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Biomedical subjects

S Jackson

Publications and source records attributed to S Jackson.

At least 127 records · Page 7Linked to original sources
PubMed1998

Adolescents' perceptions of communication with parents relative to specific aspects of relationships with parents and personal development.

Adolescents' views of communication with their parents are examined in relation to measures of family satisfaction, adolescent decision-making and disagreement with parents (Study I), and to measures of self-esteem, well-being and coping (Study II). The results provide some support for the psychometric qualities of the Parent-Adolescent Communication Scale (PACS) and suggest that good family communication is associated with satisfaction with the family and with lack of disagreement between adolescents and parents. They also indicate a positive association between family communication and adolescent self-esteem, certain aspects of adolescent well-being and type of coping strategy employed.

Adolescent↗
PubMed1998

Surviving the care system: education and resilience.

The Children Act 1989 requires local authorities in England and Wales to look after children whose parents are unable to do so and to promote their welfare. Despite a variety of initiatives over recent years by central government, local authorities, researchers, practitioners and trainers, the outcomes for the majority of young people who spend any length of time in care continue to be poor. The studies described in this paper sought to trace a group of more successful people who had grown up in care, using educational achievement as a marker. In an attempt to find out what were the qualities and circumstances that helped them to do better, 105 completed a postal questionnaire and a subgroup of 38 "high achievers" participated in a more intensive study. These were compared with a matched group of ex-care people who had not reached the threshold for inclusion in the study. The pre-care background and experiences of the successful group were found to be typical of children in the care system generally. A risk and resilience framework was used to identify the protective factors which enabled this small group to achieve a life trajectory very different from that of their siblings and peers. From their own accounts, success in education was a crucial factor. The implications for child care practice and decision-making are discussed.

Achievement↗
PubMed1998

"Tower vertebra": a new observation in sickle cell disease.

BACKGROUND: Skeletal abnormalities are common in sickle cell anemia. Ischemia, infarction, and growth disturbance of the thoracic and lumbar vertebral bodies are among the most common abnormalities, and can suggest the diagnosis radiographically. DESIGN AND PATIENTS: We recently encountered two adult patients in whom vertebrae had grown abnormally in height adjacent to infarcted short vertebrae. We then reviewed the thoracic and lumbar spine radiographs of 54 more adult patients with sickle cell anemia. RESULTS AND CONCLUSION: A total of eight patients (14%) displayed infarcted vertebrae with compensatory vertical growth of at least one adjacent vertebrae. These resemble the elongated vertebral bodies associated with other conditions. We can find no prior report of this finding in association with sickle cell anemia.

Adolescent↗
PubMed1998

The safety of intraoperative autologous blood collection and autotransfusion during cesarean section.

OBJECTIVE: We evaluated the safety of intraoperative autologous blood collection and autotransfusion during cesarean section. STUDY DESIGN: A multicenter historical cohort study identified 139 patients in whom autologous blood collection autotransfusion during cesarean section was performed. We also identified 87 control patients who underwent similar surgical procedures at the same centers without autotransfusion. The outcome variables we compared were acute respiratory distress syndrome, amniotic fluid embolism, disseminated intravascular coagulation, need for ventilatory support, infectious morbidity, and the length of postpartum hospitalization. RESULTS: Demographic and obstetric characteristics were similar in both groups. The ranges of autotransfused volumes were 200 to 11,250 mL at Yale, 225 to 1160 mL at Good Samaritan, and 125 to 4750 mL at Hinsdale. No statistically significant differences existed between the two groups in any of the outcome variables analyzed. No case of acute respiratory distress syndrome or amniotic fluid embolism was identified in either group. CONCLUSIONS: Our multicenter experience reveals no demonstrably increased risk of complications in patients receiving autologous blood collection autotransfusion during cesarean section.

Blood Specimen Collection↗
PubMed1998

Immune responses to human immunodeficiency virus (HIV) type 1 induced by canarypox expressing HIV-1MN gp120, HIV-1SF2 recombinant gp120, or both vaccines in seronegative adults. NIAID AIDS Vaccine Evaluation Group.

