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Biomedical subjects

L Watson

Publications and source records attributed to L Watson.

At least 55 records · Page 3Linked to original sources
PubMed1998

Adverse outcome after multiple pregnancy.

There is increasing interest in the outcomes of multiple pregnancies as their numbers rise, mainly owing to advances in fertility-enhancing techniques. In addition, the numbers of multiple births surviving the perinatal period is increasing with the increasing survival of very tiny babies. In order to investigate these outcomes or to evaluate procedures that may improve them, it is important to consider a number of methodological issues that affect the comparability of data both between and within populations. How a birth and a multiple birth are defined, data sources, whether multiple pregnancies or individual births are being counted and the identification of multiple gestations by zygosity and chorionicity will all affect the reported outcome rates. In light of this, perinatal mortality and neurodevelopmental disabilities are examined as adverse outcomes of multiple pregnancies.

Abortion, Spontaneous↗
PubMed1998

What constitutes cerebral palsy?

Cerebral palsy (CP) is a term of convenience applied to a group of motor disorders of central origin defined by clinical description. It is not a diagnosis in that its application infers nothing about pathology, aetiology, or prognosis. It is an umbrella term covering a wide range of cerebral disorders which result in childhood motor impairment. The precise inclusion criteria vary with the objectives for using the term. For meaningful comparison of rates of CP, as performed by and between CP registers, it is important that the rates should be generated using the same criteria. As generally understood there must be motor impairment, and this impairment must stem from a malfunction of the brain (rather than spinal cord or muscles). Furthermore, the brain malfunction must be non-progressive and it must be manifest early in life. For the purposes of comparisons of rates across time even when the condition meets all the above criteria, it must not historically have been excluded from the category of CP. This paper addresses the problem of standardizing the inclusion criteria for selecting people included on CP registers with particular reference to this last criterion.

Cerebral Palsy↗
PubMed1998

Maternal corticotropin-releasing hormone is increased with impending preterm birth.

The objective of this study was to test the hypothesis that maternal CRH concentrations are elevated in women experiencing threatened preterm labor who subsequently give birth within 24 h compared to those in women who do not. We also characterized the changes in maternal plasma cortisol, ACTH, corticosteroid binding capacity (CBC), and CRH concentrations in 28 healthy pregnant women between 20-38 weeks gestation. Overall, maternal plasma CRH concentrations were significantly greater (P < 0.05) in those women giving birth within 24 h (1343.3 +/- 143.9 pg/mL; n = 81) compared to those in women who did not (714.5 +/- 64.8 pg/mL; n = 144) or those in normal subjects. This difference was present between 28-36 weeks, but not 24-28 weeks gestation. The ratio of maternal cortisol to CBC was also significantly greater (P < 0.05; 0.65 +/- 0.04; n = 82) in women giving birth within 24 h than in those who did not (0.55 +/- 0.02; n = 136). This difference was significant at all gestational ages studied. Elevated CRH concentrations and bioavailability of free cortisol may both be implicated in the pathogenesis of preterm labor in some women. Further prospective clinical trials are warranted to determine the positive and negative predictive values of maternal CRH concentrations and/or the ratio of cortisol/CBC for identifying women with threatened preterm labor destined to give birth within 24 h.

Adrenal Cortex Hormones↗
PubMed1997

Distinction of idiopathic Parkinson's disease from multiple-system atrophy by stimulation of growth-hormone release with clonidine.

