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Biomedical subjects

L Edmunds

Publications and source records attributed to L Edmunds.

At least 19 recordsLinked to original sources
PubMed2003

Interventions for treating obesity in children.

BACKGROUND: The prevalence of overweight and obesity is increasing in child populations throughout the world. Obesity in children has significant short and long term health consequences. OBJECTIVES: To assess the effects of a range of lifestyle interventions designed to treat obesity in childhood. SEARCH STRATEGY: We searched CCTR, MEDLINE, EMBASE, CINAHL, PsychLIT, Science Citation Index, Social Science Citation Index. Each database was searched from 1985 to July 2001. We also contacted experts in child obesity treatment. SELECTION CRITERIA: We selected randomised controlled trials of lifestyle interventions for treating obesity in children with a minimum of six months duration. Examples of lifestyle interventions include dietary, physical activity and/or behavioural therapy interventions, with or without the support of associated family members. Interventions from any setting and delivered by any professional were considered. However, interventions that specifically dealt with the treatment of eating disorders were excluded. DATA COLLECTION AND ANALYSIS: Two of our research team independently assessed trial quality and extracted data. Authors of the included studies were contacted for additional information where this was appropriate. MAIN RESULTS: We included 18 randomised controlled trials with 975 participants. Many studies were run from a specialist obesity clinic within a hospital setting. Five studies (n=245 participants) investigated changes in physical activity and sedentary behaviour. Two studies (n=107 participants) compared problem-solving with usual care or behavioural therapy. Nine studies (n=399 participants) compared behavioural therapy at varying degrees of family involvement with no treatment or usual care or mastery criteria and contingent reinforcement. Two studies (n=224 participants) compared cognitive behavioural therapy with relaxation.Most of the studies included in this review were too small to have the power to detect the effects of the treatment. We did not conduct a meta-analysis since so few of the trials included the same comparisons and outcomes. Therefore, we synthesised the results in a narrative format. REVIEWER'S CONCLUSIONS: Although 18 research studies were found, most of these were very small studies drawn from homogenous, motivated groups in hospital settings and so generalisable evidence from them is limited. In conclusion, there is a limited amount of quality data on the components of programs to treat childhood obesity that favour one program over another. Further research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required. We conclude that no direct conclusions can be drawn from this review with confidence.

Child↗
PubMed2000

Ankylosing spondylitis and the shoulder: commonly involved but infrequently disabling.

OBJECTIVE: To undertake 2 independent studies of shoulder involvement in patients with ankylosing spondylitis (AS) and assess the frequency of shoulder pain, stiffness, and loss of movement and function. To evaluate and correlate shoulder symptoms, function, range of movement, and radiology. METHODS: A cross sectional design was used in both studies. In Study A, a self-administered questionnaire was sent to members of the National Ankylosing Spondylitis Society of the UK and patients attending the Royal National Hospital for Rheumatic Diseases. In Study B, a clinical assessment of 88 patients with AS was undertaken that included a radiological assessment of 26 consecutive patients. RESULTS: In Study A, 15.2% and 13.8% of subjects had severe/very severe shoulder pain or stiffness, respectively. In Study B the corresponding findings were 9.6% and 17.6%. Patient reported disability associated with shoulder involvement was uncommon. Study A revealed that patients with severe/very severe shoulder pain were more likely to have significant hip and knee involvement. Significant shoulder involvement appears to be as common as involvement of the hip joint. In Study B radiological changes were common, being present in 31% of patients, but were often minor. There was a significant correlation between the sum of the stiffness, abduction, and flexion scores for both shoulders and the total radiological score (r = 0.87; p<0.001). CONCLUSION: The results suggest that shoulder symptoms and loss of shoulder mobility are common in patients with AS, and correlate with higher pain scores and influence of AS on their lives as assessed by the Arthritis Impact Measurement Scale, but are rarely disabling. Involvement of the shoulder joint in AS correlates with involvement of other peripheral joints as well as the extent of radiographic change on shoulder radiographs.

Adult↗
PubMed1997

Physical activity promotion through primary health care in England.

