Biomedical subjects
Publications and source records attributed to R Shepherd.
There is no question that improved cost information can lead to improved accountability in health care; however, the major proponents of borrowing cost accounting concepts from manufacturing have not gone far enough. They have ignored an important aspect of manufacturing cost accounting that is also a very important prt of hospitals and health care, namely the concern for quality.
Taste sensitivity and preference for sodium chloride in bread and pea soup were assessed before and after haemodialysis in 12 female chronic renal failure patients. Blood samples were also taken pre- and post-dialysis and analysed for zinc, sodium and renin. The patients demonstrated an increased sensitivity to, and decreased preference for, sodium chloride in both bread and pea soup following dialysis. These taste changes were found to correlate with pre- to post-dialysis changes in the zinc levels in the blood. Patients receiving a more severely sodium-restricted diet showed a greater sensitivity to the taste of sodium chloride in the foods tested. Renin levels dropped in all patients following dialysis, the size of the change correlating with the size of the change in body weight.
A questionnaire on nutrition knowledge, attitudes, and consumption of foods contributing highly to fat in the diet of United Kingdom residents was completed by 210 subjects. Personal attitudes were found to be good predictors of consumption and much more important than perceived social pressure from other persons. Women, subjects in the 26- to 45-year age group, and those of higher socioeconomic class tended to have more negative attitudes toward consumption of such foods. Nutrition knowledge was not found to relate to attitudes or to consumption of the foods.
A predominantly middle-class female sample of British adults completed questionnaires designed to estimate salt intake and to assess attitudes towards adding table salt to food, along with Cattell's 16PF personality inventory. The attitudes questions were based on the approach suggested by Fishbein and Ajzen, and proved to be good predictors of table salt use. The person's own feeling about table salt use was a better predictor than perceived pressure from other people. Beliefs about adding table salt were closely related to the person's attitude, but only beliefs about taste (not beliefs about health consequences) predicted usage. Beliefs about pressure from doctors and nutritionists/dietitians, but not family, were also related to usage. There was lower usage and more negative attitudes in respondents under 35 years old. Two of the second-order personality factors from the 16PF correlated with salt intake, but appeared to act through attitudes: tough poise (i.e. given to rapid action with insufficient thought) correlated positively with estimated table and cooking salt use; anxiety correlated positively with cooking use, with salt consumed in foods and with estimated total intake. The results suggest that any attempt to reduce salt intake might best be directed at satisfying taste, and not exclusively at augmenting anxiety about the health consequences of salt intake.
Taste sensitivity for sodium chloride in solution and sensitivity and preference for sodium chloride in bread were measured in 14 male patients undergoing hemodialysis. There was an increase in sensitivity to salt taste following dialysis only when assessed using the bread samples. Patients on a lower sodium diet were more sensitive to salt taste in bread. Although the taste changes were not related to the decreases in serum sodium or to copper, greater increases in sensitivity were related to greater increases in serum zinc during dialysis.
Thirty-six female subjects took part in a study involving using pre-weighed table and cooking salt pots, along with complete urine collections for 7 days. Urinary sodium excretion was determined, and was used as an estimate of sodium (salt) intake. Other measures taken were, most preferred concentration of salt in soup, blood pressure, body weight and height, along with questionnaires on general food preferences, attitudes to adding table salt to foods, and the Eysenck Personality Inventory (EPI). Table salt (7 per cent) and cooking salt (8 per cent) were found to account for only a small proportion of total sodium intake, the major part (89 per cent) being from non-discretionary salt present in foods. Subjects, divided on the basis of table salt use and total intake, were found to differ in the most preferred concentration of salt in soup, but not in their sensitivity to variations from their ideal. Table salt use was predicted very well by the individual's attitude, and to a lesser extent by perceived social pressure. The only other variable related to higher table salt use was a lower preference for fruit on the general food preferences questionnaire. The lower preference for fruit was also related to higher total salt intake, which was also predicted by a lower neuroticism score on the EPI. While extraversion was positively related to non-discretionary salt intake, this relationship was not significant for total salt intake.
A questionnaire designed to assess salt intake was tested. This involved principal components analysis of responses from 155 subjects to find the underlying components related to the questions. Validation of the questionnaire used 7-day urinary sodium excretion for 33 subjects, along with table and cooking salt usage over 7-days. This gave comparatively good prediction for total intake (r = 0.66) and table salt use (r = 0.70) but not for cooking salt use (r = 0.17). Test-retest reliability for the estimate of total intake was r = 0.75. This method would therefore offer a useful estimate of total intake, especially where group means are required rather than accurate estimates of individual intakes.
A questionnaire on consumption of foods high in fat and attitudes towards these foods was completed by 518 subjects. The attitudes assessment followed the theory proposed by Fishbein & Ajzen (1975). The person's own feelings towards consumption of a type of food was found to be a good predictor of consumption, both for the individual type of food and for an index of the foods combined. Pressure from others was found to be less predictive of consumption. The degree of prediction did not vary between subjects grouped according to sex, age or social class. There were, however, differences in consumption and attitudes between these groups. Females were found to have lower consumption and more negative attitudes towards the high-fat foods. This was also true of the 26-45 year old group compared with both younger and older subjects. No differences were found between different social classes.
