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Biomedical subjects

R J Prescott

Publications and source records attributed to R J Prescott.

At least 91 records · Page 5Linked to original sources
PubMed1996

Smoking during pregnancy: the dose dependence of birthweight deficits.

OBJECTIVE: To assess whether a simple urine based estimate of relative daily nicotine intake could predict smoking related birthweight deficits more accurately than self-reported cigarette consumption. DESIGN: Active smokers were identified by a simple qualitative colorimetric urine test procedure and their relative nicotine intakes assessed by determining the ratios of the urinary concentrations of nicotine plus its metabolites to creatinine using automated colorimetric methods. SETTING: A large teaching hospital. PARTICIPANTS: Three thousand and thirty-eight mothers from whom smoking histories had been elicited and who gave birth to live singleton babies after 28 weeks of gestation. MAIN OUTCOME MEASURES: Birthweights (adjusted for maternal weight, maternal age, baby's sex, parity and length of gestation), maternal weight gains during pregnancy and placental weights. RESULTS: The adjusted birthweight deficits of babies born to proven active smokers averaged 226 g (95% confidence interval 194 g to 258 g), but dose dependent effects were only apparent when nicotine intake was based on urinary nicotine metabolites/creatinine ratios. Among the smokers, adjusted birthweights fell linearly with increasing nicotine intakes but gave a predicted mean birthweight for nonsmokers that was 102 g (95% CI 50 g to 154 g) lighter than that actually found (P < 0.0001). Maternal weight gains during pregnancy were substantially reduced in smokers and correlated more closely with urinary nicotine metabolite excretions than with reported daily cigarette consumptions. Placental weights were unaffected by smoking. CONCLUSION: There was a closer dose-effect relationship between birthweight deficits and urinary nicotine metabolites/creatinine ratios than with self-reported daily cigarette consumptions. The influence of nicotine exposure on birthweight appears to be biphasic, with one mechanism operating at very low levels of tobacco smoke intake and the other causing seemingly linearly related effects over the whole range of nicotine intakes of active smokers. These findings support recent evidence that passive smoking can cause substantial birthweight deficits.

Adult↗
PubMed1996

British Thoracic Society Sarcoidosis study: effects of long term corticosteroid treatment.

BACKGROUND: Corticosteroids suppress disease activity in pulmonary sarcoidosis and their use produces symptomatic, radiographic, and functional improvement. There is, however, uncertainty regarding their effects on the overall natural history of the condition and long term benefit is unproven. METHODS: Patients with pulmonary radiographic shadowing due to sarcoidosis were recruited in a multicentre study. Those who, in the first six months after entry to the study, neither required prednisolone for symptoms nor showed radiographic improvement were allocated at six months to receive either long term steroid treatment (group L) or selective treatment (group S), with regular assessment over the subsequent five years. Patients in group L were scheduled to receive steroid treatment for at least 18 months with the policy of achieving and maintaining maximal radiographic clearing, while in group S treatment was reserved for use only if warranted by later development of symptoms or deteriorating lung function. Symptoms, radiographic appearances, and respiratory function were assessed periodically during the study. RESULTS: One hundred and forty nine patients were followed: 33 required prednisolone for troublesome symptoms within six months of entry and 58 showed radiographic improvement over this period. The remaining 58 patients were allocated to groups L (n = 27) and S (n = 31). Patients in group L showed greater improvements in symptoms, respiratory function, and radiographic appearances than those in group S, although the differences were not large. After adjusting for differences at the time of allocation, the average difference in vital capacity between groups L and S at final assessment was 9% of the predicted value. Side effects of treatment were frequent but usually mild, necessitating withdrawal in only two individuals. CONCLUSIONS: After excluding those individuals who required steroids for control of symptoms, approximately half of the remaining patients with sarcoidosis and pulmonary shadowing showed spontaneous radiographic improvement during six months of observation. In those in whom the radiograph failed to improve, prolonged steroid treatment with the aim of optimising radiographic appearances resulted in a significantly better long term functional outcome.

Adult↗
PubMed1996

Human cataract risk factors: significance of abstention from, and high consumption of, ethanol (U-curve) and non-significance of smoking.

