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Biomedical subjects

R McNamee

Publications and source records attributed to R McNamee.

At least 37 records · Page 2Linked to original sources
PubMed1997

Case-control study of stroke and the quality of hypertension control in north west England.

OBJECTIVE: To examine the risk of stroke in relation to quality of hypertension control in routine general practice across an entire health district. DESIGN: Population based matched case-control study. SETTING: East Lancashire Health District with a participating population of 388,821 aged < or = 80. SUBJECTS: Cases were patients under 80 with their first stroke identified from a population based stroke register between 1 July 1994 and 30 June 1995. For each case two controls matched with the case for age and sex were selected from the same practice register. Hypertension was defined as systolic blood pressure > or = 160 mm Hg or diastolic blood pressure > or = 95 mm Hg, or both, on at least two occasions within any three month period or any history of treatment with antihypertensive drugs. MAIN OUTCOME MEASURES: Prevalence of hypertension and quality of control of hypertension assessed by using the mean blood pressure recorded before stroke) and odds ratios of stroke (derived from conditional logistic regression). RESULTS: Records of 267 cases and 534 controls were examined; 61% and 42% of these subjects respectively were hypertensive. Compared with non-hypertensive subjects hypertensive patients receiving treatment whose average pre-event systolic blood pressure was controlled to < 140 mm Hg had an adjusted odds ratio for stroke of 1.3 (95% confidence interval 0.6 to 2.7). Those fairly well controlled (140-149 mm Hg), moderately controlled (150-159 mm Hg), or poorly controlled (> or = 160 mm Hg) or untreated had progressively raised odds ratios of 1.6, 2.2, 3.2, and 3.5 respectively. Results for diastolic pressure were similar; both were independent of initial pressures before treatment. Around 21% of strokes were thus attributable to inadequate control with treatment, or 46 first events yearly per 100,000 population aged 40-79. CONCLUSIONS: Risk of stroke was clearly related to quality of control of blood pressure with treatment. In routine practice consistent control of blood pressure to below 150/90 mm Hg seems to be required for optimal stroke prevention.

Adult↗
PubMed1997

Injuries after falls at work in the United Kingdom and Sweden with special reference to fractures in women over 45.

OBJECTIVES: To describe the relation with age of risk of reported injury after a fall among women at work in two countries, the United Kingdom and Sweden, with particular emphasis on fractures, and to interpret these data. METHODS: Rates of accidents compiled under the national reporting regulations of each country during a two year period were described by age, sex, cause (fall on the level, fall from a height, other), and occurrence of fracture, with emphasis on the relative risk (RR) in workers aged 45 years and over compared with those aged under 45. For fractures (major fractures only in the United Kingdom) among women, RRs were calculated for all occupations, with the three digit occupational classification schemes of each country. Summary RRs for older versus younger women, directly standardised for occupation, were derived. RESULTS: Among women, RRs for injury after a fall on the level and fall from a height were 2.77 and 1.77 respectively in Sweden and 2.28 and 1.54 in the United Kingdom. When restricted to fractures, the RRs became 4.75 and 3.66 respectively in Sweden and 3.35 and 1.97 in the United Kingdom. Standardisation for occupation gave RRs for fractures of 4.87 and 3.75 in Sweden and 3.43 and 2.16 in the United Kingdom. Almost all occupational groups with enough fractures for analysis showed an excess of fractures related to falls among older women. A different age pattern was seen for all injuries or fracture after other types of accidents and for all types of accident in men. CONCLUSION: It is argued that, for fractures at least, the results for women are unlikely to be due to reporting bias and unlikely to be explained by a greater exposure to workplace hazards among older women. Whether there is an increased risk of falling, as distinct from sustaining a fracture, is not clear. The generality of the increased risk suggest that efforts should be made to minimise hazards in all occupational sectors, particularly those using many women.

Accidental Falls↗
PubMed1996

Shiftwork and mortality from ischaemic heart disease.

