Search PubMed⌕ Search

Biomedical subjects

N Fisher

Publications and source records attributed to N Fisher.

At least 37 records · Page 2Linked to original sources
PubMed1994

Estimating numbers of homeless and homeless mentally ill people in north east Westminster by using capture-recapture analysis.

OBJECTIVES: To use routinely collected data to provide a reliable estimate of the size and psychiatric morbidity of the homeless population of a given geographical area by using capture-recapture analysis. DESIGN: A multiple sample, log-linear capture-recapture method was applied to a defined area of central London during 6 months. The method calculates the total homeless population from the sum of the population actually observed and an estimate of the unobserved population. Data were collected from local agencies used by homeless people. SUBJECTS: Homeless people in north east Westminster residing in bed and breakfast accommodation and hotels or sleeping rough who had contacted statutory or voluntary agencies in the area. RESULTS: 2150 contacts by 1640 homeless people were recorded. The estimated unobserved population was 3293, giving a total homeless population for the period of around 5000 (SD 1250). Mental health problems were significantly less prominent in the unobserved compared with the observed population (23% (754) v 40% (627), P < 0.0001). For both groups the prevalence varied greatly with age and sex. CONCLUSIONS: Capture-recapture techniques can overcome problems of ascertainment in estimating populations of homeless and homeless mentally ill people. Prevalences of mental illness derived from surveys that do not correct for ascertainment are likely to be falsely inflated while at the same time underestimating the total size of the homeless mentally ill population. Population estimates derived from capture-recapture techniques may usefully provide a good basis for including homeless populations in capitation calculations for allocating funds within health services.

Adult↗
PubMed1992

Psychiatric morbidity in bus crews following violent assault: a follow-up study.

In a prospective study 22 bus crews who were victims of physical assault were assessed using standardized psychiatric instruments, followed up for 18 months and compared to a non-assaulted control group drawn from the same bus garage. At initial assessment the assaulted group, compared to the controls showed a significant increase in psychiatric impairment and distress (as measured by the GHQ-30 and IES respectively), with 23% of assault victims developing post-traumatic stress disorder as defined by DSM-III-R. At follow-up, while high levels of both psychiatric impairment and distress persisted there was evidence that they may be separate phenomena.

Adult↗
PubMed1992

A comparison of financial performance, organizational characteristics and management strategy among rural and urban nursing facilities.

Despite efforts to deinstitutionalize long-term care, it is estimated that 43 percent of the elderly will use a nursing facility at some point. Whether sufficient nursing facility services will be available to rural elderly is debatable due to cutbacks in governmental expenditures and recent financial losses among nursing facilities. This paper explores the challenges confronting rural nursing facilities in maintaining their viability and strategies that might be considered to improve their longevity. A comparative analysis of 18 urban and 34 rural nursing facilities in New Mexico is used in identifying promising strategic adaptations available to rural facilities. Among other considerations, rural facilities should strive to enhance revenue streams, implement strict cost control measures, emphasize broader promotional tactics, and diversify services commensurate with the constraints of the communities and populations served.

Costs and Cost Analysis↗
PubMed1991

Comparison of hemodynamic and left ventricular responses to increased after-load in healthy males and females.

Hemodynamic and left ventricular responses were studied echocardiographically in 20 males (31.5 +/- 4.5 yrs) and 20 females (30.4 +/- 4.3 yrs) at rest and during 3 min of isometric deadlift exercise at 30% of maximum voluntary contraction. Maximal tension exerted was significantly (P less than .001) lower in the female group (87.4 +/- 8.1 kg) compared with the male group (127.3 +/- 15 kg). Significant (P less than .001) increases in heart rate and contractility index were noted in both groups during exercise compared to the resting values. Mean arterial blood pressures were significantly (P less than .05) higher in the males at rest and during exercise. Ejection fraction and fractional shortening, both at rest and during exercise, differed significantly (P less than .05) between the two groups. It was raised by exercise only in the males (from 62 +/- 5% to 65 +/- 5% and 32 +/- 4% to 35 +/- 4%, respectively) but remained unchanged in the females. No significant changes in end diastolic dimension and stroke volume were observed in either group during exercise. End systolic dimension was significantly (P less than .001) lower during exercise in females and males (from 3.25 +/- .23 to 3.1 +/- .26 and 3.12 +/- .33 to 3.00 +/- .32 cm, respectively). These data indicate that hemodynamic and left ventricular function in normal male and female subjects were augmented during submaximal isometric exercise. However, females do so with lower after-load than males.

