Search PubMed⌕ Search

Biomedical subjects

R W Stout

Publications and source records attributed to R W Stout.

At least 37 records · Page 2Linked to original sources
PubMed1996

Seasonal changes in haemostatic factors in young and elderly subjects.

Morbidity and mortality from cardiovascular disease are more common in colder seasons, especially in elderly people. Previous studies have shown higher fibrinogen levels in old people in the winter months. The present studies of haemostatic factors in relation to age and season have shown that fibrinogen, tissue plasminogen activator (tPA), protein S and protein C levels are higher in old (aged 75 years and over) than young (aged 25-30 years) subjects while antiplasmin levels are lower in old people. Antiplasmin and protein C levels are lower in winter in both young and old while plasminogen activator inhibitor (PAI) is higher, and tPA higher in old people only. This study illustrates the complex interrelationships of the haemostatic system and may suggest that in 'successful' elderly people the fibrinolytic system may alter to maintain the delicate balance between thrombogenic and fibrinolytic activity. Nevertheless, the results presented here suggest that both old age and cold weather may increase the risk of atherothrombotic disease.

Adult↗
PubMed1996

Hyperinsulinemia and atherosclerosis.

For more than 25 years, there has been an expansion in the clinical and experimental evidence linking hyperinsulinemia with cardiovascular disease and atherosclerosis. Assessment of the evidence under the headings of the strength of the association, dose response, temporality, consistency, specificity, and plausibility supports the concept that hyperinsulinemia has a causal role in atherogenesis. Evidence that reducing insulin levels prevents atherosclerosis is lacking. The evidence available is strong enough to support preventive measures to lower insulin levels such as regular physical exercise and avoidance of obesity.

Arteriosclerosis↗
PubMed1996

The assessment of acute stroke in general medical wards.

In order to assess the completeness of clinical clerking, a retrospective study was made of the medical notes of 194 patients admitted with acute stroke over a 1-year period. The noting of clinical features associated with disease severity and prognosis, such as level of consciousness, proprioception, neglect, mental test score and continence was assessed. These features were rarely noted. Factors likely to influence placement following recovery were also poorly reported. In order to allow an accurate guide to stroke severity and prognosis these factors must be noted. An alternative form of clinical clerking is suggested in order to improve patient management.

Cerebrovascular Disorders↗
PubMed1996

Prognostic markers in older patients starting renal replacement therapy.

AIMS: We assessed all patients starting renal replacement therapy during a 1-year period to identify factors influencing 1-year survival in older and younger dialysis patients. METHODS: Data was collected from 113 patients. Twenty-four possible prognostic factors were introduced into a multivariate, time-based analysis. RESULTS: Hazard ratios, and hence risk of mortality, were increased with increasing alcohol consumption, cardiac dyskinesis, age at onset of dialysis, serum phosphate, number of comorbid illnesses, and Karnofsky score (listed in decreasing order of risk). Risk of death within 1 year was reduced in patients with normal serum albumin and higher Barthel scores at the time of commencing dialysis. No age interactions were found. In the elderly age group the risk of death was also increased if left ventricular dilatation was present. Comorbidity and the age of onset were not independent risk factors in patients aged over 65 years at the time of starting dialysis. CONCLUSIONS: All factors listed above increase the 1-year mortality of elderly patients. Factors known to increase medium-term morbidity in dialysis patients including diabetes mellitus, ischaemic heart disease, and hypertension do not appear to be important in the short-term survival of older patient on dialysis.

Adult↗
PubMed1995

Conservative podiatric medicine and disability in elderly people.

A survey was conducted of 248 noninstitutionalized people aged 75 years and older, residing in a designated geographical area. The effect of dependency and physical disability on the receipt of conservative podiatric medicine was examined, and, in addition, the prevalence of medical and podiatric conditions was determined.

Activities of Daily Living↗
PubMed1995

Diagnostic regimes for urinary tract infection--are research results applied to practice?