A safety and immunogenicity trial was conducted in vaccinia-immune and vaccinia-naive human immunodeficiency virus (HIV)-uninfected adults who were randomized to receive 10(6) or 10(7) TCID50 of canarypox (ALVAC) vector expressing HIV-1MN gp160 or 10(5.5) TCID50 of ALVAC-rabies virus glycoprotein control at 0 and 1 or 2 months and ALVAC-gp160 or 50 microg of HIV-1SF2 recombinant (r) gp120 in microfluidized emulsion at 9 and 12 months; others received rgp120 at 0, 1, 6, and 12 months. All vaccines were well-tolerated. Neither vaccinia-immune status before vaccination nor ALVAC dose affected HIV immune responses. HIV-1MN and HIV-1SF2 neutralizing antibodies were detected more often (100%) in ALVAC-gp160/rgp120 recipients than in recipients of ALVAC-gp160 (<65%) or rgp120 (89%) alone. ALVAC-gp160/rgp120 also elicited more frequent HIV V3-specific and fusion-inhibition antibodies, antibody-dependent cellular cytotoxicity, lymphoproliferation, and cytotoxic CD8+ T cell activity than did either vaccine alone. Trials with ALVAC expressing additional HIV components and rgp120 are underway.

AIDS Vaccines↗
PubMed1998

Cervical and vaginal shedding of human immunodeficiency virus type 1-infected cells throughout the menstrual cycle.

Cervical and vaginal secretions from 17 women infected with human immunodeficiency virus type 1 (HIV-1) were evaluated daily through the course of one menstrual cycle for HIV-1 DNA (21-31 visits per woman). HIV-1-infected cells were detected in 207 (46%) of 450 endocervical swabs and 74 (16%) of 449 vaginal swabs. There was considerable variability in the percentage of positive swabs from each woman, ranging from 4% to 100% of endocervical swabs and from 0 to 71% of vaginal swabs. In multivariate analyses, plasma HIV-1 RNA was significantly associated with shedding of HIV-1-infected cells; each 1-unit increase in the log of plasma virus load was associated with a 5.6-fold increase in the odds of cervical shedding (95% confidence interval [CI], 2.1-14.8) and a 3.9-fold increase in the odds of vaginal shedding (95% CI, 2.1-7.2). There was no discernible pattern of genital tract shedding with phase of the menstrual cycle and no significant association with serum estradiol or progesterone levels.

Adult↗
PubMed1998

Organisational effectiveness within National Health Service (NHS) Trusts.

In view of the dearth of information relating to organisational effectiveness of NHS Trusts in comparison with clinical effectiveness, a complex study was undertaken to determine whether overall effectiveness was a result of management processes, people, or a combination of both. The study incorporated two phases involving the distribution of a comprehensive questionnaire to identify the "whats" of organisational effectiveness, and a bench-marking exercise aimed at identifying the "hows". In the main, the better performing trusts were found to be subscribing to the concepts of "keeping it simple", innovation and attainment of highly efficient processes. A number of examples of better/best practices were observed which included visible leadership, a commitment towards stakeholder involvement and the practice of teamworking. Given the complexity of the study area, the findings were deemed valuable to managers practising within all areas of healthcare. However, a need for further research was identified in order to substantiate the results.

Data Collection↗
PubMed1998

Skills required for healthy commissioning.

There can be no doubt that literature regarding healthcare commissioning is on the increase. In particular, documentation is continuously emerging on the innovative models which have been designed and implemented to secure effective healthcare for the future. However, the literature tends to focus on the processes that have been designed rather than any required changes in human skills and outlook. While this article examines some of the organisational issues surrounding healthcare commissioning, it also covers the changes and demands required of the personnel practising within the purchasing arms of the National Health Service.

Benchmarking↗
PubMed1998

Using the business excellence model to effectively manage change within clinical support services.

