The Campylobacter conundrum.
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Abattoirs↗
Biomedical subjects
K Jones
Publications and source records attributed to K Jones.
Correlates of clinic referral for early conduct problems: variable- and person-oriented approaches.
The current study utilized both variable- and person-oriented analyses to examine correlates of early disruptive behavior problems. Participants included 80 preschool boys referred to a child psychiatry clinic and diagnosed with oppositional defiant disorder (with or without attention-deficit hyperactivity disorder) and 80 case-matched normal comparison boys. The study examined four domains of correlates: vulnerable child characteristics, poor parenting practices, insecure attachment, and adverse family ecology. Results indicated that the combination of these factors provided relatively high sensitivity (81%) and specificity (85%), clearly differentiating referred from comparison boys. A dramatic increase in clinic status occurred when three or more factors were present, and specific combinations of factors were differentially predictive of conduct problems. However, no correlates were found to be either necessary or sufficient for clinic status. By maintaining the integrity of individual cases, person-oriented analyses were able to answer different questions than more traditional variable-oriented analyses. Discussion focuses on the value of person-oriented analyses for understanding heterogeneous clinical groups.
Ambulatory Care↗
Preclinical prediction of AD using neuropsychological tests.
Normals (N = 42) and patients with mild memory difficulty (N = 123) were given a neuropsychological test battery, and then followed annually for 3 years to determine which individuals developed sufficient functional change that they met clinical criteria for AD. Twenty-three of the 123 participants with mild memory difficulty converted to a diagnosis of probable Alzheimer's disease (AD) within 3 years of follow-up. Four of the 20 neuropsychological measures obtained at baseline, were useful in discriminating the groups on the basis of their status 3 years after the tests were given. The 4 discriminating tests pertained to assessments of memory and executive function. When the controls were compared to the individuals with memory impairments who ultimately developed AD (the converters), the accuracy of discrimination was 89%, based on the neuropsychological measures at baseline. The discrimination of the controls from the individuals with mild memory problems who did not progress to the point where they met clinical criteria for probable AD over the 3 years of follow-up (the Questionables) was 74% and the discrimination of the questionables from the converters was 80%. The specific tests that contributed to these discriminations, in conjunction with recent neuropathological and neuroimaging data from preclinical cases, have implications for which brain regions may be affected during the prodromal phase of AD.
Aged↗
Social-cognitive processes in preschool boys with and without oppositional defiant disorder.
The social-cognitive characteristics of 88 preschool boys with Oppositional Defiant Disorder (ODD) and 80 nondisruptive boys were assessed 3 times over a 2-year period. Three questions were addressed: (1) Do social-cognitive processes (encoding, attribution, problem solving, and response evaluation) distinguish clinic-referred preschool boys from peers without behavior problems? (2) What is the relation between preschoolers' social-cognitive processes and observed problem behavior? (3) Are the social-cognitive processes of clinic boys with ODD influenced by comorbidity with Attention Deficit Hyperactivity Disorder (ADHD)? Boys were presented hypothetical, peer-oriented social dilemmas to resolve. At all 3 assessments, clinic boys were twice as likely as were comparison group boys to generate aggressive solutions. Relative to comparison boys, clinic boys' encoding of social information was less accurate. The groups did not differ in their attributions or response evaluations. Verbal IQ and language skills were modestly correlated with problem solving and encoding. Within the clinic group, social-cognitive processes were not affected by ADHD comorbidity and they showed little relation to later diagnostic status or severity of behavior problems.
Aggression↗
Effectiveness of optometrist screening for diabetic retinopathy using slit-lamp biomicroscopy.
