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Biomedical subjects

K Harding

Publications and source records attributed to K Harding.

At least 19 recordsLinked to original sources
PubMed1992

Randomised trial of case finding and surveillance of elderly people at home.

Health screening for old people who live at home has been the subject of debate for 30 years or so. It has come to the fore again in the UK with the new emphasis on annual assessments by general practitioners (GPs) of those aged 75 or more. Screening in the elderly has implications for manpower. How can it best be done? We describe here a randomised, controlled study of case finding and surveillance in patients aged 65 and over in a general practice in South Wales. Problem identification was by a postal questionnaire, focusing on function, that was sent at random to 369 eligible patients with subsequent verification and intervention by a specially appointed nurse. The 356 controls had no questionnaires and no contact with that nurse. The study lasted 3 years, and end-points included mortality, self-ratings of quality of life, and health status, and use of all services (GP contacts, hospital admission, home help, and so on). Mortality was significantly lower in the intervention group (18%) than in the controls (24%) (difference 6.0% [95% CI 0.1-11.9%], p less than 0.05). Total number of hospital admissions did not differ between intervention and control groups, but duration of hospital stay of patients aged 65 to 74 years was significantly shorter in the intervention group (difference 4.6 days [95% CI 1.6-7.6], p less than 0.01). An increase in visits to a GP was largely offset by a lower number of home visits by a GP. Quality-of-life measures revealed no between-group differences, but self-rated health status was superior in the intervention group. We conclude that the use of a postal screening questionnaire with selective follow-up and intervention can favourably influence outcome and use of health care resources by elderly people living at home.

Aged↗
PubMed1992

Fetal acidaemia, the cardiotocograph and the T/QRS ratio of the fetal ECG in labour.

OBJECTIVE: To relate the T/QRS ratio of the fetal electrocardiogram (ECG) to the cardiotocogram (CTG) and fetal pH during labour. DESIGN: Prospective data collection from selected monitored labours. SETTING: A postgraduate teaching hospital delivery suite. SUBJECTS: 113 women in labour at term. MAIN OUTCOME MEASURES: Correlation of fetal T/QRS ratio values with pH values at the time of fetal blood sampling and at birth (umbilical artery blood). Comparison of the predictive values of raised T/QRS ratio and a pathological CTG for fetal acidemia. RESULTS: Complete data sufficient for analysis was available for 51 fetal scalp blood samples and 93 umbilical artery pH samples. The median (range) of T/QRS ratio values before birth of 88 babies not requiring admission to the neonatal unit was 0.13 (0.00-0.32) with a 97.5th centile value of 0.28. T/QRS ratios did not correlate with fetal scalp pH values. Fetal scalp acidaemia (pH less than 7.20) was detected with rates of 50 and 13% respectively by a pathological CTG and by a T/QRS ratio above 0.28, the positive predictive values being 40% and 50%, respectively. There was a significant correlation between increasing T/QRS ratio and falling pH. Detection rates (sensitivities) for umbilical artery acidaemia (pH less than 7.12) were 76% and 29% whereas positive predictive values were 38% and 71% respectively for a pathological CTG and a T/QRS ratio above 0.28. CONCLUSION: A raised T/QRS ratio (greater than 0.28) had a considerably lower detection rate for fetal acidaemia during labour than a pathological CTG.

Acidosis↗
PubMed1990

The unipolar-bipolar distinction in the characterological mood disorders.

The present study explored the validity of the unipolar-bipolar distinction in the characterological mood disorders. Thirteen cyclothymic and 32 primary early-onset dysthymic outpatients, diagnosed according to DSM-III-R, were compared on demographic, clinical, personality, and family history variables. The cyclothymics exhibited significantly higher levels of depressive symptomatology and extraversion and had a higher rate of bipolar I disorder in their first-degree relatives than the dysthymics. In addition, a significantly greater proportion of cyclothymics than dysthymics had a family history of drug abuse. The groups did not differ significantly on gender, overall rates of affective disorders in relatives, or a number of symptoms which have been reported to distinguish unipolar and bipolar depressives. Although these data require replication due to the small sample and large number of analyses conducted, they provide at least partial support for extending the unipolar-bipolar distinction to the characterological mood disorders.

Bipolar Disorder↗
PubMed1990

The current cost of nuclear medicine.

