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Biomedical subjects

K Jones

Publications and source records attributed to K Jones.

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

Does organization matter? A multilevel analysis of the demand-control model applied to human services.

The demand-control model (DC model) in occupational epidemiology suggests that health, an individual attribute, is partly determined by work organization, via the interplay of demand and control, job strain. The objective of this study was empirical assessment of the model's tenet of an organizational determination of individual health. An emerging analytic method, multi-level modelling, permits such an assessment. The study encompasses two large Swedish human service organizations. It was based on a nationally representative sample of 291 local organizational units (level 2) with 8296 employees (level 1), a median of 18 employees per unit. 5730 persons (69.1%) completed the questionnaire. Listwise deletion of missing data left a net study base of 4756 individuals in 284 units. Missing data were largely random. Demand and control were measured by standard questions and combined into a job strain index. Two such indices were calculated, one for quantitative demands and one for emotional demands. Individual attributes included age, gender, marital status, having children, social anchorage, and education. There were two dependent variables, self-assessed psychovegetative symptoms (worry, anxiousness, sadness, sleep difficulties, restlessness, and tension) and exhaustion (fatigue, feelings of being used up and overworked), both measured as summative indices. For psychovegetative health, a null model yielded 2.2% level 2 variance, unchanging when individual attributes were included in a random intercepts model. Inclusion of the strain variables rendered level 2 variance non-significant, decreasing level 1 variance by 23% and level 2 variance by 62%. For exhaustion, level 2 variation was 8.3% in the null model and 1.6% in the final model, with strain variables. The strain variables utilized in the DC-model thus draw a substantial part of their variation from the organizational level. It is concluded that the claim of the DC model to rely on organizational factors receives support.

Adult↗
PubMed1997

Reducing asthma morbidity in the community: the effect of a targeted nurse-run asthma clinic in an English general practice.

Although most primary health care teams in the U.K. now offer proactive care for patients with asthma, there is relatively little published evidence showing the effectiveness of such innovations. This may be due in part to lack of targeting of extra care towards those most in need. Therefore, to demonstrate the benefits of targeted nurse-run asthma clinic care in a seven-partner general practice in a mixed urban and rural area of North Lincolnshire in the east of England, a cohort of 173 patients, with asthma selected predominantly by having high morbidity in a postal survey, completed 12 months follow-up in a nurse-run asthma clinic. A longitudinal comparison was conducted in terms of: changes in morbidity index category, inhaler technique score, knowledge score, use of inhaled steroids, use of salmeterol, method of administration of beta(2)-agonist medication and frequent use of peak flow meters. The number with high morbidity fell from 123 (71.1%) at the initial consultation to 14 (8.1%) at the 12-month review. Those with full marks on inhaler technique rose from 28 (16.2%) to 142 (82.1%), and with full marks on asthma knowledge rose from 7 (4.0%) to 98 (56.6%). The numbers of patients using inhaled steroids and salmeterol rose from 127 (73.4%) to 171 (98.9%) and from 5 (2.9%) to 35 (20.2%), respectively. The preferred inhaler device for beta(2)-bronchodilator medication changed from metered dose aerosol to dry powder. Regular use of peak flow meters in 157 subjects aged 5 years and over rose from 43 (27.4%) to 116 (73.9%). These data clearly demonstrate the benefits of targeted proactive nurse-run asthma care in terms of reduced morbidity for patients. The authors recommend the morbidity index targeting concept to other primary health care teams.

Adolescent↗
PubMed1997

Aberrant common carotid artery encountered during free jejunal graft repair of oesophageal stricture.

The origin and course of the carotid arterial system in the superior mediastinum and neck are remarkably constant. Although variations are rare, they can have important implications in certain clinical problems. In this report, a patient underwent free jejunal graft repair of a cervical oesophageal stricture caused by radiotherapy for a post-cricoid carcinoma. The common carotid artery on the side of the surgical approach was found to cross the midline to the other side of the neck, and created difficulties both with the procedure and future management. This has not been previously reported.

Aged↗
PubMed1997

Project 2000: perceptions of the philosophy and practice of nursing: shifting perceptions--a new practitioner?

