Is duplicate publishing on the increase?
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Duplicate Publications as Topic↗
Biomedical subjects
R A Elton
Publications and source records attributed to R A Elton.
Neonatal physiological trend monitoring by computer.
A premature baby born up to four months early is a fragile patient dependent on intensive care. The body systems are physiologically immature and so tolerate stress badly. The tendency of these infants to rapidly deteriorate, has led us to use a cotside computer monitoring system which displays physiological trends. Information from standard neonatal monitors is accessed by individual cotside PC's linked to a central network server and Doctors terminal. Trend graphs can be easily manipulated, displaying from 7 minutes to 3 days of physiological information on a single screen. Pathology may be observed in real time as it occurs. The system has 3 main areas of use, (a) as a real time clinical aid to patient management, e.g. apnoea of the newborn; (b) as a research tool, demonstrating the effects of procedures on physiology; (c) for educating members of staff about how physiological events develop. Data is saved for the whole of each neonates intensive care stay. Assessment of staff and parent attitudes by questionnaire have been favourable.
Humans↗
Glucose tolerance, plasma insulin, HDL cholesterol and obesity: 12-year follow-up and development of coronary heart disease in Edinburgh men.
The insulin response to a standard oral glucose tolerance test (OGTT) and other anthropometric and biochemical risk factors for coronary heart disease (CHD) were measured in a random sample of 107 Edinburgh men, who were initially studied in 1976 when they were 40 and who were reexamined in 1988-89. Fasting glucose and glucose response to OGTT were higher in 1988-89 than in 1976. In contrast, insulin levels did not differ between the initial and follow-up study either before or after the glucose load. Body mass indices increased, except triceps skinfold. Changing patterns in both fasting and OGTT insulin or glucose levels in individuals were related to changes in bodyweight or in subscapular skinfolds. Modifications in serum total and HDL cholesterol were related to changes in fasting insulin and insulin area, respectively, but not to glucose data. Eleven men developed clinical CHD. Neither glucose nor insulin measures obtained in 1976 differed between those with and without CHD. Weight-height index and abdominal skin-folds were higher in those with CHD. HDL cholesterol was significantly lower (P less than 0.05). Abdominal skin-fold but not body mass index remained significant when adjusted for HDL cholesterol. This small study confirms the importance of central obesity and low HDL cholesterol but failed to identify insulin as a risk factor for CHD in this Scottish population.
Blood Glucose↗
Factors affecting carriage of Neisseria meningitidis among Greek military recruits.
Greek military recruits (993) were examined for carriage of meningococci during July 1990. Blood, saliva and throat swab specimens were obtained and each recruit answered a questionnaire providing information on age, education (a measure of socioeconomic level), place of residence, smoking habits and recent infections. The overall carriage rate was 25% but differed between the two camps: 79/432 (18%) in Camp A and 168/561 (30%) in Camp B (P less than 0.0005). In Camp B, there were significantly higher proportions of recruits who were non-secretors (P less than 0.0005), and/or heavy smokers (P less than 0.0005). They were also younger (less than 19 years old) (P less than 0.001), and on the whole had fewer years of education (P less than 0.0005). By univariate analysis, carriage was significantly associated with smoking. By multiple logistic regression analysis, carriage was associated with smoking (P less than 0.001), age (P less than 0.01) and the camp in which the recruits were based (P less than 0.01). Among recruits in Camp B, 15/38 (40%) of those with recent viral infections were carriers compared with 30% for the camp in general.
Adolescent↗
Secretor status and humoral immune responses to Neisseria lactamica and Neisseria meningitidis.
Non-secretors of ABO blood group antigens are over-represented among patients with meningococcal diseases. Lower levels of secretory IgA reported for non-secretors have been suggested to compromise mucosal defences. Total serum and salivary IgG, IgA and IgM and levels of these isotypes specific for Neisseria lactamica and five isolates of meningococci were determined by ELISA for 357 pupils and staff of a secondary school in which an outbreak of meningitis occurred. There were no differences in total or specific levels of serum IgG, IgA or IgM or salivary IgG or IgA of secretors compared with non-secretors. Non-secretors had significantly lower levels of salivary IgM (P = 0.022). A similar pattern was observed for levels of IgM specific for N. lactamica and five meningococcal isolates. The significance of these results is discussed with reference to the role of secretory IgM in protection of mucosal surfaces in infants.
