Organochlorine chemicals in tree swallows nesting in pool 15 of the Upper Mississippi River.
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Animals↗
Biomedical subjects
M Coffey
Publications and source records attributed to M Coffey.
Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome.
AIMS: Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcome. Screening for GDM is therefore recommended but the best screening method remains controversial. This prospective, randomized study compared a risk factor-based screening programme with a universally based one. METHODS: Subjects were randomized at booking to one of two groups: the risk factor group had a 3-h 100-g oral glucose tolerance test (OGTT) at 32 weeks if any risk factor for GDM was present; the universal group had a 50-g glucose challenge test performed and if their plasma glucose at 1 h was > or = 7.8 mmol/l, a formal 3-h 100-g OGTT was then performed. RESULTS: Universal screening detected a prevalence of GDM of 2.7%, significantly more than the 1.45% detected in the risk factor screened group (P<0.03). Universal screening facilitated earlier diagnosis than risk factor screening - mean gestation 30 +/- 2.6 weeks vs. 33 +/- 3.7 weeks (P<0.05). A higher rate of spontaneous vaginal delivery at term, and lower rates of macrosomia, Caesarean section, prematurity, pre-eclampsia and admission to neonatal intensive care unit were observed in the universally screened, early diagnosis group. CONCLUSIONS: Universal screening for GDM is superior to risk factor based screening-detecting more cases, facilitating early diagnosis and is associated with improved pregnancy outcome.
Blood Glucose↗
A small pit emptying machine: an appropriate solution for a Nairobi slum.
This article describes the results of the trial period of a pedestrian-controlled pit emptying machine. This 'vacutug' has been tested for UNCHS (Habitat) in a low-income settlement in Nairobi, Kenya, through a local NGO. The trial confirmed the viability of the principle of the vacutug as the machine has been in operation for two and a half years. Repairs have been made locally out of income from the service, spare parts can be obtained and demand for the service is high. Although the cost of the service has already been raised, demand has not been reduced. The technical improvements which need to be made can be incorporated in the design, and the next batch of machines is being constructed for further trials. Management of the service is critical for financial sustainability and even during the trial of the technology, the management aspects have been the most difficult of the service.
Developing Countries↗
Stress and burnout in forensic community mental health nurses: an investigation of its causes and effects.
The increasing development of forensic services has seen the numbers of Forensic Community Mental Health Nurses (FCMHNs) mushroom. Community mental health nursing (CMHNs) has been found to be a stressful occupation. FCMHNs have largely been ignored in research into occupational stress. The current study identified and surveyed all FCMHNs (n = 104) in England and Wales who were attached to NHS Medium Secure Units using measures of occupational stress. A response rate of 76.9% was achieved. Findings from this study showed that a substantial portion (44.3%) of FCMHNs were experiencing high burnout in relation to emotional exhaustion. A number (31.2%) of FCMHNs reached or exceeded the threshold for psychiatric caseness on one measure. Concerns of FCMHNs included 'not having facilities in the community to refer patients on to' and 'interruptions in the office'. Dealing with violent patients did not feature in the top 10 stressors, although dealing with suicidal patients did. As a group FCMHNs appear to feel supported by their managers and colleagues.
Adult↗
Killing of Mycobacterium avium by neutrophils and monocytes from AIDS patients treated with recombinant granulocyte-macrophage colony-stimulating factor.
In this study, 30 AIDS patients without Mycobacterium avium infection were randomized to receive treatment with azithromycin (1200 mg), granulocyte-monocyte colony-stimulating factor (GM-CSF; 250 microg/m2/day for 5 days), or both agents. The M. avium killing capacity of neutrophils and monocytes harvested from each patient before intervention and during (day 4), and after therapy (day 8) was assessed. The mean virus load change in the groups receiving GM-CSF was +0.14 log human immunodeficiency virus RNA. After GM-CSF therapy, neither neutrophils nor monocytes could significantly reduce M. avium growth (P=.96 and.31, respectively). Bone pain, myalgia, presyncope, or fever occurred in 55% of patients receiving GM-CSF. Thus, the GM-CSF regimen used in this study did not affect virus load, frequently caused adverse reactions, and did not improve the M. avium killing capacity of neutrophils and monocytes. Future studies using a different GM-CSF regimen are indicated.
