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Biomedical subjects

S West

Publications and source records attributed to S West.

At least 73 records · Page 4Linked to original sources
PubMed1995

Impact of face-washing on trachoma in Kongwa, Tanzania.

Observational studies have suggested that the prevalence of trachoma is lower in children with clean faces than in those with ocular or nasal discharge or flies on the face. We carried out a community-based randomised trial in three pairs of villages to assess the impact on trachoma of a face-washing intervention programme following a mass topical antibiotic treatment campaign. Six villages in Kongwa, Tanzania, were randomly assigned mass treatment plus the face-washing programme or treatment only. 1417 children aged 1-7 years in these villages were randomly selected and followed up for trachoma status and observations of facial cleanliness at baseline and 2, 6, and 12 months. At 12 months, children in the intervention villages were 60% more likely to have had clean faces at two or more follow-up visits than children in the control villages. The odds of having severe trachoma in the intervention villages were 0.62 (95% Cl 0.40-0.97) compared with control villages. A clean face at two or more follow-up visits was protective for any trachoma (odds ratio 0.58 [0.47-0.72]) and severe trachoma (0.35 [0.21-0.59]). This community-based participatory approach to face-washing intervention had variable penetration rates in the villages and was labour intensive. However, we found that, combined with topical treatment, community-based strategies for improving hygiene in children in trachoma-endemic villages can reduce the prevalence of trachoma.

Administration, Topical↗
PubMed1995

Cigarette smoking and risk for progression of nuclear opacities.

OBJECTIVE: To examine the relationships between smoking and the 5-year incidence of new nuclear opacities and between smoking and the progression of nuclear opacities in a prospective study of a cohort of Chesapeake Bay watermen. METHODS: A total of 442 men (age, > or = 30 years in 1985) with paired, gradable lens photographs in at least one eye in both 1985 and 1990 were studied. Photographs were graded by two readers who used the grading scheme of the Wilmer Institute, Baltimore, Md, with severity ranging in decimal units between 0.0 and 4.0. Data on the smoking history of the subjects were collected by personal interviews that were conducted in 1985 and updated in 1990. RESULTS: The incidence and progression of opacities increased with age. A nonsignificant association was observed between smoking (for both current and ex-smokers) and the incidence of a nuclear opacity. The risk of progression of nuclear opacities of less than grade 3 at baseline to grade 3 or worse was 2.4-fold higher among current smokers in 1985, compared with that among ex-smokers and nonsmokers (95% confidence limits: 1.0, 6.0) after adjustment for age, baseline opacity status, and alcohol use. An 18% increased risk of progression was significantly associated with each pack-year that a subject smoked between 1985 and 1990. CONCLUSION: These data confirm previous findings that smoking is associated with a nuclear opacity, particularly with progression to severe opacities.

Adult↗
PubMed1995

Ocular and dermatologic health effects of ultraviolet radiation exposure from the ozone hole in southern Chile.

OBJECTIVES: This study sought to investigate numerous reports emanating from Punta Arenas, Chile (population 110,000, latitude 53 degrees S), that associated acute ocular and dermatologic disease in humans and animals with excess ultraviolet-B (UV-B) exposure in the setting of the thinning of the ozone column. METHODS: Ophthalmologic and dermatologic records in Punta Arenas were systematically reviewed to enumerate sentinel diagnoses potentially associated with UV-B exposure, ocular examinations on representative animal populations were performed, and the ambient UV-B exposure in the region during the time of maximal thinning was estimated. RESULTS: No increase in patient visits or conditions attributable to UV-B exposure was seen for periods of known ozone depletion compared with control periods. Although ambient UV-B exposure was 1.6 to 2.3 times the habitual exposure on individual days, this excess exposure conferred only a 1% increase in annual exposure on the region. CONCLUSION: This study does not support existing lay reports of ocular and dermatologic disease in humans and animals that had been associated with the ozone hole over southern Chile.

Animals↗
PubMed1995

Sexual abstinence counseling of adolescents by physicians.

Attending physicians and residents at a southeastern rural teaching hospital specializing in family practice and pediatrics, as well as local family practice physicians and pediatricians, were surveyed with regard to their counseling of adolescents about sexuality, including abstinence. The physicians were asked to complete an original 67-item questionnaire describing their attitudes and practices. More than 60% of physicians reported regularly addressing the issues of HIV, STD, pregnancy prevention, and responsible sexual behaviors. About 35% of the physicians reported regularly counseling adolescents regarding 17 other issues pertaining to pregnancy and disease prevention, sexual abuse, or related medical aspects of sexuality. No respondents felt "very effective" in their counseling. Some agree they would be helped by additional training.

Adolescent↗
PubMed1994

Shingles, allergies, family medical history, oral contraceptives, and other potential risk factors for systemic lupus erythematosus.

