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Biomedical subjects

P Flanagan

Publications and source records attributed to P Flanagan.

At least 37 records · Page 2Linked to original sources
PubMed1999

Adolescent pregnancy and substance use.

The question of just what is the relationship of early pregnancy and childbearing and substance use among adolescents remains unanswered. From a public health perspective, both behaviors are unwanted, and populations that are at risk are often at high risk for both. Perhaps prevention of one behavior may be expected to prevent the other. This, however, may be too simplistic a notion, grounded in misconception of the role of early pregnancy and specific cultural context. Furthermore, several studies have documented a decline of drug use during pregnancy and just after delivery among adolescent mothers. Does this trend continue through the parenting years? If so, for whom? What are the individual maternal, child, and family environmental characteristics that predict a decline in use or continued abstinence after early childbearing? Within the context of poverty, lower educational attainment, minority status, and high prevalence of alcohol and drug use, pregnancy may play a positive role. With a change in role, young women may be less likely than nonparenting peers and less likely than prior to their own pregnancy to become deeply involved in the negative behaviors, such as smoking, drinking, and substance use. Perhaps this is a potential opportunity to intervene. To summarize, the health risk behaviors of substance use and adolescent pregnancy and childbearing appear to be linked. Youths who become pregnant before they complete high school represent a particular group of young women who may be at higher risk than the general population for substance use, at least cigarettes, alcohol, and marijuana. Yet, most pregnant teenagers are not substance users. Among those who are, frequency and amounts of use in most samples were low compared with adult samples of pregnant women. Furthermore, there is evidence that teenagers perceive substance use as a risk to their pregnancies and their unborn children. Among users, there is a decrease in use and increase in quit rates during pregnancy and early childrearing years. Many of these young people are embedded in an environment with very high rates of use among family, partners, and peers. There appears to be strong evidence of covariation of risk behaviors. It is possible that for some youths, pregnancy can be viewed as an opportunity and a chance to intervene to decrease risks for initiating and decrease use among adolescents already using substances. It may be a natural touch point, and pregnancy and parenthood may transition youths out of a high-risk experimentation phase of their adolescence. Further research, especially that of a longitudinal nature, is needed to address the complex issues of adolescent pregnancy and substance use.

Adolescent↗
PubMed1999

Acute medical bed usage by nursing home residents.

An increasing number of elderly patients in nursing home care appears to be presenting to hospital for acute medical admission. A survey of acute hospital care was undertaken to establish accurately the number and character of such admissions. A total of 1300 acute medical beds was surveyed in Northern Ireland in June 1996 and January 1997 on a single day using a standardised proforma. Demographic details, diagnosis and length of admission were recorded. A total of 84 patients over the age of 65 (mean 79.5 years) admitted from nursing home care was identified in June 1996 and a total of 125 (mean 83.3 years) in January 1997. A total of 88 (70%) of admissions in 1997 were accompanied by a general practitioner's letter. The assessing doctor judged that 12 (9.6%) of admissions in 1997 could have had investigations and or treatment reasonably instituted in a nursing home. The proportion of acute medical beds occupied by nursing home residents was 6% in June 1996 rising to 10% in January 1997. The study accurately identifies the significant contribution of nursing home patients to acute medical admissions and the low proportion in whom admission was unnecessary. Closure of long stay hospital facilities should be accompanied by investment in community medical services and also reinvestment in acute hospital care for elderly people.

Acute Disease↗
PubMed1998

Quantitative assessment by flow cytometry of T-lymphocytes producing antigen-specific gamma-interferon in Brucella immune cattle.

Peripheral blood mononuclear cells (PBMC) isolated from cattle infected with Brucella secreted gamma-interferon (IFN-gamma) after antigen-specific stimulation with Brucellergene, which is a mixture of cytoplasmic proteins of rough Brucella melitensis B115. Following the depletion of the monocyte-macrophages from the PBMC, the enriched lymphocyte populations stimulated with Brucellergene did not produce IFN-gamma. Two-colour immunofluorescence staining of intracellular IFN-gamma and bovine cell surface molecules identified the cells producing IFN-gamma among the PBMC stimulated with Brucellergene. Moreover, this method could be used to estimate the number of T-cells specifically producing IFN-gamma. For a given animal, there is a significant correlation (p < 0.05) between the production of IFN measured by an ELISA of the supernatant of whole blood stimulated with Brucellergene and the number of T-cells producing IFN-gamma after in vitro stimulation with Brucellergene. The development of the immunofluorescence staining technique provides a new tool for analysing and for measuring the T-cell immune response in cattle.

