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Biomedical subjects

M Baker

Publications and source records attributed to M Baker.

At least 127 records · Page 7Linked to original sources
PubMed1997

Vagal regulation during bottle feeding in low-birthweight neonates: support for the gustatory-vagal hypothesis.

The gustatory-vagal hypothesis proposes that gustatory stimulation elicits a coordinated vagal response manifested as an increase in ingestive behaviors (e.g., sucking) and a decrease in nucleus ambiguus vagal tone measured by decreases in the amplitude of respiratory sinus arrhythmia (RSA). The current study tested the gustatory-vagal hypothesis in a bottle feeding paradigm with 29 clinically stable, high-risk, low-birthweight neonates. The amplitude of respiratory sinus arrhythmia (RSA) was collected before, during, and after bottle feeding. Consistent with the gustatory-vagal hypothesis, RSA decreased during bottle feeding. In a longitudinal subsample of subjects, the pattern of RSA changes during the feeding paradigm was stable across two test sessions.

Electrocardiography↗
PubMed1997

Surgical management of intrathoracic goiter.

Intrathoracic goiter is a rare clinical entity. This goiter can develop slowly and the patient may be asymptomatic for many years. A significant number of these patients, however, may develop various complications as a result of compression of vital structures or malignancy. In this report, the surgical management of 18 cases of intrathoracic goiter are reviewed. Six of the patients underwent right thoracotomy with resection of the posterior mediastinal goiter. The remaining 12 patients had their tumor removed via median sternotomy. There were no surgical deaths within this series. Although the incidence of intrathoracic tumor is limited, the threat of malignancy and compressive symptoms clearly indicates the need for surgical excision. Our group recommends thoracotomy and median sternotomy for surgical excision.

Adult↗
PubMed1997

Putting principals back into practice: an evaluation of a re-entry course for vocationally trained doctors.

BACKGROUND: Current recruitment difficulties in general practice have sharpened the interest of the profession in non-principals. No re-entry course for general practice has previously been run in the UK. AIM: To design and evaluate a re-entry course for general practice. METHOD: A re-entry course was developed to help doctors return to general practice as principals. A telephone interview was carried out with each delegate prior to their attendance on the course and was repeated one month and six months after the course to measure any change in career intentions and the perceived benefit of attending the course. RESULTS: Six months after the course, 11 out of 14 delegates had taken positive steps to return to general practice or had increased their time commitment to medicine. This contrasts with only one of the control group having made any steps to change career. CONCLUSION: The course was evaluated and found to be beneficial, particularly in terms of increasing the confidence of the delegates.

Curriculum↗
PubMed1996

Complete analysis of the presenilin 1 gene in early onset Alzheimer's disease.

The presenilin 1 gene has recently been identified as the locus on chromosome 14 which is responsible for a large proportion of early onset, autosomal dominantly inherited Alzheimer's disease (AD). We have elucidated the intron/exon structure of the gene and designed intronic primers to enable direct sequencing of the entire coding region (10 exons) of the presenilin gene in a large number of families. This strategy has enabled us to find a further two novel mutations in the gene. We discuss the distribution of mutations and the proportions of autosomal dominant AD with a mean age of onset below 60 years caused by mutations in this gene.

Alzheimer Disease↗
PubMed1996

Acute hepatitis B resulting in hospitalisation in New Zealand.

AIMS: To describe the epidemiology of acute hepatitis B resulting in hospital admission in New Zealand. METHODS: National hospitalisation data on acute hepatitis B (ICD9 codes 070.2, 070.3) were analysed. RESULTS: The average annual hospitalisation rate from acute hepatitis B in New Zealand was 1.4 per 100 000 for the years 1985-91. There was a greater risk of morbidity in Maori (relative risk (RR) for hospitalisation of Maori: RR = 2.24, (95% confidence interval (CI) 1.98, 2.52). The figure for Pacific Islands people was even higher (RR = 2.53, 95% CI = 2.01, 3.19). Relatively high hospitalisation rates occurred in males and in those aged between 15 and 29 years. Hospitalisations from acute hepatitis B were estimated to cost the hospital sector approximately $220,000 per year. Death occurred in 36 (5.4%) of these cases. CONCLUSION: Data on hospitalisations from acute hepatitis B can provide useful information on the epidemiology of this disease in New Zealand.

Acute Disease↗
PubMed1996

Peer interactions of dysphoric adolescents.

The present study sought to extend our knowledge of dysphoric adolescents' dyadic peer interactions. Thirty female dyads (ages 13-17) were videotaped interacting during both a structured and an unstructured task. Fourteen of the dyads were each comprised of a dysphoric girl and a nondysphoric girl; the remaining dyads were comprised of two nondysphoric girls. Girls were considered dysphoric if they scored 10 or higher on the Beck Depression Inventory. Dysphoric subjects evaluated their performances more negatively than nondysphoric subjects and rated their partners more negatively overall. The partners of the dysphoric girls were viewed by raters as less positive and less happy. They saw the dysphoric teens as making more critical comments and evaluated them more negatively overall. There was also a tendency for these girls to reject their dysphoric partners and to become more passive during the unstructured task. The findings indicate that dysphoric adolescent girls evoke negative reactions from peers and negatively influence their peers' behavior. These negative reactions from others may lead to further difficulties in negotiating the developmental tasks of adolescence.

