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Biomedical subjects

J Walker

Publications and source records attributed to J Walker.

At least 127 records · Page 7Linked to original sources
PubMed1999

Treatment preference in hypochondriasis.

Promising cognitive-behavioral and medication treatments for hypochondriasis are in the early stages of evaluation. Little is known about the treatment preferences and opinions of individuals seeking help for this problem. In this exploratory study, 23 volunteers from the community with a DSM-IV diagnosis of hypochondriasis were recruited through a newspaper advertisement. Participants were presented with a survey which included balanced descriptions of both a medication and a cognitive-behavioral treatment for intense illness concerns (hypochondriasis). The brief descriptions of the treatments discussed the time commitment required as well as the major advantages and disadvantages of each. Results showed that, relative to medication treatment, cognitive-behavioral treatment was predicted to be more effective in both the short and long terms and was rated as more acceptable. Psychological treatment was indicated as the first choice by 74% of respondents, medication by 4%, and 22% indicated an equal preference. Forty-eight percent of respondents would only accept the psychological treatment.

Adult↗
PubMed1999

Small bowel intussusception in celiac disease.

Intussusception is not a widely recognized complication of celiac disease and yet it is not rare. The authors report on 3 children with spontaneously resolving small bowel intussusception in association with celiac disease. Small bowel intussusception in a child with suspected celiac disease initially should be managed expectantly rather than by early surgical reduction. The finding of transient small bowel intussusception, either by contrast radiology or sonography, should prompt investigation for celiac disease.

Celiac Disease↗
PubMed1999

Improved recognition of MRSA case clusters by the application of molecular subtyping using pulsed-field gel electrophoresis.

Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly common in hospital and community populations, making the recognition of true nosocomial outbreaks more difficult. We have used pulsed-field gel electrophoresis (PFGE) with Sma I digestion to analyse retrospectively two perceived outbreaks of epidemic methicillin-resistant Staphylococcus aureus 15 (EMRSA 15) colonization. The first cluster of cases in patients and staff on a general ward (ward D) revealed three different antibiograms based on differences in ciprofloxacin and rifampicin sensitivities. All isolates typed using PFGE, which was more discriminatory than phage-typing. One PFGE banding profile labelled type 5 was predominant, but 12 isolates proved to be subtypes of type 5 and two were PFGE type 11. Four staff members carried a strain not found in patients, three carried strains found in patients and transient carriage was highlighted as a problem when screening staff. PFGE enhanced the epidemiological data and proved that the cases on this ward did not comprise one large outbreak but numerous sporadic cases and smaller clusters. In contrast, isolates from a second cluster of cases which occurred on ward F were indistinguishable using antibiograms, phage-typing and PFGE, confirming this was more likely to be a true outbreak of colonization. We conclude that PFGE usefully augments epidemiological information and allows more logical infection control decisions to be made, with better utilization of scarce resources.

Bacterial Typing Techniques↗
PubMed1999

The built environment as a component of quality care: understanding and including the patient's perspective.

BACKGROUND: Although there has been little systematic assessment of how the built environment of health care facilities affects the quality of care, the built environment is a major element of structure of care--one of three facets of quality. Yet in contrast to the growing trend of using consumer perceptions of both processes and outcomes of care in QI activities, quality assessments of the structure of care do not currently rely on patient feedback. PURPOSE OF PROJECT: During the initial phase of a multiphase project, nine focus groups were conducted in 1997 to identify the salient dimensions of experience from the patient's perspective. The content of these focus groups guided the development of assessment tools in the second phase of the project, which began in February 1998. FINDINGS: Participants in three focus groups that were held in each of three settings--ambulatory care, acute care, and long term care--described in detail a variety of reactions to the built environment. Analysis revealed eight consistent themes in what patients and family member consumers look for in the built environment of health care. In all three settings, they want an environment, for example, that facilitates a connection to staff and caregivers, is conducive to a sense of well-being, and facilitates a connection to the outside world. DISCUSSION: Data derived from the focus group research has guided the development of quantitative survey and assessment tools. For each setting, patient-centered checklists and questionnaires are designed to help institutions set priorities for the improvement of facility design from the patient's perspective.

