did not predict later convictions.

Adult↗
PubMed2001

Vaccination coverage and physician distribution in the United States, 1997.

BACKGROUND: How many physicians are needed in the United States and how they should be allocated geographically and among specialties has been the subject of intense debate, a debate that has often focused more on costs to third-party payers and government than on benefits to health. Child health is a central aspect of public health, and immunization is one of its most cost-effective and easily measured interventions. OBJECTIVE: To examine the association of immunization rates and delivery characteristics with the distribution of child health physicians in the United States in 1997. DESIGN: Cross-sectional ecological study, using the state as the unit of analysis, immunization rates and delivery characteristics (from the National Immunization Survey) as the main outcome measures, concentration of the principal physician specialties providing routine care to children (pediatric, family, and general physicians from the American Medical Association Masterfile) as the main risk factor, while controlling for demographic and economic factors (from the Bureau of the Census and other sources). RESULTS: Of the 96 689 physicians providing routine care to children, 37% were pediatric, 49% family, and 14% general physicians. Higher rates of vaccination, private sector vaccination, and increased numbers of public and private vaccination sites were all associated with the concentration of pediatricians but not of family or general physicians. The distribution of pediatricians was strongly associated with the distribution of residency positions. CONCLUSIONS: Pediatrician distribution is a strong correlate to immunization rates and delivery characteristics. Opportunities to affect pediatrician distribution may exist with allocation of residency positions.

Child↗
PubMed2001

Psychological mechanisms in hyperactivity: I. Response inhibition deficit, working memory impairment, delay aversion, or something else?

This study tested the predictions of three different theories of hyperactivity: response inhibition deficit, working memory impairment, and delay aversion. A sample of 51 pervasively hyperactive children and 119 control children, identified by screening a general population sample of 1,316 twin pairs, were assessed on tests relating to each of these theories. The hyperactive group performed worse than the control group on the delay aversion measure and some of the working memory tasks. Controlling for IQ removed the significant group differences on the working memory measures, however. There were no significant group differences on the inhibition variables derived from the stop task. However, there was evidence of a pattern of responding on the stop task that was strongly characteristic of hyperactivity: hyperactive children were variable in their speed, generally slow and inaccurate in responding. This pattern of responses may indicate a nonoptimal effort/ activation state. Hyperactive girls were indistinguishable from hyperactive boys in their performance on the tasks.

Attention Deficit Disorder with Hyperactivity↗
PubMed2001

Psychological mechanisms in hyperactivity: II. The role of genetic factors.

The main aim of this study was to combine two research approaches to hyperactivity: the behaviour genetic approach and the testing of psychological theories of hyperactivity. For a sample of 268 twin pairs aged 7-11 years we obtained ratings on the Conners' scales from both teachers (CTRS-28) and parents (CPRS-48). Forty-six hyperactive twin pairs (pairs in which at least one twin was pervasively hyperactive) and 47 control twin pairs were assessed on a psychological test battery. Confirming findings from previous twin studies, a substantial proportion of the variance in hyperactivity considered as a dimension was due to genetic effects. There was significant evidence of genetic effects also on extreme hyperactivity, although the present group heritability estimates were somewhat lower than those reported in most previous studies. We investigated the possibility that the psychological mechanisms we reported to be associated with hyperactivity (Kuntsi, Oosterlaan, & Stevenson, 2001) share common genetic factors with hyperactive behaviour. The data produced significant evidence of such shared genetic effects only on hyperactivity and the variability of reaction times. Given that the high variability in speed of responding would indicate a state-regulation problem, this is the psychological mechanism that could possibly be the "link" between genetic effects and hyperactive behaviour.

Attention Deficit Disorder with Hyperactivity↗
PubMed2001

An outbreak of acute hepatitis B infection among injecting drug users in Inverclyde, Scotland.

This large outbreak of acute hepatitis B infection among injecting drug users (IDUs) was precipitated by an increase in injecting heroin use in Inverclyde in the West of Scotland, between 1997 and 1999. Ninety-two cases of hepatitis B infection in residents of Inverclyde were reported to Argyll and Clyde Health Board from January 1996 to December 1999. An investigation of risk factors found 87% (80/92) of the cases were IDUs, of whom four-fifths were men. Fifty six per cent of cases were aged 20-29 years old and 12% were aged 16-19 years old. Further investigations among this close community of young and relatively inexperienced IDUs revealed that many admitted to sharing injecting equipment particularly spoons, water and filters. Only a minority had been using local needle exchange facilities in the area. After public consultation a second needle exchange was opened in 1998 staffed by a dedicated needle exchange development worker who has continued to develop harm reduction services locally.