Current ethanol consumption and cigarette smoking were quantified by questionnaire in Edinburgh and suburbs, Scotland, UK. Stringently matched cataract-control pairs (n = 990 and 858, respectively) were included. For ethanol, 'light and infrequent' consumption and 'light and frequent' were associated with a significantly lower risk of cataract than were total abstention and 'occasional' consumption; the prevalence of cataract rose with further increases in consumption, suggesting a U-shaped curve. For nuclear cataract, white in particular, there is a significant trend with amount consumed. Smoking was not found to be a risk factor.

Alcohol Drinking↗
PubMed1996

Three-year follow-up of a community-based cohort of men with untreated benign prostatic hyperplasia.

OBJECTIVE: To describe changes over 3 years in urinary symptom severity and bothersomeness and in interference caused by symptoms in selected everyday activities in a cohort of men with untreated benign prostatic hyperplasia (BPH). METHODS: A prospective study of a community-based cohort of 217 men from Forth Valley, Scotland, which satisfied a working clinical definition of symptomatic BPH and had not received treatment, were followed up at 1 and 3 years. RESULTS: Significant increases occurred in both mean symptom and bothersome levels for nocturia, urgency, dribbling, intermittency and incomplete emptying. Considerable proportions of men recorded changes in symptom levels, with the most fluctuation occurring for dribbling, weak stream and frequency-changes in bothersome levels showed a similar pattern. An increased number of men experienced some degree of interference in two or more selected everyday activities, but mean interference levels showed little change. CONCLUSIONS: Increasing trends in symptom prevalence, bother-someness and in the proportions of men experiencing interference in everyday activities were established over the 3 years, despite considerable within-subject variation.

Adult↗
PubMed1996

An inter-rater reliability study of the Functional Assessment Measure (FIM+FAM).

There is an increasing demand for measures of outcome to evaluate the effects of rehabilitation interventions for brain injury from clinicians, research workers and healthcare providers and purchasers. The Functional Assessment Measure (FIM+FAM), an expanded derivative of the Functional Independence Measure (FIM), is designed specifically for this purpose for this patient group. This study examined the interrater reliability of the FIM+FAM between two independent raters, a physician and a nurse, the subjects being 30 in-patients in a neurological rehabilitation unit. The results show that the inter-rater reliability was good (kappa values 0.50 to 0.95) for all but one of the 30 items rated on the FIM+FAM. The exception (with a kappa value of 0.35) was "adjustment to limits'. Higher agreement was found for rating of physical activities than for cognitive, communication and behavioural items.

Activities of Daily Living↗
PubMed1996

The prevalence of dermatophyte infection in well-controlled diabetics and the response to Trichophyton antigen.

The prevalence of dermatophyte infection was assessed in 100 patients with well-controlled insulin-dependent diabetes, and in a control group of 100 non-diabetics matched for age, sex, occupation and sporting activity. Immediate and delayed responses to intradermal testing with Trichophyton antigen were recorded in both groups. The overall infection rate (skin and nails) was 19% in diabetics and 17% in controls. There was a higher infection rate in the skin of diabetics (17%) than in controls (8%), but this was not significant. Nail infection was seen in 12% of diabetics and in 11% of controls. Intradermal testing with Trichophyton antigen gave a higher proportion of both immediate and delayed positive results in diabetics. However, more control patients showed only an immediate positive response or only a delayed one. There was no evidence of an increased infection rate in those with immediate positive responses or of diminished infection rates in those with delayed positive responses, and no correlation with oral Candida infection. These findings applied equally to diabetics and controls.

Adult↗
PubMed1996

Prevalence of atopic eczema in the community: the Lothian Atopic Dermatitis study.

An epidemiological study of atopic eczema (AE), based on a semirural community in Scotland, using sound diagnostic criteria, has yielded prevalence data for all age groups including infants and adults. The overall 1-year period prevalence, age-standardized to the Scottish population, was 2.3%. The 1-year period prevalence was highest in the under 2s (9.8%), and showed a continuous reduction with increasing age. Over the age of 40, AE was found to be relatively rare, with a 1-year period prevalence of 0.2%. Adults over 16 years made up 38% of all patients with AE.

