Accuracy and observer variation.
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Humans↗
Biomedical subjects
P Robinson
Publications and source records attributed to P Robinson.
Executive function and psychosocial adjustment in children with early treated phenylketonuria: correlation with historical and concurrent phenylalanine levels.
The issue of what level of phenylalanine (phe) constitutes a safe upper limit for the therapeutic range in dietary treatment of phenylketonuria (PKU) remains unsettled. It has been proposed that the previous guideline figure of 600 mumol l-1 may result in specific impairment of executive functions such as attention, planning and set maintenance. The executive dysfunction theory was investigated by correlation historical and concurrent phe with executive, non-executive and personality tests in a group of early and continuously treated children, aged 10-13 years, with classical PKU, whose average phe levels of 355 mumol l-1 (SD = +/-144) for the pre-school period and 480 mumol l-1 (SD +/-193) for the primary school period corresponded to the upper limits presently recommended in the UK of 360 and 480 mumol l-1 for these age ranges. No clear associations were found between historical or concurrent phe levels and any of the neuropsychological or personality measures, thereby weakening the case for the emergence of executive deficits, at least when average phe levels remain close to the upper limits now considered safe. Furthermore no significant differences were found on psychological variables where comparison with population norms was possible.
Adjustment Disorders↗
Health effects of exposure to cyanobacteria (blue-green algae) during recreational water-related activities.
The aim of this study was to investigate effects on health of exposure to cyanobacteria as a result of recreational water activities. Participants, who were aged six years and over, were interviewed at water recreation sites in South Australia, New South Wales and Victoria on selected Sundays during January and February 1995. Telephone follow-up was conducted two and seven days later to record any subsequent diarrhoea, vomiting, flu-like symptoms, skin rashes, mouth ulcers, fevers and eye or ear irritations. On the Sundays of interview, water samples from the sites were collected for cyanobacterial cell counts and toxin analysis. There were 852 participants, of whom 75 did not have water contact on the day of interview and were considered unexposed. The 777 who had water contact were considered exposed. No significant differences in overall symptoms were found between the unexposed and exposed after two days. At seven days, there was a significant trend to increasing symptom occurrence with duration of exposure (P = 0.03). There was a significant trend to increasing symptom occurrence with increase in cell count (P = 0.04). Participants exposed to more than 5000 cells per mL for more than one hour had a significantly higher symptom occurrence rate than the unexposed. Symptoms were not correlated with the presence of hepatotoxins. These results suggest symptom occurrence was associated with duration of contact with water containing cyanobacteria, and with cyanobacterial cell density. The findings suggest that the current safety threshold for exposure of 20,000 cells per mL may be too high.
Adult↗
Severe oral ulceration in patients with HIV infection: a case series.
OBJECTIVE: Oral ulceration occurs in an estimated 2-4% of patients with HIV infection. This retrospective observational study describes the aetiology and characteristics of 94 HIV-positive patients with either severe and/or recurrent oral ulceration presenting at a dedicated HIV dental unit over a 4-year period. METHODS: Case records were reviewed for diagnosis investigations, CD4 count, CDC stage and treatment modality. RESULTS: Of the 94 patients 50% had an AIDS diagnosis. In patients with asymptomatic HIV disease minor recurrent oral ulceration was the commonest diagnosis whilst large non-specific neutropenic ulcers were more frequently seen in patients with symptomatic disease with low CD4 counts. A variety of treatment modalities were used including thalidomide. An algorithm is presented for the management of patients with severe oral ulceration.
Acquired Immunodeficiency Syndrome↗
Granuloma cytokines in murine cysticercosis.
Neurocysticercosis, caused by Taenia solium, is one of the most common causes of seizures worldwide. The symptoms result from granulomatous inflammation associated with dying cyst forms of the parasite. Although the invasive larvae can be killed by immune serum plus complement, immunity to the cyst stage depends on a cellular response. This dichotomous immune response is reminiscent of the extremes of the immune response associated with T helper 1 (Th1) and Th2 cytokine profiles. To characterize the cytokine response in cysticercosis, granulomas were removed from the peritoneal cavity of mice infected with Taenia crassiceps cysts and examined for cytokine message by in situ hybridization using 35S-labeled RNA probes. The granulomas were staged based on histologic appearance of the degenerating parasite. Message for gamma interferon (IFN-gamma) was identified by light microscopy in 11 of the 12 granulomas, and interleukin-2 (IL-2) message was identified in 9 of the 12. By laser scanning confocal microscopy, significantly increased IFN-gamma and IL-2 pixel intensity was identified in nearly all of the granulomas from early histologic stages. Message for IL-4 was seen in 6 of the 12 granulomas. Only granulomas with complete destruction of the parasite architecture displayed more than minimal amounts of IL-4 message by light microscopy, and only 2 of 12 granulomas had IL-4 pixel intensity significantly above background. Only minimal amounts of IL-10 message were detected in 4 of 11 granulomas. Thus, early granulomas in cysticercosis are predominantly associated with a Th1 response, whereas later granulomas, in which parasite destruction is complete, have a mixture of Th1 and IL-4. The Th1 response appears to play an important role both in the pathogenesis of disease as well as in the clearing of the parasites, with IL-4 involved in downregulation of the initial response.
