Survey of cardiac arrhythmias during submaximal and maximal exercise in Thoroughbred racehorses.
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Animals↗
Biomedical subjects
N Ryan
Publications and source records attributed to N Ryan.
Development and initial validation of a new preference-based disease-specific health-related quality of life instrument for erectile function.
UNLABELLED: Health-related quality of life instruments may be generic or specific. In general, only generic instruments use preference-based scoring. We report on a novel approach to combine in one instrument the strengths of the specific approach, greater disease relevance and responsiveness, with those of preference-based scoring, generalizability through utilities. OBJECTIVES: The primary objective was to develop a self-administered, preference-based instrument capable of measuring utilities in the disease-specific context of erectile dysfunction (ED). METHODS: Content derivation/validation began with a literature review. Eight attributes (domains) were selected to provide clinical experts structure for focus group discussion. Four levels describing a continuum of dysfunction-function were defined for each domain. Each domain, including functional levels, was reviewed and modified until consensus was achieved regarding content. This content was then integrated into a preference based scoring instrument using two visual analogue scales (VAS) with which patients rated three 'marker' health states (representing mild, moderate and severe ED), their self-state and a previously validated external marker state. The instrument was pilot tested, and implemented in a clinical trial. Initial validation analyses have been performed. RESULTS: A self-administered, preference-based, VAS instrument was developed for use in the ED population, and the instrument was feasible to complete, was reliable beyond the threshold of acceptability established a priori and demonstrated good validity. Evidence of these properties accumulates over time and this study begins that process with this instrument. Responsiveness is being assessed in the context of a clinical trial.
Adult↗
Chronic Strongyloides stercoralis infection in Laotian immigrants and refugees 7-20 years after resettlement in Australia.
During the period 1974-91 large numbers of Southeast Asian immigrants and refugees were resettled in Western countries, including Australia. Health screening during this period demonstrated that intestinal parasite infections were common. A cross-sectional survey of 95 Laotian settlers who arrived in Australia on average 12 years prior to the study was conducted to determine if chronic intestinal parasite infections were prevalent in this group. Twenty-three participants had positive Strongyloides stercoralis test results (22 with positive serology, including I with S. stercoralis larvae detected in faeces and another with larvae and equivocal serology). Of these 23 participants, 18 (78%) had an elevated eosinophil count. Two patients had eggs of Opisthorchis spp. identified by faecal microscopy. The detection of chronic strongyloidiasis in Laotian settlers is a concern because of the potential serious morbidity associated with this pathogen.
Adolescent↗
Detection of Chlamydia trachomatis in an Australian high school student population.
OBJECTIVE: To assess the prevalence of Chlamydia trachomatis infections among an Australian high school adolescent population. METHODS: Over a 4 year period, 14 high schools were selected in which an infertility prevention programme targeting C. trachomatis was delivered to senior student populations. Coded first catch urine specimens were analysed by Amplicor PCR and infected students treated. Data retrospectively obtained from chlamydia screening programmes conducted among disadvantaged young people detached from formal education were also collated for comparison. RESULTS: Of a total student test population of 1174, 15 (1.3%; 95% CI 0.7% to 2.1%) were diagnosed with C. trachomatis. Of 516 females and 658 males, 12 (2.3%; 95% CI 1.1% to 4.1%) and 3 (0.5%; 95% CI 0.1% to 1.4%) were tested positive respectively. Data collated for three populations of disadvantaged youth returned at total of 89 C. trachomatis infections out of 560 people (15.9% 95%CI 13.0-19.2%). CONCLUSION: The overall prevalence of C. trachomatis infection among this population of senior high school adolescents is low, and significantly differs from the higher chlamydia rates detected in disadvantaged adolescents detached from formal schooling (p<0.0001).
Adolescent↗
Quality of life and costs associated with micronized progesterone and medroxyprogesterone acetate in hormone replacement therapy for nonhysterectomized, postmenopausal women.