PURPOSE: To assess the effectiveness of optometrists as screeners for diabetic retinopathy using slit-lamp binocular indirect ophthalmoscopy through dilated pupils. METHODS: Prospective study of a screening scheme. Screening was performed by 27 locally accredited optometrists in their practice. The referral protocol used a new simple grading system of retinopathy, especially designed for use in an optometrist screening programme. All positive referrals and 10% of negative referrals were reexamined by an ophthalmologist. Sensitivity, specificity, likelihood ratios and technical failure rates were calculated. RESULTS: The optometrists screened 4904 people with diabetes in 18 months. 'Subthreshold' (screen negative) reports accounted for 4438 (90.5% of 4904); 429 (9.67%) of these were re-examined at secondary screening. There was disagreement regarding grading in 13 patients, of whom 5 (1.16% of 429) had sight-threatening retinopathy (STDR); this extrapolates to 52 patients if all the 4438 test-negatives had been examined. Of the 371 'threshold' patients, 112 (30.18%) were false positives; the commonest cause for false positive referral was drusen in patients with background diabetic retinopathy. The sensitivity for identification of STDR was 76% (95% CI 70% to 81%) and specificity 95% (95% CI 95% to 96%). The likelihood ratio of a positive test indicating STDR was 16.54 (95% CI 14.17 to 19.23) and that of a negative test 0.25 (95% CI 0.20 to 0.32). The technical failure rate was 0.2%. CONCLUSIONS: Suitably trained and accredited community optometrists performed well when screening for diabetic retinopathy using slit-lamp biomicroscopy through a dilated pupil. This was facilitated by the use of simple grading and referral criteria. The sensitivity, positive likelihood ratio and specificity were high.
Accreditation↗
Prevalence of blindness and visual impairment in a population of people with diabetes.
PURPOSE: To assess the prevalence of visual impairment and the underlying causes in a population of people with diabetes. METHOD: A population-based study of a defined population of people with diabetes in a district in the North West of England was done. There were 7652 known people with diabetes, representing 2.12% of target general population of 361050. The main outcome measures were the prevalence of blindness and significant visual impairment (less than 6/18 corrected vision in their better eye) and the underlying causes. RESULTS: Visual acuity data on 6482 (84.7%) of the 7652 individuals were obtained. Of these, 184 had significant visual impairment (prevalence 2.84%) including 49 who were blind (vision of less than 3/60 in their better eye, prevalence 0.75%); if blindness was defined as vision less than or equal to 6/60, prevalence was 1.13% (n = 73). Details of 3 individuals could not be ascertained. Only 67 were registered, either as partially sighted (n = 42) or as blind (n = 25). In the majority (n = 133; 68%) of these 181 individuals the visual impairment was due to causes other than diabetic retinopathy. CONCLUSIONS: The prevalence of blindness and visual impairment in our population of people with diabetes was low. Non-diabetic eye disease accounted for the majority of this visual impairment. This provides essential baseline data against which future progress can be assessed. Screening and treatment can greatly reduce the incidence of visual impairment due to diabetic retinopathy, but its impact on overall visual impairment rates in the population of people with diabetes will be more modest.
Adolescent↗
Evaluation of normal and large sphygmomanometer cuffs using the Omron 705CP.
Sphygmomanometers are usually sold with a single cuff though some are supplied with a short cuff as standard and offer a longer one for larger arms. However, data on the differences in measurements taken with different cuffs applied to different sized arms are conflicting and this study set out to investigate the difference between those taken with 'normal' and 'large' cuffs in arms 28 cm or more in circumference. We avoided observer error by using a semi-automatic digital sphygmomanometer, the Omron 705CP. The 22 subjects employed were selected from one general practice as having a range of previous office blood pressures and a variety of arm sizes above 28 cm in circumference. Omron 'normal' and 'large' cuffs were used alternately, taking five blood pressures with each to a total of 30 readings per patient, resulting in 660 readings, 330 with each cuff. There were mean systolic/diastolic differences of 2.7/3.8 (s.d.s 4.7/2.8) for all subjects. These were greater in the normotensive. When divided into two groups with systolic blood pressures below and equal to or above 140 mm Hg, differences were -1.9/3.0 to 7.1/4.7. From the results of the study, we recommend that large cuffs should be used for all patients with an arm circumference of 28 cm or above but the Omron large cuff still requires formal validation.
Arm↗
A study of inter-arm blood pressure differences in primary care.
OBJECTIVES: To investigate whether there are inter-arm blood pressure differences that are of clinical importance to general practice. DESIGN AND SETTING: Pragmatic study with randomised order of use of left or right arm carried out in routine surgeries in an inner city and suburban general practice. SUBJECTS: There were 237 patients presenting opportunistically for blood pressure measurement to a nurse or general practitioner. MAIN OUTCOME MEASURES: 95% limits of agreement between measurements on the left and right arm and bias between arms. RESULTS: Large inter-arm blood pressure differences exist reflected in wide 95% limits of agreement; -16 mm Hg to 24 mm Hg for the right minus the left arm diastolic blood pressure. There is a small but statistically significant bias to the right arm blood pressure measuring higher than the left (3.7 mm Hg diastolic, 2.4 to 5 mm Hg 95% confidence intervals). An interarm difference of 10 mm Hg or greater for diastolic blood pressure occurred in 40% of subjects and a difference of 20 mm Hg or more for systolic blood pressure occurred in 23% of subjects. CONCLUSIONS: In a primary care setting blood pressure should be measured routinely in both arms. If one arm is to be preferred for pragmatic clinical purposes, then this should be the right arm.