BACKGROUND: Idiopathic Parkinson's disease is a common neurodegenerative disease that is difficult to distinguish from other parkinsonian syndromes such as multiple-system atrophy (MSA). In MSA, autonomic dysfunction is common and is associated with either parkinsonian or cerebellar features, or both. Differentiation of idiopathic Parkinson's disease from MSA is important because prognosis, complications, and response to therapy vary according to disorder. Our aim was to find out whether clonidine/growth hormone (GH) testing distinguishes idiopathic Parkinson's disease from MSA. METHODS: Clonidine is a centrally active alpha 2-adrenoceptor agonist that raises concentrations of GH in serum in healthy people and those with pure autonomic failure (with peripheral lesions), but not in those with MSA (with a central autonomic deficit). We investigated the effects of clonidine on 14 people with idiopathic Parkinson's disease (without autonomic deficits). 31 people with MSA of the three different clinical forms (parkinsonian, cerebellar, and mixed), 19 people with pure autonomic failure, and 27 healthy participants. In nine people with parkinsonian MSA (MSA-P), the GH response to levodopa was also assessed. FINDINGS: Clonidine raised serum GH concentrations in patients with idiopathic Parkinson's disease (median increase 8.98 [IQR 6.6-16.6] mU/L), normal participants (13.2 [7.0-18.6] mU/L), and patients with pure autonomic failure (12.5 [5.6-18.2] mU/L). In those with MSA who had central autonomic failure, GH concentrations were unchanged (MSA-P; 0.41 [-0.30 to 2.09] mU/L and cerebellar MSA [MSA-C] 1.67 [0-4.49] mU/L). The GH response to clonidine in idiopathic Parkinson's disease was significantly different from that in MSA-P (p < 0.0002). In MSA-P, the dopamine precursor levodopa raised GH concentrations (from mean 2.7 [SE 1.0] mU/L to mean 18.2 [6.0] mU/L, p < 0.05) and GH-releasing hormone (GHRH) concentrations (from mean 20.6 [3.25] ng/L to mean 68.0 [10.6] ng/L, p < 0.05), excluding dysfunction of pituitary somatotrophs or GHRH neurons as a cause for the absent GH response to clonidine in MSA. INTERPRETATION: The GH responses to clonidine clearly differentiated idiopathic Parkinson's disease from MSA-C and MSA-P. Together with the levodopa studies they indicated a specific alpha 2-adrenoceptor-hypothalamic deficit in MSA. The clonidine-GH test may provide further insight into central neurotransmitter and alpha 2-adrenoceptor-hypothalamic abnormalities in MSA.

Adrenergic alpha-Agonists↗
PubMed1997

Perspectives unifying symptom interpretation.

PURPOSE: To introduce the symptom interpretation model (SIM) and facilitate understanding symptoms from an intrapersonal perspective. Determining an individual's interpretation of symptoms is critical to understanding the resulting decisions. ORGANIZING CONSTRUCT: SIM is based on an illness representation model, knowledge structures theory, and propositions about reasoning. Individuals name and assign meaning to environmental stimuli. Based on this interpretation, behaviors are selected for symptom management. METHODS: Theory derivation was used to develop SIM for understanding comparisons of known and new symptoms in a behavioral outcomes context. CONCLUSIONS: Symptom familiarity reinforces patterns about symptom management. SIM enriches understanding of symptom experiences. Comprehensive assessment, including the intraindividual perspective, is essential to successful symptom management.

Disease↗
PubMed1997

British agencies for adoption and fostering in Scotland--Scottish Medical Advisers' survey.

Children in local authority care (The survey was conducted before the term 'in care' was replaced by 'looked after' on The Children (Scotland) Act coming into force in October 1996) come from backgrounds of high incidence of mental illness, substance abuse and learning difficulties and have often suffered from neglect and/or abuse. They have a high incidence of medical problems affecting both physical and mental health. The Committee of the Scottish Section of the Medical Group of British Agencies for Adoption and Fostering (BAAF) were concerned about the provision and co-ordination of medical services for children in local authority care. The aim of the survey was to identify the current and evolving practice among medical advisers across Scotland. Questionnaires were returned from 40 Medical Advisers representing each of the local authorities in Scotland. The responses highlighted a variation in the implementation of practice in clinical services provided to children in care and by whom. It confirmed that difficulties in follow-up did exist and revealed widespread confusion surrounding co-ordination of medical services, absence of procedures and ignorance of legal requirements. The study confirms that involved medical practitioners need to have a pro-active role in co-operating closely with social work colleagues to provide a well co-ordinated service of medical supervision providing a comprehensive assessment of health care needs as part of the overall child care plan.

Adolescent↗
PubMed1997

Complications of laser resurfacing.

The laser demonstrates significant benefits over traditional resurfacing and incisional techniques. Serious complications of laser surgery are easily avoidable provided practitioners and support staff receive proper education and training. The following article describes the more common complications of laser resurfacing followed by a brief discussion of avoidance techniques.

Face↗
PubMed1996

Breathlessness and exercise capacity in heart failure: the role of bronchial obstruction and responsiveness.

The cause of the breathlessness and reduced exercise capacity that occur in patients with chronic heart failure remains obscure. We examined the hypothesis that airway obstruction and bronchial hyper-responsiveness, which are recognised features of chronic heart failure, might contribute to the breathlessness and reduced exercise capacity in this condition. We studied 37 patients (7 female) with chronic heart failure, of mean age 61 years. Each patient underwent: (i) lung function testing with spirometry and expiratory flow volume loops. (ii) Measurement of bronchial responsiveness to methacholine. (iii) Symptom-limited treadmill exercise capacity using both incremental and fixed workload protocols, with measurement of Borg scores for breathlessness. Lung function was not significantly related to either exercise time, or Borg symptom scores in either exercise protocol. Bronchial hyper-responsiveness to methacholine was demonstrated in 12 patients. Exercise time did not correlate with the degree of bronchial hyper-responsiveness in these 12 patients. Group mean exercise time and Borg scores were not significantly different in these 12 patients when compared to the 25 patients in whom bronchial hyper-responsiveness was not found. We conclude that airway obstruction and bronchial hyper-responsiveness are not likely to be important determinants of reduced exercise capacity and breathlessness in chronic heart failure.