The authors undertook a case-control study to explore the many factors that have been postulated to be related to the etiology of systemic lupus erythematosus. A total of 195 cases of systemic lupus diagnosed in the Philadelphia, Pennsylvania, metropolitan area between 1985 and 1987 were compared with 143 controls, friends of the cases matched to them according to age (+/- 5 years) and sex. Through personal interviews and chart reviews, data were collected on demographic factors, personal and familial medical history, reproductive history, medication history, and environmental exposures. Associations were found between systemic lupus erythematosus and having a family history of autoimmune disease (age-, sex-, and race-adjusted odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.2-4.6), a history of shingles (adjusted OR = 6.4, 95% CI 1.4-28.0), a history of hives (adjusted OR = 1.8, 95% CI 1.1-3.0), and a history of medication allergies (adjusted OR = 2.6, 95% CI 1.5-4.5). No association was present between systemic lupus erythematosus and either any use or recent use of oral contraceptives (e.g., OR = 0.6 (95% CI 0.2-1.4) for use in the 3 years prior to diagnosis), family history of multiple other diseases, or a history of numerous other infections or various other types of allergies. Thus, these data indicate that systemic lupus erythematosus is associated with a family history of autoimmune diseases, a history of shingles, and a history of allergies. In contrast, if the development of systemic lupus is affected by use of oral contraceptives, this effect must be extremely modest. These findings may help clarify the possible pathogenesis of systemic lupus erythematosus, and they provide clues as to when the presence of systemic lupus should be suspected.

Adult↗
PubMed1994

Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers.

STUDY DESIGN: Pain pattern mapping of the sacroiliac joint in asymptomatic volunteers was investigated. Prospective evaluation of 10 volunteers who received sacroiliac joint injections was performed. The injections consisted of contrast material followed by Xylocaine. OBJECTIVES: To determine the pain referral pattern of the sacroiliac joint in asymptomatic individuals. SUMMARY OF BACKGROUND DATA: All 10 individuals experienced discomfort upon initial injection, with the most significant sensation felt directly around the injection site. Subsequent sensory examination revealed an area of hypesthesia running caudally from the posterior superior iliac spine. METHODS: Volunteers were asked to describe the nature and location of the sensation upon sacroiliac injection. Sensory examination immediately followed the injection to determine referral patterns. RESULTS: Sensory examination immediately after sacroiliac injection revealed an area of buttock hypesthesia extending approximately 10 cm caudally and 3 cm laterally from the posterior superior iliac spine. This area of hypesthesia corresponded to the area of maximal pain noted upon injection. CONCLUSION: A pain referral map was successfully generated using provocative injections into the right sacroiliac joint in asymptomatic volunteers.

Adult↗
PubMed1994

Molecular similarity, quantitative chirality, and QSAR for chiral drugs.

The current policy of drug regulatory authorities demanding that pharmaceutical companies justify their reasons for preferring drugs containing a mixture of enantiomers over one stereoisomer increases the importance of quantitative structure-activity relations (QSARs) for chiral drugs. The QSAR proposed by Pfeiffer for chiral drug enantiomer potencies was brought into question by the existence of sets obeying an anti-Pfeiffer rule. Using computer-aided molecular design methods and treating chirality not as an existing/nonexisting property but as a continuous one improve the QSAR proposed by Pfeiffer, yielding higher correlation coefficients and an independent ordinate. Calculated shape similarities reveal the details of the Pfeiffer behavior and the source of the anti-Pfeiffer behavior. Consequently revised models for the D2 and sigma receptor are suggested.

Computer Simulation↗
PubMed1994

Are antioxidants or supplements protective for age-related macular degeneration?

OBJECTIVES: The relationships between fasting plasma levels of retinol, ascorbic acid, alpha-tochopherol, and beta-carotene and age-related macular degeneration (AMD) were studied in a population enrolled in the Baltimore Longitudinal Study of Aging (BLSA), in which most of the data were collected 2 or more years before assessment of macular status. DESIGN: A total of 976 participants in the study were scheduled for a biennial examination from January 1988 through January 1, 1990, which included taking lens and macular photographs. A total of 827 (85%) of the participants had fundus photographs taken, and most plasma data were available for 82% of those subjects with fundus photographs. Age-related macular degeneration was defined as neovascular changes, geographic and nongeographic atrophy, large or confluent drusen, or hyperpigmentation. A total of 226 cases of AMD were available for analysis. RESULTS: Logistic regression analyses suggested that alpha-tocopherol was associated with a protective effect for AMD, adjusted for age, sex, and nuclear opacity. An antioxidant index, including ascorbic acid, alpha-tocopherol, and beta-carotene, was also protective for AMD. Our conclusions must be tempered with the knowledge that the population under study was basically well nourished, and few individuals had any clinically deficient status. The study cannot exclude the possibility that quite low levels of micronutrients, lower than those observed in this study, might be risk factors for AMD. CONCLUSIONS: The data suggest a protective effect for AMD of high plasma values of alpha-tocopherol. An antioxidant index, composed of plasma ascorbic acid, alpha-tocopherol, and beta-carotene, was also protective. The use of vitamin supplements to prevent AMD is not supported by these data, which showed no protective effect of vitamin use.

