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Biomedical subjects

M G Rowland

Publications and source records attributed to M G Rowland.

At least 19 recordsLinked to original sources
PubMed1995

Thetford plastics fire, October 1991: the role of a preventive medical team in chemical incidents.

OBJECTIVES: To review the role of a medical team in the emergency management of a major polyvinyl chloride (PVC) fire in an urban area. METHODS: The district health authority's consultant in communicable disease control (CCDC) was requested to advise on the health impacts of a fire that consumed some 1000 tonnes of plastic, mainly PVC, over 72 hours and which emitted a large smoke plume that threatened the health of local residents and emergency workers alike, constituting one of the largest incidents the local emergency services had dealt with in recent years. A medical team was formed comprising the CCDC, a regional epidemiologist, an occupational physician, and a medical toxicologist. This paper is an account of this team's experience of advising on the medical management of the emergency without having any formally established role or previous training for the task. RESULTS: The main issues requiring the input of the medical team included: the possible products of combustion and their effects on health; the clinical management of those exposed; the alerting of local hospitals to the type of casualties to expect; the special health risks posed to emergency workers, especially the firemen; the need for evacuation of local residents; the risks of contamination of soil, water, and crops; the potential health impact of the plume; and the provision of expert and authoritative advice on the short and long term health implications to the public. Active surveillance systems, which included the local general practitioners and hospitals, were established and air monitoring instigated. The 46 casualties were restricted to emergency personnel who had inadvertently received exposure to the fire smoke: all recovered within 48 hours. Local residents were unharmed. CONCLUSION: The incident showed the need for preventive medical teams trained to fill a formal advisory and investigative role for chemical releases and fires, and which can play an integral part in emergency management.

Disaster Planning↗
PubMed1994

Outcome of an exercise to notify patients treated by an obstetrician/gynaecologist infected with HIV-1.

Experience with hepatitis B suggests that the risk of HIV transmission from a health care worker infected with HIV to a patient will be greatest during major surgical procedures. The number of patients worldwide who are known to have undergone such procedures, been notified, and subsequently tested is still too small to be confident that the risk of HIV transmission in these circumstances is negligible. We describe a patient notification exercise, undertaken in the United Kingdom in 1991. Attempts were made to contact 1217 patients, in three health districts (A, B, and C), who had undergone surgical procedures performed by an obstetrician/gynaecologist who was infected with HIV. The exercise aimed to offer the patients reassurance, counselling and--if they wished--HIV testing. One thousand one hundred and forty-two patients (94%) were contacted, and all 520 who elected to be tested were negative for anti-HIV. The proportion of identified patients tested was 63% in district A, 35% in district B, and 61% in district C. Surgical procedures were classified retrospectively according to the likely risk (none, possible, or high) of exposure to the doctor's blood and, therefore, risk of HIV transmission. One hundred and ninety-five of those tested had undergone a procedure that carried a high risk of exposure; 179 had undergone a procedure thought to carry no risk. Patients in districts A and C who had undergone a procedure that carried a high risk of exposure were more likely to be tested than those who had not; 206 patients overall had undergone procedures that carried a high risk of exposure but were not subsequently tested.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS Serodiagnosis↗
PubMed1994

The incidence of meningococcal illness in the East Anglian Regional Health Authority: 1990-1991.

The rate at which notifications of meningococcal meningitis were reported by districts of the East Anglian Regional Health Authority to the Office of Population Censuses and Surveys (OPCS) varied between 6.8 and 28.0 cases per million resident population per year between 1987 and 1991. A study was conducted to find out whether this variation represented differences in incidence, completeness of notification, or reporting practices. One hundred and one cases of meningococcal illness with onset between 1 January 1990 and 31 December 1991 were identified retrospectively in residents of the East Anglian region (population 2.06 million). The ascertained incidence of meningococcal illness was 24.5 cases/million/year with a range between districts of 13.1 to 35.7 cases/million/year, similar to that expected from national data. Most of the variation in the rates of reporting to OPCS was explained by the practices of two consultants in communicable disease control (CCDCs), who reported all cases of which they were aware, irrespective of statutory notification. The study showed that communication to CCDCs was sometimes inadequate, and that control measures were not instituted in a small proportion of cases. The recommendations resulting from this study are, firstly, that OPCS should produce clear guidelines for notification and reporting. In the meantime proper officers should make their reporting practice explicit. Secondly, a sensitive case definition for meningococcal illness is needed for local monitoring of prophylactic coverage. Thirdly, CCDCs, microbiologists, clinicians, and environmental health officers should review arrangements for data exchange.

