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Biomedical subjects

M H Hall

Publications and source records attributed to M H Hall.

At least 37 records · Page 2Linked to original sources
PubMed1996

Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians.

OBJECTIVE: To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care. DESIGN: Multicentre randomised controlled trial. SETTING: 51 general practices linked to nine Scottish maternity hospitals. SUBJECTS: 1765 women at low risk of antenatal complications. INTERVENTION: Routine antenatal care by general practitioners and midwives according to a care plan and protocols for managing complications. MAIN OUTCOME MEASURES: Comparisons of health service use, indicators of quality of care, and women's satisfaction. RESULTS: Continuity of care was improved for the general practitioner and midwife group as the number of carers was less (median 5 carers v 7 for shared care group, P<0.0001) and the number of routine visits reduced (10.9 v 11.7, P<0.0001). Fewer women in the general practitioner and midwife group had antenatal admissions (27% (222/834) v 32% (266/840), P<0.05), non-attendances (7% (57) v 11% (89), P<0.01) and daycare (12% (102) v 7% (139), P<0.05) but more were referred (49% (406) v 36% (305), P<0.0001). Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders (pregnancy induced hypertension, 5% (37) v 8% (70), P<0.01) and fewer had labour induced (18% (149) v 24% (201), P<0.01). Few failures to comply with the care protocol occurred, but more Rhesus negative women in the general practitioner and midwife group did not have an appropriate antibody check (2.5% (20) v 0.4% (3), P<0.0001). Both groups expressed high satisfaction with care (68% (453/663) v 65% (430/656), P=0.5) and acceptability of allocated style of care (93% (618) v 94% (624), P=0.6). Access to hospital support before labour was similar (45% (302) v 48% (312) visited labour rooms before giving birth, P=0.6). CONCLUSION: Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit.

Clinical Protocols↗
PubMed1996

Diet in pregnancy and the offspring's blood pressure 40 years later.

OBJECTIVE: To determine how diet of the mother in pregnancy influences the blood pressure of the offspring in adult life. DESIGN: A follow up study of men and women born during 1948-1954 whose mothers had taken part in a survey of diet in late pregnancy. SETTING: Aberdeen, Scotland. POPULATION: Two hundred and fifty-three men and women born in Aberdeen Maternity Hospital. MAIN OUTCOME MEASURE: Systolic and diastolic blood pressure. RESULTS: The relations between the diet of mothers and their offsprings' blood pressure were complex. When the mothers' intake of animal protein was less than 50 g daily, a higher carbohydrate intake was associated with a higher blood pressure in the offspring (a 100 g increase in carbohydrate being associated with a 3 mmHg increase in systolic pressure (P = 0.02)). At daily animal protein intakes above 50 g, lower carbohydrate intake was associated with higher blood pressure (a 100 g decrease in carbohydrate being associated with an 11 mmHg rise in systolic blood pressure (P = 0.004)). These increases in blood pressure were associated with decreased placental size. CONCLUSION: Mothers' intakes of animal protein and carbohydrate in late pregnancy may influence their offsprings' adult blood pressure. This may be mediated through effects on placental growth.

Adult↗
PubMed1995

Antenatal screening for carriers of cystic fibrosis: randomised trial of stepwise v couple screening.

OBJECTIVE: To perform a rigorous comparative evaluation of stepwise and couple approaches to antenatal carrier screening for cystic fibrosis. DESIGN: Pragmatic randomised trial. SETTING: Hospital antenatal clinic serving a regional population. SUBJECTS: 2002 women (couples) attending for booking antenatal visit at less than 17 weeks' gestation with no family history of cystic fibrosis. INTERVENTIONS: Offering counselling and carrier testing for cystic fibrosis, either to women in the first instance (stepwise) or to couples (couple screening). MAIN OUTCOME MEASURES: Uptake rates; anxiety; knowledge of cystic fibrosis and carrier status (both partners); attitudes to health, pregnancy, the baby, and screening (both partners); and uptake of carrier testing by relatives. RESULTS: Uptake of screening was the same for both approaches (90%). After delivery most women remembered test results and their meaning, but 53/253 (21%) of those with negative results of couple testing had forgotten that repeat testing would be advisable if they had a pregnancy with a new partner. With stepwise screening women identified as carriers had high levels of anxiety when results were received (mean anxiety score 52.3). This dissipated with a reassuring partner's result (carriers' mean anxiety score 36.1) to levels similar to those receiving negative results from couple screening. Of those receiving negative results, women who had stepwise screening were significantly less anxious than those who had couple screening (mean score with result 32.1 v 35.4, 95% confidence interval for difference -4.7 to -2.1). CONCLUSIONS: Couple screening allows carriers to avoid transient high levels of anxiety, but is associated with more anxiety and false reassurance among most screenees who will test negative. Stepwise screening gives carriers and their relatives genetic information and is, in our opinion, the better method.

Anxiety↗
PubMed1995

Assessment of patients with menorrhagia: how valid is a structured clinical history as a measure of health status?

A patient-administered questionnaire for menorrhagia based on the type of questions asked when taking a gynaecological history was developed and tested using the following steps: literature reviews, devising the questions, testing responses for internal consistency and test-retest reliability and validating the questionnaire by comparing patient's scores with their responses to the SF-36 general health measure, and with family practitioner perceptions of severity. The main sample consisted of 351 women with menorrhagia, 246 referred to gynaecology ambulatory clinics and 105 from four large training practices in North-east Scotland. Following testing, two questions were discarded from the questionnaire. The final questionnaire demonstrated a good level of reliability and the resulting patient scores correlated significantly with their scores on the scales making up the general health measure. The questions asked in taking a clinical history from a woman with menorrhagia can be used to construct a valid and reliable measure of health status. This clinical measure may be a useful guide in selection for treatment and in the assessment of patient outcome following treatment.