This article describes the journey of managing the change from seven separate health providing units to one overall team providing a range of services. To facilitate the change the Malcolm Baldrige National Quality Award self-assessment model was used. The benefits and limitations of the model are described as are the activities undertaken to achieve a goal of delivering quality care within a customer driven rather than service driven focus. Finally the learning gained from the change is shared in an attempt to help others undertaking a similar journey.

Ancillary Services, Hospital↗
PubMed1998

Europe supports UK government in putting quality at the heart of health care.

The new government drive for quality to be at the heart of health care is discussed, following which an insight into the membership and remit of the new European Health-Care Working Group is given. The article also provides a brief description of the European Foundation for Quality Management model and the benefits associated with applying self-assessment as a tool for attaining business excellence. Finally, the first stages of the work proposed by the European Health-Care Working Group is highlighted along with the potential effect on health care within the UK.

Delivery of Health Care↗
PubMed1998

A double-blind, placebo controlled study of postmenopausal oestrogen replacement therapy and carotid artery pulsatility index.

OBJECTIVE: To determine whether postmenopausal oestrogen replacement therapy affects carotid artery pulsatility index. DESIGN: A prospective double-blind placebo controlled trial. SETTING: University associated teaching hospital. PARTICIPANTS: Twenty-eight postmenopausal women who were more than 12 months postmenopausal and who had not taken exogenous oestrogen. INTERVENTIONS: Independent randomisation to receive oral oestradiol (2 mg daily) or placebo for 20 to 24 weeks. MAIN OUTCOME MEASURES: Internal carotid artery Doppler pulsatility index, measured within one centimetre of the carotid bifurcation. RESULTS: Replicate data were available from 27 women. The mean pulsatility index decreased by -0.11 in 15 women receiving oestradiol, compared with a mean rise of 0.05 in the 12 women who received placebo (P = 0.006, 95% CI for treatment difference 0.06-0.31). CONCLUSIONS: Oestrogen replacement decreases postmenopausal carotid artery pulsatility index, probably reflecting decreased peripheral vascular resistance. This is a further mechanism whereby hormone replacement therapy may impart cardiovascular protection.

Administration, Oral↗
PubMed1998

Immunological and virological analyses of persons infected by human immunodeficiency virus type 1 while participating in trials of recombinant gp120 subunit vaccines.

We have studied 18 participants in phase I/II clinical trials of recombinant gp120 (rgp120) subunit vaccines (MN and SF-2) who became infected with human immunodeficiency virus type 1 (HIV-1) during the course of the trials. Of the 18 individuals, 2 had received a placebo vaccine, 9 had been immunized with MN rgp120, and seven had been immunized with SF-2 rgp120. Thirteen of the 18 infected vaccinees had received three or four immunizations prior to becoming infected. Of these, two were placebo recipients, six had received MN rgp120, and five had received SF-2 rgp120. Only 1 of the 11 rgp120 recipients who had multiple immunizations failed to develop a strong immunoglobulin G antibody response to the immunogen. However, the antibody response to rgp120 was transient, typically having a half-life of 40 to 60 days. No significant neutralizing activity against the infecting strain was detected in any of the infected individuals at any time prior to infection. Antibody titers in subjects infected despite vaccination and in noninfected subjects were not significantly different. Envelope-specific cytotoxic T-lymphocyte responses measured after infection were infrequent and weak in the nine vaccinees who were tested. HIV-1 was isolated successfully from all 18 individuals. Sixteen of these strains had a non-syncytium-inducing (NSI) phenotype, while two had a syncytium-inducing (SI) phenotype. NSI strains used the CCR5 coreceptor to enter CD4+ cells, while an SI strain from one of the vaccinees also used CXCR4. Viruses isolated from the blood of rgp120 vaccinees were indistinguishable from viruses isolated from control individuals in terms of their inherent sensitivity to neutralization by specific monoclonal antibodies and their replication rates in vitro. Furthermore, genetic sequencing of the env genes of strains infecting the vaccinees did not reveal any features that clearly distinguished these viruses from contemporary clade B viruses circulating in the United States. Thus, despite rigorous genetic analyses, using various breakdowns of the data sets, we could find no evidence that rgp120 vaccination exerted selection pressure on the infecting HIV-1 strains. The viral burdens in the infected rgp120 vaccine recipients were also determined, and they were found to be not significantly different from those in cohorts of placebo-vaccinated and nonvaccinated individuals. In summary, we conclude that vaccination with rgp120 has had,to date, no obvious beneficial or adverse effects on the individuals we have studied.

