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Biomedical subjects

P Fleming

Publications and source records attributed to P Fleming.

At least 37 records · Page 2Linked to original sources
PubMed2001

A rapid appraisal method for reviewing the effectiveness of workplace smoking policies in large and medium sized organisations.

Workplace smoking policies have been developed in response to growing scientific evidence about the harmful effects of environmental tobacco smoke (ETS), increasing opposition from non-smokers, concern over escalating costs of health damage and productivity losses, and the emergence of relevant laws and codes of good practice. Much has been written on the development and implementation of workplace smoking policies, but little about their evaluation. This paper describes a rapid appraisal method for the evaluation of workplace smoking policies. The four-stage process involves rapid, focused consultation with policy makers in the workplace, appropriate risk assessment, rapid consultation with those affected by the policy and focused feedback of results for planning and ongoing monitoring. In the pilot site the existing health and safety committee members were effective informants for the identification of key issues in smoking policy. The risk assessment phase was incorporated into the main appraisal which involved a canvass of staff and others on ETS issues identified by the informants. In the final stage of the process the health and safety committee proved to be both responsive to identified need, and proactive in facilitating ongoing review of the smoking policy. It therefore proved possible to develop the rapid appraisal process for administration in a limited time frame, three months for the whole process, with the rapid canvass element being achieved within one week.

Focus Groups↗
PubMed2001

An investigation of the correspondence between psychological problems diagnosed by GPs and those subsequently targeted for treatment by clinical psychologists.

OBJECTIVES: 1. To observe the level of concordance between problems identified by GPs in the referral letter, and primary treatment targets identified by Clinical Psychologists following assessment within an NHS Clinical Psychology Department. 2. To examine whether concordance between GP and Psychologist varies for different psychological problem areas. 3. To examine whether concordance between GP and Psychologist varies with time spent on the waiting list. DESIGN: A retrospective review, and classification, of GP referral letters and Psychologists treatment targets. SETTING: A Department of Clinical Psychology based in Scotland. Sixty five GPs based across fifteen GP practices refer to the department. CASES: Four hundred and one patients consecutively referred by GPs to the Department of Clinical Psychology between April 1 1996 and March 31 1998, and subsequently assessed by one of the qualified Clinical Psychologists. Two hundred and seventy three cases were female (68.08%), 128 male (31.92%). RESULTS: Overall agreement between GP referred problem and Psychologist treatment target, coded in terms of EPPIC 'reasons for care' categories, was 'fair', and observed for 59.6% of cases. High agreement for eating disorders, moderate agreement for anxiety and depression, and low agreement for relationship/social problems was observed. Analysis indicated one third of anxiety referrals and one half of depression referrals were treated differently. Agreement levels were high for short waiting times, and lower for long waiting times, although findings for intermediate waiting times were mixed. CONCLUSIONS: Moderate agreement levels between GP and Clinical Psychologist in cases initially referred for anxiety and depression replicate previous findings. Low levels of agreement for relationship/social problems were not anticipated. The implications of results for future research and service provision are outlined.

Family Practice↗
PubMed2000

The Changing Epidemic of HIV.

Now in its third decade, the epidemiology of human immunodeficiency virus (HIV) transmission in the United States has changed considerably since the epidemic began. Our increased understanding of the virus has fueled development of new treatments to prolong life, and research into a viable vaccine offers hope to those at risk in developed and less developed countries alike. In this review, we provide information about the current trends in HIV and Acquired Immune Deficiency Syndrome (AIDS) among those in the United States who are hardest hit by the epidemic. We also offer insights into and explanations of these changes; update the epidemiology of HIV subtypes and antiretroviral resistance; and describe current strategies for HIV surveillance.

