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Biomedical subjects

M Lay

Publications and source records attributed to M Lay.

13 recordsLinked to original sources

Ethiopian refugees in the UK: migration, adaptation and settlement experiences and their relevance to health.

OBJECTIVE: The study explores Ethiopian refugees' and asylum seekers' experiences of migration, adaptation and settlement in the UK and their health beliefs and practices. DESIGN: Data was collected using semi-structured depth interviews and a semi-structured questionnaire. The sample consisted of 106 Ethiopians resident in the UK. RESULTS: The majority of the participants fled Ethiopia due to political reasons. Whilst 65% of them had lived in the UK for over five years only 7% had full refugee status. Many of the participants faced difficulties with the immigration system, housing and social services and felt socially isolated. Many also had problems with gaining employment or employment appropriate to their qualifications, and 29% were unemployed. The majority of the participants believe that happiness is a prerequisite to healthiness and also an indication of healthiness. On the other hand the majority believed that sickness is caused by disease and mental illness is caused by both supernatural and psychosocial causes. Most of the participants sought the help of their GP in the first instance of illness although some had experienced difficulties accessing health services due to language problems and poor understanding of the primary healthcare system. The participants also believed that the stress of adaptation and settlement affected their mental health and led to depression. CONCLUSION: Migration, adaptation and settlement experiences impact on the health of refugees and are dependent on a number of barriers and enablers, both at a personal and societal level. These should be taken into account in the provision of health and social care services, in particular services should be provided in a culturally competent manner.

Acculturation↗

[Influence of institutional factors in neurological, medical and geriatric departments on length of stay in patients with stroke].

BACKGROUND: Length of hospital stay (LOS) is determined not only by medical procedures or complications but also by institutional factors. We examined the influence of various institutional factors in neurological, medical and geriatric departments on LOS in patients with ischemic stroke. METHODS: We used data of 12,410 patients from the Westphalian Stroke Register for the years 2000 and 2001. Forty-two centres including 24 neurological, 13 medical and five geriatric departments participated in the register. The register is based on a standardized data assessment, including patient-related sociodemographic and clinical items, diagnostic and treatment procedures, complications, and status at discharge. RESULTS: 7855 patients with ischemic stroke from 37 centres (median age: 73 years, 51 % female) were included in the analysis. In neurological departments, the LOS decreased with increasing numbers of stroke patients treated per centre and year, presence of a stroke unit or a rehabilitation unit. Conversely, the ratio beds to number of physicians was positively associated with LOS. In geriatric departments, a significant decrease in LOS with an increasing number of stroke cases and availability of a rehabilitation unit was also observed. In departments of medicine, no significant influence on LOS was found for the institutional factors analysed. CONCLUSIONS: Institutional factors have a significant influence on LOS in patients with stroke. In this analysis, the influence varied between the different medical specialties. Institutional factors gain importance in the management of stroke patients, when Diagnosis Related Groups (DRG) are introduced.

Aged↗

Contribution of patient related differences to multidrug resistance in rheumatoid arthritis.

BACKGROUND: There is a wide variation in responses to standard disease modifying antirheumatic drug (DMARD) treatment in rheumatoid arthritis (RA). Whether multidrug resistance, failure to respond to several DMARDs, is a specific entity over and above that expected by chance alone is unclear. OBJECTIVE: To identify patients with RA who demonstrate a multidrug resistant phenotype and to determine what proportion of the variance in drug responses is due to patient related factors. METHODS: Patients with RA (1987 American College of Rheumatology criteria) were identified from clinics at Manchester Royal Infirmary and through the Arthritis Research Campaign National RA Repository. The clinic records were reviewed and multidrug resistance was defined as stopping three or more DMARDs owing to lack of efficacy after an adequate trial of the drug. Logistic regression measured by a random effects model was used to determine the relative contribution of the drug and subject related differences to the multidrug resistance. RESULTS: 265 patients (210 (79.3%) female) were studied. The mean (SD) age and disease duration were 52.2 (12.9) and 10.7 (8.8) years, respectively. Patients had a median (range) of 2 (1-8) DMARD courses. Failure of at least one DMARD due to inefficacy occurred in 105 (40%) and 13 (5%) were multidrug resistant. Overall, 35% of the variance in drug responses was due to between-subject differences (p=0.02). Rheumatoid factor (RF) status contributed significantly to this (OR=2.15, 95% confidence interval (95% CI) 1.00 to 4.62) but explained only 3% of the total variance in drug inefficacy. CONCLUSION: Multidrug resistance occurs in an uncommon (5%) but important subgroup of patients with RA. The between-subject variance is not fully explained by demographics and RF status. Understanding the biological mechanisms that contribute to multidrug resistance may suggest new therapeutic approaches and targets in RA.

Adult↗

Direct evidence for neutrino flavor transformation from neutral-current interactions in the Sudbury Neutrino Observatory.

Observations of neutral-current nu interactions on deuterium in the Sudbury Neutrino Observatory are reported. Using the neutral current (NC), elastic scattering, and charged current reactions and assuming the standard 8B shape, the nu(e) component of the 8B solar flux is phis(e) = 1.76(+0.05)(-0.05)(stat)(+0.09)(-0.09)(syst) x 10(6) cm(-2) s(-1) for a kinetic energy threshold of 5 MeV. The non-nu(e) component is phi(mu)(tau) = 3.41(+0.45)(-0.45)(stat)(+0.48)(-0.45)(syst) x 10(6) cm(-2) s(-1), 5.3sigma greater than zero, providing strong evidence for solar nu(e) flavor transformation. The total flux measured with the NC reaction is phi(NC) = 5.09(+0.44)(-0.43)(stat)(+0.46)(-0.43)(syst) x 10(6) cm(-2) s(-1), consistent with solar models.