Facility Design and Construction↗
PubMed1999

Absence of Epstein-Barr virus encoded RNA and latent membrane protein (LMP1) in salivary gland neoplasms.

A series of 55 (42 benign and 13 malignant) salivary gland tumours were investigated by immunohistochemistry, to detect Epstein-Barr virus (EBV) latent membrane protein (LMP1) and by in situ hybridization for EBV-encoded RNA. Non-neoplastic gland from all the patients with tumours and 15 control glands were also examined. All cases, both neoplastic and non-neoplastic were negative for LMP1 and failed to show any positive signal by in situ hybridization for EBV RNA. One undifferentiated carcinoma from a European patient was included in the group. These results confirm previous reports of an ethnic association between EBV and undifferentiated carcinomas of the salivary gland. They do not support an aetiological role for EBV in other salivary gland tumours.

Adenoma↗
PubMed1999

The clam 3' UTR masking element-binding protein p82 is a member of the CPEB family.

During early development gene expression is controlled principally at the translational level. Oocytes of the surf clam Spisula solidissima contain large stockpiles of maternal mRNAs that are translationally dormant or masked until meiotic maturation. Activation of the oocyte by fertilization leads to translational activation of the abundant cyclin and ribonucleotide reductase mRNAs at a time when they undergo cytoplasmic polyadenylation. In vitro unmasking assays have defined U-rich regions located approximately centrally in the 3' UTRs of these mRNAs as translational masking elements. A clam oocyte protein of 82 kDa, p82, which selectively binds the masking elements, has been proposed to act as a translational repressor. Importantly, mRNA-specific unmasking in vitro occurs in the absence of poly(A) extension. Here we show that clam p82 is related to Xenopus CPEB, an RNA-binding protein that interacts with the U-rich cytoplasmic polyadenylation elements (CPEs) of maternal mRNAs and promotes their polyadenylation. Cloned clam p82/CPEB shows extensive homology to Xenopus CPEB and related polypeptides from mouse, goldfish, Drosophila and Caenorhabditis elegans, particularly in their RNA-binding C-terminal halves. Two short N-terminal islands of sequence, of unknown function, are common to vertebrate CPEBs and clam p82. p82 undergoes rapid phosphorylation either directly or indirectly by cdc2 kinase after fertilization in meiotically maturing clam oocytes, prior to its degradation during the first cell cleavage. Phosphorylation precedes and, according to inhibitor studies, may be required for translational activation of maternal mRNA. These data suggest that clam p82 may be a functional homolog of Xenopus CPEB.

3' Untranslated Regions↗
PubMed1999

Dual roles of p82, the clam CPEB homolog, in cytoplasmic polyadenylation and translational masking.

In the transcriptionally inert maturing oocyte and early embryo, control of gene expression is largely mediated by regulated changes in translational activity of maternal mRNAs. Some mRNAs are activated in response to poly(A) tail lengthening; in other cases activation results from de-repression of the inactive or masked mRNA. The 3' UTR cis-acting elements that direct these changes are defined, principally in Xenopus and mouse, and the study of their trans-acting binding factors is just beginning to shed light on the mechanism and regulation of cytoplasmic polyadenylation and translational masking. In the marine invertebrate, Spisula solidissima, the timing of activation of three abundant mRNAs (encoding cyclin A and B and the small subunit of ribonucleotide reductase, RR) in fertilized oocytes correlates with their cytoplasmic polyadenylation. However, in vitro, mRNA-specific unmasking occurs in the absence of polyadenylation. In Walker et al. (in this issue) we showed that p82, a protein defined as selectively binding the 3' UTR masking elements, is a homolog of Xenopus CPEB (cytoplasmic polyadenylation element binding protein). In functional studies reported here, the elements that support polyadenylation in clam egg lysates include multiple U-rich CPE-like motifs as well as the nuclear polyadenylation signal AAUAAA. This represents the first detailed analysis of invertebrate cis-acting cytoplasmic polyadenylation signals. Polyadenylation activity correlates with p82 binding in wild-type and CPE-mutant RR 3' UTR RNAs. Moreover, since anti-p82 antibodies specifically neutralize polyadenylation in egg lysates, we conclude that clam p82 is a functional homolog of Xenopus CPEB, and plays a positive role in polyadenylation. Anti-p82 antibodies also result in specific translational activation of masked mRNAs in oocyte lysates, lending support to our original model of clam p82 as a translational repressor. We propose therefore that clam p82/CPEB has dual functions in masking and cytoplasmic polyadenylation.