BACKGROUND: There is increasing research supporting the argument for a beneficial link between physical activity and health maintenance and, in the past five years, this has led to a growth in physical activity promotion schemes involving primary health care. AIM: To document and critically examine the extent and nature of physical activity promotion in general practice in England. METHOD: A postal survey to all family health services authorities and primary care facilitators was conducted to identify existing and planned activity promotion schemes involving primary health care. Telephone interviews with leaders from 50 selected schemes and further detailed case studies of 11 schemes provided descriptive information of the nature of physical activity promotion. RESULTS: The initial phase revealed 157 existing schemes and a further 35 planned schemes. Two basic models of physical activity promotion were identified that were distinguishable by the primary location of the management of the patient. Practice-managed interventions (32%) involve on-site counselling to change the behaviour of patients. Leisure centre-managed projects (68%), sometimes termed 'exercise by prescription' or 'general practitioner referral for exercise' schemes, involve the identification of suitable patients and their referral to 10- to 12-week-long leisure centre based exercise induction courses. The projects in the planning stage were all of the latter type, indicating this as the favoured model. Although such schemes were generally successful in attracting patients, in all cases they involved less than 1% of the patient base from which they were drawn. CONCLUSION: There is evidence of successful recruitment, increased short-term physical activity and fitness, and improvements in the well-being of patients. However, schemes are inadequately resourced for rigorous long-term evaluation; therefore, conclusions regarding the cost-effectiveness of the two models are not possible.

England↗
PubMed1993

Familial versus sporadic ankylosing spondylitis. Two different diseases?

OBJECTIVE: To define potential differences and the possible contribution of susceptibility or severity genes in familial versus sporadic ankylosing spondylitis (AS). METHODS: Three hundred twenty patients with AS were studied: 160 who had first-degree relatives with AS (familial) and 160 age- and sex-matched controls who had no first-degree relative with the disease (sporadic). Disease expression in the two groups was evaluated using an index of physical, psychological, and social functioning (the Arthritis Impact Measurement Scales [AIMS]) and an assessment of spinal mobility. RESULTS: Familial disease was significantly milder than sporadic disease as assessed by all measures, e.g., spinal mobility score (mean 4.08 versus 4.65, P < 0.038), AIMS overall impact score (mean 2.63 versus 3.59, P = 0.002), AIMS physical activity score (4.19 versus 5.10 [P = 0.004]), AIMS social function score (4.02 versus 4.60, P = 0.023), and AIMS pain score (4.15 versus 5.33, P = 0.002). CONCLUSION: The greater prevalence of AS in at-risk families may be explained by the occurrence of more AS "susceptibility" genes in those families, whereas the more severe disease, seen in patients with sporadic AS, is conferred by the presence of more "severity" genes than "susceptibility" genes.

Adolescent↗
PubMed1993

Fatigue in ankylosing spondylitis--why is it ignored?

OBJECTIVE: Fatigue in ankylosing spondylitis (AS) is largely ignored by physicians and classical texts. By contrast, patients frequently allude to it as a major complaint. METHODS: To address the situation, 3 studies were performed: (1) Symptoms were defined in a cross sectional evaluation of 1950 consecutive patients with AS. (2) From each of the 3 groups who specified a particular main symptom (pain, stiffness or fatigue), a random cohort of 20 was selected and all 60 were prospectively followed over a 14-day period. (3) An additional 100 patients [50 randomly selected with AS and 50 with rheumatoid arthritis (RA)] took part in a comparative prospective study. RESULTS: In the first study for those with a definitive major symptom, 34% (n = 670) described pain while stiffness and fatigue were reported by 25% (n = 492) and 6% (n = 124), respectively. Thirty-two percent (n = 616) could not distinguish between the 3. Strikingly, when prospectively studied over a 2-week period, over 50% of the patients revealed that fatigue was the main symptom. Moreover, in the cohort which expressed pain as their major problem initially, fatigue had the highest prevalence (mean fatigue value versus mean stiffness, p = 0.009; fatigue versus pain, p < 0.001). In the direct comparison between patients with RA and those with AS, the RA cohort had statistically more fatigue and pain than the AS cohort (p = 0.002, p = 0.007, respectively) with a similar amount of stiffness expressed by both groups (n = 0.149). In both subsets, pain had the least impact on the patients (mean 2.60 and 1.87, respectively). CONCLUSION: Our data reveal that fatigue should be considered a major problem for patients with AS, worthy of further exploration in terms of both etiology and therapy.