A clinical audit of ward practice for diagnosing and treating urinary tract infection was carried out to assess the impact on clinical practice four years after publication of a working protocol. Data were collected from all medical, surgical, gynaecology and geriatric wards in 25 hospitals in Northern Ireland. All wards made use of urinary dipsticks for ward testing, as recommended by the protocol. However many negative samples were still forwarded for laboratory analysis. The potential financial savings which would result from effective ward screening were not being realised and the publication appeared to have minimal impact on clinical practice. Advice on an improved diagnostic protocol for urinary tract infection may not have been disseminated to the nursing staff whose role was pivotal in the screening process.

Chi-Square Distribution↗
PubMed1994

Duration of antibody response after meningococcal polysaccharide vaccination in US Air Force personnel.

The long-term kinetics of the immunologic response after vaccination of adults with Neisseria meningitidis polysaccharide vaccine is unknown. Total meningococcal anti-capsular antibody response (measured by ELISA) and serum bactericidal activity after routine vaccination with quadrivalent meningococcal vaccine were evaluated in US Air Force personnel. In a retrospective cross-sectional study, blood samples were obtained from approximately 40 personnel before vaccination, at 1 and 4-6 months, and at 2, 3, 4, 6, 8, and 10 years after vaccination. Total anti-group A and -group C capsular antibody levels and bactericidal activity peaked 1 month after vaccination and declined substantially by 2 years. At each interval, significantly higher levels of total antibody and bactericidal activity were detected than before vaccination. Anti-capsular antibodies and bactericidal activity persisted for up to 10 years after immunization. These and further studies on the serologic measure of protection against meningococcal disease are important for evaluation of candidate vaccines and development of recommendations for immunization.

Adult↗
PubMed1994

Glucose tolerance and ageing.

Hyperglycaemia, impaired glucose tolerance and noninsulin dependent diabetes become progressively more common with advancing age. The mechanism is insensitivity to the actions of insulin at the postreceptor level. Inadequate secretion of insulin and decreased hepatic sensitivity to insulin's action in suppressing glucose output also occur. The age-related changes may be made worse by obesity, renal failure or the ingestion of certain drugs, or may be lessened by increased physical activity.

Aged↗
PubMed1994

Viral hepatitis in the U.S. Air Force, 1980-89: an epidemiological and serological study.

This paper reports the epidemiology of hospital-diagnosed acute viral hepatitis in U.S. Air Force personnel from 1980-89. First hospitalizations for viral hepatitis generally declined, ranging from 24.6 to 47.2 per 100,000 personnel. Hepatitis rates were higher among men, (RR = 1.3; 95% C.I., 1.1-1.5) and higher among blacks, compared to whites (RR = 1.4; 95% C.I., 1.3-1.6). Analysis of risk associated with various occupations demonstrated an increased risk of viral hepatitis for procedurally oriented medical personnel (physicians, clinical nurses, dentists) when compared to all other occupations (RR = 1.5; 95% C.I., 1.1-1.9). Pilots and navigators demonstrated a decreased risk of acute viral hepatitis. Members hospitalized for hepatitis B had a prior or concurrent diagnosis for sexually transmitted disease in 37% of cases; for drug abuse, 32% of cases. Serum samples from 332 individuals demonstrated that hepatitis A had the highest rate of agreement (84%) between serology and hospital discharge diagnosis. Only 3% of individuals with the diagnosis of NANB hepatitis were positive for hepatitis C.

Adolescent↗
PubMed1993

Viral hepatitis in the US Air Force, 1980-1989.

Viral hepatitis and its acute and chronic complications continue to pose significant threats to the readiness of military personnel. Knowledge about the specific viral agents and their routes of transmission are important in developing prevention strategies. A recent analysis of hepatitis in the US Navy for the period 1975-1984 is reviewed. In order to better characterize the risk of viral hepatitis among US Air Force personnel, a comprehensive review of inpatient and quarters data for hepatitis A, B and 'non-A, non-B' were reviewed from Air Force medical treatment facilities worldwide for the period 1980-1989. Following a discussion of the study methodology, preliminary data and hepatitis type-specific demographic risk variables are discussed. Preliminary results from a hepatitis serosurvey (A, B and C antibody with use of a supplemental validating assay) of the subset of the study cohort who are currently on active duty are briefly reviewed.