3' Untranslated Regions↗
PubMed1999

The impact of spinal cord injury on men's time use.

BACKGROUND: Despite evidence of the relationship between time use and health and well-being, and the World Health Organization's recognition of activity limitation as a measure of dis-ability, there has been limited investigation into the activity patterns of persons with disabilities. METHODS: Interviews and time diaries to provide preliminary descriptive and analytical information about the daily time use patterns of men with a spinal cord injury (SCI) living in the community (n=312) compared with the time use data of able-bodied men (n=3617) collected as part of the 1992 Canadian General Social Survey. The study also examined relationships between time use by men with SCI and selected factors (severity of disability and socioeconomic status). FINDINGS: Statistically different time use patterns between the SCI and able-bodied subjects. The men with spinal cord injury spent on average 7.2 h in leisure activities (able-bodied men=6.0 h); 4.7 (7.7) h in productivity; 3.7 (2.3) h in personal care; and 8.5 (8.0) h sleeping. The SCI men's lesser productivity time was accounted for largely by the lack of time spent in paid work. The average time use of the SCI sample showed the most time spent in passive leisure pursuits such as watching TV and listening to the radio. The sample rated their satisfaction with their time use as mediocre, but levels of adjustment to disability were moderate to high. Regression analysis revealed that severity of disability (lesion level, functional independence, environment) did not predict the amount of time spent in personal care, productivity, leisure, or sleep. Socioeconomic status had a mild predictive relationship with time allocation. IMPLICATIONS: The findings suggest men with SCI are socially isolated relative to their able-bodied peers. Recommendations are made and include both methodological considerations for further time use studies with persons with SCI, and policy recommendations. The latter focus on the need for rehabilitation, education and resources that go beyond functional independence such that persons with SCI can expand both their leisure and productivity roles and become better socially and economically integrated into society.

Activities of Daily Living↗
PubMed1999

Cardiovascular response during head-up tilt in chronic fatigue syndrome.

This study examined the cardiovascular response to orthostatic challenge, and incidence and mechanisms of neurally mediated hypotension in chronic fatigue syndrome (CFS) during a head-up tilt test. Stoke volume was obtained by a thoracic impedance cardiograph, and continuous heart rate and blood pressure were recorded during a 45-min 70 degrees head-up tilt test. Thirty-nine CFS patients and 31 healthy physically inactive control subjects were studied. A positive tilt, i.e. a drop in systolic blood pressure of > 25 mmHg, no concurrent increase in heart rate and/or development of presyncopal symptoms, was seen in 11 CFS patients and 12 control subjects (P > 0.05). During baseline and the first 5 min of head-up tilt, CFS patients had higher heart rate and smaller pulsatile-systolic area than control subjects (P < 0.05). Among subjects who completed the test, those with CFS had higher heart rate and smaller stroke volume (P < 0.05) than corresponding control subjects. When comparing those who had a positive test outcome in each group, CFS patients had higher heart rates and lower pulse pressure and pulsatile-systolic areas during the last 4 min before being returned to supine (P < 0.05). These data show that there are baseline differences in the cardiovascular profiles of CFS patients when compared with control subjects and that this profile is maintained during head-up tilt. However, the frequency of positive tilts and the haemodynamic adjustments made to this orthostatic challenge are not different between groups.

Adult↗
PubMed1999

A randomized trial of daily and thrice-weekly trimethoprim-sulfamethoxazole for the prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected persons. Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA)

