Valerie F. Hillier

A scaled version of the General Health Questionnaire

This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.

HEAD INJURY AND THE RISK OF ALZHEIMER'S DISEASE: A CASE CONTROL STUDY

Objectives. The objective of this study is to examine the association between Alzheimers disease and head injury in elderly patients referred to an EMI unit.

Reflexology and progressive muscle relaxation training for people with multiple sclerosis: A crossover trial

PURPOSE To compare the effects of reflexology and progressive muscle relaxation training for people with multiple sclerosis, provided by nurse therapists, on psychological and physical outcomes. METHODS A crossover design was chosen with a 4-week break between treatment phases. The Short Form 36 and General Health Questionnaire 28 were completed by patients (n=50) pre and post each of the 6-week treatment phases. Salivary cortisol levels, State Anxiety Inventory, systolic and diastolic blood pressure and heart rate data were collected pre and post the weekly sessions. RESULTS All of the chosen measures except for three SF-36 scales recorded significant changes, however, despite the 4-week break (washout period), most outcome measures did not return to their pre-treatment baseline levels. This meant that the analysis of the data was complicated by significant effects involving ordering of treatment occurring for eight of the variables (one from SF-36, two from the GHQ, SAI, Salivary Cortisol, Systolic BP and HR). However, there was a difference in the State Anxiety Inventory values between the treatments of the order of 1.092 units (95%CI 0.211-1.976) (p=0.016, Wilks lambda=0.885, df=1, 48) in favour of reflexology. Changes in salivary cortisol comparing levels pre 1st to post 6th session favoured reflexology (95%CI 0.098-2.644) (p=0.037, Wilks lambda=0.912, df=1, 48). A significant difference was found in the way the treatments affected change in systolic blood pressure following sessions; this favoured progressive muscle relaxation training (p=0.002, Wilks lambda=0.812, df=1, 48). CONCLUSION Positive effects of both treatments following sessions and over the 6 weeks of treatment are reported, with limited evidence of difference between the two treatments, complicated by ordering effects.

The distribution of cardiac macrophages in myocardial ischaemia and cardiomyopathy

Aims : Recent evidence has implicated the macrophage as an effector cell in the inflammatory processes in transplant rejection, as well as cardiac disease, including coronary atherosclerosis. Although the latter is a vascular disease, the entire myocardium is affected. We have previously demonstrated the presence and distribution of macrophages in the ‘normal’ human heart. In this paper the distribution of myocardial macrophages, in the various chambers of the failing human heart, from cases of coronary atheroma and cardiomyopathy undergoing heart transplantation is documented.

Relative Clinical Usefulness of Glycosylated Serum Albumin and Fructosamine During Short-Term Changes In Glycemic Control in IDDM

Serial changes in glycosylated blood proteins and direct measures of glycemia were studied in 100 subjects with insulin-dependent diabetes mellitus (IDDM) over a 6-wk period while attempts were made to improve glycemic control. All measures of glycemic control improved significantly (P < .001). Mean ± SE glycosylated hemoglobin (HbA,) fell from 9.1 ± 0.2 to 8.0 ± 0.1%, glycosylated serum albumin (GSA) from 9.8 ± 0.4 to 7.3 ± 0.3%, and fructosamine from 3.92 ± 0.08 to 3.42 ± 0.07 mM. Fasting blood glucose levels fell from 11.1 ± 0.6 to 8.1 ± 0.7 mM, mean blood glucose levels from 12.5 ± 0.3 to 8.8 ± 0.3 mM, and the M value from 118 ± 7 to 40 ± 3 U. Mean percentage changes in direct measures of glycemia (32–66%) and GSA (29%) were greater than for fructosamine (11%) or HbA, (12%) levels (P < .001). Furthermore, the correlation between the change in GSA and changes in direct measures of glycemia over the initial 2-wk period was significantly different from the corresponding correlations between direct measures of glycemia and fructosamine over this period (P < .05-.01). Changes in GSA also correlated more closely than HbA, or fructosamine did with direct measures of glycemia after 4 and 6 wk. The Spearman rank-correlation coefficient (rs) of absolute changes in GSA, fructosamine, and HbA1 after 2–6 wk ranged from 0.27 to 0.57, confirming that the three measures responded differently to changing glycemic control. Cross-sectional analysis between different measures of glycemia demonstrated considerable variation in the degree of association at different times, with the closest correlations observed after 6 wk when glycemic control was relatively stable. GSA and fructosamine levels correlated with levels of mean blood glucose and M values estimated 2–4 wk earlier. GSA appears to be a more sensitive indicator of short-term improvement in glycemic control and glycemic instability in IDDM than fructosamine or HbA1.

Distribution of myocardial macrophages in the normal human heart

Macrophages are important in inflammatory processes in heart disease and in transplantation rejection. A resurgence of interest in the macrophage has emanated from recent evidence implicating it as an effector cell in atherosclerosis and transplantation rejection. The detailed distribution of the macrophage within the normal human heart is unknown. We quantified macrophage numbers in the different chambers of the heart. Large tissue blocks (1.5–2.0 cm3) were removed from specific sites in 5 ‘normal’ control hearts (2 males, 3 females, age range 19–46 y). Paraffin‐embedded sections were stained with a CD68 pan macrophage marker. Positive cells were enumerated within 20 random fields. Results were analysed using a generalised linear modelling method using the Poisson distribution. Macrophages were identified within septa, and often close to blood vessels, in the myocardium, and in the majority of areas in all hearts. Macrophage numbers varied significantly between areas (range 0–6 cells/high power field; P<0.001), and between the 5 hearts analysed (P<0.001). In general, there were significantly more macrophages in the ventricles (RV P<0.01, LV P<0.05), but these differences were affected by heart differences. This study provides a baseline for the range of macrophage numbers within normal hearts, thus enabling comparisons with macrophage numbers within diseased and transplanted hearts.

