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Biomedical subjects

M McKee

Publications and source records attributed to M McKee.

At least 163 records · Page 9Linked to original sources
PubMed1996

Changing life expectancy in the 1980s: why was Denmark different from Sweden?

OBJECTIVE: To identify the contribution from specific causes of death to the changes in life expectancy at birth in Denmark relative to Sweden in different age groups during the 1980s and to compare the difference in life expectancy between the two countries in 1990. DESIGN: Mortality data from WHO mortality tapes grouped in smaller series of clinically meaningful categories were used to calculate the contribution of each of these categories at each 10 year age group to the difference in life expectancy at birth in each country between 1979 and 1990 and between the two countries. SETTING: Denmark and Sweden. RESULTS: Between 1979 and 1990 life expectancy increased in both Denmark and Sweden. However, the increase in Sweden was more than two years while that in Denmark was less than one year. In both countries a decrease in cardiovascular disease mortality contributed most to the increase in life expectancy in males as well as females. In both sexes the smaller increase in life expectancy in Denmark was a result of differences in mortality trends in cardiovascular diseases and respiratory and non-respiratory cancers. CONCLUSION: Over a short time two Nordic countries experienced remarkable but different changes in mortality. These findings suggest that mortality rates are sensitive to even minor differences in social and cultural factors across countries and over short time periods.

Adolescent↗
PubMed1996

Appropriateness of total hip replacement in the United Kingdom.

The paper discusses the use of consensus models in determining the application of Total Hip Replacement surgery. The paper notes the wide national and international variation in use of this procedure but considers it in the broader context of reaching consensus on other surgical interventions.

Decision Making↗
PubMed1996

Consistency of AO fracture classification for the distal radius.

We sought to quantify agreement by different assessors of the AO classification for distal fractures of the radius. Thirty radiographs of acute distal radial fractures were evaluated by 36 assessors of varying clinical experience. Our findings suggest that AO 'type' and the presence or absence of articular displacement are measured with high consistency when classification of distal radial fractures is undertaken by experienced observers. Assessors at all experience levels had difficulty agreeing on AO 'group' and especially AO 'subgroup'. To categorize distal radial fractures according to joint displacement and AO type is simple and reproducible. Our study examined only whether distal radial fractures could be consistently classified according to the AO system. Validation of the classification as a predictor of outcome will require a prospective clinical study.

Acute Disease↗
PubMed1996

Factors influencing the provision of clinical pharmacy services in United Kingdom National Health Service hospitals.

There is much variation in the provision of clinical pharmacy services in U.K. National Health Service hospitals. Some services are provided in groups and there are differences in the extent to which barriers exist to the provision of services. Factors that linked services included efficient use of resources; barriers involved a requirement for pharmacists to participate in multidisciplinary teams. The strong resemblances between service uptake by hospital pharmacies and the technology diffusion model provides insight into the future development of services in this era of evidence-based care.

Pharmacy Service, Hospital↗
PubMed1995

Guidelines, enthusiasms, uncertainty, and the limits to purchasing.

Recently government ministers have set out their vision of the future of purchasing. Ineffective treatments will be discarded and purchasing will be based on guidelines or protocols rather than activity. But have the advocates of this approach considered all the issues? This paper examines the challenges of balancing the desire for protocol based uniformity with the needs of individual patients, explores the extent to which existing purchasing structures can support this process, and questions whether such moves will actually lead to reduced costs. In each case it is concluded that oversimplistic analyses are likely to be misleading and that much of the current debate fails to recognise the complexity of health care.

Clinical Protocols↗
PubMed1995

N-acetylated alpha-linked acidic dipeptidase is expressed by non-myelinating Schwann cells in the peripheral nervous system.

