587 research outputs found
How accurately do adult sons and daughters report and perceive parental deaths from coronary disease?
<b>OBJECTIVES</b>: To describe how adult sons and daughters report and perceive parental deaths from heart disease
<b>DESIGN</b>: Two generation family study.
<b>SETTING</b>: West of Scotland.
<b>SUBJECTS</b>: 1040 sons and 1298 daughters aged 30-59 from 1477 families, whose fathers and mothers were aged 45-64 in 1972-76 and have been followed up for mortality over 20 years.
<b>OUTCOME</b> : Perception of a "family weakness" attributable to heart disease.
RESULTS : 26% of sons and daughters had a parent who had died of coronary heart disease (CHD). The proportion was higher in older offspring (+18% per 10 year age difference) and in manual compared with non-manual groups (+37%). Eighty nine per cent of parental deaths from CHD were correctly reported by offspring. Only 23% of sons and 34% of daughters with at least one parent who had died of CHD considered that they had a family weakness attributable to heart disease. Perceptions of a family weakness were higher when one or both parents had died of CHD, when parental deaths occurred at a younger age, in daughters compared with sons and in offspring in non-manual compared with manual occupations.
<b>CONCLUSIONS</b>: Only a minority of sons and daughters with experience of a parent having died from CHD perceive this in terms of a family weakness attributable to heart disease. Although men in manual occupations are most likely to develop CHD, they are least likely to interpret a parental death from CHD in terms of a family weakness. Health professionals giving advice to patients on their familial risks need to be aware of the difference between clinical definitions and lay perceptions of a family history of heart disease
Findings from a pilot randomised trial of an asthma internet self-management intervention (RAISIN)
<b>Objective </b>To evaluate the feasibility of a phase 3
randomised controlled trial (RCT) of a website (Living
Well with Asthma) to support self-management.<p></p>
<b>Design and setting</b> Phase 2, parallel group, RCT,
participants recruited from 20 general practices across
Glasgow, UK. Randomisation through automated voice
response, after baseline data collection, to website
access for minimum 12 weeks or usual care.<p></p>
<b>Participants </b>Adults (age≥16 years) with physician
diagnosed, symptomatic asthma (Asthma Control
Questionnaire (ACQ) score ≥1). People with unstable
asthma or other lung disease were excluded.<p></p>
<b>Intervention</b> Living Well with Asthma’ is a desktop/
laptop compatible interactive website designed with
input from asthma/ behaviour change specialists, and
adults with asthma. It aims to support optimal
medication management, promote use of action plans,
encourage attendance at asthma reviews and increase
physical activity.<p></p>
<b>Outcome measures</b> Primary outcomes were
recruitment/retention, website use, ACQ and mini-
Asthma Quality of Life Questionnaire (AQLQ).
Secondary outcomes included patient activation,
prescribing, adherence, spirometry, lung inflammation
and health service contacts after 12 weeks. Blinding
postrandomisation was not possible.<p></p>
<b>Results </b>Recruitment target met. 51 participants
randomised (25 intervention group). Age range
16–78 years; 75% female; 28% from most deprived
quintile. 45/51 (88%; 20 intervention group) followed
up. 19 (76% of the intervention group) used the
website, for a mean of 18 min (range 0–49). 17 went
beyond the 2 ‘core’ modules. Median number of logins
was 1 (IQR 1–2, range 0–7). No significant difference
in the prespecified primary efficacy measures of ACQ
scores (−0.36; 95% CI −0.96 to 0.23; p=0.225), and
mini-AQLQ scores (0.38; −0.13 to 0.89; p=0.136). No
adverse events.<p></p>
<b>Conclusions</b> Recruitment and retention confirmed
feasibility; trends to improved outcomes suggest use of
Living Well with Asthma may improve self-management
in adults with asthma and merits further development
followed by investigation in a phase 3 trial
Perceived vocal morbidity in a problem asthma clinic
<p>Aims: Asthma treatment has the potential to affect patients' voices. We undertook detailed characterisation of voice morbidity in patients attending a problem asthma clinic, and we determined how patients' perceptions related to objective assessment by an experienced observer.</p>
<p>Methods: Forty-three patients took part in the study. Subjects completed the self-administered voice symptom score (VoiSS) questionnaire and underwent digital voice recording. These voice recordings were scored using the grade–roughness–breathiness–asthenicity–strain system (GRBAS). Laryngoscopy was also performed.</p>
