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Biomedical subjects

R Fielding

Publications and source records attributed to R Fielding.

At least 37 records · Page 2Linked to original sources
PubMed2000

Hong Kong: an epicenter of increasing risk for HIV transmission? Overview and response.

Hong Kong, a Special Administrative Region (HKSAR) of the Peoples' Republic of China (PRC), has a low prevalence of HIV infection. This has been attributed to an extensive prevention and control program implemented by the Hong Kong government from the very beginning of the epidemic. Since the early 1990s, HIV-related surveys in Hong Kong have delineated the magnitude of the problem and identified particularly relevant cultural features that both increase and limit the risk of the transmission of HIV. Factors that may increase transmission include high rates of regional travel, cross-border mobility, and growing commercial sex industries nearby; the latter two are particularly important. Protective factors may include a later age for first sexual experience than in Western countries. More epidemiological research, and particularly intervention research, is needed in the HKSAR to identify new means to maintain the current low HIV/AIDS prevalence and to further strengthen prevention and control programs. Collaboration between government bodies, non-government organizations, and researchers is needed to assure that the best programs and policies are identified and implemented.

Condoms↗
PubMed1999

Effects of assisted feeding on Wobbler mouse motoneuron disease and on serotonergic and peptidergic sprouting in the cervical spinal ventral horn.

The Wobbler mouse is used as a model of human motoneuron disease (MND). During the disease progress, the significant loss of motoneurons in cervical spinal cord and cranial motor nuclei leads to the progressive loss of motor function in the forelimb, head, and neck regions. The loss of cutting and chewing ability that results in the inability to feed properly might lead to a lower mean body weight (b. wt.) that is generally one-half that of the normal phenotype littermate controls. Nutritional deficit might also influence neuronal processes sprouting in the cervical spinal ventral horn. To determine whether nutritional deficits contribute to the wt. loss, and influence the progress of MND as well as its sprouting phenomenon, Wobbler and normal phenotype control littermates were dropper-fed three times daily on a regular laboratory diet of Rat Chow. Weight measurements and behavioral tests were taken to monitor the disease. Immunocytochemisty of serotonin, substance P, and leucine enkephalin were conducted in the cervical spinal cord to investigate if any alteration occurred on the previously reported values in ad lib-fed animals. Organ wts. were measured to determine where nutritional benefit was incurred. Although mean wt. loss in Wobblers was reduced, wt. differed significantly from the control values after dropper feeding. However, the progress of the disease or alteration of neurotransmitters containing neuronal processes were not affected by nutritional factors. Therefore, nutritional intake affects wt. gain, but is not a primary consideration in the progress of MND. Behavioral deficits and neurotransmitter alterations are probably directly caused by motoneuron losses.

Animals↗
PubMed1998

A novel behavioral method to detect motoneuron disease in Wobbler mice aged three to seven days old.

The Wobbler mouse possesses an inherited autosomal recessive form of motoneuron disease. The most characteristic abnormality is the degeneration of motoneurons, mostly in the cervical spinal cord, and in the brain stem cranial motor nuclei. The underlying pathology shows up as symptoms that are only detectable confidently around the time of weaning (age 3 weeks). We now report a new method designed to identify presymptomatic Wobbler mice by behavioral and statistical approaches. We measured body weight, righting reflex (RR) and gender to examine whether these parameters have an impact on the status of the disease before age 3 weeks. Using a total of 341 NFR/wr strain pups, we found a strong association between RR and the Wobbler disease status (p<0.0001) between postnatal days 3 to 7, and achieved greater than 97% correct classification of Wobblers. Therefore the measurement of RR allows the early detection of the affected Wobbler (wr/wr) mice with a minimum of error. This method has been used in our laboratory for immunocytochemical studies that show the early sprouting of immunoreactive serotonin and peptidergic fibers in the cervical spinal ventral horn by postnatal days 7 and 12 respectively. The early detection of Wobbler mice thus facilitates significant new understanding regarding the pathogenesis of motoneuron disease. We can now examine potentially therapeutic approaches which may be more effective than when administered in the symptomatic weanlings (work in progress).