Adolescent↗
Post-menopausal atrophy in elderly women: is a vaginal smear necessary for diagnosis?
The diagnosis of post-menopausal atrophy should preferably be confirmed before any trial of oestrogen treatment for genito-urinary symptoms. The ideal method, cytological analysis of a vaginal wall smear, is not always feasible in elderly women. Might physical examination alone be sufficient? This study aimed to determine which clinical features might best predict atrophy on the smear. Of 120 consecutive women admitted to an acute geriatric unit (mean age 82 years), satisfactory smears were obtainable from 70 (58%). Sixty per cent of these showed severe atrophy but almost one-fifth showed no atrophic changes. Degree of atrophy correlated with physical thinness (p less than 0.01), low parity (p less than 0.01) and dryness on vaginal examination (p less than 0.001). However, none of the other physical findings traditionally thought to indicate atrophy were found to be associated, nor were age or medication. In contrast, severe atrophy was present in only one of nine women with breast cancer (p less than 0.01). This merits further study.
Aged↗
Affluence, age, and motor neuron disease.
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Adult↗
Factors affecting asthma mortality in Scotland.
Asthma mortality in the age group 5-44 years appeared to be stable in Scotland in both males and females at a rate of approximately 1.0 per 100,000 during the period 1970-1988 despite an increase in the hospital discharge rate for asthma of approximately 4% per annum during that period. Two-thirds of these deaths occurred outside hospital. There was evidence of a seasonal variation in asthma deaths with a peak mortality occurring in August, four to six weeks after the peak in total pollen counts. Monthly variation in atmospheric pollution did not appear to account for the variation in asthma mortality. It is suggested that the seasonal variation in asthma mortality provides a basis for further studies to elucidate the factors contributing to these deaths.
Adolescent↗
Total cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol and coronary heart disease in Scotland.
OBJECTIVE: To investigate long term changes in total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol concentrations and in measures of other risk factors for coronary heart disease and to assess their importance for the development of coronary heart disease in Scottish men. DESIGN: Longitudinal study entailing follow up in 1988-9 of men investigated during a study in 1976. SETTING: Edinburgh, Scotland. SUBJECTS: 107 men from Edinburgh who had taken part in a comparative study of risk factors for heart disease with Swedish men in 1976 when aged 40. INTERVENTION: The men were invited to attend a follow up clinic in 1988-9 for measurement of cholesterol concentrations and other risk factor measurements. Eighty three attended and 24 refused to or could not attend. MAIN OUTCOME MEASURES: Changes in total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol concentrations, body weight, weight to height index, prevalence of smoking, and alcohol intake; number of coronary artery disease events. RESULTS: Mean serum total cholesterol concentration increased over the 12 years mainly due to an increase in the low density lipoprotein cholesterol fraction (from 3.53 (SD 0.09) to 4.56 (0.11) mmol/l) despite a reduction in high density lipoprotein cholesterol concentration. Body weight and weight to height index increased. Fewer men smoked more than 15 cigarettes/day in 1988-9 than in 1976. Blood pressure remained stable and fasting triglyceride concentrations did not change. The frequency of corneal arcus doubled. Alcohol consumption decreased significantly. Eleven men developed clinical coronary heart disease. High low density lipoprotein and low high density lipoprotein cholesterol concentrations in 1976, but not total cholesterol concentration, significantly predicted coronary heart disease (p = 0.05). Almost all of the men who developed coronary heart disease were smokers (91% v 53%, p less than 0.05). CONCLUSION: Over 12 years the lipid profile deteriorated significantly in this healthy cohort of young men. Smoking, a low high density lipoprotein concentration and a raised low density lipoprotein concentration were all associated with coronary heart disease in middle aged Scottish men, whereas there was no association for total cholesterol concentration. The findings have implications for screening programmes.
Adult↗
Rectal examination in patients with abdominal pain.
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Abdominal Pain↗
Relationships of plasma viscosity, coagulation and fibrinolysis to coronary risk factors and angina.