Acquired Immunodeficiency Syndrome↗
Role of leukotrienes in antimicrobial defense of the lung.
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Animals↗
Schizophrenia: a review of current research and thinking.
Schizophrenia is the major mental illness of our time and causes serious disturbances for those with the condition as well as using up significant proportions of scarce health resources. This paper reviews the recent literature on advances in classification, aetiology, epidemiology and treatments. Methodological problems encountered in researching this condition are discussed. Advances in treatments offered for this condition have improved outcomes but whether the patient receives these treatments may depend on what local services are prepared to offer.
Antipsychotic Agents↗
Provision of out-of-hours support to a forensic population: strategies and research potential.
Community Mental Health Nurses (CMHNs) working within regional forensic services are increasingly expected to provide out-of-hours cover for community forensic patients. This is often in the absence of appropriate resources or indeed informed knowledge as to what are appropriate resources. In areas such as forensic services it would be assumed that out-of-hours cover is essential. Yet most forensic services find it difficult to provide this cover, because of the low number of CMHNs and the regional nature of the service. One option which has not been explored is the use of telephone support in conjunction with individual contingency plans for each patient. This paper explores this area and makes suggestions for researching outcomes for this service change.
Community Health Nursing↗
Neutrophils from AIDS patients treated with granulocyte colony-stimulating factor demonstrate enhanced killing of Mycobacterium avium.
Neutrophils isolated from AIDS patients have demonstrated improved growth inhibition of Mycobacterium avium when incubated with exogenous granulocyte colony-stimulating factor (G-CSF). In this clinical study, 30 AIDS patients without M. avium infection were randomized to receive 5 days of treatment with rifabutin, G-CSF, or both agents. The M. avium killing capacity of neutrophils harvested from each patient before intervention, during (day 4), and after therapy (day 7) was assessed. The mean change in human immunodeficiency virus load in the group receiving G-CSF alone was -0.07 log of viral RNA. There was a 90% reduction in M. avium growth after therapy for patients treated with G-CSF alone (P=.01), 59% for patients treated with both agents (P=.06), and 11% for patients treated with rifabutin alone (P=.84). Thus, neutrophils isolated from AIDS patients treated with G-CSF demonstrated a significant enhancement of killing of M. avium; there was no notable effect on virus load.
AIDS-Related Opportunistic Infections↗
Impaired motion sensitivity as a predictor of subsequent field loss in glaucoma suspects: the Roscommon Glaucoma Study.
AIM: To determine if impaired motion sensitivity is a significant predictor of subsequent field loss in glaucoma suspects. METHOD: A population based prospective study; a 5 year follow up of all glaucoma suspects who had been identified from a population based random sample survey in the west of Ireland. 78 glaucoma suspects whose visual field function was annually measured by Henson CFS 2000 and for whom data on family history of glaucoma, ocular status, and motion impairment had been recorded. Visual field loss was defined as Henson visual field survival score of 94 or less. RESULTS: 18 people developed visual field loss in at least one eye. Motion impairment at baseline was associated with a 2-18 times greater risk of development of the visual field loss (p < 0.001). This association was independent of sex, family history of glaucoma, intraocular pressure, and C/D ratio at baseline. The Cox's proportional hazards regression analysis confirmed the above results after adjustment for age and the C/D ratio. CONCLUSION: Motion impairment is an independent predictor of visual field loss in glaucoma suspects, although it is not clear how long motion impairment precedes visual field loss.
Age Factors↗
Pulsed low dose rate brachytherapy in a rat model: dependence of late rectal injury on radiation pulse size.