Age Factors↗
PubMed1998

Travel, sexual behaviour, and the risk of contracting sexually transmitted diseases.

This study investigates sexual behaviour and the risk of contracting sexually transmitted diseases among travellers departing from Hong Kong, with an aim supporting the design of local intervention in continuing health promotion. Travellers were interviewed by five trained multilingual interviewers in the departure lounge at Kai Tak International Airport, Hong Kong, between May and June 1996, by using a structured, pretested questionnaire. Forty-four percent (168/383) of the respondents who travelled at least once within the previous year had had sex with strangers during their travel and 37% (139/376) of the respondents reportedly do not use condoms during sexual intercourse. Middle-aged and married travellers were more likely to be in the high-risk group. These findings reflect the urgent need to target travellers in any strategy that is designed to prevent the spread of sexually transmitted diseases in Hong Kong and Asia Pacific region.

Journal Article↗
PubMed1997

A validation of the concept of current perceived health and the Current Perceived Health-42 (CPH-42) questionnaire.

Perceived or self-rated general health in its trait form reliably predicts subsequent mortality among certain sections of the community. In an investigation of the predictive value of health status at the time of assessment, 574 cases drawn from five groups (police trainees, firemen, students, out-patients and in-patients) were used to validate what we have called current perceived health (CPH) and the CPH-42, a measure of CPH is described. Results indicate those rating CPH as poorer were more likely to consult a doctor (chi 2 = 45.9, df = 1, p < 0.0000) and use medication (chi 2 = 61.0, df = 1, p < 0.0000). In comparison, general perceived health ratings did not predict either consultation or medication use. The instrument has good psychometric properties, with high divergent validity from general mental health and general health, with a Guttman split-half reliability > 0.79. Discriminant analysis using the CPH-2 achieved high correct classification rates (up to 100%). Comparison of a scoring method based on canonical coefficients (83% correct classification) with that based on summative scores (74% correct classification) indicate the former method to be more accurate. Age, and among people 40 years or older, gender were significant independent predictors of current perceived health status, with older people rating their current health less positively than younger, and females over 40 years rating their current health less positively than their male counterparts.

Adolescent↗
PubMed1997

Evaluation of two videotape instruction programmes on how to break bad news--for Cantonese-speaking medical students in Hong Kong.

OBJECTIVES: To evaluate a culture-specific videotape on how to 'break bad news' and another videotape produced by a western university, and to determine if the language of presentation influenced the students' perceived abilities to execute basic skills. SUBJECTS: Third year medical students at the Faculty of Medicine, the University of Hong Kong. DESIGN: Longitudinal study with experimental design. INTERVENTION: Two instructional tapes on breaking bad news; one using Chinese speaking role models and one using English. RESULTS: In both groups, self-efficacy summed scores increased from 26.8 (95% CI = 25.9-27.7) at the pre-test to 29.0 (95% CI = 28.4-29.6). The biggest changes occurred in perceived self-efficacy regarding specific skills. However, students using the Chinese tape rated skills as more useful than those using the English tape. CONCLUSION: The videotapes were useful in teaching communication skills. Culturally relevant audiovisual materials were more effective.

China↗
PubMed1995

The measurement of current perceived health among Chinese people in Guangzhou and Hong Kong, southern China.

General perceived health might be considered as a trait measure of perceived health and has been shown to be a reliable predictor of mortality. Current perceived health might be thought of as a state measure and as such should be more sensitive to short-term changes in health status. This paper describes the development of an instrument, the CPH-42 which measures current perceived health among Chinese people. Over 1000 items associated with ill-health were collected after interviewing 90 subjects from out-patient and in-patient settings. To these were added 38 items from section 1 of the Nottingham Health Profile (NHP) and the Chinese Health Questionnaire (CHQ30), measures of functional status and mental health respectively. These items were administered to four groups of subjects and 42 items were extracted using discriminant analysis to create the CPH-42. Results show low levels of conceptual overlap between the CHQ30 and CPH-42, and slightly more overlap between the NHP and CPH-42. Subjects' health care utilization behaviour was linearly related to rated current perceived health. It is concluded that the instrument is both a valid and reliable tool (Guttman's split-half coefficient r = 0.85) which measures a distinct area of subjective health and is shown to predict health services utilization behaviour significantly better than general perceived health.

