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Biomedical subjects

R Kennedy

Publications and source records attributed to R Kennedy.

At least 55 records · Page 3Linked to original sources
PubMed1997

Audit of screening programme for congenital hypothyroidism in Scotland 1979-93.

OBJECTIVE: To evaluate the efficiency of the screening programme for congenital hypothyroidism in Scotland and to determine the outcome in the cohort of children with positive testing for thyroid stimulating hormone (TSH). DESIGN: Establishment of comprehensive database for all Scottish infants with high TSH, detected on Guthrie screening. SUBJECTS: 344 infants born between August 1979 and December 1993 with TSH greater than 40 mU/l on initial Guthrie, or 15-40 mU/l on repeat Guthrie. MAIN OUTCOME MEASURES: Ages at time of: (a) Guthrie collection, (b) notification of positive result by laboratory, and (c) start of treatment; audit of late diagnosis/missed cases; categorisation of positive cases into definite and probable congenital hypothyroidism, transient TSH elevation, and uncertain status; educational status of children with definite and probable congenital hypothyroidism. RESULTS: 344 positive cases were categorised as having definite (224) and probable (11) congenital hypothyroidism, transient TSH elevation (88), and status uncertain (21). The overall incidence of definite/probable congenital hypothyroidism was 1 in 4400 live births. For the definite/probable groups median age of Guthrie collection was consistently between 6 and 7 days from 1983 onwards but for the whole cohort was later than 10 days in 10.5%. Median age of notification fell from 14 days in 1980 to 11 days in 1993. Median age of starting treatment ranged between 11 and 15 days from 1983 onwards. Treatment was delayed in four cases, three due to failed or late Guthrie card submission. Of 149 children with definite/ probable congenital hypothyroidism who were of school age, educational status was ascertained in 139 (93%). Only two children (1.4%) were attending special school, one of whom was known to have mild hypothyroidism. Sixteen children (11.5%) were receiving extra help in mainstream education compared with 18% of control children in the Scottish very low birth weight study. CONCLUSION: The current screening programme is working well, but efficiency could be increased by earlier and more reliable Guthrie collection. A substantial proportion of children picked up on the screening programme have a transient rise in TSH rather than true congenital hypothyroidism. The incidence of special education and learning support in Scottish children with congenital hypothyroidism appears to be no different to that of the general population.

Age Factors↗
PubMed1997

Internet-enabled solutions for health care business problems.

Many health care delivery organizations have built, installed, or made use of Nets. As single entities merge with others, and independent institutions become part of much larger delivery networks, the need for collaboration is critical. With the formation of such partnerships, existing platforms will become increasingly available from which it will be possible to build disparate technologies that must somehow be part of a single working "system." Nets can enable this leveraging, allowing access from multiple technological platforms. The collaboration, distribution, application integration, and messaging possibilities with the Nets are unprecedented. We believe that meeting a health care delivery organization's needs without these benefits will soon be unthinkable. While Nets are not the answer to the challenges facing health care delivery today, they certainly are a large contributor to the solution.

Computer Communication Networks↗
PubMed1996

Borrelia burgdorferi possesses a collagenolytic activity.

Lyme disease is a multisystemic disorder caused by Borrelia burgdorferi, an invasive spirochete. B. burgdorferi has a predilection for collagenous tissue and one major clinical manifestation of the disease is arthritis. We have identified a collagenolytic activity in B. burgdorferi detergent lysates using iodinated gelatin as well as iodinated pepsinized human collagen types II and IV as protein substrates. In addition, we describe several proteolytic activities in B. burgdorferi with molecular masses greater than 200 kDa on sodium dodecyl sulfate polyacrylamide gels containing copolymerized gelatin. We propose that the collagenolytic activity of B. burgdorferi has a role in invasion, in the pathogenesis of Lyme arthritis, and perhaps also in other manifestations of Lyme borreliosis.

Borrelia burgdorferi Group↗
PubMed1996

Juvenile xanthogranuloma: forms of systemic disease and their clinical implications.