This is the first of two papers which address aspects of the findings of a large scale study commissioned by the English National Board which set out to examine the impact of Project 2000 on perceptions of the philosophy and practice of nursing. The findings presented here suggest that there have been fundamental shifts in perceptions of the nature and discipline of nursing. Students and diplomates of the course perceive themselves as knowledgeable doers, with their practice well grounded in theory and research. They value the interpersonal skills teaching and place the patient firmly at the centre of care delivery, viewing the patient holistically and being prepared to be fierce patient advocates where necessary. It is difficult to determine the extent to which these shifts can be attributed to the Project 2000 course, although the Project 2000 approach to education appears to be an important factor.

Attitude of Health Personnel↗
PubMed1997

Project 2000. Perception of the philosophy and practice of nursing: preparation for practice.

As part of a comprehensive study of perceptions of the philosophy and practice of nursing Project 2000 students and newly qualified diplomates were asked to reflect on their Project 2000 course as a preparation for professional practice. Data were collected from both students and diplomates through self-completion questionnaires and a small number of interviews with diplomates in two study centres, one in the north and the other in the south of England. Nurse managers and G grade practitioners were invited in focus group interviews to discuss the Project 2000 preparation and assess the diplomates 'fitness for purpose'. Findings suggest that the majority of students and diplomates acknowledged that the course had prepared them well. They acknowledged the importance of the inter-personal skills component of the course, together with the life sciences input. The diplomates particularly valued the theoretical aspect of the course, being well versed in research and keen to continue their learning. Perceived limitations of the course were the management preparation and course organization. Practical skill deficits were perceived as initial skills deficits only. Managers and practitioners were keen to employ the diplomates, whilst acknowledging their need for support and preceptorship. Three important issues for nursing and nurse education are discussed, including the balance of the Project 2000 course, preceptorship and support, and preparation for a role in the community.

Attitude of Health Personnel↗
PubMed1997

Isolation of vero cytotoxin-producing Escherichia coli O157 from wild birds.

In a survey of wild birds (mainly gulls), 0.9% of the bacterial isolates from faecal samples at an urban landfill site and 2.9% of bacterial isolates from faecal samples on intertidal sediments in Morecambe Bay were Vero cytotoxin-producing Escherichia coli O157. Isolation procedures employing commonly used cultural methods were hindered by the selection of a large number of false positives. The only procedure which resulted in the isolation of E. coli O157 from bird faecal samples was: enrichment (18 h) in a selective tryptone soya broth followed by filtration using hydrophobic grid membranes and growth on Chromagar O157. The majority of isolates selected as potential E. coli O157 by characteristic growth on Chromagar O157 could be eliminated by subsequent growth on CT-SMAC or CR-SMAC. This second identification (characterization) stage reduced the number of potential E. coli O157 requiring further confirmation by typing methods (serotype and Vero cytotoxin) by more than 70%.

Animals↗
PubMed1997

Management education for undergraduate doctors. A survey of medical schools.

Explores the extent to, and ways in which, doctors are prepared for their future role in management through the undergraduate medical curriculum. Surveys the colleges across the UK offering undergraduate medical education using both prospectuses and questionnaires to establish both inclusion of healthcare management/policy in curricula and the subject content offered. Establishes that the majority of colleges offer some teaching of health care management/policy although the areas of study included vary considerably. The emphasis in most institutions appears to be on introducing the structure and organization of the NHS together with decision making in respect of resource allocation often located within a public health programme. This leads to the tentative conclusion that the management education needs of future public health physicians are reasonably well served while those of hospital doctors and general practitioners need further investigation.

Curriculum↗
PubMed1997

Synergism in biofilm formation between Salmonella enteritidis and a nitrogen-fixing strain of Klebsiella pneumoniae.