Journal Article↗
PubMed2000

Socio-demographic associations with digit and pacifier sucking at 15 months of age and possible associations with infant infection. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

AIMS: To assess the prevalence of pacifier and digit sucking at 15 months of age and to investigate whether this habit adversely affects the health of 18 month old infants. STUDY DESIGN: Data collected via self-completion questionnaires from mothers forming part of the prospective, population based Avon Longitudinal Study of Pregnancy and Childhood. SUBJECTS AND METHODS: The mothers of 10006 infants gave information on their child's use of a pacifier and of digit sucking at 15 months of age and the presence of specific health symptoms at 18 months of age. Adjusted logistic regression was performed to identify any statistically significant associations between pacifier use, digit sucking or a combination of the two with possible infection. RESULTS: 36.3% of infants sucked a pacifier, 21. 3% their thumb or finger and 2.7% sucked both at 15 months. Statistically significant differences were observed among various socio-demographic variables. Mothers were more likely to give their child a pacifier if they were younger, had lower levels of education, experienced greater financial difficulties or lived in council housing (compared to owned/mortgaged). The opposite was apparent for digit suckers. After allowing for these possible confounding factors, pacifier users had a higher incidence of earache and colic compared to children with no sucking habit, however digit suckers had a lower incidence of these symptoms. Children who sucked both were significantly more likely to have reported wheezing, earache, and poor health in the past month. CONCLUSIONS: Significantly different sociodemographic characteristics were observed with pacifier suckers compared to those who sucked their thumb or finger. It is almost impossible to attribute the direction of causality between infection and a sucking habit. Further and more detailed studies are needed before any recommendations can be made based on the statistically significant associations found as they are unlikely to be of major clinical significance.

Adult↗
PubMed2000

Bladder calculi in children who perform clean intermittent catheterization.

OBJECTIVE: To examine the role of clean intermittent catheterization (CIC) as a possible predisposing risk factor for bladder calculi, assessing risk factors in patients with and without bladder augmentation, and to evaluate management options for bladder calculi in these patients. PATIENTS AND METHODS: The records of 403 patients who were using a regimen of CIC between January 1981 and March 1998 were reviewed to identify those forming bladder calculi; stones were diagnosed in 28 patients. The patients were categorized as: group 1, patients with no bladder augmentation who catheterized urethrally (227, group 1a) or via a Mitrofanoff conduit (18, group 1b); group 2, patients with augmented bladders who catheterized urethrally (100, group 2a) or via a Mitrofanoff conduit (58, group 2b). The incidence of bladder calculi in each group was determined and compared statistically where applicable. The success of the treatment options for stone management was reviewed. RESULTS: Bladder calculi developed in 5% of patients in group 1a, 8% in group 2a, 11% in group 1b, and 10% in group 2b; the incidence of calculi was not significantly different among the groups. Of these patients, 18 (64%) were asymptomatic at the time of diagnosis and significant bacteriuria was found in 23 (88%). Difficulty in catheterizing either the Mitrofanoff conduit or the native urethra was reported in 14 (50%) of these patients. Calculi were more often solitary (71%) and typically composed of struvite or apatite. Calculi were managed by open cystolithotomy in 15 patients (54%) and endoscopically in 13 (46%). Stones recurred in nine patients (32%) after treatment, comprising four of six patients treated endoscopically with electrohydraulic lithotripsy and in five of 15 after open cystolithotomy. The mean interval to recurrence was 22.8 months. CONCLUSION: These results suggest that patients on a regimen of CIC are at risk of developing bladder calculi but the incidence of calculi is not influenced by bladder augmentation. The presence of a Mitrofanoff conduit was associated with a slightly increased incidence of calculus formation. Open cystolithotomy was associated with a lower stone recurrence rate but there were too few patients to draw definitive conclusions.

Adolescent↗
PubMed2000

The health promotion implications of the knowledge and attitude of employees in relation to health and safety leaflets.

Selected aspects of the efficacy of printed leaflets produced by a government health and safety agency and widely distributed by the enforcement bodies and other organisations to promote workplace health and safety are examined. It is based on a study of 30 small or medium-sized enterprises and examines the views of 120 employers and employees regarding the availability, attractiveness, relevance and usefulness of the leaflets and estimates the reader comprehension and readability of the selected leaflets. The results indicate that the selected leaflets are considered acceptable and comprehensible by the majority of respondents. As these are typical of the leaflets available in the health and safety field this is a positive outcome. The discussion focuses around the ability of the leaflets to engage and to inform and suggestions are made to encourage a wider debate on the criteria which contribute to these two aspects of leaflet use. It is contended that leaflets will continue to be important in the attempts of those involved in workplace health and safety to facilitate learning and to contribute to the overall process of behaviour change. This study raises a number of key issues regarding the future design and use of such leaflets.

