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Biomedical subjects

M Clarke

Publications and source records attributed to M Clarke.

At least 217 records · Page 12Linked to original sources
PubMed1991

The prevalence of dementia in a total population: a comparison of two screening instruments.

Two short screening tests for dementia, the Information/Orientation (IO) sub-test of the Clifton Assessment Scale (CAPE) and the Mini-Mental State Examination (MMSE) were included in a survey of 1579 elderly people of a large general practice. All those scoring 21 and under on the MMSE, a one in two sample of those scoring 22, 23 and a one in ten sample of the remainder were investigated further using the Cambridge Examination for Mental Disorders of the elderly (CAMDEX). The prevalences of moderate to severe dementia and mild to severe dementia determined from the CAMDEX interview were 4.8% and 14.2%, respectively. For detection of moderate to severe dementia, a cut-point of 21/22 on the MMSE gave a sensitivity of 100%, specificity of 85% and an overall prevalence of 19.7%; mild to severe dementia was best detected by a cut-point of 23/24 giving a sensitivity of 89%, specificity of 81% and prevalence of 28.5%. A cut-point of 7/8 on the IO sub-test gave a sensitivity and specificity for detecting moderate to severe dementia of 87% and 97%, respectively, with a prevalence of 7.3%; for mild to severe dementia a cut-point of 10/11 gave a sensitivity of 67%, specificity of 94% and prevalence of 14.7%.

Aged↗
PubMed1991

Getting older--feeling younger: the changing health profile of the elderly.

In 1981 a survey was undertaken of the physical and mental health and social status of all those aged 75 years and over belonging to a large general practice which alone served the town of Melton Mowbray and its surrounding area. Seven years later the survey was repeated. This elderly population had increased by almost 30% in number between the two surveys despite a relatively stable practice population over this time period. After adjustment for the different age and sex distributions of the two survey populations, significant increases in independence levels were found over the time period for: getting in and out of a chair and bed, dressing, bathing and getting to and from the toilet. No differences were found for mobility around the home, feeding or continence of urine or faeces. A higher prevalence of cognitive impairment was found in 1988 than in 1981, 7.0% compared with 4.5%, but this appeared to be due to the larger number of unclassifiable respondents in 1981. A re-analysis of the data, excluding those living in the area less than five years confirmed that the differences found in health over time were not due to a group of elderly migrating into the area. This study provides evidence that the elderly of today appear fitter than previous cohorts of elderly. Service planners will need to take this into account if sensible provision of resources for this age group are to be made.

Activities of Daily Living↗
PubMed1991

The prevalence of dementia in Europe: a collaborative study of 1980-1990 findings. Eurodem Prevalence Research Group.

To obtain age- and gender-specific estimates of the prevalence of dementia in Europe and to study differences in prevalence across countries, we pooled and re-analysed original data of prevalence studies of dementia carried out in some European countries between 1980 and 1990. The study followed these steps: census of existing datasets, collection of data in a standardized format, selection of datasets suitable for comparison, comparison of age and gender patterns. From the 23 datasets of European surveys considered, 12 were selected for comparison. Only population-based studies in which dementia was defined by DSM-III or equivalent criteria and in which all subjects were examined personally were included. Studies in which institutionalized subjects were not investigated were excluded. Age- and gender-specific prevalences were compared within and across studies and overall prevalences were computed. Although prevalence estimates differed across studies, the general age- and gender-distribution was similar for all studies. The overall European prevalences for the five-year age groups from 60 to 94 years, were 1.0, 1.4, 4.1, 5.7, 13.0, 21.6 and 32.2%, respectively. In subjects under 75 years the prevalence of dementia was slightly higher in men than in women; in those aged 75 years or over the prevalence was higher in women. The prevalence figures nearly doubled with every five years of increase in age.

Adult↗
PubMed1991

The student diary survey: a method of monitoring hospital-based medical education.

A new system of allocating the Service Increment for Teaching (SIFT) has recently been introduced which, by its nature, encourages universities to be more explicit about their teaching requirements. A detailed study of the quantity of teaching received by Leicester clinical medical students was carried out using a student diary. This instrument enables a data base to be constructed which is useful for academic and resource allocation purposes. This information can also be used to estimate the teaching time in the different sites and the source of funding of the teaching staff and thereby provide insights into the 'knock-for-knock' system of informal cost-sharing between universities and the National Health Service.