Acute Disease↗
PubMed2000

Family-based association mapping provides evidence for a gene for reading disability on chromosome 15q.

Family-based association mapping was used to follow up reports of linkage between reading disability (RD) and a genomic region on chromosome 15q. Using a two-stage approach, we ascertained 101 (stage 1) and 77 (stage 2) parent-proband trios, in which RD was characterized rigorously. In stage 1, a set of eight microsatellite markers spanning the region of putative linkage was used and a highly significant association was detected between RD and a three-marker haplotype (D15S994/D15S214/D15S146: P and empirical P < 0.001). A significant association with the same three-marker haplotype was also observed in the second-stage sample (P = 0.009, empirical P = 0.006). Our data therefore provide strong evidence for one or more genes contributing to RD being located in the vicinity of the region including D15S146 and D15S994. In addition, our results provide support for association analysis being a useful method to map susceptibility loci for complex disorders.

Chromosome Mapping↗
PubMed2000

The status of immunization measurement and feedback in the United States.

BACKGROUND: A large body of scientific and programmatic data has demonstrated that provider measurement and feedback raises immunization coverage. Starting in 1995, Congress required that all states measure childhood immunization coverage in all public clinics, and federal grant guidelines encourage private practice measurements. OBJECTIVES: To determine state immunization measurement rates and examine risk factors for high rates. METHODS: Review of 1997 state reports, with correlation of measurement rates to birth cohort and provider numbers, public/private proportions, and vaccine distribution systems. RESULTS: Of the 9505 public clinics, 48% were measured; 4 states measured all clinics; 29 measured a majority. Measurement rates were highest for Health Department clinics (67%), lower for community/migrant health centers (39%), and lowest for other clinics (22%). Rates were highly correlated among categories of clinics (r>+0.308, P<.03), and the fewer the clinics, the higher the measurement rates (r = -0.351, P =. 01), but other factors were not significant. Of the 41,378 private practices, 6% were measured; no state measured all its practices; 1 measured a majority. Private practice measurement rates were not correlated to public clinic measurement rates or other factors examined. Of the 50,883 total providers, 14% were measured; no state measured all providers; 2 measured a majority. A trend toward higher measurement rates was found in states with fewer providers (r = -0. 266, P =.06). CONCLUSIONS: Three years after the congressional mandate, only a minority of public clinics and very few private practices had their immunization coverage measured. Greater efforts will be needed to assure implementation of the intervention. Arch Pediatr Adolesc Med. 2000;154:832-836

Child↗
PubMed2000

Planum temporale, planum parietale and dichotic listening in dyslexia.

A reduction or reversal of the normal leftward asymmetry of the planum temporale (PT) has been claimed to be typical of dyslexia, although some recent studies have challenged this view. In a population-based study of 20 right-handed dyslexic boys and 20 matched controls, we have measured the PT and the adjacent planum parietale (PP) region in sagittal magnetic resonance images. For the PT, mean left and right areas and asymmetry coefficients were compared. Since a PP area often could not be identified in one or both hemispheres, a qualitative comparison was used for this region. The total planar area (sum of PT and PP) was also compared between the two groups. A dichotic listening (DL) test with consonant-vowel syllables was administered to assess functional asymmetry of language. The results showed a mean leftward PT asymmetry in both the dyslexic and the control group, with no significant difference for the degree of PT asymmetry. Planned comparisons revealed however, a trend towards smaller left PT in the dyslexic group. In control children, but not in the dyslexic children, a significant correlation between PT asymmetry and reading was observed. A mean leftward asymmetry was also found for the total planar area, with no difference between the groups for the degree of asymmetry. Significantly fewer dyslexic children than control children showed a rightward asymmetry for the PP region. Both groups showed a normal right ear advantage on the DL task, with no significant difference for DL asymmetry. No significant correlation was observed between PT asymmetry and DL asymmetry. The present population-based study adds to recent reports of normal PT asymmetry in dyslexia, but indicates that subtle morphological abnormalities in the left planar area may be present in this condition.

Child↗
PubMed2000

Specific life events and chronic experiences differentially associated with depression and anxiety in young twins.