Adolescent↗
PubMed1996

Which resources pay for treatment? A model for estimating the informal economy of health.

The model proposed is a means for (i) documenting the resources a woman deploys to choose, seek, find, get and pay for treatment; (ii) comparing what she has/does with a neighbour facing similar symptoms and problems, and (iii) understanding which difference between them makes most difference to the way they manage illness. In a narrow economic perspective, only tangible items with easily enumerated values are called resources, and only the formal economy counts. This model allows assessment of the value of both formal and informal resources in the household system. It will not establish the absolute or market worth of households in the sample, but does offer a framework for comparing households which have the same access to a given set of treatment options when faced with the same symptoms. Its application improves the possibility of understanding which resources, or combinations of resources, make most difference to a household's capacity to seek and get the treatment it has decided it needs. The paper is one element of a multi-layered and multi-disciplinary study of 'The Informal Economy of Health in African Cities'. The overall project aims are (i) to map the cultural, infrastructural and clinical factors affecting the treatment-seeking behaviour of women in low-income urban areas; (ii) to compare their effect(s) on the management of symptoms of adult venereal infection (STD) and crisis symptoms in children under five. The project mapped the social context of illness management in a district of Kampala. Important dimensions of that context are: the infrastructure of the area, and the treatment options available in or around it; women's assessments of how good/kind/shameful/private/feasible/ appropriate those options are, and the social and physical signs which trigger the conclusion that a symptom is 'serious enough' to need treatment outside the home in the first place. The focus here is the value of resources mobilized after the 'serious enough' assessment has been made.

Adult↗
PubMed1996

Estimating the costs attributable to a disease with application to ovarian cancer.

This article is concerned with the methodological issues that arise when estimating the expected costs attributable to a disease. In particular, the article considers methods appropriate for handling incomplete or censored cost and survival data, incorporating discounting, and computing attributable costs. After motivating the need for an estimate of the average, present value of the attributable costs, we present the Kaplan-Meier sample-average (KMSA) estimator, which takes into account the censored nature of the data that are typically available. We investigate the statistical properties of the estimator and compare it to others employed in the literature, showing how certain methods for incorporating discounting can introduce bias. We demonstrate the utility of the estimator by applying it to estimation of the costs attributable to ovarian cancer, using data from a database linking Medicare claims with the Surveillance, Epidemiology, and End Results cancer registry. Our analysis suggests that the average, present value of the 15-year costs attributable to ovarian cancer is $21,285 for local-stage cases and $32,126 for distant-state cases in 1990 dollars.

Aged↗
PubMed1996

A comparison of the efficacy and safety of adapalene gel 0.1% and tretinoin gel 0.025% in the treatment of acne vulgaris: a multicenter trial.

BACKGROUND: Adapalene is a new synthetic retinoid analogue developed for the topical treatment of acne vulgaris. OBJECTIVE: The study was designed to compare the efficacy and safety and adapalene gel 0.1% with tretinoin gel 0.025% in the treatment of grade II to II facial acne vulgaris. METHODS: Three hundred twenty-three patients were enrolled in this investigator-masked, randomized, parallel group, multicenter trial. Patients applied the test materials to the entire facial area daily, for a period of 12 weeks. Efficacy and cutaneous tolerance were assessed at baseline and weeks 2,4,8, and 12. Efficacy was determined by investigator counts of noninflammatory open and closed comedones, and inflammatory papules and pustules, as well as global improvement. Cutaneous tolerance was evaluated by erythema, scaling, and dryness, along with burning and pruritus. RESULTS: Staring at weeks 2 and 4, adapalene gel produced numerically greater lesion reductions than did tretinoin gel for all lesion types. At week 12, the mean percent reduction in the different lesion counts was as follow: 49% versus 37% for total lesions (p<0.01); 46% versus 33% for noninflammatory lesions (p=0.02); 48% versus 38% for inflammatory lesions (p=0.06) in adapalene and tretinoin gel treatment groups, respectively. Cutaneous side effects were limited to a mild "retinoid dermatitis" occurring in both treatment groups; however, patients treated with adapalene gel tolerated this therapy significantly better than those treated with tretinoin gel. Laboratory test evaluations (hematology, blood chemistries, urinalysis) were performed in 54 patients before and after 3 months of treatment. No clinically significant changes were observed. CONCLUSION: Adapalene gel 0.1% applied once daily was significantly more effective in reducing acne lesions and was better tolerated than tretinoin gel 0.025% in the treatment of acne vulgaris.

Acne Vulgaris↗
PubMed1996

Comparison of bronchoalveolar lavage and catheter lavage to confirm ventilator-associated lower respiratory tract infection.