OBJECTIVE: Juvenile xanthogranuloma (JXG) with systemic (extracutaneous) involvement is a rare histiocytic disorder in which significant morbidity and occasional deaths may occur. The objective of this study was to characterize the spectrum of anatomic involvement, associated clinical problems, and management considerations in children with systemic JXG. STUDY DESIGN: Two current cases and literature reports of 34 children with various forms of systemic AG were analyzed with respect to age, clinical presentation, site(s) of involvement, therapy, and outcome. RESULTS: The median age of the 36 patients was 0.3 years (range, birth to 12 years). Symptoms were usually referable to bulky or infiltrative disease. Twenty patients had disease in two or more sites. Cutaneous lesions were present in fewer than half the patients. The most frequent extracutaneous sites of disease were the subcutaneous soft tissue (12); central nervous system (8); liver/spleen (8); lung (6); eye/orbit, oropharynx, and muscle (4 each); with three or fewer instances of disease in each of several other sites. Most patients were treated with excision or had spontaneous regression (some with organ involvement). However, 12 patients received treatment that included radiation or systemic chemotherapy. Survivors, some with long-term disabilities, included young children who had received radiation therapy to the brain, eye, skin, or heart. Two patients died of disease. CONCLUSIONS: Systemic AG may involve varying numbers and combinations of extracutaneous sites. The extent of disease should be determined in patients with AG who are suspected to have systemic involvement. In contrast to the cutaneous form, systemic AG may be associated with significant complications requiring aggressive medical care. When feasible, surgical excision of lesions may be curative. Optimal treatment for symptomatic, unresectable disease is currently undefined but should be selected to minimize toxic effects in these children who are typically younger than 1 year old at presentation.

Anti-Inflammatory Agents↗
PubMed1996

Prevention of experimental postoperative peritoneal adhesions by N,O-carboxymethyl chitosan.

BACKGROUND: Postsurgical adhesion formation can result in significant morbidity and, to a lesser extent, death. The purpose of this experiment was to assess the ability of N,O-carboxymethyl chitosan (NOCC) to prevent postsurgical adhesion formation in vivo. METHODS: Randomized groups of Sprague-Dawley rats were studied under two abdominal surgery models, the uterine horn model and the small bowel laceration model, for the ability of NOCC to reduce the incidence and severity of adhesion formation. Adhesions in animals were assessed after death by a blinded observer 10 to 14 days after surgical manipulation. RESULTS: NOCC consistently reduced the size, strength, and number of adhesions in both rat models. NOCC was also found to be more effective than hyaluronic acid at inhibiting adhesion formation. CONCLUSIONS: NOCC is a more effective antiadhesion agent than is the more expensive hyaluronic acid. Although the exact mechanism of NOCC's antiadhesion activity is as yet unclear, the novel chemical is of particular interest for clinical use.

Animals↗
PubMed1996

Expression of capillary basement membrane components during sequential phases of wound angiogenesis.

Before capillaries sprout to form new vessels in a wound, the endothelial cells are sequestered from the surrounding stromal or provisional matrix by a well organized protein envelope called the basement membrane (BM). After breaching the BM, endothelial cells are exposed to the wound provisional matrix and begin to migrate and proliferate. Endothelial derived basement membrane proteins and molecules of the provisional matrix are mutually accessible to the endothelial cell surface during migration. Eventually, new capillaries again segregate in a formed envelope of basement membrane and resume a tubular morphology. Endothelial cell recognition of the architecture and concentration of basement membrane ligands appears to be an important determinant of capillary morphology during angiogenesis. In this study, we characterized the molecular composition, expression and steady-state transcript levels of BM proteins during sequential stages of wound angiogenesis. Specific analysis of rat capillary BM transcripts was achieved by employing a space-filling wound model which did not have non-capillary BM. Invading capillaries appeared between days 3 and 5 and matured by day 12. Occasionally, vessels larger than capillaries were observed to form by a process resembling vasculogenesis. Steady-state transcript levels for subunits of all major BM proteins studied were readily measured by day 3, and laminin and type IV collagen immunostaining were evident at the periphery of all vessels studied. From vessel initiation to regression, the transcript levels most changed were the alpha 1 and alpha 2 transcripts of type IV collagen; after an early peak, they exhibited a sharp three-fold decline as the response progressed. Conversely, entactin and laminin subunits did not decline as the response progressed, suggesting an increasing ratio of expression relative to type IV collagen. Perlecan expression was inconsistent, but it appeared to decline during the late phase of the response. Laminin beta 1 and gamma 1, but not alpha 1 or beta 2, transcripts were expressed by forming capillaries, providing evidence that the laminin 1, 3, 4 and 7 isotypes are not expressed by growing capillaries. These results also demonstrate that the steady-state ratios of type IV collagen transcripts to laminin and entactin transcripts are greatest during the early proliferative-migratory phase of angiogenesis but decrease significantly in later phases, when vessel maturation and tube formation predominate.