BACKGROUND: Because natural progesterone is poorly absorbed and rapidly metabolized, synthetic derivatives of progesterone, such as medroxyprogesterone acetate (MPA), are used in combination with estrogen in hormone replacement therapy. A micronized form of natural progesterone is available that is readily absorbed and reaches peak serum concentrations from 1 to 4 hours after administration. OBJECTIVE: The purpose of this study was to compare the quality of life (QOL), menopausal symptoms, and costs associated with a natural micronized progesterone (MP) formulation versus MPA as add-on therapy to estrogen in hormone replacement for post-menopausal women. METHODS: This prospective, multicenter, randomized, fixed-dose, open-label, parallel-group study enrolled postmenopausal, otherwise healthy, nonhysterectomized women 45 to 65 years of age who had been amenorrheic for > or =6 months and exhibited symptoms of estrogen deficiency. All women received 0.625 mg conjugated equine estrogens on days 1 to 25 of a 30-day cycle; on days 12 to 25, women were randomized to receive either MP 200 mg or MPA 5 mg; patients were followed for 9 months. QOL, the primary end point, was measured at baseline and months 3, 6, and 9 using the 36-Item Short-Form Health Survey (SF-36), the Nottingham Health Profile (NHP), and the condition-specific Women's Health Questionnaire (WHQ). Bleeding pattern, compliance, menopausal symptoms, and cost were evaluated as secondary end points. Costs (in 1997 Canadian dollars) were assessed from the societal perspective and included costs of study medication, hormone therapy monitoring, concomitant medication, outpatient resources, out-of-pocket expenses, and patient and caregiver time loss. RESULTS: A total of 182 women were enrolled; 89 received MP and 93 received MPA. Improvements in climacteric symptoms were observed from baseline to month 9 for both treatments. Mean scores on all domains of the SF-36 at month 9 were greater than scores at baseline in both treatment groups but the increases were not statistically significant. All domains within the NHP and WHQ improved significantly over this period for both groups (P < or = 0.008). Only patients receiving MP showed specific improvements in the menstrual problems and cognitive domains of the WHQ. The difference in average 9-month cost per patient was not statistically significant, at Can 367 dollars +/- 120 dollars and Can 360 dollars +/- 369 dollars for patients receiving MP and MPA, respectively. CONCLUSIONS: MP is a clinically effective, well-tolerated, and cost-comparable alternative to MPA.
Aged↗
The impact of diagnosis by legionella urinary antigen test on the epidemiology and outcomes of Legionnaires' disease.
Legionnaires' disease is an uncommon but important cause of life-threatening community-acquired or nosocomial pneumonia. The urinary antigen enzyme immunoassay test, used in Victoria since 1995, now accounts for the majority of initial laboratory notifications (81% in 1999). We review the impact of the test on the disease epidemiology and the public health investigative process. We focus on the major subgroup of cases due to Legionella pneumophila serogroup 1, comparing delays until notification and mortality for urinary antigen detected cases with culture detected cases. The urinary antigen test facilitates a 5-day reduction for the delay between onset of illness and notification. We observed that there was minimal clinical heterogeneity of urinary antigen detected cases whether they were subsequently culture confirmed or not. We encourage clinician use of the urinary antigen test in cases of community-acquired pneumonia where Legionnaires' disease is a possible diagnosis, in conjunction with culture of clinical specimens.
Adult↗
Anxiety disorders in suicidal youth.
OBJECTIVE: To test the hypothesis that anxiety disorders are associated with suicidal ideation and suicide attempts in a child and adolescent sample referred to a clinic. METHOD: The sample comprised 1979 patients aged 5 to 19 years who were assessed using the Schedule for Affective Disorders and Schizophrenia for School Aged Children--Present Episode (K-SADS-P) at an outpatient mood and anxiety disorders clinic. Subjects were stratified by age and categorized into mutually exclusive groups as being nonsuicidal (n = 817), having suicidal ideation (n = 768), or having attempted suicide (n = 394) in the current episode. Psychiatric diagnoses based on DSM-IV criteria were compared to determine if anxiety disorders were a risk factor for suicidal ideation and suicide attempts. Logistic regression was used to control for significant demographic characteristics and comorbid disorders. RESULTS: After stratifying by age, we found no differences across the 3 groups (ideators, attempters, and nonsuicidal youth) in rates of an anxiety disorder in general or in specific rates of panic disorder, agoraphobia, social phobia, simple phobia, and obsessive-compulsive disorder. Two salient findings involving anxiety disorders were noted with regression analysis. In younger children (age < or = 15 years), attempters had a significantly lower prevalence of separation anxiety disorder (SAD), compared with ideators (OR = 0.30; 95%CI, 0.11 to 0.80; P = 0.006) and nonsuicidal youngsters (OR = 0.14; 95%CI, 0.05 to 0.39; P < 0.0001). In older children (age > 15 years), generalized anxiety disorder (GAD) was more prevalent in ideators (OR = 1.65; 95%CI, 1.03 to 2.66; P = 0.03) than in nonsuicidal patients. CONCLUSIONS: Based on this clinical sample, the relation between pediatric anxiety disorder and suicidal ideation and suicide attempts is not straightforward. However, further studies in nonreferred samples are warranted.