AIDS Vaccines↗
PubMed1998

The management of minor traumatic brain injury.

Minor traumatic brain injury accounts for the majority of the one million head trauma attendances at A&E departments in the United Kingdom. Guidelines have been established listing criteria for skull films, admission to hospital, computed tomography, and neurosurgical consultation. These are currently undergoing revision and were the subject of a satellite symposium to the J Douglas Miller memorial meeting held in October 1996 in Edinburgh. In the East Anglia Region the current guidelines have been issued as memo-cards for A&E officers. The aim of admission is to observe for deterioration, predominantly caused by intracranial haematomas. The indicators for the development of such lesions are an impaired level of consciousness and presence of a skull fracture. Such patients should therefore undergo regular and frequent neurological observations, and be admitted for at least 12 hours. Following discharge, routine follow up should be considered to identify and treat patients with postconcussion symptoms and signs. The possible way forward for the management of these patients is adopting a greater emphasis on preventative aspects, and establishing, implementing, and auditing evidence based guidelines. Improved teaching in the form of formal induction seminars and computerised teaching aids is required, and a better understanding of the aetiology and treatment of the postconcussion syndrome.

Brain Injuries↗
PubMed1998

Differences in prevalence of and risk factors for subclinical vascular disease among black and white participants in the Cardiovascular Health Study.

A composite measure of subclinical vascular disease has been developed in the Cardiovascular Health Study (CHS). In previous reports, we measured the prevalence of subclinical disease among the original 5201 participants in the CHS, the relationship of risk factors to subclinical disease, and the association of subclinical disease to clinical coronary heart disease. In 1992 to 1993 (year 4 of the study), a larger cohort of 424 black women and 248 black men was added to the study. In this study, we have compared the prevalence of subclinical disease among blacks and whites in the CHS and the association with cardiovascular risk factors. The prevalence of subclinical disease for all participants (aged > or =65 years) was 41.3% for white women, 39.7% for black women, 41.9% for white men, and 43.7% for black men. The prevalence increased with age. The risk factor associations for subclinical disease were similar among blacks and whites. In multivariate analysis, age, systolic blood pressure, LDL cholesterol, smoking, and family history of myocardial infarction were independently associated with subclinical disease among both black and white women, while for white men, systolic blood pressure, use of antihypertensive medication, smoking, body mass index, and diastolic blood pressure (inverse) were related to subclinical disease. In black men, blood triglyceride level, use of antihypertensive medications, and family history of myocardial infarction (inverse) were associated with subclinical disease.

Black or African American↗
PubMed1998

Eradication of schistosomiasis in Guangxi, China. Part 3. Community diagnosis of the worst-affected areas and maintenance strategies for the future.

Reported are the results of a community-based assessment of maintenance of schistosomiasis eradication in Guangxi, a large autonomous region of China with a population of 44 million. Eradication of the disease was achieved in 1989 in Guangxi but maintenance costs are rising. We focused on three counties that had the most intense transmission in the past: Binyang, Jingxi, and Yishan. Four instruments were used: in-depth interviews, focus group discussions, a knowledge, attitudes and practices survey, and subsequent community feedback. In the past, schistosomiasis had serious consequences in Guangxi, decreasing work capacity and restricting marriage and occupational mobility. Since its eradication there have been clear benefits in terms of increased agricultural output and improved farming conditions. Personal habits and traditional manual farming activities in Guangxi would continue to expose a large proportion of the population to environmental risk if the disease were to return. Ignorance about control programme achievements is increasing and is related to youth and inexperience. There was a universal desire in the study counties for more local education about the history of the programme and about the risk of schistosomiasis returning. Snail surveillance is considered important, but people are not willing to volunteer for such work. Our study methods were novel for Guangxi and community feedback was helpful. Snail checking procedures have been modified to make them more efficient and no snails have been found since 1992. The animal and human stool examinations have ceased and vigilance now concentrates on snails and children (skin tests). The long-term strategy is to make the population invulnerable to future schistosomiasis transmission if the snail vectors return. This means continuing education and making the former endemic counties a high priority for water and sanitation improvements.