Animals↗
Short-chain carboxylic acid concentration in human gingival crevicular fluid.
Short-chain carboxylic acids (e.g., lactic acid, propionic acid, butyric acid) are metabolic by-products of bacterial metabolism which can accumulate in the gingival crevice. It is of no small consequence, therefore, that 1- to 5-mM concentrations of these acids exhibit significant biological activity, including the ability to alter cell proliferation and gene expression in cells of importance to the periodontium. This communication reports on the in vivo concentrations of propionic and butyric acid in the gingival crevices of periodontal subjects with severe and mild disease. The results indicated that severely diseased subjects exhibited a > 10-fold increase in the mM concentration of these acids when compared with mildly diseased subjects (mean propionic acid-severe = 9.5 +/- 1.8 mM, and mild = 0.8 +/- 0.3 mM; mean butyric acid-severe = 2.6 +/- 0.4 mM, and mild = 0.2 +/- 0.04 mM). These differences (mean +/- SE) were significant (p < 0.0001). The propionic and butyric acid concentrations were below detection limits in healthy sites of mildly diseased subjects. The propionic and butyric acid concentrations also associated significantly with clinical measures of disease severity (e.g., pocket depth, attachment level) and inflammation (e.g., subgingival temperature, % of sites bleeding when probed), and with the total microbial load (all p < 0.05). Taken together, these data suggest that short-chain carboxylic acids play a mediating role in periodontal disease pathogenesis.
Aggregatibacter actinomycetemcomitans↗
Satisfaction with care of patients attending a dedicated dental clinic: comparisons between 1989 and 1994.
This investigation aimed to audit patient satisfaction with care at a dedicated dental clinic, using previously developed standards and criteria. A self-complete questionnaire was administered to a group of 161 patients assessing the dimensions of care availability, affective behaviour and technical competence. Comparisons with baseline showed a high but slightly decreased level of satisfaction with technical competence, a significantly higher level of satisfaction with the affective behaviour of the clinic staff but a continuing level of dissatisfaction with the availability of care. Respondents with AIDS reported higher levels of satisfaction for all 3 dimensions. Women were less satisfied with the availability of care. The results indicate the inter-related nature of the dimensions of technical competence and care availability. Satisfaction with care availability will only improve if initiatives beyond the clinic are introduced to increase the overall supply of dental services available to this population.
Clinical Competence↗
Early high dose chemotherapy intensification with autologous bone marrow transplantation in lymphoma associated with retention of fertility and normal pregnancies in females. Scotland and Newcastle Lymphoma Group, UK.
As more centres consider autologous bone marrow and peripheral blood stem cell transplantation for patients with high risk Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) in first complete remission (CR1) the long term sequelae of such treatments have to be considered. One of the most important side effects of such intensive treatment is loss of fertility. Sperm banking before treatment commences is available for males but unfortunately cryopreservation of ova/ovarian tissue is not yet possible for females. We have transplanted 30 women, 23 were under 40 years and report ten females who have had successful pregnancies (including two twin pregnancies and one triplet pregnancy), leading to live births following autologous bone marrow transplantation (ABMT) for poor prognosis HD and NHL in first or second complete remission. None of these children have shown evidence of birth defects (median follow up of two years). Of the twenty one pregnancies reported to the European Bone Marrow Transplantation Registry (EBMTR) following ABMT for lymphoma, eight of the seventeen unassisted cases came from our centres. The Newcastle/SNLG autotransplant differs from the approach in many EBMTR centres in that it uses melphalan or melphalan/etoposide alone instead of the more common four drug containing regimens and yet sustained complete remission rates indicate that the non-ablative approach is equally effective as more aggressive regimens on the disease with the huge advantage of preserved fertility in females. This approach to conditioning for ABMT should be considered when treating women in the reproductive age group.
Adult↗
Taenia solium cysticercosis: host-parasite interactions and the immune response.