Health Knowledge, Attitudes, Practice↗
PubMed2000

The geographic distribution of AIDS in the United States: is there a rural epidemic?

The goal of this study was to examine where people with acquired immune deficiency syndrome (AIDS) in the United States live and the degree to which AIDS is present in rural areas. AIDS cases reported to the Centers for Disease Control and Prevention (CDC) in 1996 were categorized by metropolitan statistical area (MSA) size and compared to the general population. Data were analyzed by region, race/ethnicity and risk exposure; AIDS incidence rates were compared over time by MSA size. Relative to the U.S. population, AIDS cases were disproportionately black (43 percent vs. 11 percent), male (80 percent vs. 48 percent), and from the Northeast (32 percent vs. 20 percent). In all regions, a greater proportion of AIDS cases reside in large MSAs compared with the general population. Risk exposures differ little by MSA size, except in the Northeast. The proportion of people with AIDS who reside in large MSAs exceeds the proportion of the population in those areas, especially when race/ethnicity is considered. AIDS rates have increased in non-MSAs relative to large MSAs, yet do not indicate that the epidemic is increasing rapidly in rural areas. Fewer AIDS cases are reported from smaller communities, yet require medical and social services that may burden the rural health care system.

Acquired Immunodeficiency Syndrome↗
PubMed2000

A rapid appraisal method for the selection and pre-testing of environmental health leaflets.

This paper presents a rapid appraisal method for the selection and pre-testing of printed leaflets on environmental health issues. The method combines a staff questionnaire, a readability test and a target population survey and is designed to aid leaflet selection in a way which is practically feasible yet retaining an acceptable level of face validity. A multiple, embedded case study was used to field-test the method and the feedback from this is discussed. The results suggest that the method has the potential to replace ad hoc arrangements by the gatekeepers and make the selection of leaflets more a matter of structured decision-making involving representatives of all the stake-holders.

Environmental Health↗
PubMed2000

The effect of the position of the limb on venous impulse foot pumps.

Compression foot pumps are widely used for the prevention of postoperative venous thrombosis. We tested the efficiency of the pump in ten healthy subjects; the velocity of venous blood flow in the common femoral vein was measured in the horizontal, Trendelenberg (foot-up) and reverse-Trendelenberg (foot-down) positions. Application of the foot pump produced an increase in the venous velocity in all subjects. The mean increase in the horizontal position was 27.2% and in the Trendelenberg position 15.4%. In the reverse-Trendelenberg position, the foot pump produced a mean increase of 102.8%. The efficiency of the compression foot pump in increasing venous return is improved by adopting the reverse-Trendelenberg position. This may increase its thromboprophylactic effect.

Adult↗
PubMed2000

Drug safety during pregnancy and in infants. Lack of mortality related to mitochondrial dysfunction among perinatally HIV-exposed children in pediatric HIV surveillance.

The objectives were to assess whether any deaths reported among perinatally exposed, uninfected, or indeterminate children were consistent with mitochondrial dysfunction, and to characterize perinatal exposure to antiretrovirals among children born in the last five years and reported to perinatal HIV surveillance. Population-based HIV/AIDS surveillance data on perinatally exposed children born in 1993 through 1998 from 32 states with HIV reporting and from a special HIV surveillance project in Los Angeles County and in 22 hospitals in New York City were used. The classifications of exposure and deaths were consistent with the investigation of deaths across all US cohorts. Deaths were ascertained from recent matches with death registries in each state. Causes of death were ascertained from death certificates, autopsy records when available, and medical records. None of the 98 deaths (1.1%) among 9067 perinatally exposed uninfected or indeterminate children born from 1993 through 1998 and reported through pediatric HIV surveillance died of conditions that were consistent with mitochondrial dysfunction. This included 679 children exposed to zidovudine (ZDV) and 3TC, 277 exposed to other antiretroviral combinations, 4512 exposed to ZDV alone, 927 with no antiretroviral exposure, and 2672 with unknown exposure--1128 of whom were born before March 1994 and were unlikely to have been exposed to ZDV. No deaths attributable to mitochondrial dysfunction were found through this evaluation of population-based HIV surveillance data. Long-term follow-up of antiretroviral-exposed children has been recommended by the Public Health Service. This evaluation highlights the contribution of population-based surveillance to the evaluation of potential toxicities associated with maternal antiretroviral use.