<p>Results: The median VoiSS was 26 (range three to 83). VoiSS were significantly lower in the 17 patients with normal laryngeal structure and function (range four to 46; median 22), compared with the 26 patients with functional or structural laryngeal abnormality (range three to 83; median 33) (95 per cent confidence intervals for difference 0.0–21.0; p = 0.044). The overall grade score for the GRBAS scale did not differ between these two groups, and only 13 patients had a GRBAS score of one or more, recognised as indicating a voice problem. There were positive correlations between related GRBAS score and voice symptom score subscales. Although voice symptom scores were significantly more abnormal in patients with structural and functional abnormalities, this score performed only moderately well as a predictive tool (sensitivity 54 per cent; specificity 71 per cent). Nevertheless, the voice symptom score performed as well as the more labour-intensive GRBAS score (sensitivity 57 per cent; specificity 60 per cent). Patients' inhaled corticosteroid dose (median dose 1000 µg beclomethasone dipropionate or equivalent) had a statistically significant relationship with their overall grade score for the GRBAS scale (r = 0.56; p < 0.001), but not with their VoiSS. Only one patient had evidence of laryngeal candidiasis, and only two had any evidence of abnormality suggesting steroid-induced myopathy.</p>
<p>Conclusions: Vocal morbidity is common in patients with asthma, and should not be immediately attributed to steroid-related candidiasis. The VoiSS merits further, prospective validation as a screening tool for ENT and/or speech and language therapy referral in patients with asthma.</p>
Validity of the activPAL3 activity monitor in people moderately affected by Multiple Sclerosis
Background: Walking is the primary form of physical activity performed by people with Multiple Sclerosis (MS), therefore it is important to ensure the validity of tools employed to measure walking activity. The aim of this study was to assess the criterion validity of the activPAL3 activity monitor during overground walking in people with MS.\ud
Methods: Validity of the activPAL3 accelerometer was compared to video observation in 20 people moderately affected by MS. Participants walked 20-30m twice along a straight quiet corridor at a comfortable speed.\ud
Results: Inter-rater reliability of video observations was excellent (all intraclass correlations > 0.99). The mean difference (activPAL3- mean of raters) was -4.70 ± 9.09, -4.55 s ± 10.76 and 1.11 s ± 1.11 for steps taken, walking duration and upright duration respectively. These differences represented 8.7, 10.0 and 1.8% of the mean for each measure respectively. The activPAL3 tended to underestimate steps taken and walking duration in those who walked at cadences of ≤ 38 steps/minute by 60% and 47% respectively.\ud
Discussion: The activPAL3 is valid for measuring walking activity in people moderately affected by MS. It is accurate for upright duration regardless of cadence. In participants with slow walking cadences, outcomes of steps taken and walking duration should be interpreted with caution
The extent of public green space and alien plant species in 10 small towns of the sub-tropical Thicket Biome, South Africa
Urban areas in developing countries will accommodate nearly 90% of the projected world population increase between 1995 and 2030. Despite this, few studies, especially in smaller towns, have been carried out on urban green space areas in the developing world. This paper makes a first step in this regard, reporting on the extent and state of urban green spaces within 10 small towns in the Eastern Cape (South Africa). After measuring the size and state (in terms of woody plant cover) of public green space, we then sought patterns across the 10 towns between green space attributes, such as area, density, mean size and proportion of alien or indigenous, with socio-economic attributes of the towns. The area and state of current public green space varied markedly between the towns, with the poorer towns faring the worst. Lower income levels were significantly negatively correlated with the area and quality of public green space. Despite this, human population density and per capita green space were the best predictors of the proportion and mean area of public green space present in the towns. The proportion of town green space and the per capita green space were the best predictors of changes in woody plant composition and density
Strangers in the night: Discovery of a dwarf spheroidal galaxy on its first Local Group infall
We present spectroscopic observations of the AndXII dwarf spheroidal galaxy
using DEIMOS/Keck-II, showing it to be moving rapidly through the Local Group
(-556 km/s heliocentric velocity, -281 km/s relative to Andromeda from the MW),
falling into the Local Group from ~115 kpc beyond Andromeda's nucleus. AndXII
therefore represents a dwarf galaxy plausibly falling into the Local Group for
the first time, and never having experienced a dense galactic environment. From
Green Bank Telescope observations, a limit on the H{I} gas mass of <3000 Msun
suggests that AndXII's gas could have been removed prior to experiencing the
tides of the Local Group galaxies. Orbit models suggest the dwarf is close to
the escape velocity of M31 for published mass models. AndXII is our best direct
evidence for the late infall of satellite galaxies, a prediction of
cosmological simulations.Comment: 4 pages 5 figures 1 table, accepted in ApJ, july issu
Clinical judgement, case complexity and symptom scores as predictors of outcome in depression: an exploratory analysis
Background:
Clinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which “symptom severity measures” and “complexity measures” assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment.