Journal Article↗

Measurement of day and night neutrino energy spectra at SNO and constraints on neutrino mixing parameters.

The Sudbury Neutrino Observatory (SNO) has measured day and night solar neutrino energy spectra and rates. For charged current events, assuming an undistorted 8B spectrum, the night minus day rate is 14.0%+/-6.3%(+1.5%)(-1.4%) of the average rate. If the total flux of active neutrinos is additionally constrained to have no asymmetry, the nu(e) asymmetry is found to be 7.0%+/-4.9%(+1.3%)(-1.2%). A global solar neutrino analysis in terms of matter-enhanced oscillations of two active flavors strongly favors the large mixing angle solution.

Journal Article↗

Measurement of the rate of nu(e) + d --> p + p + e(-) interactions produced by (8)B solar neutrinos at the Sudbury Neutrino Observatory.

Solar neutrinos from (8)B decay have been detected at the Sudbury Neutrino Observatory via the charged current (CC) reaction on deuterium and the elastic scattering (ES) of electrons. The flux of nu(e)'s is measured by the CC reaction rate to be straight phi(CC)(nu(e)) = 1.75 +/- 0.07(stat)(+0.12)(-0.11)(syst) +/- 0.05(theor) x 10(6) cm(-2) s(-1). Comparison of straight phi(CC)(nu(e)) to the Super-Kamiokande Collaboration's precision value of the flux inferred from the ES reaction yields a 3.3 sigma difference, assuming the systematic uncertainties are normally distributed, providing evidence of an active non- nu(e) component in the solar flux. The total flux of active 8B neutrinos is determined to be 5.44+/-0.99 x 10(6) cm(-2) s(-1).

Journal Article↗

Quantitative RT-PCR to evaluate in vivo expression of multiple transgenes using a common intron.

An assay measuring RNA expression levels of a gene-encoded therapeutic must distinguish between endogenous mRNA and mRNA transcribed from the transgene. Specificity for the delivered transgene is especially critical when the treatment involves genes that are expressed in the target tissue. To facilitate uniform detection of transgene RNA without interference from endogenous mRNA, we have engineered expression vectors that include a 5' untranslated region (5' UTR) containing a synthetic intron (PGL3). The synthetic intron splice junction was the target sequence for a quantitative reverse transcription (RT)-PCR assay utilizing Taq-Man technology. In this study, we demonstrate that a quantitative RT-PCR assay designed to recognize an engineered intron splice site in the 5'UTR of expression constructs effectively measures the expression level of in vivo-delivered gene therapeutics.

5' Untranslated Regions↗

Symptom control, communication with health professionals, and hospital care of stroke patients in the last year of life as reported by surviving family, friends, and officials.

BACKGROUND AND PURPOSE: The needs of and appropriate service provision for patients dying from stroke have received little attention. The quality of care in the last year of life received by a population-based sample of stroke patients is described here, focusing on symptom control, communication with health professionals, and hospital care. METHODS: Secondary analysis was made of data from the Regional Study of Care for the Dying, a retrospective interview survey in 20 nationally representative English health districts. Subjects were 237 persons who died from stroke in 1990. Of informants, 20% were spouses, 48% relatives, 11% friends or neighbors, and 20% officials. RESULTS: More than half the patients were reported to have experienced pain (65%), mental confusion (51%), low mood (57%), and urinary incontinence (56%) in the last year of life. Pain control was inadequate: 51% of those treated for pain by hospital doctors and 45% of those treated by general practitioners were reported to have received treatment that relieved pain partially if at all. One third of respondents thought that hospital doctors had been too rushed (37%), and 25% thought that the patient had had insufficient choice about treatment. Two fifths had been unable to get all the information they had wanted about the patient's condition. CONCLUSIONS: Improvements in symptom control and psychosocial support for patients who die from stroke are needed, as is better communication between health professionals and patients and their families. Education of doctors and nurses working with stroke patients in the principles of palliative care may help ensure that all dying stroke patients receive high-quality care.

Aged↗

Dichloroacetamide antidotes for thiocarbamate herbicides: mode of action.

Thiocarbamate sulfoxides formed on metabolic sulfoxidation of thicoarbamate herbicides in plants and mammals are effective carbamoylating agents for glutathione and other tissue thiols. Dichloracetamides that protect corn from thiocarbamate herbicide injury more rapid detoxification of the thiocarbamate sulfoxides by increasing their rate of carbamoylation of glutathione through elevation of the root glutathione level and glutathione s-transferase activity.

Acetamides↗

Dying from heart disease.

OBJECTIVES: To describe the symptoms experienced in the last year of life by people with heart disease, their relation to quality of life, and informal carers' satisfaction with hospital services. METHODS: Interview survey of informal carers of 600 patients aged 15 and over, approximately ten months after their death from heart disease in 1990 in 20 English health districts. The districts, while self-selected, were nationally representative in social characteristics and indicators of health service provision and use. RESULTS: Pain, dyspnoea and low mood were reported to have been experienced by more than half the patients in their last year of life. Anxiety, constipation, nausea/vomiting, urinary incontinence and faecal incontinence, although not suffered by the majority of patients, also caused much distress. Hospital symptom control was reported to be limited: little or no symptom relief was reported for 35% patients with pain, 31% with constipation, 24% with dyspnoea and 24% with nausea/vomiting. Nevertheless, high levels of satisfaction with hospital staff were reported. CONCLUSIONS: Patients dying from heart disease experience a wide range of symptoms, which are frequently distressing, and often last for more than six months. There is room for an improvement in palliative care for patients with heart disease in hospital.

Adolescent↗