Plasma viscosity, molecular markers of activated coagulation and fibrinolysis (fibrinopeptides A and B beta 15-42), coagulation factors (fibrinogen and factor VII) and antiplasmins were measured in 529 men aged 35-54 years and related to new angina pectoris (n = 117) and to coronary risk factors in controls without angina (n = 412). Five major risk factors (cigarette-smoking, blood pressure, cholesterol, triglyceride and body mass index) were each associated with increases in plasma viscosity, coagulation factors, and imbalance of coagulation over fibrinolysis (increased ratio of fibrinopeptide A/fibrinopeptide B beta 15-42). Increased viscosity and fibrinogen in smokers were partly reversed in ex-smokers, but the imbalance of coagulation and fibrinolysis persisted. Cholesterol and triglyceride were also associated with increased antiplasmin activity. In men with angina, only fibrinogen was elevated compared to controls. We suggest that increased plasma viscosity and an imbalance of coagulation over fibrinolysis may be mechanisms by which known risk factors promote arterial thrombosis, but are not present in stable angina.
Adult↗
Anti-oxidants and pro-oxidants in coronary heart disease.
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Angina Pectoris↗
Rectal examination in patients with pain in the right lower quadrant of the abdomen.
OBJECTIVE: To determine whether rectal examination provides any diagnostic information in patients admitted to hospital with pain in the right lower quadrant of the abdomen. DESIGN: Casualty officer or surgical registrar recorded symptoms and signs on admission on detailed forms. Final diagnosis was noted on discharge from hospital. SETTING: District general hospital. PATIENTS: 1204 Consecutive patients admitted to hospital with pain in the right lower quadrant of the abdomen as their major complaint; 1028 had a rectal examination on admission. MAIN OUTCOME MEASURES: Odds ratio for each symptom and sign related to final diagnosis. Results of multiple logistic regression analysis for acute appendicitis. RESULTS: Right sided rectal tenderness, present in 309 of those examined, was more common in patients with acute appendicitis (odds ratio 1.34, p less than 0.05). This odds ratio was considerably less than that for other clinical signs--namely, tenderness in the right lower quadrant (odds ratio 5.09), rebound tenderness (3.34), guarding (3.07), and muscular rigidity in the abdomen (5.03). In the logistic regression analysis of patients with acute appendicitis, when allowance was made for the presence or absence of rebound tenderness, rectal tenderness on the right lost its significance. Six patients had masses palpable rectally, of which three were palpable on abdominal examination; the other three patients had acute appendicitis. No other unexpected diagnoses were established, and no useful additional diagnostic information was obtained by routine rectal examination. CONCLUSION: If patients presenting with pain in the right lower quadrant of the abdomen are tested for rebound tenderness then rectal examination does not give any further diagnostic information.
Abdominal Pain↗
Risk of angina pectoris and plasma concentrations of vitamins A, C, and E and carotene.
The relation between risk of angina pectoris and plasma concentrations of vitamins A, C, and E and carotene was examined in a population case-control study of 110 cases of angina, identified by the Chest Pain Questionnaire, and 394 controls selected from a sample of 6000 men aged 35-54. Plasma concentrations of vitamins C and E and carotene were significantly inversely related to the risk of angina. There was no significant relation with vitamin A. Smoking was a confounding factor. The inverse relation between angina and low plasma carotene disappeared and that with plasma vitamin C was substantially reduced after adjustment for smoking. Vitamin E remained independently and inversely related to the risk of angina after adjustment for age, smoking habit, blood pressure, lipids, and relative weight. The adjusted odds ratio for angina between the lowest and highest quintiles of vitamin E concentrations was 2.68 (95% confidence interval 1.07-6.70; p = 0.02). These findings suggest that some populations with a high incidence of coronary heart disease may benefit from eating diets rich in natural antioxidants, particularly vitamin E.
Adult↗
Chronic atrophic oral candidiasis among patients with diabetes mellitus--role of secretor status.
Non-diabetic individuals who are non-secretors of blood group antigens are prone to superficial infections by Candida albicans. In this study, 216 patients with diabetes mellitus who were denture wearers were examined for the presence or absence of denture stomatitis. There was an overall trend for non-secretors to be prone to denture stomatitis compared with secretors. Stepwise linear discriminant analysis was used to dissect the contribution of secretor status and other variables to the development of the disease. Secretor status was found to be a contributory factor among patients with non-insulin dependent diabetes but not among those with insulin-dependent diabetes. The possible reasons for this are discussed.