Adolescent↗
PubMed1995

Aortic dissection: rupture into right ventricle and right pulmonary artery.

Rupture of an acute ascending aortic dissection into a surrounding cardiac chamber or pulmonary artery is an uncommon occurrence, and is often only diagnoses post mortem. Although fistulization (aortopulmonary and aorta-right atrial) after acute aortic dissection has been well documented in the literature, acute aortic dissection fistulizing into both the right ventricle and pulmonary artery has not. We report on a 75-year-old woman who presented with an acute ascending aortic dissection with both aortopulmonary and aorta-right ventricular fistulas who underwent repair and had long-term survival.

Aged↗
PubMed1995

Measuring sexual functioning in premenopausal women.

OBJECTIVE: To assess the validity and reliability of a measure of sexual function for premenopausal women. DESIGN: A self-administered sexual function questionnaire, derived from the Sabbatsberg Sexual Self-Rating Scale, and other health measures were given to women who were randomly sampled from the community health index. SUBJECTS: One hundred and forty-eight premenopausal women aged between 45 and 49 years. MAIN OUTCOME MEASURES: The content validity, internal consistency and construct validity of the revised sexual rating scale. RESULTS: One hundred and thirty-seven women (92%) responded to the main questionnaire and 89 (60%) completed the sexual rating scale, which possessed a high level of internal consistency; scores on the sexual rating scale, which possessed a high level of internal consistency; scores on the sexual ratings scale had small to moderate correlations with the measures of health, two of which (depression and role limitations attributable to emotional problems) were sufficient to explain 25% of the variation in the sexual functioning scores. CONCLUSION: Questions derived from the Sabbatsberg sexual self-rating scale have been used to construct a simple, acceptable, valid and reliable measure of sexual functioning for women in the 45 to 49 years of age group. Such a measure could be widely used as an adjunct to clinical and more general measures of health in order to assess the impact of interventions on sexual functioning within clinical trials.

Female↗
PubMed1994

Psychological stress and platelet activation: differences in platelet reactivity in healthy men during active and passive stressors.

Blood platelets have been found to play a major role in the pathogenesis of coronary artery disease. This study examined the effects of active and passive stressors on platelet function and assessed the possible effects of perceived control on platelet reactivity to stress. Heart rate, blood pressure, catecholamine levels, and platelet factor 4 (PF 4) were assessed in 55 healthy males during resting baseline (25 min), 7-min stressor/task periods, and recovery (60 min). Results showed significant increases in PF 4 during the stressor/task periods for both active and passive stressor groups. Psychological stress involving both active and passive participation had a direct effect on platelet activation.

Adolescent↗
PubMed1994

Differential effects of active and passive laboratory stressors on immune function in healthy men.

The immunomodulatory effects of acute laboratory stressors were examined by comparing active and passive stressors in a between-subjects design. Healthy male volunteers (N = 67) were recruited and randomly assigned to an active, passive, or no stressor condition. Subjects were exposed to either the Stroop and mental arithmetic tasks (active). two surgery films (passive). or two nature films (no stress). Cardiovascular reactivity, plasma catecholamines and cortisol. and self-reported distress were measured pre-task and post-task. Lymphocyte proliferation to concanavalin A (Con A). pokeweed mitogen (PWM), and phytohemagglutinin was assessed a1 baseline, after the first task, after the second task, and 30 min later. Lymphocyte proliferation lo Con A and PWM was significantly reduced in response to the stressors. Different response patterns emerged, depending on the type of stressor and the mitogen used. Changes in lymphocyte proliferation were significantly associated with cardiovascular reactivity during the tasks. Results are discussed in terms of potency of the stressors and mechanisms underlying passive versus active laboratory tasks. Implications for future research are addressed.

Journal Article↗
PubMed1992

The multidisciplinary management of a family with epithelial ovarian cancer.

OBJECTIVE: To describe the management of a family with an inherited predisposition to ovarian and breast cancer. Particular attention is paid to the problems of contraception, screening, prophylactic surgery and hormone replacement therapy. SETTING: The multidisciplinary Grampian Familial Epithelial Ovarian Cancer Study Group. SUBJECTS: 162 members of a family extending over five generations. In the third generation, five of the 10 women died with epithelial ovarian cancer. Three women in generation IV have developed pre-menopausal breast cancer. There are now 78 family members in the fifth generation aged between 2 and 22 years. INTERVENTIONS: Counselling of female family members is started at the age of 18 years. The combined oral contraceptive pill is advocated to suppress ovulation. Gynaecological follow-up after the age of 28 includes yearly pelvic examination, transvaginal ultrasonography and serum CA125 estimation. Laparoscopy with peritoneal cytology is indicated if any part of this yearly assessment is abnormal. Prophylactic oophorectomy is advised between the ages of 35 and 40 years after the family is complete. In generation IV, 20 of the 29 women have undergone prophylactic oophorectomy. Oestrogen hormone replacement therapy with a cyclical progestogen is recommended after prophylactic oophorectomy. Breast cancer screening starts at the age of 25 and involves annual clinical breast examination augmented by mammography and breast ultrasound. CONCLUSIONS: Only by the careful questioning and recording of family history, including at least third degree relatives (cousins), will similar groups with familial ovarian/breast cancer be identified. When predisposing genes are characterized it will be possible to identify carriers within the family and concentrate clinical effort on them while offering appropriate reassurance to those with decreased risk.

Adult↗