Adult↗
PubMed1993

The natural history of ankylosing spondylitis. Does it burn out?

Initially, 1,492 patients with ankylosing spondylitis (AS) were assessed by a new disease activity index. This addressed the degree of pain, severity and overall disease activity (scale 3-26). As expected, there was a normal distribution with a median of 12. Sixty-five patients, selected from the extremes of the disease activity scale, (< 5, > 22), were prospectively followed over a 2-year period: 30 with high activity mean score 24.1 (SD 1.2) and 35 with low mean score 3.4 (SD 0.5). At followup, subjects were assessed with this new index and a validated functional index. Although at followup the high activity mean score was significantly reduced to 21.1 (p < 0.001) and the low activity mean score was significantly increased to 6.1 (p = 0.002), the majority of the patients had remained in their original quartiles i.e., 63 and 77%, respectively. Disease status at followup was independent of disease duration; i.e., high activity group mean 27.1 (SD 5.3) and remission group 26.9 (SD 13.77) years, respectively (NS). When the 2 disease indices were compared, an excellent correlation existed: r = 0.788, p < 0.001. Our data suggest (1) < 1% of patients with AS who present to a rheumatologist enter longterm remission ("burn out"). (2) Some 20% of patients in remission will develop active disease 2 years later. (3) The prognosis over 2 years for those with active disease is poor.

Female↗
PubMed1991

Primary ankylosing spondylitis, psoriatic and enteropathic spondyloarthropathy: a controlled analysis.

Within our ankylosing spondylitis (AS) population (n = 1331), 85% (n = 1128) had primary AS (1 degree AS), 9% (n = 121) had psoriatic AS (PsAS) and 6% (n = 82) enteropathic AS (IBDAS). In an attempt to explore further the relationship between 1 degree AS and the secondary spondyloarthritides, we evaluated 121 consecutive patients with PsAS and 82 with IBDAS, as well as 202 controls with primary disease. The patients were matched for sex and age at review PsAS:48.1 (SD 11.3) years vs 1 degree AS:48.4 (SD 11.5), and IBDAS:46.0 (SD 12.7) vs 1 degree AS:45.9 (SD 12.7). The sex distribution for IBDAS (M:F, 1:1), was significantly less (p less than 0.001) than that for PsAS (M:F, 3.5:1) or 1 degree AS (M:F, 2.4:1). Overall, compared to 1 degree AS the PsAS and IBDAS tended to have greater disease severity as defined by e.g., (1) those taking non-steroidal antiinflammatory drugs, 86 vs 72% (p less than 0.01) and 71 vs 60% (p less than 0.05), respectively; (2) decreased spinal mobility (scale 0-8) 5.0 (SD 2.0) vs 4.4 (SD 2.3); p = 0.029 and 4.9 (SD 2.0) vs 3.9 (SD 2.4); p = 0.024, respectively; and (3) PsAS resulted in a higher AIMS pain score; 4.9 (SD 2.5) vs 4.0 (SD 2.4): p = 0.042. By contrast, peripheral joint involvement, number of total hip replacements and capacity for employment were similar in all 3 groups. In conclusion (1) among the AS population the prevalence of 1 degree AS, PsAS and IBDAS is 90, 6 and 4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

New light on uveitis in ankylosing spondylitis.

Inflammatory eye disease is well recognized in ankylosing spondylitis (AS) but the relationship between the uveitis and the spondyloarthropathy is poorly defined. The following conclusions may be drawn from a study of 1331 consecutive patients with AS: the prevalence of uveitis was 40% (535 subjects), almost half of whom had greater than 5 attacks. Family studies of sib pairs, concordant for AS, showed that uveitis occurred randomly with a concordance for uveitis/no uveitis of only 43%. A comparison of patients with (n = 535) and without (n = 796) uveitis showed no important differences. Analysis of potential trigger factors among 72 patients with recurrent disease revealed no seasonal, infective or other correlation. The removal of an intrauterine device from a woman with severe intractable bilateral uveitis was associated with remission of the eye disease. In summary, although genetic background determines susceptibility to uveitis the pattern of the disease suggests the possibility of random environmental triggers unrelated to the course of the underlying rheumatological disorder.