OBJECTIVES: To investigate the relation between shift work and death from ischaemic heart disease (IHD). METHODS: A nested case-control approach was used. The cohort comprised male manual workers who joined an industrial company aged 50 years or under between 1 January 1950 and 31 December 1992 and worked there for at least one month. Cases were 467 cohort members who died during the same period aged 75 years or under, with ischaemic heart disease (IHD) (international classification of diseases (ICD) 410-414) coded from the death certificate. For each case a control worker was chosen, who joined the company at the same age and in the same period but who survived the case. Work status (shift work or day work) was assigned to cases for their entire employment and to controls for that part of their employment which preceded the matching case's death. The main source of information was historical personnel records containing pay codes which differed for day work and shift work. Information on weight, height, blood pressure, and smoking from a pre-employment medical was available. RESULTS: Two thirds of subjects had been employed for at least one month as shift workers and there was evidence that they had slightly better health at recruitment than day workers. The odds ratio for shift workers during the period starting 10 years after shift work began, and after adjustment for height, body mass index, blood pressure, smoking, duration of employment, and job status (skilled or unskilled) was 0.90 (90% confidence interval (90% CI): 0.68-1.21). There was no relation between risk of IHD death, and duration of shift work, but there was evidence of a reduced risk when actively employed as a shift worker, together with an increased risk in the first five years after leaving shift work to do day work. CONCLUSIONS: Shift work did not increase the risk of death from ischaemic heart disease in this study. Those workers with poorer cardiovascular health may be under represented in groups with longer shift work experience because of health related selection out of shift work.

Adult↗
PubMed1995

Preliminary analysis of proportional mortality in a cohort of British pottery workers exposed to crystalline silica.

A cohort of 7020 male pottery workers born in 1916-1945 was identified from all employees in dust-exposed trades, subject to medical surveillance by the Benefits Agency Medical Service of the Department of Social Security in Stoke-on-Trent in the United Kingdom. All but 256 (3.6%) were traced, 1016 (15.0%) had died by 30 June 1992, and death certificates were obtained for 940 (92.5%) of the fatalities - 122 from respiratory cancer. After the exclusion of any recorded asbestos exposure, the proportional mortality ratio (PMR) for lung cancer was 1.22 when calculated against national rates (P < 0.02), but the PMR against local rates was 1.04. Logistic regression analyses based on 75 nested case-referent pairs for which the required information was available showed that lung cancer mortality was dominated by smoking and significantly affected by past asbestos exposure. However, for 47 pairs in which both the case and referent had a history of smoking, there was also significant evidence that the risk was related to duration of silica dust exposure in pottery work but not to radiological score.

Ceramics↗
PubMed1994

Occupational exposure to hydrocarbons and chronic pancreatitis: a case-referent study.

OBJECTIVES: To investigate the hypothesis that hydrocarbon exposure is a risk factor for chronic pancreatitis. METHODS: 102 cases of chronic pancreatitis and 204 age and sex matched referents were interviewed about their occupational histories, alcohol and cigarette consumption, and diet. Exposure to hydrocarbons was inferred from interview responses by four assessors who were blind to disease state, and these data were then summarised by a cumulative hydrocarbon exposure (CHE) score. RESULTS: After adjustment for alcohol, cigarettes, dietary antioxidants, and social class, odds ratios for low CHE scores were 1.20 (90% CI: 0.62-2.35) and 2.67 (90% CI: 1.22-5.87) for high scores. A test for trend with level of exposure among only those who had exposure scores > 0 gave p = 0.09. Analysis by type of hydrocarbon was limited to four exposures for each of which there were at least 20 exposed patients. The adjusted OR for paint solvents (any level) was 0.96 (90% CI: 0.48-1.93); for diesel exhaust fumes OR = 2.66 (90% CI: 1.05-6.73); for petrochemicals OR = 1.82 (90% CI: 0.80-4.11); and for chlorinated solvents OR = 1.49 (90% CI: 0.58-3.81). CONCLUSIONS: These results support the original hypothesis. Further studies are needed to confirm or refute the findings here and to clarify the types of hydrocarbon involved.

Adult↗
PubMed1994

Effect of changes in maternal smoking habits in early pregnancy on infant birthweight.

BACKGROUND: The inverse relationship between maternal smoking and infant birthweight is well documented. AIM: The aim of the present study was to examine whether a change in maternal cigarette consumption in early pregnancy affects the infant's birthweight. METHOD: A total of 5980 women who presented to their general practitioners between 1976 and 1979 with an unplanned pregnancy and the babies resulting from these pregnancies were included in the study. Women were divided into four categories: non-smokers, smokers, quitters and reducers. RESULTS: In terms of mean infant birthweight, the non-smokers had a clear benefit over the smokers whose babies were 153 g lighter (P < 0.001), and over the quitters whose infants were 39 g lighter. There was also an advantage in stopping smoking: the smokers had babies whose mean birthweight was 120 g less than that of the quitters (P < 0.001). There was no demonstrable benefit from reducing cigarette consumption without entirely stopping. CONCLUSION: These findings may have important implications for where best to target health education.

Attitude to Health↗
PubMed1993

The effect of induced abortion on subsequent fertility.