Two experiments are reported with subjects divided according to questionnaire responses into low and high total sodium intake, and low and high table salt use. The stimuli were tomato soup with varying salt concentrations. In Experiment 1 these were rated for salt intensity, pleasantness and intensity relative to ideal. In Experiment 2 the stimuli were presented in restricted concentration ranges or using a method designed to minimise range bias; relative-to-ideal intensity rating was again used. Subjects with a high total intake were found to prefer higher concentrations of salt assessed both with the hedonic and relative-to-ideal intensity ratings, though not with restricted stimulus ranges. Subjects with high table salt use were found to prefer higher concentrations only when assessed using the hedonic ratings. Sensitivity to salt taste was not found to differ between the groups.
Total salt-intake was estimated in 33 normal subjects using urinary sodium excretion over 7 days, and table and cooking salt use were measured over the same period. Sensitivity to salt taste was measured for 31 of these subjects using a seven-category rating scale for intensity of saltiness with five concentrations of salt in water, bread and mashed potato. Preferences were assessed using a nine-category hedonic rating scale with the bread and mashed potato to determine the maximally-preferred concentration. No differences were found in the taste measures between subjects divided into high and low intake in terms of total salt-intake or total intake divided by body weight. However, differences were found in sensitivity and preferences between groups divided into high and low table salt use. This may be because the major proportion of total salt-intake arose from salt present in foods and this would not be so open to voluntary control as table salt use.
An experiment is reported which confirms earlier findings that the range of stimulus concentration affects the estimate of ideal concentration. The method proposed by Booth et al for reducing range bias has been found to give satisfactory results.
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The rectosphincteric responses of 22 spina bifida (SB) children, aged 3.0 to 11.0 years, with frequent neurogenic faecal incontinence were investigated by clinical and anomanometric techniques and a bowel habilitation programme based on the physiological rationale of timed regular and complete evacuations, regulation of bowel habit and faecal consistency by diet and biofeedback conditioning of rectosphincteric responses. Eighteen patients had perianal anaesthesia, flail anus and absent anorectal reflex, but some degree of (reduced) rectal sensation. Four had reduced perianal sensation and normal to high pressure external sphincter and a megarectum apparently causing an absence of rectal sensation. Twenty were unable to expel the rectal balloon voluntarily. After biofeedback exercises (2-5 sessions) and a home programme of evacuation and diet, 21 of the 22 achieved satisfactory continence over 2-6 months with improved rectal sensation and ability to evacuate voluntarily. This experience suggests that early anorectal evaluation and a comprehensive bowel habilitation programme may be an effective approach to the prevention of disability due to faecal incontinence in SB children.
To investigate the incidence, pathophysiology and clinic determinants of persistent diarrhoea (more than seven days) after childhood gastroenteritis, we prospectively evaluated 168 consecutive patients admitted to the Royal Children's Hospital, Brisbane, with gastroenteritis. Thirty-two children (19%) developed persistent diarrhoea; only two-thirds of them had an identifiable aetiological factor, including di- or monosaccharide intolerance (31%), persisting or suspected pathogen (22%) and cow's milk protein intolerance. Computer aided analysis of risk factors in the preceding enteritis showed this complication to be more frequent in young age groups (P less than 0.01) where the patient was less than 10th percentile for weight (P les than 0.02); in Aboriginals (P less than 0.01); where there was a history of previous diarrhoea (P less than 0.001), delayed hospital admission (P less than 0.001) and antibiotic/antidiarrhoeal usage (P less than 0.05); and where there was a bacterial pathogen (P less than 0.001). Severity and outcome were variable with most cases requiring a defined formula diet. These findings provide some insight into the problem of persisting diarrhoea after gastroenteritis, aid identification of at risk patients, and suggest guidelines for management and prevention.
The steroids prednisolone and progesterone significantly altered the therapeutic indices of the alkylating agents, nitrogen mustard, melphalan, cyclophosphamide, phenyl acetic mustard and chlorambucil. For nitrogen mustard, chlorambucil and phenyl acetic mustard, prednisolone reduced host toxicity in the rat and enhanced the antitumour effectiveness against alkylating-agent-resistant strains of the Yoshida sarcoma and Walker carcinosarcoma. Progesterone also increased the therapeutic index of chlorambucil in the rat by decreasing its systemic toxicity. Two other alkylating agents, melphalan and cyclophosphamide, exhibited lower therapeutic indices in combination with prednisolone against alkylating-agent-sensitive tumours. This was due to the greater host toxicity of the combination than of the alkylating agent alone. In alkylating-agent-resistant tumours, however, a significant increase in growth delay was achieved if prednisolone was combined with the alkylating agent.
Twenty male subjects performed a continuous task involving response to digit sets. The subject was required to respond to sets containing only odd numbers, and whose sum was greater than or equal to 20. Abundance of both left and right hemisphere EEG was inversely related to the number of odd digits in a set, showing accumulation of cortical arousal in response to cue value. This effect was stronger for the left hemisphere in some of the frequency bands. Reaction time correlated with EEg parameters for the left hemisphere only. This study overcomes many of the methodological flaws of earlier work. Differences obtained between hemispheres are thought to reflect both the exertion of mental effort in general and rapid calculation in particular.
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