N-acetylated alpha-linked acidic dipeptidase is a membrane-bound brain peptidase which cleaves the neuropeptide N-acetyl-aspartyl-glutamate to N-acetyl-aspartate and glutamate. In the present study, we have determined the localization of N-acetylated alpha-linked acidic dipeptidase in the peripheral nervous system. Using enzyme assays and immunoblotting, we demonstrate that sciatic nerve, phrenic nerve, cervical dorsal root ganglion and superior cervical ganglion contain N-acetylated alpha-linked acidic dipeptidase activity as well as an N-acetylated alpha-linked acidic dipeptidase-like protein. Furthermore, we show that N-acetylated alpha-linked acidic dipeptidase-like immunoreactivity is extensively co-localized in peripheral nerves with immunoreactivity for glial fibrillary acidic protein, a known marker for non-myelinating Schwann cells. Using electron microscopy, we demonstrate N-acetylated alpha-linked acidic dipeptidase-like immunoreactivity in cell membranes of non-myelinating Schwann cells in the superior cervical ganglion. These results show that N-acetylated alpha-linked acidic dipeptidase is expressed in the peripheral nervous system by non-myelinating Schwann cells. This cellular localization suggests that N-acetylated alpha-linked acidic dipeptidase may be involved in the signalling between axons and Schwann cells, for example during development or regeneration.

Animals↗
PubMed1995

The cellular Na+ pump as a site of action for carbon monoxide and glutamate: a mechanism for long-term modulation of cellular activity.

Carbon monoxide (CO) induces a long-lasting alteration in cerebellar alpha 3-Na,K-ATPase independent of [Na+] but linked to cGMP synthesis and localized to Purkinje neurons. The action of CO is absent in Purkinje neuron-deficient mice, mimicked by 8-Br-cGMP, and blocked by inhibition of PKG. Glutamate (Glu) and metabotropic agonists mimic the action of CO, an effect that requires PKC and is associated with CO synthesis. These data suggest that CO regulates Na,K-ATPase through cGMP and PKG, and that Glu regulates CO through mGluRs. This system is also modulated by NMDA agonists and nitric oxide, possibly via Glu release, as well as by free radicals. These findings offer a mechanism by which CO, Glu, and free radicals can exert specific effects on synaptic transmission (relevant to long-term changes in cell excitability), as well as more general actions on energy metabolism (relevant to the pathophysiology of excitotoxicity).

Animals↗
PubMed1995

Health status and quality of life of British men with lower urinary tract symptoms: results from the SF-36.

OBJECTIVES: To determine the extent to which urinary symptoms, and resulting bothersomeness interfere with daily activities and affect health status, as measured using the Medical Outcomes Study 36-item short form health survey (SF-36). METHODS: Postal population survey in a British health region of 217 men aged 55 years and over known to have reported mild, moderate, or severe lower urinary tract symptoms. Outcome measures are self-reported urinary symptoms, their bothersomeness, general health status, and quality of life (measured using the SF-36). RESULTS: Response rate among eligible subjects was 84%. Depending on the activity, between 9% and 49% of men with moderate or severe urinary symptoms reported interference with some of their daily activities. Increasing symptom severity was associated with worsening physical role, social functioning, vitality, mental health, and perception of general health, and increasing bothersomeness was associated with worsening of all dimensions of general health status and quality of life. The association between these measures and bothersomeness was stronger than with symptom score. Compared with the general population, men bothered by their symptoms to the extent that they were a medium or a large problem have worse health status for all dimensions except physical functioning. CONCLUSIONS: The SF-36 demonstrates a deterioration in general health status and quality of life with increasing lower urinary tract symptoms and the extent to which those symptoms are bothersome. As such, it provides a generic measure of the burden of ill health arising from these symptoms at a population level. There is, however, considerable individual variation in the way that men respond to their symptoms.

Activities of Daily Living↗
PubMed1995

2020 vision.

Explore the source record for details and available documents.

Diffusion of Innovation↗
PubMed1995

Teaching public health: an innovative method using computer-based project work.