Adolescent↗
PubMed1994

Surveillance of waterborne disease in England and Wales.

A pilot scheme, designed to improve the information on waterborne disease available nationally, was set up in five health regions from October 1991 to March 1992. Consultants in communicable disease control were asked to report each month on confirmed and suspected cases of waterborne disease, and microbiological and other contamination incidents. Twelve events were reported to the PHLS Communicable Disease Surveillance Centre (CDSC) in six months: five involved human illness and seven were contamination incidents. Six other events were reported to CDSC from regions that did not take part in the scheme. The total number of events reported was small and epidemiological evidence that linked disease with water consumption was often weak or absent. Nevertheless, the scheme provided valuable information on events associated with water and would prove useful if it were established nationally, linked with guidance on the investigation of incidents.

Communicable Diseases↗
PubMed1992

Assessment of costs to donor hospitals for organ transplantation.

In 1987, die Department of Health in the UK set up a working party to identify reasons contributing to a shortfall in donor organs. One recommendation was reimbursement to the District Health Authorities for costs incurred in providing the donor organs. The figure chosen was not to be seen as an incentive to donate organs, merely as an appropriate compensation for the costs incurred. There would be no direct payment to doctors, trustees or relatives of the donor. With the development of the competitive health care environment in the United Kingdom, the reimbursement of donating hospital costs is being considered with these data.

Costs and Cost Analysis↗
PubMed1991

The relation of maternal weight to the blood pressures of Gambian children.

The objective of the study was to relate blood pressure levels in children to their mother's weight in pregnancy. The blood pressures of 675 children aged from one to nine years in three villages in rural Gambia were measured. They were matched to antenatal clinic data which had been collected from all pregnant women in the three villages since 1980. Among children under eight years of age those born in the dry season had the highest blood pressures and were heavier. Their blood pressures were positively related to body weight and to mothers' weight at six months of pregnancy. These relationships were independent of mothers' age and parity, birthweight, gestational age, and placental weight. Among older children, aged eight and nine years, those born in the rainy season had the highest blood pressures. Their blood pressures were not related to their mothers' weight at six months of pregnancy. Rather they were inversely related to mothers' weight gain in the last trimester. An interpretation of these findings is that among young children differences in blood pressure are largely determined by rates of maturation. However, the long-term effects of adverse intra-uterine influences which elevate blood pressure become apparent in older children.

Age Factors↗
PubMed1991

An unusual community outbreak of influenza A.

The Hong Kong H3N2 subtype of influenza A virus appeared in 1968 and since then has caused epidemics of varying degrees of severity. We describe a community outbreak of influenza A H3N2 which occurred in members of a bowls club in an English rural village in late April 1989. The explosive onset, high attack rate (34/41 = 83 per cent) in those exposed, and the clinical presentation initially suggested a toxic or allergic aetiology. Twenty-three persons consulted their general practitioners; before the diagnosis was made all cases were considered to merit antibiotic therapy and 17/23 were prescribed steroids or bronchodilators on account of persisting severe wheeze and chest tightness. One of the 23 was admitted to hospital. There were no deaths. Influenza vaccination is recommended for people at special risk but protective efficacy is relatively low and short-lived. Only two of the group had received influenza vaccination since the beginning of October 1988 and both became symptomatic. The use of amantadine for the prevention and early treatment of influenza A in selected situations merits serious consideration, provided the diagnosis is made sufficiently early.

Aged↗
PubMed1988

Breast feeding, nutritional state, and child survival in rural Bangladesh.

The effect of breast feeding on nutritional state, morbidity, and child survival was examined prospectively in a community in rural Bangladesh. Every month for six months health workers inquired about breast feeding and illness and measured arm circumference in an average of 4612 children aged 12-36 months. Data from children who died within one month of a visit were compared with those from children who survived. Roughly one third of the deaths in the age range 18-36 months were attributable to absence of breast feeding. Within this age range protection conferred by breast feeding was independent of age but was evident only in severely malnourished children. In communities with a high prevalence of malnutrition breast feeding may substantially enhance child survival up to 3 years of age.