Clinical Clerkship↗
PubMed1991

Developmental regulation of the alpha-mannosidase gene in Dictyostelium discoideum: control is at the level of transcription and is affected by cell density.

In Dictyostelium discoideum, there is a group of genes that are expressed following starvation and when exponentially growing cells reach high densities. We have examined the expression of one of these genes, alpha-mannosidase. Using an alpha-mannosidase cDNA probe in Northern (RNA) blot analysis, we have shown that the previously observed increase in alpha-mannosidase enzyme-specific activity during development is due to an increase in the levels of alpha-mannosidase mRNA. mRNA levels reach a maximum by 8 h of development and then begin to decline by 14 to 22 h. Using nuclear run-on analysis, we have found that this gene is regulated at the level of transcription. We also examined the effects of cell-cell contacts, cyclic AMP levels, and protein synthesis on expression of this gene and found that they were not critical in regulating its expression. However, cell density did play a major role in the expression of alpha-mannosidase. High cell density or the presence of buffer conditioned by high-density cells was sufficient to induce expression of alpha-mannosidase, indicating that this is one of the prestarvation response genes. Finally, the alpha-mannosidase gene was not expressed in aggregation-negative mutant strain HMW 404.

Blotting, Northern↗
PubMed1990

Attitudes to viability of preterm infants and their effect on figures for perinatal mortality.

OBJECTIVE: To examine how local attitudes to management of extreme preterm labour can influence data on perinatal mortality. DESIGN: One year prospective study in a geographically defined population. SETTING: The 17 perinatal units of Trent region. PATIENTS: All preterm infants of less than or equal to 32 weeks' gestation in the Trent region. INTERVENTIONS: Infants who had been considered viable at birth were referred for intensive care; those who had been considered non-viable received terminal care. MAIN OUTCOME MEASURES: Whether each infant was born alive, dead, or alive but considered non-viable. RESULTS: Large differences were observed among units in the rates of delivery of infants of less than or equal to 27 weeks' gestation (rates varied from 7.2 to 0 per 1000 births). These differences were not present in the data relating to infants of between 28 and 32 weeks' gestation. The variation seemed to result from different approaches to the management of extreme preterm labour--that is, whether management took place in a labour ward or a gynaecology ward. CONCLUSIONS: Place of delivery of premature babies (less than or equal to 27 weeks' gestation) may influence classification and hence figures for perinatal mortality. In addition, the fact that the onus of judgment regarding viability and classification is often placed on relatively junior staff might also affect the figures for perinatal mortality. The introduction of a standard recording system for all infants greater than 500 g would be advantageous.

Attitude to Health↗
PubMed1990

Two-pulse monocular and binocular interactions at the differential luminance threshold.

Interaction between two pulses at the differential luminance threshold was studied for stimuli pairs presented to the same eye or to opposite eyes with an interocular delay. With monocular stimuli, the results replicated the earlier observations by Ikeda (1965) and Rashbass (1970) indicating linear interaction followed by rectification occurring at about 50-60 msec into the integration epoch. Binocular results were different, in accord with observations made in the contrast domain by Green and Blake (1981). Binocular stimuli of opposite polarity showed no cancellation. Binocular facilitation at threshold was found when either the stimuli of the same sign (+ + or - -) occurred with little interocular delay (stimulus onset asynchrony, SOA less than 15 msec), or the stimuli of the opposite sign (+ - or - +) were presented with an interocular delay between 15 and 100 msec SOA; the latter effect was at maximum with flashes 50 msec in duration presented with 50 msec interocular SOA. These results imply that binocular interaction takes place between rectified internal effects of luminance pulses. From the two-channel binocular model of Cogan (1987), binocular facilitation is attributed to the "fused" response derived from multiplicative excitation between same-sign (half-wave rectified), internal pulse responses. The absence of cancellation between simultaneous opposite-sign dichoptic stimuli is attributed to the "either-eye" binocular process dealing with full-wave rectified internal pulse responses to transient stimuli.

Humans↗
PubMed1990

Occupational risk factors in alcoholism.