Adult↗
PubMed1991

Smoking effect on exercise response kinetics of oxygen uptake and related variables.

The effects of smoking on the kinetics of oxygen uptake (VO2), carbon dioxide production (VCO2), ventilation (Ve) and heart rate (HR) in the transition from rest to steady-state submaximal exercise was investigated in 6 female and 4 male smokers (32 +/- 8 yrs). The subjects underwent two counter-balanced treadmill tests at 60% of their maximal VO2, lasting 10 min each: one following a 24-hr smoking abstinence, and one immediately after smoking three cigarettes without prior abstinence. Physiological variables were measured at rest and every 30 sec throughout each test. The time required for a given variable to rise from its respective resting baseline to half of its steady-state value (t1/2) was calculated for VO2, VCO2, Ve and HR. Smoking abstinence was associated with t1/2 values of 32 +/- 8, 42 +/- 12, 43 +/- 10, and 30 +/- 9 sec for VO2, VCO2, Ve, and HR, respectively. Smoking significantly (p less than 0.01) lengthened those values to 51 +/- 12, 58 +/- 11, 54 +/- 8, and 41 +/- 10 sec. Concurrently, smoking raised the baseline (resting) values of HR (p less than 0.01) and of Ve, VCO2, O2 pulse (O2P), and both systolic and diastolic blood pressures (p less than 0.05). During steady-state exercise only HR values were elevated by smoking (p less than 0.01), while O2P values were lowered (p less than 0.05). These findings indicate that smoking considerably retards physiological responses to submaximal exercise.

Adult↗
PubMed1991

Exercise tolerance of end-stage renal disease patients.

The purpose of this study was to evaluate the exercise tolerance of end-stage renal disease patients, and to examine pulmonary function and blood lactate as its possible limiting factors. Ten end-stage renal disease patients (age 30 +/- 11) were tested at rest and in a subsequent graded treadmill test to exhaustion. Velocity was 4.8 km/h and the grade was incremented by 2.5% every 4 min. One minute of rest, used for blood sampling, separated successive stages. Pulmonary functions (FVC, FEV1) at rest were both 76% of predicted. Resting heart rate, systolic and diastolic blood pressures, and ventilatory equivalent values were higher than normal. At peak exercise, heart rate, oxygen uptake, oxygen pulse and blood lactic acid were lower than normally predicted for maximal exercise, while ventilatory equivalent and diastolic blood pressure were higher. Only six patients reached blood lactate levels beyond 4 mM.l-1 (onset of blood lactic acid), at which point they utilized 88 +/- 5% of their respective peak Vo2. The results suggest that the low exercise tolerance demonstrated in end-stage renal disease patients is not limited by the somewhat compromised pulmonary capacity or by excessive blood lactate levels.

Adult↗
PubMed1991

Physiological responses to wrist weights during endurance cycling in normal subjects.