OBJECTIVE: To investigate the effect of induced abortion on subsequent fertility. DESIGN: 1. Prospective cohort study of women who had an unplanned pregnancy at recruitment. 2. Retrospective study of women who had a planned pregnancy at recruitment. SETTING: Joint Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists study based in general practice in England, Scotland and Wales, between 1976 and 1987. SUBJECTS: 1. Prospective study: Four hundred and thirty-three women with a recruitment unplanned pregnancy ending in induced abortion (abortion group) and 1035 women with a recruitment unplanned pregnancy which ended naturally (nonabortion group). All subsequently had a planned pregnancy, or were known to be trying to conceive at some point during the follow-up. 2. Retrospective study: Nine thousand two hundred and ninety-nine women who presented at recruitment with a planned pregnancy. MAIN OUTCOME MEASURE: The women's estimated length of planning time, expressed as a fertility rate ratio. RESULTS: Induced abortion was not related to future fertility. In the prospective study, the fertility rate ratio (FRR) of the abortion group relative to the nonabortion group was 0.94 (95% CI 0.83 to 1.07, P = 0.37). This result was supported by the retrospective study, which again showed no important difference between the two groups. CONCLUSION: Induced abortion does not appear to have an important effect on future fertility.

Abortion, Induced↗
PubMed1991

The effect of induced abortion on subsequent pregnancy outcome.

OBJECTIVE: To investigate the effect of induced abortion on the outcome of the next pregnancy. DESIGN: Long-term prospective controlled cohort study. SETTING: Joint Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists study based in general practice in England, Scotland and Wales. SUBJECTS: 1311 women whose recruitment pregnancy had ended in induced abortion (the abortion group) and 2131 women whose recruitment pregnancy had a natural conclusion (the non-abortion group). MAIN OUTCOME MEASURES: Non-viable outcome (spontaneous or missed miscarriage, ectopic pregnancy or stillbirth), birthweight, length of gestation. RESULTS: Induced abortion was not materially associated with any of the three measures of adverse outcome. Compared with the non-abortion group the relative risk of a non-viable outcome in the abortion group was 1.01 (95% CI 0.81 to 1.27). In the abortion group birthweight was an average 23 g lighter (95% CI -76 g to + 30 g) and length of gestation an average 0.9 days shorter (95% CI -2.2 days to + 0.4 days) than in the non-abortion group. Women who had their abortions in NHS premises had an increased risk of a non-viable outcome (RR 2.55, 95% CI 1.31 to 4.94) and had babies with significantly lower mean birthweight (-119 g, 95% CI -233 g to +5 g) compared with those who obtained their operations in the private sector. Women whose abortion had been carried out by a consultant had the lowest risk of non-viable outcome. Although these differences remained after adjustment for a number of important variables, it is possible that factors not measured in the present study, such as economic status and occupation, played a contributory role. CONCLUSION: Overall, induced abortion was not associated with any important effect on the three measures of adverse outcome in the subsequent pregnancy.

Abortion, Induced↗
PubMed1988

Effect of enhanced macrophage function on early wound healing.

Although the macrophage is important to wound healing, research has focused on its relationship to fibroblast and collagen synthesis. This study was designed to assess effects of enhanced macrophage function on early wound healing, before established collagen synthesis. Sprague-Dawley rats had dorsal incisions after one of three treatment regimens: (1) saline solution, 0.5 ml administered intravenously, (2) intravenous glucan, a macrophage stimulant, 20 mg; (3) topical glucan, 20 mg. Intravenous therapy was administered 24 hours before and after incision. Breaking strength was significantly increased (p less than 0.01) by both intravenous glucan (49.8 +/- 5.5 gm) and topical glucan (59.7 +/- 5.6 gm) on the fourth day after incision, compared with controls (22.0 +/- 2.6 gm). Similar results occurred on the seventh day after incision. Although formalin fixation significantly enhanced breaking strength in fresh control wounds (22.0 +/- 2.6 vs 39.5 +/- 2.2 gm), no increase occurred in wounds treated with intravenous glucan (49.8 +/- 5.0 vs 55.3 +/- 6.4 gm), indicating maximal cross-linking of collagen. Collagen synthesis, reflected by tritiated proline uptake, was no different in control versus glucan groups. Supernatants from control or glucan-activated macrophages were injected intraperitoneally or applied topically in the rat model. Activated supernatant, both intraperitoneal and topical, resulted in increased breaking strength on the fourth day after incision. Formalin fixation did not increase breaking strength in the activated supernatant groups. We conclude that enhanced macrophage function increases early wound breaking strength. This effect appears unrelated to collagen synthesis but may be related to increased cross-linking of collagen. Similar effects are seen with activated macrophage secretory products administered intraperitoneally or topically.