Adult↗
PubMed1994

Functional status and quality of life measurement among ophthalmic patients.

OBJECTIVES: Assessment of the relationship between visual function and functional status/quality of life in clinical research involving patients with eye disease by investigating whether the scores of four existing functional status/quality of life patient questionnaires are sensitive to differences in visual acuity and studying whether selected subscales of the questionnaires provide similar information concerning the relationship between functional status/quality of life and visual acuity as do the respective full-length questionnaires. DESIGN, SETTING, PARTICIPANTS: Case patients consisted of 86 consecutive patients seen at The Wilmer Ophthalmological Institute Retinal Vascular Center, Baltimore, Md. Controls consisted of 51 individuals with normal visual acuity and no known ocular disease and were frequency-matched to the case patients by age (+/- 5 years), sex, and race. Subjects were interviewed in person using each of the following questionnaires: the Sickness Impact Profile, the vision-specific Sickness Impact Profile, the Community Disability Scale, and the General Health Questionnaire. RESULTS: Scores of all four questionnaires and their subscales were significantly associated with visual acuity. The vision-specific Sickness Impact Profile and the Community Disability Scale were independently significant predictors of visual acuity. Regression analysis revealed that in our study, selected subscales of the respective full-length questionnaires were able to demonstrate the association between vision and functional status/quality of life. CONCLUSIONS: Ophthalmic patients are at high risk for decreased functional status/quality of life. Subscales of existing questionnaires potentially may be substituted for the full-length questionnaires, thereby increasing the efficiency of functional status/quality of life measurement in such patients.

Aged↗
PubMed1994

Predicting surgical compliance in a cohort of women with trichiasis.

Trichiasis/Entropion are the severe consequences of chronic trachoma during early life. Blindness and vision loss is preventable with timely lid surgery to correct trichiasis. In a trachoma hyperendemic region of Central Tanzania, a two year follow-up survey was conducted among 205 women with trichiasis to determine the proportion who had had surgery and the barriers to having surgery. Only 18% of the women had undergone surgery by the 2 year follow-up. Those who had surgery tended to report more eye problems at baseline and have more corneal opacities at baseline. Barriers preventing women from going to surgery were costs, problem of children left at home alone, and difficulties in identifying someone to accompany them to the health center. Over 2/3 of those who had surgery reported a significant decrease in pain, improvement of vision, and improved ability to carry out activities of daily life. Ways to improve compliance with recommendations for trichiasis surgery need to be developed.

Adolescent↗
PubMed1994

Junior doctors' hours: what do they really think?

Junior doctors' hours are one of the most controversial topics under debate in the health service today. We undertook a detailed postal questionnaire of hospital doctors in training within a major teaching unit in order to assess the awareness and perceived implications of the incipient changes and to elucidate how it was felt these changes would affect both the doctors and patients. The questionnaire focused specifically on the effect of the changes on quality and continuity of patient care, junior training and socio-economic factors relating to the medical staff. The questionnaire was entirely anonymous and carried only the first author name but provision was made to determine current grade, specialty, age, sex and career plans of the respondents. Importantly, space was included at the end for pertinent comments. All junior staff in training in all specialties in the Cardiff area were circulated. Three hundred and twenty-six questionnaires were sent out and 202 were returned of which 192 were properly completed (59%). Almost everyone was au fait with the proposed changes. There was a surprisingly high level of support for changes among non-surgical trainees, and half felt that quality of care would improve, though the more senior the trainee, the less enthusiastic they were in all aspects. Many felt that far too little consultation with junior staff had taken place and there was generalized criticism of general practitioner trainees by their specializing counterparts, partly because of a perceived lack of commitment and partly because of blame of this group for the inception of the changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Cortical lenticular opacification: distribution and location in a longitudinal study.

