Search PubMed⌕ Search

Biomedical subjects

L Page

Publications and source records attributed to L Page.

At least 19 recordsLinked to original sources
PubMed2005

Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache.

OBJECTIVES: Aims were to investigate (a) whether neuroimaging in patients with chronic daily headache reassures patients or fails to reassure them and/or worsens outcome, impacting on service use, costs, health anxieties, and symptoms, and (b) whether this reassurance process occurs differentially in patients with different levels of psychological morbidity. METHODS DESIGN: randomised controlled trial; setting: headache clinic in secondary care, South London; participants: 150 patients fulfilling criteria for chronic daily headache, stratified using the Hospital Anxiety and Depression Scale (HADS); intervention: treatment as usual or the offer of an MRI brain scan; main outcome measures: use of services, costs, and health anxiety. RESULTS: Seventy six patients were randomised to the offer of a brain scan and 74 patients to treatment as usual. One hundred and thirty seven (91%) primary care case notes were examined at 1 year, 103 (69%) patients completed questionnaires at 3 months and 96 (64%) at 1 year. Sixty six (44%) patients were HADS positive (scored >11 on either subscale). Patients offered a scan were less worried about a serious cause of the headaches at 3 months (p = 0.004), but this was not maintained at 1 year; other health anxiety measures did not differ by scan status. However, at 1 year HADS positive patients offered a scan cost significantly less, by 465 pounds Sterling (95% confidence interval (CI): -1028 pounds Sterling to -104 pounds Sterling), than such patients not offered a scan, due to lower utilisation of medical resources. CONCLUSIONS: Neuroimaging significantly reduces costs for patients with high levels of psychiatric morbidity, possibly by changing subsequent referral patterns of the general practitioner.

Adult↗
PubMed2003

Occupational health issues affecting the pharmaceutical sales force.

BACKGROUND: The sales force forms a significant sub-population in the pharmaceutical industry workforce. Role and organizational characteristics, such as isolation, peripatetic working and car travel and the psychosocial and ergonomic hazards related to work tasks, present particular occupational health risks. AIM: To review the occupational risks associated with peripatetic sales force work and evidence for the effectiveness of preventive interventions. METHODS: We carried out a review of the available literature between 1990 and 2003. RESULTS: The following hazards were identified as significant and worthy of further investigation for this occupational group: driving on company business; violence in the workplace; stress; ergonomic issues; and mobile phone use. CONCLUSION: To ensure effective prevention and management of employee health problems, specific health management strategies and interventions must be developed to meet the occupational health needs of this group.

Accidents, Traffic↗
PubMed2001

Furin initiates gelsolin familial amyloidosis in the Golgi through a defect in Ca(2+) stabilization.

Hereditary familial amyloidosis of Finnish type (FAF) leading to amyloid in the peripheral and central nervous systems stems from deposition of a 71 residue fragment generated from the D187N/Y variants of plasma gelsolin by two sequential endoproteolytic events. We identify the protease accomplishing the first cleavage as furin, a proprotein convertase. Endoproteolysis of plasma gelsolin occurs in the trans-Golgi network due to the inability of the FAF variants to bind and be stabilized by Ca(2+). Secretion and processing of the FAF variants by furin can be uncoupled by blocking the convergence of the exocytic pathway transporting plasma gelsolin and the endocytic recycling of furin. We propose that coincidence of membrane trafficking pathways contributes to the development of proteolysis-initiated amyloid disease.

Amyloidosis, Familial↗
PubMed2001

Homotypic fusion of immature secretory granules during maturation requires syntaxin 6.

Homotypic fusion of immature secretory granules (ISGs) gives rise to mature secretory granules (MSGs), the storage compartment in endocrine and neuroendocrine cells for hormones and neuropeptides. With the use of a cell-free fusion assay, we investigated which soluble N-ethylmaleimide-sensitive fusion protein attachment receptor (SNARE) molecules are involved in the homotypic fusion of ISGs. Interestingly, the SNARE molecules mediating the exocytosis of MSGs in neuroendocrine cells, syntaxin 1, SNAP-25, and VAMP2, were not involved in homotypic ISG fusion. Instead, we have identified syntaxin 6 as a component of the core machinery responsible for homotypic ISG fusion. Subcellular fractionation studies and indirect immunofluorescence microscopy show that syntaxin 6 is sorted away during the maturation of ISGs to MSGs. Although, syntaxin 6 on ISG membranes is associated with SNAP-25 and SNAP-29/GS32, we could not find evidence that these target (t)-SNARE molecules are involved in homotypic ISG fusion. Nor could we find any involvement for the vesicle (v)-SNARE VAMP4, which is known to be associated with syntaxin 6. Importantly, we have shown that homotypic fusion requires the function of syntaxin 6 on both donor as well as acceptor membranes, which suggests that t-t-SNARE interactions, either direct or indirect, may be required during fusion of ISG membranes.