Adolescent↗
Effect of alpha1-acid glycoprotein on the intracellular accumulation of the HIV protease inhibitors saquinavir, ritonavir and indinavir in vitro.
AIMS: Since alpha1-acid glycoprotein (AGP) levels may be raised during HIV infection, we have examined in vitro the effect of increasing the concentration of AGP on the intracellular accumulation of the HIV protease inhibitors saquinavir (SQV), ritonavir (RTV) and indinavir (IDV). METHODS: U937 cells (5 x 10(6) cells in 5 ml RPMI growth medium) were incubated at 37 degrees C for 18 h with [14C]-SQV (0.1 microCi), [3H]-RTV and [3H]-IDV (0.135 microCi) to a final concentration of 1 microM in the presence of 0, 0.5 and 2.0 mg x ml(-1) AGP. Following extraction in 60% methanol the intracellular drug concentration was determined by liquid scintillation counting. RESULTS: Binding to AGP (2.0 mg x ml(-1)) reduced the mean intracellular concentration of SQV from 31.5 microM to 7.4 microM (P < 0.0001; 95% CI 19.4-28.8). RTV concentration was also reduced (8.8 microM to 1.6 microM; P < 0.0001; 95% CI 5.4-9.0) as was the concentration of IDV (3.0 microM to 1.5 microM; P < 0.0001; 95% CI 1.1-1.9). CONCLUSIONS: Reduced intracellular protease inhibitor concentrations in the presence of increasing concentrations of AGP will certainly impact on the antiviral activity in vitro. However, since protease inhibitors are high clearance drugs, free drug concentration will likely remain unaffected in the presence of elevated AGP during chronic oral dosing although there will be an increase in total plasma drug concentration.
Cell Line↗
The effects of UVB and temperature on the survival of natural populations and pure cultures of Campylobacter jejuni, Camp. coli, Camp. lari and urease-positive thermophilic campylobacters (UPTC) in surface waters.
AIMS: To determine whether diurnal and seasonal variations in campylobacters in surface waters result from the effects of temperature and u.v. radiation, and whether natural populations of Campylobacter lari and urease-positive thermophilic campylobacters (UPTC) from birds survive better in surface waters than Camp. jejuni from sewage. METHODS AND RESULTS: Natural populations of Camp. lari and UPTC in sea water, and Camp. jejuni in river water, were exposed to artificial sunlight (equivalent to a sunny day in June). Both populations became non-culturable within 30 min, with T90s of 15 min and 25 min, respectively. Cultures of Camp. jejuni became non-culturable within 40 min and those of Camp. coli, Camp. lari and UPTC, within 60 min. In darkness, survival was temperature-dependent. Natural populations took 12 h at 37 degrees C and 5 days at 4 degrees C to become non-culturable in sea water, and slightly less in river water. Cultures of Camp. lari and UPTCs survived for significantly longer than Camp. jejuni and Camp. coli. Loss of culturability for all isolates was most rapid at 37 degrees C and slowest at 4 degrees C. Newly isolated strains from sea water and river water behaved in an almost identical manner to NCTC strains. CONCLUSION: Campylobacter lari and UPTCs survive for longer in surface waters than Camp. jejuni and Camp. coli, particularly in the dark. Low Campylobacter numbers in coastal waters in the summer, especially in the afternoon, are due to the combined effects of higher temperatures and higher levels of u.v. radiation. SIGNIFICANCE AND IMPACT OF THE STUDY: Campylobacter lari and UPTCs from birds predominate in bathing waters in Morecambe Bay because they are better able to survive; they also originate from closer to the shore than Camp. jejuni and Camp. coli in sewage effluent, which survive poorly and die before the incoming tide reaches the shore. The predominance of Camp. jejuni in river water results from its dominance of the inputs and not from its ability to survive.
Animals↗
Campylobacters in water, sewage and the environment.