Administration, Topical↗
PubMed1987

Protective effect of glucan-enhanced macrophage function in experimental pancreatitis.

In an effort to assess the impact of enhanced macrophage function in acute pancreatitis, mice were subjected to a choline-deficient diet supplemented by ethionine to induce necrotizing pancreatitis. Treatment with the macrophage stimulant glucan resulted in improved survival rates (58 percent versus 14 percent) and maintenance of pancreatic architecture. Glucan treatment also resulted in decreased plasma and peritoneal trypsin activity, as well as increased trypsin-binding activity in the blood and peritoneal cavity. Plasma interleukin-1, as well as macrophage production of interleukin-1, were increased in the glucan-treated mice, which indicated enhanced macrophage function. These composite findings suggest that by enhancing diverse aspects of reticuloendothelial function, clinical use of immunomodulators may have significant impact on the pathogenesis of acute pancreatitis.

Acute Disease↗
PubMed1987

Morbidity and early retirement among anaesthetists and other specialists.

An historically prospective study of the rates of early retirement due to permanent ill health, early retirement between 60 and 64 years of age for other reasons, and deaths while in post, among consultant anaesthetists in England was carried out. The control group comprised consultants in four other hospital specialty groups. Approximately two-thirds of all consultants employed in the five specialties at National Health Service hospitals in England during 1966-83 were included in the study. Ill-health retirements among male anaesthetists were more than twice those expected on the basis of rates in the control group (p less than 0.001). The number of other early retirements between 60 and 64 was a third higher than expected (p less than 0.005). The number of deaths in post was also raised. For the smaller group of female anaesthetists there was not a statistically significant excess of ill-health retirements, but the number of early retirements between 60 and 64 was significantly greater than expected (p less than 0.005), as was the number of deaths in post (p less than 0.001). Possible causes of these excesses are discussed.

Adult↗
PubMed1987

Synergistic effect of nonspecific immunostimulation and antibiotics in experimental peritonitis.

To assess the role of combined immunomodulator and antibiotic therapy in sepsis, glucan--a beta 1,3 polyglucose--and gentamicin were administered in a model of murine peritonitis. ICR/HSD mice received one of four treatment regimens: 5% dextrose; gentamicin 0.02 mg intramuscularly (sub-MIC) 2 hours before peritonitis; glucan 0.1 mg intraperitoneally 24 hours before peritonitis; combined glucan-gentamicin treatment. All animals were challenged with 1 X 10(8) Escherichia coli intraperitoneally. Long-term survival was significantly enhanced in the combined therapy group (56%, p less than 0.05) when compared with D5W (0%), gentamicin alone (0%), or glucan alone (9%). Macrophage secretory activity, as assayed by interleukin-1 (IL-1) production, was significantly enhanced by combined therapy when compared with the other three treatment groups. Combined therapy significantly reduced E. coli bacteremia at 8 hours after inoculation, when compared with the other three groups. Availability of host neutrophils was assessed by peripheral counts and bone marrow proliferation assay. Combined glucan-gentamicin significantly enhanced bone marrow proliferation when compared with the other three groups and this enhancement correlated with increased circulating neutrophils. Combined immunomodulator and antibiotic therapy had synergistic effects on survival in E. coli peritonitis. This combined therapy enhanced macrophage secretory activity and bone marrow proliferation. Clinical use of immunomodulators may alter conventional use and dosage of antibiotics.

Animals↗
PubMed1983

Protective effect of nonspecific immunostimulation in postsplenectomy sepsis.

The enhanced risk of severe sepsis following splenectomy is now well recognized in both adult and pediatric patients. Prophylactic antibiotics and bacterial vaccines have been utilized with limited success to inhibit the high morbidity and mortality. This study reports the use of glucan, a beta-1,3-polyglucose, as a nonspecific immunostimulant for postsplenectomy pneumococcal sepsis. ICR mice were treated with glucan or glucose (5% w/v) following splenectomy or sham operation. Mice were then challenged with 1 X 10(9) Streptococcus pneumoniae intranasally. Glucan significantly increased survival in the splenectomy group (75%) compared to controls (27%). Phagocytic function, as measured by the clearance of 131I-triolein-labeled reticuloendothelial test lipid emulsion, was increased in the glucan group when compared to control glucose animals, both in the presence and absence of pneumococcal infection. Splenectomy alone did not significantly decrease phagocytic function. An increased leukocytosis in response to pneumococcal infection was observed in splenectomized glucan-treated animals. Nonspecific immunostimulation appears to have significant potential as a treatment strategy against postsplenectomy infection.

Animals↗