Animals↗
PubMed2001

The humanization of birth.

The humanization of birth conference drew more than 2000 people from 26 countries. This article summarizes the conference. In much of the world women have learned to fear birth; this fear is represented by the increase in cesarean section rates seen in many countries. The humanization of birth may reduce this fear. Yet humanization is difficult to achieve in technocratic societies. It is important to recognize that safety and self-fulfilling experiences are not contradictions, and that humanized birth is the safest approach.

Cesarean Section↗
PubMed2001

Human resources for maternity care: the present system in Brazil, Japan, North America, Western Europe and New Zealand.

This article describes the nature of the humanization of birth and the overlapping but distinct role of professionals within the maternity services with an emphasis on the role of the midwife. It describes the status of midwives in different parts of the world, and the common characteristics of work undertaken to restore the role of the midwife. Midwifery is seen as an essential component of effective maternity services. In addition it is important to recognize the important role that traditional birth attendants play in many parts of the world. An appropriate structure including primary and secondary and tertiary care services are important for professionals to play their full part.

Brazil↗
PubMed2000

Characterizing the peak in the cosmic microwave background angular power spectrum

A peak has been unambiguously detected in the cosmic microwave background angular spectrum. Here we characterize its properties with fits to phenomenological models. We find that the TOCO and BOOM/NA data determine the peak location to be in the range 175-243 and 151-259, respectively (at 95% confidence) and determine the peak amplitude to be between approximately 70 and 90 &mgr;K. The peak shape is consistent with inflation-inspired flat, cold dark matter plus cosmological constant models of structure formation with adiabatic, nearly scale invariant initial conditions. It is inconsistent with open models and presents a great challenge to defect models.

Journal Article↗
PubMed1999

Developmental characterization of the gene for laminin alpha-chain in sea urchin embryos.

We describe the isolation and characterization of a cDNA clone encoding a region of the carboxy terminal globular domain (G domain) of the alpha-1 chain of laminin from the sea urchin, Strongylocentrotus purpuratus. Sequence analysis indicates that the 1.3 kb cDNA (spLAM-alpha) encodes the complete G2 and G3 subdomains of sea urchin a-laminin. The 11 kb spLAM-alpha mRNA is present in the egg and declines slightly in abundance during development to the pluteus larva. The spLAM-alpha gene is also expressed in a variety of adult tissues. Whole mount in situ hybridization of gastrula stage embryos indicates that ectodermal and endodermal epithelia and mesenchyme cells contain the spLAM-alpha mRNA. Immunoprecipitation experiments using an antibody made to a recombinant fusion protein indicates spLAM-alpha protein is synthesized continuously from fertilization as a 420 kDa protein which accumulates from low levels in the egg to elevated levels in the pluteus larva. Light and electron microscopy identify spLAM-alpha as a component of the basal lamina. Blastocoelic microinjection of an antibody to recombinant spLAM-alpha perturbs gastrulation and skeleton formation by primary mesenchyme cells suggesting an important role for laminin in endodermal and mesodermal morphogenesis.

Animals↗
PubMed1999

Clinical interventions and outcomes of One-to-One midwifery practice.