This study has investigated the presence and influence of six of the eight risk factors previously identified, which are common to occupations associated with high rates of alcoholism. The factors studied were availability of alcohol at work, social pressure to drink from colleagues, separation from family due to work commitments, lack of supervision, collusion by colleagues, and stresses and strains. The sample was drawn from problem drinkers attending a community drug treatment centre in London. None of the six factors was found to have a significant influence on the development or maintenance of these subjects' alcohol problems. It is concluded that these risk factors, while previously shown to be associated with those who seek medical treatment for the physical consequences of long-term alcohol misuse, are not of significance in the different populations of those who present for psychological alcohol treatment.

Adult↗
PubMed1990

Loss of vision in one eye following scoliosis surgery.

A 50-year-old woman developed left sided total external ophthalmoplegia and complete visual loss, with evidence of choroidal non-perfusion, immediately following scoliosis surgery. The ocular movements recovered, but the eye remained blind. It is suggested that these lesions may have resulted from pressure on the orbital contents during surgery.

Blindness↗
PubMed1990

Handicaps associated with incontinence: implications for management.

STUDY OBJECTIVE: The aim was to explore the relationship between dementia, impairment of mobility, and incontinence and the implications for management. DESIGN: The study was a survey of a sample population drawn from a general practice register. SETTING: A large general practice serving the entire population of Melton Mowbray, Leicestershire, UK. PARTICIPANTS: Of 1329 persons aged 75 or over, 1203 (90%) took part in the survey. Of non-responders, refusers accounted for 5%, deaths 4%, and failure to trace 1%. MEASUREMENTS AND MAIN RESULTS: 12% of the population complained of incontinence. No more than 24% of these cases were demented. Dementia and isolated locomotor problems were significantly associated with presence of incontinence, but 31% of cases were completely free of either problem. A minimum estimate of 56% of cases of incontinence were considered to be due to local physical disorders of the bladder. CONCLUSIONS: A search for local disorders causing incontinence is important, and more attention should be paid to the management of locomotor problems and possibly depression in the relief of incontinence.

Activities of Daily Living↗
PubMed1990

Pregnant women at work: a study of ethnic minority risk in Leicestershire.

Possible reasons for the excess risk of perinatal mortality experienced by Asian women living in Leicestershire who work during pregnancy were investigated. This entailed a detailed examination of the work undertaken locally by a group of pregnant Asian women and comparison with the work undertaken by an occupationally matched group of pregnant non-Asian women. A total of 306 pregnant women were interviewed. The results suggest that the two ethnic groups experienced similar working conditions, and most of the women continued working until the 29th week of pregnancy. The Asian women worked significantly longer hours on average than the non-Asian group, and were more likely to report financial dependence by the family upon their earnings.

Adult↗
PubMed1990

Ethnic differences in the consequences of alcohol misuse.

The drinking habits of Asian and indigenous patients receiving in-patient care for alcoholism in West London were studied. Although both racial groups reported similar levels of current alcohol intake, the Asian developed problems and presented for in-patient detoxification with a shorter mean duration of drinking than the indigenous subjects. Values for mean corpuscular volume (MCV) and gamma glutamyl transpeptidase (GGT) were higher in the Asians, suggesting the Asians were at greater risk of alcohol-related physical damage.

Adult↗
PubMed1989

Bovine spongiform encephalopathy in a cow in the United Kingdom.

Bovine spongiform encephalopathy (BSE) was diagnosed in a cow with a history of behavioral change, apprehension, hyperesthesia to auditory and tactile stimuli, wide-based stance, and marked hind limb hypermetria. Myoclonus involving individual muscles was observed in the shoulder region, ventral cervical region, and upper portion of the hind limb. Clonus was observed in the forelimbs. Clinicopathologic findings were normal, except for high serum globulin concentration, which was attributable mainly to an increase in the gamma-globulin fraction. Results of electroencephalography revealed almost continuous high-amplitude complexes in the occipital leads, interspersed with short runs of normal activity. There were generalized discharges, but these were not periodic. Current theory implicates the scrapie agent (prion) as the causal agent for BSE. The presence of scrapie in, and the possible entry of prion into bovine feedstuffs could result in the emergence of BSE in the United States.

Animals↗