Airway Obstruction↗
PubMed1996

The 'new' risk factors for SIDS: is there an association with the ethnic and place of birth differences in incidence in Victoria, Australia?

Home interviews and assessments of infant development were carried out in a project examining the family environments of four groups of women and their infants with different risks of sudden infant death syndrome (SIDS): a reference group of 200 Australian-born (Anglo-Celtic) women (SIDS incidence, 2.04/1000), 101 women born in Asia (0.97/1000) and 56 women born in Southern Europe (0.58/1000) whose infants have a very low risk of SIDS and 102 women who chose to give birth at home whose infants have a high risk of SIDS (8.9/1000). As these differences are not explained by the classic social and perinatal risk factors, it was possible that they might be attributable to the 'new' risk factors: prone sleeping position, not fully breast feeding, exposure to cigarette smoke and bed sharing. Analysis of the data did not show this expected association: there were no significant differences between the groups in the use of the prone position; although only two Asian-born women smoked, infant exposure to cigarette smoke was similar in the other three groups; choice of infant feeding method did not fit the expected pattern--homebirth infants were fully breast fed almost exclusively while this was so for only about 50% of infants in both low risk groups; more than 50% of homebirth families slept with their infants, but bed sharing was also significantly more common in the Asian-born group than in the reference group.

Asia↗
PubMed1996

The Fort McMurray Demonstration Project in social marketing: health- and safety-related behaviour among oil sands workers.

This is the first round in a series of surveys conducted in Fort McMurray as part of the Fort McMurray Demonstration Project in social marketing. This component of the survey was intended to focus on the most prominent group of employed workers in the community and to compare their patterns of response with the community as a whole. Respondents to the survey were overwhelmingly male (96%), married (72.9%) and living in households of two to five persons (87.9%). They were predominantly aged 30-44 (55%) and graduates of high school (53.5%). Younger male workers (below age 30) were more likely to have a high school diploma (78.3%) or some additional technical or vocational training (21.7% compared to 12.5% overall) and to be unmarried or separated. Attitudes toward safety-related behaviours were stronger than for respondents from the community as a whole. Approximately 70-100% of all age groups and both sexes showed strong agreement with attitudes involving child car seats and the unacceptability of drinking and driving. These attitudes include strong advocacy of vigorous enforcement of occupational health and safety standards. However, they showed a variability similar to the community as a whole in behaviour at home compared to work, generally reporting more consistent use of personal protection on the job than in their own homes, particularly hearing protection. Even so, they were much less likely to perform stretching and warm-up exercises prior to exertion than community residents in general. The potential may exist to transfer the technology and attitudes from workplace health and safety to community safety. One possible strategy to accomplish this is to involve workers in this industry directly in community initiatives. This strategy may be generalizable to any community in which there are major employers who place a heavy emphasis on risk control and occupational health and safety.

Adult↗
PubMed1996

Pulmonary function before and after anterior spinal surgery in adult idiopathic scoliosis.

BACKGROUND: Little is known about the long term effects of anterior spinal surgery on pulmonary function in adult patients with idiopathic scoliosis. A study was therefore undertaken of pulmonary function before and after anterior spinal surgery in this group of patients. METHODS: Fourteen patients (12 women) of mean age 26.5 years (range 17-50, 10 > or = 20 years) were studied. All 14 patients underwent thoracotomy and anterior arthrodesis, and five also underwent posterior arthrodesis. Scoliosis curves and lung volumes were measured preoperatively and at a mean follow up of 32 months (range 14-49) after surgery. RESULTS: At long term follow up after surgery the mean (SD) Cobb angle of the thoracic curve improved from 59 degrees (25 degrees) to 39 degrees (18 degrees), a correction of 31%. Despite this there was a fall in mean forced vital capacity (FVC) of 0.21 litres (95% confidence interval 0.04 to 0.38). In the patients who underwent anterior surgery without posterior surgery (n = 9) there was a fall in mean FVC of 0.31 litres (95% confidence interval 0.12 to 0.50); mean forced expiratory volume in one second and total lung capacity were also reduced and there was an increase in mean residual volume. CONCLUSIONS: Forced vital capacity is reduced at long term follow up in adult patients with idiopathic scoliosis who undergo anterior spinal surgery. The fall in FVC is small and is unlikely to be of clinical significance in patients with reasonable lung function in whom surgery is planned for prevention of curve progression or improvement of cosmetic appearance and pain. However, surgical intervention should not be undertaken in an attempt to improve pulmonary function.