Adolescent↗
The Canadian SCORE questionnaire: optimizing the use of technology for low bone density assessment. Simple Calculated Osteoporosis Risk Estimate.
The Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire is a tool to assist physicians to identify women who might require bone densitometry. The purpose of this study was to develop a Canadian SCORE and to assess validity and reliability. Twenty sites enrolled 307 postmenopausal women ages 50-70 yr. SCORE results were compared to hip and lumbar spine bone density assessed by dual X-ray absorptiometry. Sensitivity and specificity of a range of SCORE cut-points were assessed in a receiver operating characteristics analysis to determine the optimal cut-point for SCORE. With low bone density defined as a T-score < or = -2.0, a SCORE cut-point of 6 in women ages 50-59 yr displayed a sensitivity of 0. 96, 95% confidence interval (CI) (0.89, 1.00), a specificity of 0.51, 95% CI (0.43, 0.58). In women ages 60-70 yr, a SCORE cut-point of 8 displayed a sensitivity of 0.90, 95% CI (0.80, 0.97) and a specificity of 0.20, 95% CI (0.11, 0.29). The test-retest reliability (intraclass correlation coefficient) was 0.95. SCORE performed better in women in their fifties than women in ther sixties. Older women require higher SCORE cut-points. The use of SCORE as an initial measure for identifying those at risk for osteoporosis may reduce costs by limiting unnecessary tests.
Absorptiometry, Photon↗
Legionnaires' disease outbreak: Victoria's largest identified outbreak.
This paper describes and analyses some aspects of an outbreak of Legionnaires' disease in Victoria, commencing in late October 1998. In all, 18 cases caused by Legionella pneumophila serogroup 1 were notified within 10 days making this the largest outbreak in Victoria reported to that date. All cases had epidemiological links to an industrial estate in a northern Melbourne suburb. Extensive environmental sampling revealed Legionella bacteria in five cooling towers. Molecular sub-typing techniques were used to compare clinical and environmental isolates. Isolates from one tower had a pulsed-field gel electrophoresis pattern that was indistinguishable from clinical isolates from eight cases. Control of outbreaks caused by Legionella bacteria requires rapid, coordinated responses to linked cases of disease. The Legionella urinary antigen test facilitated a rapid public health response, and culture and molecular sub-typing of clinical specimens assisted in developing epidemiological links.
Adult↗
Subjectively healthy elderly consuming a liquid nutrition supplement maintained body mass index and improved some nutritional parameters and perceived well-being.
