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Biomedical subjects

Peter S Blair

Publications and source records attributed to Peter S Blair.

11 recordsLinked to original sources
PubMed2006

Modifiable risk factors, sleep environment, developmental physiology and common polymorphisms: understanding and preventing sudden infant deaths.

Unexpected death in infancy may be a consequence of recognisable pathophysiological processes, or may remain unexplained after thorough investigation. We review the appropriate investigations that should be performed after unexpected infant deaths, and the recent changes to UK law that will make such investigations mandatory from 2008. Current knowledge of the epidemiology and pathophysiology of unexpected infant deaths, together with knowledge of infant developmental physiology leads to an emphasis on the importance of a range of potential gene-environment interactions occurring in vulnerable infants at vulnerable stages of their development.

Bedding and Linens↗
PubMed2006

Sudden infant death syndrome (SIDS)--standardised investigations and classification: recommendations.

Sudden infant death syndrome (SIDS) still accounts for considerable numbers of unexpected infant deaths in many countries. While numerous theories have been advanced to explain these events, it is increasingly clear that this group of infant deaths results from the complex interaction of a variety of heritable and idiosyncratic endogenous factors interacting with exogenous factors. This has been elegantly summarised in the "three hit" or "triple risk" model. Contradictions and lack of consistencies in the literature have arisen from diverse autopsy approaches, variable applications of diagnostic criteria and inconsistent use of definitions. An approach to sudden infant death is outlined with discussion of appropriate tissue sampling, ancillary investigations and the use of controls in research projects. Standardisation of infant death investigations with the application of uniform definitions and protocols will ensure optimal investigation of individual cases and enable international comparisons of trends.

Bacteriological Techniques↗
PubMed2006

Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK.

BACKGROUND: Results of case-control studies in the past 5 years suggest that the epidemiology of sudden infant death syndrome (SIDS) has changed since the 1991 UK Back to Sleep campaign. The campaign's advice that parents put babies on their back to sleep led to a fall in death rates. We used a longitudinal dataset to assess these potential changes. METHODS: Population-based data from home visits have been collected for 369 consecutive unexpected infant deaths (300 SIDS and 69 explained deaths) in Avon over 20 years (1984-2003). Data obtained between 1993 and 1996 from 1300 controls with a chosen "reference" sleep before interview have been used for comparison. FINDINGS: Over the past 20 years, the proportion of children who died from SIDS while co-sleeping with their parents, has risen from 12% to 50% (p<0.0001), but the actual number of SIDS deaths in the parental bed has halved (p=0.01). The proportion seems to have increased partly because the Back to Sleep campaign led to fewer deaths in infants sleeping alone-rather than because of a rise in deaths of infants who bed-shared, and partly because of an increase in the number of deaths in infants sleeping with their parents on a sofa. The proportion of deaths in families from deprived socioeconomic backgrounds has risen from 47% to 74% (p=0.003), the prevalence of maternal smoking during pregnancy from 57% to 86% (p=0.0004), and the proportion of pre-term infants from 12% to 34% (p=0.0001). Although many SIDS infants come from large families, first-born infants are now the largest group. The age of infants who bed-share is significantly smaller than that before the campaign, and fewer are breastfed. INTERPRETATION: Factors that contribute to SIDS have changed in their importance over the past 20 years. Although the reasons for the rise in deaths when a parent sleeps with their infant on a sofa are still unclear, we strongly recommend that parents avoid this sleeping environment. Most SIDS deaths now occur in deprived families. To better understand contributory factors and plan preventive measures we need control data from similarly deprived families, and particularly, infant sleep environments.

Case-Control Studies↗
PubMed2004

Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial.