Adolescent↗
PubMed1995

Health care utilization as a function of subjective health status, job satisfaction and gender among health care workers in Guangzhou, southern China.

Job satisfaction, subjective health and health care utilization was studied on 72 doctors and 127 nurses working at two hospitals in Guangzhou in the People's Republic of China (P.R.C.), along with medication use and consultations with physicians over the 14 days preceding data collection. Female doctors were, on average, ten years older than male doctors. Nurses (all female) were comparable to male doctors in terms of age. Current and general subjective health, and job satisfaction differed between doctors and nurses. Nurses were less satisfied than doctors and reported poorer perceived health, until gender and age were controlled. Female doctors had poorer ratings of general and current subjective health and lower job satisfaction than their male colleagues. Path analysis tested whether lower job satisfaction leads to decrements in perceived current health which in turn increased consultation with a physician and medication use. When male and female subjects were examined separately, job satisfaction was inversely related to consultation behaviour among males and positively related to perceived current health in both genders. Among females job satisfaction and consultation behaviour related to current perceived health but were not related to each other. The hypothesized path was upheld for nurses. Lack of power prevented the same path being significant for male or female doctors. In combination, doctors showed significant relationships between the four main variables studied.

Adult↗
PubMed1994

Doctor-shopping in Hong Kong: implications for quality of care.

Doctor-shopping is defined as the changing of doctors without professional referral in the same illness episode. Two surveys on samples of patients attending Government Out-Patient Departments (GOPDs) in Hong Kong in 1989 (n = 869) and 1990 (n = 901) estimated the prevalence of shopping at nearly 40%, the main reason being a persistence of symptoms. Doctor-shoppers were likely to be younger with higher expectations of health care and who expressed dissatisfaction about aspects of the present service. In Hong Kong, patients perceive western medicine to be more effective and have high expectations of the effects of western drugs, in particular, in their administration by injection. Patients should be warned about iatrogenic health risks incurred from doctor-shopping; health education programmes are needed to modify unrealistic views about quality care. Health care providers in a mixed care system should promote greater continuity of care between doctors and both the public and private sectors, and identify and resolve problems which may be responsible for discontinuity of care.

Adult↗
PubMed1992

A comparison of case retrieval times: film versus picture archiving and communications systems.

One of the advantages that a picture archiving and communications system (PACS) is supposed to provide over a film-based operation is improved performance in retrieving images. Although it seems self-evident that this should be so, this experiment was intended to verify this and to provide some time comparisons for the two methods. The experiment consisted of randomly selecting ultrasound and computed tomography cases and determining how long it took to retrieve files at a PACS workstation or in person from the file room. To simulate actual retrieval volumes, a total of 40 cases from current to 6 months old, 20 cases from the past year, and 10 cases more than 1 year old was selected. Results indicate that PACS retrieval can indeed be faster than file room retrieval. However, the difference is less for recent cases than for older cases. For cases 6 or fewer months old, the workstation retrieval was approximately 2.5 minutes faster per case than the film file room. This time difference increased markedly when extended to the 1-year and older-than-1-year groups. This report details the results of this study and provides information about the reliability of the two archives.

Filing↗
PubMed1992

Alteration in the levels of thyrotropin releasing hormone, substance P and enkephalins in the spinal cord, brainstem, hypothalamus and midbrain of the Wobbler mouse at different stages of the motoneuron disease.