We enrolled 2,625 human immunodeficiency virus-infected patients into a randomized trial to assess the efficacy and tolerability of daily vs. thrice-weekly trimethoprim-sulfamethoxazole (160 mg/800 mg) for prophylaxis of Pneumocystis carinii pneumonia (PCP). The rate of PCP was 3.5 and 4.1 per 100 person-years in the daily and thrice-weekly groups, respectively, with a relative risk (RR) of 0.82 (95% confidence interval [CI], 0.61-1.09; P = .16) (RR of <1.0 favors daily trimethoprim-sulfamethoxazole). The RR for PCP determined by on-treatment analysis was 0.59 (P = .03). The RR for death was 0.91 (P = .12); for bacterial pneumonia, 0.82 (P = .06); and for combined PCP and bacterial pneumonia, 0.84 (P = .04). Discontinuation due to adverse events occurred more commonly in the daily trimethoprim-sulfamethoxazole group (RR, 2.14; 95% CI, 1.73-2.66; P < .001). Overall estimates for efficacy end points favored daily trimethoprim-sulfamethoxazole, although rates of intolerance were higher among patients receiving that dose. Daily trimethoprim-sulfamethoxazole may offer advantages as a first choice for PCP prophylaxis; thrice-weekly dosing is an appropriate option for patients intolerant of the daily dose.

AIDS-Related Opportunistic Infections↗
PubMed1999

Subtyping of methicillin-resistant Staphylococcus aureus isolates from the North-West of England: a comparison of standardised pulsed-field gel electrophoresis with bacteriophage typing including an inter-laboratory reproducibility study.

Bacteriophage typing is currently the recognised methodology for the typing of methicillin-resistant Staphylococcus aureus (MRSA) in the UK. Bacteriophage typing is less discriminatory and does not type all isolates compared with some molecular methods for typing MRSA. Chromosomal genotyping by pulsed-field gel electrophoresis (PFGE) is increasingly recognised as an improved method for typing MRSA, providing increased discrimination and typability. In this study the results of a comparison of bacteriophage typing and PFGE typing and subtyping are presented for a large collection of isolates from the North-West of England. Isolates belonging to the most frequently isolated epidemic methicillin-resistant Staphylococcus aureus (EMRSA) bacteriophage types 15 and 16 were typed by PFGE with further discrimination of common PFGE types possible into a number of subtypes. These results for a large collection of isolates demonstrate the improved typing of MRSA with PFGE. The widespread acceptance of PFGE for typing MRSA isolates has been hampered by the lack of standardised methodologies. Recently, a standardised PFGE strain typing system, known as the GenePath system has become available. The results of an inter-laboratory comparison of PFGE typing for a collection of isolates demonstrated good reproducibility with this system.

Bacterial Typing Techniques↗
PubMed1999

Subsequent obstetric performance related to primary mode of delivery.

OBJECTIVE: To relate subsequent obstetric performance with primary mode of delivery. DESIGN: Postal questionnaire survey of women who delivered their first child five years ago. SETTING: Huddersfield Royal Infirmary. POPULATION: Women who were delivered of their first baby in 1991: 250 by normal vaginal delivery; 250 by instrumental vaginal delivery; and 250 by caesarean section. MAIN OUTCOME MEASURES: Answers to fixed choice questions on fear of future childbirth, number of subsequent children and reasons for no further children. RESULTS: The response rate was 64%. Overall, 222 (46.6%) women were initially frightened about future childbirth. According to mode of delivery: 93 (57.1%) after instrumental vaginal; 79 (47.9%) after caesarean section; and 50 (33.8%) after normal vaginal delivery. Five years after the primary delivery, 99 women (20.8%) were still frightened about future childbirth: instrumental vaginal group 41 (25.2%); caesarean section group 43 (26.1%); and normal vaginal group 15 (10.1%). In the group of women who were delivered by caesarean section 13% more women had not had a second child after five years compared with the normal vaginal delivery group ((P < 0.03, relative risk 1.46 (1.07-1.99)). In the group of women who had a vaginal instrumental delivery 6% more had not had a second child after five years compared with normal vaginal delivery group. Of the women who had no further children, 30% who had caesarean section and 28% vaginal instrumental delivery had involuntary infertility. CONCLUSIONS: Caesarean section or vaginal instrumental delivery leaves many mothers frightened about future childbirth. Primary caesarean section and to some extent vaginal instrumental delivery is associated with an increased risk of voluntary and involuntary infertility.

Adolescent↗
PubMed1999

Bloodspot testosterone assay suitable for study of neonates and monitoring of children with congenital adrenal hyperplasia.