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Animals↗
Developing a unified language for children's nurses, children and their families in the United Kingdom.
This paper presents a taxonomy of Infant, Child and Adolescent (ICA) nursing diagnoses and clinical outcomes that has been developed with the co-operation of nurses caring for children in the United Kingdom. Three focus group interviews were conducted in one acute care NHS trust in London (referred to as the host trust in this paper) in 1998/99, in which participants were asked to consider nursing and family factors relevant for identifying and providing care. A total of 28 ICA diagnoses, including definitions, defining characteristics and outcomes, were identified for clinical testing and included in the ICA taxonomy. The ICA diagnostic labels and outcomes for care were further tested for their relevance for clinical practice in a Delphi Survey carried out in 1999 and their use in clinical practice began in 1999. This research augments the findings from an initial Delphi survey carried out in 1993 and case study research in 1996. The previous research initiated the development of a unified language for children's nurses, children and their families, to aid communication and decision-making. Implications of this and future research for clinical practice, nationally and internationally, are also discussed.
Attitude of Health Personnel↗
The implementation of venous leg ulcer guidelines: process analysis of the intervention used in a multi-centre, pragmatic, randomized, controlled trial.
The production and implementation of clinical practice guidelines is currently a high political priority and a rapidly developing field within healthcare in the United Kingdom (UK). Their purpose is to provide clinicians with a synthesis of the best available external evidence and operationalize the implementation of evidence-based practice. Despite indications that clinical guidelines can make a difference to the quality of patient care, there is some evidence that practitioners struggle with their application. The aim of this paper is to report one element of a trial undertaken by three collaborating universities in the Northern and Yorkshire Region of the UK health service during 1997-1998. The objective was to understand what makes guidelines acceptable and usable, or otherwise, to health professionals. The findings reported in this paper describe the process of care in those general practices that elected to implement guidelines for the management of patients with venous leg ulcers. We conclude that planning for training, resource and quality improvement processes must be built into a team's guidelines implementation procedures. A preliminary needs analysis of the contextual 'hurdles and levers' within each primary healthcare team is also necessary to identify individual issues that must be addressed if the process is to succeed. These findings provide some lessons for successful implementation of clinical guidelines in general. Recommendations for nursing policy makers, managers, practitioners and researchers are included.
Attitude of Health Personnel↗
Art macabre: is anatomy necessary?
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Anatomy↗
The feasibility of a 'one stop' ultrasound-based clinic for the diagnosis and management of abnormal uterine bleeding.
OBJECTIVES: We have established a 'one stop' clinic for the management of women with abnormal uterine bleeding based on transvaginal sonography and saline contrast sonohysterography. This report reviews our experience with the first 93 patients attending the clinic. DESIGN AND METHODS: Patients were seen with the intention of performing a transvaginal scan, saline contrast sonohysterography, endometrial biopsy, full blood count and thyroid function tests. The findings were prospectively recorded on a computer database and a management plan formulated. RESULTS: A transvaginal scan was performed on 89 (95.7%) women, 70 (75.3%) also undergoing saline contrast sonohysterography. An endometrial biopsy was carried out in 67 (72%) women aged 40 years and above, and 79 (84.9%) had blood tests. The median age of patients was 44 (range, 21-78) years. The majority of women presented with menstrual disorders. Uterine pathology was detected on transvaginal scan in 42 (47.2%) cases. Adnexal pathology was detected in 12 (13.5%) of the patients. Endometrial biopsy detected three (4.5%) cases of endometrial atypia, and three (4.5%) cases of adenocarcinoma. A hemoglobin level of < 10 g/dL was detected in 3 (3.4%) patients. A single clinic visit was thought sufficient for 83 (89.2%) women. Medical therapy was started in 47 (50.5%) patients, 15 (16.3%) were brought back for inpatient diagnostic hysteroscopy, and nine (9.7%) were booked for operative endoscopy, while six (6.5%) had conventional surgery; the remainder were reassured. CONCLUSIONS: This study demonstrates that a 'one stop' management philosophy based on pelvic ultrasound is feasible. Our data suggest that diagnostic hysteroscopy can be decreased using this approach, and challenge the use of hysteroscopy as the first stage test.
Adult↗
Using a revised asthma morbidity index to identify varying patterns of morbidity in U.K. general practices.