OBJECTIVE: To evaluate regular use of a liquid nutrition supplement by subjectively healthy elderly persons in terms of body mass index, nutrient intake, selected biochemical parameters, and perceived quality-of-life changes, and to identify advantages and limitations of use. DESIGN: A 16-week intervention study in which subjects were assigned randomly to either a supplemented group or a control group and compared in terms of intergroup and intragroup differences in weight, food intake, blood values, and quality-of-life indexes. Adherence to protocol was monitored by monthly visits with an interviewer and food intake records. SUBJECTS/SETTING: Seventy-one independent living, older Canadian adults (mean age = 70 +/- 7 years) consuming on average less than 4 servings of fruit and vegetables daily and a supplement-free diet before the study. Subjects were without functional limitations and did not require therapeutic diets or medical treatments that affect nutritional status. Data were collected in home interviews. Blood for analysis was obtained from a subsample of 36 subjects. INTERVENTION: Inclusion of six 235-mL cans of liquid nutrition supplement weekly into the self-selected dietary patterns of the supplemented group. STATISTICAL ANALYSIS: Results were analyzed by Student t tests or Wilcoxon rank sum test, analysis of variance, and multiple stepwise regression. RESULTS: Body mass index, energy intake, and consumption of fruit and vegetables did not change throughout the study. In the supplemented group, statistically significant increases occurred from baseline to termination of the study in these nutrients: protein, calcium, iron, magnesium, and folate. Serum albumin, folate, ferritin, hemoglobin, and zinc values were within the normal range for the supplemented and control groups. Scores for the Medical Outcomes Study 36-Item Short-Form Health Status scales increased for the supplemented group from baseline to termination for vitality and general health perception. Values for the General Well-Being Questionnaire improved for anxiety and general well-being. Of the dietary predictors, folate intake explained the most variance for vitality and for general well-being, 8.6% and 14.2%, respectively. APPLICATIONS: A liquid nutrition supplement could be recommended to the elderly when energy maintenance and increases in nutrient intake are necessary and convenience is an important consideration. Dietetics professionals should address the issues of affordability of the supplement, the role of food in achieving nutritional adequacy, and overall quality of life of clients. Folate intake as a predictor of perceived general well-being and vitality requires further investigation.
Aged↗
Clinical governance in accident and emergency services.
Owing to NHS managers' preponderance with financial issues, the present Government made improving the quality of health services a statutory requirement in 1997. In this article, one means of improving the quality of health services, clinical governance, is examined in detail before some issues related to its implementation are described. The Trust's A&E services, the context for interpreting and applying clinical governance, are briefly described before introducing a force-field analysis that demonstrates the different elements when changing services broadly and clinical governance specifically. The final section concentrates on implementing and improving clinical governance in A&E departments.
Attitude of Health Personnel↗
Platelet indices during normal pregnancy and pre-eclampsia.
Platelet count and mean platelet volume (MPV) were estimated in 349 normal pregnancies at various gestational stages, and in 30 cases of pre-eclampsia. A probability plot was constructed from these data using discriminant analysis of MPV versus platelet count for the pre-eclamptic versus normal pregnancies. The sensitivity for pre-eclampsia was 90% (27/30) and the specificity was 83.3%. This plot may be of use in confirming risk of pre-eclampsia.
Blood Platelets↗
Microsporidial disease in HIV-infected patients: a report of 42 patients and review of the literature.
Microsporidiosis is recognized as an increasingly important infection, particularly in patients with human immunodeficiency virus (HIV) infection. In this retrospective study we have reviewed the clinical features, laboratory findings and management of 42 HIV positive patients co-infected with microsporidia. All patients had spores identified in faeces stained with a modified trichome blue stain. Patients were all markedly immunosuppressed (median CD4 20 cells/microl). Common symptoms included weight loss, diarrhoea, abdominal pain, anorexia and nausea. 29 patients were diagnosed with Enterocytozoon bieneusi infection; 13 were infected with Encephalitozoon intestinalis, and disseminated disease was confirmed in 8. Albendazole therapy in patients with E. intestinalis (but not E. bieneusi) resulted in good clinical response.
Adult↗
Usefulness of Semen Microscopy in the Diagnosis of a Difficult Case of Schistosoma haematobium Infection in a Returned Traveler.
Schistosoma haematobium is endemic in many countries of Southeast Asia, eastern and western Africa, and South America. It affects mainly the urinary system, although infection of the genital organs is not infrequent.1,2 Infection of male genital organs, especially of the seminal vesicles and prostate1,3 may result in hematospermia and infertility.2,4,5,6,7,8,9 The diagnosis of Schistosoma haematobium traditionally relies on demonstrating the presence of characteristic ova in urine and, less often, in feces. Serology is nonspecific and lacks sensitivity because the antigens utilized in the indirect hemagglutination assay are derived from Schistosoma mansoni. In addition, serology cannot differentiate past from recently acquired infection. We report a case of Schistosoma haematobium infection in a returned traveler in whom numerous ova were detected in semen despite repeated negative urinary and fecal examinations and negative serology.