Humans↗
PubMed1990

Serum keratan sulphate levels rise in rheumatoid arthritis patients, but fall in ankylosing spondylitis patients compared with normal controls.

Serum levels of keratan sulphate (KS) were found to be significantly elevated in patients with destructive and predominantly seronegative rheumatoid arthritis (RA) compared with a control population. Levels in RA did not correlate with clinical or laboratory indices of joint activity or damage. Conversely levels were depressed in ankylosing spondylitis (AS) compared with controls.

Arthritis, Rheumatoid↗
PubMed1990

Is there sexual inequality in ankylosing spondylitis? A study of 498 women and 1202 men.

The responses of 1700 members (1202 men) of the National Ankylosing Spondylitis Society to a self-administered questionnaire were analyzed. The male:female ratios for primary ankylosing spondylitis, psoriatic spondylitis and spondylitis associated with inflammatory bowel disease were 2.4:1, 3.5:1 and 1:1, respectively. A positive family history was significantly less prevalent in men than women as were hand, elbow, shoulder and knee symptoms. In a parallel radiographic study, 100 men matched for age of onset and disease duration with 50 women demonstrated similar sacroiliac, cervical and hip disease but worse involvement of the lumbar spine.

Adult↗
PubMed1987

Early postoperative changes in left ventricular chamber size, architecture, and function in aortic stenosis and aortic regurgitation and their relation to intraoperative changes in afterload: a prospective two-dimensional echocardiographic study.

We prospectively studied 16 patients with isolated aortic stenosis and eight with isolated aortic regurgitation undergoing aortic valve replacement, using two-dimensional echocardiography preoperatively, intraoperatively, and 41 +/- 7 days postoperatively to calculate the intraoperative change in afterload, quantify the postoperative changes in left ventricular chamber size, architecture, load and function, determine whether the postoperative left ventricular remodeling correlated with the intraoperative change in afterload in aortic stenosis and aortic regurgitation, and assess whether preoperative afterload excess precluded postoperative improvement in left ventricular function. Preoperative left ventricular mass, end-systolic meridional and circumferential wall stresses, ejection fraction, and stress-shortening relations in patients with aortic stenosis and aortic regurgitation were similar. However, our patients with aortic regurgitation had severe systolic dysfunction, with ejection fraction less than 55% in all but one patient, compared with only 10 of 16 patients with aortic stenosis. Left ventricular end-diastolic volume, mass/volume ratio, and chamber shape were significantly different in patients with aortic stenosis and aortic regurgitation (174 +/- 64 vs 294 +/- 140 ml, p less than .01; 1.81 +/- 0.63 vs 1.14 +/- 0.18, p less than .01; and 0.59 +/- 0.09 vs 0.69 +/- 0.09, p less than .05, respectively). Intraoperative end-systolic meridional and circumferential stresses fell significantly in patients with aortic stenosis but remained unchanged in those with aortic regurgitation. The changes in left ventricular volume and ejection fraction during early postoperative remodeling (6 weeks) correlated with the intraoperative change in afterload in patients with aortic stenosis. In contrast, there was no intraoperative change in afterload in patients with aortic regurgitation and no significant changes in left ventricular volume, architecture, or function at 6 weeks or at 6 months. The differences in left ventricular remodeling and changes in function between patients with aortic stenosis and aortic regurgitation in the early postoperative period most probably relates to the major difference in intraoperative reduction in afterload, although a contributory role may have been played by the preoperative left ventricular dysfunction in those with aortic regurgitation that was underestimated by measurement of ejection fraction.

Adult↗
PubMed1983

A computer assisted quality assurance model.

This article describes a modular quality assurance program that was designed for computer automation. The author explains how the quality assurance model not only meets this need but also satisfies other critical objectives, including integration with the hospital's multidisciplinary quality assurance program and minimal redundancy in developing standards and measurement criteria. Readers will benefit from ideas for refining or developing effective quality assurance programs that can also use computer technology to increase productivity.

Computers↗