BACKGROUND: Changing Childbirth became policy for the maternity services in England in 1994 and remains policy. One-to-One midwifery was implemented to achieve the targets set. It was the first time such a service had been implemented in the Health Service. An evaluation was undertaken to compare its performance with conventional maternity care. METHODS: This was a prospective comparative study of women receiving One-to-One care and women receiving the system of care that One-to-One replaced (conventional care) to compare achievement of continuity of carer and clinical outcomes. The evaluation took place in The Hammersmith Hospitals NHS Trust, the Queen Charlotte's and Hammersmith Hospitals. This was part of a larger study, which included the evaluation of women's responses, cost implications, and clinical standards and staff reactions. The participants were all those receiving One-to-One midwifery practice (728 women), which was confined to two postal districts, and all women receiving care in the system that One-to-One replaced, in two adjacent postal districts (675 women), and expecting to give birth between 15 August 1994 and 14 August 1995. Main outcome measures were achievement of continuity of care, rates of interventions in labour, length of labour, maternal and infant morbidity, and breastfeeding rates. RESULTS: A high degree of continuity was achieved through the whole process of maternity care. One-to-One women saw fewer staff at each stage of their care, knew more of the staff who they did see, and had a high level of constant support in labour. One-to-One practice was associated with a significant reduction in the use of epidural anaesthesia (odds ratio (OR) 95 per cent confidence interval (CI) = 0.59 (0.44, 0.80)), with lower rates of episiotomy and perineal lacerations (OR 95 per cent CI = 0.70 (0.50, 0.98)), and with shorter second stage labour (median 40 min vs 48 min). There were no statistically significant differences in operative and assisted delivery or breastfeeding rates. CONCLUSIONS: This study confirms that One-to-One midwifery practice can provide a high degree of continuity of carer, and is associated with a reduction in the rate of a number of interventions, without compromising safety of care. It should be extended locally and replicated in other services under continuing evaluation.

Adult↗
PubMed1998

The use of clinical audit in evaluating maternity services reform: a critical reflection.

The clinical evaluation described here, using a casenote study, was part of a larger study evaluating the changes made to part of the maternity services in one NHS Trust, in response to the recommendations of Changing Childbirth (Department of Health 1993a). Results of the audit showed no evidence of a lowering of clinical standards within the study group and provided reassurance that a radical change in the model of care, with greatly enhanced continuity of career, an emphasis on community-based and midwifery-led care, and some reductions in labour interventions, could be implemented without compromising safety of care. The audit process raised a number of methodological problems which will need to be addressed in developing audit approaches which are able to reflect quality of care. It is important to recognize that the record of care is not a direct mirror of the care provided but a secondary source, kept for different purposes and designed to cover a different set of priorities from those which audit may seek to capture. The audit approach used in this study will be modified in continuing evaluation of the service as it moves from a pilot stage towards providing a mainstream service. Additional methods, including direct observation of care, will be employed in a sample of cases in order to assist in interpretation of audit findings.

Continuity of Patient Care↗
PubMed1998

Evaluation of one-to-one midwifery: women's responses to care.

BACKGROUND: One-to-one midwifery was a demonstration project introduced into a London-based maternity service in 1993 to put into practice the new government policy for maternity services in England. Evaluation was integral to the development of the project. METHODS: The evaluation of women's responses was conducted between August 1994 and August 1995 based on a longitudinal, self-completion questionnaire, interviews, and focus groups. Women in the study group (n = 728) received the new service and women in the control group (n = 675) received conventional care. The study design integrated quantitative and qualitative methods and went beyond a simple estimation of satisfaction with care. RESULTS: Satisfaction with antenatal and birth care was generally high, but study group women showed more positive responses overall. Both groups showed a preference for continuity of caregiver, but expectations were higher in the study group (72% of the study group and 42% of the control group preferred to see one caregiver). Both groups had less satisfied responses to hospital postnatal care (50% study and 54% control group were very satisfied). Study group women showed greater preparedness for birth than control group women (18% vs 12% "very well prepared") and for the time after the baby's birth (26% vs 15% "very prepared"). CONCLUSIONS: The study demonstrated that women were more satisfied with the one-to-one model of care. Taken together with the results of clinical and economic audit and professional responses, the evaluation suggests that this model should be developed and evaluated further to gain a greater understanding of women's needs of the maternity service.

Adult↗
PubMed1997

Bladder augmentation can be problematic with renal failure and transplantation.

Ten consecutive patients with failure of urinary bladder augmentation (UBA) performed either prior to or after reaching end-stage renal disease (ESRD) were studied. Seven patients developed increased hydroureteronephrosis, infectious complications, and advanced to ESRD after UBA. The mean time to development of ESRD in patients who had UBA performed with moderate chronic renal failure (CRF) was 1.8 years. The UBAs in all seven patients were taken down prior to transplantation. Subsequently, five of these UBA-takedown patients have received kidney grafts and all have stable, good renal function. Three patients had their UBA performed after they reached ESRD, in preparation for renal transplantation. All three of these patients experienced recurrent urosepsis following transplantation, resulting in death in one patient and loss of graft in another. The third patient will undergo takedown of the UBA. This study suggests that UBA may possibly not be the best option for patients with moderate CRF and those awaiting transplantation.

Adolescent↗