Animals↗
PubMed1996

The relation of attachment status, psychiatric classification, and response to psychotherapy.

The relation of patterns of attachment and psychiatric status was studied in 82 nonpsychotic inpatients and 85 case-matched controls using the Adult Attachment Interview (AAI). AAI transcripts rated (masked to case vs. control status and treatment) were classified using M. Main and R. Goldwyn's (1991) system. Psychiatric patients, diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) I and II structured interviews, were more likely to be classified as preoccupied and unresolved with respect to loss or abuse. On Axis I, anxiety was associated with unresolved status, and AAI scales were able to discriminate depression and eating disorder. On Axis II, borderline personality disorder (BPD) was linked to experience of severe trauma and lack of resolution with respect to it. BPD patients were also rated significantly lower on a scale measuring awareness of mental states. Preliminary outcome results suggest that individuals rated as dismissing on the AAI are more likely to show improvements in psychotherapy.

Borderline Personality Disorder↗
PubMed1996

The presentation of newly-diagnosed diabetic patients in Uganda.

We assessed the clinical characteristics of newly-diagnosed diabetic patients presenting to the Mulago Hospital Diabetic Clinic for the first time between 1 January 1993 and 10 August 1994. There were 252 patients: 117 men and 135 women. Mean age at onset of diabetes was 45 years (range 2-87 years) and peak incidence was at 40-49 years. Body mass index (BMI) was available in only 71 patients, of whom 53.5% (33.8% female, 19.7% male) were overweight (BMI > 25 in women, in > 27 men) and 11.3% (8.5% men, 2.8% women) were underweight (BMI < 20). Obesity was more marked in young women. Almost all patients presented with the classical symptoms of diabetes, and the majority were severely hyperglycaemic. A family history of diabetes was identified in 16%. Concurrent illnesses at diagnosis of diabetes were unusual. Sepsis was commonest (11.9%), followed by malaria (7.8%), tuberculosis (1.2%), AIDS (1.2%) and pancreatitis (0.8%). Peripheral neuropathy was present in 46.4% of patients, hypertension (BP > 150/100) in 27.3%, impotence in 22.2% of the men, proteinuria in 17.1%, ischaemic heart disease in 4.8%, foot ulcers in 4.0% and cataracts in 3.2%. Insulin was the most commonly prescribed treatment (52.8%); 31% of patients received oral hypoglycaemic agents, only 15.1% were managed on diet only, and 1.2% opted for herbal medicine.

Adolescent↗
PubMed1995

Sclerosing of recurrent lymphangioma using OK-432.

The authors present two cases of lymphangioma of the cervicofacial region, treated with a new investigational drug in North America, OK-432 (picibanil), a sclerosing agent intralesionally injected. Both patients had been treated surgically and had recurrence of the tumor. Intralesional injection of OK-432 without aspiration was employed for the first patient, and after aspiration in the second patient. A change in consistency of the tumor, manifested by softening, was followed by marked shrinkage. No complication either locally or systemically has occurred during the follow-up period (10 to 16 months). In both cases, satisfactory results were obtained, resulting in definite reduction in size and improvement in cosmetic appearance. The authors recommend OK-432 intralesional injection for surgically challenging lymphangioma. Their results support those of a recent Japanese study using OK-432 as sclerosing therapy for unresectable lymphangioma.