PURPOSE: Clinical protocols utilizing pulsed low dose rate brachytherapy (PDR) to replace traditional continuous low dose rate brachytherapy (CLDR) employ irradiation in individual pulses given at intervals of a few hours. A critical factor in determining whether PDR will produce equivalent or greater late-occurring normal tissue toxicity is the dose per pulse. A rat rectal model was used to determine the role of pulse size in modifying dose effectiveness in producing late-occurring toxicity. METHODS AND MATERIALS: A rat model in which the rectum is irradiated with 192Ir sources was used in conjunction with an intracavitary applicator. A section of rectum 1.3 cm in length was irradiated with either 0.75 Gy/h CLDR or one of five schemes of PDR. The schemes applied 0.375, 0.75, 1.5, 3.0, or 6.0 Gy pulses at 0.5, 1.0, 2.0, 4.0, or 8.0 h intervals, respectively. Rats were observed for up to 300 days after completion of irradiation for rectal obstruction. Rectal specimens were taken at the time of sacrifice for obstruction or at the end of follow-up and analyzed histologically for injury. RESULTS: Effectiveness of irradiation was analyzed by calculating the ED50 for incidence of obstruction and severe histological injury. The ED50 for obstruction after treatment with CLDR and pulse sizes of 0.375, 0.75, and 1.5 Gy were 70.5, 68.0, 68.6, and 68.8 Gy, respectively. These values were not significantly different. Compared to CLDR, the ED50 for obstruction after pulse sizes of 3.0 and 6.0 Gy were significantly different at 60.9 and 46.3 Gy, respectively. The relative changes in ED50 for the different radiation schemes in producing ulceration, fibrosis, and vascular sclerosis injury were similar to that observed for obstruction. The endpoints of colitis cystica profunda and atypical epithelial regeneration varied less with increasing pulse size. CONCLUSIONS: We have demonstrated that for late rat rectal injury, dose responses to PDR pulse sizes up to 1.5 Gy at 2-h intervals are not distinguishable from that seen with CLDR at a dose rate of 0.75 Gy/h.
Animals↗
The European core curriculum for radiotherapy technologists.
BACKGROUND: The Radiotherapy Technologist is the third member of the team responsible for the accurate delivery of radiotherapy to the cancer patient. Educational standards have been established for both radiotherapists and medical physicists and our group recognised the need to also standardise the education of radiotherapy technologists. MATERIALS AND METHODS: The project commenced in 1990 and was completed by 1994 when an agreed core curriculum was presented at a consensus conference. All aspects of curriculum development and education delivery were reviewed during this four year period. RESULTS: Core topics were identified. educational entry standards described and a duration of three years, consistent with European Union mobility regulations, agreed. CONCLUSIONS: The core curriculum describes the standard necessary to be achieved for entry into the profession to ensure the optimum treatment is offered to all patients throughout the European Union. Regular review of the core curriculum should be carried out to ensure the defined standards are maintained.
Curriculum↗
Eye care utilisation patterns in a rural county in Ireland: implications for service delivery.
AIMS/BACKGROUND: This investigation determined eye care utilisation patterns in a rural county in Ireland. Population based estimates of visual impairment and glaucoma were available, so the two studies will optimise planning for eye care services for the county. METHODS: Roscommon has a population of 55,000 served by one ophthalmologist and two optometrists. Data were collected on all outpatient visits for all providers for a 3 month period. Information was abstracted on demographics, presenting and final diagnoses. Expected number of visits for glaucoma were calculated using the population structure and rates of glaucoma, and assuming one visit per year per glaucoma patient. RESULTS: 1398 patients had a total of 1442 visits in 3 months. A third of the visits were to optometrists, and all but 21 visits were for normal eye examinations or glasses. The majority of children aged less than 16 years, and people older than 60 years were seen by the ophthalmologist. Among children, 81% of all visits were to the ophthalmologist and 92% were classified as a normal examination. Only an estimated 188 visits per year for glaucoma were observed, compared with 1100 expected. CONCLUSION: In this rural county, many of the visits to the ophthalmologist were for normal eye examination, particularly among children. Screening algorithms which would free the ophthalmologist to see more complicated problems could be considered. There is an underutilisation of services by glaucoma patients. Reasons for this are described.