Animals↗
PubMed1998

A homologue of Drosophila aurora kinase is oncogenic and amplified in human colorectal cancers.

Genetic and biochemical studies in lower eukaryotes have identified several proteins that ensure accurate segregation of chromosomes. These include the Drosophila aurora and yeast Ipl1 kinases that are required for centrosome maturation and chromosome segregation. We have identified two human homologues of these genes, termed aurora1 and aurora2, that encode cell-cycle-regulated serine/threonine kinases. Here we demonstrate that the aurora2 gene maps to chromosome 20q13, a region amplified in a variety of human cancers, including a significant number of colorectal malignancies. We propose that aurora2 may be a target of this amplicon since its DNA is amplified and its RNA overexpressed, in more than 50% of primary colorectal cancers. Furthermore, overexpression of aurora2 transforms rodent fibroblasts. These observations implicate aurora2 as a potential oncogene in many colon, breast and other solid tumors, and identify centrosome-associated proteins as novel targets for cancer therapy.

3T3 Cells↗
PubMed1998

Physiological versus pharmacological decongestion of the nose in healthy human subjects.

In the present study we were interested to determine whether the maximum unilateral nasal airflow associated with the nasal cycle (Fmax physiol) was equivalent to the maximum unilateral nasal airflow that could be achieved by the application of a topical nasal decongestant (Fmax pharmacol). Eight healthy subjects (three male and five female, aged between 19-28 years) were recruited for this study. Unilateral nasal airflow was measured using posterior rhinomanometry at the inspiratory reference pressure of 75 Pa by alternately occluding each nostril with surgical tape. The study was run over 2 consecutive days. On day one, measurements of unilateral nasal airflow were performed every hour for 8 h in each subject and Fmax physiol was found to be 265 cm3/sec (147) (median and interquartile range). On day 2 the median unilateral nasal airflow before application of the nasal decongestant was 171 cm3/sec (140) and this increased to 251 cm3/sec (127) (p = 0.046) at 15 min and to 278 cm3/sec (134) (p = 0.005) at 45 min after application of the decongestant (Fmax pharmacol). A paired comparison of Fmax physiol and Fmax pharmacol showed that these nasal airflow measurements were not significantly different (p > 0.999). The results show that there was no difference between the maximum physiological decongestion produced during the course of the nasal cycle and that produced pharmacologically by a topical nasal decongestant. This indicates that the point of maximal sympathetic vasoconstrictor tone occurring during the nasal cycle causes a constriction of the nasal venous sinuses that is equal to the constrictor response that can be achieved by applying a topical sympathomimetic medication.

Administration, Intranasal↗
PubMed1998

An audit of anti-D sensitisation in Yorkshire.

OBJECTIVE: To determine the likely factors that contribute to RhD sensitisation. DESIGN: Retrospective study of all new cases of RhD sensitisation occurring between 1988 and 1991. SETTING: Leeds Blood Centre, National Blood Service, Yorkshire. POPULATION: One hundred and forty-seven cases of RhD sensitisation from 15 obstetric units within the Yorkshire region, of which 129 (312 pregnancies) could be assessed. MAIN OUTCOME MEASURE: S Identification of potential immunising events and adherence with recommendations on anti-D immunoglobulin administration. RESULTS: Twenty-eight women (22%) had immune anti-D antibodies during their first pregnancy or at delivery and 50 (39%) in their second pregnancy. Overall, 98 potential immunising events were identified in 62 women, excluding delivery; 67 women (52%) had no events, other than delivery. Miscarriages and medical terminations of pregnancy accounted for 81% of all identified events. Iatrogenic failure to adhere to recommendations for the administration of anti-D immunoglobulin occurred in a significant proportion of women who subsequently developed immune anti-D antibodies. Anti-D immunoglobulin failed to protect against immunisation despite adherence to the protocol in 20 events (20%), 13 of which involved miscarriages or termination of pregnancy < 20 weeks of gestation. Potentially, antenatal prophylaxis might have prevented 86% of immunisations that were identified during the first pregnancy. CONCLUSIONS: The introduction of antenatal administration of anti-D immunoglobulin could significantly reduce the level of sensitisation in primigravidae, and adherence to recommendations for administration of anti-D immunoglobulin could be improved. Consideration should be given to reviewing the current recommendation that a dose of 250 IU of anti-D immunoglobulin is adequate following termination of pregnancy before a gestational age of 20 weeks.