ABO Blood-Group System↗
Cross-sectional study of complications of inhalational anaesthesia in 16,995 patients.
Patients undergoing anaesthesia in which halothane, enflurane or isoflurane were used, were surveyed with reference to 16 unwanted effects selected by the nominal group method. A simple record card was completed at the time of anaesthetic administration. The overall incidence of complications was 13.9%. One complication was reported in 10.8% of the cases, and more than one in 3.1%. Complications were more frequent in the obese, the elderly and those patients receiving isoflurane, but in view of the small overall use of this agent, the anaesthetists involved may still have been on a learning curve.
Adolescent↗
Dental caries experience and oral cleanliness of Asian and white Caucasian children aged 5 and 6 years attending primary schools in Glasgow and Trafford, UK.
The aim of this study was to compare the dental caries experience and oral cleanliness of Asian and white Caucasian children aged 5 and 6 years attending multi-racial schools in Trafford (Greater Manchester) and Greater Glasgow. In 1989 all schools having at least 25 per cent of per cent of pupils from an Asian background participated in the study. Although the white children in Trafford had a higher caries experience (dmft = 3.29) than those in Glasgow (dmft = 3.02), the difference failed to reach statistical significance. This was also true of the Asian population (Trafford dmft = 4.49. Glasgow dfmt = 4.18). When the Asian population was further divided according to religion and the English-speaking ability of the mother, the non-Muslim children of English-speaking mothers had similar caries levels in both areas (Trafford dmft = 2.28, Glasgow dmft = 2.32), and a better dental health than the rest of the Asian population. Oral cleanliness scores followed a similar pattern to dental caries experience. It is concluded that inequality in dental health between Asian and white schoolchildren exists in both Glasgow and Trafford. In addition, these young children who attended multi-racial schools which were located in deprived areas of Trafford and Glasgow had a similar dental health. This was true of the population as a whole and for each of the major ethnic groups.
Asia↗
After the epidemic: follow up study of HIV seroprevalence and changing patterns of drug use.
OBJECTIVE: To follow up known intravenous drug users to determine current health state and drug use, compare characteristics with those of recent drug users, and examine HIV exposure and serostate. DESIGN: Subjects were identified from conventional general practice records and recruited from 1980 to the end of 1985; they were followed up during 1987 and 1988 and compared with drug users identified in the same way but recruited after 1985. SETTING: General practice and community in north west Edinburgh. Follow up conducted throughout the United Kingdom. SUBJECTS: Subjects known to have injected illegal drugs before 1986 (n = 203) and since that time. MAIN OUTCOME MEASURES: Mortality from and prevalence of HIV seropositivity and various parameters indicative of abstinence. RESULTS: Of the 203 subjects in the follow up group, 189 (93%) were traced; 16 (8%) had died and the remaining 173 (85%) were interviewed. In all, 146 (72% of the follow up cohort) had been tested for HIV antibodies, 94 (64%) having positive and 52 (36%) negative results; 57 (28%) had not been tested. Of the 65 subjects in the recently recruited group, 51 (79%) had been tested for HIV, 15 (29%) having positive results. A further 21 (43%) were currently negative for HIV antibody but still at risk. Thirty three (19%) of those followed up were confirmed abstinent, although more (about half) showed evidence of diminished drug injecting. Age correlated strongly with abstinence (p less than 0.001). One third of the group currently used cannabis, buprenorphine, dihydrocodeine, or diazepam. When the two groups were analysed together there was a strong association between the date of starting injecting and HIV seropositivity (chi 3 = 23.81, df = 2, p less than 0.001), with a peak around 1980-3. CONCLUSIONS: Although only a fifth of the followed up group were convincingly abstinent, a much larger group showed evidence of prolonged periods of remission. Overall, much use of oral drugs was confirmed and worrying trends towards taking buprenorphine and benzodiazepines were evident. The peak incidence of starting drug use and the comparatively low seroprevalence of HIV in the newer drug users probably explain the anomalous high seroprevalence in Edinburgh drug users during 1980-5. The epidemic of HIV during the first half of the 1980s in the group suggests that the virus was probably being transmitted because of a pattern of behaviour. Changing patterns of HIV transmission suggest a need to concentrate on heterosexual transmission as the main problem in the future.
Acquired Immunodeficiency Syndrome↗