A laboratory reactor, which simulates biofilm formation in water pipes, was used to study interactions in biofilm formation between a nitrogen-fixing strain of Klebsiella pneumoniae and Salmonella enteritidis. The level of attachment of Salm. enteritidis was higher in the binar biofilm than in the single species biofilm. In the initial colonization phase the binary biofilm contained a much higher proportion of metabolically active cells than in single species biofilms formed by either Salm. enteritidis or Kl. pneumoniae. When a pulse of Salm. enteritidis was passed over an already established biofilm of Kl. pneumoniae it rapidly became integrated into the biofilm, from where it was subsequently released into the water column, along with Kl. pneumoniae. Klebsiella pneumoniae fixed nitrogen in the presence of Salm. enteritidis in both types of biofilm.

Biofilms↗
PubMed1997

Interpretation of trauma radiographs by junior doctors in accident and emergency departments: a cause for concern?

OBJECTIVES: To investigate how well junior doctors in accident and emergency (A&E) were able to diagnose significant x ray abnormalities after trauma and to compare their results with those of more senior doctors. METHODS: 49 junior doctors (senior house officers) in A&E were tested with an x ray quiz in a standard way. Their results were compared with 34 consultants and senior registrars in A&E and radiology, who were tested in the same way. The quiz included 30 x rays (including 10 normal films) that had been taken after trauma. The abnormal films all had clinically significant, if sometimes uncommon, diagnoses. The results were compared and analysed statistically. RESULTS: The mean score for the abnormal x rays for all the junior doctors was only 32% correct. The 10 junior doctors were more experience scored significantly better (P < 0.001) but their mean score was only 48%. The mean score of the senior doctors was 80%, which was significantly higher than the juniors (P < 0.0001). CONCLUSIONS: The majority of junior doctors misdiagnosed significant trauma abnormalities on x ray. Senior doctors scored well, but were not infallible. This suggests that junior doctors are not safe to work on their own in A&E departments. There are implications for training, supervision, and staffing in A&E departments, as well as a need for fail-safe mechanisms to ensure adequate patient care and to improve risk management.

Clinical Competence↗
PubMed1997

Clinical susceptibility to migraine with aura is modified by dopamine D2 receptor (DRD2) NcoI alleles.

Migraine has a major genetic component. Although most recent scientific studies have focused on the role of 5-hydroxytryptamine and neuropeptides in migraine, dopaminergic systems are also implicated in the pathogenesis. Therefore, the dopamine D2 receptor (DRD2) was analyzed as a candidate gene since antagonists of this receptor have been reported to be effective in the acute treatment of migraine. Individuals with migraine with aura (n = 52) have an increased frequency (0.84) of the DRD2 NcoI C allele (chi-square = 6.47; p < 0.005) compared with control individuals (n = 121; C allele frequency = 0.71). Individuals with migraine without aura (n = 77) showed the same DRD2 T allele frequency (0.70) as the control group. Migraine with aura was present in 27% of the C/C individuals, 16% of the C/T individuals, and 5.2% of the T/T individuals. These data suggest that activation of the DRD2 receptor plays a modifying role in the pathophysiology of migraine with aura. As a result, these data provide a molecular rationale for the documented efficacy of DRD2 antagonists in the treatment of migraine with aura.

Adult↗
PubMed1997

A preliminary analysis of interactive effects between common classroom contingencies and methylphenidate.

To assess the drug-behavior interaction effects with an 8-year-old boy wih attention deficit hyperactivity disorder, common classroom antecedent (e.g., seating arrangement) and consequent (e.g., peer prompts) stimuli were alternated within a school day while drug conditions (methylphenidate vs. placebo) were alternated across days. The results suggested that peer attention maintained disruptive behavior when methylphenidate was absent but not when it was present.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Seasonality of thermophilic Campylobacter populations in chickens.

The small intestines and caeca of chickens were monitored for seasonal variation of thermophilic campylobacters over a 12-month period. There was a significant seasonal fluctuation in the carriage rate which correlated with the following environmental parameters: sunshine hours (P = 0.0003) and minimum (P = 0.007) and maximum temperatures (P = 0.003). The number of campylobacters in the small intestine and caeca also showed significant seasonal variation (P = 0.0008); however, the periodicity in the caeca was significantly different from that in the small intestine (P = 0.007). The numbers of Campylobacter in the caeca were significantly higher than those in the small intestine (P = 0.001). No significant correlation was found between the numbers of campylobacters in the caeca and small intestines and the environmental parameters monitored.