Abortion, Induced↗
PubMed1998

Aurally and visually guided visual search in a virtual environment.

We investigated the time participants took to perform a visual search task for targets outside the visual field of view using a helmet-mounted display. We also measured the effectiveness of visual and auditory cues to target location. The auditory stimuli used to cue location were noise bursts previously recorded from the ear canals of the participants and were either presented briefly at the beginning of a trial or continually updated to compensate for head movements. The visual cue was a dynamic arrow that indicated the direction and angular distance from the instantaneous head position to the target. Both visual and auditory spatial cues reduced search time dramatically, compared with unaided search. The updating audio cue was more effective than the transient audio cue and was as effective as the visual cue in reducing search time. These data show that both spatial auditory and visual cues can markedly improve visual search performance. Potential applications for this research include highly visual environments, such as aviation, where there is risk of overloading the visual modality with information.

Adult↗
PubMed1998

HIV-related attitudes and risk behavior of young adolescent mothers.

This article reports on the prevalence of HIV-related risk behaviors among young adolescent mothers. To determine the facilitators and barriers to condom use for young adolescent mothers, a survey of HIV-related knowledge, attitudes and behavior and focus groups was conducted. Young mothers (N = 58) have basic knowledge and some personal concern about HIV, but also hold common misconceptions about HIV and people with AIDS. Despite their anxiety about HIV, almost half rarely or never protect themselves against HIV by using a condom. Although 70% of the sample use hormonal contraceptives, more than one third of the sample have had a second child within an average of 18 months after the birth of their first baby. Personal concern about HIV was significantly associated with consistency of condom use. Because of low rates of condom use and substantial rates of multiple sex partners, STDs and second pregnancies, disadvantaged adolescent mothers are at risk of exposure to HIV. Increased personalized concern for HIV may lead to greater motivations for safer behavior for these mothers. In addition to protecting their own safety, the protection of their child may be an important motivator for safe behavior. Cultural taboos against safe sex and the perception of such behavior as "unfeminine" also need to be addressed for these women.

Adolescent↗
PubMed1997

Splenic abscess caused by Clostridium difficile.

Splenic abscess is a previously unreported complication of Clostridium difficile colitis. A case of Clostridium difficile splenic abscess is reported that developed after the patient had been in intensive care for five weeks. A response was seen to radiologically guided drainage and antibiotic therapy with formal laparotomy, and surgical drainage not being required.

Abscess↗
PubMed1997

Spontaneous changes of unilateral nasal airflow in man. A re-examination of the 'nasal cycle'.

It is now over 100 years since Kayser (Archiv für Laryngol Rhinol 1895; 3: 101-120) first reported in the scientific literature that the human nasal passages exhibit spontaneous changes in unilateral nasal airway resistance, yet our understanding of this unusual phenomenon is still very confused. Spontaneous, reciprocal changes in unilateral nasal resistance are often referred to as a "nasal cycle" and although this term is now commonly used to describe spontaneous changes in nasal resistance in man and animals, there is little evidence for any true periodicity. A major problem in increasing our knowledge and understanding of the so-called "nasal cycle" is that most studies have relied on simple descriptions of the changes in nasal resistance and have not developed any numerical parameters to quantify the changes in resistance over time. This lack of definition of what actually constitutes a nasal cycle has meant that the literature of the present day generally accepts the views put forward by Heetderks (Am J Med Sci 1927; 174; 231-244) and Stoksted (Acta Otolaryngol (Stockh) 1953; Suppl 109: 159-175) that around 80% of the healthy population exhibit a regular cycle. In order to define the characteristics of the spontaneous changes in nasal airway resistance we have used numerical measures of reciprocity and also developed a measurement of the division of airflow between the nasal passages over time. With these two parameters it is possible to describe the nature of the spontaneous changes in airflow in numerical terms and to define what exactly constitutes a nasal cycle. Fifty-two volunteers underwent hourly measurement of unilateral nasal airflow for 8 h. For each volunteer, two values were derived from the graph of unilateral nasal airflows against time; the correlation coefficient between unilateral airflows (r) and the airflow distribution ratio between the two nasal airways (ADR). The spread of different types of airflow pattern (nasal cycle) throughout the population was illustrated by plotting r against ADR for each subject. A nasal cycle was defined as having an r value between -0.6 and -1.0, and an ADR value between 0.7 and 1.0. Only 21% (11 of the 52 volunteers) exhibited airflow patterns that could be defined as a nasal cycle in these terms. This finding contradicts the generally accepted, but undefined, view that around 80% of the population exhibit a regular nasal cycle. The numerical definition of a nasal cycle in terms of both reciprocity and airflow distribution, as described in this paper may help to clarify our understanding of this interesting phenomenon and allow rhinologists to describe the spontaneous changes in nasal airflow in more exact terms than have been used previously in the literature.