Adolescent↗
Prolonged reduction of high blood pressure with an in vivo, nonpathogenic, adeno-associated viral vector delivery of AT1-R mRNA antisense.
To produce a prolonged decrease in blood pressure, we have developed a nonpathogenic adeno-associated viral vector (AAV) with the antisense DNA for AT1-R. AAV has many advantages over other viral vectors. AAV does not stimulate inflammation or immune reaction. AAV enters nondividing cells and does not replicate. Therefore, it is an appropriate choice for gene therapy. Recombinant AAV was prepared with a cassette containing a cytomegalovirus promoter and the cDNA for the AT1 receptor inserted in the antisense direction. The cassette was packaged in the virion. Stable transfection of NG108-15 cells with the PAAV-AS (plasmid AAV) antisense to AT1-R produced a significant reduction in AT1 receptors. A single injection of the rAAV-AS (viral vector) was made in adult spontaneously hypertensive rats, either directly in the hypothalamus (1 microL) or in the lateral ventricles (5 microL). The result shows that there is a significant decrease of blood pressure (approximately 23 +/- 2 mm Hg) for up to 9 weeks after injection. Control injections of mock vector produced no change in blood pressure during the same time period in age-matched controls. In young spontaneously hypertensive rats (3 weeks), a single intracardiac injection of recombinant rAAV-AS reduced blood pressure and slowed the development of hypertension compared with controls (P < .01). The results suggest that a prolonged reduction in high blood pressure can be achieved with AAV vectors delivering antisense to inhibit AT1 receptors with a single administration.
Animals↗
Constitutive activation of 5-lipoxygenase in the lungs of patients with idiopathic pulmonary fibrosis.
Idiopathic pulmonary fibrosis (IPF) is a progressive disorder characterized by inflammation, fibroblast proliferation, and accumulation of extracellular matrix proteins. Leukotrienes (LTs) are pro-inflammatory and pro-fibrogenic mediators derived from the 5-lipoxygenase (5-LO) pathway of arachidonic acid metabolism. They are thought to play a role in a number of disease processes, but have received relatively little attention in investigations into the pathogenesis of IPF. In this study, we measured the levels of immunoreactive LTs B(4) and C(4) in homogenates of lung tissue obtained from patients with newly diagnosed, untreated IPF, as compared to levels measured in homogenates of uninvolved nonfibrotic lung tissue from patients undergoing resectional surgery for bronchogenic carcinoma. Compared to homogenates on nonfibrotic control lung, homogenates from IPF patients contained 15-fold more LTB(4) and 5-fold more LTC(4). IPF homogenate levels of LTB(4) were significantly correlated with histologic indices of both inflammation (r=0.861) and fibrosis (r=0.926). Activation of 5-LO is known from in vitro studies to be associated with localization of the enzyme at the nuclear membrane. Immunohistochemical staining for 5-LO protein in alveolar macrophages (AMs) demonstrated that such an "activated" localization pattern was significantly more frequent in IPF lung (19.2+/-3.3% of cells) than in control lung (9.3+/-0.9%); this localization pattern was rarely seen (3.2%) in sections from a truly normal transplant donor lung. Consistent with these data, AMs obtained from IPF patients by bronchoalveolar lavage, purified by adherence, and cultured in the absence of a stimulus for 16 h elaborated significantly greater amounts of LTB(4) and LTC(4) than did control AMs obtained from normal volunteers. These data indicate that the 5-LO pathway is constitutively activated in the lungs of patients with IPF, and the AM represents at least one cellular source of LT overproduction in this disorder. We speculate that LTs participate in the pathogenesis of IPF, and their overproduction in this disorder may be amenable to specific pharmacotherapy.