Apolipoprotein E polymorphism and lipoproteins in insulin-treated diabetes mellitus

Apolipoprotein E (apo E), a component of VLDL, HDL and chylomicron remnants, is inherited at a single genetic locus with 3 common alleles (epsilon 2, epsilon 3 and epsilon 4). epsilon 2 homozygosity is found in 0-2% of healthy populations, but in 75-100% of subjects with type III hyperlipoproteinaemia, in whom an increased prevalence of glucose intolerance has previously been reported. The lipoprotein abnormality associated with diabetes mellitus has features in common with type III hyperlipoproteinaemia and both conditions lead to accelerated atherogenesis with a similar anatomical distribution. We have therefore examined the frequency of apo E genotypes in 120 subjects with insulin-treated diabetes mellitus (ITDM) and 107 healthy controls, and examined the effect of apo E polymorphism on lipoproteins in the diabetic group. As in the general population, the apo E phenotype in ITDM was a significant determinant of the total serum and LDL cholesterol concentrations which were lowest in patients possessing the epsilon 2 allele, intermediate in those homozygous for epsilon 3 and highest in those with an epsilon 4 allele. The observed gene frequencies of epsilon 2 (0.091), epsilon 3 (0.780) and epsilon 4 (0.130) were similar to those of the healthy control group and those in the general population. However, there was an unexpected increase (P less than 0.0002) in epsilon 2 homozygosity of 6.7% compared to a prevalence of 0.8% predicted both from the Hardy-Weinberg equilibrium and the 0.9% prevalence observed in the healthy control group. This suggests either that epsilon 2 homozygosity increases susceptibility to the development of ITDM or that the two conditions are genetically linked.(ABSTRACT TRUNCATED AT 250 WORDS)

Automated breast tissue measurement of women at increased risk of breast cancer

We have analysed data from a subgroup of thirty-nine women who had previously gained more than 10kg in adult life, and who were amongst those recruited from a family history clinic to a study examining the effects of diet and exercise on breast cancer risk. At entry to the study and after 12 months they underwent a series of investigations, including mammography during which markers were attached to the compression plate to allow accurate measurement of breast thickness. A calibrated stepwedge was placed adjacent to the breast to enable quantitative analysis. The proportions of glandular and fatty tissue were calculated at each pixel from the stepwedge and thickness data and from these, the percentage gland in the breast was computed, both by area and by volume. Statistical analysis showed that the volume of glandular tissue was not related to breast size. Over the 12 month period, the majority of the women lost weight, while some gained weight. It was found that weight change was correlated with change in the volume of fat in the breasts, with those women who lost the largest amount of weight showing the greatest reduction in volume. There was little change in volume of glandular tissue for any of the women. Percentage gland is often used as an indication of risk of developing breast cancer. These results suggest that measures of percentage of gland (e.g. Boyd groups) may be dominated by excess breast fat in overweight women.

Adhesion of staphylococci to polyurethane and hydrogel-coated polyurethane catheters assayed by an improved radiolabelling technique.

Adhesion of Staphylococcus epidermidis NCTC 11047 to the external surface of polyurethane catheters was quantified by a radiolabelling assay. Maximum adhesion was achieved with an initial cell concentration of 3 x 10(8)/ml after incubation for 120 min. The assay was tested for reproducibility by analysis of variance. Adhesion of clinical strains of S. epidermidis and S. aureus to uncoated polyurethane and hydrogel (Hydromer)-coated polyurethane catheters was compared. Hydrogel coating significantly reduced adhesion for both S. epidermidis and S. aureus (mean percentage reduction 71% for S. epidermidis, 69% for S. aureus). Clinical isolates were also tested for adhesion to polystyrene by a modified microtitration well adhesion assay; there was no correlation between staphylococcal adhesion to polyurethane catheters and adhesion to polystyrene. Cell surface hydrophobicity values varied widely for both species. Positive correlations were found between cell surface hydrophobicity and adhesion to polystyrene and uncoated polyurethane catheters for S. epidermidis but not for S. aureus.

A study to assess the effect of nursing interventions at the weekend for people with stroke

Objective: To examine whether additional therapy provided by nurses at the weekend improved the physical outcome for people with stroke on a stroke rehabilitation unit. Design: A single blind randomized controlled trial. Setting: A 16-bed stroke rehabilitation unit in the north of England. Subjects: Forty-one people with stroke were randomized by means of minimization to intervention and control groups. Interventions: The intervention group received additional exercise at the weekend provided by the nursing staff and the control group received their usual care. Both groups received usual care during weekdays. Main outcome measures: The Motor Assessment Scale (MAS), the Barthel Index (BI) and length of stay in hospital. Results: No significant differences were found between the groups in terms of MAS and BI at discharge but there was a borderline significant difference between the groups on unconditional testing in terms of length of stay in hospital and on the stroke unit (p = 0.05 and p = 0.07 respectively). However, these findings were in favour of the control group. On conditional testing (adjusting for BI on admission and age) these differences disappeared (p = 0.14 and p = 0.15) for length of stay in hospital and on the stroke unit respectively. Conclusions: The present study indicates that an increase in one-to-one input by nurses for people with stroke did not lead to a measurable difference in outcome in this small study.