Acquired Immunodeficiency Syndrome↗
PubMed2000

HIV prevention community planning and communities of color: do resources track the epidemic?

The Centers for Disease Control and Prevention (CDC) funds provided to state, local, and territorial health departments for HIV-prevention activities are prioritized with the substantial involvement of HIV-prevention community planning groups (CPGs). This article examines whether or not these funds (more than $261 million in fiscal year 1998) are allocated in a way that mirrors the HIV/AIDS epidemic in terms of race/ethnicity. AIDS prevalence data were used to reflect disease burden, and were compared to budget data submitted by health departments to the CDC. The budget data report expenditures by race/ethnicity for two major types of activities: (1) health education and risk reduction (more than $104 million); and (2) counseling, testing, referral, and partner notification (more than $91 million). The rank order correlation between funding and AIDS prevalence data for the five specific racial/ethnic categories was .900 (n = 5, p < .05) for health education and risk reduction (HERR) activities, and 1.000 (n = 5, p < .05) for counseling, testing, referral, and partner notification (CTRPN) activities. From 1997 to 1998, the proportion of funds targeted and accounted for by race/ethnicity increased from 79 percent to 88 percent for HERR, and from 71 percent to 84 percent for CTRPN activities. With regard to race/ethnicity, health departments and CPGs appear to be actively targeting and accounting for HIV prevention resources, and we will argue that relatively small changes in counseling and testing resources for African-American and Latino/Latina communities would result in a close match between AIDS prevalence data and devoted resources.

Centers for Disease Control and Prevention, U.S.↗
PubMed1999

Cubilin, the endocytic receptor for intrinsic factor-vitamin B(12) complex, mediates high-density lipoprotein holoparticle endocytosis.

Receptors that endocytose high-density lipoproteins (HDL) have been elusive. Here yolk-sac endoderm-like cells were used to identify an endocytic receptor for HDL. The receptor was isolated by HDL affinity chromatography and identified as cubilin, the recently described endocytic receptor for intrinsic factor-vitamin B(12). Cubilin antibodies inhibit HDL endocytosis by the endoderm-like cells and in mouse embryo yolk-sac endoderm, a prominent site of cubilin expression. Cubilin-mediated HDL endocytosis is inhibitable by HDL(2), HDL(3), apolipoprotein (apo)A-I, apoA-II, apoE, and RAP, but not by low-density lipoprotein (LDL), oxidized LDL, VLDL, apoC-I, apoC-III, or heparin. These findings, coupled with the fact that cubilin is expressed in kidney proximal tubules, suggest a role for this receptor in embryonic acquisition of maternal HDL and renal catabolism of filterable forms of HDL.

Animals↗
PubMed1999

Long-term outcome based on the initial surgical approach to ureterocele.

PURPOSE: The management of extravesical ureterocele is controversial. Heminephrectomy and recently recommended primary incision or puncture have high reoperation rates. We reviewed and compared the long-term results of these procedures with those of primary lower tract reconstruction for ureterocele. MATERIALS AND METHODS: We reviewed the records of 106 children with ureterocele treated between 1979 and 1997. Followup was available in 99 patients, including 72 with extravesical and 27 with intravesical ureterocele. Patients with extravesical ureterocele were divided based on initial management into group 1-13 who underwent transurethral incision or puncture, group 2-41 who underwent an upper tract approach, including partial or complete nephrectomy with partial ureterectomy or ureteroureterostomy and group 3-18 who underwent complete reconstruction, including ureterocelectomy and ureteral reconstruction with or without upper tract surgery. RESULTS: Overall the reoperation rate in patients with intravesical ureterocele was 22% and 23% in those treated with initial endoscopic incision or puncture. In patients with extravesical ureterocele the reoperation rate was 100, 41 and 0% in groups 1 to 3, respectively. Differences in followup (overall mean 6 years) and the incidence of preoperative reflux in the 3 groups were not statistically significant. In group 2, the reoperation rate in patients with versus without preoperative reflux was 57 versus 20% (p = 0.08). Of the 25 prenatally diagnosed patients urinary tract infection developed preoperatively in 3 (12%) at ages 2, 3, and 6 months, respectively. Mean age at the time of the initial operation in all prenatally diagnosed patients was 3.1 months (range 5 days to 11 months). CONCLUSIONS: Complete reconstruction appears to be safe and highly effective even in infancy for treating extravesical ureterocele. Although the primary upper tract approach is associated with a significantly higher reoperation rate, it is a favorable alternative in patients with no preoperative reflux. However, while transurethral decompression is effective in the majority of patients with intravesical ureterocele, it is not definitive therapy for extravesical ureterocele and it should have a limited role in initial management.