Journal Article↗
Pharmacokinetics of elemental platinum (ultrafiltrate and total) after a thirty minute intravenous infusion of ormaplatin.
Preclinical data suggest that ormaplatin (tetrachloro-(dl-trans)-1, 2-diamminocyclohexaneplatinum) has substantial activity in cisplatin-resistant tumor models and may be less nephrotoxic than cisplatin. Based on these data we initiated a phase I clinical trial in patients with refractory metastatic cancer. This report characterizes the pharmacokinetic profile of both the total plasma concentrations of elemental platinum and the unbound ultrafiltrate concentrations of elemental platinum, following a 30 min intravenous infusion of ormaplatin. Platinum concentrations were determined by AAS, and pharmacokinetic parameters for both the total plasma concentration and the ultrafiltrate concentration of elemental platinum were determined using both compartmental and noncompartmental methods. Twenty-eight patients (14 males and 14 females; median age, 58) received ormaplatin. There was a linear relationship between Cmax and dose (r2 = 0.945) and AUC and dose (r2 = 0.976). Ormaplatin is more accurately described by a two-compartment model than by a one-compartment model. The distribution half-life (t1/2 alpha) was 0.3 h and the terminal half-life (t1/2 beta) was 39.1 h. The volume of the central compartment (V) was 68.6 L and the volume of distribution at steady state (Vdss) was 183 L. Like total plasma platinum, unbound platinum is also best characterized by a two-compartment model. The elimination of free platinum is also biphasic with a distribution half-life (t1/2 alpha) of 0.3 h and a terminal half-life (t1/2 beta) of 19.3 h. The mean volume of the central compartment (V) was 200.5 L, and the mean volume of distribution at steady state (Vdss) was 560.5 L. Clinical development of ormaplatin has been terminated due to increased frequency of neurological complications noted over other platinum agents; however, the pharmacokinetics are, in general, similar to those of other clinically used platinum compounds.
Adult↗
Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data.
OBJECTIVE: To describe the psychometric properties of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) interview, which surveys additional disorders not assessed in prior K-SADS, contains improved probes and anchor points, includes diagnosis-specific impairment ratings, generates DSM-III-R and DSM-IV diagnoses, and divides symptoms surveyed into a screening interview and five diagnostic supplements. METHOD: Subjects were 55 psychiatric outpatients and 11 normal controls (aged 7 through 17 years). Both parents and children were used as informants. Concurrent validity of the screen criteria and the K-SADS-PL diagnoses was assessed against standard self-report scales. Interrater (n = 15) and test-retest (n = 20) reliability data were also collected (mean retest interval: 18 days; range: 2 to 36 days). RESULTS: Rating scale data support the concurrent validity of screens and K-SADS-PL diagnoses. Interrater agreement in scoring screens and diagnoses was high (range: 93% to 100%). Test-retest reliability kappa coefficients were in the excellent range for present and/or lifetime diagnoses of major depression, any bipolar, generalized anxiety, conduct, and oppositional defiant disorder (.77 to 1.00) and in the good range for present diagnoses of posttraumatic stress disorder and attention-deficit hyperactivity disorder (.63 to .67). CONCLUSION: Results suggest the K-SADS-PL generates reliable and valid child psychiatric diagnoses.
Adolescent↗
A study of the contribution of effective pressure care on elderly female patients attending accident and emergency who have a suspected fractured neck of femur.
This study describes the benefit of pressure relief and the use of pressure reducing mattresses on elderly female patients with a suspected fractured neck of femur, attending an Accident and Emergency department. The main aim of the study was to determine if pressure care, appropriate to each individual patient, reduced red pressure areas and if so, in what way? The results demonstrated that pressure relief given at regular intervals was most effective at reducing red pressure areas. The pressure reducing mattresses also showed to be beneficial in reducing these areas. The study highlighted the importance of giving regular pressure relief in all patients at risk of development of pressure sores.
Aged↗
Resolved: cardiac arrhythmias make desipramine an unacceptable choice in children.
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Antidepressive Agents, Tricyclic↗