Adolescent↗
PubMed1996

Nurses who work in general medical practices: a Victorian survey.

A questionnaire survey of 452 general medical practices in Victoria attracted responses from 277 practices, many of which did not employ nurses. The 93 respondents from 85 practices who were nurses reported that they enjoyed flexible working hours and stable employment. While their main reason for working in GPs' rooms was convenience, the most important aspect of their work was interaction with patients and fellow workers. Sixtyseven percent of nurses thought continuing education in specific skills was necessary for their work, 43% thought a post-registration qualification in community health nursing would be desirable and 47% thought a special interest group of nurses working in medical practices would be useful.

Adult↗
PubMed1995

Breast and ovarian cancer incidence after infertility and in vitro fertilisation.

Concern has been expressed that exposure to fertility drugs might be associated with a risk of ovarian cancer. We have examined the incidence of breast and ovarian cancer in a cohort of 10,358 women referred for in-vitro fertilisation (IVF) treatment in Victoria, Australia, between 1978 and 1992. The "exposed" group (n = 5564) had had ovarian stimulation to induce multiple folliculogenesis and the "unexposed" group (n = 4794) had been referred for IVF but were untreated or had had "natural cycle" treatment without ovarian stimulation. Duration of follow-up ranged from 1 to 15 years. Cases of cancer were determined by record linkage with data from population-based cancer registries. 34 cases of invasive breast cancer and 6 of invasive ovarian cancer were observed. A comparison with the expected numbers, derived by applying age-standardised general population rates to the cohort gave standardised incidence ratios (SIR) for breast cancer of 0.89 (95% CI 0.55-1.46) in the exposed group and 0.98 (0.62-1.56) in the unexposed group, and for ovarian cancer SIRs were 1.70 (0.55-5.27) and 1.62 (0.52-5.02), respectively. Rates of all cancers were not significantly different from general population rates. The relative risk (RR) of cancer, adjusted for age and infertility type, was, in the treated group compared with the untreated group, 1.11 (95% CI 0.56-2.20) for breast cancer and 1.45 (0.28-7.55) for ovarian cancer. The risk of body of uterus cancer was increased in the exposed and unexposed groups combined (SIR 2.84 [1.18-6.81]). Women with unexplained infertility, independent of IVF exposure, had significantly increased risks of ovarian cancer (RR = 19.19 [2.23-165.0]) and body of uterus cancer (RR = 6.34 [1.06-38.0]) compared with women with known causes of infertility. This relatively short-term follow-up suggests that ovarian stimulation with IVF is not associated with an increased risk of breast cancer. Although there was no significantly increased risk of ovarian cancer after ovarian stimulation with IVF the small number of cases limits the conclusions that can be drawn. Longer-term follow-up of large cohorts of women who have been in IVF programmes will be necessary.

Adult↗
PubMed1995

Comparison of women who do and do not have amniocentesis or chorionic villus sampling.

Even in areas where prenatal diagnostic testing is offered at no cost to women over a certain age, uptake of testing is not complete. We have studied the factors that affect uptake in Victoria, Australia. In 1988-92, 43% of 37-39-year-old women and 29% of those 40 years and over had no diagnostic testing despite their eligibility for a free test. We compared the characteristics of untested women (n = 3074) with those of tested women (2462 amniocentesis, 1575 chorionic villus sampling) by use of record-linkage between the Victorian birth register and fetal diagnosis data collection. The indication for testing was maternal age alone. Women who had had 3 or more previous births were less likely than those of lower parity to undergo testing (odds ratio 0.54 [95% CI 0.46-0.63], p < 0.001), whereas those who had had a previous termination of pregnancy were more likely to be tested than those who had not (1.52 [1.26-1.83], p < 0.001). Women born in non-English-speaking countries and women who lived in rural areas were less likely to be tested. Women who gave birth in private hospitals were more likely to be tested than those who gave birth in any public hospital or at home. These data help to distinguish between issues of choice and access to diagnostic testing. Factors that hinder testing of rural women and of those from non-English-speaking backgrounds should be addressed.

Abortion, Induced↗