Cardiopulmonary and metabolic responses were studied in 12 healthy males aged 45 +/- 7 yr (mean +/- SD) during 25 min of cycling exercise with (WW) and without (NW) arm swing with wrist weights at 60% and 75% of their maximal heart rate reserve (MHRR). Cycling leg work was adjusted in order to produce a constant 60% and 75% of MHRR during WW and NW sessions. The results revealed that during both exercises the cardiopulmonary and hemodynamic responses were similar. However, during the NW sessions lactic acid (LA) levels were significantly (P less than 0.01) higher than those observed during WW sessions (3.2 +/- 0.9 and 5.4 +/- 1.5 mm.l-1, vs 2.9 +/- 0.9 and 3.8 +/- 1.3 mm.-1), as were ratings of perceived exertion (RPE) (13.2 +/- 1 and 14.4 +/- 0.6, vs 12.2 +/- 1 and 13.4 +/- 1.5). These data indicated a similar pattern of hemodynamic and respiratory responses to NW and WW cycling exercises, while LA and RPE were lower in WW cycling. It is therefore suggested that arm swing with wrist weights may be a beneficial mode of exercise, distributing the workload on a larger muscle mass while maintaining the target heart rate. Thus, it enables a lower reliance on anaerobic metabolism and a lower perceived exertion.

Adult↗
PubMed1989

First trimester diagnosis of a partial mole with the combined use of ultrasound and chorionic villous sampling.

A patient with vaginal bleeding in the first trimester of pregnancy had a serum human chorionic gonadotropin (hCG) titer of 495,132 mlU/ml and an abdominal ultrasound examination revealed an intrauterine gestational sac without a fetal pole. Two and a half weeks later the hCG titer was 385,000 mlU/ml and a fetal pole was visualized. Transabdominal villous sampling was performed because of the suspicion of a partial mole. Histopathologic examination showed hydropic villi and chromosomal studies were consistent with triploidy. The diagnosis of partial mole in the first trimester of pregnancy was made and the pregnancy terminated.

Adult↗
PubMed1989

Treatment of stage I breast cancer: the NSABP experience.

The results of two clinical trials carried out by the National Surgical Adjuvant Breast and Bowel Project are presented. A total of 559 histologically node-negative patients were randomised and assigned treatment in the two protocols. In the oestrogen receptor-negative patients with breast cancer, treatment with methotrexate and 5-fluorouracil produced a 31% reduction in treatment failure at 4 years when compared to no systemic treatment. In the oestrogen receptor-positive patients, treatment with tamoxifen produced a 26% reduction in treatment failure at 4 years in comparison to placebo treatment. In both protocols, this benefit was observed both in patients aged under and over 50 years.

Adult↗
PubMed1989

Effect of running versus isometric training programs on healthy elderly at rest.

Left ventricular function and hemodynamic alterations at rest were measured echocardiographically following running or isometric training in 40 healthy elderly. They were randomly assigned into two groups. Twenty (67 +/- 4 years) were engaged in running and 20 (67.8 +/- 3.8 years) in isometric training programs. All subjects underwent a 12-week program, 3 times a week 30 min each session. The running exercise (REX) group had an aerobic exercise conditioning program at 70% of their VO2max. The program for the isometric exercise (IEX) group included weight lifting utilizing large muscle mass at 30% of their maximal voluntary contraction. After training, the REX group increased significantly (p less than 0.05) their VO2max from 2.08 +/- 0.37 to 2.36 +/- 0.41 liter/min and ejection fraction 56 +/- 5.9 to 62 +/- 6.1%. They decreased significantly their heart rate, from 73 +/- 7 to 65 +/- 7 beats/min. No change occurred in the IEX group in left ventricular function and hemodynamic parameters. These data suggest that left ventricular responses at rest differ between the two groups following a short-term training with a favorable response after REX training. In addition, this study demonstrated that a controlled aerobic training program is a better way to improve physical capacity than is a weight lifting program for trained healthy elderly.

Aged↗
PubMed1988

Cardiopulmonary effects of restraint in dorsal recumbency on awake cattle.

The cardiopulmonary effects of dorsal recumbency were studied in awake cows restrained for surgical correction of left displaced abomasum. During the recumbent period, PaO2, PaCO2, arterial pH, and base excess values were significantly decreased. Heart rate, respiratory rate, blood hemoglobin concentrations, and rectal temperature increased significantly.

Abomasum↗