Methods:
Subjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of “case complexity” (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ.
Results:
298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment.
Conclusions:
These results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression
The cessation in pregnancy incentives trial (CPIT): study protocol for a randomized controlled trial
Background: Seventy percent of women in Scotland have at least one baby, making pregnancy an opportunity to help most young women quit smoking before their own health is irreparably compromised. By quitting during pregnancy their infants will be protected from miscarriage and still birth as well as low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. In the UK, the NICE guidelines: 'How to stop smoking in pregnancy and following childbirth' (June 2010) highlighted that little evidence exists in the literature to confirm the efficacy of financial incentives to help pregnant smokers to quit. Its first research recommendation was to determine: Within a UK context, are incentives an acceptable, effective and cost-effective way to help pregnant women who smoke to quit?
<p/>Design and Methods: This study is a phase II exploratory individually randomised controlled trial comparing standard care for pregnant smokers with standard care plus the additional offer of financial voucher incentives to engage with specialist cessation services and/or to quit smoking during pregnancy. Participants (n=600) will be pregnant smokers identified at maternity booking who when contacted by specialist cessation services agree to having their details passed to the NHS Smokefree Pregnancy Study Helpline to discuss the trial. The NHS Smokefree Pregnancy Study Helpline will be responsible for telephone consent and follow-up in late pregnancy. The primary outcome will be self reported smoking in late pregnancy verified by cotinine measurement. An economic evaluation will refine cost data collection and assess potential cost-effectiveness while qualitative research interviews with clients and health professionals will assess the level of acceptance of this form of incentive payment. Research questions What is the likely therapeutic efficacy? Are incentives potentially cost-effective? Is individual randomisation an efficient trial design without introducing outcome bias? Can incentives be introduced in a way that is feasible and acceptable?
<p/>Discussion: This phase II trial will establish a workable design to reduce the risks associated with a future definitive phase III multicentre randomised controlled trial and establish a framework to assess the costs and benefits of financial incentives to help pregnant smokers to quit
Newly-Discovered Globular Clusters in NGC 147 and NGC 185 from PAndAS
Using data from the Pan-Andromeda Archaeological Survey (PAndAS), we have
discovered four new globular clusters (GCs) associated with the M31 dwarf
elliptical (dE) satellites NGC 147 and NGC 185. Three of these are associated
with NGC 147 and one with NGC 185. All lie beyond the main optical boundaries
of the galaxies and are the most remote clusters yet known in these systems.
Radial velocities derived from low resolution spectra are used to argue that
the GCs are bound to the dwarfs and are not part of the M31 halo population.
Combining PAndAS with UKIRT/WFCAM data, we present the first homogeneous
optical and near-IR photometry for the entire GC systems of these dEs.
Colour-colour plots and published colour-metallicity relations are employed to
constrain GC ages and metallicities. It is demonstrated that the clusters are
in general metal poor ([Fe/H] < -1.25 dex), while the ages are more difficult
to constrain. The mean (V-I) colours of the two GC systems are very similar
to those of the GC systems of dEs in the Virgo and Fornax clusters, as well as
the extended halo GC population in M31. The new clusters bring the GC specific
frequency (S_N) to ~9 in NGC 147 and ~5 in NGC 185, consistent with values
found for dEs of similar luminosity residing in a range of environments.Comment: 14 pages, 6 figures, 6 tables, accepted for publication in MNRA
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