Behavioral genetic analyses indicate that environmental influences associated with depression and anxiety are specific to each symptom type; however, this has not been tested specifically in children. Sixty-one (61) child twin pairs in which at least one twin had a very high anxiety or depression score, and 29 nonanxious, nondepressed pairs were interviewed about life events and chronic stressors in the previous 12 months. Loss events, schoolwork stressors, family relationship problems, and friendship problems were all significantly associated with depression but not anxiety. Threat events were significantly associated with anxiety but not depression. Loss events and schoolwork stressors appeared to act as shared environment influences in that they made twin pairs resemble one another. Threat events, friendship problems, and family relationship problems were individual specific and accounted for differences within the pairs. These results clarify the associations between life events and depressive and anxious symptoms in children and adolescents and reveal specific associations previously unidentified in this age range.

Adolescent↗
PubMed2000

Hyperactivity in children: a focus on genetic research and psychological theories.

Hyperactivity has attracted a large amount of research interest in recent years. Here we review developments in genetic research and in research testing psychological theories of the condition. Family, adoptee and twin studies indicate a strong role for genetic factors in the etiology of hyperactivity. Evidence is emerging also from molecular genetic studies, implicating specific genes that may be involved. At the level of cognitive functioning, a divided, focused or sustained attention deficit does not seem to be a 'core' deficit in hyperactivity. Although children with hyperactivity often perform poorly on certain executive function tasks, there is disagreement about the interpretation of these findings. The association reported in some studies between a slow inhibitory process and hyperactivity may reflect a generally slow, variable in speed and inaccurate pattern of responding. Hypotheses about psychological mechanisms such as state regulation or delay aversion provide alternative, and particularly encouraging, interpretations of the findings. We discuss the possible integration of the two lines of research--those of genetic research and research on psychological mechanisms.

Attention Deficit Disorder with Hyperactivity↗
PubMed2000

Non-dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus.

AIMS: To assess the relevance of circadian blood pressure variation to future morbidity and mortality in patients with diabetes mellitus. METHODS: A retrospective descriptive 4 year follow-up study of data collected after ambulatory blood pressure monitoring in a clinic setting. RESULTS: Seventy-five patients (46 male; 29 female) of whom 41 % had Type 1 diabetes and 59% Type 2 were followed up for a median of 42 months (11-56). The median creatinine for the whole group at baseline was 101 (56-501) micromol/l. The median circadian blood pressures for the total study population were 147 (110-194)/87 (66-109) mmHg during daytime and 132 (86-190)/77 (50-122) mmHg during night-time. Half of the patients exhibited a fall in night-time pressures to 10% lower than daytime pressures (dippers). Dippers were younger, 47 (32-75) years, than non-dippers, 57 (35-79) years, P = 0.03. Over time, dippers had a lower mortality than non-dippers, with 8% deaths in the cohort of dippers, 26% deaths in the cohort of non-dippers, P = 0.04. Cox regression analysis revealed significant contributions from age, duration of diabetes and baseline renal function to subsequent mortality in non-dippers. Analysing current degree of renal impairment and original dipper status together revealed that, of those patients whose creatinine remained normal, 7% of patients whose blood pressure dipped had subsequently died and 10% of non-dipping patients had died; of those patients whose creatinine unequivocally rose, 10% of dipping patients had died and 42% of non-dipping patients had died, P = 0.03 CONCLUSIONS: Loss of circadian variation in blood pressure is associated with an increased mortality rate, regardless of diabetes type. The combination of non-dipping and subsequent renal impairment leads to the highest mortality rate. The study suggests a role for ambulatory blood pressure monitoring in day-to-day clinical practice to select patients with nephropathy who are at greatest risk, in an effort to alter outcome.

Adult↗
PubMed2000

Gamma hydroxybutyric acid (GHB): an increasing trend in drug abuse.

The use of recreational drugs in society is becoming a widespread problem increasing the workload of all the emergency services. Gamma hydroxybutyric acid (GHB) is one of these, a drug used primarily for its euphoric effect. Toxic effects of ingestion include bradycardia, slow respiration or apnoea, coma and death. We present seven cases, all of which had consumed GHB either alone or in conjunction with other drugs and alcohol. The presentation, clinical features and management of these cases are described. All health care personnel involved in the emergency setting need to know of its existence, toxic effects and initial management with particular reference to airway control and possible assisted ventilation.

Adolescent↗