Adolescent↗
PubMed1998

Parallel regulation of sterol regulatory element binding protein-2 and the enzymes of cholesterol and fatty acid synthesis but not ceramide synthesis in cultured human keratinocytes and murine epidermis.

After permeability barrier perturbation there is an increase in the mRNA levels for key enzymes necessary for lipid synthesis in the epidermis. The mechanism(s) responsible for this regulation is unknown. Sterol regulatory element binding proteins-1a, 1c, and -2 (SREBPs) control the transcription of enzymes required for cholesterol and fatty acid t synthesis in response to modulations of sterol levels. We now demonstrate that SREBP-2 is the predominant SREBP in human keratinocytes and murine epidermis, while SREBP-1 is not detected. Sterols regulate SREBP-2 mRNA levels in keratinocytes and the epidermis and the proteolytic cleavage of SREBP-2 to the mature active form in keratinocytes. In parallel to the increase in mature active SREBP, there is a coordinate increase in mRNA levels for cholesterol (HMG-CoA reductase, HMG-CoA synthase, farnesyl diphosphate synthase, and squalene synthase) and fatty acid (acetyl-CoA carboxylase, fatty acid synthase) synthetic enzymes. However, mRNA levels for serine palmitoyl transferase (SPT), the first committed step for ceramide synthesis, do not increase in parallel. The increase of mRNA for enzymes required for epidermal cholesterol and fatty acid synthesis is consistent with both the previously described early increase of cholesterol and fatty acid synthesis after barrier disruption and a role for SREBP-2 in the regulation of cholesterol and fatty acid synthesis for epidermal barrier homeostasis. In contrast, SPT appears to be regulated by different mechanisms, consistent with the different time course of its stimulation after barrier disruption.

Acetyl-CoA Carboxylase↗
PubMed1998

Resurgence of vivax malaria in Henan Province, China.

Henan Province (population, 90 million) in China has nonstable endemic malaria. After 1970 when 10.2 million cases of malaria were reported in the province, a huge control programme was undertaken, and in the mid-1980s indoor spraying and bednet impregnation with pyrethroids began. By 1992 only 318 cases were reported. In 1992 Henan declared "basic elimination of malaria" and in consequence spraying and bednet impregnation ceased after 1994. Subsequently, malaria broke out again in southern Henan. In 1995 we conducted a household survey for malaria transmission in southern Henan. Blood smears and serum samples for immunofluorescent antibody (IFA) testing were collected from 2329 people and 3.1% (73/2329) were positive for infection with Plasmodium vivax and 13% (301/2329) positive for malaria (titre > or = 1:20). All age groups were affected. Exophilic Anopheles sinensis occurs throughout the province; endo-anthropophilic A. anthropophagus, whose vectorial capacity is 20 times greater than that of A. sinensis, occurs mainly in southern Henan (S of latitude 33 degrees N) and was greatly reduced in numbers during 1985-92. Comparison of 1995 entomological data with historical data showed that A. anthropophagus increased in proportion to other anophelines after spraying activities and impregnation of bednets ceased. Over 10% of 9377 residents reported having malaria. The true number affected among the at-risk population of 700,000 must be larger. We conclude that impregnated bednets and malaria surveillance should continue even after an area is declared to have "basically eliminated" malaria.

Adolescent↗