Aerospace Medicine↗
PubMed1993

Diabetes and atherosclerosis.

Atherosclerosis is the most important complication of diabetes and diabetes is an important risk factor for cardiovascular disease. Atherosclerosis develops more rapidly and at an earlier age in diabetic patients than in non-diabetic people. Although a number of cardiovascular risk factors are more common in diabetic than non diabetic people, these do not entirely account for the increased frequency of cardiovascular disease. The identity of the additional factor or factors which result in increased atheroslerosis in diabetes is unknown but attention should be paid to the role of glycated lipoproteins and of hyperinsulinaemia. In treating diabetic patients, attention should be paid to cardiovascular risk factors such as dyslipidaemia and hypertension as well as to the control of blood glucose.

Arteriosclerosis↗
PubMed1993

Hyperglycaemia and mortality from acute stroke.

Hyperglycaemia has been observed after acute stroke, and is associated with a poor prognosis. It is not known whether this is due to the stress response of the acute illness or whether hyperglycaemia is, in itself, harmful to ischaemic nervous tissue. Seventy-one patients admitted to hospital with acute stroke and no history of diabetes or other acute illness were recruited, and fasting blood sampling was carried out within 24 h of symptom onset, for plasma glucose and stress hormones and levels of haemoglobin A1c (HbA1c). Computerized tomography of the brain was carried out on 77% of the subjects. The subjects were followed up for 3 months or until death. Glucose levels were higher in subjects who died during the course of the study (p = 0.025), but this relationship became non-significant after age (p < 0.001) and cortisol (p = 0.001) levels were taken into account with multivariate analysis. The correlation between serum cortisol and the volume of the lesion on CT scan was also stronger than the relation of glucose with volume. Haemoglobin A1c had no relationship with either mortality or lesion volume. These findings suggest that the hyperglycaemia seen after an acute stroke is secondary to a stress response and they do not support the theory of hyperglycaemia being harmful to ischaemic nervous tissue. These findings have implications for the treatment of acute stroke with hypoglycaemic agents.

Acute Disease↗
PubMed1993

Differences between "geriatric" and "medical" patients aged 75 and over.

We analysed the characteristics of patients aged 75 and over admitted to the geriatric and general medical wards over a three month period in a teaching hospital. Patients admitted to the geriatric wards were slightly older, were more often female, more likely to be admitted during the day and during a week day, more likely to have been seen by their own general practitioner, had more chronic and multiple illness with non-specific presentations, and stayed longer in hospital. Referring doctors seem to discriminate between patients needing geriatric care and those more suitable for general medical care, but there is an overlap in the characteristics of the two groups.

Age Factors↗
PubMed1992

Insulin and atherogenesis.

A number of processes are involved in the pathogenesis of atherosclerosis. These include an "injury" to the endothelial cell barrier of the inner lining of the artery, infiltration of the artery by lipid filled monocyte-macrophages, proliferation of smooth muscle cells, synthesis of connective tissue and thrombus formation. Insulin may be involved in several of these processes. Over 40 years ago it was shown that insulin is necessary for the production of experimental atherosclerosis in cholesterol fed, alloxan diabetic rabbits. Insulin inhibits regression and stimulates formation of lipid containing lesions in a number of species, and can promote lesions in animals fed normal diets. Insulin is also related to lipid metabolism in the artery wall and interacts with blood pressure to stimulate lipid synthesis in arteries. Arterial smooth muscle cells cultured from a number of species including humans proliferate in response to levels of insulin similar to those found in normal human physiology. The proliferative effects of insulin are mediated by the insulin-like growth factor receptor and hence may not be impaired in states of insulin resistance. Insulin also stimulates arterial smooth muscle cell migration. Insulin stimulates cholesterol synthesis in cultured smooth muscle cells and enhances LDL receptor activity in a number of cell types. Insulin stimulates connective tissue synthesis, and promotes clotting.

Arteries↗