Adolescent↗
PubMed1999

Ureteral reimplantation in infancy: evaluation of long-term voiding function.

PURPOSE: The advisability of early ureteral reimplantation in neonates and infants is controversial and to our knowledge long-term results are not available. We evaluated long-term voiding function after ureteral reimplantation in infancy. MATERIALS AND METHODS: Between 1984 and 1993, 32 children underwent ureteral reimplantation in year 1 of life at our institution. Long-term results were evaluated in regard to surgical outcome, voiding function, urinary tract infection and the need for prophylaxis. Analysis of voiding function included family interviews, uroflowmetry and post-void residual urine measurement. RESULTS: Complete long-term data were available in 14 girls and 7 boys. The diagnosis was primary bilateral and unilateral vesicoureteral reflux, and ureterovesical junction obstruction in 11, 4 and 6 cases, respectively. Of the 26 refluxing renal units overall disease was grade II in 3, III in 6 and IV to V in 17. Patient age at surgery was 0.6 to 12 months (mean 5.4) and followup was 5 to 13 years (mean 9.5). Tapered reimplantation was performed in 8 renal units using excisional or infolding in 5 and 3, respectively. There were no complications in 19 patients (94%), while 2 had postoperative reflux for which 1 underwent reoperation. In 13 patients voiding habits were normal, while 8 reported infrequent voiding (3 or fewer voids daily). In 19 of the 20 patients tested voided volume was appropriate, and the flow rate of 10.8 to 52.7 cc per second (mean 20.9) and post-void residual urine volume of 0 to 40 cc (mean 11) were considered normal. One patient with normal uroflowmetry had incomplete vesical emptying. CONCLUSIONS: Early reimplantation may result in a high technical success rate and low postoperative morbidity in infants. After long-term followup infrequent voiding was common but noninvasive assessment of bladder function revealed no significant abnormality in the majority of patients.

Female↗
PubMed1999

Lack of morbidity from urodynamic studies in children with asymptomatic bacteriuria.

OBJECTIVES: Patients on clean intermittent catheterization (CIC) have a high rate of asymptomatic bacteriuria. Although prophylactic antibiotics for routine surgical procedures in patients with bacteriuria is common practice, the role of prophylaxis for invasive diagnostic procedures remains unclear. The aim of this study was to investigate the morbidity associated with urodynamic evaluation in patients with asymptomatic bacteriuria. METHODS: Routine urodynamic evaluation was performed in 69 pediatric patients (mean age 10 years). Ninety-six percent had a neurogenic bladder, and most were on CIC. Routine urine cultures were obtained at the time of the cystometrogram. Forty-six patients had positive urine cultures, and 23 patients with sterile urine served as a comparison. Patients were evaluated subjectively for symptoms of a urinary tract infection (UTI) within 1 week of the procedure. The results of the cystometrograms were compared between the patients with and without bacteriuria. RESULTS: No patient developed symptomatic UTI after the urodynamic studies. Overall, 65% of the patients with and 52% of the patients without bacteriuria had adequate capacity and compliance, and there was no difference in the urodynamic findings between the patients with and without bacteriuria (P = 0.4). CONCLUSIONS: Urodynamic studies were performed safely in the presence of asymptomatic bacteriuria in the present study. Therefore, routine use of urine cultures or prophylactic antibiotics before urodynamic studies in pediatric patients with a neurogenic bladder does not appear to be indicated.

Bacteriuria↗