In the light of the control of expenditure and changes in radiopharmaceutical costs, changes in study protocols, new investigation procedures and inappropriate placing in Korner categories, the BNMS Council set up a working party to derive an agreed set of costings for Nuclear Medicine techniques. Using data from three hospitals with additional information from another nine, we have agreed the 1988 cost of individual nuclear medicine procedures in the UK. These figures include staffing (radiopharmacy, nursing, physics, medical including consultant), radiopharmaceuticals and other consumables, indirect costs (secretarial, administrative, portering), variable overheads (service contracts, stationery) and fixed overheads (rates, lighting, heating, building and engineering). Capital costs, equipment and buildings were not included. Because figures include salary and overhead costs they are difficult to compare with the majority of other previous nuclear medicine costings, apart from Bretland et al., or with data for other imaging modalities. Comparison of these costings with Korner schedules shows marked overlap between the Korner groups. Such groups therefore form a poor method of costing nuclear medicine procedures. We propose alternative groupings.

Costs and Cost Analysis↗
PubMed1989

Autoregulatory and gap gene response elements of the even-skipped promoter of Drosophila.

The pair-rule gene even-skipped (eve) plays a key role in the regulatory hierarchy governing segmentation in Drosophila. Here we describe the use of P-transformation and eve promoter fusions to identify cis elements that regulate the periodic seven-stripe eve pattern. A distal region of the eve promoter, located between -5.9 and -5.2 kb, controls autoregulation. Sequences from this region will induce striped expression of a heterologous hsp70 basal promoter in the presence, but not absence, of endogenous eve+ products. Autoregulatory activity was localized to a 200-bp region of the distal eve promoter. We also provide evidence that individual eve expression stripes are regulated by separate cis sequences. eve promoter sequences located between -4.7 and -3 kb upstream of the transcription start site are important for the initiation of stripe 3, whereas sequences between -1.7 and -0.4 kb are needed for stripes 2 and 7. It is possible that these latter regions are directly regulated by the products of gap genes.

Animals↗
PubMed1989

Identifying chronic affective disorders in outpatients: validation of the General Behavior Inventory.

The validity of the General Behavior Inventory (GBI) in screening outpatients for chronic unipolar and bipolar affective conditions was evaluated. The GBI was administered to 492 consecutive patients at a university clinic and a community mental health center. Using a stratified random sampling plan, 167 patients were selected and administered blind structured diagnostic interviews. In addition, unipolar depressives were followed up 6 months after the initial evaluation. Overall, the GBI exhibited fair-to-good positive predictive power and good-to-excellent negative predictive power. In addition, GBI scores in the case range were consistently associated with poor outcome at the 6-month follow-up. These findings suggest that the GBI may provide an economical means of screening for chronic unipolar and bipolar affective conditions in outpatient settings.

Adult↗
PubMed1988

Gap genes define the limits of antennapedia and bithorax gene expression during early development in Drosophila.

The maintenance of selective patterns of homeotic gene expression within the Drosophila CNS involves cross-regulatory interactions among the genes of the antennapedia and bithorax complexes (ANT-C and BX-C). Such a mechanism does not appear to be responsible for the establishment of these selective expression patterns during early development. Here we show that mutations in several of the gap genes strongly alter the early patterns of Antp and Abd-B expression. The altered patterns that are observed do not always correlate with simple expectations based on cuticular pattern defects observed in advanced-stage mutants. It appears that the initial patterns of Antp and Abd-B expression involve their differential regulation by a common set of gap genes. We propose that the gap genes are largely responsible for integrating the processes of segmentation and homeosis.

Animals↗
PubMed1988

Double depression and episodic major depression: demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome.

The authors compared 31 outpatients with double depression to 50 outpatients with episodic major depression. Patients with double depression exhibited significantly greater impairment, more severe depressive symptoms, greater comorbidity, more personality disturbance, lower levels of social support, more chronic strains, and higher rates of bipolar II and nonbipolar affective disorders in first-degree relatives. In addition, in a 6-month follow-up, the patients with double depression were significantly less likely to recover, and a higher proportion experienced hypomanic episodes than did patients with episodic major depression. These data provide strong support for the clinical significance of double depression.

Adult↗
PubMed1988

Invitation to attend a health check in a general practice setting: comparison of attenders and non-attenders.

A sample of 1570 men and women aged 20-45 years registered with an inner-city Cardiff practice were offered the opportunity by their general practitioner to have a health check at the surgery. The demographic characteristics, attitudes, beliefs and preventive health behaviour and past contact with the practice were compared for a sample of 259 non-attenders and 216 attenders. The results showed that attenders were generally better educated, better motivated to look after their health, had fewer ties and commitments, performed more healthapproved practices, had had more recent contact with their own practice and accepted the legitimacy of a general practitioner's interest in his patients' lifestyle. Offering cohorts of patients additional screening services is unlikely to be efficient or effective since it is the low-risk people already known to the doctor who are most likely to attend. The onus lies on primary health care to provide services in a way which permits appropriate screening of the high-risk groups as they attend for other reasons.

Adult↗