Bangladesh↗
PubMed1988

Impact of infection on the growth of children from 0 to 2 years in an urban West African community.

To determine the relationship between growth and morbidity in the first 2 y of life, we studied a cohort of 126 newborns in a Gambian township. Mean weight-for-age exceeded the National Center for Health Statistics (NCHS) standards in the first half of infancy but there was a mean deficit of 1.2 kg by age 1 y. Only two diseases contributed significantly to weight faltering: diarrheal diseases were estimated to cause one-half of the deficit and lower respiratory tract infections (LRTI) one-quarter. LRTI reduced weight gain in young children by 14.7 g/d of infection and diarrheal diseases in weaning infants by 14.4 g/d. Diarrhea had no significant impact on the growth of exclusively breast-fed infants. Growth velocity was normal in the second year of life, despite continuing infections.

Anthropometry↗
PubMed1987

Arm circumference and other factors in children at high risk of death in rural Bangladesh.

Mid upper arm circumference (MUAC) was measured monthly for 6 months in about 500 children aged 6-36 months from rural Bangladesh. Children who would die within 1 month of screening could be identified with 94% specificity and 56% sensitivity--almost twice the sensitivity achieved by other anthropometric screening schemes for this level of specificity. Specificity was slightly improved when the absence of breast-feeding, concurrent diarrhoea, oedema, and acute respiratory infection were taken into account. Children at high risk of death can be detected by monthly measurement of MUAC, which may be used in poor communities where interventions have to be selective.

Acute Disease↗
PubMed1987

Riboflavin, folate and vitamin C status of Gambian women during pregnancy: a comparison between urban and rural communities.

Anthropometric, haematological and vitamin status indices were measured in a group of pregnant women living in the urban community of Bakau in The Gambia, West Africa. Their haematological and anthropometric indices were generally within normal limits. Vitamin C status was also acceptable and was similar to values observed in rural Gambian women sampled at the same time of year. Folate status was similar to that seen previously in rural Gambian communities, and there was a strong intrasubject correlation between plasma and red cell folate levels, together with a trend towards higher values as pregnancy progressed. This was consistent with probable compliance with local recommendations for folate supplementation during pregnancy. The urban Gambian women also resembled their rural counterparts in having very poor biochemical riboflavin status, which deteriorated as pregnancy progressed. In this respect they differed markedly from UK women, who had satisfactory riboflavin status even in late pregnancy. The existence of severe biochemical riboflavin deficiency, even in urban Gambian women, whose anthropometric indices are not compatible with severe general malnutrition, suggests that a deficiency of this vitamin may be widespread in Sahelian West Africa. Measures to improve maternal vitamin status during pregnancy would therefore be equally appropriate in both rural and urban communities.

Adult↗
PubMed1986

The weanling's dilemma: are we making progress?

In many developing countries the weanling child (the breastfed child who is regularly receiving additional food) still suffers a high level of morbidity and mortality from diarrhoeal disease. The initiation of weaning is a critical event. No clear strategy exists for substantially enhancing the breast milk output of demand feeding mothers in underprivileged communities. Remarkably little progress has been made in our ability to advise mothers, either on a collective or an individual basis, as to when they should supplement the diet of their breastfed offspring, one continuing problem being the failure to adopt appropriate growth standards for infants. Furthermore there has been little attempt to improve traditional weaning foods in terms of consistency, shelf life and bioavailability of nutrients. Increasing insights into the normal growth pattern of breastfed infants and knowledge of localised appropriate traditional food technology remain grossly underexploited.

Breast Feeding↗
PubMed1985

Epidemiological aspects of rotavirus infection in young Gambian children.

Rotavirus gastro-enteritis in young Gambian children has its maximum impact on infants after the age of one month, in whom it produces short, well-defined annual winter epidemics with clinical dehydration in up to 18% of those infected. Sporadic infection was observed in neonates who were often asymptomatic, throughout one year but not in the subsequent year. In two consecutive years studied there was a major change from subgroup I, serotype 2 to subgroup II, serotypes 1 and 3. This could have contributed to the failure of children to develop protective immunity against sequential disease following an infection during infancy. If rotavirus morbidity in this community is to be notably reduced by a vaccination programme it would need to be carried out in early infancy prior to the winter season. Evaluation of a type-specific vaccine should include monitoring secular changes in rotavirus serotypes throughout subsequent epidemics.

Diarrhea, Infantile↗