Both in terms of morbidity and mortality, the therapeutic and organizational management of asthma pose a considerable and continuing challenge to healthcare delivery. One element in attempts to meet this challenge is the recognition of appropriate outcome measures to assess progress in tackling the burden of this disease. This study therefore aimed to assess pragmatically the effectiveness of a revised asthma morbidity index in identifying varying patterns of morbidity in U.K. general practices. A postal survey was conducted of 2,762 patients believed to have or have had asthma from the lists of 12 general practices within the Eden Valley in Cumbria, using a questionnaire which combined the revised Jones morbidity index with questions on age, medication and perception of current asthma. Prescribing data were also recovered for 11 of the practices for the quarter within which the postal survey was conducted. Responses were obtained from 2,123 subjects (77%), of whom 1,474 (70%) believed themselves to be currently asthmatic. In this group, 18% reported low morbidity 34% medium morbidity and 48% high morbidity Age and inhaled steroid use were both positively and significantly associated with high morbidity. Those taking inhaled steroids were 1.4 times more likely to report high morbidity than those nottaking steroids. The prescribed corticosteroid/bronchodilator ratio for cost was both negatively and significantly associated with high morbidity. The revised morbidity index is a simple tool of use in the surveillance of asthma in primary care. It identifies spectra of morbidity which vary between practices, which may be of use in assessing the quality of asthma care provided in the community.
Age Factors↗
Frontal lobe function, sleep loss and fragmented sleep.
Recent experimental studies involving total sleep loss, sleep reduction and clinically related sleep fragmentation report impaired performance on tasks of frontal lobe or executive function, including measures of verbal fluency, creativity and planning skills. Severity of sleep disturbance in obstructive sleep apnoea syndrome (OSAS) is correlated with level of executive impairment, with some residual impairment despite treatment (continuous positive airway pressure - CPAP). Executive impairment appears to be more closely related to hypoxaemic events rather than daytime sleepiness. Studies of electroencephalographic (EEG) changes throughout the course of sleep and following sleep deprivation as well as functional neuroimaging and psychophysiological changes (event-related potentials - ERPs) following sleep deprivation provide further indication of the relative importance of the frontal regions of the brain to sleep. However, neurocognitive studies present many inconsistencies, task classification is often ambiguous and, in the absence of any unifying explanation at the level of cognitive mechanisms, the overall picture is one of a disparate range of impairment following sleep loss and sleep fragmentation. Poorly defined concepts of frontal lobe function, executive function, memory and attention, using tasks largely developed with more severe deficit levels in mind, create further difficulties in interpreting current findings.
Journal Article↗
Comparing sports injuries in men and women.
OBJECTIVE: To compare the pattern of injury between men and women in seven collegiate sports to determine if gender-specific factors exist which could be modified to reduce the risk of injury to female athletes. DESIGN: Retrospective cohort study of injury reports compiled by certified athletic trainers between Fall 1980 and Spring 1995. SETTING: An NCAA division III College. PARTICIPANTS: Eighteen to 22 year-old male and female college athletes competing in seven like sports (basketball, cross-country running, soccer, swimming, tennis, track and water polo) at the intercollegiate level, playing similar number of contests and using the same facilities. MAIN OUTCOME MEASURES: Analyses of injury patterns, classified by sport and anatomic location, for men and women in seven like sports. RESULTS: A total of 3,767 participants were included in the study, with 1874 sports-related injuries reported among the men and women's teams. Of these injuries, 856 (45.7%) were sustained by female and 1018 (54.3%) by male athletes. Overall, no statistically significant gender difference was found for injuries per 100 participant-years (52.5 for female athlete versus 47.7 for males). A statistically significant gender difference in injury incidence (p < 0.001) was seen for two sports: swimming and water polo. Female swimmers reported more back/neck, shoulder, hip, knee and foot injuries: and female water polo players reported more shoulder injuries. When evaluating all sports concurrently, female athletes reported a higher rate of hip, lower-leg and shoulder injuries, while male athletes reported a higher rate of thigh injuries. CONCLUSION: Except for some minor gender differences in total injuries for two sports and several differences in total injuries by anatomic location, our data suggest very little difference in the pattern of injury between men and women competing in comparable sports. The increased rate of shoulder injury among female swimmers probably resulted from the more rigorous training philosophy of their coach. Thus, no gender-specific recommendations can be suggested for decreasing the incidence of injury to female athletes competing in these sports.
Adolescent↗