Adult↗
PubMed1997

Elder abuse in people with dementia in Northern Ireland: Prevalence and predictors in cases referred to a psychiatry of old age service.

OBJECTIVE: To establish the prevalence of elder abuse in community-dwelling patients with dementia and to test the hypothesis that there is no difference in carer and patient characteristics between the abused and non-abused populations. DESIGN: A cohort of consecutive referrals was formed and subdivided by the presence or absence of abuse and the two groups compared. SETTING: A rural psychiatry of old age service in N. Ireland. SUBJECTS: Each case had been newly referred, was 65 years old or over, lived at home, had an identifiable carer and met DSMIII-R criteria for a diagnosis of dementia. There were 49 such cases; 38 carers agreed to be interviewed. MAIN OUTCOME MEASURES: The General Health Questionnaire 28, the Gilleard Pre-Morbid Relationship Rating Scale and Gilleard's Problem Checklist were administered to the carer and the information/orientation sub scale of the Clifton Assessment Procedure for the Elderly used to measure cognitive impairment in the patient. RESULTS: Abuse was elicited in 14 (37%) cases; four (10.5%) of physical and 13 (34%) of verbal abuse. No cases of abuse by neglect were detected. A poor premorbid relationship, verbal or physical abuse by the dependant, problem behaviours in the dependant, the carer's level of anxiety and a perception of not receiving help were significantly associated with abuse. Alcohol consumption of the carer, physical dependence, severity of cognitive impairment or financial or social circumstances were not associated with elder abuse. CONCLUSIONS: Elder abuse is associated with aspects of the patient/carer relationship and should be regarded as a significant problem in patients with dementia referred to an old age service.

Adult↗
PubMed1997

Patterns of hospital attendance with epistaxis.

The age and sex distribution of epistaxis admissions to hospital was examined. A retrospective analysis of 6,885 patients admitted to hospitals in the whole of Wales was performed, over a period of five years. The findings were compared with data from the 1991 National Population Census for the same region, thus providing a more representative estimate of the behaviour of this disease. A clear age relationship is demonstrated, with the incidence of epistaxis increasing rapidly after the age of 40 years. The female-to-male ratio is also age dependent. In the group aged between 20 to 49 years twice as many males as females were admitted, where no sex difference was expected from the population data. This difference was not present in the group aged 50 years and over where the ratio was similar to that in the underlying population. There was a 1.6 fold difference between the sex ratios of the two groups (95% confidence intervals of 1.9 to 1.4; p < 0.0001). It is possible that the female pre-menopausal state may provide a significant protection from this disease. The mechanism for this is unknown, but may be secondary to a direct effect of oestrogen on the nasal mucosa or vasculature, or the healing of vessels in this region. Alternatively, this observation may simply be a reflection of protection the pre-menopausal state provides against cardiovascular disease in general.

Adolescent↗
PubMed1996

Effect of beta blockers on the time to first syncope recurrence in patients after a positive isoproterenol tilt table test.

Isoproterenol-headup tilt table testing provides a diagnosis of neuromediated syncope in many patients who faint. The involvement of beta-adrenoceptor stimulation in the provocation of syncope suggests that beta blockers might chronically prevent syncope. To assess this, a cohort of 153 syncope patients (age 39 +/- 20 years) underwent baseline assessment of demographic variables, symptomatic burden, and hemodynamic and clinical responses to tilt testing. Fifty-two patients then received beta blockers, and 101 did not receive drug therapy. The primary outcome was the time to the first recurrent syncopal spell. Actuarial survival analysis was used. Syncope recurred in 17 of 52 patients who received beta blockers and in 28 of 101 patients who were untreated. The actuarial probability of remaining free of syncope was similar in both groups. For example, the probability of remaining free of syncope 12 months following the tilt test was 0.72 in both populations. Thus, treatment with beta blockers may not have a significant effect in preventing syncope recurrence following a positive tilt test.

Adolescent↗