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Biomedical subjects

R H Fletcher

Publications and source records attributed to R H Fletcher.

At least 19 recordsLinked to original sources
PubMed1996

Effect of cooking fuels on respiratory diseases in preschool children in Lucknow, India.

The association between cooking fuels and the risk of respiratory disease in preschool children in Lucknow, India was studied. We interviewed mothers of 650 study children, randomly selected from among 28 urban poor neighborhoods. Children were eligible if they were less than five years of age, free of congenital heart disease, malignancy, and compromised immune status. Respiratory disease (defined as one or more of the following: runny nose, cough, sore throat, breathlessness, and noisy respiration) was assessed by observation. Exposures included the types of cooking fuels and duration of their use in the last week and other potential predictors of respiratory disease. Odds ratios (ORs) for disease were adjusted for covariables using multiple logistic regression. The point prevalence of respiratory disease was 14.5%. Cooking fuels used were wood (56.0%), kerosene (24.2%), coal (19.2%), gas (15.4%), and dung cakes (8.6%). Use of dung cakes, a sun-dried mixture of cow or buffalo dung and straw, as cooking fuel was associated with respiratory disease (adjusted OR = 2.69, 95% confidence interval [CI] = 1.37-5.31, P = 0.004), as was overcrowding in the bedroom (adjusted OR = 1.25 for each additional person, 95% CI = 1.11-1.41, P = 0.001). Age, weight, gender, family income, and household structure were not associated with disease. Use of dung cakes as cooking fuel and overcrowding in the bedroom increased the risk of respiratory disease. Interventions to modify oven design or install chimneys and, where feasible, to reduce the number of people sleeping together should be considered.

Child, Preschool↗
PubMed1996

Ambient air pollution & respiratory symptoms complex in preschool children.

To study the association between ambient air pollutants (AAP) and respiratory symptoms complex (RSC) in preschool children, a cohort of 664 children between the ages of 1 month to 4.5 yr were randomly selected from 28 slums (anganwadi centres) of Lucknow, north India. They were followed up fortnightly for six months. The outcomes assessed were presence of RSC at the time of interview and days on which symptoms had occurred in the past week. Exposure to ambient air sulphur dioxide (SO2), oxides of nitrogen (NOx) and suspended particulate matter (SPM) on the day of the interview or in the week prior, was assessed by ambient air monitoring at 9 centres within the city. The cumulative incidence of RSC was 1.06 and the incidence density per 100 days of follow up was 1.63. All three pollutants were positively correlated with each other and negatively correlated with temperature. Ambient air SPM and SO2 and cooking and heating fuels like dung cakes, wood, coal and kerosene and remaining indoors while the food was cooked were associated with increased incidence of RSC, increased duration of symptoms, or both. We conclude that to improve the respiratory health of preschool children, ambient air SPM and SO2 levels should be kept as low as possible and mothers should be advised to keep children in another room while cooking.

Air Pollution, Indoor↗
PubMed1995

General internal medicine.

Patients with insulin-dependent diabetes mellitus and microalbuminuria have a reduced rate of progression to clinical proteinuria if treated with captopril. Benefits of zidovudine use are balanced by reductions in quality of life. A panel concluded that 90% of patients with acute low back pain recover spontaneously in 4 weeks.

Humans↗
PubMed1994

Do readers and peer reviewers agree on manuscript quality?

OBJECTIVE: To study readers' judgments of manuscript quality and the degree to which readers agreed with peer reviewers. DESIGN: Cross-sectional study. SETTING: Annals of Internal Medicine. SUBJECTS: One hundred thirteen consecutive manuscripts reporting original research and selected for publication. Each of two manuscript versions (one before and one after revision) was judged by two readers, randomly sampled from those who said (based on the title) that they would read the article; one peer reviewer (peer), chosen in the usual way for Annals; and one expert in clinical research methods (expert). Each judge completed an instrument that included a 10-point subjective summary grade of manuscript quality. MAIN OUTCOME MEASURES: Agreement on the 10-point summary grade of manuscript quality between reader-expert, reader-peer, and reader-reader. RESULTS: Readers and peers gave high grades (77% and 73% gave a grade of 5 or better, respectively), while experts were more critical (52% gave a grade of 5 or better; P < .0001). Agreement was relatively high among judge groups (in all cases, > 69%) but agreement beyond chance was poor (kappa < 0.04). One third of readers (33%) thought that the manuscript had little relevance to their work. CONCLUSION: Readers, like most peer reviewers, are generally satisfied with the quality of manuscripts but would like research articles to be more relevant to their clinical practice.

Cross-Sectional Studies↗
PubMed1994

Effects of peer review and editing on the readability of articles published in Annals of Internal Medicine.