Animals↗
PubMed1996

An inhibitor of the sodium pump obtained from human placenta.

BACKGROUND: Much effort has been expended in the search for an endogenous inhibitor of the cellular sodium/potassium pump, a compound of major physiological importance, which has been implicated in the mechanism of essential hypertension. Others have suggested that ouabain or an isomer of ouabain may be the endogenous pump inhibitor. Neonatal cord serum contains an inhibitor of the sodium pump; we attempted to isolate and characterise this substance from human placentas. METHODS: Homogenised placentas were dialysed and the resulting solutes were trapped on octadecylsilyl silica and then separated by high-performance liquid chromatography. Measurement of the activity of the sodium pump of human leucocytes was used to test each fraction for the presence of the inhibitor. FINDINGS: An inhibitor of the sodium pump was obtained by this technique in a mass spectrometrically pure form with a mass of 370 Da, an empirical formula of C24H34O3 and only one hydroxyl group. The characteristic fragmentation pattern observed in negative-ion mass spectrometry was compared with those of various model compounds; this comparison suggested that the active material was a dihydropyrone-substituted steroid. INTERPRETATION: These results suggest that a dihydropyrone-substituted steroid is an endogenous regulator of the sodium pump in humans and, presumably, other mammals. Proof of the endogenous origin will require the demonstration of a previously unrecognised biosynthetic pathway.

Bufanolides↗
PubMed1996

Extracellular truncations of h beta c, the common signaling subunit for interleukin-3 (IL-3), granulocyte-macrophage colony-stimulating factor (GM-CSF), and IL-5, lead to ligand-independent activation.

The hypothesis that extracellular truncation of the common receptor subunit for interleukin-3 (IL-3), granulocyte-macrophage colony-stimulating factor, and IL-5 (h beta c) can lead to ligand-independent activation was tested by infecting factor-dependent hematopoietic cell lines with retroviruses encoding truncated forms of h beta c. A truncation, resembling that in v-Mpl, and retaining 45 h beta c-derived extracellular residues, led to constitutive activation in the murine myeloid cell line, FDC-P1. However, infection of cells with retrovirus encoding a more severely truncated receptor, retaining only 7 h beta c-derived extracellular residues, did not confer factor independence on these cells. These experiments show that truncation activates the receptor and define a 37-amino acid segment of h beta c (H395-A431) which contains two motifs conserved throughout the cytokine receptor superfamily (consensus Y/H XX R/Q VR and WSXWS), as essential for factor-independent signaling. The mechanism of activation was also investigated in less severe truncations. A receptor that retains the entire membrane-proximal domain (domain 4) also conferred factor independent growth on FDC-P1 cells; however, a retrovirus encoding a truncated form of h beta c having two intact membrane proximal domains did not have this ability, suggesting that domain 3 may have an inhibitory role in h beta c. The ability of these receptors to confer factor independence was cell specific as demonstrated by their inability to confer factor-independent growth when introduced into the murine IL-3-dependent pro-B cell line BaF-B03. These results are consistent with a model in which activation requires unmasking of an interactive receptor surface in domain 4 and association with a myeloid-specific receptor or accessory component. We suggest that in the absence of ligand intramolecular interactions prevent inappropriate signaling.

Animals↗
PubMed1996

Defining localities for health planning: a GIS approach.

The National Health Service in Britain is undergoing far-reaching changes. While District and Regional Health Authorities are currently merging, professionals agree that primary health care is most efficiently managed at the local level. This paper uses geographical information systems (GIS) capabilities to identify a nested hierarchy of localities for the management of primary health care in West Sussex, England. GIS coverages were developed which contained key criteria for defining local areas, including nodes or focal points of service provision, edges which act as physical or psychological barriers to movement, districts such as official administrative areas and interaction criteria such as journey to work, school and family doctor (GP) surgeries. Central to the derivation of the localities was a large matrix of patient to GP flows based on postcoded data. Once managed, these data revealed clear geographical patterns of patient to GP allegiance. A large-scale field survey obtained supporting information on the perception of areas from local residents.

Catchment Area, Health↗