Adolescent↗
PubMed1996

The cost of atopic eczema.

Atopic eczema affects 2.3% of the U.K. population. We have carried out a community study in a semi-rural area to assess its economic impact. One hundred and fifty-five patients with atopic eczema were identified and expenditure was assessed over a 2-month period. The mean personal cost to the patient was pounds 25.90, while the mean cost to the health service was pounds 16.20. There were 58 lost working days and 17 lost school days. A cohort of 10 severely affected patients attending the Royal Infirmary of Edinburgh were studied; each patient spent, on average, pounds 325 in 2 months, and lead to a mean health service expenditure per patient of pounds 415, in 2 months. If these results were extrapolated to the U.K. population, the annual personal cost to patients with atopic eczema would be pounds 297m, the cost to the health service would be pounds 125m, and the annual cost to society of lost working days would be pounds 43m, making the total expenditure on atopic eczema pounds 465m.

Adolescent↗
PubMed1995

Familial Hypercholesterolaemia Regression Study: a randomised trial of low-density-lipoprotein apheresis.

Low-density-lipoprotein (LDL) apheresis has the theoretical advantage over anion-exchange resins and hydroxymethylglutaryl coenzyme A inhibitors of decreasing lipoprotein(a) as well as LDL. To confirm this advantage, patients with heterozygous familial hypercholesterolaemia and coronary artery disease were randomised to receive LDL apheresis fortnightly (with disposable dextran sulphate/cellulose columns) plus simvastatin 40 mg daily, or colestipol 20 g plus simvastatin 40 mg daily. Quantitative coronary angiography was repeated after a mean of 2.1 years in 20 patients undergoing apheresis and in 19 on combination drug therapy. Changes in serum lipoproteins were similar in both groups apart from greater lowering by apheresis of LDL cholesterol (3.2 vs 3.4 mmol/L in drug group, p = 0.03) and lipoprotein(a) (geometric means 14 vs 21 mg/dL, p = 0.03). There were no significant differences in primary angiographic endpoints per patient but lesion-based and segment-based secondary endpoints were biased in favour of the drug group (change in minimum lumen diameter of lesions 0.07 vs -0.004 mm, p = 0.046; change in mean lumen diameter of segments 0.02 vs -0.06 mm, p = 0.01). None of the angiographic changes correlated with lipoprotein(a) concentrations. Per patient changes in % diameter stenosis and minimum lumen diameter in the two groups were as or more favourable than those observed in five published trials that assessed lipid-lowering drug therapy by quantitative coronary angiography. Although LDL apheresis combined with simvastatin was more effective than colestipol plus simvastatin in reducing LDL cholesterol and lipoprotein(a), it was less beneficial in influencing coronary atherosclerosis and should be reserved for patients unresponsive to drugs. Decreasing lipoprotein(a) seems to be unnecessary if LDL cholesterol is reduced to 3.4 mmol/L or less.

Adult↗
PubMed1995

Peroxides in human leucocytes in acute septic shock: a preliminary study of acute phase changes and mortality.

Peroxidation by peripheral blood leucocytes was measured in 15 patients in acute septic shock and 15 uninfected controls, using the probe dichloroflorescein. Mortality in septic subjects was 40%. In 14 of 15 patients from whom serial samples were analysed, periods of increased oxidative activity were detected. Increased peroxidation occurred early in the sequence of clinical changes, at the same time as increases in temperature, blood pressure and C-reactive protein. Peak peroxide production preceded increases in acute phase reactants and changes in leucocyte distribution. Mean peroxide production in leukocytes from patients who died was significantly higher (P < 0.001) than paired controls, and greater (P < 0.05) than peroxide production in patients who survived. The in vitro oxidative response to endotoxin was upregulated in infected patients. This supports the hypothesis that systemic mediators and leucocyte-derived reactive oxygen are involved in the vascular and organ damage associated with fatal septic shock.

Acute-Phase Reaction↗
PubMed1995

Regression to the mean occurs in measuring peak urinary flow.