OBJECTIVES: To determine whether direct access to hospital review initiated by patients with rheumatoid arthritis would result in improved clinical and psychological outcome, reduced overall use of healthcare resources, and greater satisfaction with care than seen in patients receiving regular review initiated by a rheumatologist. DESIGN: Two year randomised controlled trial extended to six years. SETTING: Rheumatology outpatient department in teaching hospital. PARTICIPANTS: 209 consecutive patients with rheumatoid arthritis for over two years; 68 (65%) in the direct access group and 52 (50%) in the control group completed the study (P = 0.04). MAIN OUTCOME MEASURES CLINICAL OUTCOME: pain, disease activity, early morning stiffness, inflammatory indices, disability, grip strength, range of movement in joints, and bone erosion. Psychological status: anxiety, depression, helplessness, self efficacy, satisfaction, and confidence in the system. Number of visits to hospital physician and general practitioner for arthritis. RESULTS: Participants were well matched at baseline. After six years there was only one significant difference between the two groups for the 14 clinical outcomes measured (deterioration in range of movement in elbow was less in direct access patients). There were no significant differences between groups for median change in psychological status. Satisfaction and confidence in the system were significantly higher in the direct access group at two, four, and six years: confidence 9.8 v 8.4, 9.4 v 8.0, 8.7 v 6.9; satisfaction 9.3 v 8.3, 9.3 v 7.7, 8.9 v 7.1 (all P < 0.02). Patients in the direct access group had 38% fewer hospital appointments (median 8 v 13, P < 0.0001). CONCLUSIONS: Over six years, patients with rheumatoid arthritis who initiated their reviews through direct access were clinically and psychologically at least as well as patients having traditional reviews initiated by a physician. They requested fewer appointments, found direct access more acceptable, and had more than a third fewer medical appointments. This radical responsive management could be tested in other chronic diseases.

Aged↗
PubMed2003

Sudden unexpected deaths after discharge from the neonatal intensive care unit.

The published evidence on the risk of sudden unexpected death in infants after discharge from the neonatal intensive care unit (NICU) is reviewed, together with the relevance of the various identified potentially modifiable post-natal risk factors, particularly sleeping position. Infants of low birthweight, short gestation, and those with adverse perinatal histories are at substantially increased risk of sudden infant death syndrome (SIDS), but the potential benefits from following the measures designed to reduce the risk of SIDS are proportionally greater than for term infants. The use of home apnoea monitors has not been shown to be of value in preventing SIDS, but the importance of maintaining adequate oxygenation in infants with bronchopulmonary dysplasia is emphasised. Evidence based recommendations for care of infants after discharge from the NICU with a view to reducing the risk of SIDS are presented, and do not differ significantly from those for low-risk infants.

Female↗
PubMed2003

Sudden infant death syndrome and social deprivation: assessing epidemiological factors after post-matching for deprivation.

As part of the confidential enquiry into stillbirths and deaths in infancy (CESDI), a 3-year population-based case-control study was specifically designed to look at risk factors associated with sudden infant death syndrome (SIDS) after the dramatic fall in incidence. The study was conducted between 1993 and 1996 in five English Health Regions (population 17 million) with parental interviews for each death and four age-matched controls. The aim of this analysis was to investigate the extent to which epidemiological characteristics associated with SIDS were particular to the syndrome or more general markers for socio-economic deprivation. One control was reassigned to each case post-matched for infant age, time of sleep and socio-economic status using components of the Townsend Deprivation Score. The post-matched analysis involved 323 SIDS infants and 323 controls with a similar socio-economic profile. Notable factors significant in the original univariable analysis that became non-significant after post-matching included young maternal age (median: 23 years 4 months SIDS vs. 23 years 11 months post-matched controls), being an unsupported mother (13.6% SIDS vs. 11.1% post-matched controls) and being bottle-fed (56.7% SIDS vs. 55.4% post-matched controls). Other factors, although clearly related to deprivation, such as parental smoking, remained significant in both the univariable and multivariable post-matched analyses.

Adult↗
PubMed2002

Age dependence of potentially toxic elements (Sb, Cd, Pb, Ag) in human liver tissue from paediatric subjects.

Toxic elements are present at low concentrations in the environment. This work was undertaken to investigate the age dependence of the liver content of selected elements in paediatric populations, as an index of internal exposure. Liver samples were collected at autopsy from 157 subjects, aged < 1 day to 6 years, as part of investigations on a possible role of Sb compounds in sudden infant death syndrome (SIDS). In addition to Sb, the concentrations of Ag, Cd and Pb were also determined by inductively coupled plasma mass spectrometry on the remaining digest. Comparison of 95% confidence intervals of the median concentrations of the four elements suggested that there were no differences between the two categories of cause of death, SIDS or those who had died of an identified disease. Cadmium, lead and antimony median concentrations were lower than corresponding values observed in adult populations. Silver concentrations were significantly higher at birth and decreased with age. Cadmium levels were almost negligible in neonates and infants, but increased in older children. The finding of non-negligible concentrations of both Ag and Pb in neonatal liver provides further direct evidence that these elements cross the human placental barrier. The reported data, by far the largest collection observed in subjects less than 1 year old, are the result of exposure, during pregnancy and in early childhood, to present levels of these elements in the environment. They can serve as a reference to compare post-mortem values from individuals or groups of subjects in this age range when an exposure risk is suspected and to highlight trends in human exposure.

Age Factors↗