A bloodspot assay for testosterone has been developed using an antiserum raised against testosterone-3-carboxymethyloxime-bovine serum albumin (T-3 CMO-BSA) conjugate and 125I-T-3CMO-histamine tracer. The method has a detection limit of 0.4 nmol/L with between-batch precision of less than 15% for testosterone values between 0.9 and 2.0 nmol/L and less than 10% for values greater than 2.0 nmol/L. Recovery of 4 nmol/L testosterone spiked into whole blood samples from 16 women (with unspiked bloodspot testosterone concentrations ranging from 0.4 to 3.7 nmol/L) was 100.9%. Bloodspot testosterone concentration was measured in thirty 6-9 day old infants (19 boys, 11 girls) with an absolute range in boys of < 0.4-2.3 nmol/L and in girls of < 0.4 nmol/L. In preterm infants (12 boys, 12 girls) of varying birth gestation and postnatal age, levels were higher than in term infants, with boys showing a rise with increasing postnatal age. Daytime bloodspot profiles in four children on replacement therapy for congenital adrenal hyperplasia demonstrated consistently low testosterone levels in the presence of moderately elevated early morning 17-hydroxyprogesterone concentrations, thus indicating adequate treatment. The bloodspot testosterone assay can be applied to the study of androgen physiology in preterm neonates as well as for monitoring treatment in disorders such as congenital adrenal hyperplasia.

Adrenal Hyperplasia, Congenital↗
PubMed1999

Nuclear medicine teleradiology in regional and rural centres of Western Australia.

We have established a nuclear medicine teleradiology service for rural and regional areas of south-west Western Australia. This study aimed to evaluate whether existing treatment models had altered in ways which were directly related to improved medical outcomes and reduced cost. Preliminary observation into musculoskeletal injury of the ankle joint included diagnosis of 10 radio-occult talar dome lesions which in some cases had not been identified until six months after the trauma. Several cases suggest that nuclear medicine provided a more timely diagnosis and actively altered treatment. Further, the potential role of radiologists as primary-care extenders in guiding appropriate investigations and defining the nature of the illness before specialist consultation may lessen the economic burden on public health care while creating economies of scale by expanding the clinical usefulness of the nuclear physician over a large rural area.

Adolescent↗
PubMed1999

The cost of radiotherapy as a function of facility size and hours of operation.

Against a background of constant or decreasing budgets, this study was undertaken to investigate the economic effects of changes in selected operational parameters within a radiation treatment programme. Using financial data from the Northeastern Ontario Regional Cancer Centre and a recognized staffing model, a commercial spreadsheet has been used to calculate the cost of an 18 fraction course of radiotherapy, including all the major preparatory processes such as simulation and treatment planning. Using the spreadsheet, and on the basis of explicit and reasonable assumptions, the cost of radiotherapy has been calculated as the facility size (i.e. equipment complement) and hours of operation are varied. Based on the assumptions used, the cost of radiotherapy in a facility treating less than about 1600 patients per year starts to rise. At 400 patients per year, a course costs approximately 50% more than at 1600 patients per annum. Extended hours of operation do not appear to generate significant, if any, savings when realistic assumptions about machine lifetime and overtime payments are made. Using a spreadsheet to simulate changes in a radiation treatment programme can be an important decision-making tool, as the effects of changes in operating parameters can be demonstrated.

Health Care Costs↗
PubMed1999

Garnering the interest of others: mediating the effects among physical attractiveness, self-worth and dominance.

OBJECTIVES: Evolutionary psychologists emphasize that self-worth and well-being are largely determined by the degree to which individuals garner and hold the interest of others. Personal attributes, such as physical attractiveness, are viewed as resources which serve as signals to others to pay attention to us. DESIGN AND METHOD: This study examined (a) the degree to which participant appraisals (N = 75) of self-worth were related to appraisals of how interested others were in them; and (b) the extent to which interest ratings account for the relation among self-worth, dominance and attractiveness ratings. RESULTS: The main findings of the present study showed (a) that the degree to which individuals derive self-worth from various attributes was strongly related to the degree to which individuals believed others were interested in them; and (b) that the amount of interest one believes others show in them mediated the relation between physical attractiveness and social self-worth. CONCLUSION: Results have a number of implications concerning the nature of self-worth and the utility of psychological theories that emphasize evolutionary principles.

Adult↗