PURPOSE: To examine the distribution of cortical opacification of the lens by lens quadrant in a longitudinal study. METHODS: In 1990, a follow-up assessment of a cohort of Chesapeake Bay watermen, initially studied in 1985, was performed. Four hundred thirty-seven subjects (834 eyes) had gradable cortical photographs for at least one eye in both 1985 and 1990. Cortical photographs were graded by both estimating total area and determining the quadrant with the greatest degree of cortical opacification. RESULTS: The prevalence and severity of cortical opacification increased with age with a high degree of concordance (84%) between eyes. For the 47 eyes with cortical opacification > or = 1/8 at baseline, the principal locations of opacification were: inferonasal 63.8%, inferotemporal 17.0%, superonasal 6.4%, and superotemporal 12.8% (P < 0.001, compared with equal distribution by quadrant). Five-year development of new cortical opacification and five-year progression of existing cortical opacification showed even greater preferential occurrence in the inferonasal quadrant of the lens. CONCLUSIONS: In this population, the inferonasal quadrant of the lens is the principal site of cortical opacification in both cross-sectional and longitudinal assessment. This finding is consistent with the hypothesis that sunlight exposure is a significant risk factor for cortical opacification.

Adult↗
PubMed1993

Non-viral risk factors for nasopharyngeal carcinoma in the Philippines: results from a case-control study.

In a case-control study of NPC conducted in the Philippines, 104 predominantly non-Chinese (< 10% ethnically Chinese) cases of nasopharyngeal carcinoma (NPC) and 205 hospital and community controls were recruited. Risk factor information was obtained through personal interview. The occupational history of each subject was reviewed "blind" by an industrial hygienist to determine estimates of exposure to formaldehyde, solvents, dusts, exhaust and pesticides. After control for confounding, subjects who were first exposed to formaldehyde 25 or more years prior to diagnosis/interview or wo were first exposed before the age of 25 were found, in relation to those never exposed, to be at a 4.0-fold excess risk of disease. Similarly, those first exposed to dust and/or exhaust 35 or more years prior to diagnosis/interview were at a 4.4-fold excess risk of disease and those first exposed before the age of 20 were at a 3.5-fold excess risk of disease. Salted fish consumption was not associated with risk, while consumption of processed meats protected against NPC. Smoking was positively associated with NPC, but only when cases were compared to community controls. Relative to non-smokers, subjects reporting more than 30 years of smoking were at an adjusted 7.2-fold excess risk of disease. Herbal medicine use and burning of anti-mosquito coils were both independently associated with risk of NPC, with ever-users of herbal medicines being at a 2.5-fold excess risk of disease and those reporting daily use of anti-mosquito coils being at a 5.9-fold excess risk of disease relative to never users. Exposure to solvents, pesticides, or use of betel nuts were not associated with NPC risk.

Adolescent↗
PubMed1993

Exposure to children and risk of active trachoma in Tanzanian women.

The authors surveyed the trachoma status of 515 women aged 18-60 years and 527 children aged 1-7 years in the trachoma hyperendemic region of Kongwa, Tanzania, in 1989 to further describe the importance of exposure to young children as a risk factor for active trachoma in women. The women were identified as caretakers, who currently cared for children aged 1-7 years; noncaretakers, who lived with, but did not care for, children aged 1-7; or those without children aged 1-7 in the household. The age-adjusted odds ratios for active trachoma seemed to rise with greater exposure to young children, from 1.00 for women without such children, to 1.63 for noncaretakers and 2.43 for caretakers (trend test, p = 0.08). Among those who lived in households with young children, the prevalence of active trachoma in women increased with the total number of young children cared for and with the number of infected children cared for. The prevalence of active trachoma was 40% (6 of 15) for caretakers of three or more infected children, compared with 0 (0 of 88) for caretakers with no infected children (p < 0.0001). Caring for infected children also appeared to be associated with signs of chronic trachoma in caretakers. Noncaretakers who lived with infected children were not at a significantly increased risk for trachoma compared with noncaretakers who were not exposed to such children (5.4% (three of 56) vs. 5.6% (one of 18); p > 0.4). None of the facial signs observed in the children (flies on the face, nasal discharge, etc.) appeared to increase the odds ratio of active trachoma in caretakers beyond the increase associated with trachoma alone in the child. These data support the hypothesis that active disease in women is associated with direct caretaking of young children with active disease. Strategies that interrupt household transmission may affect the binding sequelae of trachoma in women.

Adolescent↗
PubMed1993

Alcohol use and risk of posterior subcapsular opacities.

We conducted a follow-up study of surgical cases of posterior subcapsular cataracts and their controls to evaluate the possible association of alcohol intake and posterior subcapsular opacities. Two hundred thirty-eight cases and controls were interviewed. Current alcohol intake and usual and maximum weekly consumption ever were assessed. In this population, 57% of the cases and 56% of the controls were nondrinkers, 22% of the cases and 36% of the controls had an average of seven or fewer drinks per week, and 17% of the cases and 8% of the controls had more than seven drinks per week. A matched pair analysis controlling for other known risk factors showed an increased risk associated with heavy alcohol use. Heavy drinkers were more likely to be cases than were nondrinkers (odds ratio, 4.6; P < .05), and light drinkers were not at an increased risk. This result suggests that heavy alcohol consumption may increase the risk of posterior subcapsular cataract.

Alcohol Drinking↗