Taenia parasites have developed elaborate mechanisms of interacting with their intermediate hosts. The oncospheres which invade the intermediate host are susceptible to antibody and complement. However, by the time the host has generated an antibody response, the parasites have begun to transform to the more resistant metacestode. The metacestodes have elaborate means of evading complement-mediated destruction, including paramyosin which inhibits C1q, taeniaestatin which inhibits both classical and alternate pathways, and sulfated polysaccharides which activate complement away from the parasite. Similarly, antibody does not seem to be able to kill the mature metacestode. In fact, the parasites may even stimulate the host to produce antibody, which could be bound via Fc receptors and used as a source of protein. Finally, taeniaestatin and other poorly defined factors may interfere with lymphocyte proliferation and macrophage function, thus paralyzing the cellular immune response. Since the symptoms of NCC are typically associated with a brisk inflammatory response, we hypothesize that disease is primarily caused by injured or dying parasites. This hypothesis raises important questions in assessing the role of chemotherapy in the management of NCC, as well as in the evaluation of clinical trials, most of which were uncontrolled.
Adult↗
Prediction of length of hospital stay following stroke.
The aim of this study was to investigate the potential of using an assessment of initial physical disability post stroke to predict length of hospital stay (LOS). A series of 106 patients with a primary diagnosis of stroke, admitted consecutively to St Vincent's Hospital Rehabilitation Unit over a 2-year period, was assessed at 2 weeks post stroke using the Mobility Scale for Acute Stroke (MSAS). This scale assesses the level of assistance required for a patient to perform five mobility tasks: bridging, sitting from supine, sitting, sitting to standing, and walking. A model utilizing MSAS data explained 69% of the variation in LOS. The results of this study may assist in developing resource utilization models in stroke rehabilitation.
Activities of Daily Living↗
The education of depressed primary care patients: what do patients think of interactive booklets and a video?
BACKGROUND: Clinicians, policy makers, and health care administrators are attempting to improve depression outcomes in the primary care setting. Despite positive evidence about the efficacy of self-help materials and psychoeducational interventions, use of educational materials designed for the primary care patient are receiving little attention in present depression initiatives. The present study describes the use and evaluation of three educational materials by depressed primary care patients. METHODS: As a part of a randomized control trial, depressed primary care patients were identified by primary care physicians and randomized to a clinical trial exploring a new method of treating depression. Patients assigned to the new method of treatment received a package of educational materials at the time of the baseline interview. These materials included two brief interactive booklets (medication booklet, behavioral health booklet) and a short video. The present analysis concerns data obtained from 108 intervention patients in a telephone survey conducted 1 week after they received the package of educational materials. RESULTS: Approximately three quarters of the subjects reported that they read or viewed all of the educational products. The majority rated the products as somewhat to significantly helpful: medication booklet 81%; behavioral health booklet 82%; and video 69%. Previously reported results include findings of significantly better medication adherence and improved clinical outcomes by patients with major depression who received a primary care intervention that included the educational products discussed in this paper. CONCLUSIONS: Educational materials may play a significant role in improving depression treatment outcomes in the primary care setting.
Adaptation, Psychological↗
Assessing for audit.
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Education, Medical, Graduate↗
Immunisation. Myths and misconceptions.
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Child↗
Lack of expansion of triplet repeats in the FMR1, FRAXE, and FRAXF loci in male multiplex families with autism and pervasive developmental disorders.
Sib, twin, and family studies have shown that a genetic cause exists in many cases of autism, with a portion of cases associated with a fragile X chromosome. Three folate-sensitive fragile sites in the Xq27-->Xq28 region have been cloned and found to have polymorphic trinucleotide repeats at the respective sites; these repeats are amplified and methylated in individuals who are positive for the different fragile sites. We have tested affected boys and their mothers from 19 families with two autistic/PDD boys for amplification and/or instability of the triplet repeats at these loci and concordance of inheritance of alleles by affected brothers. In all cases, the triplet repeat numbers were within the normal range, with no individuals having expanded or premutation-size alleles. For each locus, there was no evidence for an increased frequency of concordance, indicating that mutations within these genes are unlikely to be responsible for the autistic/PDD phenotypes in the affected boys. Thus, we think it is important to retest those autistic individuals who were cytogenetically positive for a fragile X chromosome, particularly cases where there is no family history of the fragile X syndrome, using the more accurate DNA-based testing procedures.
Autistic Disorder↗
High phenotypic correlations among siblings with autism and pervasive developmental disorders.
The objective of this study was to examine familial factors influencing clinical variation in sibships that contained at least 2 children affected with autism or another form of pervasive developmental disorder (PDD). The sample included a total of 60 families, 23 with multiple cases of PDD and 37 with a single affected child. Measurements of IQ, adaptive behaviors in socialization and communication, and autistic symptoms were taken on all affected children. A high intraclass correlation, especially on IQ and an index of social behaviors, was observed between affected children from the same family. In contrast, low correlations were observed on measurements of IQ and adaptive behavior between affected and unaffected children from the same family. These data indicate that variation in severity of PDD is influenced by familial, and probably genetic, mechanisms. The results are discussed in relation to current theories on the genetics of autism and the heritable mechanisms underlying variations in clinical severity.
Autistic Disorder↗
Submandibular calculus: who was teaching whom?
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Humans↗