OBJECTIVE: To investigate the anomalous rises in maximum urinary flow rates seen in a prostate-diagnostic clinic. SUBJECTS AND METHODS: The study comprised 1994 men aged 40-79 years registered at five health centres in Central Scotland, participating in a study of the natural history of benign prostatic hyperplasia (BPH), who completed a urodynamic assessment on up to three occasions: in the community, on referral to a prostate-diagnostic clinic and at a one-year follow-up. RESULTS: Subjects referred to the diagnostic clinic on the basis of maximum flow rate (Qmax < 15 mL/s) and/or urinary symptomatology showed a mean increase in Qmax (P < 0.001) when tested at the clinic and at the one-year follow-up. In health centres which referred men to the clinic with no pre-selection, there were no significant changes in Qmax. CONCLUSION: Regression to the mean occurs when patients are selected on the basis of a low Qmax. The use of isolated low values of Qmax in the process of diagnosing BPH should be avoided.

Adult↗
PubMed1995

Some blood plasma constituents correlate with human cataract.

AIMS: To look for differences between matched pairs of patients and controls in concentrations of various plasma constituents which might indicate dysfunctions associated with cataract. METHOD: One thousand patients were taken from the cataract waiting list of a specialist eye hospital. For each patient a matched control of the same sex and half-decade of age but without cataract was taken from the patient list of the family doctor of the patient; the control was the next alphabetically after the patient on the doctor's list. The patients and controls were visited in their homes by a team of nurses who performed venepunctures and collected information for a questionnaire. Eye examinations were performed by a team of ophthalmologists. RESULTS: Significant differences were found between the cataract and control groups in 10 of the 18 examined plasma constituents. A constellation of three--bilirubin, alkaline phosphatase, and gamma glutamyl transpeptidase--was significantly higher in the cataract group, suggesting subclinical liver dysfunction as a risk factor. Steroid treatment and diabetes increased cataract risk. Endogenous basal plasma cortisol levels were raised in the cataract group, irrespective of steroid use and diabetic status. Alkaline phosphatase, calcium, glucose, and sodium were all raised in the cataract group. Given the raised total protein and albumin also found in the cataract group, the lower albumin/(total protein-albumin) ratio (an approximation for albumin/globulin ratio) may imply an increase in globulin, suggestive of possible (chronic) infection. Total cholesterol was lower in the cataract group. CONCLUSION: Human cataract in older age groups seems to be due to an accumulation of risk factors, even if individual mean concentrations are well within normal limits but, of course, differing significantly from the corresponding means in the control population.

Adult↗
PubMed1995

Audit of tumour histopathology reviewed by a regional oncology centre.

AIMS: To analyse the diagnostic differences in reporting tumour histopathology between a district general hospital and a regional oncology centre. METHODS: Tumour histopathology reports (n = 227) extracted from Bolton General Hospital files between 1988 and 1992 were compared with the corresponding Christie Hospital (oncology centre) reports, the same material having been seen at both hospitals. RESULTS: Diagnostic agreement existed in 77% of all cases. The incidence of major discrepancies was 8.37%. Of the diagnoses, 19 (36%) cases involved major discrepancies and 34 (64%) cases minor discrepancies. Most discrepancies occurred in the lymphoma group and involved subclassification of Hodgkin's and non-Hodgkin's lymphoma. Ki1 anaplastic large cell lymphoma and T cell rich B cell lymphoma were problematic diagnoses. The correct grading of follicle centre cell lymphomas using the Kiel classification was another problem area. In 19 cases certain aspects of immunohistochemistry produced discrepancies. In one case an incorrect diagnosis was made at the oncology centre and in another both centres gave an incorrect diagnosis. CONCLUSIONS: Areas of diagnostic difficulty mainly involve the subclassification of lymphomas. Review of tumour pathology by experts is recommended, at least in certain categories, to ensure correct diagnosis and uniformity in subclassification of tumours.

Cancer Care Facilities↗
PubMed1995

An open, prospective comparison of beta 2 agonists given via nebuliser, Nebuhaler, or pressurised inhaler by ambulance crew as emergency treatment.