Lower respiratory tract infection (LRTI) is a well recognised complication of artificial ventilation in intensive care units (ICU). Ideally, specimens for microbiological analysis should be obtained during bronchoscopy, but this is not always possible. Therefore, the microbiological diagnosis of lower respiratory tract infection by broncho-alveolar lavage (BAL) obtained during bronchoscopy was compared with catheter lavage (CL) with a balloon-tipped catheter. Adult patients with clinical evidence of lower respiratory tract infection in an adult ICU were randomly assigned to undergo BAL followed by CL or vice versa. Forty ml of normal saline 0.9% were instilled and then aspirated with a flexible bronchoscope to obtain BAL. A similar volume was instilled and aspirated with a 12-gauge Foley balloon-tipped catheter to obtain a CL sample. The number of inflammatory cells, epithelial cells and organisms seen by microscopy were quantified. Culture results were semi-quantified and classified as negative, positive, equivocal or contaminated. Seventy-nine paired specimens were obtained from 66 patients, including specimens from 10 patients taken on two or more occasions. Only 20% of BAL and 16% of CL had one or more epithelial cells and bacteria were seen in 26 BAL and 21 CL specimens, respectively; 35% of BAL and CL specimens were positive and there was a discrepancy in the culture result in only two cases. Staphylococcus aureus was the pathogen isolated most frequently and polymicrobial lower respiratory infection was diagnosed on 10 occasions (15%). CL fluid is as reliable as BAL in diagnosing lower respiratory tract infection in ICU. This approach does not require bronchoscopic expertise and utilises convenient laboratory techniques.

Adolescent↗
PubMed1996

Social and living skills of new long-stay hospital patients and new long-term community patients.

OBJECTIVE: The study assessed differences in social behavior skills and everyday living skills in two groups of psychiatric patients: hospital inpatients with stays of between six months and five years (new long-stay patients) and discharged patients who had resided in the community for a similar length of time (new long-term patients). METHODS: In a cross-sectional study based on a point prevalence survey in an outer London psychiatric hospital, 23 new long-stay and 23 new long-term patients were rated using the Social Behaviour Scale (SBS) and Basic Everyday Living Skills (BELS). RESULTS: Mean scores on both scales indicated significantly poorer functioning in the new long-stay group. Ratings on the BELS self-care and domestic skills subscales also indicated poorer functioning in that group. No significant differences between groups were found for the subscales measuring community and social relations skills. Significant gender differences emerged in ratings of domestic skills; men's scores indicated more impairment in the new long-stay group than in the new long-term group, while women's scores were comparable between the groups. CONCLUSIONS: Developing, enhancing, and maintaining skills among new long-stay patients, especially self-care and domestic skills, may facilitate their discharge into supported community settings.

Activities of Daily Living↗
PubMed1996

Contralateral sprouting and compensatory innervation following the permanent lesion of a ganglionic connective in the snail

The fate of sprouted fibres was examined following long-term recovery from lesions to the central nervous system of the snail Achatina fulica. Axonal dye-labelling of one of the cerebrobuccal connectives (CBC), following either a cut or a crush to the opposite CBC, revealed supernumerary labelling of neuronal elements in both the cerebral and buccal ganglia in the weeks following treatment. A part of this sprouting response involved the rerouting of axonal projections from injured neurones that project contralaterally into the uninjured CBC. In addition, intracellular dye-fills, immunocytochemistry for detection of serotonin and electrophysiological measurements all revealed that a contralateral, uninjured neurone, the metacerebral giant (MCG) cell, sprouted new processes to invade the buccal ganglion denervated by the lesion. The contralateral MCG also increased synaptic drive over a neurone in the denervated buccal ganglion, a cell that normally receives strong input only from the lesioned ipsilateral MCG. After 5 weeks of recovery, morphological and electrophysiological measurements returned to normal levels in animals receiving a crush to the CBC, suggesting a retraction of sprouted projections following successful regeneration across the lesioned pathway. In contrast, the measurements indicative of sprouted fibres continued for up to 5 months when the regenerative response was prevented by cutting the CBC. Together, these results suggest that both the cessation of sprouting and the eventual retraction of sprouted fibres in Achatina fulica is contingent upon successful regeneration of the damaged axonal pathway.

Journal Article↗
PubMed1996

Carotid endarterectomy in a community hospital.

Despite the popularity of carotid endarterectomy, considerable debate remains regarding the appropriateness of these procedures. Critics of carotid endarterectomy cite the excessive morbidity and mortality associated with these procedures, particularly when performed in a community hospital setting. A retrospective study of 130 procedures, involving 124 patients within a medium size community hospital setting, was conducted. Indications for the procedure, associated comorbidities, and complication rates were reviewed. The incidence of stroke with subsequent mortality was 0.8% within the study group. One patient (0.8%) developed acute coronary insufficiency and underwent coronary artery bypass surgery. Five (4.0%) other patients experienced minor complications. Carotid endarterectomy is a proven prophylactic measure against the prevention of stroke in a selected group of patients. This study reinforces that this procedure may be performed in a community hospital setting with very low morbidity and mortality rates.

Aged↗