Adolescent↗
PubMed1995

Building the CHIN (community health information network) organization.

This article presents a template for establishing a community health information network (CHIN) and focuses primarily on the most popular organizational model for a CHIN, the community coalition model. Additionally, practical solutions to the challenges facing these organizations are presented, based on experiences with CHIN initiatives across the country.

Catchment Area, Health↗
PubMed1995

Field trial of the Otago photoscreener.

OBJECTIVE: To assess the effectiveness of the Otago photoscreener in detecting amblyogenic factors in the general population. DESIGN: Prospective clinical trial. SETTING: Suburban school district in Delta, BC. PARTICIPANTS: A total of 1245 kindergarten children. INTERVENTIONS: Screening for visual defects was done with the Otago photoscreener (by a technician) and the regular manual method (by a health care aide). A standard ophthalmologic examination was performed by a pediatric ophthalmologist and an orthoptist in a random sample of 20% of all children with normal results of screening (n = 241) plus all those with abnormal results (n = 29). MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, rates of false-negative and false-positive results. RESULTS: The Otago screener had higher sensitivity than the manual technique (81% vs. 33%), especially for strabismus and cataracts. The specificity values of the two techniques were 98% and 97% respectively, and the positive predictive values were 77% and 54% respectively. The manual technique failed to identify 5.8% of children with visual defects, compared with 1.6% for the Otago screener. CONCLUSIONS: The Otago photoscreener is a superior instrument for identifying amblyogenic eye disease. However, given the relatively low yield, the value of any screening method should be assessed with regard to both costs and benefits.

Amblyopia↗
PubMed1994

Breast feeding in Scotland.

OBJECTIVE: To measure the prevalence of breast feeding and to examine the value of using information collected on Guthrie cards (used for detecting inherited metabolic disease and hypothyroidism when newborn infants are 7 days old) to calculate this prevalence. DESIGN: Analysis, by geographical area and maternity unit, of information on breast feeding collected on Guthrie cards for 131,759 babies born in 1990 and 1991, and comparison with prevalences from other sources. SETTING: Scotland. RESULTS: Of the 131,759 babies, only 46,949 (35.6%) were breast feeding on day 7. The prevalence of breast feeding ranged from 59.1% (376/636) in Shetland to 21.1% (1836/8719) in Lanarkshire and < 8% in some postcode districts of cities. Analysis of the data by hospital of birth showed that the prevalence ranged from 51.2% (2701/5275) to 16.4% (507/3090). CONCLUSION: The prevalence of breast feeding in Scotland is low and varies among areas and maternity units. Intervention to increase this prevalence is essential, and information collected on Guthrie cards is a useful indication of mothers' intentions to breast feed.

Breast Feeding↗
PubMed1993

The impact of spina bifida on the medical services of Newfoundland and Labrador.

This institution receives all live spina bifida patients from Newfoundland and Labrador. The aim of this study is to determine the outcome of these patients and the impact on the medical system. On a retrospective chart review, 274 patients born between 1967 and 1990 were studied. An analysis of the statistical variables showed that the incidence per 1,000 live births has remained stationary in Newfoundland and Labrador; there is a slight female predominance; 64% were born to young mothers and the peak incidence occurred in March, April, and May. A total of 179 patients of 254 who underwent surgery were alive and underwent rehabilitation programmes. Only 35% are wheelchair bound; the rest are ambulatory. One hundred sixty-one are of school age or older, 78 are in regular high school (3 dropouts), 36 are in special education, 6 graduated from high school, 4 are in university, 15 had no neurological deficit, 7 were lost in follow-up, 5 died, 9 had gross mental retardation, and 1 is the mother of three normal children. To attain these results these patients had multiple admissions and surgical procedures and the patients are seen twice a year in a rehabilitation and multidisciplinary clinic. From this study, the utilization of the medical services and impact on the community is great. However, the majority of these patients appear to attain a surprisingly high quality of life.

Female↗