BACKGROUND: The merits of the use of beta 2 agonists by ambulance crew and best methods of delivery have not been fully explored. METHODS: A prospective comparison has been made of treatments applied in three districts in South Wales (200 micrograms salbutamol by pressurised inhaler, 5 mg salbutamol via nebuliser, and 5 mg terbutaline via Nebuhaler) by emergency ambulance personnel to acutely wheezy patients en route to hospital. Pulse rate, respiratory rate, peak expiratory flow rate (PEFR), and breathlessness scored on a visual analogue scale were compared before and after treatment. Data were collected on diagnosis, artificial ventilation, cardiorespiratory arrest, and death. RESULTS: Thirty eight patients received salbutamol inhaler, 51 salbutamol via nebuliser, and 41 terbutaline via Nebuhaler. There were greater reductions in respiratory rate and breathlessness score and more improvement in PEFR in the group receiving nebulised salbutamol than in the other two groups. No patient was ventilated and of the five deaths none was caused by asthma. CONCLUSIONS: For wheezy, breathless patients treated en route to hospital by emergency ambulance personnel, 5 mg salbutamol given by an oxygen-driven nebuliser was more effective than either 5 mg terbutaline via a Nebuhaler or 200 micrograms salbutamol via a pressurised inhaler.

Acute Disease↗
PubMed1995

Combined bezafibrate and simvastatin treatment for mixed hyperlipidaemia.

The safety and efficacy of combined bezafibrate-simvastatin therapy was evaluated in 49 patients with diet-resistant mixed hyperlipidaemia (type IIb). After a two-month placebo phase, patients were randomized to receive either Bezafibrate Slow Release (SR) 400 mg mane or simvastatin 20 mg nocte followed by three months combination therapy. Total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol were measured at monthly intervals. Apolipoproteins (apo) A1 and B, lipoprotein (a) [Lp(a)] and fibrinogen were measured before and after each treatment. Simvastatin was more effective than Bezafibrate SR in reducing total cholesterol (2.0 vs. 1.1 mmol/l, p = 0.003) and lowering LDL cholesterol (1.7 vs. 0.4 mmol/l, p = 0.0001) whereas Bezafibrate SR was more effective in reducing triglycerides (by 41% vs. 17%, p = 0.001) and fibrinogen (by 23% vs. 3%, p = 0.004). Compared with simvastatin monotherapy, combined drug therapy induced further reductions in triglycerides (by 26%, p = 0.0003) and apoB (by 11 mg/dl, p = 0.03) and an increase in apoA1 (by 21 mg/dl, p = 0.0008). Symptomatic and biochemical adverse events did not occur more frequently on combined drug therapy than on monotherapy. The combination of bezafibrate and simvastatin was more effective in controlling mixed hyperlipidaemia than either drug alone and did not provoke more adverse events.

Adolescent↗
PubMed1994

Actual over best function as an outcome measure in asthma.

Several guidelines for the management of asthma suggest that actual/best function is a useful outcome measure. This implies accurate assessment of best function, and a standard for the proportion of best function to be achieved. Seventeen clinics observed their practice simultaneously during four periods in 1990. The aims of the study included testing a protocol for the assessment of best function, and validating actual/best function as an outcome measure. The proposed target for actual/best function to indicate satisfactory control was 80%. The protocol for assessment of best function required formal trial of steroids if best function was < 70% predicted; with regular recording of peak expiratory flow (PEF) if < 80% predicted. PEF was recorded in 515 and FEV1 in 680 of 767 subjects, following the usual clinic practice. If the protocol for best function was not satisfied, mean actual/best function was no higher than if it was, except when best PEF was < 70% predicted. This suggests the need for a PEF chart in these latter patients. Best function was greater in females than males, but actual/best function was almost identical. Whilst best function declined with increasing intensity of treatment, actual/best function was almost independent of regimen step, particularly in the centre which most closely adhered to the protocol. These results confirm that actual/best function is a valid outcome measure. Mean actual/best was > 80% except for FEV1 in two centres. It is suggested that the target in chronic management of asthma is raised from 80 to 85% of best, when actual/best PEF is used as a spot check in patients believed to be on optimal therapy.

Asthma↗