OBJECTIVE: To measure the effect of the peer review and editorial processes on the readability of original articles. DESIGN: Comparison of manuscripts before and after the peer review and editorial processes. SETTING: Annals of Internal Medicine between March 1 and November 30, 1992. MANUSCRIPTS: One hundred one consecutive manuscripts reporting original research. MEASUREMENTS: Assessment of readability by means of two previously validated indexes: the Gunning fog index (units of readability in the fog index roughly correlate to years of education) and the Flesch reading ease score. Each manuscript was analyzed for readability and length on receipt and after it had passed through the peer review and editorial processes. Text and abstracts were analyzed similarly but separately. Mean readability scores were compared by two-tailed t tests for paired observations. RESULTS: Mean (+/- SD) initial readability scores of manuscripts and abstracts by the Gunning fog index were 17.16 +/- 1.55 and 16.65 +/- 2.80, respectively. At publication, scores were 16.85 +/- 1.42 and 15.64 +/- 2.42 (P = .0005 and P < .0001 for before-after differences, respectively). By comparison, studies of other print media showed scores of about 11 for the New York Times editorial page and about 18 for a typical legal contract. Similar changes were found for the Flesch scores. The median length of the manuscripts increased by 2.6% and that of the abstracts by 4.2% during the processes. CONCLUSIONS: The peer review and editorial processes slightly improved the readability of original articles and their abstracts, but both remained difficult to read at publication. Better readability scores may improve readership.

Manuscripts as Topic↗
PubMed1994

Manuscript quality before and after peer review and editing at Annals of Internal Medicine.

OBJECTIVE: To evaluate the effects of peer review and editing on manuscript quality. SETTING: Editorial offices of Annals of Internal Medicine. DESIGN: Masked before-after study. MANUSCRIPTS: 111 consecutive original research manuscripts accepted for publication at Annals between March 1992 and March 1993. MEASUREMENTS: We used a manuscript quality assessment tool of 34 items to evaluate the quality of the research report, not the quality of the research itself. Each item was scored on a 1 to 5 scale. Forty-four expert assessors unaware of the design or aims of the study evaluated the manuscripts, with different persons evaluating the two versions of each manuscript (before and after the editorial process). RESULTS: 33 of the 34 items changed in the direction of improvement, with the largest improvements seen in the discussion of study limitations, generalizations, use of confidence intervals, and the tone of conclusions. Overall, the percentage of items scored three or more increased by an absolute 7.3% (95% CI, 3.3% to 11.3%) from a baseline of 75%. The average item score improved by 0.23 points (CI, 0.07 to 0.39) from a baseline mean of 3.5. Manuscripts rated in the bottom 50% showed two- to threefold larger improvements than those in the top 50%, after correction for regression to the mean. CONCLUSIONS: Peer review and editing improve the quality of medical research reporting, particularly in those areas that readers rely on most heavily to decide on the importance and generalizability of the findings.

Humans↗
PubMed1994

Task Force 4: The relationship between cardiovascular specialists and generalists.

1. An imbalance between generalists and cardiovascular subspecialists exists that will require decades to correct. We question the validity of the 50:50 generalist/specialist ratio in view of current practice patterns for cardiology. 2. There has been a large increase in the number of cardiovascular specialists in the past 30 years that will continue if training programs remain at their current size. 3. Cardiovascular specialists provide a substantial amount of inpatient care, care to older patients and care to those with cardiovascular symptoms, although generalists actually provide the majority of office-based cardiovascular care. 4. A significant portion of cardiovascular specialist care can be classified as comprehensive care to patients with and without cardiovascular disease. 5. Most generalists and cardiovascular specialists do not perceive a need for additional cardiovascular specialists. 6. Many providers perform cardiovascular procedures at levels below the recommended threshold for maintenance of clinical competence. 7. Managed care may result in a reduced demand for cardiovascular specialists. 8. If cardiovascular specialists provide general care, it may not be assumed that previous training prepares them for generalist practice. 9. The appropriate boundaries of cardiovascular care between generalists and cardiovascular specialists are indistinct. They are defined somewhat by the training programs from which the generalists graduate. 10. Many generalists have deficiencies in basic skills in clinical cardiology. 11. Desirable interactions between generalists and cardiovascular specialists involve referral of patients in both directions to the provider who can give care to a given patient, at a given time, with the best outcome and lowest cost.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiology↗
PubMed1993

The characteristics of peer reviewers who produce good-quality reviews.

OBJECTIVE: To determine the characteristics of good peer reviewers. DESIGN: Cross-sectional analysis of data gathered during a randomized controlled trial. SETTING: The Journal of General Internal Medicine. PARTICIPANTS: 226 reviewers of 131 consecutively submitted manuscripts of original research. 201 (91%) completed the review and submitted a curriculum vitae. MEASUREMENTS AND MAIN RESULTS: The quality of each review was judged on a scale from 1 to 5 by an editor who was blinded to the identity of the reviewer. Reviewer characteristics were taken from the curricula vitae. 86 of the 201 reviewers (43%) produced good reviews (a grade of 4 or 5). Using logistic regression, the authors found that when a reviewer was less than 40 years old, from a top academic institution, well known to the editor choosing the reviewer, and blinded to the identity of the manuscript's authors, the probability that he or she would produce a good review was 87%, whereas a reviewer without any of these characteristics had a 7% probability of producing a good review. Other characteristics that were significant only on bivariate analysis included previous clinical research training, additional postgraduate degrees, and more time spent on the review. There was a negative but statistically nonsignificant association between academic rank and review quality: 37% of full professors, 39% of associate professors, and 51% of assistant professors or fellows produced good reviews (p = 0.11). CONCLUSIONS: Good peer reviewers for this journal tended to be young, from strong academic institutions, well known to the editors, and blinded to the identity of the manuscript's authors.

Cross-Sectional Studies↗