Adult↗
Lymph node recovery from colorectal resection specimens removed for adenocarcinoma. Trends over time and a recommendation for a minimum number of lymph nodes to be recovered.
Recovery of pericolorectal lymph nodes from colectomy specimens has long been part of colorectal cancer staging. Recently, adjuvant therapy has been added for high stage carcinomas, providing further impetus for performing careful lymph node dissections. Pericolorectal lymph nodes were examined to determine if there has been a change over time in the number of lymph nodes recovered and proportion of specimens with pericolonic lymph node metastases from colorectal carcinoma resection specimens. Also, the authors attempted to establish a recommendation for a minimum number of lymph nodes that should be recovered before a colon can be considered free of metastases. Slides and reports of the first 20 consecutive pT3 colorectal carcinoma resections in each year from 1955 to 1995 at William Beaumont Hospital that did not have known metastases at the time of surgery were reviewed (750 specimens total). The mean number of lymph nodes recovered per specimen and incidence of detected lymph node metastases increased over the 41-year period, with the greatest increase occurring during 1992-1995. The greatest proportion of patients with lymph node metastases detected occurred in the 17 to 20 lymph nodes recovered per specimen group. Specimens with more than 20 lymph nodes did not have a higher proportion of lymph node metastases detected compared to specimens with 17 to 20 lymph nodes. Approximately 20% of the specimens with metastases had more than 17 lymph nodes recovered. These results suggest that pathologists should retrieve all the lymph nodes that can be recovered, but at least 17 lymph nodes should be recovered to insure accurate documentation of nodal metastases when present.
Adenocarcinoma↗
A brief mental health outcome scale: relationships between scale scores and diagnostic/sociodemographic variables in the long-term mentally ill.
The Global Assessment of Functioning (GAF) scale is a quick and simple measure of overall psychological disturbance. A recent study by our group reported the reliability and validity of the scale in a population of severely mentally ill people. The current study extends the analysis of this population to consider a number of questions, i.e. what are the associations for this group between variations in GAF scores and sociodemographic variables? Are lower scores associated with particular diagnoses for the group assessed? What are the characteristics of those patients whose scores were most variable? What were the completion rates for use of the scale? No associations were observed between GAF score and the sociodemographic variables used in this study. Lower GAF scores were associated with psychotic diagnoses. Those with most varying scores were, in the main, white European non-immigrant males with a diagnosis of schizophrenia. Completion rates for the study were reasonable at 73.8%. This study involved the repeated assessment of a large number of clients by a changing multidisciplinary team. Inspite of the extended nature of the study, completion rates remained reasonable, suggesting that the scale was acceptable for routine clinical use. The GAF in itself, however, appears to be unsuitable for making individual treatment decision but could be used as a first step before using more sophisticated scales.
Adult↗
A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF).
BACKGROUND: The Global Assessment of Functioning (GAF) is a quick and simple measure of overall psychological disturbance. However, there is little research on the reliability and validity of this measure in severely mentally ill populations. METHOD: Multidisciplinary keyworkers assessed 103 patients at monthly intervals over a 6-month period. Overall GAF scores were obtained, with additional separate ratings for symptoms and disability. These were compared with changes in antipsychotic medication and support needs over the same period. RESULTS: Satisfactory reliability was obtained for total GAF score and for symptom and disability measures, in spite of raters having only one brief training session. All GAF scores were associated with current support needs of patients. Symptom and disability scores were associated with changes in antipsychotic medication in the previous month. Only symptom score was associated with increases in antipsychotic medication at time of rating. CONCLUSION: GAF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill. Differences in relationships between the three GAF scores and medication/support needs indicate the usefulness of obtaining all three scores for monitoring levels and type of psychiatric disturbance in this population.
Activities of Daily Living↗