The present study was undertaken to quantify selected neuropeptides (thyrotropin releasing hormone, substance P, methionine and leucine enkephalin) in the cervical spinal cord and other regions of the central nervous system of Wobbler mice by radioimmunoassays during several stages of the motoneuron disease compared with age- and sex-matched normal phenotype littermates. In Wobbler spinal cord, thyrotropin releasing hormone is higher early in the disease, whereas in the brainstem it is higher at a later stage. Substance P in spinal cord is also higher late in the disease. Leucine enkephalin levels are greater at all stages in diseased spinal cord and brainstem, but methionine enkephalin increases only late in the disease. Highly significant increases of the peptides (except thyrotropin releasing hormone) appear in hypothalamus and midbrain only late in the motoneuron disease. Regression analyses show that thyrotropin releasing hormone in spinal cord and brainstem decreases normally with age in the control mice and at a faster rate related to the extent of motor impairment in Wobbler mice. Thyrotropin releasing hormone and methionine enkephalin in the Wobbler brainstem correlate (P less than 0.05) with the progress of the motoneuron disease. Methionine enkephalin increases faster in Wobbler brainstem and decreases faster in control spinal cord with age. The increase of leucine enkephalin in the Wobbler spinal cord correlates significantly with age and with the progress of the disease, but leucine enkephalin declines slightly with age in the controls. The changes of substance P in spinal cord and brainstem do not correlate significantly with the progress of the disease. In the hypothalamus, increasing values for substance P in control specimens and enkephalins in Wobbler specimens are significantly correlated with age. However, in the midbrain, higher methionine and leucine enkephalin levels are significantly associated with age only in the control mice. Alterations of neuropeptides in the Wobbler mouse spinal cord and brainstem may result from the degeneration of bulbospinal raphe neurons projecting to the ventral spinal cord, or from primary afferent or interneuronal nerve terminals. The data imply that the neuronal degeneration process in the Wobbler motoneuron disease is not limited to motoneurons. In the spinal cord, the data support our previous hypothesis that neuronal sprouting presynaptic to the motoneurons may account for increased neuropeptide concentrations. Alternatively, synthesis and/or degradation of these peptides may be altered. In addition, it is proposed that enkephalinergic neurons may develop abnormally in Wobbler mice. The early increase of leucine enkephalin in the Wobbler spinal cord possibly indicates its importance in the etiology of the motoneuron disease.

Animals↗
PubMed1992

Effects of social interaction on distress and recovery from minor surgery in elective paediatric patients.

Thirty-six children aged 2-10 years, the majority of whom were males admitted for urogenital surgery, were observed for level and frequency of distress and type of social interaction over the duration of hospitalization. The results indicate that high levels of observed distress were associated with longer post-operative hospital stays. Staff interactions were associated with higher levels of distress while peer caretaking interactions were associated with lower levels of distress. We tested the hypothesis that social interaction lowered distress, leading to a briefer hospital stay. Using path analysis, we found peer caretaking interactions accounted for a small but significant percentage of the observed variance in duration of post-operative hospital stay. These data illustrate the potential importance of social environments in the maintenance of reduction of distress before and after paediatric surgery. This raises the expectation that certain types of social environments could facilitate recovery from surgery.

Child↗
PubMed1991

Depression and acute myocardial infarction: a review and reinterpretation.

Depression is widely accepted as occurring in response to acute myocardial infarction (AMI), and to be an important determinant of recovery. A review of the literature reveals that three categories of patients with depressive symptomatology may be identifiable. First, many patients show depressive symptoms before admission with AMI; these may intensify during hospitalisation. For these patients, the depressive symptoms may contribute etiologically to the onset of AMI or derive from a common source along with AMI. The second group constitute patients with a history of AMI, and who on readmission with chest pain or suspected AMI are more likely to report depressive symptoms. The third group of patients are non-depressed first time admissions for AMI. These patients appear to show transient depressive reactions, much of which it is argued, occurs as a reaction to hospitalisation and not to AMI per se. This review considers the theoretical context whereby depressive symptoms may arise from the same circumstances that generate the coronary heart disease which underlies AMI, and links this to the generation of helplessness and cardiopathic processes.

Adaptation, Psychological↗