Restructuring of training in public health in the Hungarian medical schools is being undertaken in the context of a major European Union TEMPUS Joint European Project. Under the aegis of this project a common core curriculum of public health has been developed. As part of the implementation of the curriculum, new approaches to learning are being explored that should enable students to appreciate the nature and magnitude of the major challenges to public health in Hungary and promote the development of their analytic, interpretative and presentational skills. One of the approaches is based on the individual preparation of reports on important public health issues, making use of secondary data from electronic databases (WHO HFA/PC and OECD Health Data) and traditional printed sources (annuals). This method called 'computer-based project work' was introduced in Debrecen in 1992-1993 with a secondary objective to develop basic computing skills. The initial experiences of introducing computer-based project work to the curriculum have been positive. This paper describes a practical example of the implementation of innovative approaches to teaching in a highly traditional setting in Central Europe, and one that provides ideas and encouragement to those facing similar problems in the countries of Central and Eastern Europe and the former Soviet Union.

Computer-Assisted Instruction↗
PubMed1995

Options for screening for colorectal cancer in the Royal Air Force: a cost-effectiveness evaluation.

Colorectal cancer (CRC) is the second most common form of malignancy, causing death after late presentation in two-thirds of cases. Early detection makes curative treatment likely. Faecal occult blood tests (FOBTs) detect some pre-symptomatic CRCs and their precursor lesions, adenomatous polyps. A trial showed reduced mortality in USA volunteers aged 50-80 with regular FOBTs; both this and the Nottingham population-based trial detected earlier-stage CRCs. Current US guidelines recommend annual digital rectal examination and FOBTs from age 40. FOBTs have been included in the USAF examination of aircrew for several years. Day-case colonoscopy, with appropriate biopsy-excision, is the first-choice follow-up investigation. This study aims to investigate the design of any programme to introduce FOBTs as part of the RAF's existing schedule of Periodic Medical Examinations (PMEs) and Screenings, and the age groups to be included, rather than the decision as to whether or not it should be commenced. The analysis therefore examines the cost per cancer detected. The information required to evaluate subsequent outcomes, such as cost per life-year saved, is not available for the RAF population so speculative extrapolation from other data is not attempted. Over a third of RAF personnel are under the age of 25, nearly three-quarters under 35 and over four-fifths under 40. Over a quarter of the 4 RAF CRC cases pa occur under age 40 and two-thirds under 50. The most cost-effective age at which to introduce FOBTs in the RAF is 40, regardless of the following parameters. Assuming FOBT sensitivity of 55% and positivity 5%, FOBT costing 23p and colonoscopy 175 pounds, starting FOBTs RAF-wide at age 40 would cost annually 35,968 pounds and 15,881 pounds per CRC case detected. The FOBT contribution to the costs is extremely small and the importance of maximising sensitivity and specificity very great. Hence dietary modification, and using a test or combination of tests with higher sensitivity and/or lower false-positivity, even if much more expensive, would be highly cost-effective, reducing the above costs substantially. Counting as "cases" persons with adenomas reduces the cost per "case" detected by about 75%. A pilot study is proposed concerning the introduction on selected stations of FOBTs with RAF PMEs/Screenings, from age 40, to determine: sensitivity and false-positivity rates for single and serial FOBTs, and the predictive value of positive tests, in RAF screenees; the annual cost; the costs per CRC case, and per CRC-plus-adenoma case, detected; possibly, an estimate of the cost per life-year saved; and, hence, whether the programme should be extended to all RAF personnel. FOB screening from age 40 would miss the quarter of RAF CRC cases which occur in personnel under 40. Identification is therefore recommended now of personnel at high risk for CRC, because of personal or family history, at all PMEs/Screenings, regardless of age, with the subsequent offer of serial FOBTs annually and regular colonoscopy. 2 1/2 yearly [corrected] FOBTs, done with PMEs/Screenings and half-way through the 5 year interval, would detect almost as many CRCs as annual testing, missing only half as many as 5-yearly testing. This analysis provides information on the costs and consequences of various FOB screening strategies for the RAF and other Services. Similar principles can be applied to develop informed strategies for other screening.

Adenomatous Polyps↗